INCLUSION CRITERIA - PATIENT:
The following diagnoses will be considered:
a) Patients with Ewing's sarcoma family of tumors, or alveolar rhabdomyosarcoma in one of the following categories:
Patients with recurrence of tumor at any site less than one year after completing standard front-line therapy or with a second or subsequent recurrence at any time after completing standard front-line therapy. Standard front line therapy for alveolar rhabdomyosarcoma should include vincristine/cyclophosphamide and actinomycin D and/or adriamycin. For patients with Ewing's sarcoma, standard front line therapy should include vincristine, cyclophosphamide, adriamycin, ifosfamide and etoposide.
Patients with recurrence of tumor at any site les than one year after completing standard front-line therapy or with a second or subsequent recurrence at any time after completing standard front-line therapy.
Patients with progression of disease while receiving standard front-line chemotherapy who cannot achieve a CR with local treatment modalities.
b) The following patients with desmoplastic small round cell tumor are eligible after receiving front line standard therapy which is defined as a regimen containing at least vincristine, cyclophosphamide, and adriamycin:
-unresectable disease
-metastatic tumor (abdominal and extra-abdominal disease)
-progressive while receiving standard therapy
-recurrence within one year of completing therapy
Patients without evaluable tumor at the time of enrollment are eligible unless progression or recurrence is identified while receiving standard front-line therapy or on first post-therapy evaluation done within four weeks of completing standard front-line therapy.
Patients who have previously received high-dose chemotherapy with autologous stem cell rescue are eligible for this trial.
Patient age of greater than 4 years at enrollment, less than 30 years at diagnosis and age less than 35 at enrollment.
Availability of a 5 or 6 antigen HLA-matched first-degree relative donor (single HLA-A or B mismatch allowed). Genotypically identical twins may serve as stem cell donors. Genotypic identity must be confirmed by RFLP analysis.
ECOG performance status of 0, 1, or 2 or, for children less than or equal to 10 years of age, Lansky greater than or equal to 60.
Life expectancy greater than 3 months.
Cardiac function: Left ventricular ejection fraction greater than 45% by MUGA or fractional shortening greater than or equal to 28%.
Pulmonary function: DLCO greater than 50% of the expected value.
Renal function: Age-adjusted normal serum creatinine according to the following or a creatinine clearance greater than 60 ml/min/1.73 m(2).
Age less than or equal to 5 years with a maximum serum creatinine (mg/dl) of 0.8.
Age greater than 5 years, less than or equal to 10 years with a maximum serum creatinine (mg/dl) of 1.0.
Age greater than 10 years, less than or equal to 15 with a maximum serum creatinine (mg/dl) of 1.2.
Age greater than 15 years with a maximum serum creatinine (mg/dl) of 1.5.
Liver function: Serum total bilirubin less than 2 mg/dl, serum AST and ALT less than or equal to 2.5 x upper limit of normal.
Marrow function: ANC must be greater than 750/mm(3) (unless due to underlying disease in which case there is no grade restriction), platelet count must be greater than or equal to 75,000/mm(3) (not achieved by transfusion) unless due to underlying disease in which case there is no grade restriction). Lymphopenia, CD4 lymphopenia, leukopenia, and anemia will not render patients ineligible.
Ability to give informed consent. For patients less than 18 years of age their legal guardian must give informed consent. Pediatric patients will be included in age-appropriate discussion in order to obtain verbal assent.
Durable power of attorney form completed (patients greater than or equal to 18 years of age only).
INCLUSION CRITERIA - DONOR:
Weight greater than or equal to 15 kilograms.
First degree relative with genotypic identity at 5 or 6 HLA loci (single HLA-A or B locus mismatch allowed). Genotypically identical twins may serve as stem cell donors. Genotypic identity must be confirmed by RFLP analysis.
For donors less than 18 years of age, he/she must be the oldest suitable donor, their legal guardian must give informed consent, donors greater than 7 and less than 18 must give verbal assent, and he/she must be cleared by social work and a mental health specialist to participate.
For donors greater than or equal to 18 years of age, ability to give informed consent.
Adequate peripheral venous access for apheresis or consent to use a temporary central venous catheter for apheresis.
Donor selection criteria will be in accordance with NIH/CC Department of Transfusion Medicine standards.
EXCLUSION CRITERIA - PATIENT:
Uncontrolled fungal infection.
History of CNS tumor involvement. Extradural masses which have not invaded the brain parenchyma (as is commonly observed in Ewing's sarcoma family of tumors) or parameningeal tumors (as is commonly observed in rhabdomyosarcoma) without evidence for leptomeningeal spread will not render the patient ineligible.
Lactating or pregnant females.
HIV positive (due to unacceptable risk following allogeneic transplantation).
Hepatitis B surface antigen (HBsAg) positive or hepatitis C antibody positive with elevated liver transaminases. All patients with chronic active hepatitis (including those on treatment) are ineligible.
High risk of inability to comply with transplant protocol, or inability to give appropriate informed consent in the estimation of the PI, social work, or the stem cell transplant team.
Fanconi Anemia.
EXCLUSION CRITERIA - DONOR:
History of medical illness which poses a risk to donation in the estimation of the PI or the Department of Transfusion Medicine physician including, but not limited to stroke, hypertension that is not controlled with medication, or heart disease. Individuals with symptomatic angina or a history of coronary bypass grafting or angioplasty will not be eligible.
History of congenital hematologic, immunologic, oncologic or metabolic disorder, which poses a prohibitive risk to the recipient in the estimation of the PI.
Anemia (Hb less than 11 gm/dl) or thrombocytopenia (less than 100,000/microliters).
Lactating or pregnant females. Donors of childbearing potential must use an effective method of contraception during the time they are receiving G-CSF. The effects of cytokine administration on a fetus are unknown and may be potentially harmful to the infant.
HIV-positive, hepatitis B surface antigen (HBsAg) positive or hepatitis C antibody positive. Donors are providing an allogeneic blood product and there is the potential risk of transmitting these viral illnesses to the recipient.
High risk of inability to comply with transplant protocol.
Warren Grant Magnuson Clinical Center (CC)