Myeloid-Derived Suppressor Cells and Checkpoint Immune Regulators' Expression in Allogeneic SCT Using FluBuATG

Inclusion Criteria:

1. Age less than or equal to 75 years

2. The patient must be approved for transplant by the treating transplant physician. This
includes completion of their pretransplant workup, as directed by standard
Dartmouth-Hitchcock Medical Center (DHMC) Standard Operating Procedures (SOPs). DHMC
SOP for Pretransplant Evaluation of allogeneic recipient.

3. The patient must have a disease, listed below, with treatment responsiveness that the
treating transplant physician believes will benefit from an allogeneic stem cell
transplant. The diseases include:

1. Acute leukemia AML (Acute Myeloid Leukemia), ALL (Acute Lymphoid Leukemia)

2. Chronic leukemia CML (Chronic Myeloid Leukemia), CLL (Chronic Lymphoid Leukemia)

3. Myelodysplasia

4. Myelofibrosis

5. Lymphoma NHL (Non-Hodgkin's Lymphoma) and Hodgkin's disease

6. Plasma cell disorder, including myeloma, Waldenstrom's Macroglobulinemia

4. Donor availability- the patient must have an identified donor

1. Sibling Availability of a 6 out of 6 identical donor

2. Unrelated donor: Availability of a 6 out of 6 unrelated donor

5. No human immunodeficiency virus (HIV) infection or active hepatitis B or C

6. Easter Cooperative Oncology Group (ECOG) performance status 0, 1, or 2

7. Diffusing capacity of the lungs for carbon monoxide DLCO more than or equal to 40
percent predicted

8. Left ventricular ejection fraction more than or equal to 35 percent

9. Serum bilirubin less than 2x upper limit of normal transaminases less than 3x normal
at the time of transplant

10. No active or uncontrollable infection

11. In female, a negative pregnancy test if experiencing menstrual periods

12. No major organ dysfunction precluding transplantation

13. No evidence of an active malignancy that would limit the patient's survival to less
than 2 years. If there is any question, the principal investigator can make a
decision.

Exclusion Criteria:

1. Psychiatric disorder or a mental deficiency of the patient that is sufficiently severe
to make compliance with the treatment unlikely, and making informed consent
impossible.

2. Major anticipated illness or organ failure incompatible with survival from bone marrow
transplant.

3. History of refractory systemic infection

Donor eligibility

1. Human leukocyte antigen (HLA) 6 out of 6 matched related or unrelated donor.

2. The donor must be healthy and must be willing to serve as a donor, based on standard
guidelines

3. The donor must have no significant comorbidities that would put the donor at marked
increased risk

4. There is no age restriction for the donor

5. Informed consent must be signed by donor, if sibling donor, or by third party if
unrelated donor.

Donor Exclusion Criteria

6. The National Marrow Donor Program (NMDP) guidelines for exclusion criteria will be
used. In addition, the following donors are NOT eligible:

7. Syngeneic donor

8. Pregnant or lactating donor

9. Human immunodeficiency virus (HIV) or active HepB or C in the donor

10. Donor unfit to receive Granulocyte-colony stimulating factor (GCSF) and undergo
apheresis

11. A donor with a psychiatric disorder or mental deficiency that makes compliance with
the procedure unlikely and informed consent impossible