Cellular Adoptive Immunotherapy in Treating Patients With Acute Myeloid Leukemia, Acute Lymphoblastic Leukemia, or Myelodysplastic Syndromes That Relapsed After Donor Stem Cell Transplant

DISEASE CHARACTERISTICS:

• Undergoing allogeneic hematopoietic stem cell transplantation* from a major histocompatability complex (MHC)-identical related donor for 1 of the following:

  • Primary refractory acute myelogenous leukemia (AML) or acute lymphoblastic leukemia (ALL)
  • AML or ALL beyond first remission
  • Therapy-related AML at any stage
  • Philadelphia chromosome (bcr-abl)-positive p190-positive ALL at any stage

  • Acute leukemia at any stage arising from myelodysplastic syndromes or myeloproliferative disorders, including any of the following:

    • Chronic myelomonocytic leukemia
    • Chronic myelogenous leukemia
    • Polycythemia vera
    • Essential thrombocytosis
    • Agnogenic myeloid metaplasia with myelofibrosis
  • Refractory anemia with excess blasts
  • Refractory anemia with excess blasts in transformation NOTE: *Patients must be enrolled on study prior to undergoing transplantation

• Relapsed disease post-transplantation, as evidenced by 1 of the following criteria:

  • Morphologic relapse, as defined by 1 or more of the following:

    • Peripheral blasts in the absence of growth factor therapy
    • Bone marrow blasts > 5% of nucleated cells
    • Extramedullary chloroma or granulocytic sarcoma
  • Flow cytometric relapse, as defined by the appearance of cells with abnormal immunophenotype consistent with leukemia relapse in the peripheral blood or bone marrow (detected before transplantation)
  • Cytogenetic relapse, as defined by the appearance in 1 or more metaphases from bone marrow or peripheral blood cells of either a non-constitutional cytogenetic abnormality detected in at least 1 cytogenetic study performed before transplantation OR a new abnormality known to be associated with leukemia

  • Molecular relapse, as defined by 1 of the following:

    • 1 or more positive polymerase chain reaction (PCR) assays for clonotypic immunoglobulin heavy chain or T-cell receptor gene rearrangement in patients transplanted for B- or T-cell ALL respectively
    • 1 or more positive post-transplantation reverse transcription PCR assays for p190 BCR-ABL mRNA fusion transcripts in patients transplanted for Philadelphia chromosome-positive p190-positive ALL
• No grade III or IV acute graft-versus-host disease (GVHD)**
• No extensive chronic GVHD** NOTE: **At time of post-transplant relapse

PATIENT CHARACTERISTICS:

Age

• 14 and over (patients < 14 years of age may be eligible if they are deemed to be of sufficient height and weight by the pediatric attending physician)

Performance status

• Karnofsky 60-100% (at time of post-transplant relapse)

Life expectancy

• Not specified

Hematopoietic

• Not specified

Hepatic

• Not specified

Renal

• Not specified

Other

• No preexisting major nonhematopoietic organ toxicity ≥ grade 3 (at time of post-transplant relapse)

PRIOR CONCURRENT THERAPY:

Biologic therapy

• Not specified

Chemotherapy

• Not specified

Endocrine therapy

• Concurrent immunosuppressive steroid therapy for GVHD allowed provided both of the following are true:

  • Able to taper steroid dose to < 0.5 mg/kg/day
  • No increase of > 1 grade in acute GVHD OR progression of chronic GVHD within 14 days after dose change

Radiotherapy

• Not specified

Surgery

• Not specified