Non Hodgkin Lymphoma Clinical Trial
Umbilical Cord Blood Stem Cell Transplant in Treating Patients With Hematologic Cancer or Other Disease
Summary
RATIONALE: Giving low doses of chemotherapy and total-body irradiation before a donor umbilical cord blood stem cell transplant helps stop the growth of cancer or abnormal cells. It also stops the patient's immune system from rejecting the donor's stem cells. The donated stem cells may replace the patient's immune cells and help destroy any remaining cancer or abnormal cells (graft-versus-tumor effect). Sometimes the transplanted cells from a donor can also make an immune response against the body's normal cells. Giving tacrolimus and mycophenolate mofetil before the transplant may stop this from happening.
PURPOSE: This clinical trial is studying how well umbilical cord blood stem cell transplant works in treating patients with hematologic cancer or other disease.
Full Description
OBJECTIVES:
Primary
Determine the efficacy of double umbilical cord blood stem cell transplantation using a conditioning regimen comprising lower doses of busulfan and fludarabine phosphate and low-dose total body irradiation, in terms of stem cell engraftment at 60 days post transplantation, in patients with hematologic cancer or other diseases.
Determine the merits of conducting a larger, comparative study of this regimen.
Secondary
Determine mortality within 100 days of transplantation in these patients.
OUTLINE: This is a pilot study.
Reduced-intensity conditioning regimen: Patients receive busulfan IV over 3 hours on days -9 to -8 and fludarabine phosphate IV on days -7 to -3. Patients then undergo low-dose total body irradiation on day 0.
Graft-versus-host disease prophylaxis: Patients receive tacrolimus IV twice daily and mycophenolate orally or IV three times daily beginning on day -3.
CNS prophylaxis and/or treatment: Patients with a history of CNS involvement receive prophylactic cytarabine (Ara-C) intrathecally (IT) prior to transplant. Patients also undergo lumbar puncture (LP) to test for active CNS disease. Patients with cerebrospinal fluid positive for leukemia receive Ara-C IT every 2-3 days until a repeat LP shows no remaining leukemic cells. Three days after the last LP and after one final dose of Ara-C, patients begin the conditioning regimen.
Double umbilical cord blood (UCB) donor stem cell transplantation (SCT): Patients undergo double UCB donor SCT on day 0.
PROJECTED ACCRUAL: A total of 30 patients will be accrued for this study.
Eligibility Criteria
DISEASE CHARACTERISTICS:
Histologically confirmed diagnosis of 1 of the following:
Acute myeloid leukemia meeting the following criteria:
M0-M7 histologic subtypes by French-American-British classification
Previously treated disease
Meets 1 of the following criteria:
Persistent disease as evidenced by 5-30% persistent blasts in bone marrow after induction or salvage therapy
In second or subsequent complete remission (CR)
In first CR with 1 of the following high-risk features:
Philadelphia chromosome present
Noncore-binding factor type of chromosomal abnormalities
Myelodysplastic syndromes with 1 of the following International Prognostic Scoring System (IPSS) scores:
Intermediate-1
Intermediate-2
High-risk score with transfusion dependence
Chronic myelogenous leukemia meeting 1 of the following criteria:
In accelerated or blastic phase
Failed prior imatinib mesylate therapy
Acute lymphoblastic leukemia meeting 1 of the following criteria:
In first CR with any of the following high-risk features:
Philadelphia chromosome present
Translocation t(4;11) present
WBC > 30,000/mm³ (adult patients)
More than 4 weeks from initiation of treatment was required to achieve CR (adult patients)
DNA index of near haploid (N=23 chromosomes) (pediatric patients)
In second or subsequent CR
Persistent disease as evidenced by 5-20% persistent blasts in bone marrow after induction or salvage therapy
Hodgkin's or non-Hodgkin's lymphoma meeting the following criteria:
Recurrent or refractory disease
Tumor ≤ 5 cm in diameter
Myeloma or plasma cell neoplasm meeting 1 of the following staging criteria:
Stage III at presentation
Stage I-II at presentation
Not responding OR progressed after first-line therapy
Chronic lymphocytic leukemia or Waldenstrom's macroglobulinemia with refractory or progressive disease after first-line therapy
No 5-6/6 HLA-matched related or 7-8/8 HLA-matched unrelated marrow or peripheral blood stem cell donor available
No single 4-6/6 HLA-A, -B, or -DRB1-matched umbilical cord blood unit ≥ 3.5 x 10^7 nucleated cells/kg available
PATIENT CHARACTERISTICS:
ECOG performance status (PS) 0-2 OR Karnofsky or Lansky PS 70-100%
Not pregnant
Fertile patients must use effective contraception prior to and during study participation
HIV negative
Bilirubin < 3.0 mg/dL
AST and ALT ≤ 3 times upper limit of normal
Creatinine < 2.0 mg/dL OR creatinine clearance > 50 mL/min
Cardiac ejection fraction > 50% by echocardiogram OR shortening fraction > 27%
No uncontrolled symptomatic congestive heart failure
No unstable angina pectoris
No cardiac arrhythmia
FEV_1 > 50% of normal
Forced vital capacity > 50% of normal
DLCO normal
Oxygen saturation > 92% on room air (for patients < 5 years of age)
No history of allergic reactions attributed to compounds of similar chemical or biological composition to busulfan and fludarabine phosphate
No ongoing or active infection
No psychiatric illness or social situation that would preclude study compliance
No other uncontrolled illness
PRIOR CONCURRENT THERAPY:
See Disease Characteristics
At least 4 weeks since prior and no concurrent surgery
At least 4 weeks since prior and no other concurrent investigational or commercial agents or therapies for the malignancy, including chemotherapy, biologic therapy, or radiotherapy
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There is 1 Location for this study
Detroit Michigan, 48201, United States
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