Cyclophosphamide, Sirolimus, and Mycophenolate Mofetil in Preventing Graft Versus Host Disease in Patients with Blood Cancer Undergoing Donor Stem Cell Transplant

Inclusion Criteria

• Karnofsky performance status: Full intensity conditioning, 80-100%; reduced intensity conditioning, 60-100%
• Left ventricular ejection fraction must be > 45% assessed by multi-gated acquisition scan (MUGA) scan or echocardiogram; no myocardial infarction within 6 months of transplant evaluation
• Forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and adjusted diffusion capacity of the lung for carbon monoxide (DLCO) must be >= 50% of predicted values
• Transaminases (aspartate aminotransferase [AST], alanine aminotransferase [ALT]) < 2 times upper limit of normal values
• Estimated creatinine clearance >= 50 cc/min
• Signed informed consent
• Acute leukemia in complete remission (CR)1 or second/subsequent CR
• Chronic myeloid leukemia, primary myelofibrosis, chronic myelomonocytic leukemia
• Intermediate (Int)-2 or high risk myelodysplastic syndrome (MDS)
• Hodgkin lymphoma beyond CR1 with chemosensitive disease, stable disease (SD) may be included if no mass > 3 cm
• Non-Hodgkin lymphoma in high risk CR1 or subsequent CR (by clinical, cytogenetic or molecular criteria), primary induction failure (PIF) or relapsed with chemosensitive disease; SD may be included if no mass > 3 cm
• Multiple myeloma in CR/very good partial response (VGPR)
• DONOR
• Per Moffitt Cancer Center (MCC) bone marrow transplant (BMT) program practices, an allele level matched (8/8 human leukocyte antigen [HLA] A, B, C and DR) sibling or unrelated donor is preferred; if a matched donor is not found, mismatched unrelated or haploidentical donors may be considered
• If a haploidentical donor is considered, parents, children, full siblings and in selected cases, extended family, will have high resolution typing at the MCC HLA laboratory; a familiar haploidentical donor is chosen among those who share at least one HLA-A, B, C, DRB1 and DQB1 haplotype with the patient
• Patient will be screened for antibodies targeting mismatched HLA antigens in potential haploidentical donors (donor specific antibodies, DSA); antibody screen and confirmatory testing using Luminex single antigen-bead test will be done
• Among several potential donors, will choose in order of priority: * Matched cytomegalovirus (CMV) IgG serologic status between donor and recipient * ABO-matched donor preferred, then minor ABO mismatch, then major ABO mismatch * Younger donor preferred: child, then sibling, and then parent * For male recipient, male donor will be preferred; avoid mother as a donor unless no other choices

Exclusion Criteria

• Active bacterial, viral, fungal infection not controlled with appropriate antimicrobial therapy
• Prior allogeneic hematopoietic cell transplantation (HCT)
• Patients unwilling to comply with study requirements
• Patients with active, progressive or advanced disease based on diagnosis