Combination Chemotherapy in Treating Patients With Relapsed or Refractory Intermediate-Grade or High-Grade Non-Hodgkin's Lymphoma

OBJECTIVES:

- Determine the response rate and time to progression in patients with relapsed or
refractory intermediate or high grade non-Hodgkin's lymphoma treated with doxorubicin
and topotecan.

- Determine the toxicity of this regimen in these patients.

OUTLINE: Patients receive doxorubicin IV over 5-10 minutes on day 1 and topotecan IV over 30
minutes on days 3-5. Treatment repeats every 21 days for up to 6 courses in the absence of
disease progression.

Patients are followed every 6 months for 2 years and annually for the next 3 years.

DISEASE CHARACTERISTICS:

- Histologically confirmed recurrent or refractory non-Hodgkin's lymphoma of one of the
following subtypes:

- Follicular center lymphoma, grade 3

- Diffuse large B-cell lymphoma

- Diffuse large B-cell lymphoma, primary mediastinal B-cell lymphoma

- Burkitt's lymphoma

- High grade B-cell lymphoma, Burkitt-like

- Anaplastic large cell lymphoma, CD30+ cell type

- Anaplastic large cell lymphoma, T-cell type

- Anaplastic large cell lymphoma, null-cell type

- Anaplastic large cell lymphoma, Hodgkin's like

- Bidimensionally measurable disease NOTE: A new classification scheme for adult
non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of "indolent" or
"aggressive" lymphoma will replace the former terminology of "low", "intermediate",
or "high" grade lymphoma. However, this protocol uses the former terminology.

PATIENT CHARACTERISTICS:

Age:

- Any age

Performance status:

- Not specified

Life expectancy:

- Not specified

Hematopoietic:

- Absolute neutrophil count at least 1,500/mm3

- Platelet count at least 100,000/mm3

Hepatic:

- Bilirubin no greater than 2.0 mg/dL history of Gilbert's Disease

- AST no greater than 2.5 times upper limit of normal

Renal:

- Creatinine normal

Cardiovascular:

- LVEF at least 45% by MUGA or echocardiogram

Other:

- Not pregnant or nursing

- Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy:

- Not specified

Chemotherapy:

- Greater than 3 weeks since prior chemotherapy (6 weeks since prior nitrosoureas or
mitomycin)

- No greater than 96 mg/m2 mitoxantrone

- No greater than 400 mg/m2 prior doxorubicin or combined total doxorubicin and
mitoxantrone

- No prior camptothecins

- No other concurrent chemotherapy

Endocrine therapy:

- No concurrent hormonal therapy except steroids for adrenal failure or hormones given
for nondisease conditions (e.g., insulin for diabetes)

- No concurrent dexamethasone or other steroidal antiemetics

Radiotherapy:

- Greater than 3 weeks since prior radiotherapy

- No concurrent radiotherapy except whole brain irradiation for documented CNS disease

Surgery:

- Not specified