Early Intervention With Acalabrutinib in Patients With High Risk CLL
Early Intervention With Acalabrutinib in Patients With High Risk CLL
This study evaluates the effectiveness of acalabrutinib treatment in patients with chronic
 lymphocytic leukemia (CLL) deemed at high risk for Richter's Transformation (RT). This is a
 single arm study. Enrolled patients will initiate therapy with acalabrutinib and will dose
 continuously. While on study, subjects will be monitored monthly for the first 3 months, then
 every three months thereafter until disease progression, discontinuation due to toxicity,
 death, or study completion.
This is a multi-center, single arm, Phase II clinical trial to investigate the effectiveness
 of acalabrutinib treatment within 6 months of chronic lymphocytic leukemia (CLL) diagnosis
 for patients with CLL deemed at high risk for Richter's Transformation (RT).
Inclusion Criteria:

 -  Subject must be able to voluntarily sign and date an informed consent, approved by an
 Independent Ethics Committee (IEC)/Institutional Review Board (IRB), prior to the
 initiation of any screening or study specific procedures.

 -  The time from diagnosis to consent should be ≤6 months.

 -  Subject must be ≥ 18 years of age.

 -  Subject must have diagnosis of CLL/SLL based upon 2018 iwCLL Guidelines.

 -  Rai stage 0-2 disease without indication for treatment as defined by the 2018 iwCLL
 guidelines

 -  Subject must have high risk CLL as defined by any one of the following:

 -  NOTCH1 mutated (classic frameshift mutation only)

 -  Unmutated V4-39 B cell receptor usage

 -  Pathogenic c-MYC mutations

 -  Complex karyotype, (by CpG/oligodeoxynucleotide stimulation)

 -  Deletion 17p, or presence of TP53 mutation

 -  Subject has an Eastern Cooperative Oncology Group (ECOG) performance score of ≤ 2.

 -  PT/PTT/INR within 1.5 x the ULN

 -  Adequate renal function defined by serum creatinine less than 2 x ULN

 -  Adequate hepatic function:

 -  ALT/AST less than 2x ULN

 -  Tbili less than 1.5 X ULN unless bilirubin elevation is due to Gilbert's syndrome
 (total bilirubin <3)

 -  Subject must have adequate bone marrow function.

 -  Absolute neutrophil count ≥1.0 x103/μL

 -  Hemoglobin ≥ 11.0 g/dL

 -  Platelets ≥ 100 x 103/μL

 Exclusion Criteria:

 -  Previous exposure to any systemic anti-cancer therapy as a treatment for CLL,
 including but not limited to chemotherapy, immunotherapy, radiotherapy, or
 investigational therapy. Note, patients treated with chemotherapy for a prior
 non-hematologic malignancy if more than 5 years earlier are eligible.

 -  Subject with a history of malignancy except for non-melanoma skin cancers. Subjects
 treated with curative intent via methods of local resection and or locally targeted
 anticancer treatment and are free of malignancy for at least 5 years from treatment
 end will be allowed to enroll.

 -  Subject requires chronic immunosuppressive therapy for any reason or was treated with
 immunosuppressive therapy within 6 months of study entry.

 -  Subjects with a history of autoimmune hemolytic anemia or immune thrombocytopenia
 purpura.

 -  Subject has prolymphocytic leukemia.

 -  Active bleeding, or history of bleeding diathesis (e.g., hemophilia or von Willebrand
 disease)

 -  Subject requires warfarin or equivalent vitamin K antagonist

 -  Uncontrolled or active significant infection,

 -  History of or suspected or confirmed PML

 -  Clinically significant cardiovascular disease such as uncontrolled or symptomatic
 arrhythmias, congestive heart failure, or myocardial infarction within 6 months of
 screening, or any Class 3 or 4 cardiac disease as defined by the New York Heart
 Association Functional Classification. Subjects with controlled, asymptomatic atrial
 fibrillation during screening can enroll on study.

 -  Patients with stroke or CNS hemorrhage within 6 months

 -  Pregnant or breastfeeding

 -  Women of childbearing potential (WCBP) who are sexually active with heterosexual
 partners must agree to use highly effective methods of contraception during
 treatment and for 2 days after the last dose of acalabrutinib.

 -  Major surgical procedure within 28 days of first dose of study drug. If a subject had
 surgery, they must have recovered adequately from any toxicity or complications before
 the first dose of study drug.

 -  Has difficulty with or is unable to swallow oral medication or has significant
 gastrointestinal disease that would limit absorption of oral medication.

 -  Subject is known to be positive for human immunodeficiency virus (HIV)

 -  Active hepatitis C, as confirmed by being positive for Hep C RNA by PCR

 -  Active hepatitis B infection documented by a positive PCR for Hep B DNA. If hepatitis
 B serology is positive for hepatitis B core antibody, but Hep B DNA PCR is negative,
 patient is eligible to enroll.

 -  Subject requires strong CYP 3A4/5 inhibitors or inducers (Appendix B).

 -  Subject requires proton pump inhibitors. (Subjects that can transition to an H2
 antagonist are allowed to enroll.)