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

PRIMARY OBJECTIVES:

I. Estimate the progression free survival (PFS) distribution for Hodgkin lymphoma (HL),
non-Hodgkin lymphoma (NHL) and multiple myeloma (MM) for each disease-specific high dose
therapy regimen.

SECONDARY OBJECTIVES:

I. Estimate the PFS distribution for amyloidosis, acute leukemia and selected solid tumors
for each disease-specific high dose therapy regimen.

II. Explore the role of risk factors in the outcome of all treated patients. III. Examine the
high dose therapy regimen-related toxicity (RRT) and overall survival after bone marrow
transplant (BMT).

OUTLINE:

Patients are assigned to conditioning regimens based on disease, age, and co-morbidities.

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