Phase I/II Carfilzomib Plus Lenalidomide and Rituximab in the Treatment of Relapsed/Refractory Mantle Cell Lymphoma

Study Groups: If you are found to be eligible to take part in this study, you will be assigned to a study group based on when you join this study. Up to 24 patients will be enrolled in Part 1 of the study and up to 44 participants will be enrolled in Part 2. If you are enrolled in Part 1, the dose of carfilzomib you receive will depend on when you joined this study. The first group of participants will receive the lowest dose level of carfilzomib. Each new group will receive a higher dose of carfilzomib than the group before it, if no intolerable side effects were seen. Up to 4 dose levels will be studied. If you are enrolled in Part 2, you will receive carfilzomib at the highest dose that was tolerated in Part 1. All participants will receive the same dose level of lenalidomide and rituximab. Each cycle is 28 days. Carfilzomib Administration: On Days 1, 2, 8, 9, 15, and 16 of Cycles 1-12: °You will receive carfilzomib by vein over 30 minutes. The first 2 doses you receive may be lower than later doses. This is to reduce the risk of an allergic reaction. On Days 1, 2, 15, and 16 of Cycles 13 and beyond: °You will receive carfilzomib by vein over 30 minutes. You should drink at least 6-8 cups (8 ounces each) of fluid per day starting 2 days before your first day of treatment and for as long as your doctor tells you to. During Cycles 1 and 2, you will receive fluids by vein before and after your dose of carfilzomib. Before you receive carfilzomib, you will be given standard drugs (such as allopurinol, dexamethasone, antibiotics, anti-fungals, and/or anti-virals) to help decrease the risk of side effects. You may ask the study staff for information about how the drugs are given and their risks. During Cycle 1 and on Day 1 of Cycle 2, you will be monitored for side effects for 1 hour after you receive the study drug. Lenalidomide Administration: On Days 1-21 of each cycle, you will take lenalidomide by mouth at approximately the same time each day. You should take it with a glass of water on either a full or an empty stomach. Do not break, chew, or open the capsules. If you miss a dose of lenalidomide, take it as soon as you remember on the same day. If you miss taking your dose for the entire day, take your regular dose the next scheduled day. Do not take double your regular dose to make up for a missed dose. If you take more than the prescribed dose of lenalidomide, you should seek emergency medical care if needed and contact study staff right away. In order to participate in this study you must register into and follow the requirements of the RevAssist® program of Celgene Corporation. This program provides education and counseling on the risks of fetal exposure, blood clots and reduced blood counts. You will be required to receive counseling every 28 days during treatment with lenalidomide, follow the pregnancy testing and birth control requirements of the program that are appropriate for you and take telephone surveys regarding your compliance with the program. Rituximab Administration: On Days 1, 8, 15, and 22 of Cycle 1: °You will receive rituximab by vein. The first infusion takes 6-8 hours. After that, infusions take about 4 hours. On Day 1 of Cycles 3-12: °You will receive rituximab by vein over 4 hours. On Day 1 of Cycle 13 and every other cycle (15, 17, 19 and so on) for up to 24 months: °You will receive rituximab by vein over 4 hours. For some patients, you may receive the rituximab dose over 2 days. Your doctor will tell you if this is the best approach for you. Your vital signs will be monitored just before, during, and after the infusions. You will be monitored for side effects for 1 hour after you receive rituximab. Study Visits: At every study visit, you will be asked about any drugs you may be taking and if you have had any side effects. You will be given a drug diary to complete each day to record the study drugs you take. You will need to bring this to each of your study visits for the study nurse or study doctor to review. About 3-5 days before Day 1 of Cycles 1 and 2, you will have an ECHO to check your heart function. On Day 1 of all cycles: * You will have a physical exam, including measurement of your vital signs and weight. * You will have a neurological exam. * Your performance status will be recorded. * Blood (about 2 tablespoons) will be drawn for routine tests. * If your doctor thinks it is needed, you will have a bone marrow biopsy and/or aspiration to check the status of the disease. * If you are able to become pregnant, you will have a blood (about 1½ tablespoons) or urine pregnancy test. If you have an irregular menstrual cycle, you will also have a pregnancy test on Day 15 of each cycle. On Days 8 and 15 of Cycle 1, and on Day 15 of Cycles 2 and 3: * You will have a physical exam, including measurement of your vital signs. * Your performance status will be recorded. On Days 8 and 15 of Cycles 1 and 2, and on Day 15 of Cycle 3, blood (about 2 tablespoons) will be drawn for routine tests. On Days 2, 9, and 16 of all cycles: °Your vital signs will be measured. On Day 1 of Cycles 2, 4, 6, and so on up to Cycle 12, then every 3 cycles after that: * If the study doctor thinks it is needed, you will have a CT scan, MRI, PET scan, and/or PET/CT scan to check the status of the disease. * If the study doctor thinks it is needed, you will have a gastrointestinal endoscopy. About 3-5 days before Day 1 of Cycle 5, then every 3 cycles after that, you will have an ECHO to check your heart function. Length of Study: You may continue taking the study drugs for as long as the doctor thinks it is in your best interest. You will no longer be able to take the 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 once you have completed follow-up. End-of-Treatment Visit: After you finish taking the study drugs: * You will have a physical exam, including measurement of your weight and vital signs. * You will have a neurological exam. * You will have an EKG to check your heart function. * Blood (about 3-5 tablespoons) will be drawn for routine tests and to check the status of the disease. * Blood (about 2 tablespoons) will be drawn for a thyroid function test. * You will have a CT scan, MRI, and/or x-ray to check the status of the disease. * You will have a PET/CT scan, to check the status of the disease. * If your doctor thinks it is needed, you will have a bone marrow biopsy and/or aspiration * If you doctor thinks it is needed, you will have a colonoscopy/gastrointestinal endoscopy. * If you are able to become pregnant, you will have a blood (about 1½ tablespoons) or urine pregnancy test. Long Term Follow-Up: After your end-of-treatment visit, you will be called every 3 months for 1 year and every 6 months after that to see how you are doing and to find out about any other treatments you have received since you stopped study treatment. These calls will take about 2-3 minutes. In addition to the phone calls, your medical records may be reviewed as well. This is an investigational study. Lenalidomide is FDA approved for the treatment of multiple myeloma (MM) and myelodysplastic syndrome (MDS). Rituximab is FDA approved for the treatment of non-Hodgkin's lymphoma and certain types of leukemia. Carfilzomib is FDA approved and commercially available for the treatment of certain types of MM. The combination of these drugs is investigational. Up to 68 participants will be enrolled on this study. All will be enrolled at MD Anderson.