• Disease response [ Designated as safety issue: No ]
  
• Safety as measured by transplant related mortality on day 200 after allografting [ Designated as safety issue: Yes ]
  
• Donor engraftment on day 56 after allografting [ Designated as safety issue: No ]
  

OBJECTIVES:

• Determine if mixed or full donor hematopoietic chimerism can be safely achieved with nonmyeloablative conditioning therapy in patients with metastatic renal cell carcinoma.
• Determine if mixed chimerism can be safely converted to full donor hematopoietic chimerism with donor lymphocyte infusions in this patient population.
• Determine the efficacy of this treatment regimen in this patient population.

OUTLINE: This is a multicenter study.

Patients receive fludarabine IV on days -4 to -2 and undergo total body irradiation followed by filgrastim (G-CSF)-mobilized HLA-matched allogeneic peripheral blood stem cell transplantation on day 0.

Patients receive immunosuppressive therapy comprising oral cyclosporine twice daily beginning on day -3 and continuing until day 35 followed by a taper until day 56. Patients also receive oral mycophenolate mofetil three times daily on days 0-40.

Patients with stable mixed chimerism on day 56 and no evidence of graft-vs-host disease may receive escalating doses of nonmobilized T-cell donor lymphocyte infusion (DLI) over 30 minutes. Patients may receive up to 4 DLIs if there is evidence of disease progression.

Patients are followed weekly for 3 months, monthly for 3 months, every 6 months for 2 years, and then annually for 3 years.

PROJECTED ACCRUAL: A total of 25 patients will be accrued for this study within 3 years.