Flu/TBI in Treating Patients Not Responding to Previous Hormone Therapy

DISEASE CHARACTERISTICS: Diagnosis of adenocarcinoma of the prostate Metastatic and progressive disease Refractory to hormonal therapy Prostate-specific antigen (PSA) > 5 ng/mL Previously treated with a docetaxel-based regimen No CNS metastases PATIENT CHARACTERISTICS: Performance status Karnofsky 70-100% Life expectancy More than 6 months Hematopoietic Not specified Hepatic Bilirubin < 2 times upper limit of normal (ULN) AST and ALT < 4 times ULN Renal Creatinine clearance > 50 mL/min Cardiovascular LVEF > 35% No symptomatic congestive heart failure Pulmonary DLCO > 40% of predicted OR Total lung capacity or FEV_1 > 30% of predicted Other HIV negative PRIOR CONCURRENT THERAPY: Chemotherapy See Disease Characteristics Endocrine therapy See Disease Characteristics PATIENT AND DONOR SELECTION CRITERIA 4.1 Patient Inclusion Criteria: 4.1.1 Males aged 18-75. 4.1.2 Pathologically proven adenocarcinoma of the prostate with metastases and progressive disease (new metastatic lesions or increase in cancer-related pain or a rising PSA defined by consensus criteria. (A rising PSA will be defined as 2 measurements higher than an initial value. The second of the 3 measurements must be at least 7 days after the first). 4.1.3 Progressive disease despite hormonal management (including antiandrogen withdrawal, 6 weeks for bicalutamide, 4 weeks for flutamide or nilutamide) 4.1.4 PSA > 5 ng/mL 4.1.5 Serum testosterone level < 50 ng/mL 4.1.6 Prior treatment with a docetaxel-based regimen. 4.1.7 Performance status: Karnofsky Performance Scale (KPS) 70-100%. (Appendix III). 4.1.8 Signed informed patient consent. 4.2 Patient Exclusion criteria: 4.2.1 Expected survival less than 6 months 4.2.2 Active central nervous system involvement or spinal instability 4.2.3 Organ dysfunction: 4.2.3.1 Cardiac: Ejection fraction <35% or symptomatic congestive heart failure. 4.2.3.2 Pulmonary: DLCO <40% of predicted or either TLC or FEV1 < 30% predicted. 4.2.3.3 Liver dysfunction: serum total bilirubin >2x upper limit of normal (ULN) or either ALT or AST >4x ULN 4.2.3.4 Renal dysfunction: creatinine clearance < 50 ml/min 4.2.4 HIV seropositivity 4.2 Related Donor Inclusion criteria: 4.3.1 Age 18-75 4.3.2 Related to the patient and genotypically or phenotypically HLA-identical. (Appendix IV) 4.3.3 Able to give consent to peripheral blood stem cell mobilization with G-CSF and apheresis collection. Bone marrow donors are not eligible. 4.3 Unrelated Donor Inclusion criteria: 4.4.1 Age 18-75. 4.4.2 Unrelated donors who are prospectively: 4.4.2.1 Matched for HLA-DRB1 and -DQB1 alleles by high resolution typing AND 4.4.2.2 Matched for all serologically recognized HLA-A or -B or -C antigens and at least five of six HLA-A or -B or -C alleles as defined by Appendix IV. 4.4.3 Able to give consent to peripheral blood stem cell mobilization with G-CSF and apheresis collection. Bone marrow unrelated donors are not eligible. 4.4 Related and Unrelated Donor Exclusion criteria: 4.5.1 Identical twin. 4.5.2 Any contraindication to the administration of G-CSF for mobilization. 4.5.3 Serious medical or psychological illness. 4.5.4 Prior malignancy within the preceding five years, with the exception of non-melanoma skin cancers. 4.5.5 HIV seropositivity. 4.5.6 The donor is pregnant, has a positive serum ßhCG or is lactating.