Donor T Cells After Donor Stem Cell Transplant in Treating Patients With Hematologic Malignancies

This pilot phase II trial studies how well giving donor T cells after donor stem cell transplant works in treating patients with hematologic malignancies. In a donor stem cell transplant, the donated stem cells may replace the patient's immune cells and help destroy any remaining cancer cells (graft-versus-tumor effect). Giving an infusion of the donor's T cells (donor lymphocyte infusion) after the transplant may help increase this effect.

PRIMARY OBJECTIVES:

I. To determine the feasibility of escalating dose regimen (EDR) donor lymphocyte infusion (DLI) as measured by the proportion of patients who receive at least one DLI.

SECONDARY OBJECTIVES:

I. To assess progression free survival (PFS) at 2 years after stem cell transplant (SCT) for high-risk hematologic malignancies receiving T-cell depleted grafts followed by escalating dose regimen (EDR) prophylactic DLI compared to historical controls not receiving DLI.

II. To assess the safety of EDR DLI for high-risk hematologic malignancies as measured by cumulative incidence of severe grade III-IV acute graft-versus-host disease (GVHD).

III. To measure outcomes of grade II-IV acute GVHD, non-relapse mortality, overall survival and chronic GVHD of EDR DLI.

IV. To assess the full donor chimerism rate in the CD3 compartment and immune reconstitution after EDR DLI.

OUTLINE:

Patients receive DLI intravenously (IV). Treatment repeats every 4-8 weeks for 5 doses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up periodically for 2 years.

Eligibility Criteria:
Inclusion Criteria:

* INCLUSION CRITERIA PRIOR TO TRANSPLANT:
* The clinical trial will be offered to all high risk (defined 3 below) patients with hematologic malignancies who require stem cell transplants as part of their standard of care using matched related or unrelated donors
* Patients with high risk myeloid or lymphoid malignancies at stem cell transplant following American Society for Blood and Marrow Transplantation (ASBMT) criteria, including but not limited to conditions listed; these criteria apply BEFORE cyto-reductive therapy given within 28 days of planned conditioning:

  * Refractory acute myelogenous or lymphoid leukemia
  * Relapsed acute myelogenous or lymphoid leukemia
  * Myelodysplastic syndromes with 5% or more blasts
  * Chronic myelogenous leukemia in chronic phase 3 or more, blast phase presently, or second accelerated phase
  * Recurrent or refractory malignant lymphoma or Hodgkin's disease with less than a partial response at transplant
* High risk chronic lymphocytic leukemia defined as no response or stable disease to the most recent treatment regimen
* DONORS: Matched related or unrelated donor stem cell transplant (SCT) matched at human leukocyte antigen (HLA) A- B, C, and DRB1 by molecular methods; 7 of 8 matched donor acceptable for related donors
* T-cell depletion with anti-thymocyte globulin (ATG) (rabbit or horse) or at least 30 mg of alemtuzumab total in the conditioning regimen
* Immune suppression; planned post-transplant immune suppression should include tacrolimus or cyclosporin monotherapy (i.e., calcineurin inhibitor or CN) for alemtuzumab regimens and a second immune suppressant for ATG treated patients; other agents may be used if CN intolerance or toxicity occurs post-transplant
* Zubrod performance status (PS) 0-2 or equivalent Karnofsky PS
* Eligible for allogeneic transplant in the treating physicians' judgment and by institutional standards
* ELIGIBILITY TO RECEIVE DLI POST-TRANSPLANT:
* Donor lymphocytes available or able to be collected
* No evidence of disease by standard morphology; minimal residual disease or molecular evidence of disease will not exclude
* Absolute neutrophil count \>= 500/μl
* Platelet count \>= 20,000/μl without transfusion for 7 days
* Serum glutamic oxaloacetic transaminase (SGOT) and serum glutamate pyruvate transaminase (SGPT) =\< 5 x upper limit of normal (ULN)
* Bilirubin =\< 3 x ULN
* No evidence of grade II or higher acute GVHD or chronic GVHD at initiation of first DLI
* No systemic corticosteroids or immunosuppressive drugs (topical acceptable); replacement steroids for adrenal insufficiency are not excluded

Exclusion Criteria:

* EXCLUSION CRITERIA PRIOR TO TRANSPLANT:
* Pregnant or lactating females
* Hepatitis B with positive viral load prior to transplant conditioning or hepatitis C virus
* Human immune deficiency virus
* Psychiatric illness that may make compliance to the clinical protocol unmanageable or may compromise the ability of the patient to give informed consent
* Creatinine \>= 2.0 mg/dL
* SGOT and SGPT \>= 5 x ULN; liver biopsy preferred for such patients
* Bilirubin \>= 3 x ULN (unless Gilbert's syndrome)
* Diffusing capacity of the lung for carbon monoxide (DLCO) \< 50% corrected for hemoglobin
* Left ventricular ejection fraction or shortening fraction \< 40%
* Unlikely to be able to procure additional donor lymphocytes