Autologous Peripheral Blood Stem Cell Transplant Followed by Donor Bone Marrow Transplant in Treating Patients With High-Risk Hodgkin Lymphoma, Non-Hodgkin Lymphoma, Multiple Myeloma, or Chronic Lymphocytic Leukemia
Condition: B-Cell Prolymphocytic Leukemia; Hypodiploidy; Loss of Chromosome 17p; Plasma Cell Leukemia; Progression of Multiple Myeloma or Plasma Cell Leukemia; Recurrent Adult Hodgkin Lymphoma; Recurrent Adult Non-Hodgkin Lymphoma; Recurrent Childhood Hodgkin Lymphoma; Recurrent Childhood Non-Hodgkin Lymphoma; Recurrent Chronic Lymphocytic Leukemia; Recurrent Plasma Cell Myeloma; Recurrent Small Lymphocytic Lymphoma; Refractory Childhood Hodgkin Lymphoma; Refractory Chronic Lymphocytic Leukemia; Refractory Non-Hodgkin Lymphoma; Refractory Plasma Cell Myeloma; Refractory Small Lymphocytic Lymphoma; t(14;16); t(4;14); T-Cell Prolymphocytic Leukemia; Waldenstrom Macroglobulinemia
MeSH terms: Lymphoma; Leukemia; Multiple Myeloma; Neoplasms, Plasma Cell; Lymphoma, Non-Hodgkin; Leukemia, Lymphoid; Leukemia, Lymphocytic, Chronic, B-Cell; Hodgkin Disease; Waldenstrom Macroglobulinemia; Leukemia, Prolymphocytic; Leukemia, Plasma Cell; Leukemia, Prolymphocytic, T-Cell; Leukemia, Prolymphocytic, B-Cell; Recurrence
Intervention: Allogeneic Bone Marrow Transplantation; Allogeneic Hematopoietic Stem Cell Transplantation; Autologous Hematopoietic Stem Cell Transplantation; Autologous-Allogeneic Tandem Hematopoietic Stem Cell Transplantation; Carmustine; Cyclophosphamide; Cytarabine; Etoposide; Fludarabine Phosphate; Laboratory Biomarker Analysis; Melphalan; Mycophenolate Mofetil; Peripheral Blood Stem Cell Transplantation; Tacrolimus; Total-Body Irradiation
Intervention description: Undergo donor HCT; Undergo donor HCT; Undergo autologous PBSC transplant; Undergo autologous-donor tandem HCT; Given IV; Given IV; Given IV; Given IV; Given IV; Correlative study; Given IV; Given PO; Undergo donor HCT; Given IV or PO; Undergo TBI
Intervention MeSH terms: Cytarabine; Mycophenolic Acid; Cyclophosphamide; Melphalan; Mechlorethamine; Carmustine; Nitrogen Mustard Compounds; Fludarabine; Fludarabine phosphate; Etoposide; Etoposide phosphate; Podophyllotoxin; Tacrolimus
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 16.0
Sex: All
Maximum age: 75 Years
Healthy volunteers: No

Summary:

      This phase II trial studies autologous peripheral blood stem cell transplant followed by
      donor bone marrow transplant in treating patients with high-risk Hodgkin lymphoma,
      non-Hodgkin lymphoma, multiple myeloma, or chronic lymphocytic leukemia. Autologous stem cell
      transplantation uses the patient's stem cells and does not cause graft versus host disease
      (GVHD) and has a very low risk of death, while minimizing the number of cancer cells.
      Peripheral blood stem cell (PBSC) transplant uses stem cells from the patient or a donor and
      may be able to replace immune cells that were destroyed by chemotherapy. These donated stem
      cells may help destroy cancer cells. Bone marrow transplant known as a nonmyeloablative
      transplant uses stem cells from a haploidentical family donor. Autologous peripheral blood
      stem cell transplant followed by donor bone marrow transplant may work better in treating
      patients with high-risk Hodgkin lymphoma, non-Hodgkin lymphoma, multiple myeloma, or chronic
      lymphocytic leukemia.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Must have the capacity to give informed consent

          -  Detectable tumor prior to mobilization regimen

          -  Patients with stored autologous stem cells will be allowed

          -  Stem cells from an identical donor could be used for autologous hematopoietic cell
             transplant (HCT)

          -  Marrow is the preferred source of stem cells from the HLA-haploidentical donor,
             however, peripheral blood mononuclear cells (PBMC) could be used as stem cell source,
             after clearance with the Fred Hutchinson Cancer Research Center (FHCRC) principal
             investigator, in the case of difficulties or contraindications to bone marrow harvest
             from the donor

          -  Cross-over to other tandem autologous-allogeneic research protocol (#1409 or other
             appropriate protocol) will be allowed if a suitable HLA-matched related or unrelated
             donor is identified before receiving the allogeneic transplantation and if the patient
             meets the eligibility criteria of the subsequent study

          -  Cross-over from other tandem autologous-allogeneic research protocol (#1409 or other
             appropriate protocol) will be allowed if the patient loses the suitable HLA-matched
             related or unrelated donor but has an available HLA-haploidentical donor before
             receiving the allogeneic transplantation and if the patient meets the eligibility
             criteria of the subsequent study

          -  Lymphoma: patients with

               -  Diagnosis of non-Hodgkin lymphoma (NHL) or Hodgkin's lymphoma (HL), of any
                  histological grade

               -  Refractory or relapsed disease after standard chemotherapy

               -  High risk of early relapse following autograft alone

          -  Waldenstrom's macroglobulinemia: must have failed 2 courses of therapy

          -  CLL:

               -  Patients with either a:

                    -  Diagnosis of T-cell CLL or T-cell prolymphocytic leukemia (PLL) who have
                       failed initial chemotherapy, patients with T cell CLL or PLL or

                    -  Diagnosis of B-cell CLL, B-cell small lymphocytic lymphoma, or B-cell CLL
                       that progressed to PLL who either:

                         1. Failed to meet National Cancer Institute (NCI) Working Group criteria
                            for complete or partial response after therapy with a regimen
                            containing fludarabine (or another nucleoside analog, e.g.
                            2-chlorodeoxyadenosine [CDA], pentostatin) or experience disease
                            relapse within 12 months after completing therapy with a regimen
                            containing fludarabine (or another nucleoside analog)

                         2. Failed any aggressive chemotherapy regimen, such as fludarabine,
                            cyclophosphamide and rituximab (FCR), at any time point

                         3. Have "17p deletion" cytogenetic abnormality and relapsed at any time
                            point after initial chemotherapy

               -  Harvesting criteria for autologous HCT:

                    -  Previously collected PBMC may be used

                    -  Circulating CLL cells < 5000

               -  Marrow involvement with CLL cells < 50%

          -  Multiple myeloma (MM): patients who

               -  Have received induction therapy for a minimum of 4 cycles

               -  In addition, patients must meet at least one of the following criteria I-IX
                  (I-VII at time of diagnosis or pre-autograft):

                    -  Any abnormal karyotype by metaphase analysis except for isolated t(11,14),

                    -  Fluorescent in situ hybridization (FISH) translocation 4:14,

                    -  FISH translocation 14:16,

                    -  FISH deletion 17p,

                    -  Beta2 (B2)-microglobulin > 5.5 mg/ml,

                    -  Cytogenetic hypodiploidy

                    -  Plasmablastic morphology (>= 2%)

                    -  Recurrent or non-responsive (less than partial remission [PR]) MM after at
                       least two different lines of conventional chemotherapy

                    -  Progressive MM after a previous autograft (provided stored autologous
                       cluster of differentiation [CD]34 cells are available)

          -  Plasma cell leukemia: after induction chemotherapy

          -  DONOR: Related donors who are genotypically identical for one HLA haplotype and who
             may be mismatched at the HLA-A, -B, -C or DRB1 loci of the unshared haplotype with the
             exception of single HLA-A, -B or -C allele mismatches

          -  DONOR: Marrow is the preferred source of stem cells from the HLA-haploidentical donor,
             however PBMC could be used as stem cell source, after clearance with the FHCRC
             principal investigator, in the case of difficulties or contraindications to bone
             marrow harvest from the donor

          -  DONOR: In the case that PBMC will be used as stem cell source, ability of donors < 18
             years of age to undergo apheresis without use of a vascular access device; vein check
             must be performed and verified by an apheresis nurse prior to arrival at the Seattle
             Cancer Care Alliance (SCCA)

          -  DONOR: Age >= 12 years of age

        Exclusion Criteria:

          -  Life expectancy severely limited by disease other than malignancy

          -  Seropositive for the human immunodeficiency virus

          -  Female patients who are pregnant or breastfeeding

          -  Fertile men or women unwilling to use contraceptive techniques during and for 12
             months following treatment

          -  Central nervous system (CNS) involvement with disease refractory to intrathecal
             chemotherapy

          -  Patients with active non-hematological malignancies (except non-melanoma skin cancers)
             or those with non-hematological malignancies (except non-melanoma skin cancers) who
             have been rendered with no evidence of disease, but have a greater than 20% chance of
             having disease recurrence within 5 years

               -  This exclusion does not apply to patients with non-hematologic malignancies that
                  do not require therapy

          -  Patients with fungal infection and radiological progression after receipt of
             amphotericin B or active triazole for greater than 1 month

          -  Symptomatic coronary artery disease or ejection fraction < 40% or other cardiac
             failure requiring therapy (or, if unable to obtain ejection fraction, shortening
             fraction of < 26%); ejection fraction is required if the patient has a history of
             anthracyclines or history of cardiac disease; patients with a shortening fraction <
             26% may be enrolled if approved by a cardiologist

          -  Corrected diffusion capacity of the lungs for carbon monoxide (DLCO) < 50% of
             predicted, forced expiratory volume in one second (FEV1) < 50% of predicted, and/or
             receiving supplementary continuous oxygen; the FHCRC principal investigator (PI) of
             the study must approve of enrollment of all patients with pulmonary nodules

          -  Patient with clinical or laboratory evidence of liver disease will be evaluated for
             the cause of liver disease, its clinical severity in terms of liver function, bridging
             fibrosis, and the degree of portal hypertension; the patient will be excluded if
             he/she is found to have fulminant liver failure, cirrhosis of the liver with evidence
             of portal hypertension, alcoholic hepatitis, esophageal varices, a history of bleeding
             esophageal varices, hepatic encephalopathy, uncorrectable hepatic synthetic
             dysfunction evinced by prolongation of the prothrombin time, ascites related to portal
             hypertension, bacterial or fungal liver abscess, biliary obstruction, chronic viral
             hepatitis with total serum bilirubin > 3 mg/dL, and symptomatic biliary disease

          -  Karnofsky score < 50% for adult patients

          -  Lansky play-performance score < 40 for pediatric patients

          -  Patient with poorly controlled hypertension despite multiple antihypertensives

          -  DONOR: Donor-recipient pairs in which the HLA-mismatch is only in the
             host-versus-graft (HVG) direction

          -  DONOR: Infection with human immunodeficiency virus (HIV)

          -  DONOR: Weight < 20 kg

          -  DONOR: A positive anti-donor cytotoxic crossmatch