Phase II Trial of Standard Dose Cyclophosphamide, Doxorubicin, Vincristine, Prednisone (CHOP) and Rituximab Plus Bevacizumab for Advanced Stage Diffuse Large B-Cell NHL

Inclusion Criteria

DISEASE CHARACTERISTICS:

- Histologically confirmed* diffuse large B-cell lymphoma, meeting 1 of the following
stage criteria:

- Bulky stage II

- Stage III

- Stage IV NOTE: *Adequate sections from the original diagnostic specimen must be
available; needle aspiration or cytology are not considered adequate

- Bidimensionally measurable disease

- CD20-positive disease

- No prior indolent lymphoma, including histologic transformation or mixed histology
with an indolent or nodular component

- No clinical evidence of CNS involvement by lymphoma

PATIENT CHARACTERISTICS:

Age

- 18 and over

Performance status

- Zubrod 0-2

Life expectancy

- Not specified

Hematopoietic

- Absolute neutrophil count > 1,000/mm^3

- Platelet count > 100,000/mm^3

- No bleeding diathesis or coagulopathy

Hepatic

- Not specified

Renal

- Creatinine < 2 times upper limit of normal

- No proteinuria ≥ +1 by dipstick or urinalysis OR

- Urine protein:creatinine ratio < 1.0 OR

- Urine protein < 1 g by 24-hour urine collection

Cardiovascular

- No uncontrolled hypertension

- No myocardial infarction within the past 6 months

- No unstable angina within the past 6 months

- No stroke within the past 6 months

- No arterial thrombosis within the past 6 months

- No clinically significant peripheral vascular disease

- Ejection fraction ≥ 45% by MUGA or 2-dimensional echocardiogram (2-D ECHO)

- No significant cardiac abnormality by MUGA or 2-D ECHO

Pulmonary

- No requirement for continuous supplemental oxygen

Gastrointestinal

- No abdominal fistula within the past 6 months

- No gastrointestinal perforation within the past 6 months

- No intra-abdominal abscess within the past 6 months

Other

- Not pregnant or nursing

- Fertile patients must use effective contraception during and for 6 months after
completion of study therapy

- No known HIV positivity

- No history of hypersensitivity reaction to products containing polysorbate 20 (Tween
20), Chinese hamster ovary cell products, or recombinant human antibodies

- No traumatic injury within the past 28 days

- No serious or non-healing wound, ulcer, or bone fracture

- No other malignancy within the past 5 years except adequately treated basal cell or
squamous cell skin cancer, carcinoma in situ of the cervix, or adequately treated
stage I or II cancer in complete remission

PRIOR CONCURRENT THERAPY:

Biologic therapy

- No prior antibody-based therapy for lymphoma

Chemotherapy

- No prior chemotherapy for lymphoma

Endocrine therapy

- Not specified

Radiotherapy

- No prior radiotherapy for lymphoma

Surgery

- More than 28 days since prior and no concurrent major surgery

- No prior solid organ transplantation

Other

- Concurrent full-dose anticoagulants allowed for treatment of venous thrombosis
provided the following criteria are met:

- INR in range (i.e., 2-3)

- Patient is on a stable dose of warfarin or low molecular weight heparin

- No bleeding or pathological condition that would confer a high risk of bleeding
(e.g., tumor involving major vessels or known varices)