Low-Dose Total Body Irradiation and Donor Peripheral Blood Stem Cell Transplant Followed by Donor Lymphocyte Infusion in Treating Patients With Non-Hodgkin Lymphoma, Chronic Lymphocytic Leukemia, or Multiple Myeloma
Condition: Adult Nasal Type Extranodal NK/T-cell Lymphoma; Anaplastic Large Cell Lymphoma; Angioimmunoblastic T-cell Lymphoma; Cutaneous B-cell Non-Hodgkin Lymphoma; 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; Recurrent Adult Acute Lymphoblastic 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 Immunoblastic Large Cell Lymphoma; Recurrent Adult Lymphoblastic Lymphoma; Recurrent Adult T-cell Leukemia/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; Refractory Chronic Lymphocytic Leukemia; Refractory Hairy Cell Leukemia; Refractory Multiple Myeloma; Small Intestine Lymphoma; Splenic Marginal Zone Lymphoma; Stage II Multiple Myeloma; Stage III Multiple Myeloma; Testicular Lymphoma; Waldenström Macroglobulinemia
MeSH terms: Burkitt Lymphoma; Mycoses; Lymphoma; Leukemia; Multiple Myeloma; Neoplasms, Plasma Cell; Lymphoma, Follicular; Lymphoma, Non-Hodgkin; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Leukemia, Lymphoid; Lymphoma, B-Cell; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphoma, Mantle-Cell; Lymphoma, T-Cell; Lymphoma, T-Cell, Peripheral; Lymphoma, B-Cell, Marginal Zone; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Large-Cell, Immunoblastic; Plasmablastic Lymphoma; Mycosis Fungoides; Sezary Syndrome; Leukemia, T-Cell; Lymphoma, T-Cell, Cutaneous; Waldenstrom Macroglobulinemia; Leukemia-Lymphoma, Adult T-Cell; Lymphoma, Large-Cell, Anaplastic; Leukemia, Hairy Cell; Lymphomatoid Granulomatosis; Lymphoma, Extranodal NK-T-Cell; Intraocular Lymphoma; Immunoblastic Lymphadenopathy; Recurrence
Study type: Interventional

Summary: 
      This pilot clinical trial studies low-dose total body irradiation and donor peripheral blood
      stem cell transplant followed by donor lymphocyte infusion in treatment patients with
      non-Hodgkin lymphoma, chronic lymphocytic leukemia, or multiple myeloma. Giving total-body
      irradiation before a donor peripheral blood stem cell transplant helps stop the growth of
      cells in the bone marrow, including normal blood-forming cells (stem cells) and cancer cells.
      When healthy stem cells from a donor are infused into the patient they may help the patient's
      bone marrow make stem cells, red blood cells, white blood cells, and platelets. Once the
      donated stem cells begin working, the patient's immune system may see the remaining cancer
      cells as not belonging in the patient's body and destroy them. Giving an infusion of the
      donor's white blood cells (donor lymphocyte infusion) may boost this effect.
    

Detailed description: 
      PRIMARY OBJECTIVES:

      I. To determine whether mixed hematopoietic chimerism can be safely established using a
      non-myeloablative conditioning regimen in patients with non-Hodgkin lymphoma (NHL), chronic
      lymphocytic leukemia (CLL) and multiple myeloma.

      II. To determine whether mixed chimerism, established with non- myeloablative conditioning
      regimens, can be safely converted to full donor hematopoietic chimerism by infusions of donor
      lymphocytes (DLI).

      OUTLINE:

      CYTOREDUCTION: If necessary, patients with advanced malignancies undergo cytoreductive
      chemotherapy to reduce tumor size at discretion of primary physician and study investigators.

      CONDITIONING REGIMEN: Patients undergo low-dose total-body irradiation followed by allogeneic
      peripheral blood stem cell (PBSC) transplant on day 0.

      IMMUNOSUPPRESSION: Patients receive cyclosporine intravenously (IV) twice daily (BID) on days
      -1 to 0 and then orally (PO) BID on days 1-35 with taper to day 56. Patients also receive
      mycophenolate mofetil PO BID on days 0-27.

      POST-TRANSPLANT DLI: Patients with mixed chimerism on day 56 and no evidence of graft-vs-host
      disease (GVHD) undergo DLI over 30 minutes on day 65 and may receive up to 3 additional
      infusions in the absence of GVHD and disease progression or persistence. Patients who have
      not achieved mixed chimerism at day 56 undergo DLI if complete response is not obtained after
      a 2 month monitoring period.

      After completion of study treatment, patients are followed up at 4, 6, 12, 18, and 24 months
      and then annually thereafter.
    

Intervention name(s): chemotherapy; total-body irradiation; peripheral blood stem cell transplantation; cyclosporine; mycophenolate mofetil; allogeneic hematopoietic stem cell transplantation; therapeutic allogeneic lymphocytes
Intervention type(s): Drug; Radiation; Procedure; Drug; Drug; Procedure; Biological
Intervention description(s): Undergo cytoreductive chemotherapy; Undergo TBI; Undergo allogeneic PBSC transplant; Given IV or PO; Given PO; Undergo allogeneic PBSC transplant; Undergo DLI
Other intervention name(s): chemo; TBI; PBPC transplantation; PBSC transplantation; peripheral blood progenitor cell transplantation; transplantation, peripheral blood stem cell; ciclosporin; cyclosporin; cyclosporin A; CYSP; Sandimmune; Cellcept; MMF; ALLOLYMPH
Intervention MeSH terms: Cyclosporine; Mycophenolic Acid; Cyclosporins
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment