Monoclonal Antibody Therapy, Combination Chemotherapy, and Peripheral Stem Cell Transplant in Non-Hodgkin’s Lymphoma

Inclusion Criteria:

Diagnosis of non-Hodgkin's lymphoma (NHL) of one of the following types:

Diffuse large B-cell
Composite (at least 50% of tumor showing diffuse histology)
Diffuse mixed cell
Immunoblastic
Relapsed or refractory disease sensitive to initial or subsequent conventional therapy (at least a partial response)
Eligible for high-dose carmustine, etoposide, cytarabine, and melphalan protocol and autologous bone marrow transplantation or peripheral blood stem cell transplantation
Evidence of CD20 antigen expression in tumor tissue
Bidimensionally measurable disease

Adequate peripheral blood stem cells

At least 15,000,000 CD34+ cells/kg or
At least 25,000 granulocyte macrophage colony-forming units/kg
Age: 19 to 70
Performance status: Karnofsky 70-100%
Life expectancy: at least 4 months post-transplantation
Bilirubin less than 2.0 mg/dL
Creatinine less than 2.0 mg/dL

Cardiac ejection fraction at least 40% for any of the following criteria:

Age 60 and over
Significant cardiac history (myocardial infarction or congestive heart failure)
Received greater than 350 mg/m^2 of prior doxorubicin
DLCO at least 50% of predicted
HIV negative
Fertile patients must use effective contraception during and for at least 6 months after study participation
At least 4 weeks since prior biologic therapy and recovered
Human antimouse antibody negative
At least 4 weeks since prior cytotoxic chemotherapy and recovered
At least 4 weeks since prior radiotherapy and recovered
At least 4 weeks since prior immunosuppressants and recovered

Exclusion Criteria:

No progressive disease in a field that has been previously irradiated with more than 3,500 cGy within the past year
No known brain or leptomeningeal metastases
No active obstructive hydronephrosis
No New York Heart Association class III or IV heart disease
No evidence of severe organ dysfunction
No other major medical illnesses
No active infection requiring IV antibiotics
No other malignancy within the past 5 years except adequately treated skin cancer or carcinoma in situ of the cervix
Not pregnant/negative pregnancy test
No prior peripheral blood stem cell transplantation following high-dose chemotherapy or chemoradiotherapy
No other concurrent biologic therapy for NHL
No concurrent steroids except maintenance-dose steroids for noncancerous disease
No concurrent external beam radiotherapy for NHL
No other concurrent participation on protocol involving non-FDA-approved drugs or biologics