Donor Peripheral Stem Cell Transplant in Treating Patients With Advanced Hematologic Cancer or Other Disorders

A regiszterben nem jelölt feltételek

• DISEASE CHARACTERISTICS:
• Diagnosis of one of the following:
  • Acute lymphocytic leukemia (ALL), meeting one of the following criteria:
  • In first relapse or beyond
  • High-risk ALL, defined by any of the following:
  • Hypoploidy (≤ 44 chromosomes)
  • Pseudodiploidy with translocations or molecular evidence of t(9;22), 11q23, or t(8;14), excluding B-cell ALL
  • Elevated WBC at presentation (WBC \> 20,000/mm³ \[for patients \> 18 years of age\]; WBC \> 200,000/mm³ \[for patients 12-18 years of age\])
  • Acute myeloid leukemia (AML), meeting one of the following criteria:
  • In first complete remission
  • Failed to achieve remission
  • In first relapse or beyond
  • Secondary AML (\> 30% blasts in marrow aspirate)
  • Should receive induction chemotherapy to obtain remission, if possible, before transplant
  • Chronic myelogenous leukemia, meeting one of the following criteria:
  • In first or second chronic phase or accelerated phase
  • In blast crisis, defined as \> 30% promyelocytes plus blasts in the bone marrow
  • Myelodysplastic syndromes, including any of the following:
  • Refractory anemia with excess blasts (RAEB)
  • Chronic myelomonocytic leukemia
  • RAEB in transformation
  • Refractory non-Hodgkin lymphoma, chronic lymphocytic leukemia, Hodgkin lymphoma, or multiple myeloma
  • Received and failed front-line therapy, high-dose therapy and autologous stem cell transplantation, or salvage therapy
  • Myeloproliferative disorders/myelofibrosis may be allowed on a case by case basis
  • Severe aplastic anemia, paroxysmal nocturnal hemoglobinuria, or any other hematologic disorder requiring transplantation
• Patients \> 55 years of age with hematologic diseases treatable by allogeneic stem cell transplantation who are not eligible for IRB 99190 are eligible
• No uncontrolled CNS involvement of disease
• No matched (6/6) related donor available
• HLA-identical unrelated donor available
  • HLA-phenotypically identical for HLA-A and HLA-B alleles and identical for DRB1 alleles by DNA typing for both class I and class II antigens
  • Allele mismatch for HLA class I (i.e., B 2701 vs B 2702) allowed if no alternative donors
  • Allele mismatch for class II (i.e., DRB1 0401 vs 0402) or minor mismatch for class I cross reactive group (CREG) (i.e., A 2 vs A 28) allowed in patients ≤ 35 years of age requiring urgent transplant
  • PATIENT CHARACTERISTICS:
• Karnofsky performance status 50-100%
• Life expectancy \> 8 weeks
• LVEF ≥ 45% at rest
• AST ≤ 2 times normal (unless liver function abnormality is due to underlying disease)
• Total bilirubin \< 1.5 times normal (unless liver function abnormality is due to underlying disease)
• Creatinine ≤ 1.5 times normal OR creatinine clearance ≥ 60 mL/min
• DLCO ≥ 40% of predicted (corrected for hemoglobin)
• No coexisting medical problem that would significantly increase the risk of the transplant procedure
• HIV negative
• Not pregnant
  • PRIOR CONCURRENT THERAPY:
• See Disease Characteristics