donor t cells after donor stem cell transplant in treating patients with hematologic malignancies

Conditions: Accelerated Phase Chronic Myelogenous Leukemia; Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); 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); Adult Nasal Type Extranodal NK/T-cell Lymphoma; Anaplastic Large Cell Lymphoma; Angioimmunoblastic T-cell Lymphoma; Blastic Phase Chronic Myelogenous Leukemia; Childhood Burkitt Lymphoma; Childhood Chronic Myelogenous Leukemia; Childhood Diffuse Large Cell Lymphoma; Childhood Immunoblastic Large Cell Lymphoma; Childhood Myelodysplastic Syndromes; Childhood Nasal Type Extranodal NK/T-cell Lymphoma; Chronic Phase Chronic Myelogenous Leukemia; Cutaneous B-cell Non-Hodgkin Lymphoma; de Novo Myelodysplastic Syndromes; Extranodal Marginal Zone B-cell Lymphoma of Mucosa-associated Lymphoid Tissue; Hepatosplenic T-cell Lymphoma; Intraocular Lymphoma; Nodal Marginal Zone B-cell Lymphoma; Noncutaneous Extranodal Lymphoma; Peripheral T-cell Lymphoma; Post-transplant Lymphoproliferative Disorder; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; 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 Hodgkin Lymphoma; Recurrent Adult Immunoblastic Large Cell Lymphoma; Recurrent Adult Lymphoblastic Lymphoma; Recurrent Adult T-cell Leukemia/Lymphoma; Recurrent Childhood Acute Lymphoblastic Leukemia; Recurrent Childhood Acute Myeloid Leukemia; Recurrent Childhood Anaplastic Large Cell Lymphoma; Recurrent Childhood Grade III Lymphomatoid Granulomatosis; Recurrent Childhood Large Cell Lymphoma; Recurrent Childhood Lymphoblastic Lymphoma; Recurrent Childhood Small Noncleaved Cell Lymphoma; Recurrent Cutaneous T-cell Non-Hodgkin Lymphoma; Recurrent Grade 1 Follicular Lymphoma; Recurrent Grade 2 Follicular Lymphoma; Recurrent Grade 3 Follicular Lymphoma; Recurrent Mantle Cell Lymphoma; Recurrent Marginal Zone Lymphoma; Recurrent Mycosis Fungoides/Sezary Syndrome; Recurrent Small Lymphocytic Lymphoma; Recurrent/Refractory Childhood Hodgkin Lymphoma; Refractory Chronic Lymphocytic Leukemia; Refractory Hairy Cell Leukemia; Relapsing Chronic Myelogenous Leukemia; Secondary Myelodysplastic Syndromes; Small Intestine Lymphoma; Splenic Marginal Zone Lymphoma; T-cell Large Granular Lymphocyte Leukemia; Testicular Lymphoma; Waldenström Macroglobulinemia

Summary: this pilot phase ii trial studies how well giving donor t cells after donor stem cell transplant works in treating patients with hematologic malignancies. in a donor stem cell transplant, the donated stem cells may replace the patient's immune cells and help destroy any remaining cancer cells (graft-versus-tumor effect). giving an infusion of the donor's t cells (donor lymphocyte infusion) after the transplant may help increase this effect.

primary objectives: i. to determine the feasibility of escalating dose regimen (edr) donor lymphocyte infusion (dli) as measured by the proportion of patients who receive at least one dli. secondary objectives: i. to assess progression free survival (pfs) at 2 years after stem cell transplant (sct) for high-risk hematologic malignancies receiving t-cell depleted grafts followed by escalating dose regimen (edr) prophylactic dli compared to historical controls not receiving dli. ii. to assess the safety of edr dli for high-risk hematologic malignancies as measured by cumulative incidence of severe grade iii-iv acute graft-versus-host disease (gvhd). iii. to measure outcomes of grade ii-iv acute gvhd, non-relapse mortality, overall survival and chronic gvhd of edr dli. iv. to assess the full donor chimerism rate in the cd3 compartment and immune reconstitution after edr dli. outline: patients receive dli intravenously (iv). treatment repeats every 4-8 weeks for 5 doses in the absence of disease progression or unacceptable toxicity. after completion of study treatment, patients are followed up periodically for 2 years.

Eligibility criteria:
inclusion criteria: * inclusion criteria prior to transplant: * the clinical trial will be offered to all high risk (defined 3 below) patients with hematologic malignancies who require stem cell transplants as part of their standard of care using matched related or unrelated donors * patients with high risk myeloid or lymphoid malignancies at stem cell transplant following american society for blood and marrow transplantation (asbmt) criteria, including but not limited to conditions listed; these criteria apply before cyto-reductive therapy given within 28 days of planned conditioning: * refractory acute myelogenous or lymphoid leukemia * relapsed acute myelogenous or lymphoid leukemia * myelodysplastic syndromes with 5% or more blasts * chronic myelogenous leukemia in chronic phase 3 or more, blast phase presently, or second accelerated phase * recurrent or refractory malignant lymphoma or hodgkin's disease with less than a partial response at transplant * high risk chronic lymphocytic leukemia defined as no response or stable disease to the most recent treatment regimen * donors: matched related or unrelated donor stem cell transplant (sct) matched at human leukocyte antigen (hla) a- b, c, and drb1 by molecular methods; 7 of 8 matched donor acceptable for related donors * t-cell depletion with anti-thymocyte globulin (atg) (rabbit or horse) or at least 30 mg of alemtuzumab total in the conditioning regimen * immune suppression; planned post-transplant immune suppression should include tacrolimus or cyclosporin monotherapy (i.e., calcineurin inhibitor or cn) for alemtuzumab regimens and a second immune suppressant for atg treated patients; other agents may be used if cn intolerance or toxicity occurs post-transplant * zubrod performance status (ps) 0-2 or equivalent karnofsky ps * eligible for allogeneic transplant in the treating physicians' judgment and by institutional standards * eligibility to receive dli post-transplant: * donor lymphocytes available or able to be collected * no evidence of disease by standard morphology; minimal residual disease or molecular evidence of disease will not exclude * absolute neutrophil count \>= 500/μl * platelet count \>= 20,000/μl without transfusion for 7 days * serum glutamic oxaloacetic transaminase (sgot) and serum glutamate pyruvate transaminase (sgpt) =\< 5 x upper limit of normal (uln) * bilirubin =\< 3 x uln * no evidence of grade ii or higher acute gvhd or chronic gvhd at initiation of first dli * no systemic corticosteroids or immunosuppressive drugs (topical acceptable); replacement steroids for adrenal insufficiency are not excluded exclusion criteria: * exclusion criteria prior to transplant: * pregnant or lactating females * hepatitis b with positive viral load prior to transplant conditioning or hepatitis c virus * human immune deficiency virus * psychiatric illness that may make compliance to the clinical protocol unmanageable or may compromise the ability of the patient to give informed consent * creatinine \>= 2.0 mg/dl * sgot and sgpt \>= 5 x uln; liver biopsy preferred for such patients * bilirubin \>= 3 x uln (unless gilbert's syndrome) * diffusing capacity of the lung for carbon monoxide (dlco) \< 50% corrected for hemoglobin * left ventricular ejection fraction or shortening fraction \< 40% * unlikely to be able to procure additional donor lymphocytes