Donor Lymphocyte Infusion in Treating Patients With Recurrent or Persistent Hematologic Cancer After Donor Stem Cell Transplant

RATIONALE: Giving an infusion of donor lymphocytes may be able to kill cancer cells in patients with hematologic cancer that has come back after a donor stem cell transplant.

PURPOSE: This clinical trial is studying how well donor lymphocyte infusion works in treating patients with recurrent or persistent hematologic cancer after donor stem cell transplant.

OBJECTIVES:

Primary

* Determine if the complete response rate exceeds 10% in patients with recurrent or persistent hematologic malignancies treated with donor lymphocyte infusion.

Secondary

* Estimate the complete response rate in these patients.
* Assess the toxicity of donor lymphocyte infusion in these patients.

OUTLINE: Patients receive up to four donor lymphocyte infusions at least 1 month apart in the absence of disease progression, unacceptable toxicity, or uncontrolled graft-versus-host disease.

Eligibility Criteria:
DISEASE CHARACTERISTICS:

* Has undergone allogeneic stem cell transplantation (ASCT) for hematologic malignancy at least 30 days ago

  * No failure to engraft following transplant
  * No active acute or chronic graft-versus-host disease (GVHD)

    * Minimal GVHD allowed
* Persistent or relapsed disease after ASCT, including 1 of the following:

  * Chronic myelogenous leukemia (CML), meeting any of the following criteria:

    * Molecular relapse (may be treated with imatinib mesylate after transplant), as defined by any of the following:

      * ASCT was non-T-cell depleted, a negative bcr/abl was documented by PCR post-transplant, and bcr/abl is now detectable by 2 consecutive PCR determinations \> 30 days apart
      * ASCT was non-T-cell depleted and bcr/abl is detectable by PCR at any time after day 180 post-transplant
    * Cytogenetic relapse after 3-6 months of imatinib mesylate
    * Relapsed chronic phase, accelerated phase, or blastic phase CML after 3-6 months of imatinib mesylate

      * Must currently be in chronic phase or accelerated phase CML only
      * Patients with blastic phase CML must attain a second chronic phase
  * Acute myeloid leukemia, acute lymphoblastic leukemia, or myelodysplastic syndromes, meeting any of the following criteria:

    * Molecular relapse, as evidenced by \< 5% blasts in the bone marrow and the patient's leukemia-specific molecular abnormality detectable by PCR
    * Cytogenetic relapse, as evidenced by \< 5% blasts in the bone marrow and the patient's leukemia-specific chromosome abnormality detectable by standard cytogenetics at any time after day 60 post-transplant
    * Hematologic relapse, as evidenced by \> 20% blasts in bone marrow or soft tissue recurrence

      * Must be treated with chemotherapy after transplant, but before study donor lymphocyte infusion (DLI)
  * Multiple myeloma

    * Relapsed disease or recurrence of M-protein after thalidomide or other salvage treatment

      * Prior post-transplant documentation of disappearance of M-protein by immunofixation
    * Residual or progressive disease
    * Rising M-protein level at any time post-transplant (measured at 3-month intervals)
    * Original M-protein detectable at 6 months post-transplant
    * Immune protein electrophoresis (IPEP) is required to show that M-component is the same on day 60 post-transplant as pre-transplant
    * Residual (\> 5%) plasma cells in bone marrow
  * Relapsed non-Hodgkin lymphoma or Hodgkin lymphoma

    * Relapse or progression of disease must be evidenced within 3 months prior to donor lymphocyte infusion by physical exam, radiographic studies, or molecular studies

      * Tumor should be re-biopsied to determine histology
    * If Epstein-Barr virus (EBV) lymphoma is suspected, peripheral blood must be assayed for EBV genome (i.e., EBV DNA testing by PCR) within the past 30 days
  * EBV infection with associated pancytopenia

    * Persistent or refractory pancytopenia with EBV genome detected by PCR in the peripheral blood

      * Refractory pancytopenia is defined as pancytopenia that is poorly responsive to growth factors and/or transfusions
  * EBV lymphoproliferative disorder

    * Clonal lymphadenopathy that is refractory to standard therapy with acyclovir and immunoglobulin (DLI may be given with rituximab)
* Not a candidate for repeat ASCT

  * Chimerism status is not required for determining eligibility for DLI
* Patients eligible for allogeneic ASCT, but for whom DLI is offered as the first option, should have full donor chimerism at relapse or after therapy for relapsed disease
* Patients with relapsed underlying disease after transplant who achieved remission after chemotherapy are allowed
* No CNS recurrence that is not cleared by standard chemotherapy

  * CNS remission status must be maintained for 2 weeks
* Original hematopoietic progenitor stem cell donor must be available for cell donation

  * No syngeneic donors

PATIENT CHARACTERISTICS:

* Karnofsky performance status 60-100%
* Life expectancy ≥ 8 weeks
* Creatinine \< 3 mg/dL
* ABO/Rh and CMV IgG/IgM status known
* No HIV1 and HIV2 antibody
* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use effective contraception during and for 3 months (males) or 6 months (females) after completion of study treatment

PRIOR CONCURRENT THERAPY:

* See Disease Characteristics