Rituximab-HyperCVAD (R-HCVAD) Alternating With Rituximab-Methotrexate-Cytarabine- (R-MC) in Newly Diagnosed Patients With Diffuse Large B-Cell Lymphoma With MYC-Rearrangement.
Rituximab-HyperCVAD (R-HCVAD) Alternating With Rituximab-Methotrexate-Cytarabine- (R-MC) in Newly Diagnosed Patients With Diffuse Large B-Cell Lymphoma With MYC-Rearrangement.
To estimate the I-year progression-free survival probability in patients up to 70 years of
 age with previously untreated diffuse large B-celllymphoma (DLBCL), or with intermediate
 (Burkitt-like) lymphoma, whose tumor cells show MYC rearrangement, and who are treated with
 alternating cycles of Rituximab-HCV AD and Rituximab-Methotrexate-Cytarabine, in concert with
 optimal supportive treatment including Pegfilgrastim, prophylactic antimicrobials, and close
 clinical follow-up.
Inclusion Criteria:

 1. Diffuse large B-cell lymphoma or intermediate ("Burkitt-like") lymphoma, newly
 diagnosed from an excisional biopsy or from a large core biopsy with sufficient
 diagnostic material to perform genetic testing for MYC-R.

 2. Positivity for MYC-R by Fluorescent in-situ Hybridization (FISH) or by classical
 cytogenetics.

 3. No prior lymphoma treatment, with one exception: One cycle of R-CHOP regimen is
 permitted (consisting of one single dose each of Rituximab, of cyclophosphamide, of
 doxorubicine, and of vincristine, as well as up to 5 doses of Prednisone when part of
 chemotherapy).

 4. No prior radiation therapy is permitted

 5. Age ≥ 18 years to 70 years of age

 6. CT imaging of neck, chest, abdomen and pelvis within 28 days prior to registration.
 Any additional imaging used to assess extent of disease must also have been done
 within 28 days prior to registration

 7. Bidimensionally measurable disease by imaging within 28 days prior to registration

 8. Adequate bone marrow biopsy, and aspiration performed for staging within 28 days
 before registration, and before start of any treatment

 9. Indication for primary treatment with systemic multiagent chemotherapy

 10. Creatinine ≤ 2.0 mg/dL and estimated (Cockroft-Gault) creatinine clearance> 50 ml/min
 within 7 days prior to registration

 11. Cardiac ejection fraction of ≥ 50% by MUGA scan or by 2-D echocardiogram , as well as
 EKG without significant abnormality within 28 days prior to registration

 12. Performance status of 0, of 1, or of 2 (ECOG scale)

 13. Patient willing to have, and to maintain, a central venous line throughout the
 treatment phase (either PICC line, or double lumen tunnelled catheter, or double lumen
 subcutaneous venous port system)

 14. Willing and logistically able to be followed as outpatient at least twice weekly,
 during the treatment phase.

 15. Signed informed consent to accept transfusion of blood products as medically indicated

 16. Signed informed consent to participate in this trial

 Exclusion Criteria:

 1. Age > 70 years

 2. Leukemic presentation, or no evidence of disease by imaging

 3. Unwilling to be screened for HIV. HIV positive patients must receive combined
 antiretroviral treatment while on study. They are excluded from participation unless
 they show a CD4 count >250/uL and a viral load < 50 within 28 days of registration.

 4. Hepatic involvement and total serum bilirubin ≥ 5 mg/dL within 7 days prior to
 registration, or total serum bilirubin ≥ 1.6 mg/ dL without hepatic involvement within
 7 days prior to registration

 5. Patients with bone marrow involvement and either ANC < 1000/uLor Platelets <
 50,000/uL, within 7 days before registration

 6. Patients without bone marrow involvement by lymphoma, and either ANC < 1500/uL or
 Platelets < 100,000/uL within 7 days before registration

 7. Patients with myelodysplastic syndrome, with sickle cell disease, or with transfusion
 dependence for over 6 months antedating the diagnosis oflymphoma.

 8. Known hypersensitivity to E. coli derived proteins

 9. Patients at risk of reactivation of hepatitis B who are unwilling to be treated with
 appropriate antivirals as medically indicated.

 10. Pregnant or nursing women, or any patient with reproductive potential and unwilling to
 use effective contraceptive method from study start to one year after the last dose of
 protocol therapy. Adequate contraception is defined as hormonal birth control,
 intrauterine device, double barrier method, or total abstinence.

 11. Additional or prior malignancy except adequately treated basal cell or squamous cell
 skin cancer, in situ cervical cancer, or other cancer for which the patient has been
 disease-free for ~ 5 years

 12. Unwilling to receive transfusions of blood products as medically indicated