A Phase II Study of Fludarabine (F), Rituxan (R) and Avastin (A) Followed by RA Maintenance in Patients With Relapsed/Refractory B-cell Chronic Lymphocytic Leukemia (CLL)
Inclusion Criteria
Inclusion
- Relapse or refractory chronic Lymphocytic leukemia as defined by the WHO criteria and
exhibit active disease requiring treatment as per the NCI working group in CLL
- Disease measurable defined by a combination of lymphocytosis >= 5,000/mm^3 in
peripheral blood and lymphocytosis >= 30% in bone marrow
- Confirmed CD20 expression on malignant CLL cells
- ECOG performance status of 0-2
- Life expectancy of at least 6 months
- Documented negative serologic testing for human immunodeficiency virus (HIV),
hepatitis B (unless serologically positive due to prior vaccination), and hepatitis C
within the year prior to enrollment
- Aspartate aminotransferase (AST) < 2.5 x upper limit of normal (ULN)
- Total serum bilirubin < 2.5 x ULN
- Serum creatinine < 1.5 x ULN
- Hemoglobin > 8 g/dL
- Absolute neutrophil count (ANC) > 1,000 cells/mm^3
- Platelet count > 50,000/mm^3
- PT/INR and PTT < 1.5 x ULN
- Within 2 weeks prior to registration, patients must have had a urinalysis negative
for protein or a 24-hour urine collection demonstrating < 500 mg protein
- If female and of child-bearing potential, have a negative serum pregnancy test within
14 days of enrollment
- If sexually active male or sexually active female of reproductive capability, has
agreed to use a medically accepted form of contraception from time of enrollment to
completion of all follow-up study visits
- Signed an institutional review board (IRB)-approved informed consent document for
this protocol
Exclusion
- Patients must not require sustained support of hematopoietic cytokines or transfusion
of blood products
- Presence of acute infection or other significant systemic illness
- Central nervous system involvement by malignancy, history of CVA, or seizure
- Previously received Bevacizumab
- Received transplant or Alemtuzumab within 3 months of enrollment
- Received an investigational agent, systemic corticosteroids, chemotherapy,
immunotherapy, biologic therapy, antibody therapy (e.g., Rituximab) and/or radiation
therapy within one month of enrollment
- Radiation to > 25% of bone marrow or any radiation therapy within 4 weeks prior to
start of therapy
- Inability to comply with study and/or follow-up procedures
- Life expectancy of less than 6 months
- Fludarabine-refractory disease (no response of disease to >= 3 cycles of a
fludarabine-based regimen or relapse within 6 months of fludarabine-based regimen)
- Current, recent (within 4 weeks of the first infusion of this study), or planned
participation in an experimental drug study other than a Genentech-sponsored
bevacizumab cancer study
- Patients with prior malignancy other than lymphoma, except for adequately-treated
skin cancer (basal cell or squamous cell carcinoma), in situ cervical cancer, or
other cancer for which the patient has been disease-free for 5 years unless approved
by the PI
- Inadequately controlled hypertension (defined as systolic blood pressure > 150 mmHg
and/or diastolic blood pressure > 100 mmHg)
- Prior history of hypertensive crisis or hypertensive encephalopathy
- New York Heart Association (NYHA) Grade II or greater congestive heart failure
- History of myocardial infarction or unstable angina within 6 months prior to Day 1
- History of stroke or transient ischemic attack within 6 months prior to Day 1
- Known CNS disease, except for treated brain metastasis; Patients with CNS metastases
treated by neurosurgical resection or brain biopsy performed within 3 months prior to
Day 1 will be excluded
- Significant vascular disease (e.g., aortic aneurysm, requiring surgical repair or
recent peripheral arterial thrombosis) within 6 months prior to Day 1
- History of hemoptysis (>= 1/2 teaspoon of bright red blood per episode) within 1
month prior to Day 1
- Evidence of bleeding diathesis or significant coagulopathy (in the absence of
therapeutic anticoagulation)
- Major surgical procedure, open biopsy, or significant traumatic injury within 28 days
prior to Day 1, or anticipation of need for major surgical procedure during the
course of the study
- Core biopsy or minor surgical procedure, excluding placement of a vascular access
device, within 7 days prior to Day 1
- History of abdominal fistula or gastrointestinal perforation within 6 months prior to
Day 1
- Serious, non-healing wound, active ulcer, or untreated bone fracture
- Proteinuria as demonstrated by a UPC ratio >= 1.0 at screening
- Known hypersensitivity to any component of bevacizumab
- Pregnancy (positive pregnancy test) or lactation; use of effective means of
contraception (men and women) in subjects of childbearing potential