Giving Chemotherapy for a Shortened Amount of Time Before a Stem Cell Transplantation

Inclusion Criteria

• •Patients aged ≥ 18 years old.
• •Patients with any of the following hematologic malignancies for which allo-HCT is indicated, including:
• •* Acute myeloid leukemia (AML) with intermediate or high-risk features in CR1.
• •* Relapsed AML in ≥ CR2.
• •* Acute leukemias of ambiguous lineage in ≥ CR1.
• •* Acute lymphoid leukemia (ALL) in CR1 with clinical, flow cytometric, or molecular features indicating a high risk for relapse, or ALL in ≥ CR2.
• •* CML meeting one of the following criteria:
• •* Failed response to or intolerant to BCR-ABL tyrosine kinase inhibitors (TKIs).
• •* CML with BCR-ABL mutation consistent with poor response to TKIs (e.g., T315I mutation)
• •* CML in accelerated phase or blast crisis with \<10% blasts after therapy, or in second chronic phase.
• •* Myelodysplastic syndromes (MDS), myeloproliferative neoplasms (MPN), or MDS/MPN overlap syndromes with least one of the following:
• •* Revised International Prognostic Scoring System risk score of intermediate or higher at the time of transplant evaluation.
• •* Life-threatening cytopenias.
• •* Karyotype or genomic changes that indicate high risk for progression to acute myelogenous leukemia, including abnormalities of chromosome 7 or 3, mutations of TP53, or complex or monosomal karyotype.
• •* Therapy related disease or disease evolving from other malignant processes.
• •* Chronic myelomonocytic leukemia (CMML-1 or CMML-2).
• •* Severe aplastic anemia.
• •* Relapsed Hodgkin lymphoma meeting both of the following criteria:
• •* Responding to therapy prior to enrollment.
• •* Relapse after autologous HCT or are ineligible for autologous HCT.
• •* Relapsed non-Hodgkin lymphoma meeting both of the following criteria:
• •* Responding to therapy prior to enrollment.
• •* Relapse after prior autologous HCT or are ineligible for autologous HCT.
• •* High-risk multiple myeloma following autologous HCT or relapsed multiple myeloma following autologous HCT with chemosensitive disease.
• •Adequate organ function is required, defined as follows:
• •* Serum bilirubin ≤ 2 mg/dL, unless benign congenital hyperbilirubinemia. Patients with hyperbilirubinemia related to paroxysmal nocturnal hemoglobinuria or other hemolytic disorders are eligible with PI approval.
• •* AST, ALT, and alkaline phosphatase \< 3 times the upper limit of normal unless thought to be disease-related.
• •* Creatinine clearance ≥ 50 ml/min (calculated by Cockcroft Gault)
• •* LVEF ≥ 45% by MUGA or resting echocardiogram.
• •* Pulmonary function (FEV1 and corrected DLCO) ≥ 50% predicted.
• •Adequate performance status of ECOG ≤ 2.
• •Each patient must be willing to participate as a research subject and must sign an informed consent form.