Azacitidine in Haploidentical Donor Hematopoietic Cell Transplantation

Inclusion Criteria:

Diagnosis of acute leukemia (AML/ALL) or advanced MDS (INT-2 or high risk) in complete remission (CR/CRc/CRi) documented by bone marrow biopsy done within 30 days prior to the initiation of conditioning regimen.

Available HLA-haploidentical donor that meets the following criteria:

Immediate family member (sibling, offspring, or parent)
At least 18 years of age
HLA-haploidentical donor/recipient match by class I serologic typing at the A&B locus.
In the treating physician's opinion, is in general good health, and medically able to tolerate leukapheresis required for harvesting HSC
No active hepatitis (B, C), HTLV, and HIV infections
Not pregnant
Karnofsky performance status ≥ 70 %

Adequate organ function as defined below:

Total bilirubin ≤ 2.5 mg/dl (unless the patient has a history of Gilbert's syndrome)
AST(SGOT) and ALT(SGPT) ≤ 3.0 x IULN
Creatinine ≤ 2.0 x IULN OR estimated creatinine clearance ≥ 30 mL/min/1.73 m^2 by Cockcroft-Gault Formula
Oxygen saturation ≥ 90% on room air
LVEF ≥ 40%
FEV1 and FVC ≥ 50% predicted, corrected DLCO ≥ 40% predicted
At least 18 years of age at the time of study registration
Able to understand and willing to sign an IRB approved written informed consent document (or that of legally authorized representative, if applicable)

Exclusion Criteria:

Recipients with donor sensitive antibodies (DSA), defined by 2000 or higher MFI against one or more class I or II antigens
Known HIV or active Hepatitis B or C infection
Underwent a previous related or unrelated allogeneic transplant
Known hypersensitivity to one or more of the study agents
Currently receiving or has received any investigational drugs within the 14 days prior to the first dose of the conditioning regimen.
Pregnant and/or breastfeeding
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, or unstable cardiac arrhythmias.
Presence of a readily available 6/6 matched sibling donor who is a candidate for donation