Neuroblastoma, Sarcoma, Unspecified Childhood Solid Tumor, Protocol Specific
Conditions
Keywords
unspecified childhood solid tumor, protocol specific, recurrent neuroblastoma, recurrent Ewing sarcoma/peripheral primitive neuroectodermal tumor, recurrent childhood rhabdomyosarcoma
Brief summary
RATIONALE: A peripheral stem cell, bone marrow, or umbilical cord blood transplant may be able to replace blood-forming cells that were destroyed by chemotherapy and radiation therapy. Sometimes the transplanted cells from a donor can make an immune response against the body's normal cells. Giving busulfan and melphalan with or without antithymocyte globulin before transplant and cyclosporine with methylprednisolone or methotrexate after transplant may stop this from happening. PURPOSE: This phase I trial is studying the side effects of donor stem cell transplant in treating young patients with relapsed or refractory solid tumors.
Detailed description
OBJECTIVES: * Determine the toxicity of allogeneic hematopoietic stem cell transplantation, in terms of the incidence of grade 3-4 acute graft-versus-host disease, in young patients with relapsed or refractory solid tumors. * Determine the incidence of transplant-related mortality at 100 days post-transplantation in these patients. OUTLINE: * Conditioning: Patients receive busulfan IV or orally 4 times daily on days -8 to -5 (a total of 16 doses) and melphalan IV over 15-20 minutes on days -4 to -2. Patients with an unrelated donor also receive anti-thymocyte globulin IV on days -4 to -2. * Allogeneic hematopoietic stem cell transplantation (SCT): Patients undergo allogeneic hematopoietic SCT on day 0. * Post-transplant graft-versus-host disease (GVHD) prophylaxis: Patients who undergo cord blood SCT receive cyclosporine and methylprednisolone for graft-versus-host disease (GVHD) prophylaxis. Patients who undergo peripheral blood or bone marrow SCT receive cyclosporine and methotrexate (short course) for GVHD prophylaxis. After completion of study treatment, patients are followed at 1, 3, 6, and 12 months and then annually thereafter. PROJECTED ACCRUAL: A total of 10 patients will be accrued for this study within 4 years.
Interventions
BIOLOGICALanti-thymocyte globulin
DRUGbusulfan
DRUGcyclosporine
DRUGmelphalan
DRUGmethotrexate
DRUGmethylprednisolone
PROCEDUREallogeneic bone marrow transplantation
PROCEDUREperipheral blood stem cell transplantation
PROCEDUREumbilical cord blood transplantation
Sponsors
Milton S. Hershey Medical Center
Study design
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
No minimum to 30 Years
Healthy volunteers
No
Inclusion criteria
DISEASE CHARACTERISTICS: * Diagnosis of relapsed or refractory solid tumor, including, but not limited to, relapsed neuroblastoma, relapsed Ewing's sarcoma, and relapsed rhabdomyosarcoma * No isolated local disease recurrence at the site of the primary tumor \> 1 year after completion of prior therapy * No brain tumor or brain metastases * Related or unrelated hematopoietic stem cell donor available, meeting 1 of the following criteria: * Matched for HLA-A, -B, -C, -DR, and -DQ (9/10 or 10/10 allelles) (marrow or peripheral blood) * Matched for HLA-A, -B, and -DR (5/6 or 6/6 allelles) (cord blood) * Cord blood specimen must contain ≥ 2 x 10 \^7 nucleated cells/kg body weight PATIENT CHARACTERISTICS: Age * 30 and under Performance status * ECOG 0-1 OR * Lansky 80-100% Life expectancy * Not specified Hematopoietic * Not specified Hepatic * Bilirubin ≤ 3.0 mg/dL Renal * Creatinine clearance ≥ 50 mL/min Cardiovascular * Ejection fraction ≥ 50% Pulmonary * DLCO ≥ 70% OR * O\_2 saturation ≥ 95% on room air Other * Not pregnant * Negative pregnancy test * Fertile patients must use effective contraception * HIV negative PRIOR CONCURRENT THERAPY: Biologic therapy * Prior autologous stem cell transplantation allowed Chemotherapy * Not specified Endocrine therapy * Not specified Radiotherapy * Not specified Surgery * Not specified
Countries
United States
Outcome results
None listed