Combined Bone Marrow and Renal Transplantation for Hematologic Disorders With End Stage Renal Disease

Participant Inclusion Criteria

* Participants with end-stage renal failure due to or in association with multiple myeloma or systemic AL amyloidosis which hematopoietic cell transplantation is appropriate and a ≥ 50% five-year survival probability with transplantation is expected. This includes, but is not limited to:
* Multiple myeloma (MM), ISS stage II or III in complete or very good partial remission
* AL amyloidosis without significant cardiac disease
* Males or females 18 - 65 years of age.
* Participants must have an HLA-matched or one of six HLA A, B, or DR antigen-mismatched related donor, with high resolution molecular class I and II allele typing.
* Men and women of reproductive potential must agree to use a reliable method of birth control during the treatment, and women should do so for a period of 2 years following the transplant.
* Participants should be on dialysis or have a CrCl \<20 ml/min.
* Patients should not have evidence of renal recovery of their renal failure over a 90 day period of therapy for their underlying malignancy or other blood disorder.
* .
* Patients with a history of other malignancies excluding basal cell carcinoma of the skin and carcinoma in situ of the cervix with a disease-free survival interval of \>2 years. Patients with the following malignancies must demonstrate a 5 year disease-free survival:

  * Breast cancer with positive nodes
  * Malignant melanoma (other than in situ)
  * Colorectal cancer (other than Dukes Stage A or B1)
* Patients with multiple myeloma must have received previous treatment with a bortezomib-based regimen.

Patients with AL amyloidosis must have received previous treatment with a bortezomib-based regimen and/or autologous stem cell transplantation

* Patients with a history of malignant melanoma must be reviewed by an independent oncologist prior to enrollment.
* Recipient ability to understand and provide informed consent.

Participant Exclusion Criteria

* Evidence of active infection as defined by: a) clinical syndrome consistent with viral or bacterial infection (e.g., influenza, URI, UTI) or b) fever with a clinical site of infection identified, or c) microbiologically documented infection, including, but not limited to, bacteremia or septicemia.
* Participation in other investigational drug use at the time of enrollment.
* Contraindication to therapy with any one of the proposed agents (e.g., history of allergy to horse serum in ATG).
* Serologic positivity to HIV or HCV.
* Women of childbearing age in whom adequate contraception cannot be maintained.
* AST/ALT \> 3 x normal or bilirubin \> 1.5 x normal (unless due to Gilbert's syndrome).
* Pregnancy or uncontrolled serious medical illness not related to underlying myeloma.
* Cardiac ejection fraction \< 40% by echocardiogram.
* FEV1 \< 50% predicted or corrected DLCO \< 50% predicted.
* ABO blood group incompatibility in the host-vs-graft direction.

  * Diagnosis of myelodysplastic syndrome

Donor Inclusion Criteria

* HLA-matched or one of six HLA A, B, or DR antigen-mismatched related male or female donor 18-65 years of age.
* ECOG performance status 0 or 1.
* Excellent health per conventional pre-donor history (medical and psychosocial evaluation).
* Acceptable laboratory parameters (hematology in normal or near-normal range; liver function \< 2 times the upper limit of normal and normal creatinine).
* Compatible ABO blood group.
* Negative donor lymphocyte crossmatch.
* No positive testing for viral infection (HbsAg, HIV, HCV, HTLV-1).
* Cardiac/Pulmonary evaluation within normal limits (CXR, EKG).
* Donor ability to understand and provide informed consent.