Donor Stem Cell Transplant in Treating Patients With High-Risk Hematologic Cancer

You may be eligible if

• Diagnosis of one of the following hematological malignancies:
• * CML, with 1 of the following:
• * In first CP AND failed imatinib mesylate therapy, defined as failure to obtain a hematologic remission at 3 months or a major cytogenetic response (i.e., Ph+ cells \< 35%) at 6 months or demonstrated clonal evolution or disease progression during therapy
• * In accelerated phase with \< 15% blasts
• * In blast crisis that has entered into a second CP following induction chemotherapy
• * AML, with 1 of the following:
• * In second or subsequent complete remission (CR) (i.e., \< 5% blasts by morphology, no residual leukemia by flow cytometry, and absence of cytogenetic abnormalities)
• * Failed primary induction chemotherapy, but subsequently entered into a CR with ≤ 2 subsequent re-induction chemotherapy treatment(s)
• * In first CR with intermediate-risk or poor-risk cytogenetics
• * ALL with 1 of the following:
• * In second or subsequent CR
• * In first CR AND presence of t(9;22)
• * MDS, with the following:
• * High-risk disease, defined by IPSS score of ≥ 1.5 at diagnosis AND meets 1 of the following criteria:
• * ≤ 10% blasts at diagnosis
• * In morphologic CR (\< 5% blasts) following cytoreductive chemotherapy
• * CMML, with 1 of the following:
• * ≤ 10% blasts at diagnosis
• * In morphologic CR (\< 5% blasts) following cytoreductive chemotherapy
• * CLL/PLL with the following:
• * Rai stage I-IV disease
• * Failed ≥ 1 prior chemotherapy regimen (including fludarabine phosphate) or ASCT
• * Documented chemosensitive or stable, non-bulky disease prior to transplant, defined as \< 20% bone marrow involvement AND lymph node size \< 3 cm in axial diameter
• * No bulky tumor masses, elevated lactate dehydrogenase (LDH), B symptoms, or progressive disease prior to transplant
• * Low-grade non-Hodgkin lymphoma (NHL) (i.e., small lymphocytic lymphoma, follicular center lymphoma \[grade 1 or 2\], marginal zone lymphoma, or B-cell lymphoma), with the following criteria:
• * Failed ≥ 1 prior chemotherapy regimen or ASCT
• * Documented chemosensitive or stable, non-bulky disease prior to transplant, defined as \< 20% bone marrow involvement AND lymph node size \< 3 cm in axial diameter
• * Received ≤ 3 prior chemotherapy regimens (monoclonal antibody therapy and involved-field radiotherapy are not considered a prior regimen)
• * No bulky tumor masses, elevated LDH, B symptoms, or progressive disease prior to transplant
• * Mantle cell lymphoma, with the following:
• * Failed to achieve remission or recurred after either conventional chemotherapy or ASCT
• * Responsive or stable disease to most recent prior therapy
• * No bulky tumor masses, elevated LDH, B symptoms, or progressive disease prior to transplant
• * Intermediate-grade NHL (i.e., follicular center lymphoma \[grade 3\] or diffuse large cell lymphoma), meeting the following criteria:
• * Failed to achieve remission or recurred after either conventional chemotherapy or ASCT
• * Documented chemosensitive, non-bulky disease prior to transplant, defined as at least a partial remission to salvage chemotherapy (≥ 50% reduction in diameter of all disease sites)
• * No bulky tumor masses, elevated LDH, B symptoms, or progressive disease prior to transplant
• * Hodgkin lymphoma, with the following:
• * Relapsed after prior ASCT OR after ≥ 2 combination chemotherapy regimens and ineligible for ASCT
• * Documented chemosensitive, non-bulky disease prior to transplant, defined as at least a partial remission to salvage chemotherapy (≥ 50% reduction in diameter of all disease sites)
• * No bulky tumor masses, elevated LDH, B symptoms, or progressive disease prior to transplant
• * Peripheral T-cell NHL, with the following:
• * Failed to achieve remission or recurred after either conventional chemotherapy or ASCT
• * Documented chemosensitive, non-bulky disease prior to transplant, defined as at least a partial remission to salvage chemotherapy (≥ 50% reduction in diameter of all disease sites)
• * No bulky tumor masses, elevated LDH, B symptoms, or progressive disease prior to transplant
• Myeloproliferative syndrome with poor risk features, meeting 1 of the following criteria:
• * \< 55 years old AND Lille score of 1
• * Lille score of 2
• * HgB \< 10 g/dL AND abnormal karyotype
• High-risk disease, with 1 of the following:
• * Age 40-72 years
• * Any age AND deemed to be at significantly increased risk of morbidity and death following a standard, myeloablative unrelated donor stem cell transplant (e.g., received extensive prior therapy, including ASCT)
• HLA-matched unrelated donor available, with 1 of the following:
• * 8/8 match at HLA-A, B, C, or DR loci by high-resolution genotyping
• * Single allelic mismatch at either the HLA-B or HLA-C loci donor by high-resolution molecular typing
• * No single allelic mismatch at HLA-A or HLA-DR loci
• KPS 80-100%
• Adapted weighted Charlson Comorbidity Index \< 3
• Serum creatinine ≤ 2.0 mg/dL
• AST or ALT \< 3 times upper limit of normal (ULN)
• Total bilirubin \< 1.5 times ULN
• LVEF ≥ 45%
• DLCO \> 50%
• No hypoxia at rest with oxygen saturation \< 92% on room air (corrected with bronchodilator therapy)
• No other severe pulmonary function abnormalities
• No HIV infection
• No active hepatitis B or C infection that, in the opinion of a gastroenterologist or the transplant committee, places the patient at moderate to high risk for developing severe hepatic disease
• No active opportunistic infection (e.g., fungal pneumonia, tuberculosis, or viral infection)