Ibrutinib Post Stem Cell Transplantation (SCT) in Double-Hit B-Cell Lymphoma

Study Drug Administration:

If you take part in this study, you will take ibrutinib by mouth 1 time each day for up to 3
years. You must swallow the capsules whole with a glass (about 8 ounces) of water. Do not
open, break, or chew the capsules. You should take ibrutinib at the same time every day.

If you miss a dose of ibrutinib, take it as soon as you remember on the same day. Take your
next dose of ibrutinib at your regular time on the next day. Do not take 2 doses of ibrutinib
on the same day to make up for a missed dose.

You will be given a study drug diary to write down what time you take each dose of ibrutinib.
You need to bring the study drug diary, any leftover study drug, and any empty study drug
containers with you to each visit.

The dose of ibrutinib you receive may be lowered, if the doctor thinks it is needed.

Study Visits:

One (1) time during Weeks 1-4, 6, and 8 and then 1 time each month after that for up to 3
years after your first dose of ibrutinib, blood (about 2 tablespoons) will be drawn for
routine tests and to check your kidney and liver function. The blood draws may be performed
at MD Anderson or at a lab closer to your home.

If the study doctor thinks it is needed, you may need to have these blood draws more often.

Around 1 month after your first dose of ibrutinib, you will have a bone marrow
biopsy/aspirate to check the status of the disease, if the study doctor thinks it is needed.
To collect a bone marrow biopsy/aspirate, an area of the hip or other site is numbed with
anesthetic, and a small amount of bone and bone marrow is withdrawn through a large needle.

Around 3, 6, 9, and 12 months, then every 6 months for 3 years after your first dose of
ibrutinib:

- You will have a physical exam.

- You will have computed tomography (CT) scans to check the status of the disease.

- You will have a bone marrow biopsy/aspirate to check the status of the disease.

Length of Study:

You may continue taking the study drug for up to 3 years. You will no longer be able to take
the study drug if the disease gets worse, if intolerable side effects occur, or if you are
unable to follow study directions.

Your participation on this study will be over after about 3 years.

Follow-Up Visit:

You will continue to have the CT scans and blood draws described in the study visits section
1 time a year for up to 3 years.

If you had a positron emission tomography (PET) scan that was performed at the time of your
transplant and the scan showed that the disease was still in your body, you will have a PET
scan 1 time each year while taking ibrutinib. The PET scan will not be repeated if the
results show that there is no disease in the body.

This is an investigational study. Ibrutinib is FDA-approved and commercially available for
the treatment of many types of cancers, including mantle cell lymphoma with 1 prior therapy.
The use of ibrutinib to treat double hit lymphoma after an autologous stem cell transplant is
considered investigational. The study doctor can explain how the study drug is designed to
work.

Up to 30 participants will be enrolled in this study. All will take part at MD Anderson.

Inclusion Criteria:

1. Patients with newly diagnosed double hit in first complete remission, anytime during
the first 3 months after chemoimmunotherapy followed by autologous stem cell
transplantation if there was no evidence of progression.

2. Double hit lymphoma is defined as B-cell lymphoma with genetic abnormalities involving
A) and in addition, B) and/or C): A) C-MYC arrangement or amplification by FISH study.
B) BCL2 rearrangement or amplification by FISH study. C) BCL6 rearrangement or
amplification by FISH study.

3. ANC >/= 1,000, platelets >/= 75,000.

4. AST and/or ALT < 3 times the ULN.

5. Creatinine clearance > 30 ml/min (Cockcroft-Gault formula using ideal body weight).

6. Male or female age >/= 18 years.

7. ECOG performance status
8. Willing and able to participate in all required evaluations and procedures in this
study protocol including swallowing capsules without difficulty.

9. Ability to understand the purpose and risks of the study and provide signed and dated
informed consent and authorization to use protected health information.

10. Patient should preferably have received a pre-transplant conditioning with rituximab
and Carmustine/Etoposide/Cytarabine/Melphalan/Rituxan (BEAM/R) . Other regimens which
are similar may be accepted at the discretion of the PI.

Exclusion Criteria:

1. Prior chemotherapy within 3 weeks, nitrosoureas (carmustine) within 6 weeks,
therapeutic anticancer antibodies within 4 weeks, radio- or toxin-immunoconjugates
within 10 weeks, radiation therapy within 3 weeks, or major surgery within 2 weeks of
first dose of study drug.

2. Relapsed within three months post transplant.

3. History of other malignancies within the past year except for treated basal cell or
squamous cell skin cancer or in situ cervical cancer.

4. Known CNS lymphoma.

5. Clinically significant cardiovascular disease such as uncontrolled or symptomatic
arrhythmias, congestive heart failure, or myocardial infarction within 6 months of
screening, or any Class 3 (moderate) or 4 (severe) cardiac disease as defined by the
New York Heart Association Functional Classification.

6. Requires treatment with a strong cytochrome P450 (CYP)3A inhibitor (i.e. Voriconazole,
posaconazole, itraconazole, clarithromycin, etc.) or inducer (carbamazepine, rifampin,
phenytoin, etc.).

7. AST and/or ALT >/= 3 times the ULN.

8. Malabsorption syndrome, disease significantly affecting gastrointestinal function, or
resection of the stomach or small bowel or symptomatic ulcerative colitis, symptomatic
inflammatory bowel disease, or partial or complete bowel obstruction.

9. Known history of human immunodeficiency virus or active infection with hepatitis C
virus or hepatitis B virus or any uncontrolled active systemic infection.

10. Positive pregnancy test in women of childbearing potential.

11. Lactating or pregnant or will not agree to use contraception during the study and for
30 days after the last dose of study drug if sexually active and able to bear
children.

12. Concomitant use of warfarin or other Vitamin K antagonists.