Ultraviolet-B Light Therapy and Allogeneic Stem Cell Transplantation in Treating Patients With Hematologic Malignancies

Study Overview
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Brief Summary
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RATIONALE: Peripheral stem cell transplantation may be able to replace immune cells that were destroyed by chemotherapy. Sometimes the transplanted cells from a donor are rejected by the body's normal cells. Ultraviolet-B light therapy given before and after allogeneic stem cell transplantation may help prevent this from happening. PURPOSE: Clinical trial to study the effectiveness of combining ultraviolet-B light therapy with allogeneic stem cell transplantation in treating patients who have hematologic malignancies.

Detailed Description
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OBJECTIVES: Primary Determine the safety of ultraviolet-B light therapy and allogeneic peripheral blood stem cell transplantation in patients with hematologic malignancies by demonstrating 100-day mortality no greater than 15% and 1-year mortality no greater than 40%. Determine the frequency of treatment-related toxicity leading to death and frequency of disease relapse resulting in death in patients treated with this regimen. Determine the incidence and severity of acute and chronic graft-versus-host disease in patients treated with this regimen. Secondary Determine the rates of donor allogeneic hematologic engraftment in patients treated with this regimen. Determine the rate and quality of immune reconstitution in the peripheral blood and the composition of immune cells in the skin before and after transplantation in these patients. Determine the event-free and overall survival of patients treated with this regimen. OUTLINE: Preparative regimen: Patients receive fludarabine IV over 30 minutes on days -8 to -4 and cyclophosphamide IV over 1 hour on days -3 to -2. Patients also receive anti-thymocyte globulin IV over 4 hours on days -2 to -1. Patients undergo ultraviolet-B (UVB) light therapy every other day between days -10 and -2 for a total of 3 days. Allogeneic peripheral blood stem cell (PBSC) transplantation: Patients undergo PBSC transplantation on day 0. Graft-versus-host disease prophylaxis: Patients receive oral cyclosporine on days -1 to 100 and methylprednisolone (oral or IV) on days 5-15. Posttransplantation UVB light therapy: Following PBSC transplantation, patients undergo UVB light therapy twice weekly on week 1 (at least 1 day apart) and three times weekly on weeks 2-4. Donor lymphocyte infusion is performed per institutional guidelines for patients in whom emerging donor chimerism post allogeneic PBSC transplantation is not progressing (consistently below 50% during first 3 months), for whom donor chimerism is receding (to below 25%) despite cessation of cyclosporine, or who relapse within 24 months after allografting. Patients are followed at least monthly for 3 months and then at 6, 12, 18, and 24 months. PROJECTED ACCRUAL: A total of 23-36 patients will be accrued for this study.

Official Title
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Immunomodulation by Ultraviolet B-Irradiation (UVB) to Facilitate Allogeneic Stem Cell Transplantation for Treatment of Hematologic Malignancies

Conditions
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Chronic Myeloproliferative Disorders, Leukemia, Lymphoma, Multiple Myeloma and Plasma Cell Neoplasm, Myelodysplastic Syndromes, Myelodysplastic/Myeloproliferative Diseases

Intervention / Treatment
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* Biological: anti-thymocyte globulin
* Drug: cyclophosphamide
* Drug: cyclosporine
* Drug: fludarabine phosphate
* Drug: methylprednisolone
* Procedure: UV light therapy
* Procedure: allogeneic bone marrow transplantation
* Procedure: peripheral blood stem cell transplantation


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Histologically confirmed diagnosis of any of the following hematologic malignancies: Acute myeloid leukemia (AML) meeting any of the following criteria: First complete remission with high-risk karyotype Translocations t(15;17) allowed only if failed first-line induction therapy OR molecular evidence of persistent disease exists Translocations t(8;21) and inv(16) allowed only if failed first-line induction therapy Second or subsequent complete remission Minimal residual disease* Acute lymphoblastic leukemia meeting any of the following criteria: Failed induction therapy and has minimal residual disease* by salvage therapy First complete remission with high-risk karyotype (e.g., t[4;11] or t[9;22]) Relapsed disease allowed provided a second or subsequent complete remission or minimal residual disease* is achieved Chronic myelogenous leukemia meeting any of the following criteria: Persistent or relapsed disease after 1 year of imatinib mesylate therapy Accelerated phase or blast crisis Blast crisis allowed after reinduction chemotherapy places disease in chronic phase Myelodysplastic syndromes meeting any of the following criteria: Refractory to medical management Cytogenetic abnormalities predictive of transformation into acute leukemia, including 5q-, 7q-, monosomy 7 and trisomy 8, or evidence of evolution to AML (e.g., refractory anemia with excess blasts (RAEB) or RAEB in transformation) Non-Hodgkin's lymphoma or Hodgkin's lymphoma meeting any of the following criteria: Beyond first complete remission or failed primary induction therapy and demonstrated sensitivity to therapy during the 6 months before transplantation Recurrent disease after autologous stem cell transplantation Must be at least 3 months posttransplantation Cyclin D1+ mantle cell lymphoma allowed after induction therapy and in first remission Multiple myeloma meeting either of the following criteria: Refractory or relapsed disease Residual disease after autologous transplantation Chronic lymphocytic leukemia (CLL) meeting all of the following criteria: Peripheral blood absolute lymphocyte count greater than 5,000/mm^3 Small to moderate size lymphocytes and less than 55% pro-lymphocytes, atypical lymphocytes, or lymphoblasts morphologically B-cell or T-cell Myeloproliferative disorders, including myelofibrosis Philadelphia negative Availability of a HLA-A, B, and DR identical family donor OR HLA-A, B, and DR genetically matched unrelated donor Must meet 1 of the following criteria: At least 55 years of age at time of transplantation Received extensive prior therapy (i.e., more than 1 year of alkylator therapy or more than 2 different prior salvage regimens) or stem cell transplantation with myeloablative conditioning (either autologous or allogeneic) Presenting with comorbid condition (e.g., abnormal cardiac, pulmonary, or renal function and/or prior life-threatening infection) that precludes eligibility for enrollment in allogeneic transplantation protocols with full ablation conditioning No active CNS disease NOTE: *Defined as having no circulating blasts, absolute neutrophil count greater than 1,000/mm3 and less than 10% blasts in bone marrow at least 3 weeks after last systemic chemotherapy PATIENT CHARACTERISTICS: Age See Disease Characteristics Over 18 Performance status ECOG 0-2 Life expectancy At least 3 months Hematopoietic See Disease Characteristics Hepatic Bilirubin no greater than 2.0 mg/dL ALT/AST no greater than 4 times normal Renal See Disease Characteristics Creatinine less than 2.0 mg/dL OR Creatinine clearance at least 50 mL/min Cardiovascular See Disease Characteristics Normal cardiac function by echocardiogram or radionuclide scan Shortening fraction or ejection fraction at least 40% of normal Pulmonary See Disease Characteristics DLCO at least 60% FEV_1 greater than 50% of predicted Pulse oximetry greater than 85% Other Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception HIV negative No uncontrolled active infection PRIOR CONCURRENT THERAPY: Biologic therapy See Disease Characteristics At least 2 weeks since prior biologic response modifiers, signal transduction inhibitors, or monoclonal antibodies Chemotherapy See Disease Characteristics At least 4 weeks since prior systemic conventional chemotherapy Endocrine therapy Not specified Radiotherapy Not specified Surgery Not specified Other Recovered from prior therapy No concurrent sun block/sunscreen or any cosmetic that may act as a sunscreen (e.g., lotion with SPF) on the days of scheduled ultraviolet-B light therapy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 120 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

| Intervention/Treatment |
| --- |
|Biological: anti-thymocyte globulin|anti-thymocyte globulin IV over 4 hours on days -2 to -1|
|Drug: cyclophosphamide|cyclophosphamide IV over 1 hour on days -3 to -2|
|Drug: cyclosporine|oral cyclosporine on days -1 to 100|
|Drug: fludarabine phosphate|fludarabine IV over 30 minutes on days -8 to -4|
|Drug: methylprednisolone|methylprednisolone (oral or IV) on days 5-15|
|Procedure: UV light therapy|Patients undergo ultraviolet-B (UVB) light therapy every other day between days -10 and -2 for a total of 3 days. Posttransplantation UVB light therapy: Following PBSC transplantation, patients undergo UVB light therapy twice weekly on week 1 (at least 1 day apart) and three times weekly on weeks 2-4.|
|Procedure: allogeneic bone marrow transplantation|nan|
|Procedure: peripheral blood stem cell transplantation|Allogeneic peripheral blood stem cell (PBSC) transplantation: Patients undergo PBSC transplantation on day 0.|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Study the effectiveness of combining ultraviolet-B light therapy with allogeneic stem cell transplantation in treating patients who have hematologic malignancies. |  | Patients are followed at least monthly for 3 months and then at 6, 12, 18, and 24 months. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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refractory multiple myeloma, accelerated phase chronic myelogenous leukemia, adult acute lymphoblastic leukemia in remission, adult acute myeloid leukemia in remission, blastic phase chronic myelogenous leukemia, recurrent adult acute lymphoblastic leukemia, recurrent adult acute myeloid leukemia, refractory chronic lymphocytic leukemia, relapsing chronic myelogenous leukemia, de novo myelodysplastic syndromes, previously treated myelodysplastic syndromes, recurrent adult diffuse large cell lymphoma, recurrent adult diffuse mixed cell lymphoma, recurrent adult diffuse small cleaved cell lymphoma, recurrent adult Burkitt lymphoma, recurrent adult immunoblastic large cell lymphoma, recurrent adult lymphoblastic lymphoma, recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, recurrent mantle cell lymphoma, refractory anemia with excess blasts in transformation, refractory anemia with excess blasts, secondary myelodysplastic syndromes, Philadelphia chromosome negative chronic myelogenous leukemia, chronic idiopathic myelofibrosis, B-cell chronic lymphocytic leukemia, T-cell large granular lymphocyte leukemia, chronic phase chronic myelogenous leukemia, recurrent adult Hodgkin lymphoma, recurrent adult T-cell leukemia/lymphoma, stage III chronic lymphocytic leukemia, stage IV chronic lymphocytic leukemia, recurrent cutaneous T-cell non-Hodgkin lymphoma, recurrent mycosis fungoides/Sezary syndrome, secondary acute myeloid leukemia, atypical chronic myeloid leukemia, myelodysplastic/myeloproliferative disease, unclassifiable, recurrent marginal zone lymphoma, recurrent small lymphocytic lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, splenic marginal zone lymphoma, adult acute myeloid leukemia with t(8;21)(q22;q22), adult acute myeloid leukemia with t(16;16)(p13;q22), adult acute myeloid leukemia with inv(16)(p13;q22), adult acute myeloid leukemia with 11q23 (MLL) abnormalities, adult acute myeloid leukemia with t(15;17)(q22;q12)