Study: NCT01745913

Intervention type: DEVICE
Group type: EXPERIMENTAL
Intervention: CliniMACS® CD34 Reagent System
Description: If a subject is randomized to the haplo-cord transplant group, their family member will undergo a stem cell collection. The stem cells from the haplo-identical donor will be purified by a procedure called CD34 selection before they are given to the subject. A special device called the CliniMACS® CD34 Reagent System, which is not FDA approved, will be used for this purpose. The manufacturer of the device, Miltenyi Biotec, is providing the researchers access to the device for use in this research study. Because the stem cells from the haplo-identical donor are treated using the CliniMACS CD34 selection device, they cells are considered investigational.

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Fludarabine
Description: Fludarabine: 30 mg/m2 /day intravenously x 5 days total dose 150 mg/m2. Fludarabine will be dosed according to actual body weight

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Fludarabine
Description: Fludarabine: 30 mg/m2 /day intravenously x 5 days total dose 150 mg/m2. Fludarabine will be dosed according to actual body weight

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Melphalan
Description: Melphalan: 70mg/m2/day intravenously x 2 days. Melphalan will be dosed according to actual body weight. Cryotherapy with ice chips will be administered to prevent mucositis.

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Melphalan
Description: Melphalan: 70mg/m2/day intravenously x 2 days. Melphalan will be dosed according to actual body weight. Cryotherapy with ice chips will be administered to prevent mucositis.

Intervention type: DRUG
Group type: EXPERIMENTAL
Intervention: Rabbit ATG
Description: Rabbit ATG (rATG): 1.5 mg/kg/day intravenously x 4 days, total 6 mg/kg. ATG will be dosed according to actual body weight. The first dose will be infused over at least six hours, and subsequent doses over at least 4 hours. Pre-medications include acetaminophen 650 mg by mouth, diphenhydramine 25-50 mg by mouth or intravenously, and methylprednisolone 2 mg/kg (1 mg/ kg at the initiation and 1 mg/kg half-way through anti-thymocyte globulin administration).

Intervention type: DRUG
Group type: ACTIVE_COMPARATOR
Intervention: Rabbit ATG
Description: Rabbit ATG (rATG): 1.5 mg/kg/day intravenously x 4 days, total 6 mg/kg. ATG will be dosed according to actual body weight. The first dose will be infused over at least six hours, and subsequent doses over at least 4 hours. Pre-medications include acetaminophen 650 mg by mouth, diphenhydramine 25-50 mg by mouth or intravenously, and methylprednisolone 2 mg/kg (1 mg/ kg at the initiation and 1 mg/kg half-way through anti-thymocyte globulin administration).

Intervention type: PROCEDURE
Group type: ACTIVE_COMPARATOR
Intervention: Double Umbilical Cord Blood Transplantation
Description: All subjects will receive an UCB dose of \> 3 x107/kg nucleated blood cells. It is expected that this will require co-infusion of two UCB in the large majority of cases. If two UCB are required, they will be at least 4/5 matched to the recipient.

Intervention type: PROCEDURE
Group type: EXPERIMENTAL
Intervention: Haplo-Identical Cord Transplantation
Description: If randomized to the haplo-cord group, a family member will undergo a stem cell collection. In both arms, subjects will receive a conditioning regimen prior to transplantation. The conditioning regimen utilized in this study incorporates fludarabine-Melphalan and antithymocyte globulin (ATG). This regimen has the advantage of being nearly identical to the regimen utilized for our haplo-cord regimen is based on the experience of the Dana-Farber/Mass-General regimen.