post t-plant infusion of allogeneic cytokine induced killer (cik) cells as consolidative therapy in myelodysplastic syndromes/myeloproliferative disorders

Conditions: Neural Tube Defects; Anemia; Leukemia, Myeloid; Bone Marrow Transplant Failure; Myelodysplastic Syndromes (MDS); Myeloproliferative Disorders

Summary: allogeneic stem cell transplantation (transplant of blood cells from another individual) is a treatment option for patients with myelodysplasia or myeloproliferative disorders. during the course of this study, it will be evaluated whether a particular type of blood cell, called a cytokine-induced killer (cik) cell, may add benefit to allogeneic stem cell transplantation. cik cells are present in small quantities in the bloodstream but their numbers can be expanded after a brief period of nurturing in a laboratory.

primary objectives: to determine the rate of conversion to fdc following infusion of allogeneic cik cells among patients with mds, therapy-related myeloid neoplasms, or mpd who receive non myeloablative preparative regimen of tli / atg followed by allogeneic hct and consolidation with allogeneic cik cells. secondary objectives: * to determine the 2 year overall survival (os) and event free survival (efs) * to determine the incidence of acute gvhd following infusion of allogeneic cik cells * to assess the pre-transplant expression of nkg2d ligands in patients' bone marrow aspirates.

Eligibility criteria:
inclusion criteria, recipient with myelodysplastic syndrome (mds) * diagnosis of mds classifiable by the world health organization (who) on the basis of: * refractory anemia * refractory anemia with excess blasts-1 * refractory anemia with excess blasts-2 * refractory cytopenia with multi-lineage dysplasia * refractory cytopenia with multi-lineage dysplasia and ringed sideroblasts * chronic myelomonocytic leukemia (cmml) * mds transformed to acute leukemia * mds-unclassified * participants with advanced mds must have \< 10% marrow blasts prior to receiving conditioning with tli/atg, documented by marrow examination within 1 month prior. * participants with evolution to acute leukemia (aml) must be in a morphologic leukemia free-state (mlfs) with blasts \< 5% inclusion criteria, recipient with myeloproliferative disorder (mpd) * diagnosis of mpd on the basis of: * idiopathic myelofibrosis * polycythemia vera * essential thrombocythemia * chronic myelomonocytic leukemia (cml) * cml, philadelphia chromosome-negative * chronic neutrophilic leukemia * chronic eosinophilic leukemia * hypereosinophilic cyndrome * systemic mastocytosis * \< 10% marrow blasts prior to receiving conditioning with tli/atg, documented by marrow examination within 1 month prior. * participants with evolution to acute leukemia (aml) must be in a morphologic leukemia free-state (mlfs) with blasts \< 5%. presence of residual dysplastic features following cytoreductive therapy is acceptable. inclusion criteria, recipient with therapy-related myeloid neoplasm (t mds) * \< 10% marrow blasts prior to receiving conditioning with tli/atg, documented by marrow examination within 1 month prior. * morphologic leukemia free-state with blasts \< 5 %. * age \> 50 years, or \< 50 years of age but at high-risk for regimen-related toxicity associated with conventional myeloablative transplants due to pre-existing medical conditions or prior therapy * availability of a fully hla-matched or single antigen/allele mismatched sibling or unrelated donor * prior malignancy diagnosed \> 5 years ago without evidence of disease, or \ 5 years are eligible (prior malignancy is not a requirement) inclusion criteria, donor * donors must be hla-matched or one allele mismatched. * donor age \< 75 (exception by principal investigator discretion) * must consent to pbsc mobilization with g-csf; apheresis; and collection and donation of plasma * donor must consent to placement of a central venous catheter in the event that peripheral venous access is limited. exclusion criteria, recipient any of the following: * uncontrolled cns involvement with disease * pregnant * cardiac function: ejection fraction (ef) \< 35% or uncontrolled cardiac failure * diffusing capacity of the lungs for carbon monoxide (dlco) \< 40% predicted * bilirubin \> 3 mg/dl * aspartate aminotransferase (ast) \> 3x the upper limit of normal (uln) * alanine aminotransferase (alt) \> 3x uln * estimated creatinine clearance \< 50 ml/min * karnofsky performance score (kps) \< 70% * documented fungal disease that is progressive despite treatment * hiv-positive exclusion criteria, donor any of the following: * identical twin to recipient * pregnant or lactating * prior malignancy within the preceding 5 years (exception: non-melanoma skin cancers) * hiv seropositivity