peripheral stem cell transplantation with specially treated stem cells in treating patients with non-hodgkin's lymphoma or hodgkin's disease

Conditions: Lymphoma

Summary: rationale: drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. radiation therapy uses high-energy x-rays to damage cancer cells. combining chemotherapy and radiation therapy with peripheral stem cell transplantation using specially treated stem cells may allow the doctor to give higher doses of chemotherapy drugs and radiation therapy and kill more cancer cells. purpose: phase ii trial to study the effectiveness of peripheral stem cell transplantation using specially treated stem cells in treating patients who have non-hodgkin's lymphoma or hodgkin's disease.

objectives: * determine whether priming with hematopoietic cytokines and chemotherapy increases the yield of hematopoietic progenitors in peripheral blood stem cells (pbsc) in patients with non-hodgkin's lymphoma or hodgkin's disease undergoing autologous pbsc transplantation. * determine whether in vitro studies can predict the transduction efficiency of early and late engrafting hematopoietic stem cells in this patient population undergoing this treatment. * determine whether in vitro transduction of a graft product stable long term transduction of marrow cells in these patients after autologous transplantation. outline: patients receive filgrastim (g-csf) subcutaneously (sc) twice daily on days 1-7. peripheral blood stem cells (pbsc) are collected on days 5-7. patients receive cyclophosphamide iv over 2 hours, mitoxantrone iv, and cytarabine iv every 12 hours for 2 doses on day 10, and dexamethasone every 12 hours for 4 doses on days 10 and 11. patients receive g-csf sc for the next 10-20 days. additional pbsc are collected on days 25-28 or 29. beginning 7 days before pbsc transplantation, patients receive cyclophosphamide iv over 2 hours on days -7 and -6 and total body irradiation (tbi) twice daily on days -4 to -1. patients unable to tolerate tbi receive cyclophosphamide iv over 2 hours on days -6 to -3, carmustine iv over 1 hour on days -6, and etoposide iv over 1 hour every 12 hours on days -6 to -4. retrovirally transduced pbsc are reinfused on day 0 followed by another course of g-csf sc until hematopoietic recovery. patients are followed at 1, 3, 6, 9, 12, 18, and 24 months and then annually thereafter. projected accrual: a total of 15-20 patients will be accrued for this study within 12-15 months.

Eligibility criteria:
disease characteristics: * intermediate or high grade non-hodgkin's lymphoma (nhl) or hodgkin's disease (hd) * chemotherapy sensitive, initial partial remission or * relapse after initial complete or partial remission * low grade nhl eligible provided progression following initial partial or complete remission * ineligible for ongoing allogeneic marrow donor transplant protocols or elected not to participate in such protocols * no chemotherapy resistant nhl or hd note: a new classification scheme for adult non-hodgkin's lymphoma has been adopted by pdq. the terminology of "indolent" or "aggressive" lymphoma will replace the former terminology of "low", "intermediate", or "high" grade lymphoma. however, this protocol uses the former terminology. patient characteristics: age: * 18 to 70 performance status: * karnofsky 90-100% life expectancy: * not specified hematopoietic: * not specified hepatic: * ast less than 2.5 times upper limit of normal (uln) * bilirubin less than 2.5 times uln renal: * creatinine less than 2.0 mg/dl cardiovascular: * resting lvef at least 40% * no unstable ischemic heart disease pulmonary: * spirometry and dlco greater than 50% predicted other: * no active uncontrolled infection * hiv negative prior concurrent therapy: biologic therapy: * see disease characteristics chemotherapy: * see disease characteristics * at least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas) endocrine therapy: * not specified radiotherapy: * not specified surgery: * not specified

Keywords: recurrent adult hodgkin 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 recurrent mantle cell lymphoma recurrent marginal zone lymphoma recurrent small lymphocytic lymphoma extranodal marginal zone b-cell lymphoma of mucosa-associated lymphoid tissue nodal marginal zone b-cell lymphoma splenic marginal zone lymphoma