Sequential Myeloablative Stem Cell Transplantation and Reduced Intensity Allogeneic Stem Cell Transplantation in Patients With Refractory or Recurrent Non-Hodgkin's Lymphoma and Hodgkin's Disease
- Patient must have adequate organ function as below
Adequate renal function defined as:
Serum creatinine 2.0 x normal, or Creatinine clearance or radioisotope GFR > 40 ml/min/m2
or >60 ml/min/1.73 m2 or an equivalent GFR as determined by the institutional normal range
Adequate liver function defined as:
Total bilirubin <2.0 x normal; or SGOT (AST) or SGPT (ALT) <5.0 x normal
Adequate cardiac function defined as:
Shortening fraction of >27% by echocardiogram, or Ejection fraction of >47% by
radionuclide angiogram or echocardiogram
Adequate pulmonary function defined as:
DLCO >50% by pulmonary function test for autologous transplant DLCO > 40% by pulmonary
fuction test for reduced intensity allogeneic transplant For children who are
uncooperative, no evidence of dyspnea at rest, no exercise intolerance, and a pulse
oximetry >94% in room air.
Disease Status (Eligibility)
- Patients with Non-Hodgkin's Lymphoma with either of the following: Primary induction
failure* (failure to achieve initial CR) who have a partial response (PR) or stable
disease (SD) with reinduction chemotherapy. *All patients are required to have a biopsy
regardless of PET/Gallium results.
Patients with 1st PR, 2nd CR, 2nd PR, or 2nd SD following reinduction chemotherapy
Patients with 3rd CR, 3rd PR, 3rd SD following reinduction chemotherapy - Patients with
Hodgkin's Disease with either of the following: Primary induction failure (failure to
achieve initial CR) and/or primary refractory disease.
First relapse Early relapse (within 12 months off therapy) (excluding those who received
no therapy or radiation therapy only for intial therapy) Late relapse (greater than 12
months off therapy). Only patients with recurrent Stage III or IV disease and/or those
with B symptoms at relapse (all other late relapses are excluded).
Second relapse. Third relapse.
- Patients must achieve a CR, PR or SD after reinduction chemotherapy.
- Patients with NHL or HD with 4th or greater CR, PR, and/or SD
- Patients with progressive disease (PD) unresponsive to reinduction chemo, radio, or
- Hodgkin's Disease in late relapse (other than those discussed above).
- Patients with post-transplant lymphoproliferative disease following a solid organ
transplantation or AIDS associated NHL .
- Patients who don't have an eligible donor
- Women who are pregnant