Total Marrow and Total Lymph Node Irradiation, Fludarabine, and Melphalan Followed By Donor Stem Cell Transplant in Treating Patients With Advanced Hematological Cancer That Has Not Responded to Treatment
Chronic Myeloproliferative Disorders, Leukemia, Lymphoma
About this trial
This is an interventional treatment trial for Chronic Myeloproliferative Disorders focused on measuring 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), recurrent adult acute lymphoblastic leukemia, recurrent adult acute myeloid leukemia, recurrent adult T-cell leukemia/lymphoma, secondary acute myeloid leukemia, stage III adult T-cell leukemia/lymphoma, stage IV adult T-cell leukemia/lymphoma, adult grade III lymphomatoid granulomatosis, adult nasal type extranodal NK/T-cell lymphoma, anaplastic large cell lymphoma, angioimmunoblastic T-cell lymphoma, splenic marginal zone lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, stage III adult Burkitt lymphoma, stage III adult diffuse large cell lymphoma, stage III adult diffuse mixed cell lymphoma, stage III adult diffuse small cleaved cell lymphoma, stage III adult immunoblastic large cell lymphoma, stage III adult lymphoblastic lymphoma, stage III cutaneous T-cell non-Hodgkin lymphoma, stage III mycosis fungoides/Sezary syndrome, stage III grade 1 follicular lymphoma, stage III grade 2 follicular lymphoma, stage III grade 3 follicular lymphoma, stage III mantle cell lymphoma, stage III marginal zone lymphoma, stage III small lymphocytic lymphoma, stage IV adult Burkitt lymphoma, stage IV adult diffuse large cell lymphoma, stage IV adult diffuse mixed cell lymphoma, stage IV adult diffuse small cleaved cell lymphoma, stage IV adult immunoblastic large cell lymphoma, stage IV adult lymphoblastic lymphoma, stage IV cutaneous T-cell non-Hodgkin lymphoma, stage IV mycosis fungoides/Sezary syndrome, stage IV grade 1 follicular lymphoma, stage IV grade 2 follicular lymphoma, stage IV grade 3 follicular lymphoma, stage IV mantle cell lymphoma, stage IV marginal zone lymphoma, stage IV small lymphocytic lymphoma, recurrent adult Burkitt lymphoma, recurrent adult diffuse large cell lymphoma, recurrent adult diffuse mixed cell lymphoma, recurrent adult diffuse small cleaved cell lymphoma, recurrent adult grade III lymphomatoid granulomatosis, recurrent adult immunoblastic large cell lymphoma, recurrent adult lymphoblastic lymphoma, recurrent cutaneous T-cell non-Hodgkin lymphoma, recurrent mycosis fungoides/Sezary syndrome, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, recurrent mantle cell lymphoma, recurrent marginal zone lymphoma, recurrent small lymphocytic lymphoma, intraocular lymphoma, primary central nervous system non-Hodgkin lymphoma, primary myelofibrosis, stage II multiple myeloma, stage III multiple myeloma, refractory multiple myeloma, de novo myelodysplastic syndromes, previously treated myelodysplastic syndromes, secondary myelodysplastic syndromes, myelodysplastic/myeloproliferative neoplasm, unclassifiable, cutaneous B-cell non-Hodgkin lymphoma, Waldenstrom macroglobulinemia
Eligibility Criteria
DISEASE CHARACTERISTICS:
Histopathologically confirmed diagnosis of 1 of the following:
- Acute myeloid leukemia (AML)
Myelodysplastic syndromes
- Intermediate- or high-risk disease
- Myelofibrosis
Granulocytic sarcoma (chloroma)
- With or without bone marrow involvement
Mixed lineage leukemia
- Induction therapy must have been directed predominantly against AML
- Acute lymphoblastic leukemia
- Non-Hodgkin lymphoma
- Multiple myeloma
Relapsed or refractory disease with M3 marrow (marrow blasts > 25%), meeting 1 of the following criteria:
- Persistent disease after an induction attempt
- Persistent initial disease after two induction attempts
- Relapse after one re-induction attempt (second relapse)
- Persistent disease after first relapse and initial re-induction attempt
Not eligible for myeloablative allogeneic hematopoietic stem cell transplantation due to age (> 50 years), organ insufficiency, or significant comorbidity
Patients 16-50 years of age must meet ≥ 1 of the following criteria:
- Ejection fraction 50-60% by MUGA scan and/or echocardiogram
- DLCO 50-75% of predicted
- Creatinine clearance or GFR 60-80 mL/min
- Serum bilirubin ≤ 2.0 mg/dL
- SGOT and SGPT 1.5-5 times upper limit of normal
- No other medical and/or psychosocial problem that, in the opinion of the primary physician or principal investigator, would place the patient at unacceptable risk from study regimen
- No Fanconi anemia
- HLA-identical sibling OR matched unrelated donor available
PATIENT CHARACTERISTICS:
- Zubrod or Karnofsky performance status 70-100%
- Negative pregnancy test
- Able to lie supine in a full body cast for 30 minutes
- No HIV infection
- No evidence of active hepatitis B or C infection
- No evidence of cirrhosis
- No uncontrolled viral, bacterial, or fungal infection within the past 4 weeks
- No radiographic changes indicating pulmonary disease (e.g., pulmonary nodules, infiltrates, or pleural effusion) unless cleared by pulmonary biopsy that shows no evidence of active pulmonary disease
- No major medical or psychiatric disorder that would seriously compromise patient tolerance of study regimen
PRIOR CONCURRENT THERAPY:
- See Disease Characteristics
- No prior radiation therapy
Sites / Locations
- City of Hope Comprehensive Cancer Center