Sargramostim in Increasing Infiltration of Immune Cells in Younger Patients with Incompletely Resected or Recurrent Ependymoma

Inclusion Criteria

• Age > 12 months and < 21 years at the time of study enrollment
• Patients must be one of the following: * Newly diagnosed with posterior fossa ependymoma with a subtotal resection at initial surgery; these patients will be eligible for stratum 1 * Be in first relapse of their posterior fossa ependymoma; these patients will be eligible for stratum 2
• Histologically confirmed diagnosis of intracranial ependymoma
• Pre or post-operative magnetic resonance (MR) imaging of the brain demonstrates no evidence of non-contiguous spread beyond the primary site
• Pre or post-operative MR imaging of the spine demonstrates no evidence of non-contiguous spread beyond the primary site
• Pre-operative cerebrospinal fluid (CSF) cytology obtained from the lumbar CSF space demonstrated no evidence of non-contiguous spread beyond the primary site * The requirement for lumbar CSF examination may be waived if deemed to be medically contraindicated
• Eastern Cooperative Oncology Group (ECOG) performance status scores of 0, 1, or 2
• Karnofsky score of >= 50 for patients > 16 years of age or Lansky score of >= 50 for patients =< 16 years of age
• Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 ml/min/1.73 m^2 or a serum creatinine based on age/gender as follows: * Age 1 month to < 6 months: 0.4 mg/dL for males and females * Age 6 months to < 1 year: 0.5 mg/dL for males and females * Age 1 year to < 2 years: 0.6 mg/dL for males and females * Age 2 years to < 6 years: 0.8 mg/dL for males and females * Age 6 years to < 10 years: 1 mg/dL for males and females * Age 10 years to < 13 years: 1.2 mg/dL for males and females * Age 13 years to < 16 years: 1.5 mg/dL for males and 1.4 mg/dL for females * Age >= 16 years: 1.7 mg/dL for males and 1.4 mg/dL for females
• Total bilirubin =< 1.5 x upper limit of normal (ULN) for age
• Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) or serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 3 x upper limit of normal (ULN) for age
• Patients with Gilbert syndrome or hemolytic anemia are eligible if total bilirubin is =< 3 x upper limit of normal (ULN) for age
• Peripheral absolute neutrophil count (ANC) >= 1,000/uL
• Platelet count >= 100,000/uL (transfusion independent)

Exclusion Criteria

• Patients with a diagnosis of spinal cord ependymoma, myxopapillary ependymoma, subependymoma, supratentorial ependymoma, ependymoblastoma, supratentorial ependymoma, or mixed glioma are NOT eligible
• Patients with evidence of metastatic disease by magnetic resonance imaging (MRI) or CSF cytology are NOT eligible