combination chemotherapy in treating patients with non-hodgkin's lymphoma or acute lymphocytic leukemia

Conditions: Leukemia; Lymphoma

Summary: rationale: drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. combining more than one drug may kill more cancer cells. purpose: phase ii trial to study the effectiveness of combination chemotherapy in treating patients who have non-hodgkin's lymphoma or acute lymphocytic leukemia.

objectives: * determine if increasing the methotrexate dose in combination with standard treatment is feasible in patients with advanced small noncleaved cell non-hodgkin's lymphoma or b-cell acute lymphocytic leukemia. * assess the toxicity of this intensified therapy in these patients. * assess the feasibility of treating these patients that have cns disease at diagnosis with this intensified therapy plus etoposide and ifosfamide. * assess toxicities and late effects of this intensive therapy on the central nervous system, cardiac function, and fertility in these patients. outline: this is a multicenter study. patients are stratified according to stage and disease (stage iii non-hodgkin's lymphoma (nhl) vs stage iv nhl with no cns involvement vs stage iv nhl with cns involvement vs b-cell acute lymphocytic leukemia (b-all) with no cns involvement vs b-all with cns involvement). patients receive methotrexate and cytarabine intrathecally on days 1, 4, 11, and 36 (on day 40 for patients with stage iv nhl or b-all only) in combination with alternating courses of: a) cyclophosphamide iv every 12 hours for a total of six doses on days 1-3, doxorubicin iv over 30 minutes on day 4, vincristine iv on days 4 and 11, dexamethasone iv or orally twice daily on days 1-5, and filgrastim (g-csf) subcutaneously (sq) or iv over 30 minutes beginning on day 5 and continuing until blood counts recover and b) methotrexate iv over 24 hours on day 18, methotrexate intrathecally on day 18, dexamethasone iv or orally twice daily on days 18-22, leucovorin calcium iv or orally every 6 hours for a total of 6 doses on days 20-21, cytarabine iv over 48 hours on days 20-21, and g-csf sq or iv over 30 minutes beginning on day 22 and continuing until blood counts recover. patients with stage iii nhl receive at total of 5 courses of treatment (a-b-a-b-a) and patients with stage iv nhl or b-all with no cns involvement receive a total of 6 courses of treatment (a-b-a-b-a-b). patients with cns involvement receive a third course of treatment: c) etoposide iv over 1 hour on days 36-40, ifosfamide iv over 1 hour on days 36-40, oral dexamethasone twice daily on days 36-40, and g-csf sq or iv over 30 minutes beginning on day 41 and continuing until blood counts recover. patients with cns involvement receive a total of 7 courses of treatment (a-b-c-a-b-a-b). patients are followed every 6 months for 4 years and then annually thereafter. projected accrual: a total of 27-80 patients will be accrued for this study over 24 months.

Eligibility criteria:
disease characteristics: * one of the following diagnoses: * histologically confirmed small noncleaved cell non-hodgkin's lymphoma * stage iii or iv * burkitt's or non-burkitt's by the working formulation or * burkitt's or burkitt's-like by the real classification * histologically confirmed b-cell acute lymphocytic leukemia * at least 25% blasts in bone marrow * fab l3 morphology * fab l1 morphology allowed if blasts show b-cell markers (cd19, 20, 22) and surface immunoglobulin positivity * must be registered on pog-9900 in past 8 days patient characteristics: age: * under 22 at time of diagnosis performance status: * not specified life expectancy: * not specified hematopoietic: * not specified hepatic: * not specified renal: * not specified other: * not pregnant or nursing * negative pregnancy test * hiv positive allowed prior concurrent therapy: biologic therapy: * not specified chemotherapy: * not specified endocrine therapy: * no concurrent use of dexamethasone as antiemetic radiotherapy: * not specified surgery: * prior surgery allowed other: * no prior therapy except surgery

Keywords: childhood burkitt lymphoma l3 childhood acute lymphoblastic leukemia b-cell childhood acute lymphoblastic leukemia l3 adult acute lymphoblastic leukemia b-cell adult acute lymphoblastic leukemia stage iii adult burkitt lymphoma stage iv adult burkitt lymphoma stage iii childhood small noncleaved cell lymphoma stage iv childhood small noncleaved cell lymphoma