Donor Stem Cell Transplant in Treating Patients With Previously Treated Lymphoma, Multiple Myeloma, or Chronic Lymphocytic Leukemia
Condition: Leukemia; Lymphoma; Multiple Myeloma and Plasma Cell Neoplasm
MeSH terms: Lymphoma; Leukemia; Multiple Myeloma; Neoplasms, Plasma Cell; Leukemia, Lymphoid; Leukemia, Lymphocytic, Chronic, B-Cell; Plasmacytoma
Intervention: busulfan; cyclophosphamide; Stem cell infusion; Total body irradiation
Intervention description: For those not eligible for total body irradiation: busulfan 4 mg/kg/day orally (1 mg/kg orally every 6 hrs) on Days -9 through -6.; Cyclophosphamide 60 mg/kg/day on days -7 and -6. For patients not eligible for total body irradiation: cytoxan 50 mg/kg intravenously (IV) on days -5 through -2.; Infused on Day 0; 165 cGy morning and evening on days -4 through -1.
Intervention MeSH terms: Cyclophosphamide; Busulfan
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 6.0
Sex: All
Maximum age: 55 Years
Healthy volunteers: No
Keywords: stage I multiple myeloma; stage II multiple myeloma; stage III multiple myeloma; refractory multiple myeloma; recurrent adult Hodgkin lymphoma; recurrent/refractory childhood Hodgkin lymphoma; refractory chronic lymphocytic leukemia; stage III chronic lymphocytic leukemia; stage IV chronic lymphocytic leukemia; recurrent adult grade III lymphomatoid granulomatosis; adult nasal type extranodal NK/T-cell lymphoma; Waldenstrom macroglobulinemia; recurrent adult Burkitt lymphoma; stage I adult Burkitt lymphoma; stage II adult Burkitt lymphoma; stage III adult Burkitt lymphoma; stage IV adult Burkitt lymphoma; recurrent adult diffuse large cell lymphoma; recurrent adult diffuse mixed cell lymphoma; recurrent adult diffuse small cleaved cell lymphoma; recurrent adult immunoblastic large cell lymphoma; stage I adult immunoblastic large cell lymphoma; stage II adult immunoblastic large cell lymphoma; stage III adult immunoblastic large cell lymphoma; stage IV adult immunoblastic large cell lymphoma; recurrent adult lymphoblastic lymphoma; stage I adult lymphoblastic lymphoma; stage II adult lymphoblastic lymphoma; stage III adult lymphoblastic lymphoma; stage IV adult lymphoblastic lymphoma; recurrent grade 1 follicular lymphoma; recurrent grade 2 follicular lymphoma; recurrent grade 3 follicular lymphoma; recurrent mantle cell lymphoma; extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue; nodal marginal zone B-cell lymphoma; recurrent marginal zone lymphoma; splenic marginal zone lymphoma; recurrent small lymphocytic lymphoma; recurrent childhood anaplastic large cell lymphoma; recurrent childhood grade III lymphomatoid granulomatosis; childhood diffuse large cell lymphoma; childhood immunoblastic large cell lymphoma; recurrent childhood large cell lymphoma; recurrent childhood lymphoblastic lymphoma; childhood nasal type extranodal NK/T-cell lymphoma; Burkitt lymphoma; recurrent childhood small noncleaved cell lymphoma; stage I childhood small noncleaved cell lymphoma; stage II childhood small noncleaved cell lymphoma; stage III childhood small noncleaved cell lymphoma; stage IV childhood small noncleaved cell lymphoma

Summary:

      RATIONALE: Giving chemotherapy, such as cyclophosphamide and busulfan, and total-body
      irradiation before a donor stem cell transplant helps stop the growth of cancer cells. It
      also stops the patient's immune system from rejecting the donor's stem cells. The donated
      stem cells from bone marrow or umbilical cord blood may replace the patient's immune cells
      and help destroy any remaining cancer cells (graft-versus-tumor effect). Sometimes the
      transplanted cells from a donor can also make an immune response against the body's normal
      cells. Giving methotrexate and cyclosporine after transplant may stop this from happening.

      PURPOSE: This phase II trial is studying how well a donor stem cell transplant works in
      treating patients with previously treated lymphoma, multiple myeloma, or chronic lymphocytic
      leukemia.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Donors will be <55 years of age and in good health as approved by the National Marrow
             Donor Program (NMDP) donor and collection centers. Related donors will be < 70 years
             of age.

          -  Recipients will be <55 years, will have satisfactory organ function (excluding bone
             marrow) and will have a Karnofsky activity assessment >90% and will have:

               -  Creatinine <2.0 mg/dl.

               -  Bilirubin, Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) <2
                  x normal.

               -  Pulmonary function test and Carbon Monoxide Diffusing Capacity (DLCO) > 50% of
                  normal.

               -  Multi Gated Acquisition Scan (MUGA) >45% injection fraction.

          -  Recipients with unrelated donor matched at the HLA A, B, DRBI loci, or if < 35 years
             mismatched at a single HLA A or B, or DRBI locus.

          -  Umbilical cord blood (5) used as an unrelated stem cell source will provide > 2.0 x
             10^7 cells/kg and will be matched at 4 - 6 of 6 HLA A, B, and DRBI loci. Cord blood
             grafts may include a single or pair of cord units depending on the cell dose.

          -  Partially matched related donors will be at least haploidentical (matched at >3 of 6
             HLA A, B, DRB1 loci).

          -  Recipients will fall under one of the following disease categories

               -  Chronic lymphocytic leukemia -- must have all three:

                    -  Rai Stage III/IV

                    -  Progression after previous Complete Response (CR) or Partial Response (PR)
                       including purine antagonist (i.e. fludarabine).

                    -  Recent chemotherapy responsiveness

               -  Advanced non-Hodgkin's lymphoma(NHL).

                    -  Low-grade NHL (Working Formulation A, B, C) following progression after
                       initial therapy if asymptomatic at diagnosis (>CR2, >PR2; response duration
                       < 1 year from last therapy) or if no CR was achieved (>PR1). At least one
                       prior therapy of intermediate intensity (e.g. CHOP).

                    -  Mantle zone lymphoma after any progression following initial therapy (>CR1,
                       > PR1). At least one prior therapy of intermediate intensity (e.g. CHOP).

                    -  Intermediate grade lymphoma (>PR2). Response duration <1 year from prior
                       therapy.

                    -  High-grade Non-Hodgkin's Lymphoma (NHL) (IWF H, I, J) after initial therapy
                       if >stage III at diagnosis; after any progression even if localized (stage
                       I, II) at diagnosis with prior response duration < 1 year.

                    -  Recent chemotherapy responsiveness after treatment with > 3 intermediate
                       intensity regimens.

               -  Advanced Hodgkin's disease beyond PR2 (>CR3, >PR3).

                    -  Recent chemotherapy responsiveness

               -  Multiple Myeloma (>CR2, >PR2) or after initial therapy if no prior PR.

                    -  Recent chemotherapy responsiveness

          -  Recipients will sign informed consent approved by the Committee on the Use of Human
             Subjects at the University of Minnesota.

        Exclusion Criteria:

          -  No available histocompatible related donor; 2nd bone marrow transplant (BMT), HIV-1
             positive; active uncontrolled infection; or resistant malignancy.