Autologous Followed by Non-myeloablative Allogeneic Transplantation for Non-Hodgkin's Lymphoma

Inclusion Criteria:

   - Age 18 to 70 years.

   - Histologically proven non-Hodgkin's lymphoma

   - Relapse after achieving initial remission or failure to achieve initial remission.

   - KPS > 70%

   - Matched related or unrelated donor identified and available. Donor must be a complete
   match or have only a single allele mismatch.

   - Recent Bone marrow biopsy and cytogenetic analysis

   - Patients must have a pretreatment serum bilirubin < 2 x the institutional ULN, a serum
   creatinine < 2 x the institutional ULN and measured or estimated creatinine clearance
   > 50 cc/min by the following formula (all tests must be performed within 28 days prior
   to mobilization ): Estimated Creatinine Clearance = (140 age) X WT(kg) X 0.85 if
   female 72 X serum creatinine(mg/dl).

   - Patients must have an EKG within 42 days prior to registration that shows no
   significant abnormalities that are suggestive of active cardiac disease.

   - Patients must have an echocardiogram or MUGA scan within 42 days of registration. If
   the ejection fraction is < 40%, the patient will not be eligible. If the ejection
   fraction is 40-50%, patients must have an exercise echocardiogram or dobutamine-echo
   with a normal response to exercise.

   - Patients must have a corrected diffusion capacity > 50% prior to the autologous
   transplant and > 40% prior to the allogeneic transplant.

   - Patients with known allergy to etoposide or a history of Grade 3 hemorrhagic cystitis
   with cyclophosphamide are not eligible.

   - Patients must be informed of the investigational nature of this study and must sign
   and give written informed consent in accordance with institutional and federal
   guidelines.

Exclusion Criteria:

   - Pregnant or breast-feeding women are ineligible due to the known birth defects
   association with the treatments used in this study.

   - Patients known to be human immunodeficiency virus (HIV)-positive are ineligible
   because the concern for opportunistic infection and hematologic reserve are considered
   to be significantly greater in this population.

   - Patients with prior maligancies diagnosed > 5 years ago without evidence of disease
   are eligible. Patients with a prior malignancy treated < 5 years ago but have a life
   expectancy of > 5 years for that malignancy are eligible.

   - Patients with uncontrolled infection.

   - No prior autologous or allogeneic hematopoietic cell transplantation.

Donor Selection/Evaluation:

   - Related or unrelated HLA identical donors who are in good health and have no
   contra-indication to donation.

   - No contra-indication for the donor to collection by apheresis of mononuclear cells
   mobilized by G-CSF at a dose of 16 µg/kg of body weight.

   - Virology testing including CMV, HIV, EBV, HTLV, RPR, Hepatitis A, B and C will be
   performed within 30 days of donation.

   - No prior malignancy is allowed except adequately treated basal cell or squamous cell
   skin cancer, in situ cervical cancer or other cancer for which the donor has been
   disease-free for five years