Yttrium Y 90 Ibritumomab Tiuxetan, Etoposide, Cyclophosphamide, and an AHSCT in Non-Hodgkin's Lymphoma Patients

Inclusion Criteria

• •DISEASE CHARACTERISTICS:
• •Biopsy proven diagnosis of low- or intermediate-grade\* non-Hodgkin lymphoma (NHL) including any of the following:
• •* Follicular small cleaved
• •* Follicular mixed
• •* Follicular large cell
• •* Diffuse small cleaved
• •* Diffuse mixed
• •* Diffuse large cell
• •* Immunoblastic (working formulation B, C, D, E, F, G and H) NOTE: \*A new classification scheme for adult non-Hodgkin 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.
• •Mantle cell and transformed low-grade lymphomas allowed
• •Demonstrated monoclonal CD20-positive B-cell population in lymph nodes and/or bone marrow
• •Favorable biodistribution on imaging dose
• •Patient either relapsed after achieving a complete (CR) or partial response (PR) to prior therapy, never responded to prior therapy, or has poor-risk disease
• •* Sensitivity of disease based on 1 of the following:
• •* Induction failure: patients who did not achieve a CR or PR from induction chemotherapy
• •* Resistant relapse: patients who did not achieve a CR or PR from the most recent standard salvage chemotherapy
• •* Sensitive relapse: patients who did achieve a CR or PR from the most recent standard salvage chemotherapy
• •* Poor-risk disease defined as any of the following:
• •* Age-adjusted International Prognostic Index (IPI) High- (3 risk factors) or High-Intermediate (2 risk factors) based on the following risk factors:
• •* Stage III-IV disease
• •* Elevated serum lactate dehydrogenase level
• •* ECOG performance status 2-4
• •* Patients with aggressive NHL including mantle cell lymphoma and who required 2 different induction chemotherapy regimens to achieve a CR/PR
• •* Patients with B-cell NHL and who failed to achieve a CR after adequate induction chemotherapy regimen(s)
• •Patients must have bone marrow aspiration and biopsy within 42 days before salvage chemotherapy or stem cell collection which show ≤ 10% lymphomatous involvement of total cellularity
• •Normal cytogenetic study on bone marrow (prior to salvage chemotherapy or stem cell collection)
• •* Cytogenetic study on peripheral blood is acceptable if bone marrow biopsy has already been done and shows no sign of myelodysplastic syndrome (MDS) or lymphoma and a repeat bone marrow is deemed unnecessary by attending physician
• •No active or prior history of CNS diseases
• •No human anti-mouse antibody (HAMA) or human anti-chimeric antibody
• •PATIENT CHARACTERISTICS:
• •ECOG performance status (PS) 0-1 or Karnofsky PS 80-100%
• •Platelet count normal
• •Serum creatinine ≤ 1.5 mg/dL or creatinine clearance ≥ 60 mL/min
• •FEV\_1 \> 65% of predicted or DLCO ≥ 50% of predicted
• •LVEF \> 50% by ECHO or MUGA scan
• •Bilirubin ≤ 1.5 times normal
• •SGOT or SGPT ≤ 2 times normal
• •HIV antibody-negative
• •No prior malignancy except for adequately treated basal cell or squamous cell skin cancer, adequately treated noninvasive carcinoma, or other cancer from which the patient has been disease-free for at least five years
• •No active evidence of hepatitis B or C infection
• •No hepatitis B surface antigen positivity
• •No history of alcohol abuse
• •Body weight ≤ 250 pounds
• •PRIOR CONCURRENT THERAPY:
• •See Disease Characteristics
• •Patients who have received involved field external beam therapy to area excluding lung, heart, liver and kidney are allowed, but will be evaluated on a case-by-case basis
• •Patients must have recovered from last therapy and should be at least four weeks from prior radiation or chemotherapy
• •No prior radioimmunotherapy
• •No prior bone marrow transplantation