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