Alemtuzumab and Glucocorticoids in Treating Newly Diagnosed Acute Graft-Versus-Host Disease in Patients Who Have Undergone a Donor Stem Cell Transplant
Breast Cancer, Chronic Myeloproliferative Disorders, Gestational Trophoblastic Tumor
About this trial
This is an interventional supportive care trial for Breast Cancer focused on measuring graft versus host disease, adult acute myeloid leukemia with 11q23 (MLL) abnormalities, adult acute myeloid leukemia with inv(16)(p13;q22), adult acute myeloid leukemia with t(15;17)(q22;q12), adult acute myeloid leukemia with t(16;16)(p13;q22), adult acute myeloid leukemia with t(8;21)(q22;q22), accelerated phase chronic myelogenous leukemia, adult acute lymphoblastic leukemia in remission, adult acute myeloid leukemia in remission, atypical chronic myeloid leukemia, blastic phase chronic myelogenous leukemia, childhood chronic myelogenous leukemia, chronic phase chronic myelogenous leukemia, chronic eosinophilic leukemia, chronic idiopathic myelofibrosis, chronic myelomonocytic leukemia, chronic neutrophilic leukemia, de novo myelodysplastic syndromes, disseminated neuroblastoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, juvenile myelomonocytic leukemia, myelodysplastic/myeloproliferative disease, unclassifiable, nodal marginal zone B-cell lymphoma, noncontiguous stage II adult Burkitt lymphoma, stage III adult Burkitt lymphoma, stage IV adult Burkitt lymphoma, noncontiguous stage II adult diffuse large cell lymphoma, stage III adult diffuse large cell lymphoma, stage IV adult diffuse large cell lymphoma, noncontiguous stage II adult diffuse mixed cell lymphoma, stage III adult diffuse mixed cell lymphoma, stage IV adult diffuse mixed cell lymphoma, noncontiguous stage II adult diffuse small cleaved cell lymphoma, stage III adult diffuse small cleaved cell lymphoma, stage IV adult diffuse small cleaved cell lymphoma, noncontiguous stage II adult immunoblastic large cell lymphoma, stage III adult immunoblastic large cell lymphoma, stage IV adult immunoblastic large cell lymphoma, noncontiguous stage II adult lymphoblastic lymphoma, stage III adult lymphoblastic lymphoma, stage IV adult lymphoblastic lymphoma, noncontiguous stage II grade 1 follicular lymphoma, stage III grade 1 follicular lymphoma, stage IV grade 1 follicular lymphoma, noncontiguous stage II grade 2 follicular lymphoma, stage III grade 2 follicular lymphoma, stage IV grade 2 follicular lymphoma, noncontiguous stage II grade 3 follicular lymphoma, stage III grade 3 follicular lymphoma, stage IV grade 3 follicular lymphoma, noncontiguous stage II mantle cell lymphoma, stage III mantle cell lymphoma, stage IV mantle cell lymphoma, noncontiguous stage II marginal zone lymphoma, splenic marginal zone lymphoma, stage III marginal zone lymphoma, stage IV marginal zone lymphoma, noncontiguous stage II small lymphocytic lymphoma, stage III small lymphocytic lymphoma, stage IV small lymphocytic lymphoma, poor prognosis metastatic gestational trophoblastic tumor, stage I multiple myeloma, stage II multiple myeloma, stage III multiple myeloma, stage II ovarian epithelial cancer, stage III ovarian epithelial cancer, stage IV ovarian epithelial cancer, aggressive, noncontiguous stage II adult non-Hodgkin lymphoma, stage III adult Hodgkin lymphoma, stage IV adult Hodgkin lymphoma, stage III chronic lymphocytic leukemia, stage IV chronic lymphocytic leukemia, stage III malignant testicular germ cell tumor, stage IIIA breast cancer, stage IIIB breast cancer, stage IIIC breast cancer, stage IV breast cancer, childhood acute lymphoblastic leukemia in remission, childhood acute myeloid leukemia in remission, childhood myelodysplastic syndromes
Eligibility Criteria
DISEASE CHARACTERISTICS:
Newly diagnosed acute graft-versus-host disease (GVHD)
- Grade IIB-IV disease
Requires glucocorticoids for treatment of GVHD, as indicated by 1 of the following:
Initial treatment with prednisone or methylprednisolone at 2 mg/kg is indicated (in the judgement of the attending physician) by any of the following:
- Severity of GVHD requires hospitalization
- GVHD manifestations include symptoms other than anorexia, nausea, and vomiting
- GVHD begins within 2-3 weeks after hematopoietic stem cell transplantation (HSCT)
- GVHD manifestations progress rapidly from 1 day to the next before treatment
- Initial treatment with prednisone or methylprednisolone at 1 mg/kg did not produce adequate clinical improvement within the first 4 days (in the judgement of the attending physician)
Has undergone allogeneic HSCT with myeloablative conditioning
- No nonmyeloablative conditioning or autologous HSCT
No primary treatment of acute GVHD with methylprednisolone at any of the following doses:
- More than 2 mg/kg/day at any time
- 2 mg/kg/day for > 72 hours
- 1 mg/kg/day for > 96 hours
- No presence of distinctive or diagnostic manifestations of chronic GVHD
- No relapsed, refractory, or secondary malignancy
PATIENT CHARACTERISTICS:
- Karnofsky performance status (PS) 20-100% OR Lanksy PS 20-100%
- Life expectancy ≥ 1 month
- Absolute neutrophil count ≥ 500/mm^3
- Negative pregnancy test
- No Mini Mental State Exam score < 24/30 or confusion (for patients > 12 years of age)
- No history of type I hypersensitivity reaction to alemtuzumab or any of its components
- No increasing levels of viremia by serial quantitative viral plasma polymerase chain reaction assays
- No invasive viral or fungal disease that does not respond to appropriate antiviral or antifungal medications
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- No systemic immunosuppression tapered or stopped for treatment of leukemic relapse or minimal residual disease
Sites / Locations
- Fred Hutchinson Cancer Research Center