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Pentostatin to be administered intravenously on days - 10, -9, and -8 at a dose of 4mg/m2/day

4 mg/m\^2 intravenous(IV)once a day(QD)x3days (days -10, -9, -8)

TBI will consist of 2.0 GY at 8-12cGy/min via 6MV photons delivered AP/PA fields, without lung blocks or via lateral fields with lucite compensator along the head and neck region. TLD (thermal luminescent dosimetry) will be used to verify dose uniformity. TBI will be given on day -1.

Total-body irradiation (TBI)

CsA will be given at 2.0 mg/kg intravenous (IV) Q 12hrs on days -1,0,and+1 (total 6 doses) then converted to oral at 2 mg/kg by mouth (PO) twice a day (BID) until day+80, then tapered 10% per week over approximately 3 months if no GVHD for related donor transplants. For unrelated CsA will be given at same dose and schedule until day+100 then tapered by 10% per week if no GVHD

Cyclosporine A (CsA)

MMF 15 mg/kg by mouth twice a day (PO BID) will be given from day 0-27 then stopped without tapering for related donor transplants. For unrelated donor transplants MMF will be given at same dose until day+40 then tapered over 2months. in absence of GVHD. Doses will be rounded to nearest 250 mg.

Mycophenolate Mofetil (MMF)

10 mcg/kg/day subcutaneously for at least 4 consecutive days.

G-CSF

Gregory Bociek, MD

This is a continuation of a pilot study which is now regarded as a phase II trial with a plan to enroll an additional 40 patients (20 related and 20 unrelated donor transplants) with hematological malignancy assessing the safety and efficacy of a minimally myelosuppressive regimen with pentostatin and low-dose total body irradiation (TBI) followed by allogeneic peripheral blood stem cell transplantation (alloPSCT).

This is a pilot study which began with a plan to enroll 50 patients (20 related and 30 unrelated donor transplants) with hematological malignancy assessing the safety and efficacy of a minimally myelosuppressive regimen with Pentostatin and low-dose total body irradiation (TBI) followed by allogeneic peripheral blood stem cell transplantation (alloPSCT). Patients with persistent or progressive malignancy after transplantation will be treated with GM-CSF (cytokine therapy) to assess its toxicity and potential therapeutic efficacy. Patients with persistent or progressive disease who fail or do not qualify for the cytokine therapy portion of the study will become candidates for donor leukocyte infusions.

The purpose of this protocol remains a pilot study which is now regarded as a phase II trial with a plan to enroll 40 ADDITIONAL patients (20 related and 20 unrelated donor transplants) with hematological malignancy assessing the safety and efficacy of a modified version of the original preparative regimen of Pentostatin and low-dose total body irradiation (TBI) followed by allogeneic peripheral blood stem cell transplantation (alloPSCT). Patients who fail will become candidates for donor-leukocyte infusion (DLI).

Primary Objectives

1. To determine the safety of treating hematological malignancies by establishing donor hematopoietic chimerism using pentostatin and low-dose total body irradiation followed by allogeneic peripheral blood stem cell transplantation.
2. To determine the immunomodulatory effects of pentostatin as part of the conditioning regimen for allogeneic peripheral blood stem cell transplantation.

Secondary Objectives

1. To determine the incidence of infections after using a minimally myelosuppressive conditioning regimen.
2. To determine the kinetics of hematological and immunological reconstitution after allotransplantation with a minimally myelosuppressive conditioning regimen.
3. To determine the incidence of chronic GVHD after using allogeneic peripheral blood stem cell transplantation with a minimally myelosuppressive preparative regimen.
4. To evaluate the role of the preparative regimen and donor source (related versus unrelated) on inflammatory cytokine profiles.
5. To evaluate blood and where possible, biopsy specimens for a recently identified nuclear protein (molecular weight 44/46) in mononuclear cells obtained from study subjects.

Interventions, evaluation, and follow up will include:

Pentostatin 4 mg/m\^2/d intravenously once a day x 3 days will be administered with 1000 cc NS hydration before and after pentostatin ten days prior to stem cell infusion (days -10, -9, and -8). Total-body irradiation (TBI): TBI 2.0 Gy will be given on day -1. Antiemetics will be given as needed. Patients will receive one liter normal saline over 2 hours pre TBI. A bone marrow biopsy and aspiration with cytogenetics and flow cytometry will be performed on Day +28, Day +70 and 6, 12, 18 and 24 months following the transplant to monitor hematologic recovery. DNA fingerprinting will also be conducted at the same time at 3, 4, 5, 6, 12, 18, and 24 months to determine chimerism.

Safety and Efficacy of Pentostatin and Low Dose TBI With Allogenic Peripheral Blood Stem Cell Transplant

Allogeneic Peripheral Blood Stem Cell Transplantation With Minimally Myelosuppressive Regimen of Pentostatin and Low-dose Total-body Irradiation

the efficacy of the regimen as determined by engraftment rate and establishment of donor hematopoietic chimerism at day +28 and day +70.

Incidence of acute and chronic graft-versus-host disease. Acute GVHD usually occurs during the first three months following transplant. Chronic GVHD usually develops after the third month post-transplant.

event-free and overall survival at 12 months

Rate of return of immune cells after allogeneic transplantation

Astex Pharmaceuticals, Inc.

University of Nebraska

Pentostatin to be administered intravenously on days -10, -9, and -8 at a dose of 4mg/m2/day

Cohort I

Age, Categorical

Age, Continuous

Sex: Female, Male

United States

Region of Enrollment

R Gregory Bociek

Day 28

Day 70

Percent of Participants With Chimerism: Full Donor Chimerism Defined as >95% Donor CD3+ Cell in Blood as Assessed by DNA Fingerprinting

Absolute neutrophil count < 500/mm^3

platelet count < 20,000/mm^3

Grade 3 or 4 Fever

Grade 3 or 4 hypokalemia

Grade 3 or 4 bacteremia

Grade 3 or 4 infection

Grade 3 or 4 renal toxicity

Grade 3 or 4 thromboembolism

Toxicity for the Combination of Pentostatin and Low Dose Total Body Irradiation (TBI)

Acute GVHD

Chronic GVHD

Incidence of Acute and Chronic Graft-versus-host Disease

Event free survival

Overall survival

Responses to Therapy

CD3 cells

CD4 cells

CD8 cells

T-cell count (CD3, CD4 and CD8 cells) prior to transplant

Study Baseline

T-cell count (CD3, CD4 and CD8 cells) on Day + 28 post transplant. Measure of donor chimerism (donor CD3+ Cell in blood as assessed by DNA fingerprinting)

Day + 28 Post Transplant

Kinetics of Immunologic Reconstitution

Overall Study

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Safety and Efficacy of Pentostatin and Low Dose TBI With Allogenic Peripheral Blood Stem Cell Transplant	NCT00571662	Acute Myelogeno... Acute Lymphocyt... Chronic Myeloge... Chronic Lymphoc... Myelodysplastic... Multiple Myelom... Non-Hodgkins Ly... Hodgkins Diseas... Peripheral T-ce...	Pentostatin Total-body irra... Cyclosporine A ... Mycophenolate M... G-CSF	19 Years - 75 Years	University of Nebraska
Safety and Efficacy of Pentostatin and Low Dose TBI With Allogenic Peripheral Blood Stem Cell Transplant	NCT00571662	Acute Myelogeno... Acute Lymphocyt... Chronic Myeloge... Chronic Lymphoc... Myelodysplastic... Multiple Myelom... Non-Hodgkins Ly... Hodgkins Diseas... Peripheral T-ce...	Pentostatin Total-body irra... Cyclosporine A ... Mycophenolate M... G-CSF	19 Years - 75 Years	University of Nebraska

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