Autologous Blood and Marrow Transplantation for Hematologic Malignancies and Selected Solid Tumors

Inclusion Criteria

DISEASE CHARACTERISTICS:

- Histologically confirmed diagnosis of 1 of the following:

- Hodgkin lymphoma, meeting the following criteria:

- Relapsed or refractory disease after ≥ 1 prior standard chemotherapy
regimen

- Must have received 2 prior courses of salvage chemotherapy followed by
disease-specific restaging prior to mobilization and collection of stem
cells

- Non-Hodgkin lymphoma, meeting the following criteria:

- Low-, intermediate-, or high-grade disease, meeting 1 of the following
criteria:

- Relapsed or refractory disease after ≥ 1 prior standard chemotherapy
regimen

- Small non-cleaved cell or lymphoblastic lymphoma in first complete
remission (CR) at high risk for relapse by IPI score

- Must have received 2 prior courses of salvage chemotherapy followed by
disease-specific restaging prior to mobilization and collection of stem
cells

- Acute myeloid leukemia, meeting the following criteria:

- Low- or high-risk disease in first or second CR or greater

- Must have received 2 prior courses of chemotherapy (induction chemotherapy
and mobilization chemotherapy) followed by disease-specific restaging prior
to mobilization and collection of stem cells

- Risk of allogeneic stem cell transplantation outweighs the benefits

- Acute lymphoblastic leukemia, meeting the following criteria:

- Low- or high-risk disease in first or second CR or greater

- Must have received 2 prior courses of chemotherapy (induction chemotherapy
and mobilization chemotherapy) followed by disease-specific restaging prior
to mobilization and collection of stem cells

- Risk of allogeneic stem cell transplantation outweighs the benefits

- Multiple myeloma, meeting the following criteria:

- Low- or high-risk disease in first or greater response (stable disease or
better) OR responding disease and now in first progression

- Must have received 2 prior courses of chemotherapy (≥ 1 of the courses must
have been standard induction therapy) followed by disease-specific
restaging prior to mobilization and collection of stem cells

- Other malignant lymphoproliferative disease, including chronic lymphocytic
leukemia or Waldenstrom macroglobulinemia, meeting the following criterion:

- Relapsed or refractory disease after first-line chemotherapy

- Amyloidosis, meeting the following criteria:

- Primary or previously treated disease

- Prior induction chemotherapy is not required

- Patients with malignancies who would be treated with an autologous stem cell
transplant but have a syngeneic donor. A syngeneic donor would be considered to
have the same risk as an autologous stem cell transplant patient.

- Solid tumors, including any of the following:

- Testicular cancer, meeting the following criteria:

- Relapsed disease or primary progressive disease that responded to
salvage therapy

- Must have received 2 prior courses of salvage chemotherapy
followed by disease-specific restaging prior to mobilization and
collection of stem cells

- Neuroblastoma, meeting the following criteria:

= 30 years of age or under

- Relapsed disease OR newly diagnosed advanced disease

- Must have received 2 prior courses of chemotherapy (induction chemotherapy and
mobilization chemotherapy) followed by disease-specific restaging prior to
mobilization and collection of stem cells

- Small round blue cell tumor, meeting the following criteria:

= 30 years of age or under

- Relapsed disease OR newly diagnosed advanced disease

- Must have received either prior standard chemotherapy or surgical intervention

- Other solid tumor, meeting the following criteria:

- Recurrent disease following conventional therapy OR at high risk for relapse

- Must have received 2 prior courses of chemotherapy followed by disease-specific
restaging prior to mobilization and collection of stem cells

- Demonstrates chemosensitivity

- Allogeneic stem cell transplantation (SCT) is not possible, or is not desirable
(e.g., over 65 years of age; no compatible donor available; and estimated risk
of graft-versus-host disease complications are greater than risk of recurrence
after autologous SCT)

- Adequate bone marrow or peripheral blood stem cell dose obtained

- Total CD34+ peripheral blood stem cell dose ≥ 2 x 10^6/kg, or if unable to
collect this dose, total nucleated cell bone marrow dose ≥ 1 x 10^8/kg

- Bone marrow may be used in conjunction with blood progenitor cells NOTE: A
new classification scheme for adult non-Hodgkin's lymphoma has been adopted
by PDQ. The terminology of "indolent" or "aggressive" lymphoma will replace
the former terminology of "low", "intermediate", or "high" grade lymphoma.
However, this protocol uses the former terminology.

PATIENT CHARACTERISTICS:

- Karnofsky performance status (PS) 70-100% or PS 0-2

- Patients with amyloidosis or multiple myeloma with decreased Karnofsky PS due to
disease are eligible

- Life expectancy > 2 months

- ANC > 1,500/mm³

- Platelet count > 75,000/mm³

- Bilirubin < 3 times upper limit of normal (ULN)

- Alkaline phosphatase < 3 times ULN

- SGOT < 3 times ULN

- Creatinine clearance ≥ 50 mL/min (requirement waived in selected multiple myeloma and
amyloidosis patients due to renal compromise characteristic of the disease)

- Glomerular filtration rate by renal scan required for patients with
neuroblastoma

- HIV I and HIV II antibody negative

- DLCO or DLVA ≥ 50% of predicted (DLCO to be corrected for hemoglobin and/or alveolar
ventilation)

- Cardiac ventricular ejection fraction ≥ 50% by radionuclide ventriculogram or
echocardiogram

- No uncontrolled or severe cardiovascular disease, including any of the following:

- Myocardial infarction within the past 6 months

- Congestive heart failure

- Symptomatic angina

- Life-threatening arrhythmia

- Hypertension

- No active bacterial, viral, or fungal infection

- Patients with positive CMV IgM and/or positive hepatitis serologies
demonstrating infection, or any other active infection, will require an
Infectious Disease consult and subsequent clearance

- No active peptic ulcer disease

- No uncontrolled diabetes mellitus

- No other serious organ dysfunction unless it is caused by the underlying disease

- No serious medical or psychiatric illness

- No psychiatric condition that would prevent delivery of care (psychology clearance is
necessary)

- Not pregnant

PRIOR CONCURRENT THERAPY:

- See Disease Characteristics

- No radiotherapy within 3 weeks prior to stem cell harvest