chemotherapy and radiation therapy followed by peripheral stem cell transplantation in treating patients with non-hodgkin's lymphoma

Conditions: Lymphoma

Summary: rationale: drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. radiation therapy uses high-energy x-rays to damage cancer cells. peripheral stem cell transplantation may allow doctors to give higher doses of chemotherapy and radiation therapy and kill more cancer cells. purpose: phase i/ii trial to study the effectiveness of etoposide plus radiation therapy followed by peripheral stem cell transplantation in treating patients who have non-hodgkin's lymphoma.

objectives: i. evaluate the overall and progression-free survival of patients with selected poor-prognosis non-hodgkin's lymphomas treated with high-dose etoposide and total-body irradiation followed by rescue with peripheral blood stem cells. ii. determine the toxicity of this regimen. iii. evaluate the short-term and long-term engraftment characteristics of patients treated on this regimen. outline: patients who respond on regimen a and who have no bulk disease greater than 5 cm are treated on regimen b. regimen a: single-agent chemotherapy/stem cell mobilization with urothelial protection and growth factor therapy. cyclophosphamide, ctx, nsc-26271; with mesna, nsc-113891; and granulocyte colony stimulating factor (amgen), g-csf, nsc-614629. regimen b: sequential radiotherapy, single-agent chemotherapy, and stem cell rescue. total-body irradiation, tbi (equipment not specified); etoposide, vp-16, nsc-141540; and peripheral blood stem cells, pbsc. projected accrual: 20 patients will be studied.

Eligibility criteria:
disease characteristics: pathologically confirmed non-hodgkin's lymphomas of the following histologic subtypes: small lymphocytic follicular small cleaved cell follicular mixed cell follicular large cell (relapsed) disease in first, second, or third partial remission (25% shrinkage in cross-sectional area of measurable disease) or first, second, or subsequent relapse required transformed non-hodgkin's lymphoma eligible, i.e., low-grade lymphoma subsequently transformed to intermediate- or high-grade lymphoma no lymphosarcoma cell leukemia patient characteristics: age: 16 to 65 performance status: karnofsky 80-100% hematopoietic: wbc at least 5,000/mm3 (polys at least 2,000/mm3) platelet count at least 100,000/mm3 hepatic: bilirubin no greater than 2.0 mg/dl sgot no greater than 2 times normal renal: creatinine no greater than 1.8 mg/dl cardiovascular: lvef at least 50% pulmonary: fvc greater than 1.5 liters fev1 greater than 1.2 liters mvv greater than 50 liters dlco greater than 12 ml/min po2 greater than 70 mm hg on room air other: no other serious psychiatric, neurologic, or medical illness prior concurrent therapy: biologic therapy: not specified chemotherapy: not specified endocrine therapy: not specified radiotherapy: less than 3,500 cgy prior irradiation to the mediastinum, lungs, or spinal cord surgery: not specified

Keywords: waldenstrom macroglobulinemia recurrent small lymphocytic lymphoma recurrent grade 1 follicular lymphoma recurrent grade 2 follicular lymphoma recurrent grade 3 follicular lymphoma