Gemcitabine and Hodgkin's Disease Chemotherapy Followed by Peripheral Blood Stem Cell Rescue for Hodgkin's Disease

To assess the non-hematologic toxicity and determine the phase 2 dose of gemcitabine in combination with vinorelbine followed by carmustine, etoposide and cyclophosphamide and autologous hematopoietic stem cell transplantation [aka peripheral blood stem cell (PBSC)].

Inclusion criteria

• Histologically-proven recurrent or refractory Hodgkin's Disease (Hodgkin's lymphoma) on the basis of excisional biopsy whenever possible.
• Age < 70 years
• Eastern Cooperative Oncology Group (ECOG) performance status 0 to 3.
• Phase 1 study component only: 1 or more of the following adverse risk factors

• Stage IV extranodal disease at relapse "B" symptoms
• Failure to achieve minimal disease with most recent chemotherapy (single lymph nodes < 2 cm or >75% reduction in a bulky tumor mass and bone marrow involvement < 10%)
• Progression during induction or salvage therapy
• Phase 2 study component only: No risk factor criteria
• Computerized tomography (CT) scan of the chest, abdomen and pelvis, with assessment of response to last chemotherapy, within 4 weeks of registration. Gallium scan or positron emission tomography (PET) scan confirmation of disease within 4 weeks of registration is highly recommended
• Bone marrow biopsy and cytogenetic analysis within 8 weeks of registration
• Women of child-bearing potential and sexually active males expected to use an accepted and effective method of birth control
• Pretreatment serum bilirubin < 2 x the institutional upper limit of normal (ULN) (within 28 days prior to registration)
• Serum creatinine < 2 x the institutional ULN (within 28 days prior to registration)
• Measured or estimated creatinine clearance > 60 cc/min by the following formula (within 28 days prior to registration):

• Estimated Creatinine Clearance = (140 age) x WT(kg) x 0.85 (if female) x creatinine (mg/dL)
• Electrocardiogram (ECG) demonstrating no significant abnormalities suggestive of active cardiac disease (within 42 days prior to registration)
• Patients over age 50, who have received chest irradiation or a total of 300 mg/m2 of doxorubicin or with any history of cardiac disease must have a radionuclide ejection fraction (within 42 days prior to registration). If the ejection fraction is 40 to 50%, the patient will have a cardiology consult
• Corrected diffusion capacity > 55%
• Written informed consent in accordance with institutional and federal guidelines

Exclusion criteria

• Positive HIV antibody test (must be conducted within 42 days of registration)
• No chemotherapy other than corticosteroids should be administered within 2 weeks of the initiation of protocol therapy
• Pregnant
• Breast-feeding
• Requiring therapy for:

• Coronary artery disease
• Cardiomyopathy
• Dysrhythmia, or
• Congestive heart failure
• Over age 50 and has received chest irradiation or a total of 300 mg/m^2 of doxorubicin
• History of cardiac disease and the ejection fraction is < 40% (radionuclide ejection fraction must be within 42 days of registration)
• Known allergy to etoposide
• History of Grade 3 hemorrhagic cystitis with cyclophosphamide
• History of grade 2 or greater sensory or motor peripheral neuropathy due to prior vinca alkaloid use
• No prior malignancy (EXCEPTION: adequately treated basal cell or squamous cell skin cancer; in situ cervical cancer; or other cancer for which the patients has been disease-free for 5 years). Patients with a prior diagnosis of non-Hodgkin's lymphoma are not eligible.