Comparison of Two Salvage Chemotherapy Regimens Before Autologous Stem Cell Transplantation With or Without Maintenance Rituximab in Treating Patients With Relapsed or Refractory Aggressive Non-Hodgkin's Lymphoma

DISEASE CHARACTERISTICS:

• Histologically confirmed aggressive non-Hodgkin's lymphoma of 1 of the following subtypes:

  • Diffuse large cell lymphoma (includes primary mediastinal B-cell lymphoma and T-cell-rich B-cell lymphoma)

  • Prior indolent lymphoma (e.g., follicular center cell lymphoma; marginal zone lymphoma, including extranodal mucosa-associated lymphoid tissue [MALT] lymphoma; and lymphoplasmacytoid lymphoma) with transformation to diffuse large B-cell lymphoma at relapse

    • Must be histologically confirmed
    • No transformed lymphoma at diagnosis with subsequent indolent histology without transformation at relapse
  • Peripheral T-cell lymphoma
  • Anaplastic large cell lymphoma
  • Small noncleaved Burkitt-like lymphoma
• T-cell or B-cell lineage confirmed by immunohistochemistry

• Clinically or radiologically documented disease meeting either of the following criteria:

  • Measurable disease, defined as at least 1 bidimensionally measurable site of disease using clinical exam, CT scan, or MRI

    • Lymph nodes must be > 1.5 cm by physical exam or CT scan
    • Other non-nodal lesions must be ≥ 1.0 cm by physical exam, CT scan, or MRI
    • Bone lesions are not considered measurable

  • Evaluable disease, defined as only nonmeasurable disease, including any of the following:

    • Marrow infiltration
    • Cytology-confirmed ascites or effusions
    • Bony involvement
    • Enlarged liver or spleen
    • Unidimensionally measurable intrathoracic or abdominal masses
• Previously treated with 1, and only 1, chemotherapy regimen including an anthracycline and excluding cisplatin, cytarabine, and gemcitabine

• No uncontrolled CNS involvement by lymphoma

  • No CNS disease at time of relapse
  • CNS disease diagnosed at initial presentation allowed provided a complete response for CNS disease was achieved and maintained

PATIENT CHARACTERISTICS:

Age

• 16 to 65

Performance status

• ECOG 0-3

Life expectancy

• At least 12 weeks

Hematopoietic

• Absolute granulocyte count ≥ 1,000/mm^3
• Platelet count ≥ 75,000/mm^3

Hepatic

• Bilirubin ≤ 1.5 times upper limit of normal (ULN)
• AST or ALT ≤ 2.5 times ULN (5 times ULN if liver involvement with lymphoma)
• Hepatitis B status known (for patients with a history of hepatitis B or who are at high risk of hepatitis B infection)

Renal

• Creatinine ≤ 1.5 times ULN

Cardiovascular

• No significant cardiac dysfunction or cardiovascular disease

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• Willing to complete quality of life questionnaires
• HIV negative
• No active, uncontrolled bacterial, fungal, or viral infection
• No other malignancy within the past 5 years except adequately treated basal cell skin cancer or carcinoma in situ of the cervix
• No other concurrent serious illness or medical condition that would preclude study participation

PRIOR CONCURRENT THERAPY:

Biologic therapy

• See Chemotherapy
• Prior rituximab allowed

Chemotherapy

• See Disease Characteristics
• At least 4 weeks since prior IV chemotherapy
• No prior high-dose chemotherapy with stem cell transplantation

Endocrine therapy

• No concurrent corticosteroids except for physiologic replacement

Radiotherapy

• At least 4 weeks since prior radiotherapy and recovered

  • Exceptions may be made for low-dose, non-myelosuppressive radiotherapy
• No prior radiotherapy to more than 25% of functioning bone marrow
• Involved-field radiotherapy may be given to areas of bulky disease at relapse (≥ 5 cm) after stem cell transplantation, according to the center's policy

Surgery

• At least 2 weeks since prior major surgery

Other

• No other concurrent anticancer therapy
• No other concurrent experimental agents