Busulfan/Clofarabine + Allogeneic Stem Cell Transplantation

• Assessment of donor stem cell engraftment: ANC count [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  ANC at least 500/uL and at least 75% of hematopoietic elements are donor-derived as determined by chimerism assays from peripheral blood prior to day +40 after Busulfan/Clofarabine (BuClo) reduced intensity allogeneic stem cell transplantation
  
  
• Assessment of donor stem cell engraftment: Platelet count [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  Platelets at least 20,000/uL on 3 consecutive measurements without transfusional support prior to day +100 after BuClo RIC HSCT
  
  

• Assessment of non-relapse mortality [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  Assessment of non-relapse mortality (NRM) at day 100 and 1 year after BuClo RIC SCT
  
  
• Assessment of progression-free and overall survival [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  Assess 1-year and 2-year progression-free and overall survival
  
  
• Assess incidence and severity of GVHD [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  Assess the incidence and severity of grades 2-4 and grades 3-4 acute graft-versus-host disease (GVHD) developing by day 200
  
  
• Assess incidence and severity of chronic GVHD [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  Assess the incidence and severity of chronic GVHD
  
  
• Assess incidence of hepatic veno-occlusive disease [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  Assess the incidence of hepatic veno-occlusive disease (VOD)
  
  
• Assess toxicity of BuClo RIC regimen [ Time Frame: 2 years ] [ Designated as safety issue: Yes ]
  Assess toxicity of BuClo RIC regimen
  
  
• Assess infection-related complications [ Time Frame: 2 years ] [ Designated as safety issue: No ]
  Assess infection-related complications
  
  

You will start the conditioning regimen, which is also called the preparative regimen. Conditioning is done to kill more cancer cells which may remain as well as prepare your body for transplant. You will receive the conditioning drugs into a vein. The conditioning regimen consists of the following drugs: Busulfan and Clofarabine.

While you are in the hospital you will have regular physical exams and you will be asked specific questions about any problems that you might be having. You will also have blood tests every day to look at how your bone marrow is recovering, to give possible transfusional support, and how to see how your liver and kidneys are functioning.

You will receive the following drugs before and after the allogeneic stem cell transplant: Neupogen (G-CSF) injections, drugs to prevent infections, Tacrolimus to prevent GVHD and Methotrexate.

You will have routine and regular follow-up in the transplant clinic after discharge from the hospital. The following will be performed at each visit:

Physical exam to monitor your health and check for signs of GVHD, infections and any side effects you may be having; Blood draw for routine blood tests to measure your blood cell count and chemistry; Blood tests to see if the transplanted stem cells are being accepted and are growing in the body (engraftment); Bone marrow biopsy to see the status of the underlying disease (to be done around 100 days after the stem cell transplant).

You will be asked to return to the clinic, at a minimum, for follow-up visits at 6 months, 9 months, 12 months, 18 months and 24 months after your stem cell transplant.