Combination Chemotherapy and Rituximab in Treating Patients With Diffuse Large B-Cell Non-Hodgkin Lymphoma

You may be eligible if

• DISEASE CHARACTERISTICS:
• Histologically confirmed diffuse large B-cell non-Hodgkin lymphoma
• * International Prognostic Index (IPI) score high-intermediate (score = 3) OR high (score = 4 or 5), defined as:
• * Stage III or IV disease
• * Raised lactic dehydrogenase and poor performance status (WHO performance status 2-4)
• * All morphological variants included
• * B-cell nature of the proliferation must be verified by a positive anti-CD20 antibody (i.e., CD20-positive disease)
• No T-cell lymphoma
• No history of treated or non-treated indolent lymphoma
• * Patients newly diagnosed who have large B-cell lymphoma with some small cell infiltration in the bone marrow or lymph node may be allowed
• PATIENT CHARACTERISTICS:
• See Disease Characteristics
• Life expectancy \> 3 months
• ANC \> 1,500/mm\^3\*
• Platelet count \> 100,000/mm\^3\*
• Serum creatinine \< 150 μmol/L\*
• Serum bilirubin \< 35 μmol/L\*
• AST and/or ALT \< 2.5 times upper limit of normal\* NOTE: \*Unless attributed to bone marrow infiltration by lymphoma.
• Fertile patients must use effective contraception
• Normal MUGA or echocardiogram without areas of abnormal contractility
• LVEF ≥ 50% and only tested if patient meets 1 of the following criteria:
• * History of diabetes
• * Prior cardiac disease, hypertension, or abnormal resting ECG
• No history of heart failure or uncontrolled angina pectoris
• No cardiac contraindication to doxorubicin hydrochloride (e.g., abnormal contractility on echocardiography or MUGA)
• No neurological contraindication to vincristine sulfate (e.g., pre-existing diabetic neuropathy)
• No concurrent uncontrolled medical condition
• No other serious active disease
• No general status that, according to the investigator, does not allow the administration of 2 courses of CODOX-M/IVAC
• No active malignant disease within the past 10 years except curatively treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the uterine cervix
• No positive serology for HIV or hepatitis B or C
• No medical or psychiatric conditions that compromise the patient's ability to give informed consent
• PRIOR CONCURRENT THERAPY:
• See Disease Characteristics
• No prior chemotherapy, radiotherapy, or other investigational drug for diffuse large B-cell non-Hodgkin lymphoma