NK Cell Transplantation for AML

Natural killer cells extracted from a [parental] donor are infused intravenously. Most
patients are given a multi-agent chemotherapeutic conditioning regimen prior to the
infusion. The conditioning regimen may be omitted for patients who have previously received
traditional stem cell transplant.

Secondary objectives of this study are:

- To explore the efficacy of NK infusion therapy

- To describe in a descriptive manner, the engraftment, phenotypes, function, and
engraftment of NK cells after infusion

Details of Treatment Plan:

Stratum 1 (AML in complete remission)

Cyclophosphamide 60 mg/kg IV Day -7 Fludarabine 25 mg/m2/day IV Days -6 through -2 Donor
pheresis Day -1 Start IL-2 on Day -1, then 3 times per week x 2 weeks NK Cell purification
and infusion on Day 0

Stratum 2 (AML that is refractory or relapsed or AML with increasing minimal residual
disease)

Clofarabine 40 mg/m2 IV, days -6 through -2 Etoposide 100 mg/m2 IV, days -6 through -2
Cyclophosphamide 400 mg/m2 IV, days -6 through 02 Donor pheresis Day -1 Start IL-2 Day -1,
and then 3 times per week x 2 weeks NK Cell purification and infusion on Day 0.

For patients who have received prior SCT, the conditioning regimen may be omitted if the NK
cells are obtained from the original SCT donor.

Cytokine regimen (stratum 1 and 2): 1 million units/m2 of IL-2 given subcutaneously three
times per week for two weeks (6 doses) starting on the evening of day -1.

NK Cell Transplantation (stratum 1 and 2): NK cells from haplo-identical family donor will
be infused on day 0.