Intensity-Modulated Radiation Therapy, Etoposide, and Cyclophosphamide Followed By Donor Stem Cell Transplant in Treating Patients With Relapsed or Refractory Acute Lymphoblastic Leukemia or Acute Myeloid Leukemia

• Status: Active, not recruiting
• Trial end date: 2021-12-30
• Target enrollment: 0
• Participant gender: All

Summary

RATIONALE: Giving intensity modulated radiation therapy (IMRT) and chemotherapy, such as etoposide and cyclophosphamide, before a donor stem cell transplant helps stop the growth of cancer cells. It also helps stop the patient's immune system from rejecting the donor's stem 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 IMRT together with chemotherapy before transplant may stop this from happening.

PURPOSE: This phase I/II trial is studying the side effects and best dose of intensity-modulated radiation therapy (IMRT) when given together with etoposide and cyclophosphamide followed by donor stem cell transplant and to see how well they work in treating patients with relapsed or refractory acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML).

• Phase: Phase 1/Phase 2
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: City of Hope Medical Center
• Collaborator: National Cancer Institute (NCI)
• Treatments: Cyclophosphamide; Etoposide; Etoposide phosphate

Criteria

Inclusion Criteria:

• Patients with acute lymphocytic leukemia or acute myelogenous leukemia who are not in first or second remission (i.e., after failing remission induction therapy or in relapse or beyond second remission)

• All candidates for this study must have a human leukocyte antigen (HLA) (A, B, C, DR) identical sibling who is willing to donate bone marrow or primed blood stem cells or a 10/10 allele matched unrelated donor; a single allele mismatch at A, B, C, DR, or DQ and a KIR mismatch at C will be allowed; all ABO blood group combinations of the donor/recipient are acceptable since even major ABO compatibilities can be dealt with by various techniques

• Prior therapy with VP-16, Busulfan, and Cytoxan is allowed

• A cardiac evaluation with an electrocardiogram showing no ischemic changes or abnormal rhythm and an ejection fraction of >= 50% established by multi gated acquisition scan (MUGA) or echocardiogram

• Patients must have a serum creatinine of less than or equal to 1.2 or creatinine clearance > 80 ml/min

• A bilirubin of less than or equal to 1.5

• Serum glutamic oxaloacetic transaminase (SGOT) less than 5 times the upper limit of normal

• Serum glutamate pyruvate transaminase (SGPT) less than 5 times the upper limit of normal

• Pulmonary functioning tests including diffusing capacity of carbon monoxide (DLCO) will be performed; forced expiratory volume in one second (FEV1) and DLCO should be greater than 50% of the predicted normal value

• The time from the end last induction or reinduction attempt should be >= 14 days

• Signed informed consent form approved by the Institutional Review Board (IRB) is required

DONOR: Any sibling donors who are histocompatible with the prospective recipient will be considered a suitable donor

• Donors will be excluded if for psychological or medical reasons they are unable to tolerate the procedure

• Donor should be able to donate peripheral blood stem cells or bone marrow

Exclusion Criteria:

• Prior radiation therapy that would exclude the use of total-body irradiation

• Patients who have undergone bone marrow transplantation previously and who have relapsed

• Patients with psychological or medical condition that patients physician deems unacceptable to proceed to allogeneic bone marrow transplant

• Pregnancy

• Electrocardiogram (EKG) showing ischemic changes or abnormal rhythm and/or an echocardiogram or MUGA scan showing abnormal wall motion or ejection fraction < 50%