Risk Adapted Therapy in Diffuse Large B Cell Lymphoma

Inclusion Criteria

• •1\. Histologically documented de novo CD20+ DLBCL with stage II, III or IV disease.
• •Stage I primary mediastinal (thymic) DLBCL is also eligible. Diagnosis should be based on an adequate tissue sample, including open biopsy or core needle biopsy.
• •Needle aspiration for primary diagnosis is unacceptable.
• •Patients must have one of the following WHO classification subtypes:
• •Diffuse large B-cell lymphoma (includes morphological variants: centroblastic, immunoblastic, T-cell/histiocyte rich, and anaplastic) Mediastinal (thymic) large B-cell lymphoma Intravascular large B-cell lymphoma Patients without adequate frozen material should have a biopsy performed to obtain material.
• •2\. Patients may be entered if they have received prior limited field radiation therapy or a short course of glucocorticoids (\< 10 days) for an urgent local disease complication at diagnosis (e.g., cord compression, SVC syndrome).
• •3\. Age \>16 years old. 4. ECOG Performance Status 0-2 5. If there is suspicion of cardiac disease, a cardiac ejection fraction must show LVEF \> 45%.
• •6\. Required Initial Laboratory Values (unless non-Hodgkin lymphoma):
• •ANC ≥ 1000/μL
• •Platelets ≥ 100,000/μL
• •Creatinine≤ 1.5 mg/dL or creatinine clearance ≥ 50 cc/min
• •Total Bilirubin ≤ 2 mg/dL (unless a history of Gilbert's Disease)