Allogeneic Transplantation Using Total Lymphoid Irradiation (TLI) and Anti-Thymocyte Globulin (ATG) for Older Patients With Hematologic Malignancies

INCLUSION CRITERIA:

   - Any patient with one of the following hematolymphoid malignancies or syndromes in whom
   allogeneic hematopoietic stem cell transplant (HST) is warranted. Specific disease
   categories include:

      - Indolent advanced stage non-Hodgkin lymphomas

      - Mantle cell lymphoma

      - Chronic lymphocytic leukemia

      - Hodgkin disease (Hodgkin's lymphoma)

      - Acute leukemias in complete remission

      - Aplastic anemia

      - Paroxysmal nocturnal hemoglobinuria

      - Myelodysplastic or myeloproliferative syndromes.

      - Other selected malignancies/disorders may also be considered but must be approved
      by the transplant team and the Principal Investigator.

   - Age > 50 years, or if < 50 years of age, considered to be at high risk for
   regimen-related toxicity associated with conventional myeloablative transplants due to
   pre-existing medical conditions or prior therapy.

   - A fully human leukocyte antigen (HLA)-identical sibling or matched unrelated donor is
   available. Potential participants with one antigen mismatched donors can be considered
   but only after discussion with the transplant team and the Principal Investigator.

   - Participant must be competent to give consent.

EXCLUSION CRITERIA:

   - Progressive hematolymphoid malignancies despite conventional therapies, or acute
   leukemias not in complete remission.

   - Uncontrolled central nervous system (CNS) involvement with disease

   - Fertile men or women unwilling to use contraceptive techniques during and for 12
   months following treatment

   - Pregnant

   - Cardiac ejection fraction < 30%

   - Uncontrolled cardiac failure

   - Pulmonary diffusing capacity (DLCO) < 40% predicted

   - Elevation of bilirubin to > 3 mg/dL

   - Transaminases > 4 x the upper limit of normal

   - Creatinine clearance < 50 cc/min (24-hour urine collection)

   - Karnofsky performance score < 60%

   - Poorly controlled hypertension on multiple antihypertensives

   - Documented fungal disease that is progressive despite treatment

   - HIV-positive. Other viral infections, ie, Hepatitis B- and C- positive, evaluated on a
   case-by-case basis

   - Psychiatric disorders or psychosocial problems which in the opinion of the primary
   physician or Principal Investigator would place the patient at unacceptable risk from
   this regimen.