Dasatinib in Treating Patients With Chronic Lymphocytic Leukemia

Inclusion Criteria:

Written informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization for release of personal information
Eastern Cooperative Oncology Group (ECOG) =< 2
In vitro dasatinib sensitivity (IC 50 =< 50 nm per MTS assay)

Diagnosis of CLL and must meet one of the following:

Relapsed CLL in all patients who have failed at least one prior treatment, regardless of risk group
OR De novo (treatment-naïve) patients age >= 65 who are not candidates for or do not want to pursue aggressive chemotherapy treatment

Have indications for treatment or evidence of progressive disease defined as follows (1996 NCI working group):

Massive or progressive splenomegaly
Massive lymph nodes (>= 10 cm), nodal clusters (>= 10 cm), or progressive lymphadenopathy
Symptomatic anemia and/or thrombocytopenia (Rai stages III or IV disease)
Autoimmune hemolytic anemia and/or thrombocytopenia that are poorly responsive to corticosteroid therapy
Progressive lymphocytosis with increase in lymphocyte count of >= 50% over a 2-month period or an anticipated doubling time of < 6 months
Repeated episodes of infection
Have not received CLL treatment within the past 2 weeks
Total bilirubin < 2.0 x upper limit of normal (ULN)
Aspartate aminotransferase (AST) =< 2.5 x ULN
Alanine aminotransferase (ALT) =< 2.5 x ULN
Serum creatinine < 2.0 x ULN
International normalized ratio (INR) =< 1.2
Platelet (Plt) count > 30,000
Ability to take oral medication (dasatinib must be swallowed whole)
No clinically significant infections as determined by the investigator
Normal corrected QT (QTc) interval (< 450 msec)
Serum potassium and magnesium are within normal limits
Women of childbearing potential (WOCBP) must have a negative serum or urine pregnancy test (sensitivity =< 25 IU HCG/L) within 72 hours prior to the start of study drug administration
Persons of reproductive potential must agree to use an adequate method of contraception throughout treatment and for at least 4 weeks after study drug is stopped prior to study enrollment; women of childbearing potential must be advised of the importance of avoiding pregnancy during trial participation and the potential risk factors for an unintentional pregnancy
After consent, discontinuation ("washout period") of any medications known to contribute significantly to the risk of QT prolongation or interfere with cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) mediated drug metabolism
Patient agrees to discontinue St. John's Wort while receiving dasatinib therapy (discontinue St. John's Wort at least 5 days before starting dasatinib)
Patient agrees that IV bisphosphonates will be withheld for the first eight weeks of dasatinib therapy due to risk of hypocalcemia
Patient agrees to discontinue anti-coagulants and anti-platelet drugs; note: a low dose aspirin regimen (81mg QD) is permitted with close monitoring of the subject's platelets for a level >= 50,000/mm^3

Exclusion Criteria:

Patients may not receive concurrent chemotherapy, radiotherapy, or immunotherapy
Pleural or pericardial effusion of any grade
Uncontrolled angina, > New York Heart Association (NYHA) class III congestive heart failure or myocardial infarction (MI) within 6 months prior to study enrollment
Diagnosed congenital long QT syndrome
Any history of clinically significant ventricular arrhythmias (such as ventricular tachycardia, ventricular fibrillation, or Torsades de pointes)
Prolonged QTc interval on pre-entry electrocardiogram (> 450 msec)
Subjects who are detained or imprisoned are not eligible

History of significant bleeding disorder unrelated to cancer, including:

Diagnosed congenital bleeding disorders (e.g., von Willebrand's disease)
Diagnosed acquired bleeding disorder within one year (e.g., acquired anti-factor VIII antibodies)

May not take concomitant medications that are generally accepted to have a risk of causing Torsades de Pointes including: (patients must discontinue drug 7 days prior to starting dasatinib)

Quinidine, procainamide, disopyramide
Amiodarone, sotalol, ibutilide, dofetilide
Erythromycin, clarithromycin
Chlorpromazine, haloperidol, mesoridazine, thioridazine, pimozide
Cisapride, bepridil, droperidol, methadone, arsenic, chloroquine, domperidone, halofantrine, levomethadyl, sparfloxacin, lidoflazine
Patients already taking other CYP inducers or inhibitors other than those listed above are eligible for the study only after principal investigator (PI) review; dose adjustments and/or monitoring of drug levels where applicable will be made as needed by the PI after consultation with pharmacy

Women who:

Are unwilling or unable to use an acceptable method to avoid pregnancy for the entire study period and for at least 4 weeks after cessation of study drug, or
Have a positive pregnancy test at baseline, or
Are pregnant or breastfeeding