S0313 Cyclophosphamide, Doxorubicin, Vincristine, Prednisone, and Radiation Therapy Followed By Rituximab and Yttrium Y 90 Ibritumomab Tiuxetan in Treating Patients With Stage I or Stage II Non-Hodgkin's Lymphoma
Condition: Lymphoma
MeSH terms: Lymphoma; Lymphoma, Non-Hodgkin
Intervention: rituximab; Cyclophosphamide; doxorubicin hydrochloride; prednisone; vincristine sulfate; radiation therapy; Yttrium-90 ibritumomab tiuxetan; Indium-111 ibritumomab tiuxetan
Intervention description: 250 mg/m^2, as part of Zevalin regimen; 750 mg/m^2; 50 mg/m^2; 100 mg; 1.4 mg/m^2; 4000-5000 cGy total; 0.4 mCi/kg; 5 mCi
Intervention MeSH terms: Prednisone; Cyclophosphamide; Rituximab; Doxorubicin; Liposomal doxorubicin; Vincristine; Antibodies, Monoclonal
Phase: Phase 2
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 46.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No
Keywords: stage I mantle cell lymphoma; stage I adult diffuse large cell lymphoma; stage I adult Burkitt lymphoma; anaplastic large cell lymphoma; contiguous stage II adult diffuse large cell lymphoma; contiguous stage II adult Burkitt lymphoma; contiguous stage II mantle cell lymphoma; noncontiguous stage II adult diffuse large cell lymphoma; noncontiguous stage II adult Burkitt lymphoma; noncontiguous stage II mantle cell lymphoma

Summary:

      RATIONALE: Drugs used in chemotherapy, such as cyclophosphamide, doxorubicin, vincristine,
      and prednisone, 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. Monoclonal antibodies,
      such as rituximab and yttrium Y 90 ibritumomab tiuxetan, can locate cancer cells and either
      kill them or deliver radioactive cancer-killing substances to them without harming normal
      cells. Combining chemotherapy with radiation therapy and monoclonal antibody therapy may kill
      more cancer cells.

      PURPOSE: This phase II trial is studying how well giving combination chemotherapy together
      with radiation therapy and monoclonal antibody therapy works in treating patients with stage
      I or stage II non-Hodgkin's lymphoma.
    

Eligibility criteria:

        DISEASE CHARACTERISTICS:

          -  Histologically confirmed aggressive non-Hodgkin's lymphoma of 1 of the following
             subtypes:

               -  Diffuse large B-cell

               -  Mantle cell

               -  High-grade B-cell, Burkitt's, or Burkitt-like

               -  Anaplastic large cell (B-cell phenotype only)

          -  Stage I, IE, or non-bulky* stage II or IIE disease by Ann Arbor classification

               -  Patients who have bulky stage II or IIE disease are ineligible even if, after
                  resection, the measurements are less than 10.0 cm NOTE: *Non-bulky disease
                  defined as any tumor measuring less than 10.0 cm or occupying less than 1/3 of
                  the chest diameter

          -  CD20-expressing disease by flow cytometry or immunoperoxidase staining

          -  Aggressive lymphomas must have at least 1 of the following adverse prognostic factors:

               -  Non-bulky stage II or IIE disease

               -  At least 60 years of age

               -  Zubrod performance status of 2

               -  Lactic dehydrogenase greater than upper limit of normal

          -  All disease must be encompassable in a single radiation port (including any site of
             resected disease) 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

          -  Over 18

        Performance status

          -  Zubrod 0-2

        Life expectancy

          -  Not specified

        Hematopoietic

          -  Not specified

        Hepatic

          -  Not specified

        Renal

          -  Not specified

        Other

          -  Not pregnant or nursing

          -  Negative pregnancy test

          -  Fertile patients must use effective contraception

          -  No other malignancy within the past 5 years except adequately treated basal cell or
             squamous cell skin cancer or carcinoma in situ of the cervix

          -  No medical contraindication to study chemotherapy, rituximab, or ibritumomab tiuxetan

          -  No known AIDS syndrome or HIV-associated complex

        PRIOR CONCURRENT THERAPY:

        Biologic therapy

          -  No prior monoclonal antibody therapy

        Chemotherapy

          -  No prior chemotherapy for lymphoma

        Endocrine therapy

          -  Not specified

        Radiotherapy

          -  See Disease Characteristics

          -  No prior radiotherapy for lymphoma

          -  No concurrent intensity-modulated radiotherapy

          -  Planned involved-field radiotherapy must not encompass more than 25% of active bone
             marrow space

        Surgery

          -  See Disease Characteristics

        Other

          -  Concurrent participation in SWOG-8947 or SWOG-8819 allowed