Biological Therapy in Treating Patients With Advanced Myelodysplastic Syndrome, Acute or Chronic Myeloid Leukemia, or Acute Lymphoblastic Leukemia Who Are Undergoing Stem Cell Transplantation

PRIMARY OBJECTIVES: I. To determine the safety and potential toxicities associated with
infusing donor CD8+ CTL clones specific for WT1 in patients who have relapsed or at a high
risk of relapse post transplant for MDS, CML, AML, or ALL. SECONDARY OBJECTIVES: I. To
determine the in vivo persistence of transferred T cells and assess migration to the bone
marrow, a predominant site of leukemic relapse. II. To determine if adoptively transferred
WT1-specific T cells mediate antileukemic activity. OUTLINE: Donors undergo leukapheresis
for stem cell harvest to generate CD8-positive Wilms' tumor (WT1) gene-specific cytotoxic
T-lymphocyte (CTL) clones at the time of allogeneic stem cell transplantation. After
post-transplantation hematopoietic recovery, patients receive treatment for either
highest-risk disease (prophylactically) or relapsed disease. Highest-risk disease group:
Patients receive CD8-positive Wilms' tumor (WT1) gene-specific CTL clones IV over 1-2 hours
on days 0, 14, and 28. Beginning 2-4 hours after CTL infusion, patients receive
interleukin-2 subcutaneously twice daily on days 28-42 in the absence of unacceptable
toxicity. Relapsed-disease group: Some patients with evidence of leukemic relapse may
receive standard salvage chemotherapy prior to donor CTL infusions and then receive
CD8-positive Wilms' tumor (WT1) gene-specific CTL clones and interleukin-2 as in the
highest-risk group. Patients in both groups who have progressive disease after complete
or partial response to therapy may be eligible for retreatment with CD8-positive Wilms'
tumor (WT1) gene-specific CTL clones. After completion of study treatment, patients are
followed every 3 months for 2 years.