Sirolimus and Mycophenolate Mofetil in Preventing GVHD in Patients With Hematologic Malignancies Undergoing HSCT

Inclusion Criteria:

   - Subjects must have one of the following disease categories:

      - Acute myeloid leukemia (AML) beyond 2nd remission or relapsed/refractory disease

      - Acute lymphoblastic leukemia (ALL) beyond 2nd remission or relapsed/refractory
      disease

      - Chronic myeloid leukemia (CML) beyond 2nd chronic phase or in blast crises

      - Myelodysplastic syndrome (MDS)

      - Myeloproliferative disorders including myeloid metaplasia and myelofibrosis

      - High risk non-Hodgkin's lymphoma (NHL) in first remission

      - Relapsed or refractory NHL

      - Hodgkin's lymphoma (HL) beyond first remission

   - Performance status by Karnofsky of >= 70% or Lansky > 70% for patients < 16 years of
   age

   - Human leukocyte antigen (HLA) mismatched related or unrelated donor identified 8/10 or
   9/10

   - Willingness to take oral medications during the transplantation period

   - Willingness and ability to sign a written informed consent (assent if applicable)

Exclusion Criteria:

   - Prior myeloablative allogeneic or autologous HSCT

   - Human immunodeficiency virus (HIV) infection

   - Pregnant or lactating females

   - Evidence of uncontrolled active infection

   - Down syndrome

   - Serum creatinine (CR) < 1.5mg/dl or 24 hour CR clearance < 50 ml/min

   - Direct bilirubin > 2 x upper limit of normal (ULN)

   - Alanine aminotransferase (ALT) or aspartate aminotransferase (AST) > 2 x ULN

   - Carbon monoxide diffusing capability test (DLCO) > 60% predicted and in children- room
   air oxygen saturation > 92%

   - Left ventricular ejection fraction < 45% and in children-shortening fraction < 26%

   - Fasting cholesterol > 300 mg/dl or triglycerides > 300 while on lipid lowering agents

   - Patients who have received an investigational drug within 30 days of enrollment in
   study

   - Patients with prior malignancies except basal cell carcinoma or treated carcinoma
   in-situ; cancer treated with curative intent > 5 years will be allowed; cancer
   treatment with curative intent =< 5 years will not be allowed