peripheral stem cell transplantation in treating patients with breast cancer or hematologic cancer

Conditions: Breast Cancer; Leukemia; Lymphoma; Multiple Myeloma and Plasma Cell Neoplasm; Myelodysplastic/Myeloproliferative Diseases

Summary: rationale: peripheral stem cell transplantation may be able to replace immune cells that were destroyed by chemotherapy or radiation therapy. purpose: randomized phase i/ii trial to study the effectiveness of peripheral stem cell transplantation in treating patients who have breast cancer or hematologic cancer.

objectives: * determine the toxicity of ex vivo expanded megakaryocytes (eve mk) as a supplement to peripheral blood stem cell (pbsc) transplantation in patients with breast cancer or hematologic malignancies. * compare the effect of this treatment regimen on platelet recovery and platelet function in these patients vs historical controls. * compare the frequency of malignant cells in the eve mk vs the uncultured pbsc collection in these patients. * determine the optimal time of mk harvest for the production of platelets in vivo. * determine the required number of mks for clinical efficacy in these patients. outline: this is a randomized study. patients are randomized to 1 of 2 durations of cd34+ culture times (6 days vs 9 days). after an initial harvest of filgrastim (g-csf)-mobilized autologous peripheral blood stem cells (pbsc) for transplantation, patients receive one additional dose of g-csf and undergo one additional apheresis. the cd34+ cells are cultured in the presence of recombinant human thrombopoietin, interleukin-3, and flt3 ligand to expand megakaryocytes. patients then undergo treatment with high-dose chemotherapy (and, in some cases, total body irradiation) followed by reinfusion of the conventional pbsc harvest and the ex vivo expanded megakaryocytes. patients are followed until blood counts recover. projected accrual: a total of 24 patients will be accrued for this study.

Eligibility criteria:
disease characteristics: * diagnosis of carcinoma of the breast or hematologic malignancies * no metastases to bone marrow * planned high-dose chemotherapy with autologous peripheral blood stem cell transplantation * at least 2.0 million cd34+ cells/kg collected * hormone receptor status: * not specified patient characteristics: age: * 18 to 60 sex: * female or male menopausal status: * not specified performance status: * ecog 0-1 life expectancy: * not specified hematopoietic: * absolute neutrophil count greater than 1,500/mm\^3 * platelet count greater than 100,000/mm\^3 hepatic: * sgot or sgpt less than 2.5 times upper limit of normal (uln) * bilirubin less than 2.5 times uln (except in gilbert's syndrome) * alkaline phosphatase less than 2.5 times uln * no active hepatitis b or c renal: * creatinine clearance greater than 50 ml/min cardiovascular: * normal ejection fraction pulmonary: * dlco at least 50% predicted * fev_1 and/or fvc at least 75% predicted other: * no concurrent serious nonneoplastic disease that would preclude study entry * hiv negative * not pregnant or nursing * negative pregnancy test * fertile patients must use effective contraception prior concurrent therapy: biologic therapy: * see disease characteristics chemotherapy: * see disease characteristics endocrine therapy: * not specified radiotherapy: * not specified surgery: * not specified

Keywords: stage iv adult hodgkin lymphoma stage iv breast cancer stage iiia breast cancer recurrent breast cancer stage iiib breast cancer stage iiic breast cancer recurrent adult hodgkin lymphoma stage ii cutaneous t-cell non-hodgkin lymphoma stage iii cutaneous t-cell non-hodgkin lymphoma stage iv cutaneous t-cell non-hodgkin lymphoma recurrent cutaneous t-cell non-hodgkin lymphoma isolated plasmacytoma of bone extramedullary plasmacytoma refractory multiple myeloma waldenstrom macroglobulinemia stage i multiple myeloma stage ii multiple myeloma stage iii multiple myeloma stage ii chronic lymphocytic leukemia stage iv chronic lymphocytic leukemia recurrent adult acute lymphoblastic leukemia adult acute myeloid leukemia in remission adult acute lymphoblastic leukemia in remission t-cell large granular lymphocyte leukemia acute undifferentiated leukemia stage iii grade 1 follicular lymphoma stage iii grade 2 follicular lymphoma stage iii grade 3 follicular lymphoma stage iii adult diffuse small cleaved cell lymphoma stage iii adult diffuse mixed cell lymphoma stage iii adult diffuse large cell lymphoma stage iii adult immunoblastic large cell lymphoma stage iii adult lymphoblastic lymphoma stage iii adult burkitt lymphoma stage iv grade 1 follicular lymphoma stage iv grade 2 follicular lymphoma stage iv grade 3 follicular lymphoma stage iv adult diffuse small cleaved cell lymphoma stage iv adult diffuse mixed cell lymphoma stage iv adult diffuse large cell lymphoma stage iv adult immunoblastic large cell lymphoma stage iv adult lymphoblastic lymphoma stage iv adult burkitt lymphoma recurrent grade 1 follicular lymphoma recurrent grade 2 follicular lymphoma recurrent grade 3 follicular lymphoma recurrent adult diffuse small cleaved cell lymphoma recurrent adult diffuse mixed cell lymphoma recurrent adult diffuse large cell lymphoma recurrent adult immunoblastic large cell lymphoma recurrent adult lymphoblastic lymphoma recurrent adult burkitt lymphoma stage i adult t-cell leukemia/lymphoma stage ii adult t-cell leukemia/lymphoma stage iii adult t-cell leukemia/lymphoma stage iv adult t-cell leukemia/lymphoma recurrent adult t-cell leukemia/lymphoma primary central nervous system lymphoma male breast cancer intraocular lymphoma stage i mantle cell lymphoma contiguous stage ii grade 1 follicular lymphoma contiguous stage ii grade 2 follicular lymphoma contiguous stage ii grade 3 follicular lymphoma contiguous stage ii adult diffuse small cleaved cell lymphoma contiguous stage ii mantle cell lymphoma contiguous stage ii adult diffuse mixed cell lymphoma contiguous stage ii adult immunoblastic large cell lymphoma contiguous stage ii adult diffuse large cell lymphoma contiguous stage ii adult burkitt lymphoma contiguous stage ii adult lymphoblastic lymphoma noncontiguous stage ii grade 1 follicular lymphoma noncontiguous stage ii grade 2 follicular lymphoma noncontiguous stage ii grade 3 follicular lymphoma noncontiguous stage ii adult diffuse small cleaved cell lymphoma noncontiguous stage ii mantle cell lymphoma noncontiguous stage ii adult diffuse mixed cell lymphoma noncontiguous stage ii adult immunoblastic large cell lymphoma noncontiguous stage ii adult diffuse large cell lymphoma noncontiguous stage ii adult burkitt lymphoma noncontiguous stage ii adult lymphoblastic lymphoma stage iii mantle cell lymphoma stage iv mantle cell lymphoma recurrent mantle cell lymphoma angioimmunoblastic t-cell lymphoma anaplastic large cell lymphoma stage i mycosis fungoides/sezary syndrome stage ii mycosis fungoides/sezary syndrome stage iii mycosis fungoides/sezary syndrome stage iv mycosis fungoides/sezary syndrome recurrent mycosis fungoides/sezary syndrome chronic myelomonocytic leukemia atypical chronic myeloid leukemia myelodysplastic/myeloproliferative disease, unclassifiable noncontiguous stage ii small lymphocytic lymphoma noncontiguous stage ii marginal zone lymphoma recurrent marginal zone lymphoma recurrent small lymphocytic lymphoma stage iii small lymphocytic lymphoma stage iii marginal zone lymphoma stage iv small lymphocytic lymphoma stage iv marginal zone lymphoma contiguous stage ii marginal zone lymphoma contiguous stage ii small lymphocytic lymphoma extranodal marginal zone b-cell lymphoma of mucosa-associated lymphoid tissue nodal marginal zone b-cell lymphoma splenic marginal zone lymphoma