Combination Chemotherapy Plus Radiation Therapy Followed by Peripheral Stem Cell Transplantation in Treating Patients With Non-Hodgkin's Lymphoma
Lymphoma
About this trial
This is an interventional treatment trial for Lymphoma focused on measuring recurrent grade 1 follicular lymphoma, recurrent grade 2 follicular lymphoma, recurrent grade 3 follicular lymphoma, recurrent adult diffuse small cleaved cell lymphoma, recurrent adult diffuse mixed cell lymphoma, recurrent adult diffuse large cell lymphoma, recurrent adult immunoblastic large cell lymphoma, recurrent marginal zone lymphoma, recurrent small lymphocytic lymphoma, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, nodal marginal zone B-cell lymphoma, splenic marginal zone lymphoma
Eligibility Criteria
DISEASE CHARACTERISTICS: One of the following diagnoses: Histologically proven recurrent non-Hodgkin's lymphoma Previously in complete remission (CR) Refractory or recurrent intermediate-grade lymphoma (IGL) or high-grade immunoblastic lymphoma (IBL) meeting 1 of the following conditions: In partial remission (PR) or CR to and currently enrolled on the MSKCC standard dose salvage regimen with ifosfamide, carboplatin, and etoposide (ICE) In PR or CR after 1-2 other salvage chemotherapy regimens (e.g., 3 courses of dexamethasone, high-dose cytarabine, and cisplatin (DHAP); 2 courses of cyclophosphamide, mechlorethamine, vincristine, procarbazine, and prednisone (C-MOPP)) No prior ifosfamide Low-grade lymphoma In second or greater remission or chemosensitive relapse No HLA identical sibling donor available IGL or IBL In first CR Poor prognosis, defined by age-adjusted international index of 3 or 4 based on lactic dehydrogenase, number of extranodal sites, stage, and performance status Adequate bone marrow cellularity No lymphoblastic or small noncleaved cell lymphoma Ineligible for total body irradiation (TBI) phase of study if prior radiotherapy dose precludes the use of TBI NOTE: A new classification scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of "indolent" or "aggressive" lymphoma will replace the former terminology of "low", "intermediate", or "high" grade lymphoma.However, this protocol uses the former terminology. PATIENT CHARACTERISTICS: Age: Physiologic 18 to 65 Performance status: Not specified Hematopoietic: Not specified Hepatic: Bilirubin no greater than 2.0 mg/dL (if no history of Gilbert's disease) No chronic active or persistent hepatitis Hepatitis B positivity allowed provided that the following conditions are met: Bilirubin same as above* SGPT no greater than 500 IU/L* Alkaline phosphatase no greater than 2 times normal* NOTE: * In the absence of liver involvement by lymphoma Renal: Creatinine no greater than 1.5 mg/dL OR Creatinine clearance at least 60 mL/min No history of chronic renal insufficiency Cardiovascular: LVEF at least 50% by echocardiogram or MUGA scan No myocardial infarction within the past 6 months No unstable angina No arrhythmia other than chronic atrial fibrillation Pulmonary: DLCO at least 50% predicted (corrected for hemoglobin and alveolar ventilation) Other: HIV negative No uncontrolled infection No other malignancy within the past 5 years except curatively treated basal cell skin cancer or carcinoma in situ of the cervix Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception PRIOR CONCURRENT THERAPY: Biologic therapy Not specified Chemotherapy See Disease Characteristics Endocrine therapy Not specified Radiotherapy See Disease Characteristics Surgery Not specified
Sites / Locations
- Memorial Sloan-Kettering Cancer Center