Donor White Blood Cell Infusions and Interleukin-2 in Treating Patients Who Are Undergoing an Autologous Stem Cell Transplant for Relapsed Advanced Lymphoid Cancer

OBJECTIVES:

Primary

• Determine the feasibility and toxicity of haploidentical related donor lymphocyte infusions (DLI) and interleukin-2, in terms of acute graft-versus-host-disease, graft failure, and transplant-related mortality, in patients with relapsed advanced lymphoid malignancies undergoing autologous stem cell transplantation.

Secondary

• Determine the extent, degree, and duration of donor chimerism in patients treated with this regimen.
• Determine, preliminarily, activity of haploidentical DLI, as measured by complete response rate, in these patients.

OUTLINE: This is a pilot study.

Patients receive high-dose melphalan IV over 15-60 minutes on day -2 and undergo autologous stem cell transplantation on day 0. Patients receive haploidentical related donor lymphocyte infusions (DLI) IV on days 1, 5*, and 10* and interleukin-2 (IL-2) IV continuously on days 1-12.

NOTE: *DLI are not administered on days 5 or 10 if grade 3 or 4 graft-versus-host disease is present

After completion of study treatment, patients are followed monthly for 3 months and then every 3-12 months thereafter.

PROJECTED ACCRUAL: A total of 20 patients will be accrued for this study.

DISEASE CHARACTERISTICS:

• Diagnosis of 1 of the following advanced lymphoid malignancies:

• Multiple myeloma, meeting both of the following criteria:

• Deletion of chromosome 13
• Elevated pre-transplant lactic dehydrogenase
• Chronic lymphocytic leukemia (CLL)

• Failed ≥ 2 prior conventional chemotherapy regimens, including fludarabine
• Small lymphocytic lymphoma
• Follicular non-Hodgkin's lymphoma

• Received ≥ 3 prior conventional chemotherapy regimens
• Mantle cell lymphoma

• Received ≥ 3 prior conventional chemotherapy regimens
• Predicted poor outcome and relapsed disease after undergoing autologous stem cell transplantation ≥ 6 months ago
• Measurable disease, defined as any evidence of disease by scans or blood or urine analysis
• At least 8 x 10^6 autologous CD34-positive cells/kg available for transplantation

• Stem cell mobilization allowed
• Haploidentical related donor available

• Sex-mismatched
• Identical for 1 HLA haplotype AND mismatched for ≥ 1 HLA-A, -B, -C, or DRB1 locus of the unshared haplotype
• No HLA-identical related or unrelated donor available
• Not eligible for first-line autologous stem cell transplantation on protocol FHCRC-1368.00, FHCRC-1366.00, FHCRC-1461.00, or FHCRC-1595.00
• No bulky disease, defined as total volume of all measurable tumor > 500 cc
• No CNS disease resistant to therapy

PATIENT CHARACTERISTICS:

Age

• 18 to 69

Performance status

• Karnofsky 70-100%

Life expectancy

• Not specified

Hematopoietic

• Not specified

Hepatic

• Liver function tests or liver enzymes ≤ 2 times upper limit of normal

Renal

• Not specified

Cardiovascular

• Ejection fraction ≥ 45%
• No symptomatic cardiac disease

Pulmonary

• DLCO ≥ 50%

Other

• Not pregnant or nursing
• Fertile patients must use effective contraception
• HIV Negative
• No active infection

PRIOR CONCURRENT THERAPY:

Biologic therapy

• See Disease Characteristics
• No prior allogeneic stem cell transplantation

Chemotherapy

• See Disease Characteristics

Endocrine therapy

• Not specified

Radiotherapy

• Not specified

Surgery

• Not specified

Other

• No concurrent contrast dye during and for 3 weeks after completion of interleukin-2 administration