Allogeneic Transplantation Using Total Lymphoid Irradiation (TLI) and Anti-Thymocyte Globulin (ATG) for Older Patients With Hematologic Malignancies

INCLUSION CRITERIA:

* Any patient with one of the following hematolymphoid malignancies or syndromes in whom allogeneic hematopoietic stem cell transplant (HST) is warranted. Specific disease categories include:

  * Indolent advanced stage non-Hodgkin lymphomas
  * Mantle cell lymphoma
  * Chronic lymphocytic leukemia
  * Hodgkin disease (Hodgkin's lymphoma)
  * Acute leukemias in complete remission
  * Aplastic anemia
  * Paroxysmal nocturnal hemoglobinuria
  * Myelodysplastic or myeloproliferative syndromes.
  * Other selected malignancies/disorders may also be considered but must be approved by the transplant team and the Principal Investigator.
* Age \> 50 years, or if \< 50 years of age, considered to be at high risk for regimen-related toxicity associated with conventional myeloablative transplants due to pre-existing medical conditions or prior therapy.
* A fully human leukocyte antigen (HLA)-identical sibling or matched unrelated donor is available. Potential participants with one antigen mismatched donors can be considered but only after discussion with the transplant team and the Principal Investigator.
* Participant must be competent to give consent.

EXCLUSION CRITERIA:

* Progressive hematolymphoid malignancies despite conventional therapies, or acute leukemias not in complete remission.
* Uncontrolled central nervous system (CNS) involvement with disease
* Fertile men or women unwilling to use contraceptive techniques during and for 12 months following treatment
* Pregnant
* Cardiac ejection fraction \< 30%
* Uncontrolled cardiac failure
* Pulmonary diffusing capacity (DLCO) \< 40% predicted
* Elevation of bilirubin to \> 3 mg/dL
* Transaminases \> 4 x the upper limit of normal
* Creatinine clearance \< 50 cc/min (24-hour urine collection)
* Karnofsky performance score \< 60%
* Poorly controlled hypertension on multiple antihypertensives
* Documented fungal disease that is progressive despite treatment
* HIV-positive. Other viral infections, ie, Hepatitis B- and C- positive, evaluated on a case-by-case basis
* Psychiatric disorders or psychosocial problems which in the opinion of the primary physician or Principal Investigator would place the patient at unacceptable risk from this regimen.