
    recruitment difficulties and toxicity
  
['chronic lymphocytic leukemia', 'small lymphocytic lymphoma']
['lenalidomide, ibrutinib, rituximab']

        Inclusion Criteria:

          -  Previously treated chronic lymphocytic leukemia or small lymphocytic lymphoma that
             requires treatment

          -  No prior systemic treatment within 4 weeks of enrollment

          -  No corticosteroids within 2 weeks prior to study entry

          -  Measurable disease must be present

          -  No concomitant anti-cancer therapies

          -  ECOG status </= 2

          -  Patients with HIV infection are eligible

          -  Patients with treated CLL or SLL in CNS are eligible

          -  Non-pregnant and non-nursing

          -  Life expectancy greater than 60 days

          -  Adequate bone marrow, kidney and liver function

          -  No major surgery within 28 days or minor surgery within 5 days of starting treatment

        Exclusion Criteria:

          -  History od Richter's transformation

          -  History of prior allogeneic transplant

          -  Radioimmunotherapy within 1 year of enrollment

          -  Prior Bruton's tyrosine kinase inhibitor or lenalidomide

          -  History of allergic reactions to compounds similar to ibrutinib, lenalidomide or
             rituximab or hypersensitivity

          -  active or uncontrolled autoimmune hemolytic anemia or ITP

          -  Transfusion-dependent thrombocytopenia or bleeding disorders

          -  Active hepatitis B or C infections

          -  History of known Human Anti-Chimeric Antibody positivity

          -  History of erythema multiforme, toxic epidermal necrolysis, or Stevens-Johnson
             syndrome

          -  History of uncontrolled seizures

          -  Autoimmune disorder that requires active immunosuppression

          -  Stroke or intracranial hemorrhage within last 6 months

          -  History of congestive heart failure, myocardial infarction, unstable angina,
             uncontrolled arrhythmia or any Class 3 or 4 heart disease in the last 6 months

          -  No prior malignancy except if treated with curative intent with no active disease for
             more than 3 years; adequately treated non-melanoma skin cancer or cervical cancer in
             situ

          -  using warfarin or similar Vitamin K antagonists Unable to swallow capsules or disease
             significantly affecting gastrointestinal function or inhibiting small intestine
             absorption
      