Dose Adjusted EPOCH-R, to Treat Mature B Cell Malignancies

"Day 1: Rituximab IV~Days 1-4: After rituximab, etoposide, vincristine, and doxorubicin will be given in a vein over 96 hours as a continuous infusion.~Day 5: cyclophosphamide will be given in a vein~Days 1-5: prednisone given by mouth twice a day~G-CSF 5mcg/kg/day will be given under the skin from day 6 until ANC has improved."

"CNS negative patients with high CNS risk DLBCL will receive age based, intrathecal dosing of MTX on days 1 and 5 of cycles 3 - 6 only.~CNS positive patients will receive age based, intrathecal (within the spinal fluid) MTX twice weekly for 2 weeks past the first negative cytology with a minimum of 4 weeks treatment. Then, weekly for 6 weeks and then every 4 weeks for 6 months.~DLBCL/PTLD/PMBCL CNS prophylaxis for cycles 3-6 ONLY if:~* 2+ extranodal sites~* elevated LDH,~* MYC rearrangement OR~* bone or marrow disease.~ALL OTHERS receive IT MTX cycles 3-6."

Etoposide will be given at 50mg/m2/day on days 1-4 of the first cycle of therapy (dose based on patient height and weight). The doses in later cycles will be adjusted up or down based on the patient's blood test results.

Doxorubicin will be given at 10mg/m2/day on days 1-4 of the first cycle (dose based on patient height and weight). The doses in later cycles will be adjusted up or down based on the patient's blood test results.

Vincristine will be given on days 1-4 of each cycle at 0.4mg/m2/day (dose based on patient height and weight).

Rituximab (375mg/m2/dose) will only be given on Day 1 of each cycle prior to all the other chemotherapy agents. Dose is based on patient height and weight.

Cyclophosphamide will be given on Day 5 of each cycle. In cycle 1, the dose will be 750 mg/m2 (based on patient height and weight), and the dose will be adjusted up or down for future cycles based on blood test results.

Prednisone will be given by mouth at 60mg/m2/dose (based on height and weight) twice a day on days 1-5 of each cycle.

G-CSF will be given at 5 mcg/kg/day during each cycle, starting on day 6, until the patient's ANC (absolute neutrophil count) is greater than 5000/mcL past nadir.