Bevacizumab and Combination Chemotherapy in Treating Patients With Peripheral T-Cell Lymphoma or Natural Killer Cell Neoplasms

DISEASE CHARACTERISTICS:

• Diagnosis of peripheral T-cell or natural killer cell neoplasm

  • Any stage disease allowed
  • HTLV-positive tumors allowed

• At least 1 objective measurable disease parameter

  • Abnormal positron emission tomography scans are not considered evidence of measurable disease unless results are confirmed by CT scan or other appropriate imaging techniques

• No anaplastic lymphoma kinase (ALK)-positive T-cell large cell lymphoma

  • ALK-negative T-cell large cell lymphoma allowed
• No cutaneous T-cell lymphoma
• No history of or current radiographic evidence of CNS metastasis, including previously treated, resected, or asymptomatic brain lesions or leptomeningeal involvement

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• ECOG 0-2

Life expectancy

• Not specified

Hematopoietic

• Absolute neutrophil count ≥ 1,000/mm^3(500/mm^3 if due to bone marrow involvement with lymphoma)
• Platelet count ≥ 100,000/mm^3(50,000/mm^3 if due to bone marrow involvement with lymphoma)
• No evidence of bleeding diathesis or coagulopathy

Hepatic

• Bilirubin ≤ 2.0 mg/dL (≤ 3 times upper limit of normal [ULN] if due to hepatic involvement with lymphoma)
• AST ≤ 2 times ULN (5 times ULN if due to hepatic involvement with lymphoma)
• PT, INR, and PTT ≤ 1.5 times normal

Renal

• Creatinine ≤ 2.0 mg/dL
• Urinary protein:creatinine ratio ≤ 1

Cardiovascular

• No cerebrovascular accident within the past 6 months
• No myocardial infarction within the past 6 months
• No unstable angina within the past 6 months
• No New York Heart Association class II-IV congestive heart failure
• No uncontrolled hypertension (i.e., systolic blood pressure [BP] > 150 mm Hg or diastolic BP > 100 mm Hg)
• No other clinically significant cardiovascular or peripheral vascular disease
• History of deep venous thrombosis allowed provided patient is on a stable dose of anticoagulants for at least 2 weeks prior to study entry
• LVEF ≥ 50%

Pulmonary

• History of pulmonary embolism allowed provided patient is on a stable dose of anticoagulants for at least 2 weeks prior to study entry

Gastrointestinal

• No abdominal fistula within the past 6 months
• No gastrointestinal perforation within the past 6 months
• No intra-abdominal abscess within the past 6 months

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• No history of active seizures
• No significant traumatic injury within the past 4 weeks
• No non-healing ulcer (unless involved with lymphoma)
• No bone fracture
• No active infection requiring parenteral antibiotics
• No known HIV positivity
• No other active malignancy within the past 6 months except carcinoma in situ of the cervix or basal cell carcinoma of the skin

PRIOR CONCURRENT THERAPY:

Biologic therapy

• Not specified

Chemotherapy

• One prior cycle of CHOP for PTCL allowed

Endocrine therapy

• Not specified

Surgery

• More than 4 weeks since prior major invasive surgery or open biopsy

• At least 7 days since prior minor surgery

  • Peripheral lymph node core biopsy, bone marrow biopsy, fine needle aspiration, skin biopsy, or central line placement are not considered minor surgical procedures
• No concurrent major surgery

Other

• More than 7 days since prior and no concurrent anti-platelet drugs (e.g., ticlopidine, clopidogrel, or cilostazol) except aspirin or other nonsteroidal anti-inflammatory drugs

• Concurrent anticoagulants allowed provided patient is on a stable dose

  • INR must be stable for at least 2 weeks prior to study entry
  • PT/INR and/or PTT must be closely monitored and levels kept within acceptable range for underlying thrombotic disease
  • Concurrent heparin flush for maintenance of central line patency allowed