Nonmyeloablative Allogeneic Hematopoietic Stem Cell Transplantation Using Antithymocyte Globulin With Either Melphalan and Cladribine or Total Lymphoid Irradiation

Inclusion Criteria:

1. Age > 55 years or

2. Age < 55 and LVEF < 45% or creatinine clearance < 60 ml/min

Guidelines for Cladribine-Melphalan-based conditioning:

- Bone Marrow Failure States Severe Aplastic Anemia (relapsed following
immunosuppressive therapy) Paroxysmal Nocturnal Hemoglobinuria (poor prognostic
features or hemosiderosis)

- AML (first CR except for t(15;17), inv16, t(8,21); second CR; relapse failing second
induction attempt)

- ALL (first CR with at least one poor prognostic feature; second or greater CR;
relapse failing reinduction attempt)

- MDS (RAEB, RAEBiT, CMMoL)

- CML (chronic phase; accelerated phase; blast phase following reinduction attempt; 2nd
chronic or accelerated phase following gleevec therapy

- Hodgkin's lymphoma (first or greater relapse)

- Non-Hodgkin's Lymphoma

- Aggressive Histology (includes T Cell NHL) Incomplete response to induction Second CR
Sensitive or refractory relapse

- Indolent Histology Second or greater relapse

- Mantle Cell Lymphoma (any Stage - must have received induction chemotherapy)

- Multiple Myeloma (10% residual plasmacytosis following anthracycline-based
chemotherapy or residual disease following autologous transplant)

- Waldenstrom Macroglobulinemia (must have failed either purine analogue-based
chemotherapy (Fludara or 2CdA) or standard CVP therapy; hyperviscosity or cytopenias)

Guidelines for total lymphoid irradiation-based conditioning

- MDS (RA, RARS)

- CLL (Rai stage III or IV - must have received at least two different treatment
regimens in the past)

- Breast Cancer (symptomatic metastatic disease, who have failed standard chemotherapy)

- Renal Cell Cancer (metastatic disease at multiple sites)

- Malignant Melanoma (metastatic disease at multiple sites)

- Sarcoma (all subtypes presently, unresectable metastatic disease)

- Ovarian Cancer (stage III or IV, platinum insensitive disease, i.e. progression
within 6 months of initial platinum chemotherapy)

- Thymoma (unresectable disease)

Exclusion Criteria:

1. Prior allogeneic stem cell or bone marrow transplant

2. Current or past history of invasive mycotic infection

3. Breast Feeding