Ofatumumab and Dinaciclib in Treating Patients With Relapsed or Refractory Chronic Lymphocytic Leukemia, Small Lymphocytic Lymphoma, or B-Cell Prolymphocytic Leukemia

• Maximum-tolerated dose graded according to the National Cancer Institute (NCI ) CTCAE v4.0 (Phase I) [ Time Frame: Up to day 56 ] [ Designated as safety issue: Yes ]
  Assessed using the continuous variables as the outcome measures (primarily nadir and percent change from baseline values) as well as categorization.
• Number of dose-limiting toxicity incidents graded according to the NCI CTCAE v4.0 (Phase I) [ Time Frame: Up to day 56 ] [ Designated as safety issue: Yes ]
  The maximum grade for each type of toxicity will be recorded for each patient, and frequency tables will be reviewed to determine toxicity patterns.
• Proportion of patients who achieve an overall response, defined as achieving a complete response (CR), an unconfirmed complete response (Cru, SLL only), or a partial response (PR) (Phase II) [ Time Frame: Up to 7 courses ] [ Designated as safety issue: No ]
  The 95% confidence intervals should also be provided.

• Maximum-tolerated dose (Phase I) [ Designated as safety issue: No ]
• Number of dose-limiting toxicity incidents (Phase I) [ Designated as safety issue: Yes ]
• Proportion of patients who achieve an overall response (Phase II) [ Designated as safety issue: No ]

• Complete response rate [ Time Frame: Up to 7 courses ] [ Designated as safety issue: No ]
  95% confidence intervals will be constructed using the methods of Duffy and Santner with the assumption that these rates are binomially distributed.
• PFS [ Time Frame: Time from study entry to documentation of disease progression and/or death, assessed up to 5 years ] [ Designated as safety issue: No ]
  95% confidence intervals will be constructed using the methods of Duffy and Santner with the assumption that these rates are binomially distributed. Distributions will be explored and assessed using the methods of Kaplan and Meier.
• Overall survival [ Time Frame: Time from study entry to death due to any cause, assessed up to 5 years ] [ Designated as safety issue: No ]
  Distributions will be explored and assessed using the methods of Kaplan and Meier.
• Time to treatment failure [ Time Frame: Time from study entry to the date patients end treatment, up to 7 courses ] [ Designated as safety issue: No ]
  Distributions will be explored and assessed using the methods of Kaplan and Meier.

• Complete response rate [ Designated as safety issue: No ]
• PFS [ Designated as safety issue: No ]
• Overall survival [ Designated as safety issue: No ]
• Time to treatment failure [ Designated as safety issue: No ]
• Correlation between prognostic markers and response to therapy [ Designated as safety issue: No ]

This phase I/II trial studies the side effects and the best dose of ofatumumab and dinaciclib and to see how well they work in treating patients with relapsed or refractory chronic lymphocytic leukemia, small lymphocytic lymphoma, or B-cell prolymphocytic leukemia. Monoclonal antibodies, such as ofatumumab, can block cancer growth in different ways. Some block the ability of cancer to grow and spread. Others find cancer cells and help kill them or carry cancer-killing substances to them. Dinaciclib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving ofatumumab together with dinaciclib may kill more cancer cells

PRIMARY OBJECTIVES:

I. To determine the tolerable dose of combination therapy with ofatumumab and dinaciclib (phase 1b component) in chronic lymphocytic leukemia (CLL), small lymphocytic leukemia (SLL), and B-cell prolymphocytic leukemia (B-PLL).

II. To characterize the toxicity of combination therapy with ofatumumab and dinaciclib in CLL/SLL/B-PLL.

III. To determine the overall response rate associated with this treatment as assessed by consensus response criteria. (Phase II)

SECONDARY OBJECTIVES:

I. To estimate progression-free survival (PFS) after combination treatment with ofatumumab and dinaciclib.

II. To characterize the pharmacokinetics of dinaciclib when given in combination with ofatumumab.

III. To correlate pharmacokinetic features of dinaciclib with response, toxicity (particularly tumor lysis syndrome), and pharmacodynamic endpoints.

IV. To perform detailed baseline and serial pharmacodynamic studies of combination therapy with ofatumumab and dinaciclib and correlate these with response to therapy.

V. To correlate baseline disease-risk parameters (i.e., ZAP-70 expression, interphase cytogenetics, IgVH mutational analysis, and other clinical prognostic factors) with response to therapy. (Exploratory)

OUTLINE: This is a phase I, dose-escalation study followed by a phase II study.

Patients receive ofatumumab IV over 4-6 hours on days 1, 8, 15, and 22 of courses 1-2, and on day 1 of courses 4-7. Beginning on course 2, patients also receive dinaciclib IV over 2 hours on days 2, 8, and 15 of course 2, and on days 1, 8, and 15 of courses 3-7. Treatment repeats every 28 days for up to 7 courses in the absence of disease progression or unacceptable toxicity.

Plasma, serum, urine, and buccal swab samples are collected at baseline and periodically during study for pharmacokinetic, pharmacogenomic, and pharmacodynamic studies, and other biomarker studies.

After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for up to 5 years.

• B-cell Chronic Lymphocytic Leukemia
• Prolymphocytic Leukemia
• Recurrent Small Lymphocytic Lymphoma
• Refractory Chronic Lymphocytic Leukemia

• Biological: ofatumumab
  Given IV
  Other Names:

  • Arzerra
  • HuMax-CD20
• Drug: dinaciclib
  Given IV
  Other Names:

  • CDK inhibitor SCH 727965
  • cyclin-dependent kinase inhibitor SCH 727965
  • SCH 727965
• Other: laboratory biomarker analysis
  Correlative studies
• Other: pharmacological study
  Correlative studies
  Other Name: pharmacological studies

Inclusion Criteria:

• Patients must have histologically confirmed B-cell chronic lymphocytic leukemia (B-CLL)/small lymphocytic lymphoma (SLL) or a B-cell prolymphocytic leukemia (B-PLL) according to 2008 World Health Organization (WHO) diagnostic criteria

• Patients must meet one or more of the following modified indications for treatment as described in the 2008 International Workshop on chronic lymphocytic leukemia (CLL) (IWCLL) guidelines for the diagnosis and treatment of CLL:

  • Progressive disease or marked splenomegaly and/or lymphadenopathy or disease requiring de-bulking for future allogeneic transplantation
  • Anemia (hemoglobin < 11 mg/dL) or thrombocytopenia (platelets < 100,000/μL)
  • Unexplained weight loss exceeding 10% of body weight over the preceding 6 months
  • Cancer Therapy Evaluation Program (CTEP) Active Version of the Common Terminology Criteria for Adverse Events (CTCAE) grade 2 or 3 fatigue
  • Fevers > 100.5 º F or night sweats for greater than 2 weeks without evidence of infection
  • Progressive lymphocytosis, with an increase exceeding 50% over a 2-month period or a doubling time of less than 6 months
  • Need for cytoreduction prior to allogeneic stem cell transplant
• Patients with known brain metastases should be excluded from this clinical trial
• Patients previously treated with ofatumumab will be eligible as long as their disease responded to previous treatment (defined as achieving at least stable disease by consensus criteria) and did not subsequently progress < 3 months from completing treatment
• Eastern Cooperative Oncology Group (ECOG) performance status ≤ 2 (Karnofsky ≥ 60%)
• Life expectancy ≥ 12 weeks
• Absolute neutrophil count ≥ 1,000/μL in absence of bone marrow involvement
• Platelets ≥ 30,000/μL in absence of bone marrow involvement
• Total bilirubin ≤ 5 times institutional upper limit of normal (ULN) unless secondary to Gilbert syndrome
• Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamic pyruvate transaminase[SGPT]) ≤ 2.5 times institutional ULN unless due to infiltration of the liver
• Creatinine ≤ 2.0 mg/dL OR creatinine clearance ≥ 50 mL/min
• Organ and marrow function; documented by bone marrow pathology obtained within 6 months of beginning protocol treatment if no intervening therapy for CLL/SLL/B-PLL
• Patients with a history of current/previous infection with hepatitis B virus will be eligible if receiving appropriate antiviral prophylaxis
• Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation
• Pregnant and/or breast-feeding women are excluded from this study
• No history of allergic reactions attributed to compounds of similar chemical or biologic composition as dinaciclib
• No history of anaphylactic reaction to rituximab or other anti-CD20 monoclonal antibody
• Patients with glucose-6-phosphate dehydrogenase(G6PD) deficiency are excluded
• No uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
• No prior malignancy, except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer from which the subject is considered by his or her physician to have a 2-year survival expectation
• Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral therapy are ineligible because of the potential for pharmacokinetic interactions with dinaciclib
• Patients must have received at least one prior therapy that includes either fludarabine or equivalent nucleoside analogue, or an alternative regimen if there was a contraindication (i.e., autoimmune hemolytic anemia) or patient elected not to receive fludarabine

• No patients who have had chemotherapy or radiotherapy within 4 weeks (6 weeks for nitrosoureas or mitomycin C) prior to entering the study or those who have not recovered from adverse events due to agents administered more than 4 weeks earlier

  • Corticosteroids alone will not be considered prior therapy, but must be discontinued at least 24 hours prior to the first day of therapy unless continued for indications other than the primary malignancy
• No patients who are receiving any other investigational agent
• Patients who have received prior treatment with dinaciclib will not be eligible