Nelfinavir Mesylate and Bortezomib in Treating Patients With Relapsed or Progressive Advanced Hematologic Cancer

This is an interventional treatment trial for Leukemia focused on measuring refractory multiple myeloma, recurrent adult acute myeloid leukemia, recurrent adult acute lymphoblastic leukemia, recurrent adult diffuse large cell lymphoma, recurrent adult Hodgkin lymphoma, recurrent mantle cell lymphoma, recurrent adult T-cell leukemia/lymphoma, adult nasal type extranodal NK/T-cell lymphoma, angioimmunoblastic T-cell lymphoma, peripheral T-cell lymphoma, T-cell large granular lymphocyte leukemia, anaplastic large cell lymphoma, recurrent grade 3 follicular lymphoma, recurrent cutaneous T-cell non-Hodgkin lymphoma, recurrent mycosis fungoides/Sezary syndrome, aggressive NK-cell leukemia, adult acute myeloid leukemia with 11q23 (MLL) abnormalities, adult acute myeloid leukemia with inv(16)(p13;q22), adult acute myeloid leukemia with t(15;17)(q22;q12), adult acute myeloid leukemia with t(16;16)(p13;q22), adult acute myeloid leukemia with t(8;21)(q22;q22), secondary acute myeloid leukemia, stage III adult diffuse large cell lymphoma, stage IV adult diffuse large cell lymphoma, stage III adult Hodgkin lymphoma, stage IV adult Hodgkin lymphoma, stage III mantle cell lymphoma, stage IV mantle cell lymphoma, stage III adult T-cell leukemia/lymphoma, stage IV adult T-cell leukemia/lymphoma, stage III grade 3 follicular lymphoma, stage IV grade 3 follicular lymphoma, stage III mycosis fungoides/Sezary syndrome, stage IV mycosis fungoides/Sezary syndrome, stage III cutaneous T-cell non-Hodgkin lymphoma, stage IV cutaneous T-cell non-Hodgkin lymphoma, prolymphocytic leukemia Read More

DISEASE CHARACTERISTICS:

• Diagnosed with advanced hematologic malignancies meeting the following criteria:

  • Multiple myeloma

    • Received ≥ 2 lines of prior chemotherapy (induction chemotherapy followed by high-dose chemotherapy and autologous stem cell transplant with or without maintenance therapy is considered one line of therapy)
  • Acute myeloid leukemia
  • Acute lymphoblastic leukemia
  • Diffuse large B-cell lymphoma
  • Hodgkin lymphoma
  • Mantle cell lymphoma

  • Mature T- and NK-cell neoplasms restricted to the following WHO-defined entities:

    • T-cell prolymphocytic leukemia
    • T-cell large granular lymphocytic leukemia
    • Aggressive NK-cell leukemia
    • Adult T-cell leukemia/lymphoma
    • Extranodal NK/T-cell lymphoma (nasal type)
    • Mycosis fungoides
    • Sézary syndrome
    • Primary CD30-positive T-cell lymphoproliferative disorders
    • Primary cutaneous anaplastic large cell lymphoma
    • Primary cutaneous gamma-delta T-cell lymphoma
    • Peripheral T-cell lymphoma (not otherwise specified)
    • Angioimmunoblastic T-cell lymphoma
    • Anaplastic large cell lymphoma (ALK-positive/ALK-negative)
  • Grade 3B follicular lymphoma
• Relapsed following or progressed during standard therapy

• Meeting the following criteria:

  • Standard intensive therapy is not feasible
  • Current disease state for which there is no standard effective therapy
  • Refused standard therapy where no curative option exists

• Measurable disease, defined as the following:

  • Myeloma: measurable serum monoclonal protein > 1 g/dL for IgG, or > 0.5 g/dL for IgA, IgM or IgD, or difference between involved and uninvolved free light chain levels in serum > 100 mg/L
  • Lymphoma: must have ≥ 1 lesion measurable by CT (longest diameter ≥ 15 mm)
  • Acute leukemia: ≥ 20% blasts in bone marrow or in peripheral blood (≥ 200/mL blasts in peripheral blood)
• No HIV-associated lymphoma

PATIENT CHARACTERISTICS:

• WHO performance status 0-2
• Absolute neutrophil count ≥ 1,500/mm³
• Platelet count ≥ 75,000/mm³ (if bone marrow impairment, ≥ 20,000/mm^3)
• Hemoglobin > 80 g/L (if considered to be caused by the underlying hematologic malignancy or bone marrow impairment, > 80 g/L after transfusion)
• Bilirubin ≤ 1.5 times upper limit of normal (ULN) (if suspected hemolysis, direct bilirubin ≤ 1.5 times ULN)
• ALT ≤ 2.5 times ULN
• Calculated creatinine clearance > 30 mL/min
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 12 months after completion of study treatment
• Willing and capable to comply with an oral regimen
• Capable of understanding information given by the investigator on the trial
• Able to adhere and remain in geographic proximity to allow proper staging, treatment, and followup
• No other non-hematologic malignancy within the past 5 years, except adequately treated cervical carcinoma in situ or localized nonmelanoma skin cancer
• No known chronic hepatitis B or C infection or known HIV infection

• No serious underlying medical condition (at the judgment of the investigator) which would impair the ability of the patient to participate in the trial, including any of the following:

  • Active autoimmune disease
  • Uncontrolled diabetes
  • Ongoing or active infection
  • Symptomatic congestive heart failure
  • Unstable angina pectoris
  • Cardiac arrhythmia
  • Psychiatric disorder
• No myocardial infarction within the past 6 months
• No polyneuropathy > grade 1 significantly interfering with activities of daily living or painful polyneuropathy
• No known hypersensitivity to trial drugs or hypersensitivity to any other component of the trial drugs

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• No more than 4 prior lines of chemotherapeutic regimens (induction chemotherapy followed by high-dose chemotherapy and autologous stem cell transplant with or without maintenance therapy is considered one line of therapy)
• More than 30 days since prior treatment in a clinical trial

• More than 30 days since prior and no concurrent chemotherapy or biologic agents

  • For patients with acute leukemia, hydroxyurea may be given up to 48 hours before first administration of the trial treatment, and low dose cytarabine (up to 20 mg/m^2) and mitoxantrone up to 20 mg up to 14 days before first dosing
• At least 1 week since prior and no concurrent CYP3A4 modulators
• No concurrent other experimental drugs
• No concurrent radiotherapy
• No concurrent antineoplastic therapy with chemotherapeutic or biologic agents