Bevacizumab and CHOP (A-CHOP) in Combination for Patients With Peripheral T-Cell or Natural Killer Cell Neoplasms

Inclusion Criteria

DISEASE CHARACTERISTICS:

- Diagnosis of peripheral T-cell or natural killer cell neoplasm

- Any stage disease allowed

- HTLV-positive tumors allowed

- At least 1 objective measurable disease parameter

- Abnormal positron emission tomography scans are not considered evidence of
measurable disease unless results are confirmed by CT scan or other appropriate
imaging techniques

- No anaplastic lymphoma kinase (ALK)-positive T-cell large cell lymphoma

- ALK-negative T-cell large cell lymphoma allowed

- No cutaneous T-cell lymphoma

- No history of or current radiographic evidence of CNS metastasis, including
previously treated, resected, or asymptomatic brain lesions or leptomeningeal
involvement

PATIENT CHARACTERISTICS:

Age

- 18 and over

Performance status

- ECOG 0-2

Life expectancy

- Not specified

Hematopoietic

- Absolute neutrophil count ≥ 1,000/mm^3(500/mm^3 if due to bone marrow involvement
with lymphoma)

- Platelet count ≥ 100,000/mm^3(50,000/mm^3 if due to bone marrow involvement with
lymphoma)

- No evidence of bleeding diathesis or coagulopathy

Hepatic

- Bilirubin ≤ 2.0 mg/dL (≤ 3 times upper limit of normal [ULN] if due to hepatic
involvement with lymphoma)

- AST ≤ 2 times ULN (5 times ULN if due to hepatic involvement with lymphoma)

- PT, INR, and PTT ≤ 1.5 times normal

Renal

- Creatinine ≤ 2.0 mg/dL

- Urinary protein:creatinine ratio ≤ 1

Cardiovascular

- No cerebrovascular accident within the past 6 months

- No myocardial infarction within the past 6 months

- No unstable angina within the past 6 months

- No New York Heart Association class II-IV congestive heart failure

- No uncontrolled hypertension (i.e., systolic blood pressure [BP] > 150 mm Hg or
diastolic BP > 100 mm Hg)

- No other clinically significant cardiovascular or peripheral vascular disease

- History of deep venous thrombosis allowed provided patient is on a stable dose of
anticoagulants for at least 2 weeks prior to study entry

- LVEF ≥ 50%

Pulmonary

- History of pulmonary embolism allowed provided patient is on a stable dose of
anticoagulants for at least 2 weeks prior to study entry

Gastrointestinal

- No abdominal fistula within the past 6 months

- No gastrointestinal perforation within the past 6 months

- No intra-abdominal abscess within the past 6 months

Other

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

- No history of active seizures

- No significant traumatic injury within the past 4 weeks

- No non-healing ulcer (unless involved with lymphoma)

- No bone fracture

- No active infection requiring parenteral antibiotics

- No known HIV positivity

- No other active malignancy within the past 6 months except carcinoma in situ of the
cervix or basal cell carcinoma of the skin

PRIOR CONCURRENT THERAPY:

Biologic therapy

- Not specified

Chemotherapy

- One prior cycle of CHOP for PTCL allowed

Endocrine therapy

- Not specified

Surgery

- More than 4 weeks since prior major invasive surgery or open biopsy

- At least 7 days since prior minor surgery

- Peripheral lymph node core biopsy, bone marrow biopsy, fine needle aspiration,
skin biopsy, or central line placement are not considered minor surgical
procedures

- No concurrent major surgery

Other

- More than 7 days since prior and no concurrent anti-platelet drugs (e.g.,
ticlopidine, clopidogrel, or cilostazol) except aspirin or other nonsteroidal
anti-inflammatory drugs

- Concurrent anticoagulants allowed provided patient is on a stable dose

- INR must be stable for at least 2 weeks prior to study entry

- PT/INR and/or PTT must be closely monitored and levels kept within acceptable
range for underlying thrombotic disease

- Concurrent heparin flush for maintenance of central line patency allowed