Donor Stem Cell Transplant Followed By Donor White Blood Cell Infusions in Treating Young Patients With Hematologic Cancer
Leukemia, Lymphoma
About this trial
This is an interventional treatment trial for Leukemia focused on measuring childhood acute lymphoblastic leukemia in remission, childhood acute myeloid leukemia in remission, recurrent childhood acute lymphoblastic leukemia, recurrent childhood acute myeloid leukemia, recurrent childhood small noncleaved cell lymphoma, juvenile myelomonocytic leukemia, chronic phase chronic myelogenous leukemia, accelerated phase chronic myelogenous leukemia, relapsing chronic myelogenous leukemia, recurrent childhood large cell lymphoma, recurrent childhood lymphoblastic lymphoma, recurrent/refractory childhood Hodgkin lymphoma, childhood chronic myelogenous leukemia
Eligibility Criteria
DISEASE CHARACTERISTICS: Diagnosis of one of the following hematopoietic malignancies: Acute lymphoblastic leukemia or myeloid leukemia with < 30% blasts in the bone marrow Juvenile myelomonocytic leukemia Chronic myelogenous leukemia in chronic or accelerated phase Relapsed non-Hodgkin's or Hodgkin's lymphoma in at least partial remission Considered at high risk (> 30%) of toxic death with standard hematopoietic stem cell transplantation (HSCT), as indicated by at least one of the following: Creatinine > 1.5 times normal OR creatinine clearance < 70 mL/min OR tubular damage that is not corrected by cessation of chemotherapy DLCO < 60% of predicted OR history of prior intubation due to lung disease (intubation for surgery excluded) Shortening fraction < 30% History of disseminated fungal infection during chemotherapy OR currently receiving antifungal agents OR history of ≥ 2 septic episodes (confirmed by cultures) that required ICU support Patients with improving fungal or other infections eligible Improving infection is defined as confirmed negative cultures on 2 separate occasions, at least 1 week apart, and/or stable or improving imaging studies (e.g., CT scan) of the infected site Two imaging studies taken at least 2 weeks apart must show stable or improved disease History of stroke or abnormal MRI/MRA OR leukoencephalopathy OR seizures that are not fully controlled with anticonvulsants (> 2 episodes of seizures in the preceding year or 1 episode of status epilepticus in a patient who is receiving anticonvulsant therapy) History of prior significant bleeding (e.g., pulmonary, CNS, or gastrointestinal) OR history of a clotting disorder as manifested by prior significant thromboses (e.g., superior vena cava, inferior vena cava, or femoral vein) Failed conventional therapies and not eligible for myeloablative protocols May have failed prior conventional HSCT No active CNS leukemia Unrelated or related donor available, meeting the following criteria: Matched for at least 7/8 loci by high-resolution typing One mismatch at A, B, or C loci allowed Fully matched at DRB1 locus PATIENT CHARACTERISTICS: ECOG performance status (PS) 0-2 OR Karnofsky PS 60-100% No active/progressing viral, bacterial, protozoal, or fungal infection Transaminases ≤ 5 times normal (except in the presence of autoimmune liver disease) Shortening fraction ≥ 25% DLCO ≥ 40% OR pulse oximetry ≥ 85% on room air Glomerular filtration rate ≥ 40 mL/min PRIOR CONCURRENT THERAPY: See Disease Characteristics Prior prolonged intensive chemotherapy (> 3 years of therapy or ≥ 3 different chemotherapeutic protocols) allowed
Sites / Locations
- UCSF Helen Diller Family Comprehensive Cancer Center