Yttrium Y 90 Ibritumomab Tiuxetan, Etoposide, Cyclophosphamide, and an Autologous Stem Cell Transplant in Treating Patients With Non-Hodgkin Lymphoma

DISEASE CHARACTERISTICS:

• Biopsy proven diagnosis of low- or intermediate-grade* non-Hodgkin lymphoma (NHL) including any of the following:

  • Follicular small cleaved
  • Follicular mixed
  • Follicular large cell
  • Diffuse small cleaved
  • Diffuse mixed
  • Diffuse large cell
  • Immunoblastic (working formulation B, C, D, E, F, G and H) NOTE: *A new classification scheme for adult non-Hodgkin 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.
• Mantle cell and transformed low-grade lymphomas allowed
• Demonstrated monoclonal CD20-positive B-cell population in lymph nodes and/or bone marrow
• Favorable biodistribution on imaging dose

• Patient either relapsed after achieving a complete (CR) or partial response (PR) to prior therapy, never responded to prior therapy, or has poor-risk disease

  • Sensitivity of disease based on 1 of the following:

    • Induction failure: patients who did not achieve a CR or PR from induction chemotherapy
    • Resistant relapse: patients who did not achieve a CR or PR from the most recent standard salvage chemotherapy
    • Sensitive relapse: patients who did achieve a CR or PR from the most recent standard salvage chemotherapy

  • Poor-risk disease defined as any of the following:

    • Age-adjusted International Prognostic Index (IPI) High- (3 risk factors) or High-Intermediate (2 risk factors) based on the following risk factors:

      • Stage III-IV disease
      • Elevated serum lactate dehydrogenase level
      • ECOG performance status 2-4
    • Patients with aggressive NHL including mantle cell lymphoma and who required 2 different induction chemotherapy regimens to achieve a CR/PR
    • Patients with B-cell NHL and who failed to achieve a CR after adequate induction chemotherapy regimen(s)
• Patients must have bone marrow aspiration and biopsy within 42 days before salvage chemotherapy or stem cell collection which show ≤ 10% lymphomatous involvement of total cellularity

• Normal cytogenetic study on bone marrow (prior to salvage chemotherapy or stem cell collection)

  • Cytogenetic study on peripheral blood is acceptable if bone marrow biopsy has already been done and shows no sign of myelodysplastic syndrome (MDS) or lymphoma and a repeat bone marrow is deemed unnecessary by attending physician
• No active or prior history of CNS diseases
• No human anti-mouse antibody (HAMA) or human anti-chimeric antibody

PATIENT CHARACTERISTICS:

• ECOG performance status (PS) 0-1 or Karnofsky PS 80-100%
• Platelet count normal
• Serum creatinine ≤ 1.5 mg/dL or creatinine clearance ≥ 60 mL/min
• FEV_1 > 65% of predicted or DLCO ≥ 50% of predicted
• LVEF > 50% by ECHO or MUGA scan
• Bilirubin ≤ 1.5 times normal
• SGOT or SGPT ≤ 2 times normal
• HIV antibody-negative
• No prior malignancy except for adequately treated basal cell or squamous cell skin cancer, adequately treated noninvasive carcinoma, or other cancer from which the patient has been disease-free for at least five years
• No active evidence of hepatitis B or C infection
• No hepatitis B surface antigen positivity
• No history of alcohol abuse
• Body weight ≤ 250 pounds

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• Patients who have received involved field external beam therapy to area excluding lung, heart, liver and kidney are allowed, but will be evaluated on a case-by-case basis
• Patients must have recovered from last therapy and should be at least four weeks from prior radiation or chemotherapy
• No prior radioimmunotherapy
• No prior bone marrow transplantation