Peripheral Stem Cell Transplantation in Treating Patients With Metastatic or Recurrent Kidney Cancer

DISEASE CHARACTERISTICS:

• Histologically confirmed renal cell carcinoma (RCC)

  • Histology demonstrates major clear cell component
  • Metastatic (stage IV) or recurrent disease

• Prior debulking nephrectomy required

  • Disease not amenable to complete surgical resection

• Must have HLA-identical donor

  • Matched related sibling donors must have 6/6 serologic HLA A, B, and DR match with molecular confirmation at DRB1

    • A 5/6 serologic mismatch with one antigen mismatch at locus A or B (not DR) with molecular confirmation at locus A, B, and DRB1 allowed
  • Matched unrelated donors must have a minimum of 8 out of 10 molecular matches at loci A, B, C, DRB1, and DQB1

• No brain metastases

  • Negative MRI required

PATIENT CHARACTERISTICS:

Age:

• 18 to 65

Performance status:

• Karnofsky 80-100% OR
• ECOG 0-1

Life expectancy:

• Not specified

Hematopoietic:

• Not specified

Hepatic:

• Bilirubin less than 2 times upper limit of normal (ULN)
• ALT/AST less than 2 times ULN
• Alkaline phosphatase less than 2 times ULN
• Hepatitis A, B, and C negative

Renal:

• Creatinine clearance greater than 50 mL/min
• Calcium less than 10.5 mg/dL (bisphosphonates allowed)

Cardiovascular:

• LVEF no less than 10% below lower limit of normal

Pulmonary:

• FEV_1 and DLCO greater than 50%

Other:

• HIV negative
• No active bacterial, fungal, or viral (including cytomegalovirus) infections
• No intolerance or allergy to tacrolimus, mycophenolate mofetil, or fludarabine
• No intolerance to 200 cGy of total body irradiation
• No other serious comorbid disease, neurologic condition, or psychosocial condition that would preclude study follow-up
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception for at least 1 month before, during, and for at least 3 months after study participation

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• Prior interleukin-2 allowed
• Prior interferon alfa allowed

Chemotherapy:

• Prior chemotherapy allowed
• No other concurrent chemotherapy for RCC

Endocrine therapy:

• No concurrent corticosteroids for other comorbid disease

Radiotherapy:

• No prior extensive radiotherapy to marrow microenvironment greater than 20% of total marrow mass
• No prior radiotherapy that has reached tissue tolerance for heart, lung, liver, kidney, or spinal cord

Surgery:

• See Disease Characteristics

Other:

• No other concurrent therapy for RCC
• No concurrent enrollment on another investigational protocol for treatment of RCC
• No other concurrent immunosuppressive medications
• No other concurrent investigational drugs