17-N-Allylamino-17-Demethoxygeldanamycin With or Without Rituximab in Treating Patients With Relapsed B-Cell Chronic Lymphocytic Leukemia or Prolymphocytic Leukemia
B-cell Chronic Lymphocytic Leukemia, Prolymphocytic Leukemia, Refractory Chronic Lymphocytic Leukemia
About this trial
This is an interventional treatment trial for B-cell Chronic Lymphocytic Leukemia
Eligibility Criteria
Inclusion Criteria: Histologically confirmed B-cell chronic lymphocytic leukemia or prolymphocytic leukemia requiring treatment, defined by 1 of the following criteria: Massive or progressive splenomegaly and/or lymphadenopathy Anemia (hemoglobin < 11 g/dL) OR thrombocytopenia (platelet count < 100,000/mm^3) Weight loss > 10% within the past 6 months Grade 2 or 3 fatigue Fevers > 100.5°F or night sweats for > 2 weeks with no evidence of infection Progressive lymphocytosis with an increase of > 50% over a 2 month period OR an anticipated doubling time of < 6 months Relapsed disease Failed prior fludarabine or pentostatin therapy OR cannot receive fludarabine Lymphocyte count ≥ 5,000/mm^3 Performance status - ECOG 0-2 Performance status - Karnofsky 60-100% More than 12 weeks Bilirubin < 1.5 times upper limit of normal (ULN) AST and ALT ≤ 2.5 times ULN Creatinine ≤ 2.0 mg/dL LVEF > 40% by MUGA QTc < 450 msec for male patients and < 470 msec for female patients Resting ejection fraction ≥ 50% by MUGA or echocardiogram No symptomatic congestive heart failure No unstable angina pectoris No cardiac arrhythmia No significant cardiac disease including any of the following: New York Heart Association class III or IV heart failure History of myocardial infarction within the past year History of uncontrolled dysrhythmias Active ischemic heart disease within the past year Poorly controlled angina No history of serious ventricular arrhythmia (e.g., ventricular fibrillation, history of symptomatic or sustained ventricular tachycardia, nonsustained ventricular tachycardia > 3 beats within the past 6 months) No history of cardiac toxicity due to anthracyclines (e.g., doxorubicin hydrochloride, daunorubicin hydrochloride, or mitoxantrone hydrochloride) No other cardiac symptoms ≥ grade 2 DLCO (i.e., oxygen diffusion capacity) ≥ 80% by pulmonary function testing Resting and exercise oxygen saturation ≥ 90% by pulse oximetry No pulmonary symptoms ≥ grade 2 No history of pulmonary toxicity due to bleomycin or carmustine No significant, symptomatic pulmonary disease requiring oxygen or medications No ongoing pulmonary symptoms ≥ grade 2 including any of the following: Dyspnea on or off exertion Paroxysmal nocturnal dyspnea Significant pulmonary disease (e.g., chronic obstructive or restrictive pulmonary disease) No Medicare requirements for home oxygen (e.g., resting O_2 saturations ≥ 90% or desaturation to ≥ 90% with exertion) Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception HIV negative No history of allergic reaction attributed to compounds of similar chemical or biologic composition to 17-N-allylamino-17-demethoxygeldanamycin No history of serious allergic reaction to eggs No ongoing or active infection No psychiatric illness or social situation that would preclude study compliance No other uncontrolled illness that would preclude study participation More than 3 months since prior rituximab and recovered More than 4 weeks since prior chemotherapy (6 weeks for nitrosoureas or mitomycin) and recovered More than 4 weeks since prior radiotherapy and recovered No prior radiotherapy that potentially included the heart in the field (e.g., mantle) No history of chest radiation No concurrent medications that prolong or may prolong QTc No concurrent antiarrhythmic drugs No other concurrent investigational agents No other concurrent anticancer therapy
Sites / Locations
- Ohio State University Medical Center
Arms of the Study
Arm 1
Experimental
Treatment (17-AGG and rituximab)
Patients receive 17-AAG IV over 2 hours on days 1, 4, 8, 11, 15 and 18 (course 1). Patients achieving ≥ 25% reduction in measurable disease after course 1 receive an additional course of single-agent 17-AAG approximately 10 days later in the absence of disease progression or unacceptable toxicity and provided absolute lymphocyte count continues to decrease. Patients failing to achieve a 25% reduction in measurable disease after course 1 OR with disease progression after courses 1 or 2 of single-agent 17-AAG proceed to combination therapy comprising 17-AAG IV over 2 hours on days 1, 4, 8, 11, 15, 18, and 22; and rituximab IV over 4 hours on days 1 and 2 and over 1 hour on days 4, 8, 15, and 22 in the absence of disease progression or unacceptable toxicity.