Sorafenib in Treating Patients With Relapsed Chronic Lymphocytic Leukemia

Inclusion Criteria: Histologically or cytologically confirmed chronic lymphocytic leukemia (CLL) by NCI-WG immunophenotype and blood criteria Documentation of current or prior peripheral blood (PB) or bone marrow (BM) immunophenotype compatible with CLL Patients who currently do not have > 5,000/mm³ absolute lymphocytosis are eligible if they have previously met PB lymphocytosis criteria and have a current immunophenotype documenting monoclonal B lymphocytosis morphologically and immunophenotypically compatible with CLL Intermediate-risk (Rai stage I or II) or high-risk (Rai stage III or IV) disease, including any of the following: Rai stage I disease with lymphocytosis and enlarged nodes Rai stage II disease with lymphocytosis plus splenomegaly and/or hepatomegaly (nodes positive or negative) Rai stage III disease with lymphocytosis plus anemia Rai stage IV disease with lymphocytosis and thrombocytopenia Must require treatment with active disease, experiencing disease related symptoms, or having deterioration of blood counts, meeting ≥ 1 of the following criteria: Presence of ≥ 1 of the following disease-related symptoms: Weight loss > 10% within the past 6 months Extreme fatigue (i.e., ECOG performance status 2: cannot work or unable to perform usual activities) Fever > 100.5°F for 2 weeks without evidence of infection Night sweats without evidence of infection Evidence of progressive marrow failure, as manifested by worsening of anemia (hemoglobin < 10 g/dL), thrombocytopenia (platelet count < 100,000/mm³), and/or neutropenia (neutrophil count < 2,000/mm³) Massive (i.e., > 6 cm below left costal margin) or progressive splenomegaly or discomfort from splenomegaly Massive nodes or clusters (i.e., > 10 cm in longest diameter), progressive adenopathy, or discomfort from lymphadenopathy Deterioration of blood counts and/or progressive lymphocytosis, with an increase of ≥ 10% documented over a 2-month period OR an anticipated doubling time < 6 months Relapsed disease Must receive at least 1, but no more than 3, prior chemotherapy regimens with any cytotoxic agent or antibody therapy No fludarabine refractory disease Responded to prior fludarabine without relapse or disease progression for at least 6 months Patients with a history of Coombs-positive hemolytic anemia are eligible provided recovery from treatment of hemolysis and off steroids No stage 0 CLL No known CNS involvement Life expectancy > 6 months ECOG performance status 0-2 OR Karnofsky performance status 70-100% Absolute neutrophil count ≥ 1,000/mm³ Platelets ≥ 30,000/mm³ Bilirubin ≤ 2 mg/dL AST/ALT ≤ 2.5 times upper limit of normal (ULN) Creatinine ≤ 1.5 times ULN OR creatinine clearance ≥ 60 mL/min (for patients with creatinine levels above normal) No currently active second malignancy Not pregnant or nursing Negative pregnancy test Fertile patient must use effective contraception prior to and during study participation No uncontrolled hypertension, defined as blood pressure (BP) > 150/100 mm Hg on 2 different measurements at least 1 day apart with either systolic or diastolic number meeting this definition Patients may later enter the study, if they have achieved stable BP (i.e., < 140/90 mm Hg) on a regimen of ≤ 2 drugs after 6-8 weeks of therapy No history of allergic reactions attributed to compounds of similar chemical or biologic composition to sorafenib No uncontrolled intercurrent illness including, but not limited to, any of the following: Symptomatic congestive heart failure Unstable angina pectoris Cardiac arrhythmia Psychiatric illness or social situations that would limit compliance with the study requirements No active infection requiring systemic antibiotics No evidence of bleeding diathesis No evidence of bowel perforation or obstruction risk No swallowing dysfunction leading to difficulty taking the study drug See Disease Characteristics Recovered from prior therapy At least 2 weeks since prior antibiotic therapy At least 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin C) or radiotherapy At least 12 weeks since prior monoclonal antibody Concurrent warfarin for anticoagulation allowed provided all of the following are met: On a stable therapeutic dose INR ≤ 3 No active bleeding or pathological condition that carries high-risk of bleeding No prior MAPK signaling inhibitor agents or anti-angiogenesis agents No concurrent combination anti-retroviral therapy for HIV-positive patients No concurrent cytochrome P450 enzyme-inducing antiepileptic drugs (phenytoin, carbamazepine, or phenobarbital), rifampin, or Hypericum perforatum (St. John's wort) No other concurrent investigational agents