Chemotherapy with or without Total Body Irradiation before Stem Cell Transplant in Treating Patients with Hodgkin or Non-Hodgkin Lymphoma

Inclusion Criteria

• Patients with chemo-sensitive histologically confirmed non-Hodgkin lymphoma (NHL) will be eligible for this treatment protocol contingent on histologic sub-classification
• Patients in partial or complete remission following cell therapy will also be eligible
• NHL patients with resistant or refractory lymphoma (no partial remission [PR] following up to three cycles of combination chemotherapy) will not be eligible for transplant in this trial
• Lymphoblastic lymphoma * All patients will be eligible in second or greater complete remission (CR) or first or subsequent partial remission (PR) * Patients with any high-risk features will be eligible in first complete remission * High risk features include: ** Stage IV ** Lactate dehydrogenase (LDH) > 2 x upper limit of normal ** >= 2 extranodal sites
• Mature B-cell lymphoma * Follicular lymphoma and other indolent lymphoma ** In >= second CR2/PR2 * Diffuse large B-cell lymphoma ** In >= CR2 or >= PR1 ** A high intermediate or high international prognostic index (IPI) (>= 2 for age-adjusted IPI) at diagnosis and double-hit or triple-hit lymphoma will be eligible in first CR ** Transformed lymphoma from follicular lymphoma (FL) (or other indolent lymphoma) or chronic lymphocytic leukemia will be eligible if chemosensitive and bone marrow has < 5% of chronic lymphocytic leukemia (CLL) cells by morphology * Mantle cell lymphoma ** In first or greater CR or PR * Burkitt’s/Burkitt’s like ** All patients except localized lymphoma will be eligible any time after initial therapy (after achievement of first complete remission), or in partial remission if they fail to achieve CR ** Patients with localized (stage I or Ziegler stage A) will be eligible only if they fail to achieve CR1 or after relapse
• Mature T-cell lymphoma * Chemosensitive T-cell lymphomas including primary T-cell not otherwise specified angioimmunoblastic, and ALK-positive anaplastic large cell, will be eligible after initial therapy, whether or not CR is achieved * Mycosis fungoides/Sezary syndrome will be eligible in >= CR2/PR2
• Patients with histologically proven Hodgkin lymphoma (HL) will be eligible for transplantation after failing prior therapy
• Patients with resistant disease (initial or at relapse): those who fail to achieve an objective partial response to three cycles of combination non-cross resistant chemotherapy will not be eligible for transplant in this trial
• For stage I/II patients treated with primary chemotherapy-radiation, they must have failed (no CR or progression after CR) at least one salvage combination chemotherapy treatment regimen
• For advanced (stage III/IV) Hodgkin lymphoma, patients must have failed an Adriamycin containing regimen (for example adriamycin-bleomycin-vinblastine-dacarbazine [ABVD]) or an alternative non-cross resistant regimen (e.g. mustargen-oncovin-procarbazine-prednisone [MOPP]) or unable to receive curative intent front-line regimen for HL
• Patients with any high-risk features will also be eligible, including those who: * Fail to achieve complete remission with initial combination chemotherapy * Have bulky disease after initial therapy (chemotherapy or radiation) defined as residual mediastinal mass >= 5 cm or other residual mass >= 10 cm accompanied by other features of persisting disease (e.g., positron emission tomography [PET] scan positive; high LDH; enlarging on serial x-rays or biopsy positive) will be eligible - if feasible, persistent disease should be proven by biopsy
• Patients should receive chemotherapy to attempt to achieve CR or minimal disease state pre-transplantation; the use of up to three cycles of non-cross resistant combination chemotherapy is advised
• Residual areas of limited disease should be considered for radiotherapy after and not prior to transplantation
• Human immunodeficiency virus (HIV) positive patients who are otherwise eligible for this study may be enrolled if they meet the following requirements: * Are seen in the infectious disease (ID)/HIV clinic prior to enrollment on study for the purpose of determining eligibility and for local coordination of HIV care during the peri-transplant period ** Are on maximally active anti-HIV regimen to control disease as determined appropriate by the ID/HIV physicians; for the majority of patients, this will be a highly active anti-retroviral therapy (HAART)-type therapy including a protease inhibitor * CD4+ >= 50/uL * HIV ribonucleic acid (RNA) viral load =< 100,000 copies per mL on each of samples 4 weeks apart; the most recent level must be within 30 days of enrollment * HIV infection with undetectable viral load. The most recent level must be within 30 days of enrollment * All HIV+ patients must be evaluated by Infectious Disease (ID) and a HIV management plan establish prior to transplantation
• Primary central nervous system (CNS) lymphoma in first or later remission
• Secondary CNS lymphoma with relapsed disease AND PR or CR after last therapy (some patients may be eligible in first CR if high risk)
• Stable, non-progressive disease (defined as non-progressive abnormalities on physical exam or magnetic resonance imaging [MRI] or/and positron emission tomography [PET], computed tomography [CT]) within 2 weeks of study entry
• Karnofsky performance status >= 80% for patients >= 16 years of age or Lansky play score >= 80 for patients < 16 years of age * Note: if poor performance status is due to lymphoma - Karnofsky performance status (KPS) >= 60% or Lansky performance score (LPS) >= 60 is acceptable
• Hemoglobin >= 8 gm/dL
• White blood cell (WBC) >= 2.5 x 10^9/L with an absolute neutrophil count (ANC) >= 1.5 x 10^9/L off granulocyte colony-stimulating factor (G-CSF) or granulocyte macrophage colony-stimulating factor (GM-CSF) for 3 days or Neulasta for 14 days
• Platelets >= 100 x 10^9/L without transfusion
• Bone marrow cellularity of >= 20% with < 5% involvement with tumor
• Glomerular filtration rate (GFR) > 50 ml/min/1.73 m^2 or serum creatinine =< 2.5 x upper limit of normal (ULN) for age
• No history of severe prior or ongoing chronic liver disease
• Total bilirubin =< 2.0 mg/dl
• Aspartate aminotransferase (AST) < 5 x upper limit of normal
• Alkaline phosphatase < 5 x upper limit of normal
• Free of symptoms of uncontrolled cardiac disease including unstable angina, decompensated congestive heart failure, or arrhythmia; the ejection fraction by gated cardiac blood flow scan (MUGA) or echocardiogram must be >= 40%
• No significant obstructive airways disease (forced expiratory volume in 1 second [FEV1] must be >= 50%) and must have acceptable diffusion capacity (corrected carbon monoxide diffusing capability [DLCO] >= 50% of predicted)
• Patients with a primary or secondary central nervous system (CNS) involvement by lymphoma will be eligible for arm 3; patients with active CNS disease are eligible if they have completed a standard treatment for CNS lymphoma and have no evidence of progressive CNS disease at the time of enrollment
• Planned mobilization must be scheduled at least 4 weeks from previous chemotherapy; 6 weeks from nitrosoureas and 2 weeks from oral anti-cancer therapy
• Sexually active women of child bearing potential and sexually active males with partners of child bearing potential must agree to use adequate birth control for the duration of treatment
• Patients who are carriers of hepatitis B will be included in this study
• Voluntary written consent

Exclusion Criteria

• Pregnant or breastfeeding - females of childbearing potential must have a blood test or urine study within 14 days prior to registration to rule out pregnancy
• Eligible for any higher priority transplant protocols
• Chemotherapy resistant disease
• Untreated active infection