A Pilot Study to Evaluate the Safety and Efficacy of Rituximab in Combination with Out-Patient Based Vinorelbine, Gemcitabine and Pegfilgrastim (VGF)/Pegfilgrastim, Gemcitabine, Ifosfamide and Vinorelbine (F-GIV) Salvage Therapies in the treatment of Relapsed/Refractory CD20+ Lymphomas.

This is an open label, Phase II, pilot study of 12 patients using a risk-adjusted outpatient-based approach to non- Hodgkin Lymphoma salvage therapy with R-VGF (Rituximab 375mg/m2 IV, Vinorelbine 25mg/m2 IV, Gemcitabine 1000mg/m2 IV and Pegfilgrastim 6mg subcutaneous) and R-F-GIV (Rituximab 375mg/m2 IV, Gemcitabine 1000mg/m2 IV, Ifosfamide 3g/m2 IV, Vinorelbine 25mg/m2 IV and Pegfilgrastim 6mg subcutaneous. Patients will be stratified at the time of accrual to 1 of 3 groups: Good risk (Group 1), poor risk (Group 2) or post-transplant (Group 3). Patients in Groups 1 and 3 will commence treatment with R-VGF. Patients in Group 2 will commence treatment with R-F-GIV. Patients failing to show an adequate response following 2 cycles of therapy and who do not have progressive disease will escalate to a more intensive regimen for 2 further cycles of therapy (R-VGF to R-F-GIV, R-F-GIV to IVAC). IVAC comprises Etoposide 60mg/m2 IV and Ifosfamide 1.5g/m2 IV given on Day 1 to 5, Cytarabine 2g/m2 IV given on Day 1 and 2 and Pegfilgrastim 6mg subcutaneous given on Day 6 of each 21 Day cycle. The pegylated form of Filgrastim, Pegfilgrastim, will be used once per cycle instead of daily Filgrastim. Patients will receive treatment on Day 1 and 8 of every 3 week cycle.