MedPath

Ibrutinib in Combination With Corticosteroids vs Placebo in Combination With Corticosteroids in Participants With New Onset Chronic Graft Versus Host Disease (cGVHD)

Phase 3
Completed
Conditions
Chronic Graft Versus Host Disease
Interventions
Registration Number
NCT02959944
Lead Sponsor
Pharmacyclics LLC.
Brief Summary

To evaluate the safety and efficacy of ibrutinib in combination with prednisone in subjects with newly diagnosed moderate to severe cGVHD.

Detailed Description

Not available

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
193
Inclusion Criteria
  • New onset moderate or severe cGVHD as defined by the 2014 National Institutes of Health (NIH) Consensus Development Project Criteria
  • Need for systemic treatment with corticosteroids for cGVHD
  • No previous systemic treatment for cGVHD (including extracorporeal photopheresis [ECP])
  • Participants may be receiving other immunosuppressants for the prophylaxis or treatment of acute GVHD but if the subject is receiving prednisone for prophylaxis or treatment of acute GVHD it must be at or below 0.5 mg/kg/d
  • Age ≥12 years old
  • Karnofsky or Lansky (subjects <16 years) performance status ≥60

Key

Read More
Exclusion Criteria
  • Received any previous systemic treatment for cGVHD with the exception of corticosteroids administered for cGVHD within the 72 hours prior to signing the informed consent form.
  • Inability to begin a prednisone dose ≥0.5 mg/kg/d for the treatment of cGVHD
  • Any uncontrolled infection or active infection requiring ongoing systemic treatment
  • Progressive underlying malignant disease or any post-transplant lymphoproliferative disease
  • Known bleeding disorders
  • Active hepatitis C virus (HCV) or hepatitis B virus (HBV)
Read More

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
Placebo + PrednisonePlaceboPlacebo given orally once daily continuously starting on Week 1 Day 1 until cGVHD progression, progression of underlying malignancy, participant begins another systemic treatment for cGVHD or unacceptable toxicity. Prednisone 1 mg/kg/d given orally once daily continuously starting on Week 1 Day 1 until unacceptable toxicity or until participant is successfully tapered from the prednisone. Starting prednisone dose may be as low as 0.5 mg/kg/d if a participant cannot tolerate higher doses.
Ibrutinib + PrednisoneibrutinibIbrutinib (420 mg) given orally once daily continuously starting on Week 1 Day 1 until cGVHD progression, progression of underlying malignancy, participant begins another systemic treatment for cGVHD or unacceptable toxicity. The 420 mg dose was adjusted for cytochrome P450 \[CYP\] inhibitors or hepatic dysfunction as applicable. Prednisone 1 mg/kg/d given orally once daily continuously starting on Week 1 Day 1 until unacceptable toxicity or until participant is successfully tapered from the prednisone. Starting prednisone dose may be as low as 0.5 mg/kg/d if a participant cannot tolerate higher doses.
Ibrutinib + PrednisonePrednisoneIbrutinib (420 mg) given orally once daily continuously starting on Week 1 Day 1 until cGVHD progression, progression of underlying malignancy, participant begins another systemic treatment for cGVHD or unacceptable toxicity. The 420 mg dose was adjusted for cytochrome P450 \[CYP\] inhibitors or hepatic dysfunction as applicable. Prednisone 1 mg/kg/d given orally once daily continuously starting on Week 1 Day 1 until unacceptable toxicity or until participant is successfully tapered from the prednisone. Starting prednisone dose may be as low as 0.5 mg/kg/d if a participant cannot tolerate higher doses.
Placebo + PrednisonePrednisonePlacebo given orally once daily continuously starting on Week 1 Day 1 until cGVHD progression, progression of underlying malignancy, participant begins another systemic treatment for cGVHD or unacceptable toxicity. Prednisone 1 mg/kg/d given orally once daily continuously starting on Week 1 Day 1 until unacceptable toxicity or until participant is successfully tapered from the prednisone. Starting prednisone dose may be as low as 0.5 mg/kg/d if a participant cannot tolerate higher doses.
Primary Outcome Measures
NameTimeMethod
Primary Analysis: Response Rate at 48 Weeks48 weeks (Cumulatively up to 30 March 2020)

Response rate was defined as the percentage of participants who were responders. Responders were defined as participants who had a complete response (CR) or a partial response (PR) at 48 weeks without starting any subsequent therapy for cGVHD or having evidence of relapse of their underlying disease that was indication for transplant prior to response assessment at 48 weeks.

Response was defined using the National Institutes of Health (NIH) Consensus Panel Chronic GVHD Activity Assessment (2014). Skin, mouth, liver, upper and lower gastrointestinal, esophagus, lung, eye, and joint/fascia are the organs or sites considered in evaluating overall response. CR is defined as resolution of all manifestations in each organ or site. PR is defined as improvement in at least 1 organ or site without progression in any other organ or site.

Final Analysis: Response Rate at 48 Weeks48 weeks (Cumulatively up to 12 July 2021)

Response rate was defined as the percentage of participants who were responders. Responders were defined as participants who had a complete response (CR) or a partial response (PR) at 48 weeks without starting any subsequent therapy for cGVHD or having evidence of relapse of their underlying disease that was indication for transplant prior to response assessment at 48 weeks.

Response was defined using the National Institutes of Health (NIH) Consensus Panel Chronic GVHD Activity Assessment (2014). Skin, mouth, liver, upper and lower gastrointestinal, esophagus, lung, eye, and joint/fascia are the organs or sites considered in evaluating overall response. CR is defined as resolution of all manifestations in each organ or site. PR is defined as improvement in at least 1 organ or site without progression in any other organ or site.

Secondary Outcome Measures
NameTimeMethod
Primary Analysis: Cumulative Incidence of Withdrawal of All Corticosteroids for Treatment of cGVHDMonths 3, 6, 9, 12, 15, 18, 21, 24 (Cumulatively up to 30 March 2020)

The cumulative incidence of withdrawal of all corticosteroids (95% confidence interval \[CI\]) was calculated using SAS lifetest procedure adjusting for competing risks including death, cGVHD progression, relapse of underlying disease, and start of subsequent cGVHD therapy. Data presented are the estimated proportion of participants withdrawing all corticosteroids at given time point. The time to withdrawal of corticosteroids is computed from randomization date to the first date of withdrawal of all corticosteroids for treatment of cGVHD to 0 mg daily for at least 30 days.

Primary Analysis: Response Rate at 24 Weeks24 weeks (Cumulatively up to 30 March 2020)

Response rate was defined as the percentage of participants who were responders. Responders were defined as participants who had a CR or PR at 24 weeks without starting any subsequent therapy for cGVHD or having evidence of relapse of their underlying disease that was indication for transplant prior to response assessment at 24 weeks.

Response was defined using the National Institutes of Health (NIH) Consensus Panel Chronic GVHD Activity Assessment (2014). Skin, mouth, liver, upper and lower gastrointestinal, esophagus, lung, eye, and joint/fascia are the organs or sites considered in evaluating overall response. CR is defined as resolution of all manifestations in each organ or site. PR is defined as improvement in at least 1 organ or site without progression in any other organ or site.

Final Analysis: Response Rate at 24 Weeks24 weeks (Cumulatively up to 12 July 2021)

Response rate was defined as the percentage of participants who were responders. Responders were defined as participants who had a CR or PR at 24 weeks without starting any subsequent therapy for cGVHD or having evidence of relapse of their underlying disease that was indication for transplant prior to response assessment at 24 weeks.

Response was defined using the National Institutes of Health (NIH) Consensus Panel Chronic GVHD Activity Assessment (2014). Skin, mouth, liver, upper and lower gastrointestinal, esophagus, lung, eye, and joint/fascia are the organs or sites considered in evaluating overall response. CR is defined as resolution of all manifestations in each organ or site. PR is defined as improvement in at least 1 organ or site without progression in any other organ or site.

Final Analysis: Cumulative Incidence of Withdrawal of All Corticosteroids for Treatment of cGVHDMonths 3, 6, 9, 12, 15, 18, 21, 24 (Cumulatively up to 12 July 2021)

The cumulative incidence of withdrawal of all corticosteroids (95% confidence interval \[CI\]) was calculated using SAS lifetest procedure adjusting for competing risks including death, cGVHD progression, relapse of underlying disease, and start of subsequent cGVHD therapy. Data presented are the estimated proportion of participants withdrawing all corticosteroids at given time point. The time to withdrawal of corticosteroids is computed from randomization date to the first date of withdrawal of all corticosteroids for treatment of cGVHD to 0 mg daily for at least 30 days.

Primary Analysis: Percentage of Participants Who Achieved Reduction of Prednisone Dose Level to Less Than 0.15 mg/kg/Day at 24 Weeks Sustained for at Least 30 Days24 weeks (Cumulatively up to 30 March 2020)
Primary Analysis: Overall Survival (OS)Median time on study (cumulatively up to 30 March 2020) was 19.8 months and 18.4 months for the Ibrutinib + Prednisone and Placebo + Prednisone arms, respectively.

OS was defined as the time of randomization until the time of death due to any cause, in months.

Final Analysis: OSMedian time on study (cumulatively up to 12 July 2021) was 33.1 months and 32.5 months for the Ibrutinib + Prednisone and Placebo + Prednisone arms, respectively.

OS was defined as the time of randomization until the time of death due to any cause, in months.

Primary Analysis: Cumulative Incidence of Withdrawal of All ImmunosuppressantsMonths 3, 6, 9, 12, 15, 18, 21, 24 (cumulatively up to 30 March 2020)

The cumulative incidence of withdrawal of all immunosuppressants (95% CI) was calculated using SAS lifetest procedure adjusting for competing risks including death, cGVHD progression, relapse of underlying disease, and start of subsequent cGVHD therapy. Data presented are the estimated proportion of participants withdrawing all immunosuppressants at a given time point. The time to withdrawal of all immunosuppressants is computed from randomization date to the first date of withdrawal of all immunosuppressants for treatment of cGVHD, sustained for at least 30 days. All immunosuppressants include corticosteroids but they do not include ibrutinib.

Final Analysis: Cumulative Incidence of Withdrawal of All ImmunosuppressantsMonths 3, 6, 9, 12, 15, 18, 21, 24 (Cumulatively up to 12 July 2021)

The cumulative incidence of withdrawal of all immunosuppressants (95% CI) was calculated using SAS lifetest procedure adjusting for competing risks including death, cGVHD progression, relapse of underlying disease, and start of subsequent cGVHD therapy. Data presented are the estimated proportion of participants withdrawing all immunosuppressants at a given time point. The time to withdrawal of all immunosuppressants is computed from randomization date to the first date of withdrawal of all immunosuppressants for treatment of cGVHD, sustained for at least 30 days. All immunosuppressants include corticosteroids but they do not include ibrutinib.

Primary Analysis: Duration of Response (DOR) for Participants Who Had PR or CR at Any TimeResponse was assessed every 4 weeks from Week 5 through Week 25, Week 37, Week 49, 30 days after the last dose of study drug, and then every 12 weeks of follow-up until progressed disease. (Cumulatively up to 30 March 2020)

Response was defined using the NIH Consensus Panel Chronic GVHD Activity Assessment (2014). Skin, mouth, liver, upper and lower GI, esophagus, lung, eye, and joint/fascia are the organs or sites considered in evaluating overall response. CR was defined as resolution of all manifestations in each organ or site. PR was defined as improvement in at least 1 organ or site without progression in any other organ or site. Duration of response was estimated by Kaplan-Meier methodology.

Primary Analysis: Percentage of Participants With Improvement in Overall Score on Lee cGVHD Symptom Scale at Two Consecutive VisitsAssessed at Weeks 5, 13, 25, 37, 49, 30 days after the last dose of study drug, and then every 12 weeks of follow-up until progressed disease. (Cumulatively up to 30 March 2020)

Clinically meaningful improvement on Lee cGVHD symptom scale was defined as at least a 7-point decrease in Lee Symptom Scale overall summary score on at least 2 consecutive visits, not preceded by progressive disease, relapse of underlying disease or start of subsequent cGVHD treatment.

The Lee cGVHD Symptom Scale score has 7 subscales (Skin, Eyes and Mouth, Breathing, Eating and Digestion, Muscles and Joints, Energy, and Mental and Emotional) with ratings as follows: 0- Not at all, 1- Slightly, 2 Moderately, 3 Quite a bit, 4-Extremely, with lower values representing a better outcome. A score is calculated for each subscale by taking the mean of all items completed if more than 50% were answered and normalizing to a 0 to 100 scale. An overall score is calculated as the average of these 7 subscales if at least 4 subscales have valid scores.

Final Analysis: Percentage of Participants Who Achieved Reduction of Prednisone Dose Level to Less Than 0.15 mg/kg/Day at 24 Weeks Sustained for at Least 30 Days24 weeks (Cumulatively up to 12 July 2021)
Final Analysis: Percentage of Participants With Improvement in Overall Score on Lee cGVHD Symptom Scale at Two Consecutive VisitsAssessed at Weeks 5, 13, 25, 37, 49, 30 days after the last dose of study drug, and then every 12 weeks of follow-up until progressed disease. (Cumulatively up to 12 July 2021)

Clinically meaningful improvement on Lee cGVHD symptom scale was defined as at least a 7-point decrease in Lee Symptom Scale overall summary score on at least 2 consecutive visits, not preceded by progressive disease, relapse of underlying disease or start of subsequent cGVHD treatment.

The Lee cGVHD Symptom Scale score has 7 subscales (Skin, Eyes and Mouth, Breathing, Eating and Digestion, Muscles and Joints, Energy, and Mental and Emotional) with ratings as follows: 0- Not at all, 1- Slightly, 2 Moderately, 3 Quite a bit, 4-Extremely, with lower values representing a better outcome. A score is calculated for each subscale by taking the mean of all items completed if more than 50% were answered and normalizing to a 0 to 100 scale. An overall score is calculated as the average of these 7 subscales if at least 4 subscales have valid scores.

Final Analysis: DOR for Participants Who Had PR or CR at Any TimeResponse was assessed every 4 weeks from Week 5 through Week 25, Week 37, Week 49, 30 days after the last dose of study drug, and then every 12 weeks of follow-up until progressed disease. (Cumulatively up to 12 July 2021)

Response was defined using the NIH Consensus Panel Chronic GVHD Activity Assessment (2014). Skin, mouth, liver, upper and lower GI, esophagus, lung, eye, and joint/fascia are the organs or sites considered in evaluating overall response. CR was defined as resolution of all manifestations in each organ or site. PR was defined as improvement in at least 1 organ or site without progression in any other organ or site. Duration of response was estimated by Kaplan-Meier methodology.

Primary Analysis: Number of Participants With Treatment-Emergent Adverse Events (AEs), Serious AEs (SAEs), and Discontinuations Due to AEs Placebo in Combination With PrednisoneFrom first dose of study drug through the end of treatment plus 30 days. As of data cutoff (cumulatively up to 30 March 2020), median ibrutinib treatment duration was 5.4 months and the median placebo treatment duration was 6.4 months.

AE: any untoward medical occurrence, which does not necessarily have a causal relationship with this treatment. SAE: any untoward medical occurrence that at any dose: results in death; is life-threatening; requires in-patient hospitalization \>24 hours or prolongation of existing hospitalization; results in persistent or significant disability/incapacity; is a congenital anomaly/birth defect; is an important medical event. Severity was graded according to the Common Terminology Criteria for Adverse Events version 4.03 (grade 1=mild, grade 2=moderate, grade 3=severe, grade 4=life-threatening, grade 5=death). Treatment-related events are those that were possibly related or related to study treatment per investigator's judgment. Treatment emergent AEs (TEAEs) occurred from the first dose of study drug up to 30 days after the last dose of study drug.

Final Analysis: Number of Participants With Treatment-Emergent Adverse Events (AEs), Serious AEs (SAEs), and Discontinuations Due to AEs Placebo in Combination With PrednisoneFrom first dose of study drug through the end of treatment plus 30 days. As of data cutoff (cumulatively up to 12 July 2021), median ibrutinib treatment duration was 5.4 months and the median placebo treatment duration was 6.4 months.

AE: any untoward medical occurrence, which does not necessarily have a causal relationship with this treatment. SAE: any untoward medical occurrence that at any dose: results in death; is life-threatening; requires in-patient hospitalization \>24 hours or prolongation of existing hospitalization; results in persistent or significant disability/incapacity; is a congenital anomaly/birth defect; is an important medical event. Severity was graded according to the Common Terminology Criteria for Adverse Events version 4.03 (grade 1=mild, grade 2=moderate, grade 3=severe, grade 4=life-threatening, grade 5=death). Treatment-related events are those that were possibly related or related to study treatment per investigator's judgment. Treatment emergent AEs (TEAEs) occurred from the first dose of study drug up to 30 days after the last dose of study drug.

Trial Locations

Locations (102)

Emory University, Winship Cancer Institute /ID# 1140-0033

🇺🇸

Atlanta, Georgia, United States

Stanford University/Stanford Cancer Center, Pasteur Drive /ID# 1140-0400

🇺🇸

Stanford, California, United States

Loyola University /ID# 1140-0713

🇺🇸

Maywood, Illinois, United States

Arizona Oncology - Scottsdale - Cancer Transplant Institute Location /ID# 1140-1120

🇺🇸

Scottsdale, Arizona, United States

Dr. Haunerschen Kinderspital /ID# 1140-1142

🇩🇪

Munich, Germany

Centro Trapianti Cellule Staminali, Ospedale Infantile Regina Margherita /ID# 1140-1156

🇮🇹

Turin, Italy

Hyogo College of Medicine College Hospital /Id# 1140-1434

🇯🇵

Nishinomiya-shi, Hyogo, Japan

IRCCS Ospedale Pediatrico Bambino Gesu /ID# 1140-1150

🇮🇹

Rome, Lazio, Italy

Okayama University Hospital /ID# 1140-1430

🇯🇵

Okayama-shi, Okayama, Japan

Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital /ID# 1140-1437

🇯🇵

Hiroshima-shi, Hiroshima, Japan

Yonsei University Health System, Severance Hospital /ID# 1140-0927

🇰🇷

Seodaemun-gu, Seoul Teugbyeolsi, Korea, Republic of

Singapore General Hospital /ID# 1140-1162

🇸🇬

Singapore, Singapore

SoonChunHyang University Seoul /ID# 1140-1163

🇰🇷

Seoul, Korea, Republic of

Kyungpook National Univ Hosp /ID# 1140-1153

🇰🇷

Daegu, Daegu Gwang Yeogsi, Korea, Republic of

China Medical University Hosp /ID# 1140-1199

🇨🇳

Taichung City, Taichung, Taiwan

National Taiwan Univ Hosp /ID# 1140-1184

🇨🇳

Taipei City, Taipei, Taiwan

Indiana University Melvin and Bren Simon Cancer Center /ID# 1140-0010

🇺🇸

Indianapolis, Indiana, United States

Univ Hosp Cleveland /ID# 1140-0941

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Cleveland, Ohio, United States

University of Pittsburgh - UPMC (Hillman Cancer Center) /ID# 1140-0050

🇺🇸

Pittsburgh, Pennsylvania, United States

Jackson Memorial Hospital, University of Miami /ID# 1140-0647

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Miami, Florida, United States

Boston Childrens Hospital /ID# 1140-1615

🇺🇸

Boston, Massachusetts, United States

Dana-Farber Cancer Institute /ID# 1140-0349

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Boston, Massachusetts, United States

Massachusetts General Hospital Cancer Center /ID# 1140-0020

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Boston, Massachusetts, United States

Fred Hutchinson Cancer Research Center /ID# 1140-0404

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Seattle, Washington, United States

Hopital de Brabois /ID# 1140-0775

🇫🇷

Vandoeuvre-lès-nancy, Meurthe-et-Moselle, France

CHU Sainte-Justine /ID# 1140-1143

🇨🇦

Montreal, Quebec, Canada

Duplicate_University of Tsukuba Hospital /ID# 1140-1445

🇯🇵

Tsukuba-shi, Ibaraki, Japan

Kumamoto Medical Center /ID# 1140-1431

🇯🇵

Kumamoto, Japan

Osaka Women's and Children's Hospital /ID# 1140-1440

🇯🇵

Izumi-Shi, Osaka, Japan

Hokkaido University Hospital /ID# 1140-1436

🇯🇵

Sapporo, Japan

Hospital Clinic /ID# 1140-0533

🇪🇸

Barcelona, Spain

Stony Brook University Medical Center /ID# 1140-0719

🇺🇸

New York, New York, United States

Columbia University Medical Center, MS-CHONY /ID# 1140-1124

🇺🇸

New York, New York, United States

Weill Cornell Physicians - Hematologic Malignancies & Bone Marrow Transplant /ID# 1140-0019

🇺🇸

New York, New York, United States

LPCH Stanford /ID# 1140-1128

🇺🇸

Palo Alto, California, United States

Emory University/Winship Cancer Institute /ID# 1140-1179

🇺🇸

Atlanta, Georgia, United States

Children's National Medical Center /ID# 1140-1122

🇺🇸

Washington, District of Columbia, United States

University of Chicago /ID# 1140-0126

🇺🇸

Chicago, Illinois, United States

University of Kentucky /ID# 1140-1140

🇺🇸

Lexington, Kentucky, United States

University of Maryland /ID# 1140-0205

🇺🇸

Baltimore, Maryland, United States

Hackensack University Medical Center/ John Theurer Cancer Center /ID# 1140-0343

🇺🇸

Hackensack, New Jersey, United States

New York Presbyterian Hospital/Weill Cornell Med College /ID# 1140-0200

🇺🇸

New York, New York, United States

University of Rochester Cancer Center /ID# 1140-0127

🇺🇸

Rochester, New York, United States

West Virginia University /ID# 1140-1090

🇺🇸

Morgantown, West Virginia, United States

Westmead Hospital /ID# 1140-0848

🇦🇺

Westmead, New South Wales, Australia

The Kinghorn Cancer Centre /ID# 1140-1165

🇦🇺

Darlinghurst, New South Wales, Australia

Royal Children's Hospital/ID# 1140-1154

🇦🇺

Parkville, Victoria, Australia

Royal Melbourne Hospital (RMH) /ID# 1140-0633

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Parkville, Victoria, Australia

Krankenhaus der Elisabethinen Linz /ID# 1140-0849

🇦🇹

Linz, Austria

Fiona Stanley Hospital /ID# 1140-0880

🇦🇺

Perth, Western Australia, Australia

Univ. Klinik for Innere Medizin, Klinische Abteilung for Hematologie, Graz /ID# 1140-0373

🇦🇹

Graz, Austria

The Ottawa Hospital Regional Cancer Center /ID# 1140-0159

🇨🇦

Ottawa, Ontario, Canada

Chinese PLA General Hospital /ID# 1140-1198

🇨🇳

Beijing, China

The First Affiliated Hospital of Soochow University /ID# 1140-1208

🇨🇳

Suzhou, Jiangsu, China

Nanfang Hospital /ID# 1140-1379

🇨🇳

Guangzhou Shi, China

CHU de GRENOBLE Alpes /ID# 1140-1058

🇫🇷

Grenoble, France

CHU Amiens Groupe hospitalier Sud /ID# 1140-1205

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Amiens, France

Centre Hospitalier Regional Universitaire de Lille /ID# 1140-0750

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Lille, France

Groupe Hospitalier Pitie-Salpetriere /ID# 1140-0918

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Paris, France

Robert Bosch Hospital /ID# 1140-1160

🇩🇪

Stuttgart, Baden-Wuerttemberg, Germany

CHU de Nantes /ID# 1140-0520

🇫🇷

Nantes, France

Universitatsklinikum Munster /ID# 1140-1195

🇩🇪

Munster, Niedersachsen, Germany

Universitaetsklinikum Dresden /ID# 1140-1367

🇩🇪

Dresden, Germany

Hannover Medical School /ID# 1140-1141

🇩🇪

Hannover, Germany

University Hospital of Regensburg /ID# 1140-1446

🇩🇪

Regensburg, Germany

A.O. Univ. Ospedali Riuniti /ID# 1140-0932

🇮🇹

Ancona, Marche, Italy

Ospedale San Raffaele IRCCS /ID# 1140-0523

🇮🇹

Milan, Italy

University of Torino /ID# 1140-1268

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Torino, Italy

Anjou Kousei Hospital /ID# 1140-1435

🇯🇵

Anjo, Aichi, Japan

ASST Papa Giovanni XXIII /ID# 1140-1231

🇮🇹

Bergamo, Italy

Kobe City Medical Center General Hospital /ID# 1140-1438

🇯🇵

Kobe-shi, Hyogo, Japan

Duplicate_Kurashiki Central Hospital /ID# 1140-1442

🇯🇵

Kurishiki-shi, Okayama, Japan

Tokai University Hospital /ID# 1140-1444

🇯🇵

Isehara-shi, Kanagawa, Japan

Osaka City University Hospital /ID# 1140-1157

🇯🇵

Osaka-shi, Osaka, Japan

National Center for Child Health and Development /ID# 1140-1443

🇯🇵

Setagaya-ku, Tokyo, Japan

Cath Univ Seoul St Mary's Hosp /ID# 1140-0928

🇰🇷

Seoul, Seoul Teugbyeolsi, Korea, Republic of

Asan Medical Center /ID# 1140-0963

🇰🇷

Seoul, Korea, Republic of

National University Cancer Institute - National University Health System /ID# 1140-1155

🇸🇬

Singapore, Singapore

Hospital Universitario Virgen del Rocio /ID# 1140-0863

🇪🇸

Sevilla, Spain

Hospital Clinico Universitario de Valencia /ID# 1140-1145

🇪🇸

Valencia, Spain

Princess Margaret Cancer Centre /ID# 1140-0043

🇨🇦

Toronto, Ontario, Canada

Samsung Medical Center /ID# 1140-0925

🇰🇷

Seoul, Seoul Teugbyeolsi, Korea, Republic of

Rutgers Cancer Institute of NJ /ID# 1140-0803

🇺🇸

New Brunswick, New Jersey, United States

St. Laszlo Hospital /ID# 1140-1164

🇭🇺

Budapest, Hungary

Hopital Saint-Louis - Institut Hematologie Centre Hayem CHU /ID# 1140-0735

🇫🇷

Paris, Ile-de-France, France

Royal Brisbane and Women's Hospital /ID# 1140-0190

🇦🇺

Herston, Queensland, Australia

Hospital Santa Creu i Sant Pau /ID# 1140-0535

🇪🇸

Barcelona, Spain

Ucsf /Id# 1140-0003

🇺🇸

San Francisco, California, United States

University of Louisville Hospital /ID# 1140-1131

🇺🇸

Louisville, Kentucky, United States

University of Minnesota /ID# 1140-0807

🇺🇸

Minneapolis, Minnesota, United States

UCHSC Anschultz Cancer Pavilion /ID# 1140-0068

🇺🇸

Aurora, Colorado, United States

Florida Hospital Cancer Institute/Adventist Health System/Sunbelt, Inc /ID# 1140-1121

🇺🇸

Orlando, Florida, United States

Barbara Ann Karmanos Cancer In /ID# 1140-0130

🇺🇸

Detroit, Michigan, United States

Mayo Clinic, Rochester, MN /ID# 1140-0240

🇺🇸

Rochester, Minnesota, United States

Vanderbilt University Medical Center Vanderbilt Ingram Cancer Center /ID# 1140-0024

🇺🇸

Nashville, Tennessee, United States

Methodist San Antonio /ID# 1140-1118

🇺🇸

San Antonio, Texas, United States

UHC Zagreb /ID# 1140-1169

🇭🇷

Zagreb, Croatia

Dup_Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital /ID# 1140-1439

🇯🇵

Bunkyo-ku, Tokyo, Japan

University of British Columbia (UBC) - Vancouver General Hospital (VGH) /ID# 1140-1166

🇨🇦

Vancouver, British Columbia, Canada

Montefiore Medical Center - Moses Campus /ID# 1140-0120

🇺🇸

Bronx, New York, United States

University of North Carolina - Lineberger Comprehensive Cancer Center /ID# 1140-1133

🇺🇸

Chapel Hill, North Carolina, United States

Medical University of South Carolina, MUSC /ID# 1140-0738

🇺🇸

Charleston, South Carolina, United States

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