Histocompatible Unrelated Donors

Transplantation Of Bone Marrow From Histocompatible Unrelated Donors For Patients With Hematologic Malignancies, Severe Aplastic Anemia, Or Congenital Disorders of the Lymphohematopoietic System

Objectives:

2. To determine the incidence of graft rejection when using non-T-cell-depleted marrow in this setting. Patients will be examined separately depending on the inclusion of total body irradiation in the pretransplantation preparative regimen.

3. To determine the incidence and severity of acute and chronic graft-vs-host disease (GVHD) in engrafted recipients of unrelated marrow.

4. To determine actuarial estimates of disease-free survival in the various patient groups, comparing these figures to previously published series of matched unrelated as well as matched related transplants.

Eligibility:

1. Patients must be <50 years old, must have either a 6/6 antigen matched donor by serological tissue typing of Class I (i.e., HLA-A and B) antigens and by DNA-based typing for Class II (i.e., HLA-DR and DQ) alleles, or a 5/6 antigen-matched donor where the HLA disparity is within a cross-reacting group in a Class I antigen.

2. The patient’s overall clinical conditions, in the judgment of the Attending Physician, must be such as to allow the administration of myeloablative doses of total body irradiation and/or high-dose chemotherapy, as evidenced by:

* Creatinine clearance > 60 ml/min/1.73m2
* Serum ALT and AST < 4 x upper limit of normal, serum bilirubin < 2 x upper limit of normal
* LVEF .50% at rest
* Absence of acute infection

a.) Hematologic malignancies
b.) Acute myelogenous leukemia
c.) Acute lymphoblastic leukemia / Non-Hodgkin’s Lymphoma
d.) Myelodysplastic syndrome
e.) Chronic myelogenous leukemia
f.) Severe aplastic anemia Congenital Disorders
a.) Congenital immunodeficiency disorders
b.) Severe combined immunodeficiency
c.) Wiskott-Aldrich syndrome
d.) T-cell immunodeficiencies
e.) Fanconi anemia
f.) Inborn errors of metabolism

* Hurler syndrome
* Chedjak-Higashi syndrome
* Osteoporosis