Pentostatin and Lymphocyte Infusion in Preventing Graft Rejection in Patients Who Have Undergone Donor Stem Cell Transplant
Condition: Acute Lymphoblastic Leukemia; Acute Myeloid Leukemia; Chronic Lymphocytic Leukemia; Chronic Myelogenous Leukemia, BCR-ABL1 Positive; Graft Versus Host Disease; Hodgkin Lymphoma; Myelodysplastic/Myeloproliferative Neoplasm; Non-Hodgkin Lymphoma; Plasma Cell Myeloma; Waldenstrom Macroglobulinemia
MeSH terms: Lymphoma; Leukemia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Leukemia, Lymphocytic, Chronic, B-Cell; Leukemia, Myeloid; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Waldenstrom Macroglobulinemia; Multiple Myeloma; Myeloproliferative Disorders; Myelodysplastic-Myeloproliferative Diseases; Graft vs Host Disease
Intervention: Cyclosporine; Mycophenolate Mofetil; Pentostatin; Therapeutic Allogeneic Lymphocytes
Intervention description: Given PO; Given PO; Given IV; Given IV
Intervention MeSH terms: Cyclosporine; Mycophenolic Acid; Vidarabine; Pentostatin; Cyclosporins
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 36.0
Sex: All
Healthy volunteers: No

Summary:

      This phase II trial studies pentostatin and donor lymphocyte infusion in preventing graft
      rejection in patients who have undergone donor stem cell transplant. Giving pentostatin and
      an infusion of the donor's T cells (donor lymphocyte infusion) after a donor stem cell
      transplant may stop the patient's immune system from rejecting the donor's stem cells. The
      donated stem cells 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 pentostatin before donor
      lymphocyte infusion may stop this from happening.
    

Eligibility criteria:

        Inclusion Criteria:

          -  Patients having received a preceding allogeneic transplantation from either a human
             leukocyte antigen (HLA)-matched related or unrelated donor are eligible for this
             protocol

               -  Related donor: HLA genotypically identical at least at one haplotype and may be
                  phenotypically or genotypically identical at the allele level at HLA A, B, C,
                  DRB1, and DQB1

               -  Unrelated donor who are prospectively:

                    -  Matched for HLA-A, B, C, DRB1 and DQB1 by high resolution typing; OR

                    -  Only a single allele disparity will be allowed for HLA-A, B, or C as defined
                       by high resolution typing

          -  Patients with less than 50% donor CD3 peripheral blood chimerism on two separate,
             consecutive evaluations; the two evaluations must be at least 14 days apart OR
             patients with absolute decreases of donor CD3 peripheral blood chimerism of >= 20% if
             the second test shows < 50% donor CD3 cells; the two evaluations must be at least 14
             days apart

          -  Patients with evidence of disease are only eligible if the disease is stable (or
             persistent) in comparison to the status prior to transplantation

          -  Patients must be tapered off systemic steroids to a dosage of less than or equal to
             0.25 mg/kg/day

          -  Patients must have persistent donor CD3 cells (>= 5% donor CD3 cells by a
             deoxyribonucleic acid [DNA]-based assay that compares the profile of amplified
             fragment length polymorphisms [ampFLP] [or fluorescent in situ hybridization (FISH)
             studies or variable number of tandem repeats (VNTR)])

          -  DONOR: Alternatively to a fresh unmodified leukapheresis product, previously collected
             cryopreserved peripheral blood stem cells (PBSC) after mobilization with G-CSF or
             cryopreserved unmodified leukapheresis product from the original donor can be used; if
             cryopreserved product is not available, the following criteria apply for the DLI
             product:

          -  DONOR: Original donor of hematopoietic cell transplantation

          -  DONOR: Donor must give consent to leukapheresis

          -  DONOR: Donor must have adequate veins for leukapheresis or agree to placement of
             central venous catheter (femoral or subclavian)

          -  DONOR: Donor must be medically fit to undergo the apheresis procedure (institutional
             guidelines for apheresis)

        Exclusion Criteria:

          -  Current grade II to IV acute GVHD or extensive chronic GVHD

          -  Karnofsky score < 50%

               -  Pediatric criteria

                    -  Lansky play-performance score < 40

          -  Evidence of relapse or progression of disease after transplantation

          -  Prior recipient of cord blood

          -  DONOR: Donors who are not suitable for medical reasons to donate peripheral blood
             mononuclear cells (PBMC) by continuous centrifugation according to the criteria of the
             American Association of Blood Banks (AABB)

          -  DONOR: Pregnancy

          -  DONOR: Human immunodeficiency virus (HIV) or human T-lymphotrophic virus (HTLV)
             infection

          -  DONOR: Recent immunization may require a delay