Tocilizumab for the Prevention of Graft Versus Host Disease After Cord Blood Transplantation

Inclusion Criteria

I. Acute myelogenous leukemia (AML)

• Complete first remission (CR1) at high risk for relapse such as any of the following:
• Known prior diagnosis of myelodysplasia (MDS) or myeloproliferative disorder
• Therapy-related AML
• White cell count at presentation > 100,000
• Presence of extramedullary leukemia at diagnosis
• Any unfavorable subtype by FAB or WHO classification
• High-risk cytogenetics (e.g. those associated with MDS, abnormalities of 5, 7, 8, complex karyotype) or high risk molecular abnormalities
• Requirement for 2 or more induction to achieve CR1
• Any patient with newly diagnosed AML with intermediate risk cytogenetics who elects allograft with curative intent over consolidation chemotherapy
• Any patient unable to tolerate consolidation chemotherapy as would have been deemed appropriate by the treating physician
• Other high risk features not defined above
• Complete second remission (CR2)
• Primary refractory or relapsed AML with less than 10% blasts before transplant. Persistent/relapsed AML with cytogenetic, flow cytometric, or molecular aberrations in >/= 10% of cells are eligible

II. Acute lymphoblastic leukemia (ALL)

• Complete first remission (CR1) at high risk for relapse such as any of the following:
• White cell count at presentation > 30,000 for B-cell lineage and > 100,00 for T-cell lineage
• Presence of any high-risk cytogenetic abnormalities such as t(9;22), t(1;19), t(4;11) or other MLL rearrangements (11q23) or other high-risk molecular abnormality
• Failure to achieve complete remission after four weeks of induction therapy
• Persistence or recurrence of minimal residual disease on therapy
• Any patient with newly diagnosed ALL >/= 50 years-old
• Any patient unable to tolerate consolidation and/or maintenance chemotherapy as would have been deemed appropriate by the treating physician
• Other high risk features not defined above
• Complete second remission (CR2)
• Primary refractory or relapsed ALL with less than 5% blasts before transplant. Persistent/relapsed ALL with cytogenetic, flow cytometric or molecular aberrations in >/=5% of cells are eligible.

III. Other acute leukemias: leukemias of ambiguous lineage or of other types e.g. blastic plasmacytoid dendritic cell neoplasm with less than 5% blasts. Persistent/relapsed disease with cytogenetic, flow cytometric or molecular aberrations in >/=5% of cells are eligible

IV. Myelodysplastic Syndrome (MDS)/ Myeloproliferative Disorders (MPD) other than myelofibrosis:

• International prognostic scoring system (IPSS) risk score of INT-2 or high risk at the time of diagnosis
• Any IPSS risk category if life-threatening cytopenia(s) exists
• Any IPSS risk category with karyotype or genomic changes that indicate high risk for progression to acute myelogenous leukemia
• MDS/ myeloproliferative disorder overlap syndromes without myelofibrosis
• MDS/ MPD patients must have less than 10% bone marrow myeloblasts and ANC >/= 0.2 (growth factor supported if necessary) at transplant work-up

V. Non-Hodgkin lymphoma (NHL) or Hodgkin lymphoma (HL) at high-risk of relapse or progression if not in remission:

• Eligible patients with aggressive histologies (such as, but not limited to, diffuse large B-cell NHL, mantle cell NHL, and T-cell histologies) in CR
• Eligible patients with indolent B cell NHL (such as, but not limited to, follicular, small cell or marginal zone NHL) will have 2nd or subsequent progression with stable disease/CR/PR with no single lesion equal to or more than 5 cm.
• Eligible patients with HL will be without progression of disease (POD) after salvage chemotherapy with no single lesion equal to or more than 5cm.

Organ Function and Performance Status Criteria:

• Karnofsky score >/= 70% (inpatient Leukemia service transfers without discharge are acceptable provided patient has equivalent KPS as if were outpatient)
• Calculated creatinine clearance >/= 60 ml/min
• Bilirubin /= 50% predicted
• Left ventricular eje