This phase II trial studies the side effects and how well ibrutinib works in treating patients with chronic lymphocytic leukemia who responded to initial treatment used to reduce a cancer (front-line therapy) but have residual disease. Ibrutinib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth.
PRIMARY OBJECTIVES: I. Determine the rate of minimal residual disease (MRD)-negative responses (in both blood and bone marrow) at any time during treatment with ibrutinib maintenance. SECONDARY OBJECTIVES: I. Median time to achieve MRD- (negative) status (in blood and in bone marrow) after initiation of ibrutinib maintenance treatment. II. Toxicity profile of ibrutinib as maintenance therapy after frontline induction. III. Durability of the MRD- state (determined from the time of first documentation of MRD- until the first documentation of MRD+ (positive) (or last date shown to be MRD- for a censor). IV. Determine the number of patients who improve their remission category (i.e., upgrade clinical response achieved after the induction such as from partial response \[PR\] to complete response \[CR\]) after initiating the maintenance therapy. V. Time to requirement of next therapy for patients who achieve confirmed MRD- vs. those who remain MRD+ disease at 48 weeks (end of 12 cycles). VI. Progression free survival (as determined by the International Workshop on Chronic Lymphocytic Leukemia \[IWCLL\] criteria) among patients who achieve confirmed MRD- vs. those who remain MRD+ disease at 48 weeks (end of 12 cycles). TERTIARY OBJECTIVES: I. To conduct correlative studies for further understanding of the mechanism of antitumor activity of ibrutinib in eradication of the MRD. II. Determine the impact of ibrutinib on depression and anxiety symptoms to better understand toxicity profile of ibrutinib maintenance. III. Determine impact of social support or lack thereof on mood symptoms in chronic lymphocytic leukemia (CLL) patients receiving maintenance treatment. OUTLINE: Patients receive ibrutinib orally (PO) once daily (QD) on days 1-28. Treatment repeats every 4 weeks\* for up to 36 courses in the absence of disease progression or unacceptable toxicity. Note: \*The last course may last up to 56 days to accommodate the study drug discontinuation visit. After completion of study treatment, patients are followed up every 3-6 months for up to 2 years.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
35
Given PO
Correlative studies
Mayo Clinic in Florida
Jacksonville, Florida, United States
Rate of Confirmed MRD-negative Response
This outcome is summarized by the proportion of patients achieving MRD negative status. A confirmed MRD-negative response is defined as an achievement of MRD-negative status in both the blood and the bone marrow on two consecutive evaluations at least 3 months apart.
Time frame: 3 years
Duration of MRD-negative Response
Defined as the time from the earliest date that the patient was noted as having MRD-negative response in both the blood and bone marrow until the first notation of MRD positive disease in the blood or the bone marrow.
Time frame: 5 years
Improvement in Clinical Response
Assessed using International Workshop on Chronic Lymphocytic Leukemia (iwCLL) criteria
Time frame: Baseline to up to 5 years
Incidence of Adverse Events
Will be graded according to the Grading Scale for Hematologic Adverse Events in CLL Studies. The maximum grade for each type of adverse event, regardless of causality, will be recorded and reported for each patient, and frequency tables will be reviewed to determine adverse event patterns.
Time frame: Up to 30 days after the last day of study drug treatment
Progression-free Survival
Defined as the time from the 48-week MRD evaluation until the time of disease progression per the IWCLL criteria or death due to any cause
Time frame: Up to 5 years
Time to MRD-negative Response
Defined as the time from the date of registration to the earliest date that the patient was noted as having MRD-negative response in both the blood and bone marrow
Time frame: 5 years
Time to Requirement of Next Therapy
Defined as the time from the 48-week MRD evaluation until the time of initiation of subsequent treatment for progressive CLL
Time frame: Up to 5 years
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.