RATIONALE: Monoclonal antibodies, such as alemtuzumab, can find cancer cells and either kill them or deliver cancer-killing substances to them without harming normal cells. Giving chemotherapy drugs, such as busulfan and cyclophosphamide, before a donor stem cell transplant helps stop the growth of cancer cells. When the healthy 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 tacrolimus and methotrexate after the transplant may stop this from happening. PURPOSE: This phase I/II trial is studying the best dose of alemtuzumab when given together with busulfan and cyclophosphamide followed by a donor stem cell transplant and to see how well it works in treating patients with hematologic cancer.
OBJECTIVES: Primary * Identify the lowest dose of alemtuzumab that is associated with day 180 transplant-related mortality ≤ 45%. Secondary * Determine the incidence of life-threatening infection in patients receiving this treatment. * Determine the incidence of grades III-IV acute graft-vs-host disease (GVHD) in patients receiving this treatment. * Determine the survival at 1 year in patients receiving this treatment. * Determine the incidence of disease relapse at 1 year in patients receiving this treatment. * Determine the incidence of extensive chronic GVHD at 1 year in patients receiving this treatment. * Determine the incidence of graft failure at day 100 in patients receiving this treatment. OUTLINE: * Chemotherapy: Patients receive alemtuzumab IV over 2 hours on days -10 to -6, busulfan IV over 3 hours on days -7 to -4, and cyclophosphamide IV on days -3 and -2. * Peripheral blood stem cell (PBSC) transplantation: Patients undergo allogeneic filgrastim (G-CSF)-mobilized PBSC transplantation on day 0. * Graft-vs-host disease prophylaxis: Patients receive tacrolimus IV continuously or orally twice daily on days -1 to 50 and methotrexate IV on days 1, 3, 6, and 11. After completion of study therapy, patients are followed periodically.
Study Type
INTERVENTIONAL
Purpose
TREATMENT
Enrollment
1
Fred Hutchinson Cancer Research Center
Seattle, Washington, United States
Seattle Cancer Care Alliance
Seattle, Washington, United States
Lowest Dose of Alemtuzumab Associated With Transplant-related Mortality
Lowest dose of alemtuzumab associated with transplant-related mortality at day 180
Time frame: Up to day 180
Life-threatening Infection
Time frame: Up to 180 days
Grades III-IV Acute Graft-vs-host Disease (GVHD)
Time frame: Up to 100 days
Overall Survival
Count of surviving participants at 1 year
Time frame: Up to 1 year
Disease Relapse
Count of participants with disease relapse at 1 year
Time frame: Up to 1 year
Extensive Chronic GVHD
Count of participants with extensive chronic GVHD at 1 year
Time frame: Up to 1 year
Graft Failure
Count of participants with graft failure at day 100
Time frame: Up to day 100
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