Cyclophosphamide Plus T-Cell Transplantation for Patients With Hematologic Malignancies

DISEASE CHARACTERISTICS:

• Diagnosis of 1 of the following:

  • Myelodysplastic syndromes (MDS)

    • International Prognostic Scoring System (IPSS) score ≥ intermediate-2
  • Chronic myelomonocytic leukemia
  • Acute myeloid leukemia arising from MDS

• Must have failed or are ineligible for or intolerant to treatment with azacitidine

  • Patients with normal marrow cytogenetics or an isolated 5q- abnormality must have failed or are ineligible for or intolerant to treatment with lenalidomide
  • Patients who are HLA-DR15-positive must have failed or are ineligible for pharmacologic immunosuppression (e.g., anti-thymocyte globulin, cyclosporine, steroids)
• No presence of cytotoxic antibodies against donor lymphocytes
• No HLA-identical donor available OR ineligible for HLA-identical allogeneic bone marrow transplantation

• HLA partially mismatched (haploidentical) related donor available

  • First-degree related donor, including half-siblings or first cousins
  • Inherited recombinant haplotype from parents allowed if donor shares ≥ 1 HLA antigen at each of the HLA-A, -B, and DR loci

PATIENT CHARACTERISTICS:

• ECOG performance status (PS) 0-1 OR Karnofsky PS 80-100%
• Bilirubin < 3.0 mg/dL
• AST and ALT ≤ 4 times upper limit of normal
• Creatinine < 3.0 mg/dL
• LVEF > 35%

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• Recovered from prior therapy
• No prior transfusions from donor
• At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C) or radiotherapy
• No other concurrent investigational drugs