Filgrastim-Treated Donor Peripheral Stem Cell Transplantation in Treating Patients With Acute Leukemia</p>

OBJECTIVES:

• Determine whether filgrastim (G-CSF)-mobilized allogeneic peripheral blood stem cell transplantation reduces the incidence of non-leukemic mortality in patients with acute leukemia.
• Determine the kinetics and durability of engraftment after treatment with this regimen in these patients.
• Determine the incidence and severity of acute and chronic graft-versus-host disease in patients treated with this regimen.
• Determine the leukemia-free survival of patients treated with this regimen.

OUTLINE: Donors receive filgrastim (G-CSF) subcutaneously (SC) on days -5 to -1. Donors then undergo leukapheresis on days -1 and 0.

Patients undergo total body irradiation twice daily on days -7 to -4. Patients receive 2 doses of intrathecal methotrexate per local guidelines between days -10 and -3. Patients also receive cyclophosphamide IV on days -3 and -2. Patients receive infusion of allogeneic peripheral blood stem cells on day 0.

PROJECTED ACCRUAL: A total of 5-60 patients will be accrued for this study within 3 years.

DISEASE CHARACTERISTICS:

• One of the following diagnoses:

• Primary acute leukemia beyond first remission
• High-risk acute myelogenous leukemia
• Acute lymphoblastic leukemia in first remission
• Must have HLA-matched donor identical for HLA-A, -B, and DRB1 alleles

• No HLA-matched identical sibling or haploidentical relative incompatible for 0 or 1 HLA-A, -B, or -DRB1 loci on the non-shared haplotype
• No leukoencephalopathy

PATIENT CHARACTERISTICS:

Age:

• 55 and under

Performance status:

• Not specified

Life expectancy:

• Not specified

Hematopoietic:

• Not specified

Hepatic:

• SGOT no greater than 2 times normal
• Hepatitis B surface antigen negative
• No prior hepatitis C

Renal:

• No impaired renal function
• Creatinine less than 2 times normal

Cardiovascular:

• No symptomatic cardiac disease

Pulmonary:

• No active pulmonary disease
• DLCO at least 60% predicted

Other:

• HIV negative
• No disease or other malignancy that severely limits life expectancy
• No severe or life-threatening infection within the past 2 weeks
• No history of septate fungal infection or disseminated candidiasis

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• No prior bone marrow or peripheral blood stem cell transplantation

Chemotherapy:

• Not specified

Endocrine therapy:

• Not specified

Radiotherapy:

• No prior radiotherapy greater than 3,000 cGy to whole brain
• No prior radiotherapy of 1,500 cGy to chest or abdomen
• At least 6 months since prior involved-field radiotherapy to chest or abdomen

Surgery:

• Not specified