Bortezomib and Romidepsin in Patients With Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma

DISEASE CHARACTERISTICS:

* Diagnosis of 1 of the following:

• CLL or SLL, relapsed or refractory

• Indolent B-cell lymphoma, relapsed or refractory:

  • Follicle center lymphoma, follicular or diffuse
  • Marginal zone B-cell lymphoma (splenic, nodal, extranodal [this includes mucosa associated lymphoid tissue (MALT)])
  • Lymphoplasmacytic lymphoma

• PTCL, relapsed or refractory:

  • Anaplastic large cell lymphoma, anaplastic lymphoma kinase (ALK)-positive
  • Anaplastic large cell lymphoma, ALK-negative
  • Angioimmunoblastic T-cell lymphoma
  • Enteropathy-associated T-cell lymphoma
  • Extranodal natural killer (NK)/T-cell lymphoma, nasal type
  • Hepatosplenic T-cell lymphoma
  • PTCL, not otherwise specified (NOS)
  • Subcutaneous panniculitis-like T-cell lymphoma

• CTCL:

  * CTCL with subtypes of mycosis fungoides Stage IB or higher, Sézary syndrome, or primary cutaneous anaplastic large cell lymphoma who have failed a previous systemic treatment, as per the following:

  • Stage IA plaque, IB, or IIA: At least 4 prior conventional and/or experimental regimens (topical or systemic, including psoralen-ultraviolet light [PUVA] and systemic corticosteroids)
  • Stage IIB, III, or IV: At least 1 prior systemic regimen (systemic corticosteroids alone or PUVA alone do not count as systemic regimens for this purpose) NOTE: Repeated use of the same regimen is considered 1 regimen

• Prior allogeneic stem cell transplant is allowed provided that all of the following conditions are met:

  • >= 6 months have elapsed since allogeneic transplant
  • No Graft vs. Host Disease (GVHD) is present
  • Not currently on immunosuppressive therapy
• No prior or concurrent CNS malignancy

PATIENT CHARACTERISTICS:

• ECOG performance status 0-1
• ANC > 1,500/mm^3
• Platelet count > 75,000/mm^3
• Hemoglobin > 7.5 g/dL (transfusion allowed)
• Serum creatinine ≤ 1.2 mg/dL or actual or calculated creatinine clearance > 60 mL/min
• AST and ALT ≤ 2.5 times upper limit of normal (ULN)
• Bilirubin ≤ ULN
• Serum potassium ≥ 3.5 mEq/L (supplementation allowed)
• Serum magnesium ≥ 1.7 mEq/L (supplementation allowed)
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective non-hormonal contraception
• Willing and able to comply with protocol requirements
• No prior severe allergic reactions to bortezomib, boron, mannitol, or romidepsin
• No progressing toxicity secondary to bortezomib
• No grade 1 peripheral neuropathy with pain or ≥ grade 2 peripheral neuropathy by NCI-CTCAE criteria (v4.0) within the past 14 days

• No condition related to ischemic heart disease, heart failure, or the risk of torsades de pointes or sudden cardiac death, including any of the following:

  • History of sustained ventricular tachycardia, ventricular fibrillation, torsades de pointes, or resuscitated cardiac arrest unless currently addressed with an implantable cardiac defibrillator
  • Baseline heart rate > 140 beats per minute
  • Known congenital long QT syndrome
  • QTc interval > 480 milliseconds
  • Type II second-degree atrio-ventricular (AV) block, third-degree AV block, or ventricular rate < 50 beats per minute

  • Myocardial infarction within the past 6 months

    • Patients who have had a myocardial infarction 6-12 months ago are eligible provided they are asymptomatic and have a negative cardiac risk assessment (i.e., treadmill stress test, nuclear medicine stress test, or stress echocardiogram)

  • Angina upon ordinary physical activity

    • Angina only with strenuous, rapid, or prolonged exertion allowed

  • ECG with evidence of cardiac ischemia, as defined by the following:

    • ST depression of ≥ 2 mm, measured from isoelectric line to ST segment
    • T-wave inversion ≥ 4 mm, measured from isoelectric line to peak of T-wave
  • NYHA class II-IV congestive heart failure
  • Known left ventricular ejection fraction < 40% by MUGA scan or < 50% by echocardiogram or MRI
  • Known hypertrophic cardiomegaly or restrictive cardiomyopathy
• No uncontrolled hypertension, defined as persistent blood pressure ≥ 160/95 mm Hg despite medical management
• No clinically significant active infection, including known HIV infection or hepatitis B or C
• No other malignancy within the past 3 years except completely resected basal cell carcinoma or squamous cell carcinoma of the skin, in situ malignancy, or curatively treated low-risk prostate cancer
• No concurrent medical condition that, in the investigator's opinion, would compromise study treatment or assessment of toxicity

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics
• At least 3 weeks since prior chemotherapy, radiation therapy or investigational agents. If steroids for cancer control have been used, patients must be off theses agents for at least 1 week before starting treatment. (Maintenance therapy for non-malignant disease with prednisone or steroid equivalent dose less than 10 mg/day is permitted)
• Prior allogeneic stem cell transplantation allowed provided all of the following conditions are met:
• Greater than or equal to 6 months have elapsed since allogeneic transplant
• No Graft vs. Host Disease (GVHD) is present
• More than 4 weeks since prior bortezomib
• No concurrent oral hormonal contraceptives
• No concurrent potent or moderate CYP3A4 inhibitors
• No concurrent anti-arrhythmic agents

• No concurrent treatment with any drugs that are generally accepted to having a risk of causing torsades de pointes (class 1 drugs)

  • Class 2 or 3 drugs allowed at the discretion of the investigator
• No other concurrent systemic therapy for the malignancy
• Concurrent warfarin (coumadin) allowed