Rituximab and Galiximab in Treating Patients With Stage II, Stage III, or Stage IV Non-Hodgkin’s Lymphoma

Documentation of Disease

1.1 Previously untreated, histologically confirmed follicular lymphoma, WHO classification, grade 1, 2, or 3a (> 15 centroblasts per high power field with centrocytes present) which is stage III, IV, or bulky (i.e., single mass ≥ 7 cm in any unidimensional measurement) stage II.

1.1.1 Bone marrow biopsies as the sole means of diagnosis are not acceptable, but they may be submitted in conjunction with nodal biopsies. Fine needle aspirates are not acceptable.

1.1.2 Failure to submit pathology specimens within 60 days of patient registration will result in the patient being declared ineligible.

1.2 Institutional flow cytometry or immunohistochemistry must confirm CD20 antigen expression.

1.3 Patients classified as high risk according to the Follicular Lymphoma International Prognostic Index (FLIPI) should be considered for CALGB 50102/SWOG S0016 (A Phase III Trial of CHOP vs CHOP + Rituximab vs CHOP + Iodine-131-Labeled Monoclonal Anti-B1 Antibody [Tositumomab] For Treatment of Newly Diagnosed Follicular Non-Hodgkin's Lymphomas).

Prior Treatment

2.1 No prior therapy for non-Hodgkin lymphoma including chemotherapy, radiation or immunotherapy (e.g., monoclonal antibody-based therapy)

2.2 No corticosteroids within two weeks prior to study, except for maintenance therapy for a non-malignant disease

Age - Patients must be ≥ 18 years of age
ECOG Performance Status - Patients must have ECOG Performance Status 0-2.

Measurable Disease - Measurable disease must be present either on physical examination or imaging studies.

5.1 Non-measurable disease alone is not acceptable.

5.2 Any tumor mass > 1 cm is acceptable.

5.3 Lesions that are considered non-measurable include the following:

Bone lesions (lesions if present should be noted)
Ascites
Pleural/pericardial effusion
Lymphangitis cutis/pulmonis
Bone marrow (involvement by non-Hodgkin lymphoma should be noted).
CNS Involvement - Patients must have no known CNS involvement by lymphoma.

HIV Infection - Patients must have no known HIV infection.

7.1 Patients with a history of intravenous drug abuse or any behavior associated with an increased risk of HIV infection should be tested for exposure to the HIV virus.

7.2 Patients who test positive or who are known to be infected are not eligible due to an increased risk of infection with this regimen. An HIV test is not required for entry on this protocol, but is required if the patient is perceived to be at risk.

Human Anti-Chimeric Antibody - Patients must have no known baseline human anti-chimeric antibody (HACA) positivity.

Pregnancy and Nursing Status - Patients must be non-pregnant and non-nursing.

9.1 Due to the unknown teratogenic potential of galiximab, pregnant or nursing patients may not be enrolled.

9.2 Women and men of reproductive potential should agree to use an effective means of birth control throughout their participation in this study.

9.3 Appropriate methods of birth control include oral contraceptives, implantable hormonal contraceptives, or double barrier method (diaphragm plus condom).

Second Malignancy - Patients with a "currently active" second malignancy, other than non-melanoma skin cancers are not eligible.

10.1 This includes Waldenstrom's Macroglobulinemia, since such patients have experienced transient increases in IgM following initiation of rituximab, with the potential for hyperviscosity syndrome requiring plasmapheresis.

10.2 Patients are not considered to have a "currently active" malignancy if they have completed anti-cancer therapy, and are considered by their physician to be at less than 30% risk of relapse.

Required Initial Laboratory Values:

ANC ≥ 1000/µL
Platelet Count ≥ 50,000/µL
Creatinine ≤ 2 x ULN Unless attributable to lymphoma
Total Bilirubin ≤ 2 x ULN*† Unless attributable to Gilbert's disease