Pentostatin, Cyclophosphamide And Rituximab (PCR) For B-Cell Chronic Lymphocytic Leukemia (CLL) And Small B-Cell Lymphocytic Lymphoma (SLL): Four Phase II Trials With Patient Stratification Based On Prior Therapy

Inclusion Criteria

DISEASE CHARACTERISTICS:

- Diagnosis of B-cell chronic lymphocytic leukemia (CLL) or small B-cell lymphocytic
lymphoma (SLL) with the following:

- Lymph node biopsy interpreted as SLL or consistent with CLL or all of the
following:

- Peripheral lymphocyte count greater than 5,000/mm^3 with small to moderate
peripheral lymphocytes and no more than 55% prolymphocytes

- Bone marrow aspirate containing at least 30% lymphoid cells

- Immunophenotypic evaluation of peripheral blood lymphocytes demonstrating
monoclonality of B lymphocytes with all of the following:

- CD19 or CD20 coexpressed with CD5 antigen in the absence of other
pan-T- cell markers (e.g., CD2 or CD3)

- Expression of CD23 on CLL cells or Dim B-cell expression of kappa or
lambda light chains

- Measurable disease with any of the following:

- 1 or more lymph nodes at least 1.5 cm by CT scan

- Splenomegaly by CT scan

- Peripheral lymphocyte count greater than 5,000/mm3 with coexpression of CD5 and
B-cell markers

- Bone marrow aspirate with at least 30% lymphoid cells

- No mantle cell lymphoma

PATIENT CHARACTERISTICS:

Age

- 18 and over

Performance status

- ECOG 0-2

Life expectancy

- At least 2 years

Hematopoietic

- See Disease Characteristics

- No immune thrombocytopenia

- No hemolytic anemia

Hepatic

- Bilirubin no greater than 3 times upper limit of normal (ULN)

- SGOT no greater than 3 times ULN (unless due to hemolysis or CLL)

- No hepatitis

Renal

- Creatinine no greater than 1.5 times ULN

Cardiovascular

- No cardiac dysfunction

- No New York Heart Association class III or IV heart disease

- No myocardial infarction within the past month

Other

- HIV negative

- No active acute or chronic infection

- No immunosuppressive diseases

- No autoimmune disorder

- No secondary malignancy that is projected to limit life expectancy

- Not pregnant or nursing

- Negative pregnancy test

- Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy

- See Chemotherapy

- No prior rituximab

- At least 4 weeks since prior biologic therapy

Chemotherapy

- At least 4 weeks since prior chemotherapy

- No prior combination chemotherapy and rituximab or other antibody therapy

- No prior combination chemotherapy comprising an alkylating agent and a purine
nucleoside analog (i.e., cyclophosphamide or chlorambucil in combination with
fludarabine, cladribine, or pentostatin)

- No prior pentostatin

Endocrine therapy

- At least 4 weeks since prior corticosteroids

- No concurrent supra-physiologic doses of corticosteroids

Radiotherapy

- At least 4 weeks since prior radiotherapy

Surgery

- At least 4 weeks since prior major surgery

Other

- No concurrent immunosuppressive therapy (e.g., cyclosporine)