Yttrium Y 90 Ibritumomab Tiuxetan and Rituximab in Treating Patients With Non-Hodgkin’s Lymphoma

DISEASE CHARACTERISTICS:

Histologically confirmed transformed CD20+ B-cell non-Hodgkin's lymphoma (NHL)

Transformation defined as:

Progression to a more aggressive diffuse lymphoma, excluding conversion to a more aggressive grade of follicular lymphoma (e.g., WHO/REAL follicular center, large, grade III NHL)
Initial large cell follicular lymphoma must progress to a diffuse large cell lymphoma
De novo transformed NHL ineligible

Requiring treatment as determined by any of the following characteristics:

An increase in overall tumor size
Presence of B symptoms
Presence of masses that are causing ongoing clinical symptomatology
Must have less than 25% bone marrow involvement with lymphoma
Must have received and either relapsed or failed to respond to prior therapy for initial low grade or follicular NHL

Must have bidimensionally measurable disease defined as:

Greater than 2 cm OR 1.5 cm if 0.5 cm slices are used during spiral CT scan

Nonmeasurable disease includes any of the following:

Bone lesions
Leptomeningeal disease
Ascites
Pleural or pericardial effusion
Inflammatory breast disease
Lymphangitis cutis/pulmonis
Abdominal masses that are not confirmed and followed by imaging techniques
Cystic lesions
Lesions that are situated in a previously irradiated area

No expected impairment in bone marrrow reserve meeting any of the following criteria:

Platelet count less than 150,000/mm^3
Hypocellular bone marrow (less than 15% cellularity)
Marked reduction in bone marrow precursors of one or more cell lines (e.g., granulocytic, megakaryocytic, or erythroid)
History of failed stem cell collection

Patients with peritoneal invasion and/or ascites with positive cytology for lymphoma OR pleural invasion and/or effusion with positive cytology for lymphoma are eligible only if their effusion or ascites can be tapped dry

No significant remaining malignant effusion or ascites at the time of study drug administration
No known meningeal lymphoma or known parenchymal CNS lymphoma NOTE: A new classification scheme for adult non-Hodgkin's 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.

PATIENT CHARACTERISTICS:

Age

18 and over

Performance status

0-2

Life expectancy

Not specified

Hematopoietic

See Disease Characteristics
Absolute neutrophil count at least 1,500/mm^3
Lymphocyte count no greater than 5,000/mm^3
Platelet count at least 150,000/mm^3

Hepatic

Bilirubin no greater than 2.0 mg/dL

Renal

Creatinine no greater than 2.0 mg/dL

Other

Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception during and for 1 year after study treatment
HIV negative
No other malignancy except nonmelanoma skin cancer unless patient has completed therapy and is considered to be at less than 30% risk of relapse
No human anti-mouse antibody (HAMA) reactivity (patients with prior exposure to murine antibodies)

PRIOR CONCURRENT THERAPY:

Biologic therapy

See Radiotherapy
At least 3 weeks since prior anticancer immunotherapy (6 weeks for rituximab) and recovered
More than 2 weeks since prior filgrastim (G-CSF) or sargramostim (GM-CSF)
No prior myeloablative therapy with bone marrow transplantation or peripheral blood stem cell rescue

Chemotherapy

See Biologic therapy
At least 3 weeks since prior anticancer chemotherapy (6 weeks for nitrosourea or mitomycin) and recovered

Endocrine therapy

No concurrent systemic corticosteroids with either of the following dose schedules:

No greater than 50 mg of prednisone as a single dose (or equivalent)
No greater than 50 mg of prednisone per dose (or equivalent) for more than 6 doses

Radiotherapy

See Disease Characteristics
At least 3 weeks since prior anticancer radiotherapy and recovered
No prior radioimmunotherapy, including yttrium Y 90 ibritumomab tiuxetan
No prior external beam radiotherapy to more than 25% of active bone marrow (involved field or regional)

Surgery

At least 3 weeks since prior anticancer surgery and recovered
More than 4 weeks since prior major surgery (other than diagnostic surgery)

Other

At least 3 weeks since other prior anticancer therapy and recovered