Pentostatin and Lymphocyte Infusion in Preventing Graft Rejection in Patients Who Have Undergone Donor Stem Cell Transplant
Acute Lymphoblastic Leukemia, Acute Myeloid Leukemia, Chronic Lymphocytic Leukemia
About this trial
This is an interventional treatment trial for Acute Lymphoblastic Leukemia
Eligibility Criteria
Inclusion Criteria: Patients having received a preceding allogeneic transplantation from either a human leukocyte antigen (HLA)-matched related or unrelated donor are eligible for this protocol Related donor: HLA genotypically identical at least at one haplotype and may be phenotypically or genotypically identical at the allele level at HLA A, B, C, DRB1, and DQB1 Unrelated donor who are prospectively: Matched for HLA-A, B, C, DRB1 and DQB1 by high resolution typing; OR Only a single allele disparity will be allowed for HLA-A, B, or C as defined by high resolution typing Patients with less than 50% donor CD3 peripheral blood chimerism on two separate, consecutive evaluations; the two evaluations must be at least 14 days apart OR patients with absolute decreases of donor CD3 peripheral blood chimerism of >= 20% if the second test shows < 50% donor CD3 cells; the two evaluations must be at least 14 days apart Patients with evidence of disease are only eligible if the disease is stable (or persistent) in comparison to the status prior to transplantation Patients must be tapered off systemic steroids to a dosage of less than or equal to 0.25 mg/kg/day Patients must have persistent donor CD3 cells (>= 5% donor CD3 cells by a deoxyribonucleic acid [DNA]-based assay that compares the profile of amplified fragment length polymorphisms [ampFLP] [or fluorescent in situ hybridization (FISH) studies or variable number of tandem repeats (VNTR)]) DONOR: Alternatively to a fresh unmodified leukapheresis product, previously collected cryopreserved peripheral blood stem cells (PBSC) after mobilization with G-CSF or cryopreserved unmodified leukapheresis product from the original donor can be used; if cryopreserved product is not available, the following criteria apply for the DLI product: DONOR: Original donor of hematopoietic cell transplantation DONOR: Donor must give consent to leukapheresis DONOR: Donor must have adequate veins for leukapheresis or agree to placement of central venous catheter (femoral or subclavian) DONOR: Donor must be medically fit to undergo the apheresis procedure (institutional guidelines for apheresis) Exclusion Criteria: Current grade II to IV acute GVHD or extensive chronic GVHD Karnofsky score < 50% Pediatric criteria Lansky play-performance score < 40 Evidence of relapse or progression of disease after transplantation Prior recipient of cord blood DONOR: Donors who are not suitable for medical reasons to donate peripheral blood mononuclear cells (PBMC) by continuous centrifugation according to the criteria of the American Association of Blood Banks (AABB) DONOR: Pregnancy DONOR: Human immunodeficiency virus (HIV) or human T-lymphotrophic virus (HTLV) infection DONOR: Recent immunization may require a delay
Sites / Locations
- Huntsman Cancer Institute/University of Utah
- LDS Hospital
- VA Puget Sound Health Care System
- Fred Hutch/University of Washington Cancer Consortium
- University of Torino
Arms of the Study
Arm 1
Experimental
pentostatin, DLI, mycophenolate mofetil, cyclosporine
Group I (pentostatin, DLI): Patients receive pentostatin IV over 20-30 minutes on day -2 and DLI over 15-30 minutes on day 0. Treatment may repeat once beginning with an escalated or same CD3-dose at least 4 weeks if persistent donor T-cells are documented, no GvHD has developed, and the chimerism status worsens or, if chimerism status is unchanged after at least 8 weeks with two subsequent tests of chimerism 4 weeks apart. Group II (pentostatin, DLI, mycophenolate mofetil, cyclosporine): Patients receive treatment as in group I. Patients also receive cyclosporine PO BID on days -3 to 56 and mycophenolate mofetil PO QD on days 0 to 27. Treatment continues in the absence of GvHD.