Ibrutinib Versus Ibrutinib + Rituximab (i vs iR) in Patients With Relapsed Chronic Lymphocytic Leukemia (CLL)

Study Groups and Drug Administration:

If you are found to be eligible to take part in this study, you will be randomly assigned (as
in the flip of a coin) to 1 of 2 study groups. This is done because no one knows if one study
group is better, the same, or worse than the other group. There is an equal chance of being
in either group.

- Group 1 will receive ibrutinib alone.

- Group 2 will receive ibrutinib plus rituximab.

Study Drug Administration:

Each cycle is 28 days.

If you are in Group 1, you will take 3 capsules of ibrutinib by mouth 1 time every day with 1
cup (8 ounces) of water.

If you are in Group 2, you will take 3 capsules of ibrutinib by mouth 1 time every day with 1
cup of water. Your doctor will tell you if you will start taking the ibrutinib on Day 1 or
Day 2 of Cycle 1. You will receive rituximab by vein over between 3 and 8 hours on Days 1, 8,
15, and 22 of Cycle 1, then on Day 1 of Cycles 2-6.

If you miss a dose of ibrutinib, it can be taken as soon as possible on the same day with a
return to the normal schedule the following day. You should not take extra capsules to make
up the missed dose.

Study Visits:

On Days 8, 15, and 22 of Cycle 1:

- You will have a physical exam.

- Blood (about 1-2 teaspoons) will be drawn for routine tests.

After Cycles 1-6, then Cycles 9, 12, 15, 18, 21, and 24:

- You will have a physical exam.

- Blood (about 1-2 teaspoons) will be drawn for routine tests.

After Cycle 3 or 6, you will have a CT scan, MRI, or PET scan of the chest, abdomen, and
pelvis to check the status of the disease.

After Cycles 12 and 24, then every 12 cycles if the doctor thinks it is needed:

- You will have a bone marrow aspiration to check the status of the disease.

- You will have a CT scan, MRI, or PET scan of the chest, abdomen, and pelvis to check the
status of the disease.

Once every 6 months after Cycle 24:

- You will have a physical exam.

- Blood (about 1-2 teaspoons) will be drawn for routine tests.

Length of Study:

You may continue taking ibrutinib for as long as the doctor thinks it is in your best
interest. You will no longer be able to take the study drug if the disease gets worse, if
intolerable side effects occur, or if you are unable to follow study directions.

Your participation on the study will be over after the follow-up visits.

Follow-Up:

At 60 days after the last dose of study drug(s), then about every 4 months for 5 years (or
until the disease gets worse or a new treatment is started), blood (about 1-2 teaspoons) will
be drawn for routine tests.

This is an investigational study. Ibrutinib is FDA approved and commercially available for
the treatment of patients with mantle cell lymphoma and in patients with CLL who have
received at least 1 prior treatment. Its use in this study is investigational. Rituximab is
FDA approved and commercially available for the treatment of CLL. The combination of
rituximab and ibrutinib is investigational.

Up to 208 participants will be enrolled in this study. All will be enrolled at MD Anderson.

Inclusion Criteria:

1. Patients must have a diagnosis CLL/SLL or Prolymphocytic Leukemia (PLL) and be
previously treated. Given the poor outcome of CLL/SLL/PLL patients with 17p del or
TP53 mutation to standard frontline chemo-immunotherapy, such patients will be
eligible if they are untreated.

2. Patients must have an indication for treatment by 2008 IWCLL Criteria.

3. Patients must be age >/= 18 years at the time of signing informed consent, understand
and voluntarily sign an informed consent, and be able to comply with study procedures
and follow-up examinations.

4. ECOG performance status of 0-2.

5. Patients of childbearing potential must be willing to practice highly effective birth
control (e.g., condoms, implants, injectables, combined oral contraceptives,
intrauterine devices [IUDs], sexual abstinence, or sterilized partner) during the
study and for 30 days after the last dose of study drug. Women of childbearing
potential include any female who has experienced menarche and who has not undergone
successful surgical sterilization (hysterectomy, bilateral tubal ligation, or
bilateral oophorectomy) or is not postmenopausal.

6. Adequate renal and hepatic function as indicated by all of the following: Total
bilirubin bilirubin elevation due to Gilbert's disease who will be allowed to participate; an
ALT 30 mL/min, as
calculated by the Cockcroft- Gault equation unless disease related.

7. Free of prior malignancies for 3 years with exception of patients diagnosed with basal
cell or squamous cell carcinoma of the skin, or carcinoma "in situ" of the cervix or
breast, who are eligible even if they are currently treated or have been treated
and/or diagnosed in the past 3 years prior to study enrolment. If patients have
another malignancy that was treated within the last 3 years, such patients can be
enrolled, after consultation with the Principal Investigator, if the likelihood of
requiring systemic therapy for this other malignancy within 2 years is less than 10%,
as determined by an expert in that particular malignancy at MD Anderson Cancer Center.

8. A Urine Pregnancy Test (within 7 days of enrollment date) is required for women with
childbearing potential.

Exclusion Criteria:

1. Pregnant or breast-feeding females.

2. Prior therapy with ibrutinib or other kinase inhibitors that target Bruton's tyrosine
kinase (BTK). Patients who previously received therapy with the PI3K delta inhibitor
idelalisib (Zydelig) are allowed to be enrolled.

3. Treatment including chemotherapy, chemo-immunotherapy, monoclonal antibody therapy,
radiotherapy, high-dose corticosteroid therapy (more than 60 mg Prednisone daily or
equivalent), or immunotherapy within 21 days prior to enrollment or concurrent with
this trial.

4. Investigational agent received within 30 days prior to the first dose of study drug.

5. Systemic fungal, bacterial, viral, or other infection not controlled (defined as
exhibiting ongoing signs/symptoms related to the infection and without improvement,
despite appropriate antibiotics or other treatment).

6. Patients with uncontrolled Autoimmune Hemolytic Anemia (AIHA) or autoimmune
thrombocytopenia (ITP).

7. Patients with severe hematopoietic insufficiency, as defined by an absolute neutrophil
count of less than 500/MuL, unless disease-related, and/or a platelet count of less
than 30,000/MuL at time of screening for this protocol.

8. Any other severe concurrent disease, or have a history of serious organ dysfunction or
disease involving the heart, kidney, liver or other organ system that may place the
patient at undue risk to undergo therapy with ibrutinib and rituximab.

9. 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.

10. History of stroke or cerebral hemorrhage within 6 months.

11. Evidence of bleeding diathesis or coagulopathy within 3 months.

12. Major surgical procedure, open biopsy, or significant traumatic injury within 28 days
prior to enrollment date, anticipation of need for major surgical procedure during the
course of the study.

13. Minor surgical procedures, fine needle aspirations or core biopsies within 7 days
prior to enrollment date. Bone marrow aspiration and/or biopsy are allowed.

14. Serious, non-healing wound, ulcer, or bone fracture.

15. Treatment with Coumadin. Patients who recently received Coumadin must be off Coumadin
for at least 7 days prior to start of the study.