Cellular Infusions in Patients With Recurrent or Persistent Hematologic Malignancies After Allogeneic Stem Cell Transplant
Inclusion 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