Haploidentical Donor Hematopoietic Stem Cell Transplant in Treating Patients With Hematologic Malignancies

Study Overview
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Brief Summary
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This phase II trial studies how well haploidentical donor hematopoietic stem cell transplant works in treating patients with hematologic malignancies. Giving chemotherapy and total-body irradiation before a donor stem cell transplant helps stop the growth of cancer cells. It may also stop the patient's immune system from rejecting the donor's stem cells. Giving an infusion of the donor's T cells (donor lymphocyte infusion) may replace the patient's immune cells and help destroy any remaining cancer cells. When the stem cells from a related donor, that closely matches the patient's blood, are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets.

Detailed Description
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PRIMARY OBJECTIVES: I. Examine the 1 year disease free survival (DFS) rate of patients with maternal donors or sibling donors who share the maternal haplotype (maternal group) and compare them to patients receiving cells from donors who have points from other characteristics such as killer immunoglobulin-like receptor (KIR) ligand mismatching, minor histocompatibility antigen (MHag) differences, or number of human leukocyte antigen (HLA) mismatches (non-maternal group). SECONDARY OBJECTIVES: I. Assess the incidences of relapse and graft-versus-host disease (GVHD) in maternal recipients whose only eligible donors are offspring. II. Assess the incidence of grades III-IV GVHD in female recipients with male donors. III. Compare the rates of DFS in recipient-donor combinations in which there is at least 1 KIR ligand mismatch versus those without a KIR ligand mismatch. OUTLINE: Patients undergo total body irradiation (TBI) twice daily (BID) on days -9 to -6, undergo donor lymphocyte infusion (DLI) on day -6, and receive cyclophosphamide intravenously (IV) over 2 hours on days -3 and -2. TRANSPLANT: Patients undergo haploidentical allogeneic hematopoietic stem cell transplant on day 0. GVHD PROPHYLAXIS: Patients receive tacrolimus IV beginning on day -1 with taper beginning on day 42, and mycophenolate mofetil IV BID from day -1 to day 28. After completion of study treatment, patients are followed up at 90, 180, and 270 days, and 1 year.

Official Title
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A Two Step Approach to Haploidentical Hematopoietic Stem Cell Transplantation for Patients in Remission From HLA Partially-Matched Related Donors-Effect of Maternal Donors on Outcomes

Conditions
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Malignant Neoplasm

Intervention / Treatment
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* Radiation: Total-body irradiation
* Biological: Donor lymphocytes infusion (DLI)
* Drug: Cyclophosphamide
* Procedure: Allogeneic hematopoietic stem cell transplantation (HSCT)
* Drug: Tacrolimus
* Drug: Mycophenolate mofetil


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Any patient with a hematologic or oncologic diagnosis without morphological evidence of disease in which allogeneic HSCT is thought to be beneficial. Patients must have a related donor who is a two or more allele mismatch at the HLA-A; B; C; DR loci. Patients must have adequate organ function: LVEF (Left ventricular ejection fraction) of >50% Diffusion Capacity for Carbon Monoxide (DLCO) >50% of predicted corrected for hemoglobin Adequate liver function as defined by a serum bilirubin <1.8, Aspartate Aminotransferase (AST) or alanine aminotransferase (ALT) < 2.5X upper limit of normal Creatinine clearance of > 60 ml/min Performance status > 80% (TJU Karnofsky) Hematopoietic Comorbidity Index (HCT-CI) Score < 5 Points Patients must be willing to use contraception if they have childbearing potential Able to give informed consent, or if decisionally impaired, have a legal next of kin or guardian that can give informed consent Exclusion Criteria: Performance status < 80 % (TJU Karnofsky) HCT-CI Score > 5 Points Combination of Performance status of < 80% (TJU Karnofsky) and an HCT-CI of 4 points or more. HIV positive Active involvement of the central nervous system with malignancy Psychiatric disorder that would preclude patients from signing an informed consent Pregnancy Patients with life expectancy of < 6 months for reasons other than their underlying hematologic/oncologic disorder Patients who have received alemtuzumab within 8 weeks of the transplant admission, or who have recently received horse or rabbit anti-thymocyte globulin and have an ATG level of > 2 ugm/ml Patients who cannot receive cyclophosphamide Patients with evidence of another malignancy, exclusive of a skin cancer that requires only local treatment, should not be enrolled on this protocol

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treatment (haploidentical allogeneic HSCT)<br>Patients undergo TBI BID on days -9 to -6, undergo DLI on day -6, and receive cyclophosphamide IV over 2 hours on days -3 and -2. TRANSPLANT: Patients undergo haploidentical allogeneic hematopoietic stem cell transplant on day 0. GVHD PROPHYLAXIS: Patients receive tacrolimus IV beginning on day -1 with taper beginning on day 42, and mycophenolate mofetil IV BID from day -1 to day 28. | Radiation: Total-body irradiation<br>* Undergo TBI<br>* Other names: TBI;Biological: Donor lymphocytes infusion (DLI)<br>* Undergo DLI<br>* Other names: ALLOLYMPH;Drug: Cyclophosphamide<br>* Given IV<br>* Other names: cytophosphane;Procedure: Allogeneic hematopoietic stem cell transplantation (HSCT)<br>* Undergo haploidentical allogeneic HSCT<br>Drug: Tacrolimus<br>* Given IV<br>* Other names: Protopic;Drug: Mycophenolate mofetil<br>* Given IV<br>* Other names: MMF;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Disease-free Survival (DFS) | Disease free survival (DFS), defined as the time to death, relapse or disease progression. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Relapse of Disease | Relapse of Disease is defined as the return of a disease or the signs and symptoms of a disease after a period of improvement. Relapse is almost always associated with the immunological failure of the donor immune system to recognize and/or respond to reemergence of a tumor. The number of participants with relapse of disease will be collected. | Up to 1 year | 
| Rate of Grade III-IV GVHD in Female Recipients With Male Donors | The rates of grade III-IV GVHD in female recipients with male donors will be computed with corresponding exact binomial 95% confidence intervals. | Up to 1 year | 
| The Rates of Grade III-IV GVHD in Female Recipients With Male Donors Will be Computed With Corresponding Exact Binomial 95% Confidence Intervals. | The difference in DFS in recipient-donor combinations in which there is at least 1 KIR ligand mismatch versus those without a KIR ligand mismatch will be tested using log-rank test. | Up to 1 year |