Ofatumumab in Treating Patients With Previously Untreated Stage II, Stage III, or Stage IV Follicular Non-Hodgkin Lymphoma

DISEASE CHARACTERISTICS:

• Histologically confirmed follicular non-Hodgkin lymphoma (NHL) meeting 1 of the following criteria:
• Bulky (i.e., single mass ≥ 7cm in any uni-dimensional measurement) stage II disease
• Stage III or IV disease
• WHO grade 1, 2, or 3a disease
• Bone marrow biopsies allowed provided they are submitted in conjunction with nodal biopsies
• No fine-needle aspirates for diagnosis
• Tumor tissue must express the CD20-positive antigen by flow cytometry or IHC
• At least 1 site of measurable disease that is > 1 cm in diameter in ≥ 1 dimension present either on physical exam or imaging studies
• Non-measurable disease alone not allowed, including the following:
• Bone lesions (lesions if present should be noted)
• Ascites
• Pleural/pericardial effusion
• Lymphangitis cutis/pulmonis
• Bone marrow (involvement by NHL should be noted)
• Low- or intermediate-risk disease by the Follicular Lymphoma International Prognostic Index (FLIPI)
• FLIPI score meeting 1 or 2 of the following risk factors:
• Age > 60 years
• Involvement of > 4 nodal sites
• Stage III-IV disease
• Hemoglobin < 12.0 g/dL
• LDH normal
• Risk determined by the following:
• Low Risk: 0-1 of the above risk factors
• Intermediate Risk: 2 risk factors
• Poor Risk: ≥ 3 risk factors
• No known CNS involvement

PATIENT CHARACTERISTICS:

• ECOG performance status 0-2
• ANC ≥ 1,000/μL
• Platelet count ≥ 75,000/μL
• Creatinine clearance ≥ 30 mL/min
• Bilirubin ≤ 2 times upper limit of normal (unless secondary to Gilbert syndrome or hepatic involvement of NHL)
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 3 months after completion of study treatment
• Patients with HIV infection allowed provided the following criteria are met:
• No evidence of coinfection with hepatitis B or C
• CD4+ cell count ≥ 400/mm³
• No evidence of resistant strains of HIV
• HIV viral load < 10, 000 copies HIV RNA/mL if not on anti-HIV therapy OR HIV viral load < 50 copies if on anti-HIV therapy
• No history of AIDS-defining conditions
• No evidence of active hepatitis B (HBV) or C (HCV) infection (i.e., no positive serology for anti-HBc or anti-HCV antibodies)
• HBV seropositivity allowed (HBsAg+) provided they are closely monitored for evidence of active HBV infection by HBV DNA testing
• After completing treatment, HBsAg + patients must be monitored by HBV DNA testing every 2 months for 6 months post-treatment, while continuing lamivudine (required)

PRIOR CONCURRENT THERAPY:

• No prior chemotherapy or immunotherapy (e.g., monoclonal antibody-based therapy) for NHL
• Prior involved-field radiation therapy allowed
• More than 2 weeks since prior corticosteroids except for maintenance therapy for a non-malignant disease
• No concurrent dexamethasone or other steroids as antiemetics
• No live virus vaccination within 6 weeks prior to study entry
• No concurrent zidvoudine or stavudine