Combined Haploidentical Reduced Intensity Bone Marrow and Kidney Transplantation for Patients With Chronic Kidney Disease and Advanced Hematological Disorders
Inclusion Criteria:
- Patients ages 18-70
- Underlying hematological disorder which is potentially curable with allogeneic bone
marrow transplantation. This includes, but is not limited to: acute myeloid leukemia
(AML), acute lymphoblastic leukemia (ALL), chronic myelogenous leukemia (CML),
chronic lymphocytic leukemia (CLL), non-Hodgkin lymphoma (NHL), Hodgkin lymphoma,
multiple myeloma (MM), myelodysplastic syndrome (MDS), AL amyloidosis, diamond
blackfan anemia, myelofibrosis or other myeloproliferative disease, sickle cell
anemia, and thalassemia.
- Existence of haploidentical first degree relative who passes standard donor
evaluations for bone marrow and kidney donation
- LVEF > 40% as measured by echocardiography or MUGA
- FEV1, FVC, and DLCO > 50% of predicted as measured by standard PFTs
- Total bilirubin < 2.0 (unless diagnosis of Gilbert's or hemolysis is made) and AST,
ALT, alkaline phosphatase all < 5x institutions upper limit of normal
- ABO compatibility in the host vs. graft direction
- 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 1 year following
the transplant.
- Participants should be on dialysis or have an estimated or measured CrCl < 35 ml/min
- Life expectancy greater than six months.
- Recipient ability to understand and provide informed consent
Exclusion Criteria:
- Active serious infection
- 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 rabbit serum in ATG)
- Serologic positivity for HIV, HCV, or HbsAg positivity
- ABO blood group incompatibility in the host-vs-graft direction
- Active serious infection