Study of Infusion of Blood Cells (Lymphocytes) to Stimulate the Immune System to Fight Leukemia/Lymphoma

There have been important advances in the modulation of the immune system for the treatment
of hematologic malignancies and solid tumors.

This protocol will build upon these previous observations as follows:

- Haploidentical peripheral blood pheresed cells will be used at 1-2x108 CD3 cells/kg.

- Total body radiation will not be utilized.

- This modification may more effectively activate the recipient's immune system to
attack their hematological malignancy by not damaging the recipient's immune cells
prior to cellular infusion. Safety should be improved since the risk of graft
versus host disease should be greatly reduced as the host's immune system will not
be conditioned.

- Granulocyte-colony stimulating factor (G-CSF) priming will not be used.

- In our first clinical trial, G-CSF priming was not used for matched transplants.
Our second trial did employ G-CSF priming in the haplo-identical setting. Previous
data has cited a role for G-CSF in stimulation of invariant Natural Killer(NK)
cells with enhanced GVL effects11. However, our most recent laboratory data with
unprimed PBMC has shown effective cell kill activity without the addition of
G-CSF. As G-CSF would be administered to healthy volunteers, the unclear benefit
of the addition of this cytokine is offset by the potential side effects such as
headache, fever, and bone pain. G-CSF mobilization serves to shift the response
from a TH1 to TH2 through the increased production of T regulatory cells. The end
result would be a decrease in immune stimulation. Since the goal of this study is
to NOT have engraftment, the manipulation of the donor cells to dampen the host
versus tumor stimulation is not needed nor desired. Furthermore, since this
protocol is not a stem cell transplant, stem cells do not need to be mobilized
with G-CSF.

It is important to note that the proposed study is not a stem cell transplant study. In the
situation of stem cell transplants, the goal of the procedure is to have engraftment, or
sustainable donor chimerism in the marrow to provide hematopoietic reconstitution as well as
immunologic reconstitution. In this study, we are evaluating the use of donor lymphocytes
(not stem cells) to stimulate an immune response of the recipients' immune system.

Inclusion Criteria:

- Histologic confirmation of hematological malignancy consisting of the following
leukemias/lymphomas:

- Mantle cell lymphoma with Ki-67>30%

- Diffuse Large Cell Lymphoma

- Burkitts Lymphoma

- Systemic T Cell Lymphomas

- Acute Myeloid Leukemia

- Acute Lymphoblastic Leukemia

- Recurrence or progression of hematological malignancy after at least 1 prior standard
treatment with progression within 6 months from last treatment.

- No curative treatment option is available.

-> 4-weeks since prior chemotherapy or radiation to cellular therapy infusion.
(Hydroxyurea may be utilized up to 48 hours prior to initiation of treatment on this
protocol).

- Age equal to or greater than 18 years.

- Patients with a history of invasive second malignancy unless disease free for > 5
years.

- Patients must have an expected life expectancy of at least 2 months at the time of
initiation of treatment.

- No active systemic infection.

- Patients who have relapsed after standard autologous stem cell infusion are eligible
as long as they meet all inclusion criteria and no exclusion criteria. These patients
must be out more than 6 months from cell infusion to be eligible for enrollment.

- DLCO > 40% with no symptomatic pulmonary disease.

- LVEF > 40% by MUGA or echocardiogram.

- Creatinine < 2.0 mg/dl. Total bilirubin less than 1.5x the upper limit of normal
(ULN), AST < 3x ULN.

- Non-pregnant and willing to use appropriate birth control during the duration of the
study period.

Exclusion Criteria:

- Evidence of HIV infection.

- Any uncontrolled severe, concurrent illness which in the opinion of the treating
physician would make this protocol treatment unreasonably hazardous for the patient.

- Oxygen dependent obstructive pulmonary disease.

- Failure to demonstrate adequate compliance with medical therapy and follow-up.

- Significant medical or psychiatric illness that would impair the ability to
participate in protocol therapy.

- For women of reproductive potential, refusal to use effective form of contraception.

- Previous allogeneic stem cell transplant

- Patients who have had previous purine analog (fludarabine, pentostatin, 2-CDA)
-Patients with chronic myeloid leukemia (CML), chronic lymphocytic leukemia (CLL),
multiple myeloma, and indolent lymphoma (follicular lymphoma, marginal zone lymphoma)

- Patients with HLA antibodies to donor HLA type.