Busulfan and Etoposide Followed by Peripheral Blood Stem Cell Transplant and Low-Dose Aldesleukin in Treating Patients With Acute Myeloid Leukemia
Condition: Adult Acute Myeloid Leukemia in Remission; Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Childhood Acute Myeloid Leukemia in Remission; Recurrent Adult Acute Myeloid Leukemia; Recurrent Childhood Acute Myeloid Leukemia
MeSH terms: Leukemia; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Recurrence
Intervention: busulfan; etoposide; aldesleukin; peripheral blood stem cell transplantation
Intervention description: Given PO or IV; Given IV; Given SC; Undergo autologous or syngeneic stem cell rescue
Intervention MeSH terms: Aldesleukin; Etoposide; Etoposide phosphate; Busulfan; Interleukin-2
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 30.0
Sex: All
Maximum age: 65 Years
Healthy volunteers: No

Summary:

      This phase II trial studies the side effects and how well giving busulfan and etoposide
      followed by peripheral blood stem cell transplant (PBSCT) and low-dose aldesleukin works in
      treating patients with acute myeloid leukemia (AML). Drugs used in chemotherapy, such as
      busulfan and etoposide, work in different ways to stop the growth of cancer cells, either by
      killing the cells or by stopping them from dividing. A PBSCT may be able to replace
      blood-forming cells that were destroyed by chemotherapy. This may allow more chemotherapy to
      be given so that more cancer cells are killed. Aldesleukin may stimulate the white blood
      cells to kill cancer cells. Giving busulfan and etoposide together followed by PBSCT and
      aldesleukin may be an effective treatment for AML.
    

Eligibility criteria:

        Inclusion Criteria:

          -  The patient must have AML that falls into one of the following categories:

          -  AML in 1st complete remission (CR) with intermediate or high risk of relapse following
             conventional therapy; at least, one of the following features is needed:

               -  Patient required more than one cycle of induction to achieve first CR

               -  White blood cell count (WBC) > 100,000/mm^3 at diagnosis

               -  Any of the following cytogenetic abnormalities: inv (3), t(3:3), del (5q) or -5,
                  11q23, del(7q) or -7, del (20q) or -20, abnormal 12p, +11 or t8

               -  Any other abnormalities or combination of abnormalities which would predict
                  intermediate or high risk of relapse

          -  AML beyond first CR

          -  Any patient with an identical twin donor who also meets the criteria above

          -  Patients with AML in 1st CR should receive at least two cycles of consolidation
             chemotherapy prior to mobilization and transplant

          -  Patients must have an adequate number of stem cells previously collected (i.e., > 2 x
             10^8 total nucleated cell [TNC] of bone marrow [BM]/kg or 4 x 10^6 [CD]34+ PBSC/kg,
             unless approved otherwise by Dr. Holmberg); prior to stem cell collection patients
             must be documented to be in remission and to have received two cycles of consolidation
             therapy after induction therapy

          -  Pre-Study tests have been performed

          -  Patient must sign an institutional review board (IRB) approved informed consent,
             conforming with federal and institutional guidelines

        Exclusion Criteria:

          -  Patients with good risk AML defined by cytogenetic evaluation with these
             abnormalities: inversion 16 or t8;21

          -  Patient's life expectancy is severely limited by diseases other than AML

          -  Patient is human immunodeficiency virus (HIV) seropositive

          -  Patient is pregnant

          -  Patient's creatinine > 2.0 mg/dl

          -  Patient's total bilirubin > 2.0 mg/dl (unless Gilbert's disease)

          -  Or serum glutamic oxaloacetic transaminase (SGOT)/serum glutamic pyruvic transaminase
             (SGPT) >= 2.5 x upper limit of normal (ULN) not due to leukemia

          -  Patient has a history of congestive heart failure, uncontrolled arrhythmias or left
             ventricular ejection fraction (LVEF) < 50%

          -  Patient has an unrelated human leukocyte antigen (HLA) matched donor and is eligible
             for a higher priority Fred Hutchinson Cancer Research Center (FHCRC) protocol (for
             FHCRC patients only)

          -  Patient has an HLA matched or one antigen mismatch family donor available

          -  Patients with a significant active infection that precludes transplant

          -  Patients with a Karnofsky Performance Score less than 70