Addition of Loncastuximab Tesirine to Acalbrutinib , Chronic Lymphocytic Leukemia

Eligibility Criteria

• 1. Diagnosis of CLL according to the IwCLL criteria or SLL according to the World Health Organization (WHO) criteria. This includes previous documentation of:
• * Biopsy-proven small lymphocytic lymphoma OR
• * Diagnosis of CLL according to the IWCLL criteria as evidenced by Peripheral blood lymphocyte count of greater than 5 x109/L .
• * Immunophenotype consistent with CLL defined as the predominant population of lymphocytes share both B cell antigens (CD19, CD20 (typically dim expression), or CD23) as well as CD5 in the absence of other pan-T-cell markers (CD3, CD2, etc).
• 2. On therapy with acalabrutinib for a minimum of 3 months without evidence of progression as per IWCLL 2018 criteria.
• 3. Relapsed or Refractory CLL who have received at least one prior therapy before initiation of acalabrutinib
• 4. Presence of measurable residual disease in the peripheral blood or bone marrow aspirate by NGS based clonoseq test.
• 5. Adequate organ function as defined below unless attributed to disease involvement:
• * Liver function (bilirubin ≤ 1.5 × ULN, AST and/or ALT \<3 x ULN). Patients with Gilbert Disease are permitted irrespective of bilirubin values.
• * Kidney function (crcl \> 30ml/min using Cockroft-Gault, based on actual weight).
• * ANC ≥ 1,000/µL, Hgb \> 8, Platelet Count ≥ 50,000/ µL. Use of G-CSF is not permitted for up to 7 days prior to enrollment.
• * Exclusion Criteria For all patients
• 1. Current evidence of central nervous system involvement.
• 2. Unable to generate clonoseq ID specimen for measurable residual disease tracking.
• 3. Completion of an autologous hematopoietic stem cell transplantation within 3 months prior to first dose of study drug.
• 4. Prior allogeneic stem cell transplant within 6 months. The patient should not have any active Graft vs. Host disease (GVH) or should be on immune suppressive agents.
• 5. Completion of treatment with any radiotherapy, chemotherapy, antibody, immunoconjugates and/or another investigational drug ≤4 weeks (or 5 half-lives of the drug, whichever is shorter) prior to the first dose of study drug. Patients may be enrolled after a minimum of 2 weeks of radiation if radiation was for palliative intent.
• 6. Progression of disease on BTK inhibitor.
• 7. Unable to tolerate full dose of acalabrutinib at 100 mg twice a day.
• 8. Inability to swallow and retain oral medications.
• 9. Pregnant women are excluded from this study.
• 10. Any active, concurrent, significant illness or disease (other underlying lymphoma) or clinically significant findings including psychiatric and behavioral problems, medical history and/or physical examination findings that would preclude the patient from participation in the study such as:
• * active infection requiring systemic therapy ≤10 days before the first dose of study drug
• * unstable angina pectoris, symptomatic congestive heart failure (New York Heart Association \[NYHA\] II, III, IV;), myocardial infarction ≤6 months prior to first study drug, uncontrolled cardiac arrhythmia e.g., atrial fibrillation/flutter, cerebrovascular accidents ≤6 months before first dose of study drug
• * Significant (as defined by study doctor) pulmonary disease or disorder
• * any severe or uncontrolled other disease or condition which might increase the risk associated with study participation
• 11. Vaccination with live, attenuated vaccines within 28 days prior to the first dose of study medication.
• 12. Receiving systemic immunosuppressive medications (including, but not limited to, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor agents). The use of inhaled corticosteroids is permitted.
• 13. Corticosteroids ≥ 10 mg of prednisone within the last 7 days.
• 14. Has had a solid organ transplant within the last 3 years. Note: Patients who have had a Solid organ transplant \>3 years ago are eligible if there are no signs/symptoms of graft versus host disease (GvHD) and off immunosuppressive medications as per above.
• 15. Known history of hypersensitivity to loncastuximab tesirine
• 16. Clinically significant third space fluid accumulation (i.e., ascites requiring drainage or pleural effusion that is either requiring drainage or associated with shortness of breath)
• 17. Breastfeeding or pregnant
• 18. Any other malignancy known to be active, with the exception of
• * Cervical carcinoma of Stage 1A (1A1,1A2) and 1B (1B1,1B2,1B3)
• * Non-invasive basal cell or squamous cell skin carcinoma
• * Non-invasive, superficial bladder cancer
• * Prostate cancer with a current PSA level \< 0.1 ng/mL
• * Any curable or localized cancer with a CR of \> 2 years' duration.