Vaccine Therapy and Sargramostim Compared With Placebo and Sargramostim Following Rituximab in Treating Patients With Non-Hodgkin's Lymphoma

DISEASE CHARACTERISTICS:

• Histologically confirmed follicular B-cell non-Hodgkin's lymphoma (NHL)

  • Grade 1, 2, or 3

• Meets 1 of the following criteria for treatment with rituximab:

  • Treatment naïve
  • Relapsed or refractory disease after prior chemotherapy
  • Relapsed after a prior documented response (i.e., complete or partial response) to rituximab of at least 6 months duration
• Tumor accessible for biopsy OR existing biopsy material (taken within the past 6 months) suitable for vaccine preparation
• Measurable or evaluable disease after tumor tissue procurement for vaccine production

• No more than 2 prior treatment regimens for NHL

  • Single regimens include any of the following:

    • Maintenance rituximab
    • Rituximab administered once weekly for 8 courses
    • Cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus rituximab* NOTE: *CHOP followed by rituximab at time of relapse is considered 2 treatment regimens
• No history of CNS lymphoma or meningeal lymphomatosis

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• ECOG 0-1

Life expectancy

• Not specified

Hematopoietic

• Absolute granulocyte count ≥ 1,500/mm^3
• Platelet count ≥ 75,000/mm^3 (unless related to bone marrow involvement by lymphoma)
• Hemoglobin ≥ 10g/dL

Hepatic

• Not specified

Renal

• Not specified

Cardiovascular

• No congestive heart failure

Pulmonary

• No compromised pulmonary function

Immunologic

• HIV negative
• No prior allergic response to GM-CSF
• No active bacterial, viral, or fungal infection

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No psychiatric disorder that would preclude study participation
• No other malignancy within the past 2 years except nonmelanoma skin cancer or carcinoma in situ of the cervix
• No other serious nonmalignant disease that would preclude study participation

PRIOR CONCURRENT THERAPY:

Biologic therapy

• See Disease Characteristics
• See Chemotherapy
• At least 4 weeks since prior immunotherapy
• No prior radiolabeled anti-lymphoma antibody (e.g., iodine I 131 tositumomab or ibritumomab tiuxetan)
• No prior autologous or allogeneic stem cell transplantation
• No prior lymphoma-specific idiotype immunotherapy (e.g., Id vaccine)
• No prior investigational vaccine or immunotherapeutic containing keyhole limpet hemocyanin (KLH)

Chemotherapy

• See Disease Characteristics
• At least 4 weeks since prior chemotherapy
• More than 9 months since prior fludarabine
• More than 2 years since prior chemotherapy/rituximab combination therapy (e.g., CHOP/rituximab or cyclophosphamide, vincristine, and prednisone [CVP]/rituximab)
• No more than 6 total prior treatment courses with fludarabine

Endocrine therapy

• No concurrent steroids for allergic reaction to sargramostim (GM-CSF)

Radiotherapy

• See Biologic therapy
• At least 4 weeks since prior radiotherapy

Surgery

• Not specified

Other

• At least 4 weeks since prior experimental therapy
• No concurrent systemic immunosuppressive therapy
• No other concurrent anti-lymphoma therapy