High-Dose Chemotherapy With or Without Total-Body Irradiation Followed by Autologous Stem Cell Transplant in Treating Patients With Hematologic Cancer or Solid Tumors

Inclusion Criteria:

• Histologically confirmed diagnosis of malignant hematologic disorders, amyloidosis or solid tumor malignancy
• Recurrent or refractory disease or disease at high risk for recurrence
• Hodgkin Disease (HL): Relapsed or refractory disease after chemotherapy with a minimum of one standard regimen
• Non-Hodgkin Lymphoma (NHL): (Low, Intermediate or High Grade) Relapsed or refractory disease after chemotherapy with at least one standard regimen or first complete remission (CR) lymphoblastic or small, non-cleaved cell lymphoma at high risk of relapse by high International Prognostic Index (IPI) Score
• Acute Myeloid Leukemia (AML): Low or High Risk disease in first or second CR or greater in patients in whom the risks of an allogeneic transplant outweigh the benefits
• Acute Lymphoblastic Leukemia (ALL): Low or high risk disease in first or second CR in whom the risks of an allogeneic transplant outweigh the benefits
• Multiple Myeloma (MM): Low or high risk in first or greater response (stable disease or better) or for responding patients at first progression
• Other Malignant Lymphoproliferative Disorders: (chronic lymphocytic lymphoma [CLL], Waldenstroms macroglobulinemia, relapsed or refractory disease after first-line chemotherapy
• Amyloidosis: primary or previously treated
• Solid Tumors: Testicular cancer patients who have relapsed disease or primary progressive disease which is responding to salvage therapy; relapsed or advanced-stage newly diagnosed neuroblastoma (NBL) or small round blue cell tumors (SRBCT) in patients 30 years of age; other patients with solid tumors who have recurred following conventional treatment or are at high risk for relapse, and demonstrate chemosensitivity
• Patients with malignancies who would be treated with an autologous stem cell transplant but have a syngeneic donor; a syngeneic donor would be considered to have the same risk as an autologous stem cell transplant patient
• Performance status 0-2 (Karnofsky performance status [KPS] >= 70%); patients with amyloidosis or MM with decreased KPS due to disease are eligible
• Life expectancy > 2 months
• Pulmonary function tests; diffusing capacity of the lung for carbon monoxide (DLCO) or diffusing volume of the alveolar volume (DLVA) >= 50% predicted; DLCO to be corrected for hemoglobin and/or alveolar ventilation
• Cardiac ventricular ejection fraction >= 50% by radionuclide ventriculogram or echocardiogram
• Bilirubin \< 3 x normal
• Alkaline phosphatase, serum glutamic oxaloacetic transaminase (SGOT) \< 3 x normal
• Calculated creatinine clearance \< 40 cc/min by the modified Cockcroft-Gault formula for adults or the Schwartz formula for pediatrics
• Glomerular filtration rate by renal scan for neuroblastoma patients, to determine dosing parameters
• Positive cytomegalovirus (CMV) immunoglobulin M (IgM) and/or positive hepatitis serologies demonstrating infection will require an Infectious Disease consult and subsequent clearance
• Any active infection will require an Infectious Disease consult and subsequent clearance
• Peripheral Blood Counts of polymorphonuclear neutrophil (PMN) > 1500/uL
• Platelet (Plt) > 75,000/uL

• Prior to stem cell storage:

  • No radiation within three weeks before stem cell harvest
  • Bone marrow may be used in conjunction with blood progenitor cells
• Hematologic Malignancy patients with human immunodeficiency virus (HIV) positivity but on appropriate anti-retroviral therapy may go autotransplant with the following laboratory tests; (CD4+ cell count > 75 cells per microliter and HIV copy number \< 100,000 per microliter and with Infectious Disease clearance
• Acute Leukemia, HL, NHL, MM and Solid Tumor patients must have received 2 cycles of chemotherapy followed by disease-specific restaging prior to mobilization and collection of stem cells; small round blue cell tumor patients must have received either standard therapy or surgical intervention; the disease status and response to therapy must be known prior to transplant to establish the disease status at transplant; amyloidosis patients may proceed to BMT without receiving chemotherapy

• No serious organ dysfunction unless it is caused by the underlying disease, exclusion criteria include the following:

  • Uncontrolled or severe cardiovascular disease, including recent (\< 6 months) myocardial infarction, congestive heart failure, symptomatic angina, life-threatening arrhythmia or hypertension
  • Active bacterial, viral, or fungal infection
  • Active peptic ulcer disease
  • Uncontrolled diabetes mellitus
• No serious medical or psychiatric illness
• Not pregnant
• No psychiatric conditions which would prevent delivery of care; psychology clearance is necessary

• Allogeneic BMT not possible, or not desirable

  • Age > 65 years
  • No compatible donor identified
  • Estimated risk of graft vs. host disease complications greater than risk of recurrence after autologous BMT

• Adequate bone marrow or blood stem cell dose obtained:

  • For blood stem cells: total CD 34+ >= 2 x 10\^6/kg or if unable to collect this dose, a total nucleated cell bone marrow dose of >= l x 10\^8/kg