Rituximab Plus CHOP Chemotherapy for Diffuse Large B-cell Lymphoma

Inclusion Criteria: * Informed consent obtained and signed. Age 18-60 years. ECOG performance status (PS) 0-2. Histologically confirmed CD20-positive DLBCL, any stage, bulky or nonbulky disease. * No prior treatment for lymphoma. Willing to have documentation of HIV status. CD4 count ≥ 100 cells/µL if HIV-infected. Measurable disease by physical exam. * Adequate bone marrow renal and hepatic function as evidenced by the following: * Absolute neutrophil count (ANC) ≥ 1,000/µL * Platelet count ≥ 100,000/µL * Creatinine ≤ 1.5 mg/dL * Total bilirubin ≤ 2 mg/dL (unless directly attributable to lymphoma) * Able to understand and comply with protocol requirements for the entire length of the study. * Willing to reside \<50 kilometers from Kamuzu Central Hospital (KCH) until chemotherapy completion. * Negative urine B-HCG in women of child-bearing potential within 7 days prior to start of treatment. * Fertile patients must use effective contraception (condom or other barrier methods, oral contraceptives, implantable contraceptives, intrauterine devices) during and for six months after completion of treatment. Exclusion Criteria * Pregnant or nursing. Central nervous system (CNS) involvement by lymphoma (clinically or cytologically confirmed). * Receiving other anti-cancer or investigational therapy during study treatment, apart from those agents specified in the study protocol. * Known cardiac disease including any of the following: * New York Heart Association (NYHA) Grade II or greater congestive heart failure * History of myocardial infarction or unstable angina within 6 months prior to Day 1 * History of stroke or transient ischemic attack within 6 months prior to Day 1 * Second active malignancy requiring systemic therapy. * Hepatitis B virus (HBV) surface-antigen positive unless receiving both tenofovir and lamivudine as part of antiretroviral therapy if HIV-infected. * Other serious, ongoing, non-malignant disease or infection that would in the opinion of the site investigator compromise other protocol objectives.