Testing the Addition of a New Anti-cancer Drug, Venetoclax, to Usual Chemotherapy for High Grade B-cell Lymphomas

Phase 2

Active, not recruiting

Conditions: Diffuse Large B-Cell Lymphoma, Not Otherwise Specified
Diffuse Large B-Cell Lymphoma
Double-Expressor Lymphoma
EBV-Positive Diffuse Large B-Cell Lymphoma, Not Otherwise Specified
High Grade B-Cell Lymphoma With MYC and BCL2 or BCL6 Rearrangements
High Grade B-Cell Lymphoma, Not Otherwise Specified
Neoplastic Cells With Double Expression of MYC and BCL2 Proteins Present
Transformed Indolent B-Cell Non-Hodgkin Lymphoma to Diffuse Large B-Cell Lymphoma

Interventions: Procedure: Biospecimen Collection
Procedure: Bone Marrow Biopsy
Procedure: Computed Tomography
Drug: Cyclophosphamide
Drug: Doxorubicin Hydrochloride
Drug: Etoposide
Procedure: Lumbar Puncture
Procedure: Positron Emission Tomography
Drug: Prednisone
Biological: Rituximab
Drug: Vincristine Sulfate
Drug: Venetoclax

Registration Number: NCT03984448

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This phase II/III trial tests whether it is possible to decrease the chance of high-grade B-cell lymphomas returning or getting worse by adding a new drug, venetoclax to the usual combination of drugs used for treatment. Venetoclax may stop the growth of cancer cells by blocking a protein called Bcl-2. Drugs used in usual chemotherapy, such as rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone, and etoposide, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving venetoclax together with usual chemotherapy may work better than usual chemotherapy alone in treating patients with high-grade B-cell lymphomas, and may increase the chance of cancer going into remission and not returning.

Detailed Description: PRIMARY OBJECTIVE:

I. To compare the progression-free survival (PFS) of rituximab (R)-chemotherapy plus venetoclax versus R-chemotherapy alone in MYC/BCL2 double-hit and double expressing lymphomas.

SECONDARY OBJECTIVES:

I. To compare the overall survival (OS) of R-chemotherapy plus venetoclax versus R-chemotherapy alone in MYC/BCL2 double-hit and double expressing lymphomas.

II. To compare the event-free survival (EFS) of R-chemotherapy plus venetoclax versus R-chemotherapy alone in MYC/BCL2 double-hit and double expressing lymphomas.

III. To assess the toxicity profile of the experimental regimens in MYC/BCL2 double-hit and double expressing lymphomas using Common Terminology Criteria for Adverse Events (CTCAE) and patient reported outcomes (PRO)-CTCAE.

IV. To compare response rates of R-chemotherapy plus venetoclax versus R-chemotherapy alone in MYC/BCL2 double-hit and double expressing lymphomas.

V. To estimate differences in response rates, EFS, PFS, and OS of R-chemotherapy plus venetoclax versus R-chemotherapy alone within each of the disease subtypes (double hit lymphoma \[DHL\] and double expressing lymphoma \[DEL\]).

VI. To determine whether cell of origin and intensity of the MYC and BCL2 protein expression on diagnostic tumor biopsy correlate with PFS, EFS, and OS.

VII. To determine whether local subtyping results for DHL and DEL are consistent with central analysis (phase II only).

OUTLINE: Patients are randomized to Arm 1 or Arm 2.

ARM 1 (DEL): Patients with DEL receive R-CHOP chemotherapy regimen consisting of rituximab intravenously (IV) on day 1, cyclophosphamide IV on day 1, doxorubicin hydrochloride IV on day 1, vincristine sulfate IV on day 1, and prednisone orally (PO) once daily (QD) on days 1-5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo position emission tomography (PET) scan, computed tomography (CT) scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study.

ARM 1 (DHL): Patients with DHL receive dose-adjusted (DA)-EPOCH-R chemotherapy regimen consisting of rituximab IV on day 1, doxorubicin hydrochloride IV on days 1-4, etoposide IV on days 1-4, vincristine sulfate IV on days 1-4, prednisone PO twice daily (BID) on days 1-5, and cyclophosphamide IV on day 5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study.

ARM 2 (DEL): Patients with DEL receive R-CHOP chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study.

ARM 2 (DHL): Patients with DHL receive DA-EPOCH-R chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study.

After completion of study treatment, patients are followed up every 12 weeks for 2 years, then every 24 weeks for up to 5 years, and then every 6 months for up to 10 years from registration.

Recruitment & Eligibility

Status: ACTIVE_NOT_RECRUITING

Sex: All

Target Recruitment: 363

Inclusion Criteria

Pathologic diagnosis of diffuse large B-cell lymphoma (DLBCL) or high grade B-cell lymphoma not otherwise specified (HGBCL not otherwise specified [NOS]). Eligible subtypes include DLBCL NOS, Epstein Barr Virus positive (EBV+) DLBCL, HGBCL NOS and DLBCL/HGBCL transformed from an underlying indolent B-cell lymphoma. Patients with T-cell/histiocyte rich large B-cell lymphoma and primary mediastinal B-cell lymphoma are not eligible
Double hit lymphoma (DHL) or double expressing lymphoma (DEL)
- DHL is defined as high grade B-cell lymphoma with one of the below:
  - Translocations of MYC and BCL2
  - Translocations of MYC and BCL2 and BCL6 (triple hit lymphoma)
  - Translocations of MYC and BCL6 without BCL2 translocation BUT with immunohistochemistry (IHC) expression of BCL2 (>=50%)
- DEL is defined as DLBCL or high grade B-cell lymphoma not otherwise specified (NOS) with protein expression by IHC of both MYC (>= 40%) and BCL2 (>= 50%) in the absence of dual translocations of both MYC and BCL2 and/or BCL6). (Double Expressing Lymphoma, DEL). Local determination of fluorescence in situ hybridization (FISH) and IHC will be performed per standardized guidelines and will be acceptable for study entry, but local IHC and FISH results for MYC must be submitted for central review in order to determine eligibility if enrolling as DEL based on local results during phase II. Central pathology review is no longer required as of Update #03.
The diagnosis of DLBCL/HGBCL and assessment of DEL/DHL will be performed per standardized guidelines at local institutions and patients will be enrolled based on local determination. Cases submitted as DHL must demonstrate the presence of a MYC translocation as well as a translocation of BCL2, BCL6, or both. Cases submitted as a DEL must demonstrate appropriate IHC protein expression of MYC and BCL2, and be negative for translocations of MYC along with translocations of BCL2 and/or BCL6 by FISH. Patients with MYC translocations and no translocations of either BCL2 or BCL6 are eligible for the DEL cohort
Patients must have FDG-avid disease on PET/CT
No prior treatment for DLBCL/HGBCL is allowed with the exception of corticosteroids administered for palliation, or a single cycle of either rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or dose adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) administered prior to enrollment. Corticosteroids or local radiation therapy are also allowed. Patients may have received intrathecal chemotherapy for CNS prophylaxis prior to registration. This single pre-registration cycle is being allowed to facilitate enrolling patients who required immediate initiation of therapy for rapidly progressing disease, or for patients where FISH or IHC results returned after initiation of chemotherapy rendered them protocol eligible. Patients with DLBCL or HGBCL transformed from an underlying indolent lymphoma cannot have received prior chemotherapy, but prior anti-CD20 monoclonal antibody therapy or radiation therapy for an indolent B-cell lymphoma is allowed.
Not pregnant and not nursing, because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown.

Therefore, for women of childbearing potential only, a negative pregnancy test done =< 14 days prior to registration is required.

Age 18 - 80 years
Eastern Cooperative Oncology Group (ECOG) Performance Status 0-2.
Absolute neutrophil count (ANC) >= 1,000/mm^3.
- Unless attributable to lymphoma.
Platelet count >= 100,000/mm^3.
- Unless attributable to lymphoma.
Creatinine =< 1.5 mg/dL OR calculated (calc.) creatinine clearance >= 50 mL/min.
- Unless attributable to lymphoma.
Total bilirubin =< 2.0 mg/dL.
- Unless attributable to lymphoma.
- Unless attributable to Gilbert's disease.
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 3 times institution upper limit of normal (ULN).
- Unless attributable to lymphoma.
Archival tissue must be available for submission in all patients for histopathology review, though participation in correlative substudies is optional.
No active ischemic heart disease or congestive heart failure, and left ventricular ejection fraction (LVEF) >= 45%.
No known active human immunodeficiency virus (HIV) disease. Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial.
No known lymphomatous involvement of the central nervous system (CNS). A lumbar puncture or neuroimaging prior to study enrollment is not required in the absence of neurological signs or symptoms concerning for CNS involvement.
No active hepatitis B or hepatitis C infection. Patients with prior hepatitis B virus (HBV) exposure (positive HBV core antibody and/or surface antigen) are eligible if they have no detectable viral load, and are taking appropriate prophylactic antiviral therapy to prevent reactivation. Patients with history of hepatitis C virus (HCV) are eligible if they have been treated for HCV and have an undetectable HCV viral load.
Chronic concomitant treatment with strong inhibitors of CYP3A4 is not allowed on this study. Patients on strong CYP3A4 inhibitors must discontinue the drug for 14 days prior to initiation of venetoclax.
Chronic concomitant treatment with strong CYP3A4 inducers is not allowed. Patients must discontinue the drug 14 days prior to the start of venetoclax.

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm 1 (R-CHOP, DA-EPOCH-R)	Doxorubicin Hydrochloride	DEL: Patients with DEL receive R-CHOP chemotherapy regimen consisting of rituximab IV on day 1, cyclophosphamide IV on day 1, doxorubicin hydrochloride IV on day 1, vincristine sulfate IV on day 1, and prednisone PO QD on days 1-5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen consisting of rituximab IV on day 1, doxorubicin hydrochloride IV on days 1-4, etoposide IV on days 1-4, vincristine sulfate IV on days 1-4, prednisone PO BID on days 1-5, and cyclophosphamide IV on day 5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study
Arm 1 (R-CHOP, DA-EPOCH-R)	Etoposide	DEL: Patients with DEL receive R-CHOP chemotherapy regimen consisting of rituximab IV on day 1, cyclophosphamide IV on day 1, doxorubicin hydrochloride IV on day 1, vincristine sulfate IV on day 1, and prednisone PO QD on days 1-5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen consisting of rituximab IV on day 1, doxorubicin hydrochloride IV on days 1-4, etoposide IV on days 1-4, vincristine sulfate IV on days 1-4, prednisone PO BID on days 1-5, and cyclophosphamide IV on day 5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study
Arm 1 (R-CHOP, DA-EPOCH-R)	Biospecimen Collection	DEL: Patients with DEL receive R-CHOP chemotherapy regimen consisting of rituximab IV on day 1, cyclophosphamide IV on day 1, doxorubicin hydrochloride IV on day 1, vincristine sulfate IV on day 1, and prednisone PO QD on days 1-5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen consisting of rituximab IV on day 1, doxorubicin hydrochloride IV on days 1-4, etoposide IV on days 1-4, vincristine sulfate IV on days 1-4, prednisone PO BID on days 1-5, and cyclophosphamide IV on day 5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study
Arm 1 (R-CHOP, DA-EPOCH-R)	Bone Marrow Biopsy	DEL: Patients with DEL receive R-CHOP chemotherapy regimen consisting of rituximab IV on day 1, cyclophosphamide IV on day 1, doxorubicin hydrochloride IV on day 1, vincristine sulfate IV on day 1, and prednisone PO QD on days 1-5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen consisting of rituximab IV on day 1, doxorubicin hydrochloride IV on days 1-4, etoposide IV on days 1-4, vincristine sulfate IV on days 1-4, prednisone PO BID on days 1-5, and cyclophosphamide IV on day 5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study
Arm 1 (R-CHOP, DA-EPOCH-R)	Computed Tomography	DEL: Patients with DEL receive R-CHOP chemotherapy regimen consisting of rituximab IV on day 1, cyclophosphamide IV on day 1, doxorubicin hydrochloride IV on day 1, vincristine sulfate IV on day 1, and prednisone PO QD on days 1-5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen consisting of rituximab IV on day 1, doxorubicin hydrochloride IV on days 1-4, etoposide IV on days 1-4, vincristine sulfate IV on days 1-4, prednisone PO BID on days 1-5, and cyclophosphamide IV on day 5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study
Arm 1 (R-CHOP, DA-EPOCH-R)	Cyclophosphamide	DEL: Patients with DEL receive R-CHOP chemotherapy regimen consisting of rituximab IV on day 1, cyclophosphamide IV on day 1, doxorubicin hydrochloride IV on day 1, vincristine sulfate IV on day 1, and prednisone PO QD on days 1-5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen consisting of rituximab IV on day 1, doxorubicin hydrochloride IV on days 1-4, etoposide IV on days 1-4, vincristine sulfate IV on days 1-4, prednisone PO BID on days 1-5, and cyclophosphamide IV on day 5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study
Arm 1 (R-CHOP, DA-EPOCH-R)	Positron Emission Tomography	DEL: Patients with DEL receive R-CHOP chemotherapy regimen consisting of rituximab IV on day 1, cyclophosphamide IV on day 1, doxorubicin hydrochloride IV on day 1, vincristine sulfate IV on day 1, and prednisone PO QD on days 1-5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen consisting of rituximab IV on day 1, doxorubicin hydrochloride IV on days 1-4, etoposide IV on days 1-4, vincristine sulfate IV on days 1-4, prednisone PO BID on days 1-5, and cyclophosphamide IV on day 5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study
Arm 1 (R-CHOP, DA-EPOCH-R)	Prednisone	DEL: Patients with DEL receive R-CHOP chemotherapy regimen consisting of rituximab IV on day 1, cyclophosphamide IV on day 1, doxorubicin hydrochloride IV on day 1, vincristine sulfate IV on day 1, and prednisone PO QD on days 1-5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen consisting of rituximab IV on day 1, doxorubicin hydrochloride IV on days 1-4, etoposide IV on days 1-4, vincristine sulfate IV on days 1-4, prednisone PO BID on days 1-5, and cyclophosphamide IV on day 5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study
Arm 1 (R-CHOP, DA-EPOCH-R)	Rituximab	DEL: Patients with DEL receive R-CHOP chemotherapy regimen consisting of rituximab IV on day 1, cyclophosphamide IV on day 1, doxorubicin hydrochloride IV on day 1, vincristine sulfate IV on day 1, and prednisone PO QD on days 1-5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen consisting of rituximab IV on day 1, doxorubicin hydrochloride IV on days 1-4, etoposide IV on days 1-4, vincristine sulfate IV on days 1-4, prednisone PO BID on days 1-5, and cyclophosphamide IV on day 5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study
Arm 1 (R-CHOP, DA-EPOCH-R)	Vincristine Sulfate	DEL: Patients with DEL receive R-CHOP chemotherapy regimen consisting of rituximab IV on day 1, cyclophosphamide IV on day 1, doxorubicin hydrochloride IV on day 1, vincristine sulfate IV on day 1, and prednisone PO QD on days 1-5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen consisting of rituximab IV on day 1, doxorubicin hydrochloride IV on days 1-4, etoposide IV on days 1-4, vincristine sulfate IV on days 1-4, prednisone PO BID on days 1-5, and cyclophosphamide IV on day 5. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study
Arm 2 (R-CHOP, DA-EPOCH-R, venetoclax)	Biospecimen Collection	DEL: Patients with DEL receive R-CHOP chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study.
Arm 2 (R-CHOP, DA-EPOCH-R, venetoclax)	Bone Marrow Biopsy	DEL: Patients with DEL receive R-CHOP chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study.
Arm 2 (R-CHOP, DA-EPOCH-R, venetoclax)	Computed Tomography	DEL: Patients with DEL receive R-CHOP chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study.
Arm 2 (R-CHOP, DA-EPOCH-R, venetoclax)	Cyclophosphamide	DEL: Patients with DEL receive R-CHOP chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study.
Arm 2 (R-CHOP, DA-EPOCH-R, venetoclax)	Etoposide	DEL: Patients with DEL receive R-CHOP chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study.
Arm 2 (R-CHOP, DA-EPOCH-R, venetoclax)	Lumbar Puncture	DEL: Patients with DEL receive R-CHOP chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study.
Arm 2 (R-CHOP, DA-EPOCH-R, venetoclax)	Positron Emission Tomography	DEL: Patients with DEL receive R-CHOP chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study.
Arm 2 (R-CHOP, DA-EPOCH-R, venetoclax)	Prednisone	DEL: Patients with DEL receive R-CHOP chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study.
Arm 2 (R-CHOP, DA-EPOCH-R, venetoclax)	Rituximab	DEL: Patients with DEL receive R-CHOP chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study.
Arm 2 (R-CHOP, DA-EPOCH-R, venetoclax)	Venetoclax	DEL: Patients with DEL receive R-CHOP chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study.
Arm 2 (R-CHOP, DA-EPOCH-R, venetoclax)	Vincristine Sulfate	DEL: Patients with DEL receive R-CHOP chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study. DHL: Patients with DHL receive DA-EPOCH-R chemotherapy regimen as in Arm 1. Patients also receive venetoclax PO QD on days 4-8 of cycle 1 and days 1-5 for cycles 2-6. Treatment repeats every 21 days for 6 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo PET scan, CT scan and blood sample collection and may undergo bone marrow biopsy and lumbar puncture throughout the study.

Primary Outcome Measures

Name	Time	Method
Progression-free survival (PFS) (phase II)	From randomization date until the earlier of disease progression, or death from any cause, assessed up to 10 years	Will be compared between the experimental and control arms using a stratified log-rank test. If one of the strata has 0 events or there are numerical issues due to the sparseness of the date within strata, an unstratified log-rank test will be used. The Kaplan-Meier method will be used to estimate PFS distributions. One-year PFS estimates, medians, and corresponding hazard ratios will be provided with 95% confidence intervals for each of the double hit lymphoma (DHL) and double expressing lymphoma (DEL) cohorts.
PFS (phase III)	At 24 months	Will be compared between the experimental and control arms using a Mantel-Haenszel test without a continuity correction. In the event that there is censoring prior to 24 months, a test based on the complementary log-log transformation of Kaplan-Meier estimates will compare PFS at 24 months between experimental and control arms. Two-year PFS estimates, medians, and corresponding hazard ratios will be provided with 95% confidence intervals overall.

Secondary Outcome Measures

Name	Time	Method
Overall survival (OS) (phase III)	From randomization date until death from any cause, assessed up to 10 years	Using a modified intent-to-treat approach, all eligible patients who are centrally confirmed as having a DHL/DEL subtype will be considered evaluable and included in the analysis of the key secondary endpoint in the arm to which they were randomized and under the centrally designated subtype. OS will be compared between the experimental and control arms using a stratified log-rank test. Two-year OS estimates, medians, and corresponding hazard ratios will be provided with 95% confidence intervals overall.
Event-free survival	From randomization date until the earlier of non-protocol lymphoma therapy, disease progression, or death from any cause, assessed up to 10 years	Will be compared between the experimental and control arms using a log-rank test. Estimated using Kaplan-Meier method by arm and lymphoma subtype.
Response rate	Up to 1 week after end of cycle 6	Response will be evaluated using the Lugano criteria for lymphoma response. Best achieved response rate with the intervention will be determined, defined as the number of patients who attain a complete or partial response using positron emission tomography (PET)/computed tomography (CT) out of the total number of evaluable patients who are randomized. Response rates will be compared between arms using a chi-square test once all patients on the study have been evaluated for response. Response rates will be estimated by arm and lymphoma subtype with 95% confidence intervals. Logistic regression will be used in a multivariable analysis to identify baseline variables associated with response.
Inconsistency of local and central results for DEL or DHL status	Until last patient is registered, up to month 57	Estimated by the number of patients with a local determination of DHL but not central determination of DHL (i.e., positive for DEL or negative for both DHL and DEL) or local determination of DEL but not central determination of DEL (i.e., positive for DHL or negative for both DHL and DEL) divided by the total number of registered patients with adequate material/tissue for central review.

Trial Locations

Locations (635): OSF Saint Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Peru
🇺🇸
Peru, Illinois, United States
Valley Radiation Oncology
🇺🇸
Peru, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸
Princeton, Illinois, United States
Genesys Hurley Cancer Institute
🇺🇸
Flint, Michigan, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
Sanford Thief River Falls Medical Center
🇺🇸
Thief River Falls, Minnesota, United States
Nebraska Medicine-Village Pointe
🇺🇸
Omaha, Nebraska, United States
Greater Dayton Cancer Center
🇺🇸
Kettering, Ohio, United States
First Dayton Cancer Care
🇺🇸
Kettering, Ohio, United States
University of Alabama at Birmingham Cancer Center
🇺🇸
Birmingham, Alabama, United States
Anchorage Associates in Radiation Medicine
🇺🇸
Anchorage, Alaska, United States
Anchorage Radiation Therapy Center
🇺🇸
Anchorage, Alaska, United States
Alaska Breast Care and Surgery LLC
🇺🇸
Anchorage, Alaska, United States
Alaska Oncology and Hematology LLC
🇺🇸
Anchorage, Alaska, United States
Alaska Women's Cancer Care
🇺🇸
Anchorage, Alaska, United States
Anchorage Oncology Centre
🇺🇸
Anchorage, Alaska, United States
Katmai Oncology Group
🇺🇸
Anchorage, Alaska, United States
Providence Alaska Medical Center
🇺🇸
Anchorage, Alaska, United States
Fairbanks Memorial Hospital
🇺🇸
Fairbanks, Alaska, United States
Cancer Center at Saint Joseph's
🇺🇸
Phoenix, Arizona, United States
Mercy Hospital Fort Smith
🇺🇸
Fort Smith, Arkansas, United States
CHI Saint Vincent Cancer Center Hot Springs
🇺🇸
Hot Springs, Arkansas, United States
Mission Hope Medical Oncology - Arroyo Grande
🇺🇸
Arroyo Grande, California, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸
Burbank, California, United States
Community Cancer Institute
🇺🇸
Clovis, California, United States
University Oncology Associates
🇺🇸
Clovis, California, United States
Loma Linda University Medical Center
🇺🇸
Loma Linda, California, United States
Fremont - Rideout Cancer Center
🇺🇸
Marysville, California, United States
University of California Davis Comprehensive Cancer Center
🇺🇸
Sacramento, California, United States
UCSF Medical Center-Parnassus
🇺🇸
San Francisco, California, United States
Pacific Central Coast Health Center-San Luis Obispo
🇺🇸
San Luis Obispo, California, United States
Mission Hope Medical Oncology - Santa Maria
🇺🇸
Santa Maria, California, United States
Gene Upshaw Memorial Tahoe Forest Cancer Center
🇺🇸
Truckee, California, United States
Rocky Mountain Cancer Centers-Aurora
🇺🇸
Aurora, Colorado, United States
The Medical Center of Aurora
🇺🇸
Aurora, Colorado, United States
Boulder Community Hospital
🇺🇸
Boulder, Colorado, United States
Boulder Community Foothills Hospital
🇺🇸
Boulder, Colorado, United States
Rocky Mountain Cancer Centers-Boulder
🇺🇸
Boulder, Colorado, United States
Rocky Mountain Cancer Centers - Centennial
🇺🇸
Centennial, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸
Colorado Springs, Colorado, United States
Rocky Mountain Cancer Centers-Penrose
🇺🇸
Colorado Springs, Colorado, United States
Cancer Center of Colorado at Sloan's Lake
🇺🇸
Denver, Colorado, United States
National Jewish Health-Main Campus
🇺🇸
Denver, Colorado, United States
The Women's Imaging Center
🇺🇸
Denver, Colorado, United States
AdventHealth Porter
🇺🇸
Denver, Colorado, United States
Colorado Blood Cancer Institute
🇺🇸
Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸
Denver, Colorado, United States
Rocky Mountain Cancer Centers-Midtown
🇺🇸
Denver, Colorado, United States
Saint Joseph Hospital - Cancer Centers of Colorado
🇺🇸
Denver, Colorado, United States
Rocky Mountain Cancer Centers-Rose
🇺🇸
Denver, Colorado, United States
Rose Medical Center
🇺🇸
Denver, Colorado, United States
Western Surgical Care
🇺🇸
Denver, Colorado, United States
Mercy Medical Center
🇺🇸
Springfield, Massachusetts, United States
Southwest Oncology PC
🇺🇸
Durango, Colorado, United States
Mountain Blue Cancer Care Center - Swedish
🇺🇸
Englewood, Colorado, United States
Rocky Mountain Cancer Centers - Swedish
🇺🇸
Englewood, Colorado, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
The Melanoma and Skin Cancer Institute
🇺🇸
Englewood, Colorado, United States
National Jewish Health-Western Hematology Oncology
🇺🇸
Golden, Colorado, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸
Grand Junction, Colorado, United States
Banner North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
Good Samaritan Hospital - Cancer Centers of Colorado
🇺🇸
Lafayette, Colorado, United States
Rocky Mountain Cancer Centers-Lakewood
🇺🇸
Lakewood, Colorado, United States
Saint Anthony Hospital
🇺🇸
Lakewood, Colorado, United States
Rocky Mountain Cancer Centers-Littleton
🇺🇸
Littleton, Colorado, United States
AdventHealth Littleton
🇺🇸
Littleton, Colorado, United States
Rocky Mountain Cancer Centers-Sky Ridge
🇺🇸
Lone Tree, Colorado, United States
Sky Ridge Medical Center
🇺🇸
Lone Tree, Colorado, United States
Longmont United Hospital
🇺🇸
Longmont, Colorado, United States
Rocky Mountain Cancer Centers-Longmont
🇺🇸
Longmont, Colorado, United States
Banner McKee Medical Center
🇺🇸
Loveland, Colorado, United States
AdventHealth Parker
🇺🇸
Parker, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸
Pueblo, Colorado, United States
National Jewish Health-Northern Hematology Oncology
🇺🇸
Thornton, Colorado, United States
Rocky Mountain Cancer Centers-Thornton
🇺🇸
Thornton, Colorado, United States
Intermountain Health Lutheran Hospital
🇺🇸
Wheat Ridge, Colorado, United States
Beebe Medical Center
🇺🇸
Lewes, Delaware, United States
Beebe South Coastal Health Campus
🇺🇸
Millville, Delaware, United States
Delaware Clinical and Laboratory Physicians PA
🇺🇸
Newark, Delaware, United States
Helen F Graham Cancer Center
🇺🇸
Newark, Delaware, United States
Medical Oncology Hematology Consultants PA
🇺🇸
Newark, Delaware, United States
Christiana Care Health System-Christiana Hospital
🇺🇸
Newark, Delaware, United States
Beebe Health Campus
🇺🇸
Rehoboth Beach, Delaware, United States
TidalHealth Nanticoke / Allen Cancer Center
🇺🇸
Seaford, Delaware, United States
Christiana Care Health System-Wilmington Hospital
🇺🇸
Wilmington, Delaware, United States
Holy Cross Hospital
🇺🇸
Fort Lauderdale, Florida, United States
Cleveland Clinic-Weston
🇺🇸
Weston, Florida, United States
Emory University Hospital/Winship Cancer Institute
🇺🇸
Atlanta, Georgia, United States
Emory Saint Joseph's Hospital
🇺🇸
Atlanta, Georgia, United States
Memorial Health University Medical Center
🇺🇸
Savannah, Georgia, United States
Summit Cancer Care-Memorial
🇺🇸
Savannah, Georgia, United States
Hawaii Cancer Care - Westridge
🇺🇸
'Aiea, Hawaii, United States
Pali Momi Medical Center
🇺🇸
'Aiea, Hawaii, United States
Queen's Cancer Center - Pearlridge
🇺🇸
'Aiea, Hawaii, United States
The Cancer Center of Hawaii-Pali Momi
🇺🇸
'Aiea, Hawaii, United States
Island Urology-Hilo
🇺🇸
Hilo, Hawaii, United States
Hawaii Cancer Care Inc - Waterfront Plaza
🇺🇸
Honolulu, Hawaii, United States
Island Urology
🇺🇸
Honolulu, Hawaii, United States
Queen's Cancer Cenrer - POB I
🇺🇸
Honolulu, Hawaii, United States
Queen's Medical Center
🇺🇸
Honolulu, Hawaii, United States
Straub Clinic and Hospital
🇺🇸
Honolulu, Hawaii, United States
University of Hawaii Cancer Center
🇺🇸
Honolulu, Hawaii, United States
Hawaii Cancer Care Inc-Liliha
🇺🇸
Honolulu, Hawaii, United States
Kuakini Medical Center
🇺🇸
Honolulu, Hawaii, United States
Queen's Cancer Center - Kuakini
🇺🇸
Honolulu, Hawaii, United States
The Cancer Center of Hawaii-Liliha
🇺🇸
Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children
🇺🇸
Honolulu, Hawaii, United States
Wilcox Memorial Hospital and Kauai Medical Clinic
🇺🇸
Lihue, Hawaii, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸
Boise, Idaho, United States
Saint Luke's Cancer Institute - Boise
🇺🇸
Boise, Idaho, United States
Saint Alphonsus Cancer Care Center-Caldwell
🇺🇸
Caldwell, Idaho, United States
Kootenai Health - Coeur d'Alene
🇺🇸
Coeur d'Alene, Idaho, United States
Walter Knox Memorial Hospital
🇺🇸
Emmett, Idaho, United States
Saint Luke's Cancer Institute - Fruitland
🇺🇸
Fruitland, Idaho, United States
Idaho Urologic Institute-Meridian
🇺🇸
Meridian, Idaho, United States
Saint Luke's Cancer Institute - Meridian
🇺🇸
Meridian, Idaho, United States
Saint Alphonsus Cancer Care Center-Nampa
🇺🇸
Nampa, Idaho, United States
Saint Luke's Cancer Institute - Nampa
🇺🇸
Nampa, Idaho, United States
Kootenai Clinic Cancer Services - Post Falls
🇺🇸
Post Falls, Idaho, United States
Kootenai Clinic Cancer Services - Sandpoint
🇺🇸
Sandpoint, Idaho, United States
Saint Luke's Cancer Institute - Twin Falls
🇺🇸
Twin Falls, Idaho, United States
OSF Saint Anthony's Health Center
🇺🇸
Alton, Illinois, United States
Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
Illinois CancerCare-Bloomington
🇺🇸
Bloomington, Illinois, United States
Illinois CancerCare-Canton
🇺🇸
Canton, Illinois, United States
Memorial Hospital of Carbondale
🇺🇸
Carbondale, Illinois, United States
SIH Cancer Institute
🇺🇸
Carterville, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸
Carthage, Illinois, United States
Centralia Oncology Clinic
🇺🇸
Centralia, Illinois, United States
Northwestern University
🇺🇸
Chicago, Illinois, United States
Rush University Medical Center
🇺🇸
Chicago, Illinois, United States
University of Illinois
🇺🇸
Chicago, Illinois, United States
University of Chicago Comprehensive Cancer Center
🇺🇸
Chicago, Illinois, United States
Carle at The Riverfront
🇺🇸
Danville, Illinois, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸
Decatur, Illinois, United States
Decatur Memorial Hospital
🇺🇸
Decatur, Illinois, United States
Northwestern Medicine Cancer Center Kishwaukee
🇺🇸
DeKalb, Illinois, United States
Illinois CancerCare-Dixon
🇺🇸
Dixon, Illinois, United States
Carle Physician Group-Effingham
🇺🇸
Effingham, Illinois, United States
Crossroads Cancer Center
🇺🇸
Effingham, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸
Eureka, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸
Galesburg, Illinois, United States
Western Illinois Cancer Treatment Center
🇺🇸
Galesburg, Illinois, United States
Northwestern Medicine Cancer Center Delnor
🇺🇸
Geneva, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸
Kewanee, Illinois, United States
Northwestern Medicine Lake Forest Hospital
🇺🇸
Lake Forest, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸
Macomb, Illinois, United States
Carle Physician Group-Mattoon/Charleston
🇺🇸
Mattoon, Illinois, United States
Loyola University Medical Center
🇺🇸
Maywood, Illinois, United States
SSM Health Good Samaritan
🇺🇸
Mount Vernon, Illinois, United States
UC Comprehensive Cancer Center at Silver Cross
🇺🇸
New Lenox, Illinois, United States
Cancer Care Center of O'Fallon
🇺🇸
O'Fallon, Illinois, United States
University of Chicago Medicine-Orland Park
🇺🇸
Orland Park, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸
Ottawa, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸
Pekin, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin
🇺🇸
Pekin, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
OSF Saint Francis Radiation Oncology at Peoria Cancer Center
🇺🇸
Peoria, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
Southern Illinois University School of Medicine
🇺🇸
Springfield, Illinois, United States
Springfield Clinic
🇺🇸
Springfield, Illinois, United States
Springfield Memorial Hospital
🇺🇸
Springfield, Illinois, United States
Southwest Illinois Health Services LLP
🇺🇸
Swansea, Illinois, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
The Carle Foundation Hospital
🇺🇸
Urbana, Illinois, United States
Northwestern Medicine Cancer Center Warrenville
🇺🇸
Warrenville, Illinois, United States
Illinois CancerCare - Washington
🇺🇸
Washington, Illinois, United States
Rush-Copley Healthcare Center
🇺🇸
Yorkville, Illinois, United States
Reid Health
🇺🇸
Richmond, Indiana, United States
University of Iowa Healthcare Cancer Services Quad Cities
🇺🇸
Bettendorf, Iowa, United States
Saint Anthony Regional Hospital
🇺🇸
Carroll, Iowa, United States
Mercy Cancer Center-West Lakes
🇺🇸
Clive, Iowa, United States
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
🇺🇸
Clive, Iowa, United States
Alegent Health Mercy Hospital
🇺🇸
Council Bluffs, Iowa, United States
Greater Regional Medical Center
🇺🇸
Creston, Iowa, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
UI Health Care Mission Cancer and Blood - Des Moines Clinic
🇺🇸
Des Moines, Iowa, United States
Broadlawns Medical Center
🇺🇸
Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
UI Health Care Mission Cancer and Blood - Laurel Clinic
🇺🇸
Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Trinity Regional Medical Center
🇺🇸
Fort Dodge, Iowa, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸
Iowa City, Iowa, United States
Siouxland Regional Cancer Center
🇺🇸
Sioux City, Iowa, United States
MercyOne Waterloo Cancer Center
🇺🇸
Waterloo, Iowa, United States
Methodist West Hospital
🇺🇸
West Des Moines, Iowa, United States
Mercy Medical Center-West Lakes
🇺🇸
West Des Moines, Iowa, United States
Central Care Cancer Center - Garden City
🇺🇸
Garden City, Kansas, United States
Central Care Cancer Center - Great Bend
🇺🇸
Great Bend, Kansas, United States
University of Kansas Cancer Center
🇺🇸
Kansas City, Kansas, United States
University of Kansas Cancer Center-Overland Park
🇺🇸
Overland Park, Kansas, United States
University of Kansas Hospital-Westwood Cancer Center
🇺🇸
Westwood, Kansas, United States
Flaget Memorial Hospital
🇺🇸
Bardstown, Kentucky, United States
Commonwealth Cancer Center-Corbin
🇺🇸
Corbin, Kentucky, United States
Saint Joseph Radiation Oncology Resource Center
🇺🇸
Lexington, Kentucky, United States
Saint Joseph Hospital East
🇺🇸
Lexington, Kentucky, United States
Saint Joseph London
🇺🇸
London, Kentucky, United States
Jewish Hospital
🇺🇸
Louisville, Kentucky, United States
Saints Mary and Elizabeth Hospital
🇺🇸
Louisville, Kentucky, United States
UofL Health Medical Center Northeast
🇺🇸
Louisville, Kentucky, United States
Jewish Hospital Medical Center South
🇺🇸
Shepherdsville, Kentucky, United States
Ochsner LSU Health Monroe Medical Center
🇺🇸
Monroe, Louisiana, United States
Louisiana State University Health Science Center
🇺🇸
New Orleans, Louisiana, United States
University Medical Center New Orleans
🇺🇸
New Orleans, Louisiana, United States
Ochsner LSU Health Saint Mary's Medical Center
🇺🇸
Shreveport, Louisiana, United States
LSU Health Sciences Center at Shreveport
🇺🇸
Shreveport, Louisiana, United States
Harold Alfond Center for Cancer Care
🇺🇸
Augusta, Maine, United States
Eastern Maine Medical Center
🇺🇸
Bangor, Maine, United States
MaineHealth Maine Medical Center - Biddeford
🇺🇸
Biddeford, Maine, United States
Lafayette Family Cancer Center-EMMC
🇺🇸
Brewer, Maine, United States
MaineHealth Cancer Care and IV Therapy - Sanford
🇺🇸
Sanford, Maine, United States
MaineHealth Cancer Care and IV Therapy - South Portland
🇺🇸
South Portland, Maine, United States
University of Maryland/Greenebaum Cancer Center
🇺🇸
Baltimore, Maryland, United States
Johns Hopkins University/Sidney Kimmel Cancer Center
🇺🇸
Baltimore, Maryland, United States
Walter Reed National Military Medical Center
🇺🇸
Bethesda, Maryland, United States
Massachusetts General Hospital Cancer Center
🇺🇸
Boston, Massachusetts, United States
Beth Israel Deaconess Medical Center
🇺🇸
Boston, Massachusetts, United States
Dana-Farber Cancer Institute
🇺🇸
Boston, Massachusetts, United States
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
🇺🇸
Ann Arbor, Michigan, United States
Bronson Battle Creek
🇺🇸
Battle Creek, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Brighton
🇺🇸
Brighton, Michigan, United States
Trinity Health Medical Center - Brighton
🇺🇸
Brighton, Michigan, United States
Henry Ford Cancer Institute-Downriver
🇺🇸
Brownstown, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Canton
🇺🇸
Canton, Michigan, United States
Trinity Health Medical Center - Canton
🇺🇸
Canton, Michigan, United States
Caro Cancer Center
🇺🇸
Caro, Michigan, United States
Chelsea Hospital
🇺🇸
Chelsea, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
🇺🇸
Chelsea, Michigan, United States
Hematology Oncology Consultants-Clarkston
🇺🇸
Clarkston, Michigan, United States
Newland Medical Associates-Clarkston
🇺🇸
Clarkston, Michigan, United States
Henry Ford Macomb Hospital-Clinton Township
🇺🇸
Clinton Township, Michigan, United States
Henry Ford Medical Center-Fairlane
🇺🇸
Dearborn, Michigan, United States
Henry Ford Hospital
🇺🇸
Detroit, Michigan, United States
Henry Ford Health Saint John Hospital
🇺🇸
Detroit, Michigan, United States
Henry Ford River District Hospital
🇺🇸
East China Township, Michigan, United States
Cancer Hematology Centers - Flint
🇺🇸
Flint, Michigan, United States
Genesee Hematology Oncology PC
🇺🇸
Flint, Michigan, United States
Corewell Health Grand Rapids Hospitals - Butterworth Hospital
🇺🇸
Grand Rapids, Michigan, United States
Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
🇺🇸
Grand Rapids, Michigan, United States
Trinity Health Grand Rapids Hospital
🇺🇸
Grand Rapids, Michigan, United States
Henry Ford Saint John Hospital - Academic
🇺🇸
Grosse Pointe Woods, Michigan, United States
Henry Ford Saint John Hospital - Breast
🇺🇸
Grosse Pointe Woods, Michigan, United States
Henry Ford Saint John Hospital - Van Elslander
🇺🇸
Grosse Pointe Woods, Michigan, United States
Allegiance Health
🇺🇸
Jackson, Michigan, United States
Bronson Methodist Hospital
🇺🇸
Kalamazoo, Michigan, United States
West Michigan Cancer Center
🇺🇸
Kalamazoo, Michigan, United States
Ascension Borgess Hospital
🇺🇸
Kalamazoo, Michigan, United States
University of Michigan Health - Sparrow Lansing
🇺🇸
Lansing, Michigan, United States
Hope Cancer Clinic
🇺🇸
Livonia, Michigan, United States
Trinity Health Saint Mary Mercy Livonia Hospital
🇺🇸
Livonia, Michigan, United States
Henry Ford Saint John Hospital - Macomb Medical
🇺🇸
Macomb, Michigan, United States
Henry Ford Warren Hospital - Breast Macomb
🇺🇸
Macomb, Michigan, United States
Saint Mary's Oncology/Hematology Associates of Marlette
🇺🇸
Marlette, Michigan, United States
Trinity Health Muskegon Hospital
🇺🇸
Muskegon, Michigan, United States
Corewell Health Lakeland Hospitals - Niles Hospital
🇺🇸
Niles, Michigan, United States
Cancer and Hematology Centers of Western Michigan - Norton Shores
🇺🇸
Norton Shores, Michigan, United States
Henry Ford Medical Center-Columbus
🇺🇸
Novi, Michigan, United States
Hope Cancer Center
🇺🇸
Pontiac, Michigan, United States
Michigan Healthcare Professionals Pontiac
🇺🇸
Pontiac, Michigan, United States
Newland Medical Associates-Pontiac
🇺🇸
Pontiac, Michigan, United States
Trinity Health Saint Joseph Mercy Oakland Hospital
🇺🇸
Pontiac, Michigan, United States
Corewell Health Reed City Hospital
🇺🇸
Reed City, Michigan, United States
Henry Ford Rochester Hospital
🇺🇸
Rochester Hills, Michigan, United States
MyMichigan Medical Center Saginaw
🇺🇸
Saginaw, Michigan, United States
Oncology Hematology Associates of Saginaw Valley PC
🇺🇸
Saginaw, Michigan, United States
Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center
🇺🇸
Saint Joseph, Michigan, United States
Corewell Health Lakeland Hospitals - Saint Joseph Hospital
🇺🇸
Saint Joseph, Michigan, United States
Henry Ford Macomb Health Center - Shelby Township
🇺🇸
Shelby, Michigan, United States
Bhadresh Nayak MD PC-Sterling Heights
🇺🇸
Sterling Heights, Michigan, United States
MyMichigan Medical Center Tawas
🇺🇸
Tawas City, Michigan, United States
Munson Medical Center
🇺🇸
Traverse City, Michigan, United States
Advanced Breast Care Center PLLC
🇺🇸
Warren, Michigan, United States
Henry Ford Health Warren Hospital
🇺🇸
Warren, Michigan, United States
Henry Ford Madison Heights Hospital - Breast
🇺🇸
Warren, Michigan, United States
Henry Ford Warren Hospital - GLCMS
🇺🇸
Warren, Michigan, United States
Macomb Hematology Oncology PC
🇺🇸
Warren, Michigan, United States
Henry Ford West Bloomfield Hospital
🇺🇸
West Bloomfield, Michigan, United States
Saint Mary's Oncology/Hematology Associates of West Branch
🇺🇸
West Branch, Michigan, United States
University of Michigan Health - West
🇺🇸
Wyoming, Michigan, United States
Huron Gastroenterology PC
🇺🇸
Ypsilanti, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
🇺🇸
Ypsilanti, Michigan, United States
Riverwood Healthcare Center
🇺🇸
Aitkin, Minnesota, United States
Sanford Joe Lueken Cancer Center
🇺🇸
Bemidji, Minnesota, United States
Essentia Health Saint Joseph's Medical Center
🇺🇸
Brainerd, Minnesota, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Minnesota Oncology - Burnsville
🇺🇸
Burnsville, Minnesota, United States
Cambridge Medical Center
🇺🇸
Cambridge, Minnesota, United States
Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Essentia Health - Deer River Clinic
🇺🇸
Deer River, Minnesota, United States
Essentia Health Saint Mary's - Detroit Lakes Clinic
🇺🇸
Detroit Lakes, Minnesota, United States
Essentia Health Cancer Center
🇺🇸
Duluth, Minnesota, United States
Essentia Health Saint Mary's Medical Center
🇺🇸
Duluth, Minnesota, United States
Miller-Dwan Hospital
🇺🇸
Duluth, Minnesota, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Lake Region Healthcare Corporation-Cancer Care
🇺🇸
Fergus Falls, Minnesota, United States
Essentia Health - Fosston
🇺🇸
Fosston, Minnesota, United States
Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Essentia Health Hibbing Clinic
🇺🇸
Hibbing, Minnesota, United States
Fairview Clinics and Surgery Center Maple Grove
🇺🇸
Maple Grove, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸
Maplewood, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Health Partners Inc
🇺🇸
Minneapolis, Minnesota, United States
Monticello Cancer Center
🇺🇸
Monticello, Minnesota, United States
New Ulm Medical Center
🇺🇸
New Ulm, Minnesota, United States
Essentia Health - Park Rapids
🇺🇸
Park Rapids, Minnesota, United States
Fairview Northland Medical Center
🇺🇸
Princeton, Minnesota, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸
Saint Louis Park, Minnesota, United States
Regions Hospital
🇺🇸
Saint Paul, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Essentia Health Sandstone
🇺🇸
Sandstone, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Essentia Health Virginia Clinic
🇺🇸
Virginia, Minnesota, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸
Woodbury, Minnesota, United States
Sanford Cancer Center Worthington
🇺🇸
Worthington, Minnesota, United States
Fairview Lakes Medical Center
🇺🇸
Wyoming, Minnesota, United States
University of Mississippi Medical Center
🇺🇸
Jackson, Mississippi, United States
Saint Louis Cancer and Breast Institute-Ballwin
🇺🇸
Ballwin, Missouri, United States
Central Care Cancer Center - Bolivar
🇺🇸
Bolivar, Missouri, United States
Parkland Health Center-Bonne Terre
🇺🇸
Bonne Terre, Missouri, United States
Cox Cancer Center Branson
🇺🇸
Branson, Missouri, United States
Mercy Cancer Center - Cape Girardeau
🇺🇸
Cape Girardeau, Missouri, United States
Saint Francis Medical Center
🇺🇸
Cape Girardeau, Missouri, United States
MU Health - University Hospital/Ellis Fischel Cancer Center
🇺🇸
Columbia, Missouri, United States
Siteman Cancer Center at West County Hospital
🇺🇸
Creve Coeur, Missouri, United States
Parkland Health Center - Farmington
🇺🇸
Farmington, Missouri, United States
MU Health Care Goldschmidt Cancer Center
🇺🇸
Jefferson City, Missouri, United States
Freeman Health System
🇺🇸
Joplin, Missouri, United States
Mercy Hospital Joplin
🇺🇸
Joplin, Missouri, United States
Mercy Clinic-Rolla-Cancer and Hematology
🇺🇸
Rolla, Missouri, United States
Phelps Health Delbert Day Cancer Institute
🇺🇸
Rolla, Missouri, United States
Heartland Regional Medical Center
🇺🇸
Saint Joseph, Missouri, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸
Saint Louis, Missouri, United States
Washington University School of Medicine
🇺🇸
Saint Louis, Missouri, United States
Mercy Hospital South
🇺🇸
Saint Louis, Missouri, United States
Siteman Cancer Center-South County
🇺🇸
Saint Louis, Missouri, United States
Missouri Baptist Medical Center
🇺🇸
Saint Louis, Missouri, United States
Mercy Hospital Saint Louis
🇺🇸
Saint Louis, Missouri, United States
Siteman Cancer Center at Saint Peters Hospital
🇺🇸
Saint Peters, Missouri, United States
Sainte Genevieve County Memorial Hospital
🇺🇸
Sainte Genevieve, Missouri, United States
Mercy Hospital Springfield
🇺🇸
Springfield, Missouri, United States
CoxHealth South Hospital
🇺🇸
Springfield, Missouri, United States
Missouri Baptist Sullivan Hospital
🇺🇸
Sullivan, Missouri, United States
BJC Outpatient Center at Sunset Hills
🇺🇸
Sunset Hills, Missouri, United States
Mercy Hospital Washington
🇺🇸
Washington, Missouri, United States
Community Hospital of Anaconda
🇺🇸
Anaconda, Montana, United States
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
Saint Vincent Healthcare
🇺🇸
Billings, Montana, United States
Saint Vincent Frontier Cancer Center
🇺🇸
Billings, Montana, United States
Bozeman Health Deaconess Hospital
🇺🇸
Bozeman, Montana, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸
Butte, Montana, United States
Benefis Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
Logan Health Medical Center
🇺🇸
Kalispell, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸
Missoula, Montana, United States
Community Medical Center
🇺🇸
Scranton, Pennsylvania, United States
Nebraska Medicine-Bellevue
🇺🇸
Bellevue, Nebraska, United States
Nebraska Cancer Specialists/Oncology Hematology West PC
🇺🇸
Grand Island, Nebraska, United States
CHI Health Good Samaritan
🇺🇸
Kearney, Nebraska, United States
Saint Elizabeth Regional Medical Center
🇺🇸
Lincoln, Nebraska, United States
Nebraska Methodist Hospital
🇺🇸
Omaha, Nebraska, United States
Alegent Health Immanuel Medical Center
🇺🇸
Omaha, Nebraska, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸
Omaha, Nebraska, United States
Alegent Health Lakeside Hospital
🇺🇸
Omaha, Nebraska, United States
Creighton University Medical Center
🇺🇸
Omaha, Nebraska, United States
University of Nebraska Medical Center
🇺🇸
Omaha, Nebraska, United States
Midlands Community Hospital
🇺🇸
Papillion, Nebraska, United States
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
🇺🇸
Lebanon, New Hampshire, United States
Saint Barnabas Medical Center
🇺🇸
Livingston, New Jersey, United States
Morristown Medical Center
🇺🇸
Morristown, New Jersey, United States
Rutgers Cancer Institute of New Jersey
🇺🇸
New Brunswick, New Jersey, United States
The Valley Hospital - Luckow Pavilion
🇺🇸
Paramus, New Jersey, United States
Neurosurgeons of New Jersey-Ridgewood
🇺🇸
Ridgewood, New Jersey, United States
Valley Health System Ridgewood Campus
🇺🇸
Ridgewood, New Jersey, United States
Overlook Hospital
🇺🇸
Summit, New Jersey, United States
Valley Health System-Hematology/Oncology
🇺🇸
Westwood, New Jersey, United States
University of New Mexico Cancer Center
🇺🇸
Albuquerque, New Mexico, United States
Presbyterian Kaseman Hospital
🇺🇸
Albuquerque, New Mexico, United States
Presbyterian Rust Medical Center/Jorgensen Cancer Center
🇺🇸
Rio Rancho, New Mexico, United States
New York-Presbyterian/Brooklyn Methodist Hospital
🇺🇸
Brooklyn, New York, United States
Roswell Park Cancer Institute
🇺🇸
Buffalo, New York, United States
Glens Falls Hospital
🇺🇸
Glens Falls, New York, United States
Northwell Health/Center for Advanced Medicine
🇺🇸
Lake Success, New York, United States
North Shore University Hospital
🇺🇸
Manhasset, New York, United States
Long Island Jewish Medical Center
🇺🇸
New Hyde Park, New York, United States
NYP/Weill Cornell Medical Center
🇺🇸
New York, New York, United States
University of Rochester
🇺🇸
Rochester, New York, United States
State University of New York Upstate Medical University
🇺🇸
Syracuse, New York, United States
Upstate Cancer Center at Verona
🇺🇸
Verona, New York, United States
UNC Lineberger Comprehensive Cancer Center
🇺🇸
Chapel Hill, North Carolina, United States
Wake Forest University at Clemmons
🇺🇸
Clemmons, North Carolina, United States
Southeastern Medical Oncology Center-Clinton
🇺🇸
Clinton, North Carolina, United States
Duke University Medical Center
🇺🇸
Durham, North Carolina, United States
Southeastern Medical Oncology Center-Goldsboro
🇺🇸
Goldsboro, North Carolina, United States
Southeastern Medical Oncology Center-Jacksonville
🇺🇸
Jacksonville, North Carolina, United States
ECU Health Oncology Kenansville
🇺🇸
Kenansville, North Carolina, United States
ECU Health Oncology Kinston
🇺🇸
Kinston, North Carolina, United States
ECU Health Oncology Richlands
🇺🇸
Richlands, North Carolina, United States
Wake Forest University Health Sciences
🇺🇸
Winston-Salem, North Carolina, United States
Sanford Bismarck Medical Center
🇺🇸
Bismarck, North Dakota, United States
Essentia Health Cancer Center-South University Clinic
🇺🇸
Fargo, North Dakota, United States
Sanford South University Medical Center
🇺🇸
Fargo, North Dakota, United States
Southpointe-Sanford Medical Center Fargo
🇺🇸
Fargo, North Dakota, United States
Sanford Medical Center Fargo
🇺🇸
Fargo, North Dakota, United States
Sanford Broadway Medical Center
🇺🇸
Fargo, North Dakota, United States
Sanford Roger Maris Cancer Center
🇺🇸
Fargo, North Dakota, United States
Essentia Health - Jamestown Clinic
🇺🇸
Jamestown, North Dakota, United States
Indu and Raj Soin Medical Center
🇺🇸
Beavercreek, Ohio, United States
Strecker Cancer Center-Belpre
🇺🇸
Belpre, Ohio, United States
Saint Elizabeth Boardman Hospital
🇺🇸
Boardman, Ohio, United States
Cleveland Clinic Mercy Hospital
🇺🇸
Canton, Ohio, United States
Mercy Hematology and Oncology Associates Inc
🇺🇸
Canton, Ohio, United States
Dayton Physicians LLC-Miami Valley South
🇺🇸
Centerville, Ohio, United States
Miami Valley Hospital South
🇺🇸
Centerville, Ohio, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
University of Cincinnati Cancer Center-UC Medical Center
🇺🇸
Cincinnati, Ohio, United States
Good Samaritan Hospital - Cincinnati
🇺🇸
Cincinnati, Ohio, United States
Oncology Hematology Care Inc-Kenwood
🇺🇸
Cincinnati, Ohio, United States
Bethesda North Hospital
🇺🇸
Cincinnati, Ohio, United States
TriHealth Cancer Institute-Westside
🇺🇸
Cincinnati, Ohio, United States
TriHealth Cancer Institute-Anderson
🇺🇸
Cincinnati, Ohio, United States
Case Western Reserve University
🇺🇸
Cleveland, Ohio, United States
MetroHealth Medical Center
🇺🇸
Cleveland, Ohio, United States
Cleveland Clinic Cancer Center/Fairview Hospital
🇺🇸
Cleveland, Ohio, United States
Cleveland Clinic Foundation
🇺🇸
Cleveland, Ohio, United States
Mount Carmel East Hospital
🇺🇸
Columbus, Ohio, United States
Columbus Oncology and Hematology Associates Inc
🇺🇸
Columbus, Ohio, United States
Riverside Methodist Hospital
🇺🇸
Columbus, Ohio, United States
Grant Medical Center
🇺🇸
Columbus, Ohio, United States
The Mark H Zangmeister Center
🇺🇸
Columbus, Ohio, United States
Mount Carmel Health Center West
🇺🇸
Columbus, Ohio, United States
Doctors Hospital
🇺🇸
Columbus, Ohio, United States
Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Dayton Physician LLC - Englewood
🇺🇸
Dayton, Ohio, United States
Miami Valley Hospital North
🇺🇸
Dayton, Ohio, United States
Delaware Health Center-Grady Cancer Center
🇺🇸
Delaware, Ohio, United States
Grady Memorial Hospital
🇺🇸
Delaware, Ohio, United States
Dublin Methodist Hospital
🇺🇸
Dublin, Ohio, United States
Armes Family Cancer Center
🇺🇸
Findlay, Ohio, United States
Blanchard Valley Hospital
🇺🇸
Findlay, Ohio, United States
Orion Cancer Care
🇺🇸
Findlay, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Dayton Physicians LLC-Atrium
🇺🇸
Franklin, Ohio, United States
Central Ohio Breast and Endocrine Surgery
🇺🇸
Gahanna, Ohio, United States
Dayton Physicians LLC-Wayne
🇺🇸
Greenville, Ohio, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
Mount Carmel Grove City Hospital
🇺🇸
Grove City, Ohio, United States
Kettering Medical Center
🇺🇸
Kettering, Ohio, United States
Fairfield Medical Center
🇺🇸
Lancaster, Ohio, United States
Saint Rita's Medical Center
🇺🇸
Lima, Ohio, United States
OhioHealth Mansfield Hospital
🇺🇸
Mansfield, Ohio, United States
Cleveland Clinic Cancer Center Mansfield
🇺🇸
Mansfield, Ohio, United States
Marietta Memorial Hospital
🇺🇸
Marietta, Ohio, United States
OhioHealth Marion General Hospital
🇺🇸
Marion, Ohio, United States
Hillcrest Hospital Cancer Center
🇺🇸
Mayfield Heights, Ohio, United States
Knox Community Hospital
🇺🇸
Mount Vernon, Ohio, United States
Licking Memorial Hospital
🇺🇸
Newark, Ohio, United States
Newark Radiation Oncology
🇺🇸
Newark, Ohio, United States
Mercy Health - Perrysburg Hospital
🇺🇸
Perrysburg, Ohio, United States
Southern Ohio Medical Center
🇺🇸
Portsmouth, Ohio, United States
North Coast Cancer Care
🇺🇸
Sandusky, Ohio, United States
Springfield Regional Cancer Center
🇺🇸
Springfield, Ohio, United States
Springfield Regional Medical Center
🇺🇸
Springfield, Ohio, United States
Cleveland Clinic Cancer Center Strongsville
🇺🇸
Strongsville, Ohio, United States
Mercy Health - Saint Vincent Hospital
🇺🇸
Toledo, Ohio, United States
Mercy Health - Saint Anne Hospital
🇺🇸
Toledo, Ohio, United States
Dayton Physicians LLC - Troy
🇺🇸
Troy, Ohio, United States
Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
South Pointe Hospital
🇺🇸
Warrensville Heights, Ohio, United States
Saint Joseph Warren Hospital
🇺🇸
Warren, Ohio, United States
University of Cincinnati Cancer Center-West Chester
🇺🇸
West Chester, Ohio, United States
Saint Ann's Hospital
🇺🇸
Westerville, Ohio, United States
Cleveland Clinic Wooster Family Health and Surgery Center
🇺🇸
Wooster, Ohio, United States
Saint Elizabeth Youngstown Hospital
🇺🇸
Youngstown, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸
Zanesville, Ohio, United States
Cancer Centers of Southwest Oklahoma Research
🇺🇸
Lawton, Oklahoma, United States
University of Oklahoma Health Sciences Center
🇺🇸
Oklahoma City, Oklahoma, United States
Mercy Hospital Oklahoma City
🇺🇸
Oklahoma City, Oklahoma, United States
Saint Alphonsus Cancer Care Center-Baker City
🇺🇸
Baker City, Oregon, United States
Saint Charles Health System
🇺🇸
Bend, Oregon, United States
Clackamas Radiation Oncology Center
🇺🇸
Clackamas, Oregon, United States
Providence Cancer Institute Clackamas Clinic
🇺🇸
Clackamas, Oregon, United States
Bay Area Hospital
🇺🇸
Coos Bay, Oregon, United States
Providence Newberg Medical Center
🇺🇸
Newberg, Oregon, United States
Saint Alphonsus Cancer Care Center-Ontario
🇺🇸
Ontario, Oregon, United States
Providence Portland Medical Center
🇺🇸
Portland, Oregon, United States
Providence Saint Vincent Medical Center
🇺🇸
Portland, Oregon, United States
Oregon Health and Science University
🇺🇸
Portland, Oregon, United States
Saint Charles Health System-Redmond
🇺🇸
Redmond, Oregon, United States
Lehigh Valley Hospital-Cedar Crest
🇺🇸
Allentown, Pennsylvania, United States
Lehigh Valley Hospital - Muhlenberg
🇺🇸
Bethlehem, Pennsylvania, United States
Christiana Care Health System-Concord Health Center
🇺🇸
Chadds Ford, Pennsylvania, United States
Chambersburg Hospital
🇺🇸
Chambersburg, Pennsylvania, United States
Geisinger Medical Center
🇺🇸
Danville, Pennsylvania, United States
Pocono Medical Center
🇺🇸
East Stroudsburg, Pennsylvania, United States
Ephrata Cancer Center
🇺🇸
Ephrata, Pennsylvania, United States
Ephrata Community Hospital
🇺🇸
Ephrata, Pennsylvania, United States
Adams Cancer Center
🇺🇸
Gettysburg, Pennsylvania, United States
WellSpan Medical Oncology and Hematology
🇺🇸
Hanover, Pennsylvania, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸
Hazleton, Pennsylvania, United States
Lehigh Valley Hospital-Hazleton
🇺🇸
Hazleton, Pennsylvania, United States
Sechler Family Cancer Center
🇺🇸
Lebanon, Pennsylvania, United States
Geisinger Medical Oncology-Lewisburg
🇺🇸
Lewisburg, Pennsylvania, United States
Lewistown Hospital
🇺🇸
Lewistown, Pennsylvania, United States
University of Pennsylvania/Abramson Cancer Center
🇺🇸
Philadelphia, Pennsylvania, United States
University of Pittsburgh Cancer Institute (UPCI)
🇺🇸
Pittsburgh, Pennsylvania, United States
Geisinger Cancer Services-Pottsville
🇺🇸
Pottsville, Pennsylvania, United States
Geisinger Medical Oncology-Selinsgrove
🇺🇸
Selinsgrove, Pennsylvania, United States
Geisinger Medical Group
🇺🇸
State College, Pennsylvania, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸
Wilkes-Barre, Pennsylvania, United States
WellSpan Health-York Cancer Center
🇺🇸
York, Pennsylvania, United States
WellSpan Health-York Hospital
🇺🇸
York, Pennsylvania, United States
Prisma Health Cancer Institute - Spartanburg
🇺🇸
Boiling Springs, South Carolina, United States
Medical University of South Carolina
🇺🇸
Charleston, South Carolina, United States
Prisma Health Cancer Institute - Laurens
🇺🇸
Clinton, South Carolina, United States
Prisma Health Cancer Institute - Easley
🇺🇸
Easley, South Carolina, United States
Saint Francis Hospital
🇺🇸
Federal Way, Washington, United States
Prisma Health Cancer Institute - Butternut
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Faris
🇺🇸
Greenville, South Carolina, United States
Saint Francis Cancer Center
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Eastside
🇺🇸
Greenville, South Carolina, United States
Self Regional Healthcare
🇺🇸
Greenwood, South Carolina, United States
Prisma Health Cancer Institute - Greer
🇺🇸
Greer, South Carolina, United States
Prisma Health Cancer Institute - Seneca
🇺🇸
Seneca, South Carolina, United States
Sanford Cancer Center Oncology Clinic
🇺🇸
Sioux Falls, South Dakota, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸
Sioux Falls, South Dakota, United States
Saint Joseph Regional Cancer Center
🇺🇸
Bryan, Texas, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸
Dallas, Texas, United States
American Fork Hospital / Huntsman Intermountain Cancer Center
🇺🇸
American Fork, Utah, United States
Sandra L Maxwell Cancer Center
🇺🇸
Cedar City, Utah, United States
Logan Regional Hospital
🇺🇸
Logan, Utah, United States
Intermountain Medical Center
🇺🇸
Murray, Utah, United States
McKay-Dee Hospital Center
🇺🇸
Ogden, Utah, United States
Utah Valley Regional Medical Center
🇺🇸
Provo, Utah, United States
Riverton Hospital
🇺🇸
Riverton, Utah, United States
Saint George Regional Medical Center
🇺🇸
Saint George, Utah, United States
Utah Cancer Specialists-Salt Lake City
🇺🇸
Salt Lake City, Utah, United States
Huntsman Cancer Institute/University of Utah
🇺🇸
Salt Lake City, Utah, United States
LDS Hospital
🇺🇸
Salt Lake City, Utah, United States
Central Vermont Medical Center/National Life Cancer Treatment
🇺🇸
Berlin, Vermont, United States
University of Vermont Medical Center
🇺🇸
Burlington, Vermont, United States
University of Vermont and State Agricultural College
🇺🇸
Burlington, Vermont, United States
Dartmouth Cancer Center - North
🇺🇸
Saint Johnsbury, Vermont, United States
Cancer Specialists of Tidewater Limited
🇺🇸
Chesapeake, Virginia, United States
Inova Schar Cancer Institute
🇺🇸
Fairfax, Virginia, United States
Inova Fairfax Hospital
🇺🇸
Falls Church, Virginia, United States
Peninsula Cancer Institute-Gloucester
🇺🇸
Gloucester, Virginia, United States
Centra Alan B Pearson Regional Cancer Center
🇺🇸
Lynchburg, Virginia, United States
Peninsula Cancer Institute-Newport News
🇺🇸
Newport News, Virginia, United States
Riverside Shore Cancer Center
🇺🇸
Onancock, Virginia, United States
Virginia Cancer Institute
🇺🇸
Richmond, Virginia, United States
Virginia Commonwealth University/Massey Cancer Center
🇺🇸
Richmond, Virginia, United States
Cancer Specialists of Tidewater-Suffolk
🇺🇸
Suffolk, Virginia, United States
Peninsula Cancer Institute-Cancer Specialists of Tidewater
🇺🇸
Virginia Beach, Virginia, United States
Peninsula Cancer Institute-Williamsburg
🇺🇸
Williamsburg, Virginia, United States
Providence Regional Cancer System-Aberdeen
🇺🇸
Aberdeen, Washington, United States
MultiCare Auburn Medical Center
🇺🇸
Auburn, Washington, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸
Bellingham, Washington, United States
Highline Medical Center-Main Campus
🇺🇸
Burien, Washington, United States
Providence Regional Cancer System-Centralia
🇺🇸
Centralia, Washington, United States
Swedish Cancer Institute-Edmonds
🇺🇸
Edmonds, Washington, United States
Saint Elizabeth Hospital
🇺🇸
Enumclaw, Washington, United States
Providence Regional Cancer Partnership
🇺🇸
Everett, Washington, United States
MultiCare Gig Harbor Medical Park
🇺🇸
Gig Harbor, Washington, United States
Swedish Cancer Institute-Issaquah
🇺🇸
Issaquah, Washington, United States
Kadlec Clinic Hematology and Oncology
🇺🇸
Kennewick, Washington, United States
Providence Regional Cancer System-Lacey
🇺🇸
Lacey, Washington, United States
Saint Clare Hospital
🇺🇸
Lakewood, Washington, United States
PeaceHealth Saint John Medical Center
🇺🇸
Longview, Washington, United States
Jefferson Healthcare
🇺🇸
Port Townsend, Washington, United States
Harrison HealthPartners Hematology and Oncology-Poulsbo
🇺🇸
Poulsbo, Washington, United States
MultiCare Good Samaritan Hospital
🇺🇸
Puyallup, Washington, United States
Pacific Gynecology Specialists
🇺🇸
Seattle, Washington, United States
Swedish Medical Center-Ballard Campus
🇺🇸
Seattle, Washington, United States
Swedish Medical Center-Cherry Hill
🇺🇸
Seattle, Washington, United States
Swedish Medical Center-First Hill
🇺🇸
Seattle, Washington, United States
PeaceHealth United General Medical Center
🇺🇸
Sedro-Woolley, Washington, United States
Providence Regional Cancer System-Shelton
🇺🇸
Shelton, Washington, United States
Saint Michael Cancer Center
🇺🇸
Silverdale, Washington, United States
MultiCare Deaconess Cancer and Blood Specialty Center - Valley
🇺🇸
Spokane Valley, Washington, United States
MultiCare Deaconess Cancer and Blood Specialty Center - Downtown
🇺🇸
Spokane, Washington, United States
MultiCare Deaconess Cancer and Blood Specialty Center - North
🇺🇸
Spokane, Washington, United States
Franciscan Research Center-Northwest Medical Plaza
🇺🇸
Tacoma, Washington, United States
Mary Bridge Children's Hospital and Health Center
🇺🇸
Tacoma, Washington, United States
MultiCare Tacoma General Hospital
🇺🇸
Tacoma, Washington, United States
Northwest Medical Specialties PLLC
🇺🇸
Tacoma, Washington, United States
PeaceHealth Southwest Medical Center
🇺🇸
Vancouver, Washington, United States
Providence Saint Mary Regional Cancer Center
🇺🇸
Walla Walla, Washington, United States
Providence Regional Cancer System-Yelm
🇺🇸
Yelm, Washington, United States
ThedaCare Regional Cancer Center
🇺🇸
Appleton, Wisconsin, United States
Duluth Clinic Ashland
🇺🇸
Ashland, Wisconsin, United States
Northwest Wisconsin Cancer Center
🇺🇸
Ashland, Wisconsin, United States
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