Rituximab and Combination Chemotherapy in Treating Patients With Newly Diagnosed Waldenstrom’s Macroglobulinemia

INCLUSION CRITERIA:

Diagnosis of Waldenstrom's macroglobulinemia confirmed by the presence of the following:

Bone marrow lymphoplasmacytosis with: > 10% lymphoplasmacytic cells OR aggregates or sheets of one of the following: lymphocytes, plasma cells or lymphoplasmacytic cells on the bone marrow biopsy (measured within 4 weeks prior to registration)
Measurable disease defined as a quantitative immunoglobulin M (IgM) monoclonal protein of > 1,000 mg/dL obtained within 4 weeks prior to registration
Cluster of differentiation 20 (CD20) positive stain of bone marrow or lymph node samples obtained < 8 weeks prior to registration

Impaired bone marrow function due to infiltration by lymphoplasmacytic lymphoma, defined by 1 of the following:

Hemoglobin no greater than 11 g/dL
Serum viscosity level relative to water of at least 4.0 centipoise
Absolute neutrophil count at least 1,000/mm^3
Platelet count at least 75,000/mm^3
Bilirubin no greater than 3.0 mg/dL
Aspartate aminotransferase (AST) no greater than 3 times upper limit of normal
Creatinine no greater than 3.0 mg/dL
Age of 18 and over
ECOG (Eastern Cooperative Oncology Group) performance status 0-1

Must be symptomatic with 1 of the following:

Clinically significant anemia (hemoglobin no greater than 11 g/dL)
Bulky lymphadenopathy
Symptoms attributable to hyperviscosity (e.g., nose bleeding, gingival bleeding, or retinal hemorrhage)

History of heart disease allowed only if 1 of the following is demonstrated by echocardiography, multigated acquisition scan (MUGA), exercise MUGA, or coronary catheterization:

Ejection fraction of at least 45%
Normal fractional shortening of the left ventricle
Must have been tested for hepatitis B surface antigen within 2 weeks of registration
Negative pregnancy test
Fertile patients must use effective contraception

EXCLUSION CRITERIA:

Prior treatment for Waldenstrom's macroglobulinemia
Prior anti-CD20 therapy
Concurrent steroids exceeding 10 mg prednisone (or equivalent) per day
Prior irradiation if less than 4 weeks had elapsed prior to registration and the date of last treatment
Prior anthracyclines
Prior malignancy except curatively treated basal cell or squamous cell carcinoma of the skin, carcinoma in situ of the cervix, or other cancer curatively treated with surgery alone and from which patient has been disease free for at least 5 years
Active heart disease
Pregnant or nursing
Myocardial infarction within the past 3 months
Congestive heart failure
Symptomatic ventricular arrhythmia