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TCR Alpha/Beta-Depleted Progenitor Cells with CD45RA-Depleted Donor Lymphocyte Infusion and Selected Use of Blinatumomab in Children and Young Adults with Blood Cancers at High Risk for Relapse

Trial Status: active

This phase I trial tests the effects of T-cell receptor (TCR) alpha/beta-depleted blood making (progenitor) cells and CD45RA-depleted donor white blood cells (lymphocytes) in children and young adults with a blood cancer that is in remission but is at high risk of relapse. Giving chemotherapy, such as cyclophosphamide, fludarabine, thiotepa, and melphalan, before a donor (peripheral blood progenitor cell) transplant helps kill cancer cells in the body and helps make room in the patient's bone marrow for new blood-forming cells (progenitor cells) to grow. Colony-stimulating factors, such as granulocyte colony-stimulation factor (G-CSF), may increase the production of white blood cells so that the immune system is better able to fight infection. When the healthy stem cells from a related donor, such as TCR alpha/beta-depleted progenitor cells, are infused into a patient they may help the patient's bone marrow make more healthy cells and platelets and may help destroy any remaining cancer cells. Giving an infusion of a donor's white blood cells (donor lymphocyte infusion [DLI]), such as CD4RA-depleted DLI, may help the patient's immune system see the remaining cancer cells and destroy them. Antithymocyte globulin (ATG), a gamma globulin, is given to a patient before a transplantation to kill T cells and lower the risk of graft-versus-host disease (GVHD). Giving TCR alpha/beta-depleted progenitor cells with CD4RA-depleted DLI may be safe and tolerable in treating children and young adults with a blood cancer that is in remission but at a high risk of relapse. This trial also evaluates the addition of blinatumomab in patients that have a CD-19 positive cancer. Blinatumomab binds to CD19, which is found on most B cells (a type of white blood cell) and some types of leukemia cells. It also binds to a protein called CD3, which is found on T cells (another type of white blood cell). This may help the immune system kill cancer cells. Blinatumomab is a type of bispecific T-cell engager. Adding blinatumomab to TCR alpha/beta-depleted progenitor cells with CD4RA-depleted DLI may be safe, tolerable and may improve response in children and young adult patients with a CD19 positive blood cancer.