HLA-Mismatched Peripheral Blood Mobilized Hematopoietic Precursor Cell Transplantation for Hematological Malignancies

Inclusion Criteria

• •Patient:
• •Ages 10-45 years.
• •Chronic myelogenous leukemia, any of these categories: accelerated phase or blast transformation.
• •Acute lymphoblastic leukemia, any of these categories: Adults (greater than 18 years) in any remission with high-risk features (presenting leukocyte count greater than 100,000/cu mm, Karyotypes t9; 22, t4, t19, t11, biphenotypic leukemia). All second remissions, primary induction failure including partial remission, partially responding or untreated relapse.
• •Acute myelogenous leukemia (AML): All AML in second or subsequent remission, primary induction failure or partial remission and resistant relapse.
• •Myelodysplastic syndromes, any of these categories: refractory anemia with excess of blasts, transformation to acute leukemia, chronic myelomonocytic leukemia.
• •Myeloproliferative disorders undergoing transformation to terminal stages.
• •Chronic lymphocytic leukemia (CLL) in Richter transformation.
• •High-grade lymphoma, refractory to standard treatment approaches, mantle cell lymphoma.
• •No major organ dysfunction precluding transplantation.
• •DLCO greater than 65% predicted.
• •Left ventricular ejection fraction: greater than 40% predicted.
• •ECOG performance status of 0 or 1.
• •Informed consent given. Informed consent from parents for minors.
• •Women of childbearing age with a negative pregnancy test may participate.
• •Donor:
• •Partially HLA matched family donor (3-5/6 matches).
• •Fit to receive G-CSF and give peripheral blood stem cells (normal blood count, normotensive, and no history of stroke).
• •Informed consent given.
• •Patients or donors must not be pregnant or nursing.
• •Must not have ECOG performance status of 2 or more.
• •No severe psychiatric illness in patient or donor: Mental deficiency sufficiently severe as to make compliance with the BMT treatment unlikely and making informed consent impossible.
• •No major anticipated illness or organ failure incompatible with survival from BMT.
• •DLCO must not be less than 65% predicted.
• •No left ventricular ejection fraction: less than 40% predicted.
• •Must not have serum creatinine greater than 3 mg/dl.
• •Must not have serum bilirubin greater than 4 mg/dl, Transaminases greater than 3 times the upper limit of normal.
• •Donor or patient must not be HIV positive.
• •Must not have history of other malignancies except basal cell or squamous carcinoma of the skin, positive PAP smear and subsequent negative follow up.
• •Donor must be fit to receive G-CSF and undergo apheresis.
• •Must not fail to mobilize adequate numbers of CD34+ cells after two cycles of G-CSF.