Combination Chemotherapy and Rituximab in Treating Patients With Newly Diagnosed AIDS-Related B-Cell Non-Hodgkin's Lymphoma

DISEASE CHARACTERISTICS:

• Histologically or cytologically confirmed AIDS-related B-cell non-Hodgkin's lymphoma (NHL), including any of the following subtypes:

  • Grade III follicular large cell lymphoma
  • Diffuse large B-cell lymphoma
  • Immunoblastic lymphoma
  • Plasmablastic lymphoma
  • Primary effusion lymphoma
• Previously untreated disease
• Any stage disease
• CD20 positive disease

• Must have documented HIV infection

  • Documentation may be by serology (enzyme-linked immunosorbent assay, western blot), culture, or quantitative polymerase chain reaction or branched DNA assays
  • Prior documentation of HIV seropositivity allowed
• Measurable or nonmeasurable disease
• Currently receiving effective highly active anti-retroviral therapy
• No primary CNS lymphoma, including parenchymal brain or spinal cord lymphoma
• No presence of leptomeningeal disease (positive cerebrospinal fluid for lymphoma) or presence of metastatic disease to brain, in terms of any mass lesion

PATIENT CHARACTERISTICS:

• ECOG performance status (PS) 0-2 OR Karnofsky PS 50-100%
• Life expectancy ≥ 2 months
• Absolute granulocyte (neutrophil) count ≥ 1,000/mm³ (unless secondary to lymphomatous involvement of bone marrow)
• Platelet count ≥ 75,000/mm³ (unless secondary to lymphomatous involvement of bone marrow or due to HIV-related thrombocytopenia)
• Bilirubin ≤ 2.0 mg/dL (unless elevated secondary to lymphomatous involvement of liver or biliary system or due to other HIV medications [e.g., indinavir, tenofavir, or atazanavir])
• SGOT ≤ 5 times upper limit of normal
• Creatinine ≤ 2.0 mg/dL OR creatinine clearance ≥ 60 mL/min (unless secondary to renal involvement by lymphoma)
• LVEF normal by MUGA or echocardiogram
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 6 months after completion of study treatment
• No other malignancy, except nonmelanoma skin cancer, carcinoma in situ of the cervix, or Kaposi's sarcoma that does not require systemic therapy
• No serious, ongoing, nonmalignant disease or infection that would preclude study compliance, in the opinion of the investigator
• No history of cutaneous or mucocutaneous reactions, or diseases in the past, due to any cause, severe enough to cause hospitalization or an inability to eat or drink for ≥ 2 days

• No acute, intercurrent infection that would preclude study treatment

  • Patients with Mycobacterium avium are eligible

• No cardiovascular problems, including any of the following:

  • Myocardial infarction within the past 6 months
  • New York Heart Association class II-IV heart failure
  • Uncontrolled angina
  • Severe uncontrolled ventricular arrhythmias
  • Clinically significant pericardial disease
  • ECG evidence of acute ischemic or active conduction system abnormalities.
• No shortness of breath at rest
• Arterial PO_2 ≥ 70 or pulse oximeter-derived O_2 saturation ≥ 94% on room air (unless due to lymphomatous involvement of the lungs)
• Able to comply with study and provide adequate informed consent

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• At least 4 weeks since prior major surgery (except diagnostic surgery)
• At least 12 months since prior rituximab unless it was only given for indications other than the treatment of aggressive lymphoma

• No prior cytotoxic chemotherapy or radiotherapy for this lymphoma

  • Concurrent radiotherapy, with or without steroids, for emergency conditions secondary to lymphoma (i.e., CNS tumor or cord compression) allowed
• No zidovudine or zidovudine-containing regimen (including Combivir® or Trizivir®) during and for 2 months after completion of chemotherapy

• Concurrent erythropoietin or filgrastim (G-CSF) allowed

  • Growth factor therapy must be discontinued ≥ 24 hours prior to study entry