Rituximab, Pentostatin, Cyclophosphamide, and Lenalidomide in Treating Patients With Previously Untreated B-Cell Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma

This is an interventional treatment trial for Leukemia focused on measuring B-cell chronic lymphocytic leukemia, stage I chronic lymphocytic leukemia, stage II chronic lymphocytic leukemia, stage III chronic lymphocytic leukemia, stage IV chronic lymphocytic leukemia, contiguous stage II small lymphocytic lymphoma, noncontiguous stage II small lymphocytic lymphoma, stage I small lymphocytic lymphoma, stage III small lymphocytic lymphoma, stage IV small lymphocytic lymphoma Read More

DISEASE CHARACTERISTICS:

• Diagnosis of chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL), meeting the following criteria:

  • Biopsy-proven SLL according to WHO criteria

  • CLL diagnosis* according to NCI working group criteria as evidenced by all of the following:

    • Peripheral blood lymphocyte count of > 5,000/mm³
    • Small to moderate peripheral blood lymphocyte with < 55% prolymphocytes

    • Immunophenotyping consistent with CLL defined as:

      • B-cell markers with CD5 antigen in the absence of other pan-T-cell markers (e.g., CD3, CD2)
      • CD19, CD20, or CD23
      • Dim surface immunoglobulin expression
      • Exclusively kappa or lambda light chains
    • Diagnosis of mantle cell lymphoma must be excluded by negative FISH analysis for t(11;14)(IgH/CCND1) on peripheral blood or tissue biopsy or negative immunohistochemical stains for cyclin D1 on involved tissue biopsy NOTE: *Splenomegaly, hepatomegaly, or lymphadenopathy are not required for the diagnosis of CLL

• Previously untreated disease and meets ≥ 1 of the following criteria*:

  • At least 1 or more of the following disease-related symptoms:

    • Weight loss > 10% within the previous 6 months
    • Extreme fatigue attributed to CLL
    • Fevers > 100.5º F for 2 weeks without evidence of infection
    • Night sweats without evidence of infection
  • Evidence of progressive marrow failure as manifested by the development of or worsening anemia (i.e., hemoglobin ≤ 11 g/dL) and/or thrombocytopenia (i.e., platelet count ≤ 100,000/mm³) not due to autoimmune disease
  • Symptomatic or progressive lymphadenopathy, splenomegaly, or hepatomegaly
  • Progressive lymphocytosis due to CLL with an increase of > 50% over a 2-month period or an anticipated doubling time < 6 months NOTE: *Marked hypogammaglobulinemia or the development of a monoclonal protein in the absence of any of the above criteria for active disease are not sufficient for protocol therapy

PATIENT CHARACTERISTICS:

• ECOG performance status 0-3
• Serum creatinine ≤ 1.5 times upper limit of normal (ULN)

• Total bilirubin ≤ 3.0 times ULN (unless due to Gilbert disease)

  • Direct bilirubin < 1.5 mg/dL for Gilbert disease to be diagnosed if total bilirubin > 3.0 times ULN
• AST and ALT ≤ 3.0 times ULN (unless due to hemolysis or CLL)
• Willing to provide blood samples
• Able to take acetylsalicylic acid (ASA) (81 or 325 mg) daily as prophylactic anticoagulation (patients intolerant to ASA may use low molecular weight heparin)
• Not pregnant or nursing
• Negative pregnancy test
• Female patients must use effective double-method contraception beginning 1 month prior to, during, and for 4 weeks after completion of study treatment
• Male patients must use effective contraception during and for 4 weeks after completion of study treatment

• No comorbid conditions, including any of the following:

  • New York Heart Association class III or IV heart disease
  • Recent myocardial infarction (< 1 month)
  • Uncontrolled infection
  • Infection with HIV/AIDS
• No other active primary malignancy requiring treatment or that limits survival to ≤ 2 years
• No history of deep venous thrombosis or pulmonary embolism ≤ 12 months prior to study registration
• No active hemolytic anemia requiring immunosuppressive or other pharmacologic therapy

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• No prior chemotherapy or monoclonal antibody-based therapy for treatment of CLL
• Nutraceutical treatments with no established benefit in CLL (e.g., epigallocatechin gallate or other herbal treatments) are not considered prior therapy
• More than 4 weeks since prior radiotherapy
• At least 4 weeks since prior major surgery

• No concurrent corticosteroids

  • Concurrent low doses of steroids (e.g., < 10 mg of prednisone or equivalent dose of other steroid) used for treatment of non-hematologic medical conditions allowed
  • Prior use of corticosteroids allowed
• No prior thalidomide or lenalidomide

• No concurrent therapeutic doses of coumadin-derivative anticoagulants (e.g., warfarin)

  • Doses of ≤ 2 mg daily allowed for thrombosis prophylaxis
  • Prophylactic doses of low molecular weight heparin allowed