Combination Chemotherapy and Rituximab in Treating Patients with Untreated Burkitt Lymphoma

Inclusion Criteria

• Patients must have Burkitt lymphoma; effective with Amendment J (version date: 06/24/2014), the following histologies were removed: B-cell lymphoma: unclassifiable with features intermediate between diffuse large B–cell lymphoma and Burkitt lymphoma; c-MYC + DLBCL and c-MYC+ plasmablastic lymphoma * If questions arise related to diagnosis, please contact the National Cancer Institute (NCI) principle investigator, Dr. Mark Roschewski or the NCI study coordinator, A. Nicole Lucas
• Pathology confirmed by treating institution’s pathology department
• No prior treatment except patients may be entered if they have had prior limited-field radiotherapy, a short course of glucocorticoids, cyclophosphamide for an urgent problem at diagnosis (e.g. epidural cord compression, superior vena cava syndrome) and/or a single dose of intrathecal methotrexate (MTX) at the time of the pre-treatment diagnostic lumbar puncture
• All disease stages
• Human immunodeficiency virus (HIV) negative or positive
• HIV positive patients on antiretroviral therapy regimen must be willing to suspend all highly active antiretroviral therapy (HAART) except in circumstances described
• Eastern Cooperative Oncology Group (ECOG) 0-4
• Ability of patient or durable power of attorney (DPA) for healthcare to give informed consent
• Hepatitis B + patients may be enrolled at the discretion of the investigator

Exclusion Criteria

• Patients with primary central nervous system (CNS) lymphoma
• Serum creatinine (Cr) > 1.5 mg/dL or creatinine clearance < 50 ml/min/1.73 m^2 unless lymphoma related
• Bilirubin > 2 mg/dl (total) except > 5 mg/dl in patients with Gilbert’s syndrome as defined by > 80% unconjugated
• Absolute neutrophil count (ANC) < 1000
• Platelets < 75,000
• The effects of EPOCH-R on the developing human fetus are unknown; for this reason and because chemotherapy agents are known to be teratogenic, female subject of child-bearing potential not willing to use an acceptable method of birth control (i.e., a hormonal contraceptive, intra-uterine device, diaphragm with spermicide, condom with spermicide, or abstinence) for the duration of the study and one year beyond treatment completion will not be eligible to participate in the study
• Female subject pregnant or breast-feeding; confirmation that the subject is not pregnant must be established by a negative serum beta-human chorionic gonadotropin (b-hCG) pregnancy test result obtained during screening; pregnancy testing is not required for women without child-bearing potential
• The effects of EPOCH-R on the developing human fetus are unknown; for this reason and because chemotherapy agents are known to be teratogenic, male subject unwilling to use an acceptable method for contraception for the duration of the study and one year beyond treatment completion, will not be eligible to participate in the study
• History of a prior invasive malignancy in past 5 years
• Active symptomatic ischemic heart disease, myocardial infarction or congestive heart failure within the past year; if echocardiogram (ECHO) is obtained the left ventricular ejection fraction (LVEF) should exceed 40%
• Serious concomitant medical illnesses that would jeopardize the patient's ability to receive the regimen with reasonable safety
• HIV positive patients with advanced immune suppression and evidence of HIV resistant to all combinations of antiretroviral therapy considered at high risk of non-lymphoma related death within 12-months due to other acquired immune deficiency syndrome (AIDS) complications should not be enrolled on the study