Lymphoma Clinical Trial
Official title:
T-cell Depletion In Unrelated Donor Marrow Transplantation
RATIONALE: Bone marrow transplantation may be able to replace immune cells that were
destroyed by chemotherapy or radiation therapy used to kill cancer cells.
PURPOSE: Randomized phase II/III trial to determine the effectiveness of bone marrow
transplantation in treating patients who have leukemia.
OBJECTIVES: I. Compare unrelated donor bone marrow transplantation using T-cell-depleted
marrow versus unmodified marrow in adults and children with leukemia. II. Evaluate 2-year
leukemia-free survival, primary and secondary graft failure, graft-versus-host disease,
infection, and relapse in these patients. III. Assess the quality of life associated with
T-cell-depleted versus unmodified, unrelated donor transplantation.
OUTLINE: This is a randomized, multicenter study. Patients are stratified by center. Patients
receive myeloablative therapy according to diagnosis: those with acute lymphocytic leukemia
and lymphoblastic lymphoma are treated with total body irradiation (TBI), with a testicular
and chest wall boost as appropriate, followed by cyclophosphamide (CTX); patients with
undifferentiated or biphenotypic leukemia or with acute or chronic myelocytic leukemia are
treated with CTX followed by TBI. Patients are then randomly assigned to receive
non-T-cell-depleted, unrelated marrow versus T-cell-depleted, unrelated marrow. The modified
marrow is depleted of T-lymphocytes by counterflow elutriation and positively selected for
CD34 cells. Graft-versus-host disease (GVHD) prophylaxis with cyclosporine and methotrexate
is given to the unmodified marrow group. Patients who receive modified marrow are given
antithymocyte globulin (or methylprednisolone) for graft rejection prophylaxis before
transplantation and cyclosporine and methylprednisolone for GVHD prophylaxis after
transplantation.
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