Mesenchymal Stem Cell Infusion as Prevention for Graft Rejection and Graft-versus-host Disease

V.1. Patients

V.1.1. Diseases

Hematological malignancies confirmed histologically and not rapidly progressing:

* AML in CR;
* ALL in CR;
* CML unresponsive/intolerant to Imatinib but not in blast crisis;
* Other myeloproliferative disorders not in blast crisis and not with extensive myelofibrosis;
* MDS with \< 5% blasts;
* Multiple myeloma;
* CLL;
* Non-Hodgkin's lymphoma (aggressive NHL should have chemosensitive disease);
* Hodgkin's disease.

V.1.2. Clinical situations

* Theoretical indication for a standard allo-transplant, but not feasible because:

  * Age \> 55 yrs;
  * Unacceptable end organ performance;
  * Patient's refusal.
* Indication for a standard auto-transplant: perform mini-allotransplantation 2-6 months after standard autotransplant.

V.1.3. Other inclusion criteria

* Male or female; fertile female patients must use a reliable contraception method;
* Age \< 75 yrs.
* Informed consent given by patient or his/her guardian if of minor age.

V.1.4. Exclusion criteria

* Any condition not fulfilling inclusion criteria;
* HIV positive;
* Terminal organ failure, except for renal failure (dialysis acceptable);
* Uncontrolled infection, arrhythmia or hypertension;
* Previous radiation therapy precluding the use of 2 Gy TBI;
* HLA-identical donor.

V.2. PBSC donors

V.2.1. Inclusion criteria

* Related to the recipient (sibling, parent or child) or unrelated;
* Male or female;
* Weight \> 15 Kg (because of leukapheresis);
* Fulfills generally accepted criteria for allogeneic PBSC donation;
* Informed consent given by donor or his/her guardian if of minor age, as per donor center standard procedures.

V.2.2. Exclusion criteria

* Any condition not fulfilling inclusion criteria;
* HIV positive;
* Unable to undergo leukapheresis because of poor vein access or other reasons.

V.2.3. HLA matching

Related or unrelated donors who have 1-2 HLA mismatches, as either :

* One antigenic mismatch at HLA-A or -B or -C or -DRB1 or -DQB1
* One allelic mismatch at HLA-A or -B or -C or -DRB1 or -DQB1
* Two allelic mismatches at HLA-A or -B or -C or -DRB1 or -DQB1
* One antigenic mismatch + 1 allelic mismatch at HLA-A or -B or -C or -DRB1 or -DQB1.
* One antigenic mismatch at -DQB1 and one other antigenic mismatch at HLA-A or -B or -C or -DRB1

V.3. Cord blood unit

Banked cord blood units will be used if they fulfill the following criteria:

* No more than 2/6 HLA mismatches (antigenic mismatch at HLA-A or HLA-B or allelic mismatch at HLA-DRB1)
* \> 2.5 x 107 TNC/kg
* Standard validation by FACT/Netcord criteria.