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.
Patients with residual radiographic abnormalities after primary therapy are eligible
if abnormalities are FDG-PET positive. Eligible patients must have 1) transformed
lymphoma, 2) mycosis fungoides that is resistant or refractory to therapy, 3) other
histological subtypes in patients that do not have adequate cytoreduction to salvage
chemotherapy to reach a minimal disease state, 4) patients in 2nd or greater relapse
or 3 or subsequent remission, or 5) other patients with non-Hodgkin's lymphoma felt
to have less than a 20% chance of event-free survival with autologous transplant
after discussion with the BMT Faculty and the Principal Investigator

- Definition of Minimal Disease State- No individual lymph nodes greater than 2
cm, greater than >75% reduction in a bulky mass (> 10 cm) and < 10% bone marrow
involvement with lymphoma.

- ECOG performance status < 2

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

- Bone marrow biopsy and cytogenetic analysis within 8 weeks of registration

- Women of child-bearing potential and sexually active males must use an accepted and
effective method of birth control.

- 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 > 60 cc/min by the following formula (all tests must be performed within 28
days prior to registration):

- Estimated Creatinine Clearance = (140Óage)X WT(kg) X 0.85 if female 72X 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. The antibody test for HIV
must be performed within 42 days of registration.

- No chemotherapy other than corticosteroids should be administered within 2 weeks of
the initiation of protocol therapy.

- 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 patients has been
disease-free for five years.

- Patients with active infection requiring oral or intravenous antibiotics are
excluded.

- No prior autologous or allogeneic hematopoietic cell transplantation.

- No prior radioimmunotherapy

- Patient with recurrent/refractory diffuse large B cell lymphoma.

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.