Reduced-intensity, Related-donor Bone Marrow Transplantation Followed by High-dose Cyclophosphamide for Hematologic Cancers

Inclusion Criteria:

First-degree related donor who is at minimum HLA haploidentical

Eligible diagnoses:

Low-grade non-Hodgkin's lymphoma or plasma cell neoplasm that has progressed during multiagent therapy, failed at least two prior therapies (excluding single agent rituximab and single agent steroids), or in the case of lymphoma undergone histological conversion:

Follicular grade 1 or 2 lymphoma
Follicular lymphoma not otherwise specified
Marginal zone (or MALT) lymphoma
Lymphoplasmacytic lymphoma / Waldenstrom's macroglobulinemia
Hairy cell leukemia
Small lymphocytic lymphoma (SLL) or chronic lymphocytic leukemia (CLL)
Prolymphocytic leukemia
Low grade B-cell lymphoma, unspecified
Multiple myeloma
Plasma cell leukemia
Poor-risk SLL or CLL, defined by an 11q or 17p deletion, histological conversion, or disease progression < 6 months after a purine analog-containing regimen

Aggressive lymphoma that has failed at least one prior regimen of multiagent chemotherapy, and patient is either ineligible for autologous BMT or autologous BMT is not recommended:

Hodgkin lymphoma
Follicular grade 3 lymphoma
Mantle cell lymphoma or leukemia
Diffuse large B-cell lymphoma (excluding primary CNS lymphoma). Eligible subtypes include primary mediastinal large B-cell lymphoma, T-cell rich large B-cell lymphoma, and large B-cell lymphoma not otherwise specified.
Burkitt's lymphoma/leukemia
Atypical Burkitt's lymphoma/leukemia (high grade B-cell lymphoma, unclassified, including that with features intermediate between Burkitt's and diffuse large B-cell lymphoma)
Anaplastic large cell lymphoma
Plasmablastic lymphoma
Peripheral T-cell lymphoma
Relapsed or refractory acute leukemia in second or subsequent remission
Poor-risk acute leukemia in first remission

AML with at least one of the following:

AML arising from MDS or a myeloproliferative disorder, or secondary AML
Presence of Flt3 internal tandem duplications
Poor-risk cytogenetics

Primary refractory disease

ALL (leukemia and/or lymphoma) with at least one of the following:
Adverse cytogenetics
Clear evidence of hypodiploidy

Primary refractory disease

Biphenotypic leukemia
MDS with at least one of the following features:
Poor-risk cytogenetics
IPSS score of INT-2 or greater
Treatment-related MDS
MDS diagnosed before age 21 years
Progression on or lack of response to standard DNA-methyltransferase inhibitor therapy
Life-threatening cytopenias, including those generally requiring greater than weekly transfusions
Interferon- or imatinib-refractory CML in first chronic phase, or non-blast crisis CML beyond first chronic phase
Philadelphia chromosome negative myeloproliferative disease (including myelofibrosis)
Chronic myelomonocytic leukemia

Juvenile myelomonocytic leukemia

For patients with SLL, CLL, or prolymphocytic leukemia, < 20% of bone marrow cellularity involved by this process
Adequate end-organ function:
Left ventricular ejection fraction greater than or equal to 35%
Bilirubin ≤ 3.0 mg/dL (unless due to Gilbert's syndrome or hemolysis), and ALT and AST < 5 x ULN

FEV1 and FVC > 40% of predicted; or in pediatric patients, if unable to perform pulmonary function tests due to young age, oxygen saturation >92% on room air

ECOG performance status < 2 or Karnofsky or Lansky score > 60

Exclusion Criteria:

Pregnant or breast-feeding
Uncontrolled infection Note: Infection is permitted if there is evidence of response to medication. Eligibility of HIV infected patients will be determined on a case-by-case basis.
Any previous BMT within 3 months prior to start of conditioning
Active extra-medullary leukemia or known active Central Nervous System (CNS) involvement by malignancy. Such disease treated into remission is permitted.