Fludarabine and 400 CGY Total Body Irradiation for Recipients of HLA-Matched or Mis-Matched Family or Unrelated Donor Hematopoietic Stem Cell Transplants Who Have Rejected Their First Allogeneic Stem Cell Transplant

Exclusion Criteria

• •1. Patients whose low donor chimerism is felt to be due to rapidly progressive hematological malignancies, unless they can be treated into a minimal disease state with additional treatment.
• •2. Patients with active uncontrolled CNS involvement with malignancy.
• •3. Fertile men or women unwilling to use contraceptive techniques during and for 12 months following treatment.
• •4. Females who are pregnant.
• •5. Patients who are HIV positive
• •6. Organ dysfunction felt to be due to the conditioning for the first transplant including the following:
• •* Left ventricle ejection fraction \< 35%.
• •* DLCO \<35% of predicted, or receiving continuous supplementary oxygen.
• •* Karnofsky score \<50 for patients \< 60 years, or \<70 for patients aged 60 - 69 years (see appendix B).
• •* Creatinine clearance \< 40 ml/min.
• •* Patients with these end-organ toxicities may be presented to the RMBMTP Patient Care Conference. If the majority opinion is that this treatment is the safest option for a patient who has rejected their first transplant, they will be allowed to undergo the treatment, after informed consent has been signed.
• •* Patients with a positive PRA or anti-donor T or B cell (+) will be considered for this treatment protocol only if no other option is available. They should not be eligible for another research study. The transplantation group must have a majority opinion that this is the best available option for the patient in question. In patients with either condition, the only acceptable stem cell source will be peripheral blood.