Donor Stem Cell Transplant After Chemotherapy for the Treatment of Recurrent or Refractory High-Risk Solid Tumors in Pediatric and Adolescent-Young Adults

Korábbi kezelés

• Uncontrolled bacterial, viral, or fungal infections (currently taking medication yet clinical symptoms progress); stable, controlled disease with treatment is not an exclusion criteria

Más betegség

• End-organ failure that precludes the ability to tolerate the transplant procedure, including conditioning regimen
• Renal failure requiring dialysis
• Congenital heart disease resulting in congestive heart failure
• Ventilatory failure: requires invasive mechanical ventilation
• Human immunodeficiency virus (HIV) infection

Egyéb

• Lack of histocompatible suitable related donor/ graft source
• A female of reproductive potential who is pregnant, planning to become pregnant during the study, or is nursing a child
• Any patient who does not fulfill the inclusion criteria listed above

• Pathological criteria, including malignant recurrent/refractory solid tumors. This would include:
  • Ewing's/peripheral primitive neuroectodermal tumor (PNET)
  • Malignant peripheral nerve sheath tumor, neurofibrosarcoma
  • Rhabdomyosarcoma
  • Neuroblastoma (patients who are ineligible for tandem autologous transplant or who are at least 3 months post autologous HCT)
  • Desmoplastic small round cell tumor (DSRCT)- both new diagnoses as well as recurrent/refractory disease
• Patients must have chemo-responsive disease, defined as; 30% or greater decrease in the tumor target lesions when compared to its pre-treatment evaluation. Patients with complete response will be eligible to participate
• Available suitable HCT donor
• Creatinine clearance or glomerular filtration rate (GFR) \>= 50 ml/min/1.73m\^2, and not requiring dialysis
• Diffusing capacity of lung for carbon monoxide (DLCO) (corrected for hemoglobin) \>= 50% predicted. If unable to perform pulmonary function tests, then oxygen (O2) saturation \>= 92% in room air
• Bilirubin =\< 3 x upper limit of normal (ULN) and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =\< 5 x for age (with the exception of isolated hyperbilirubinemia due to Gilbert's syndrome)
• DONOR: Matched related donor bone marrow (10 of 10 HLA alleles \[HLA-A, B, C, DR, and DQ\]. Matched related donor peripheral blood stem cell (PBSC) is allowed only if collection of bone marrow (BM) is not available or refused by parents/donor
• DONOR: Matched allogeneic umbilical cord blood (UCB): related
  • High-resolution matching at A,B, DRB1 (minimum 4/6)
  • KIR major histocompatibility complex (MHC) class 1 preferential mismatch (minimum 4/6)
• DONOR: Matched allogeneic umbilical cord blood: unrelated
  • High-resolution matching at A,B, DRB1 (minimum 4/6) •\*KIR MHC class 1 preferential mismatch (minimum 4/6)