Safety and Efficacy of Pentostatin and Low Dose TBI With Allogenic Peripheral Blood Stem Cell Transplant
Condition: Acute Myelogenous Leukemia; Acute Lymphocytic Leukemia; Chronic Myelogenous Leukemia; Chronic Lymphocytic Leukemia; Myelodysplastic Syndromes; Multiple Myeloma; Non-Hodgkins Lymphoma; Hodgkins Disease; Peripheral T-cell Lymphoma
MeSH terms: Lymphoma; Leukemia; Multiple Myeloma; Leukemia, Lymphoid; Leukemia, Lymphocytic, Chronic, B-Cell; Leukemia, Myeloid; Lymphoma, T-Cell, Peripheral; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Myeloid, Acute; Hodgkin Disease; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Myelodysplastic Syndromes
Study type: Interventional
Phase: Phase 2

Summary: 
      This is a continuation of a pilot study which is now regarded as a phase II trial with a plan
      to enroll an additional 40 patients (20 related and 20 unrelated donor transplants) with
      hematological malignancy assessing the safety and efficacy of a minimally myelosuppressive
      regimen with pentostatin and low-dose total body irradiation (TBI) followed by allogeneic
      peripheral blood stem cell transplantation (alloPSCT).
    

Detailed description: 
      This is a pilot study which began with a plan to enroll 50 patients (20 related and 30
      unrelated donor transplants) with hematological malignancy assessing the safety and efficacy
      of a minimally myelosuppressive regimen with Pentostatin and low-dose total body irradiation
      (TBI) followed by allogeneic peripheral blood stem cell transplantation (alloPSCT). Patients
      with persistent or progressive malignancy after transplantation will be treated with GM-CSF
      (cytokine therapy) to assess its toxicity and potential therapeutic efficacy. Patients with
      persistent or progressive disease who fail or do not qualify for the cytokine therapy portion
      of the study will become candidates for donor leukocyte infusions.

      The purpose of this protocol remains a pilot study which is now regarded as a phase II trial
      with a plan to enroll 40 ADDITIONAL patients (20 related and 20 unrelated donor transplants)
      with hematological malignancy assessing the safety and efficacy of a modified version of the
      original preparative regimen of Pentostatin and low-dose total body irradiation (TBI)
      followed by allogeneic peripheral blood stem cell transplantation (alloPSCT). Patients who
      fail will become candidates for donor-leukocyte infusion (DLI).

      Primary Objectives

        1. To determine the safety of treating hematological malignancies by establishing donor
           hematopoietic chimerism using pentostatin and low-dose total body irradiation followed
           by allogeneic peripheral blood stem cell transplantation.

        2. To determine the immunomodulatory effects of pentostatin as part of the conditioning
           regimen for allogeneic peripheral blood stem cell transplantation.

      Secondary Objectives

        1. To determine the incidence of infections after using a minimally myelosuppressive
           conditioning regimen.

        2. To determine the kinetics of hematological and immunological reconstitution after
           allotransplantation with a minimally myelosuppressive conditioning regimen.

        3. To determine the incidence of chronic GVHD after using allogeneic peripheral blood stem
           cell transplantation with a minimally myelosuppressive preparative regimen.

        4. To evaluate the role of the preparative regimen and donor source (related versus
           unrelated) on inflammatory cytokine profiles.

        5. To evaluate blood and where possible, biopsy specimens for a recently identified nuclear
           protein (molecular weight 44/46) in mononuclear cells obtained from study subjects.

      Interventions, evaluation, and follow up will include:

      Pentostatin 4 mg/m^2/d intravenously once a day x 3 days will be administered with 1000 cc NS
      hydration before and after pentostatin ten days prior to stem cell infusion (days -10, -9,
      and -8). Total-body irradiation (TBI): TBI 2.0 Gy will be given on day -1. Antiemetics will
      be given as needed. Patients will receive one liter normal saline over 2 hours pre TBI. A
      bone marrow biopsy and aspiration with cytogenetics and flow cytometry will be performed on
      Day +28, Day +70 and 6, 12, 18 and 24 months following the transplant to monitor hematologic
      recovery. DNA fingerprinting will also be conducted at the same time at 3, 4, 5, 6, 12, 18,
      and 24 months to determine chimerism.
    

Intervention name(s): Pentostatin; Total-body irradiation (TBI); Cyclosporine A (CsA); Mycophenolate Mofetil (MMF); G-CSF
Intervention type(s): Drug; Radiation; Drug; Drug; Drug
Intervention description(s): 4 mg/m^2 intravenous(IV)once a day(QD)x3days (days -10, -9, -8); TBI will consist of 2.0 GY at 8-12cGy/min via 6MV photons delivered AP/PA fields, without lung blocks or via lateral fields with lucite compensator along the head and neck region. TLD (thermal luminescent dosimetry) will be used to verify dose uniformity. TBI will be given on day -1.; CsA will be given at 2.0 mg/kg intravenous (IV) Q 12hrs on days -1,0,and+1 (total 6 doses) then converted to oral at 2 mg/kg by mouth (PO) twice a day (BID) until day+80, then tapered 10% per week over approximately 3 months if no GVHD for related donor transplants. For unrelated CsA will be given at same dose and schedule until day+100 then tapered by 10% per week if no GVHD; MMF 15 mg/kg by mouth twice a day (PO BID) will be given from day 0-27 then stopped without tapering for related donor transplants. For unrelated donor transplants MMF will be given at same dose until day+40 then tapered over 2months. in absence of GVHD. Doses will be rounded to nearest 250 mg.; 10 mcg/kg/day subcutaneously for at least 4 consecutive days.
Other intervention name(s): Nipent; Neoral; Leukine
Intervention MeSH terms: Cyclosporine; Mycophenolic Acid; Pentostatin; Cyclosporins
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment