Experimental Bone Marrow Transplant Protocol

INCLUSION CRITERIA FOR RECIPIENTS: Recipient Ages 10-55 years inclusive (but less than 56) Chronic myelogenous leukemia in chronic phase A) Patients not treated with STI 571 under the age of 41 (subject to regular DSMB review). B) 10-55 age limits patients in chronic phase who have failed treatment with STI-571. C) 10-55 age limits patients in accelerated phase or blast transformation. Acute lymphoblastic leukemia, any of these categories: Adults (greater than 18 years) in first remission with high-risk features (presenting leukocyte count greater than 100,000/cu mm, Karyotypes t9; 22, t4, t19, t11, biphenotypic leukemia) All second or subsequent remissions, primary induction failure, partially responding or untreated relapse. Acute myelogenous leukemia (AML): AML in first remission Except AML with good risk karyotypes: AML M3 (t15; 17), AML M4Eo (inv 16), AML t (8; 21). All AML in second or subsequent remission, primary induction failure and resistant relapse. Myelodysplastic syndromes, any of these categories: refractory anemia with transfusion dependence, refractory anemia with excess of blasts, transformation to acute leukemia, chronic myelomonocytic leukemia. Myeloproliferative disorders (myelofibrosis, polycythemia vera, essential thrombocythemia) in transformation to acute leukemia Chronic lymphocytic leukemia refractory to fludarabine treatment and with bulky progressive disease or with thrombocytopenia (less than or equal to 100,000/ml) or anemia (less than or equal to 10g/dl) not due to recent chemotherapy. Non-Hodgkin s lymphoma including Mantle cell lymphoma relapsing or refractory to current chemotherapy and monoclonal antibody treatment and unsuitable for autologous stem cell transplantation. No major organ dysfunction precluding transplantation. DLCO greater than or equal to 60% predicted. Left ventricular ejection fraction: greater than or equal to 40% predicted. ECOG performance status of 0 or 1. For adults: Ability to comprehend the investigational nature of the study and provide informed consent. For minors: Written informed consent from one parent or guardian. Informed oral consent from minors: The process will be explained to the minor on a level of complexity appropriate for their age and ability to comprehend. Negative pregnancy test for women of childbearing age. INCLUSION CRITERIA FOR DONORS: HLA 6/6 identical family donor Weight greater than or equal to 18 kg Age greater than or equal to 2 or less than or equal to 80 years old Fit to receive G-CSF and give peripheral blood stem cells (normal blood count, normotensive, no history of stroke) For adults: Ability to comprehend the investigational nature of the study and provide informed consent. For minors: Written informed consent from one parent or guardian and informed assent: The process will be explained to the minor on a level of complexity appropriate for their age and ability to comprehend. EXCLUSION CRITERIA FOR RECIPIENTS (any of the following): Patient pregnant Age less than 10 years and 56 years or more Patients with CML in chronic phase who are 41 years or over in whom STI 571 is the treatment of choice ECOG performance status of 2 or more Severe psychiatric illness. Mental deficiency sufficiently severe as to make compliance with the BMT treatment unlikely, and making informed consent impossible. Major anticipated illness or organ failure incompatible with survival from BMT DLCO less than 60% predicted. Left ventricular ejection fraction: less than 40% predicted Serum creatinine greater than 3mg/dl Serum bilirubin greater than 4 mg/dl Transaminases greater than 3 times the upper limit of normal HIV positive History of other malignancies except basal cell or squamous carcinoma of the skin, positive PAP smear and subsequent negative follow up, individuals with diseases listed in eligibility criteria for this protocol, but where debility or age makes the risk of intensive myeloablative therapy unacceptable. This includes patients who have received busulfan treatment for more than 6 months continuously. These patients will be considered for a non-myeloablative allogeneic transplantation protocols. EXCLUSION CRITERIA: Donor (any of the following) Pregnant or lactating Donor unfit to receive G-CSF and undergo apheresis. (Uncontrolled hypertension, history of congestive heart failure or unstable angina, thrombocytopenia) HIV positive. Donors who are positive for HBV, HCV or HTLV-1 may be used if the risk-benefit ratio is considered acceptable by the patient and investigator. Weight less than 18 kg Age less than 2 or greater than 80 years Severe psychiatric illness. Mental deficiency sufficiently severe as to make compliance with the BMT treatment unlikely, and making informed consent impossible