A Phase II Trial of Reduced Intensity Conditioning and Partially HLA-mismatched (HLA-haploidentical) Bone Marrow Transplantation for High-risk Solid Tumors
- Patients must have an HLA-mismatched, related donor (3/6 to 5/6 i.e., 3 to 6 antigen
match). Patients who have inherited a recombinant HLA haplotype may receive marrow
from parent in whose gamete the recombination occurred.
- Sarcoma patients: Males and Females < 40 years of age. All other diagnosis: Males and
Females < 21 years of age
-Patients must have a confirmed histopathologic diagnosis and be classified as high risk
defined by having an expected survival of < 10%. -
- Neuroblastoma or ganglioneuroblastoma (Failure to achieve at least a PR after
induction therapy with COG ANBL0532 or standard chemotherapy; Refractory to
induction chemotherapy or standard chemotherapy; Patients with high risk disease as
defined in Appendix 1 whose autologous peripheral blood stem cell product is
contaminated with neuroblastoma or who do not have an autologous product available;
Patients with high risk disease who do not meet eligibility requirements/organ
function requirements for myeloablative conditioning; Patients with >5 identified
lesions on the end of induction MIBG scan
- Stage 4 rhabdomyosarcoma
- Metastatic Ewing Sarcoma
- Osteosarcoma with metastatic disease beyond the lungs and/or with lung metastases not
amenable to resection
- Hepatoblastoma not amenable to resection
- Metastatic Melanoma
- Desmoplastic small round cell tumor
- Brain tumors such as astrocytic tumors, oligodendroglial tumors, ependymal tumors,
choroid plexus tumors, other neuroepithelial tumors, neuronal and mixed
neuronal-glial tumors, tumors of the pineal region, embryonic tumors
- Any other solid tumor and soft tissue sarcoma with an estimated <10% chance of
survival will be considered on a case by case basis at the departmental tumor board
and/or sarcoma meeting
- Previous therapy:
- It is expected that patients will have received upfront standard of care therapy for
their respected disease
- Patients who relapse after either single or tandem autologous BMT are eligible (>
6 months must have elapsed from start of last BMT).
- Patients must be recovered from the acute toxicities of any prior
chemo/radio/immunotherapy or BMT
- Patients do not need to have measurable disease at time of enrollment. Patients with
measurable disease must have stable disease by RECIST criteria on two scans at least
4 weeks apart.
- Patients with adequate organ function as measured by:
- Cardiac: Left ventricular ejection fraction at rest must be ≥ 35%, or shortening
fraction > 25%.
- Hepatic: Bilirubin ≤ 3.0 mg/dL; and ALT, AST, and Alkaline Phosphatase < 5 x ULN.
- Renal: Serum creatinine within normal range for age, or if serum creatinine outside
normal range for age, then renal function (creatinine clearance or GFR) > 40
- Pulmonary: FEV1, FVC, DLCO (diffusion capacity) > 50% predicted (corrected for
hemoglobin); if unable to perform pulmonary function tests, then O2 saturation > 92%
on room air.
- Good performance status (Karnofsky/Lansky 70-100)
- Patients (Parents/guardians for those <18) and donors must be able to sign consent
- Patients must be willing to participate in all stages of treatment
Criteria for donor eligibility:
- Age >0.5 years
- Donors must meet the selection criteria as defined by the Foundation for the
Accreditation of Hematopoietic Cell Therapy (FACT).
- Lack of recipient anti-donor HLA antibody Note: In some instances, low level,
non-cytotoxic HLA specific antibodies may be permissible if they are found to be at a
level well below that detectable by flow cytometry. This will be decided on a
case-by-case basis by the PI and one of the immunogenetics directors.
- In the event that two or more eligible donors are identified, the following order of
priority will be used to determine the preferred donor:
1. Medically and psychologically fit and willing to donate
2. Killer Immunoglobulin Receptor (KIR) Haplotype B Donor
3. Red blood-cell compatibility (in order of preference)
1. RBC cross-match compatible
2. Minor ABO incompatibility
3. Major ABO incompatibility
- For CMV seronegative recipients, a CMV seronegative donor. For CMV seropositive
recipients, a CMV seropositive donor is preferred.
- If more than one preferred donor is identified from the above list and there is no
medical reason to prefer one of them, then the following guidelines are recommended:
1. If the patient is male, choose a male donor
2. Choose the youngest preferred donor
3. If the patient and family express a strong preference for a particular donor,
use that one
- Patients will not be excluded on the basis of sex, racial or ethnic background.
- Donor (donor anti-recipient) ABO incompatibility if an ABO compatible donor is
- Positive leukocytotoxic crossmatch
- Women of childbearing potential who currently are pregnant or who are not practicing
- Uncontrolled viral, bacterial, or fungal infections.