Pixantrone, Cytarabine, Methylprednisolone, and Cisplatin in Treating Patients With Aggressive Non-Hodgkin's Lymphoma in First Relapse

DISEASE CHARACTERISTICS:

• Histologically confirmed aggressive non-Hodgkin's lymphoma (NHL)
• Any stage, with or without B symptoms
• The following subtypes are eligible:
• Diffuse large cell (B and T cell types)
• Anaplastic large cell
• Diffuse mixed cell
• Immunoblastic large cell
• Follicular large cell
• Transformed follicular NHL
• Diffuse aggressive not otherwise classified
• Burkitt-like lymphoma
• Bone marrow positive or negative
• At least 1 measurable lesion
• Patients with bone marrow as the only site of disease are eligible without a measurable lesion
• No more than 1 episode of progressive disease, occurring after a response (complete response [CR], complete response unconfirmed [CR_u], or partial response [PR]) to prior chemotherapy* NOTE: *Patients with less than a CR, CRu, or PR and no progression, but who are good candidates for high-dose chemotherapy with stem cell support may be eligible (will be decided on an individual basis)
• No chemotherapy-refractory disease, defined as follows:
• Stable or progressive disease documented at restaging immediately after the completion of induction therapy
• No lymphoblastic lymphoma, or mantle cell lymphoma

PATIENT CHARACTERISTICS:

Age

• 18 and over

Performance status

• WHO 0-1

Life expectancy

• At least 3 months

Hematopoietic

• Neutrophil count at least 1,500/mm^3*
• Platelet count at least 100,000/mm^3* NOTE: *Lower values may be accepted if clearly due to bone marrow involvement by lymphoma

Hepatic

• Bilirubin no greater than 1.5 times upper limit of normal (ULN)*
• AST or ALT no greater than 2.0 times ULN*
• Alkaline phosphatase no greater than 2.0 times ULN*
• No history or clinical symptoms of hepatitis B or hepatitis C virus
• Patients with seropositivity due to prior vaccination for hepatitis B are eligible NOTE: *Higher values may be accepted if clearly due to liver involvement by lymphoma

Renal

• Creatinine no greater than 1.5 mg/dL

Cardiovascular

• LVEF at least 50% by MUGA
• No clinically significant cardiovascular abnormalities
• No New York Heart Association grade II-IV cardiovascular disease
• No myocardial infarction within the past 6 months
• No severe cardiac arrhythmia
• No uncontrolled hypertension

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 6 months after study participation
• HIV negative
• No clinically significant neurological abnormalities
• No condition that would preclude study safety or interfere with study results
• No concurrent serious uncontrolled infection

PRIOR CONCURRENT THERAPY:

Biologic therapy

• Prior rituximab immediately after the first chemotherapy regimen allowed

Chemotherapy

• See Disease Characteristics
• See Biologic therapy
• At least 6 months since prior anthracycline therapy (e.g., cyclophosphamide, doxorubicin, vincristine, and prednisone [CHOP])
• More than 2 years since prior fludarabine
• More than 2 years since prior nitrosoureas
• More than 1 year since prior platinum-based chemotherapy or cytarabine, unless a CR or CR_u was achieved
• No prior cumulative dose of cisplatin greater than 600 mg/m^2
• No prior single or cumulative dose of doxorubicin greater than 450 mg/m^2

Endocrine therapy

• Not specified

Radiotherapy

• No prior radiotherapy to the whole pelvis
• No prior radioimmunotherapy

Surgery

• More than 4 weeks since prior major thoracic and/or abdominal surgery
• At least 1 week since prior minor surgery

Other

• Recovered from prior therapy
• Alopecia allowed
• Grade 1 peripheral neuropathy allowed
• More than 30 days since prior participation in another investigational drug study
• No other concurrent investigational drugs