Phase 2 Poor Risk DLBCL of TLI and ATG Followed by Matched Allogeneic HT as Consolidation to Autologous HCT

INCLUSION CRITERIA

   - Age 18 to 70 years.

   - Histologically-proven diffuse large B-cell lymphoma (DLBCL) by the World Health
   Organization (WHO) classification.

   - Relapse after achieving initial remission or failure to achieve initial remission.
   Patients with residual radiographic abnormalities after primary therapy are eligible
   if abnormalities are postive by fluorodeoxyglucose (FDG)-positron emission tomography
   (PET) (FDG-PET).

   - Receipt of 2 cycles of second-line therapy and FDG-PET positive per Stanford (central)
   review. FDG-PET to be done 2 weeks after cycle 2 of second line chemotherapy.

   - Eastern Cooperative Oncology Group (ECOG) performance status < 2

   - Matched related or unrelated donor identified and available

   - Bone marrow biopsy and cytogenetic analysis within 8 weeks of registration

   - Pretreatment serum bilirubin < 2 x the institutional upper limit of normal (ULN)

   - Serum creatinine < 2 x the institutional ULN and measured or estimated creatinine
   clearance > 60 mL/min by the following formula (all tests must be performed within 28
   days prior to registration):

      - Estimated Creatinine Clearance = (140 age) x weight (kg) x 0.85 if female 72 x
      serum creatinine (mg/dL).

   - EKG within 42 days prior to registration with no significant abnormalities suggestive
   of active cardiac disease

   - Patients must have a radionuclide ejection fraction within 42 days of registration. If
   the ejection fraction is < 40%, the patient will not be eligible. If the ejection
   fraction is 40-50%, the patient will have a cardiology consult.

   - Corrected diffusion capacity > 55%.

   - Sexually active males are advised to use an accepted and effective method of birth
   control

   - Women of child-bearing potential are advised to use an accepted and effective method
   of birth control

   - Patients must sign and give written informed consent in accordance with institutional
   and federal guidelines. Patients must be informed of the investigational nature of
   this study.

EXCLUSION CRITERIA

   - Known allergy to etoposide or a history of Grade 3 hemorrhagic cystitis with
   cyclophosphamide

   - Greater than Grade 2 sensory or motor peripheral neuropathy from prior vinca alkaloid
   use

   - Requiring therapy for coronary artery disease, cardiomyopathy, dysrhythmia, or
   congestive heart failure

   - Known to be human immunodeficiency virus (HIV)-positive. The antibody test for HIV
   must be performed within 42 days of registration.

   - Prior chemotherapy other than corticosteroids administered within 2 weeks of the
   initiation of protocol therapy.

   - Prior malignancy, except adequately treated basal cell or squamous cell skin cancer,
   in situ cervical cancer or other cancer for which the patients has been disease-free
   for five years.

   - Prior diagnosis of non-Hodgkin's lymphoma

   - Active infection requiring oral or intravenous antibiotics

   - Prior autologous or allogeneic hematopoietic cell transplantation

   - Prior radioimmunotherapy

   - Pregnant

   - Lactating

DONOR ELIGIBILITY

   - Related or unrelated HLA-identical donors who are in good health and have no
   contra-indication to donation

   - No contra-indication for the donor to collection by apheresis of mononuclear cells
   mobilized by G-CSF at a dose of 16 µg/kg of body weight.

   - Donors will be evaluated with a full history and physical examination.

   - Virology testing including HIV; cytomegalovirus (CMV); Epstein-Barr virus (EBV); human
   T-lymphotropic virus (HTLV); rapid plasma reagin (RPR); Hepatitis A, B and C be
   performed within 30 days of donation.

   - Prospective donors will be screened for CMV seroreactivity and seronegative donors
   will be utilized if available.

   - If more than one human leukocyte antigen (HLA)-matched related donor exists, then the
   donor will be selected on the basis of CD31 allotype.