Fludarabine and Total-Body Irradiation Followed By Donor Stem Cell Transplant and Cyclosporine and Mycophenolate Mofetil in Treating HIV-Positive Patients With or Without Cancer

• Death from regimen toxicity or opportunistic infection [ Time Frame: Within the first 100 days ] [ Designated as safety issue: Yes ]
  
• Death from GVHD [ Time Frame: Within the first 360 days ] [ Designated as safety issue: Yes ]
  
• Successful induction of mixed hematopoietic chimerism as assessed by the percentage of peripheral blood T cells that are of donor origin [ Time Frame: Up to day 80 ] [ Designated as safety issue: No ]
  Determined by a DNA-based assay that compares the profile of amplified fragment length polymorphisms (ampFLP) of the patient and donor.
  
  

• Overall survival [ Time Frame: Up to 1 year ] [ Designated as safety issue: No ]
  Examined and presented descriptively.
  
  
• Progression of HIV [ Time Frame: Within 1 year ] [ Designated as safety issue: No ]
  Examined and presented descriptively.
  
  
• Reconstitution of HIV-specific immunity [ Time Frame: Up to 1 year ] [ Designated as safety issue: No ]
  Examined and presented descriptively.
  
  

PRIMARY OBJECTIVES:

I. To determine the safety of treating high-risk HIV1-infected patients with 200 centigray (cGy) TBI plus post-transplant MMF/CSP.

II. To determine whether 200 cGy TBI plus post-transplant MMF/CSP results in stable mixed donor lymphocyte chimerism (5-95% donor cluster of differentiation [CD]3) in high-risk human immunodeficiency virus (HIV)-1 infected patients.

SECONDARY OBJECTIVES:

I. To define the kinetics of immune reconstitution following a non-lethal conditioning regimen in HIV1-infected patients.

II. To determine the effect of a non-lethal conditioning regimen on viral load.

OUTLINE:

CONDITIONING REGIMEN: Patients receive fludarabine intravenously (IV) over 2 hours on days -4, -3, and -2. Patients undergo TBI on day 0.

TRANSPLANTATION: After completion of TBI, patients undergo allogeneic bone marrow or peripheral blood stem cell transplantation on day 0.

IMMUNOSUPPRESSION: Patients receive cyclosporine IV or orally (PO) 2 to 3 times daily on days -3 to 99 with taper beginning on day 100 and continuing until day 177 in the absence of graft-vs-host disease (GVHD). Beginning within 6 hours after transplantation, patients also receive mycophenolate mofetil IV or PO 3 times daily on days 0 to 40 followed by a taper in the absence of GVHD.

After completion of study treatment, patients are followed up for at least 1 year.