Study of Four Different Chemotherapy Regimens With or Without Total-Body Irradiation Followed by Umbilical Cord Blood Transplant in Treating Patients With Relapsed or Refractory Hematologic Cancer

• Status: Active, not recruiting
• Trial end date: 2022-09-09
• Target enrollment: 0
• Participant gender: All

Summary

RATIONALE: Giving chemotherapy with or without total-body irradiation before a donor umbilical cord blood transplant helps stop the growth of cancer or abnormal cells. It also helps stop the patient's immune system from rejecting the donor's stem cells. When the stem cells from a donor are infused into the patient they may help the patient's bone marrow make stem cells, red blood cells, white blood cells, and platelets. Sometimes the transplanted cells from a donor can make an immune response against the body's normal cells. Giving cyclosporine and mycophenolate mofetil before and after transplant may stop this from happening.

PURPOSE: This clinical trial is studying how well four different chemotherapy regimens given with or without total-body irradiation before umbilical cord blood transplant work in treating patients with relapsed or refractory hematologic cancer.

• Phase: N/A
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: City of Hope Medical Center
• Collaborator: National Cancer Institute (NCI)
• Treatments: Busulfan; Cyclophosphamide; Cyclosporine; Cyclosporins; Fludarabine; Fludarabine phosphate; Melphalan; Mycophenolate mofetil; Mycophenolic Acid; Vidarabine

Criteria

DISEASE CHARACTERISTICS:

• Histologically confirmed hematological or lymphatic malignancy, including any of the following:

• Acute myeloid leukemia

• Relapsed or primary refractory disease with < 10% blasts on peripheral blood smear

• In first remission with poor risk factors and molecular prognosis [i.e., AML with -5, -7, t(6;9), tri8, -11] (preparative regimen 3 or 4)

• Acute lymphocytic leukemia

• In second complete remission or higher OR in first remission with poor risk factors, including any of the following (preparative regimen 1 or 2):

• BCR/ABL by fluorescence in situ hybridization (FISH) or reverse transcriptase-polymerase chain reaction

• t(9;22)(q34;q11) detected by cytogenetics

• Chromosomes < 44 by cytogenetics

• DNA index < 0.81 by flow cytometry

• Any rearrangement of chromosome 11 that results in disruption of MLL gene (11q23) by cytogenetics and SER

• In first remission with poor risk factors and molecular prognosis [ALL with Philadelphia chromosome-positive t(9;22), t(4;22), (q34;q11)] (preparative regimen 3 or 4)

• Chronic myelogenous leukemia

• In accelerated phase or greater (preparative regimen 1 or 2)

• In accelerated or second chronic phase (preparative regimen 3 or 4)

• Myelodysplastic syndromes

• With deletion of chromosome 7 or short arm of chromosome 5 (preparative regimen 1 or 2)

• In high and high-intermediate risk categories (preparative regimen 3 or 4)

• Non-Hodgkin lymphoma in relapse with marrow involvement

• Refractory chronic lymphocytic leukemia

• Patients deemed ineligible for conventional high-dose chemotherapy programs (i.e., regimens 1 or 2) due to any of the following concurrent medical conditions may be eligible for regimens 3 or 4 at the discretion of the treating physician and principal investigator (preparative regimen 3 or 4):

• LVEF < 50% and > 40%

• FEV1, FVC, or DLCO < 50%

• Bilirubin > 3 mg/dL

• Creatinine > 2 mg/dL

• Two partially HLA-matched umbilical cord blood (UCB) units available

• HLA-matched minimally at 4 of 6 HLA-A, HLA-B, and -DRB1 loci with the patient

• DRB1 matched by high resolution DNA typing

• HLA-A and HLA-B matched by low resolution at the "serological match" level

• Two pooled units with a nucleated cell number > 2.5 x 10^7/kg

• No available HLA-identical sibling or 1 antigen-mismatched related donor

• No available HLA-matched unrelated bone marrow donor

PATIENT CHARACTERISTICS:

• See Disease Characteristics

• Karnofsky performance status (PS) 60-100% OR Lansky PS 60-100% OR Zubrod PS 0-1

• Physiological age 60 or less (at any chronological age)

• Weight > 50 kg

• Creatinine normal for age OR creatinine clearance by 24-hour urine collection or glomerular filtration rate > 60 mL/min

• Bilirubin ≤ 1.5 mg/dL

• LVEF ≥ 50%

• DLCO ≥ 60% of predicted

• No HIV-1 infection

• No active uncontrolled infection

• Not pregnant

• Negative pregnancy test

• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

• Recovered from prior intensive chemotherapy