| Eligibility |
Inclusion Criteria:
- Adult patients with previously untreated CLL or SLL defined following IWCLL criteria
(Hallek, 2008).
- Must understand and voluntarily sign an informed consent form.
- Age = 18 years at the time of signing the informed consent form and must be able to
adhere to the study visit schedule and other protocol requirements.
- Must have a documented diagnosis of CLL or SLL [IWCLL guidelines for diagnosis and
treatment of CLL (Hallek, 2008)] meeting at least one of the following criteria:
Evidence of progressive marrow failure as manifested by the development of, or worsening
of, anemia and/or thrombocytopenia.
Massive (i.e. > 6 cm below the left costal margin) or progressive or symptomatic
splenomegaly.
Massive nodes (i.e. > 10 cm in longest diameter) or progressive or symptomatic
lymphadenopathy.
Progressive lymphocytosis with an increase of > 50% over a 2-month period, or lymphocyte
doubling time (LDT) of less than 6 months.
A minimum of any one of the following disease-related symptoms: unintentional weight loss =
10% within the previous 6 months, significant fatigue (i.e., ECOG PS 2; cannot work or
unable to perform usual activities), fevers of greater than 38.0° C or 100.5F for 2 or more
weeks without other evidence of infection, or night sweats for more than 1 month without
evidence of infection
- Physically fit patients defined as CIRS < 6 (CIRS Scale, Appendix E).
- Must have an Eastern Cooperative Oncology Group (ECOG) performance status score of =2.
- All sexually active subjects with the capacity to reproduce (male and female) must use
high-efficacy contraceptive methods during the course of the study. These restrictions
apply for 12 months after the last dose of ofatumumab or 3 months after the last dose
of ibrutinib, whichever happens later. High-efficacy contraceptive methods include:
Total abstinence when consistent with the subject's typical and preferred lifestyle
(periodic abstinence [e.g. calendar methods, ovulation, symptothermal and post-ovulation
methods] and the withdrawal method are not acceptable contraceptive methods).
Female sterilisation defined as surgical hysterectomy, bilateral oophorectomy, or tubal
ligation at least six weeks prior to the study treatment (a simple oophorectomy does not
meet the definition of female sterilisation).
Male sterilisation (at least six months before screening). A man who has undergone a
vasectomy must be the only partner who is a study subject.
Combination of two of the following methods (a+b or a+c or b+c):
1. Use of oral, injected or implanted hormonal contraceptives, or other hormonal
contraceptive methods that have a comparable efficacy (failure rate < 1%), for
example, hormonal vaginal ring or transdermal hormonal contraceptive. If an oral
contraceptive is used, women must use the same pill for a minimum of three months
before taking the study treatment.
2. Placement of an intrauterine device (IUD) or an intrauterine system (IUS).
3. Barrier contraceptive methods: condom or cervical cap (cervical/vault diaphragm or
cap) with foam/gel/film/spermicidal cream/vaginal suppository.
- Female subjects of childbearing potential must have a negative pregnancy test at
screening. Females of child bearing potential are defined as sexually mature
women without prior hysterectomy or who have had any evidence of menses in the
past 12 months. However, women who have been amenorrheic for 12 or more months
are still considered to be of childbearing potential if the amenorrhea is
possibly due to other causes, including prior chemotherapy, anti-estrogens, or
ovarian suppression
Exclusion Criteria:
- Prior treatment for CLL or SLL.
- Any serious medical condition, laboratory abnormality, or psychiatric illness that
would prevent the patient from signing the informed consent form.
- Systemic infection that has not resolved prior to initiating study treatment in spite
of adequate anti-infective therapy.
- Pregnant or lactating females.
- Participation in any clinical study or having taken any investigational therapy within
28 days prior to initiating study therapy.
- Central nervous system (CNS) involvement as documented by spinal fluid cytology or
imaging.
- Prior history of malignancies, other than CLL, unless the patient has been free of the
disease for = 3 years.
Exceptions include the following:
Basal cell carcinoma of the skin Squamous cell carcinoma of the skin Carcinoma in situ of
the cervix Carcinoma in situ of the breast Incidental histologic finding of prostate cancer
(TNM stage of T1a or T1b)
- Known Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV) and/or Hepatitis C
Virus (HCV) infection.
- Any of the following laboratory abnormalities:
Serum creatinine = 2 x ULN or estimated Glomerular Filtration Rate (Cockroft-GaultAppendix
C) = 40 mL/min/1.73m2 Absolute neutrophil count (ANC) < 1.0 X 109/L, unless secondary to
bone marrow involvement by CLL.
Platelet count <100,000/mm3 or <50,000/mm3 if bone marrow involvement independent of
transfusion support in either situation Serum aspartate aminotransferase (AST)/serum
glutamic-oxaloacetictransaminase (SGOT) or alanine transaminase (ALT)/serum glutamate
pyruvate transaminase (SGPT) >3 x upper limit of normal (ULN).
Serum total bilirubin > 1.5 x ULN, except in cases of Gilbert's syndrome.
- Presence of autoimmune haemolytic anemia or autoimmune thrombocytopenia.
- Disease transformation [i.e. Richter's Syndrome (lymphomas) or prolymphocytic
leukemia.
- Major surgery within the last 28 days prior to registration.
- History of stroke or intracranial hemorrhage within 6 months prior to enrolment.
- Currently active, clinically significant cardiovascular disease or a history of
myocardial infarction within 3 months prior to enrolment.
- Requires or receiving anticoagulation with warfarin or equivalent vitamin K
antagonists within 28 days of first dose of study drug.
- Any life-threatening illness, medical condition, or organ system dysfunction which, in
the investigator's opinion, could compromise the subject's safety, interfere with the
absorption or metabolism of ibrutinib capsules, or put the study outcomes at undue
risk.
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