To Evaluate the Efficacy and Safety of Parsaclisib and Ruxolitinib in Participants With Myelofibrosis (LIMBER-313)
- Conditions
- MyelofibrosisPost Polycythemia Vera MyelofibrosisPrimary MyelofibrosisPost Essential Thrombocythemia Myelofibrosis
- Interventions
- Registration Number
- NCT04551066
- Lead Sponsor
- Incyte Corporation
- Brief Summary
The purpose of the study is to compare the efficacy of parsaclisib when combined with ruxolitinb versus placebo combined with ruxolitinib in participants with myelofibrosis.
- Detailed Description
This is a Phase 3, randomized, double-blind study of the combination of the PI3Kδ inhibitor parsaclisib or matching placebo and the JAK1/2 inhibitor ruxolitinib in participants with PMF or secondary MF (PPV-MF or PET-MF) with DIPSS risk category of intermediate or high. Prospective participants must have not received prior MF therapy with a JAK inhibitor or a PI3K inhibitor. After participants have been determined to be eligible for the study and completed the baseline symptom diary assessment for 7 days, they will be randomized to 1 of 2 treatment groups, with stratification for platelet count (≥ 100 × 10\^9/L vs 50 to \< 100 × 10\^9/L inclusive) and DIPSS risk category (high vs intermediate-2 vs intermediate-1).
Once all enrolled participants completed the week 24 assessments the study will be unblinded and and participants randomized to placebo will have the opportunity to cross over to begin receiving parsaclisib, together with continued ruxolitinib, as long as hematology parameters are adequate.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 252
- Diagnosis of PMF, PPV-MF, or PET-MF.
- DIPSS risk category of intermediate-1, intermediate-2, or high.
- Palpable spleen of ≥ 5 cm below the left costal margin on physical examination at the screening visit.
- Active symptoms of MF at the screening visit, as demonstrated by the presence of a TSS of ≥ 10 using the Screening Symptom Form.
- Participants with an ECOG performance status score of 0, 1, or 2.
- Screening bone marrow biopsy specimen and pathology report(s) available that was obtained within the prior 2 months or willingness to undergo a bone marrow biopsy at screening/baseline; willingness to undergo bone marrow biopsy at Week 24 and every 24 weeks there after. Screening/baseline biopsy specimen must show diagnosis of MF.
- Life expectancy of at least 24 weeks.
- Willingness to avoid pregnancy or fathering children.
- Prior use of any JAK inhibitor.
- Prior therapy with any drug that inhibits PI3K (examples of drugs targeting this pathway include but are not limited to INCB040093, idelalisib, duvelisib, buparlisib, copanlisib, and umbralisib).
- Use of experimental drug therapy for MF or any other standard drug (eg, danazol, hydroxyurea) used for MF within 3 months of starting study drug and/or lack of recovery from all toxicities from previous therapy to ≤ Grade 1.
- Inability to swallow food or any condition of the upper gastrointestinal tract that precludes administration of oral medications.
- Recent history of inadequate bone marrow reserve.
- Inadequate liver and renal function at screening.
- Active bacterial, fungal, parasitic, or viral infection that requires therapy.
- Active HBV or HCV infection that requires treatment or at risk for HBV reactivation.
- Known HIV infection.
- Uncontrolled, severe, or unstable cardiac disease that in the investigator's opinion may jeopardize the safety of the participant or compliance with the Protocol.
- Active invasive malignancy over the previous 2 years.
- Splenic irradiation within 6 months before receiving the first dose of study drug.
- Concurrent use of any prohibited medications.
- Active alcohol or drug addiction that would interfere with the ability to comply with the study requirements.
- Use of any potent CYP3A4 inhibitors or inducers within 14 days or 5 half lives(whichever is longer) before the first dose of study drug or anticipated during the study.
- Inadequate recovery from toxicity and/or complications from a major surgery before starting therapy.
- Currently breastfeeding or pregnant.
- Any condition that would, in the investigator's judgment, interfere with full participation in the study, including administration of study drug and attending required study visits; pose a significant risk to the participant; or interfere with interpretation of study data.
- History of Grade 3 or 4 irAEs from prior immunotherapy.
- Receipt of any live vaccine within 30 days of the first dose of study drug
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Group B : placebo + ruxolitinib placebo Participants will receive placebo and ruxolitinib starting from Day 1 for the duration of study, ruxolitinib dose will be determined by baseline platelet count. Group A : parsaclisib + ruxolitinib parsaclisib Participants will receive parsaclisib and ruxolitinib starting from Day 1 for the duration of study, ruxolitinib dose will be determined by baseline platelet count. Group A : parsaclisib + ruxolitinib ruxolitinib Participants will receive parsaclisib and ruxolitinib starting from Day 1 for the duration of study, ruxolitinib dose will be determined by baseline platelet count. Group B : placebo + ruxolitinib ruxolitinib Participants will receive placebo and ruxolitinib starting from Day 1 for the duration of study, ruxolitinib dose will be determined by baseline platelet count.
- Primary Outcome Measures
Name Time Method Percentage of Participants Achieving ≥35% Reduction in Spleen Volume From Baseline to Week 24 as Measured by Magnetic Resonance Imaging [MRI] (or Computed Tomography [CT] Scan in Applicable Participants) Baseline; Week 24 Participants had an MRI of the upper and lower abdomen and pelvis to determine the spleen volume. A CT scan was substituted for participants who were not candidates for MRI or when MRI was not readily available. Determination of spleen length below the left costal margin was measured by palpation, using a flexible ruler provided by the sponsor.
- Secondary Outcome Measures
Name Time Method Percentage of Participants Who Had a ≥50% Reduction in Total Symptom Score (TSS) From Baseline to Week 24 as Measured by the Myelofibrosis Symptom Assessment Form v4.0 (MFSAF v4.0) Diary Baseline; Week 24 Symptoms of myelofibrosis were assessed using the MFSAF v4.0 diary. The MFSAF v4.0 is composed of 7 individual symptom scores (fatigue, night sweats, itchiness, abdominal discomfort, pain under left ribs, early satiety, bone pain), each collected daily using a 0- (no symptoms) to 10-point (worst imaginable symptoms) scale. The daily TSS (0 to 70) is the sum of the 7 individual symptom scores collected on the same day. Higher TSS indicate more severe symptoms. The TSS was missing if there were any missing individual scores. Observations with missing dates were excluded from the analysis. The Baseline/Week 24 total score was defined as the average of the daily total scores from the last 7 days before the first dose of parsaclisib, placebo, or ruxolitinib/the Week 24 visit. The Baseline/Week 24 total scores was missing if there were ≥4 missing out of the 7 daily total scores.
Change in TSS From Baseline to Week 24 as Measured by the MFSAF v4.0 Diary Baseline; Week 24 Symptoms of myelofibrosis were assessed using the MFSAF v4.0 diary. The MFSAF v4.0 is composed of 7 individual symptom scores (fatigue, night sweats, itchiness, abdominal discomfort, pain under left ribs, early satiety, bone pain), each collected daily using a 0- (no symptoms) to 10-point (worst imaginable symptoms) scale. The daily TSS (0 to 70) is the sum of the 7 individual symptom scores collected on the same day. Higher TSS indicate more severe symptoms. The TSS was missing if there were any missing individual scores. Observations with missing dates were excluded from the analysis. The Baseline/Week 24 total score was defined as the average of the daily total scores from the last 7 days before the first dose of parsaclisib, placebo, or ruxolitinib/the Week 24 visit. The Baseline/Week 24 total scores was missing if there were ≥4 missing out of the 7 daily total scores. Change from Baseline was calculated as the post-Baseline value minus the Baseline value.
Time to the First ≥50% Reduction in TSS as Measured by the MFSAF v4.0 Diary Baseline; up to Week 24 Symptoms of myelofibrosis were assessed using the MFSAF v4.0 diary. The MFSAF v4.0 is composed of 7 individual symptom scores (fatigue, night sweats, itchiness, abdominal discomfort, pain under left ribs, early satiety, bone pain), each collected daily using a 0- (no symptoms) to 10-point (worst imaginable symptoms) scale. The daily TSS (0 to 70) is the sum of the 7 individual symptom scores collected on the same day. Higher TSS indicate more severe symptoms. The TSS was missing if there were any missing individual scores. Observations with missing dates were excluded from the analysis. The Baseline/Week 24 total score was defined as the average of the daily total scores from the last 7 days before the first dose of parsaclisib, placebo, or ruxolitinib/the Week 24 visit. The Baseline/Week 24 total scores was missing if there were ≥4 missing out of the 7 daily total scores.
Overall Survival up to 749 days Overall survival was defined as the interval between the randomization date and the date of death due to any cause.
Number of Participants With Any Treatment-emergent Adverse Event (TEAE) up to 749 days An adverse event (AE) is defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not it is considered drug related. An AE could therefore be any unfavorable or unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study treatment. A TEAE is defined as any AE either reported for the first time or the worsening of a pre-existing event after the first dose of study drug until 30 to 35 days after the last dose of parsaclisib/matching placebo or ruxolitinib.
Number of Participants With Any Grade 3 or Higher TEAE up to 749 days An AE is defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not it is considered drug related. A TEAE is defined as any AE either reported for the first time or the worsening of a pre-existing event after the first dose of study drug until 30 to 35 days after the last dose of parsaclisib/matching placebo or ruxolitinib. The severity of AEs was assessed using Common Terminology Criteria for Adverse Events (CTCAE) v5.0 Grades 1 through 5. Grade 1: mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated. Grade 2: moderate; minimal, local or noninvasive intervention indicated; limiting instrumental activities of daily living (ADL). Grade 3: severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self care ADL. Grade 4: life-threatening urgent intervention indicated. Grade 5: death related to AE.
Time of Onset of a ≥35% Reduction in Spleen Volume up to 749 days The time to the first ≥35% reduction in spleen volume is defined as the time from randomization to the first time participants had ≥35% reduction in spleen volume.
Duration of Maintenance of a ≥35% Reduction in Spleen Volume up to 749 days The duration of ≥35% reduction from Baseline in spleen volume was defined as the interval between the first spleen volume measurement that was a ≥35% reduction from Baseline and the date of the first measurement that was no longer a ≥35% reduction from Baseline.
Trial Locations
- Locations (175)
Kelsey Seybold Clinic
🇺🇸Houston, Texas, United States
A.Z. St.-Jan A.V.
🇧🇪Brugge, Belgium
Oregon Health & Science University
🇺🇸Portland, Oregon, United States
Sutter Health Alta Bates Summit Medical Center Absmc Alta Bates Summit Comprehensive Cancer Center
🇺🇸Berkeley, California, United States
Mayo Clinic Rochester
🇺🇸Phoenix, Arizona, United States
California Research Institute (Cri)
🇺🇸Los Angeles, California, United States
Georgetown University
🇺🇸Washington, District of Columbia, United States
Emory University
🇺🇸Atlanta, Georgia, United States
University of Kentucky-Markey Cancer Center
🇺🇸Lexington, Kentucky, United States
Massachusetts General Hospital
🇺🇸Boston, Massachusetts, United States
New Jersey Hematology Oncology Associates Llc
🇺🇸Brick, New Jersey, United States
Morristown Medical Center-Atlantic Health System
🇺🇸Morristown, New Jersey, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
Westchester Medical Center Advanced Oncology and Infusion Center
🇺🇸Hawthorne, New York, United States
Ohio State University
🇺🇸Columbus, Ohio, United States
Kaiser Permanente-Northwest
🇺🇸Portland, Oregon, United States
Avera Cancer Institute
🇺🇸Sioux Falls, South Dakota, United States
Renovatio Clinical
🇺🇸Spring, Texas, United States
Texas Oncology-Baylor Sammons Cancer Center
🇺🇸Dallas, Texas, United States
Houston Methodist Hospital
🇺🇸Houston, Texas, United States
Grand Hospital de Charleroi
🇧🇪Charleroi, Belgium
Cliniques Universitaires Ucl Saint-Luc
🇧🇪Brussels, Belgium
AZ DELTA
🇧🇪Roeselare, Belgium
Jessa Ziekenhuis
🇧🇪Hasselt, Belgium
Fujian Medical University Union Hospital
🇨🇳Fuzhou, China
Peking University Third Hospital
🇨🇳Beijing, China
The First Hospital of Jilin University
🇨🇳Changchun, China
The First Affiliated Hospital of Zhejiang University
🇨🇳Hangzhou, China
Nanfang Hospital
🇨🇳Guangzhou, China
Anhui Provincial Hospital
🇨🇳Hefei, China
Harbin Institute of Hematology and Oncology
🇨🇳Harbin, China
The Affiliated Hospital of Inner Mongolia Medical University
🇨🇳Hohhot, China
Jinan Central Hospital
🇨🇳Jinan, China
The First Hospital of Lanzhou University
🇨🇳Lanzhou, China
Lanzhou University Second Hospital
🇨🇳Lanzhou, China
The First Affiliated Hospital of Nanchang University
🇨🇳Nanchang, China
Shenzhen University Hospital
🇨🇳Shenzhen, China
Jiangsu Province Hospital
🇨🇳Nanjing, China
Zhongshan Hospital Fudan University
🇨🇳Shanghai, China
The Second Hospital of Hebei Medical University
🇨🇳Shijiazhuang, China
Tianjin Medical University General Hospital
🇨🇳Tianjin, China
Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology
🇨🇳Wuhan, China
Yantai Yuhuangding Hospital
🇨🇳Yantai, China
Henan Provincial Peoples Hospital
🇨🇳Zhengzhou, China
Aalborg University Hospital
🇩🇰Aalborg, Denmark
Odense University Hospital
🇩🇰Odense, Denmark
Centre Hospitalier Universitaire Grenoble Alpes (Chu Grenoble Alpes) - Hopital Albert Michallon
🇫🇷La Tronche, France
Centre Hospitalier de Versailles - Hopital Andre Mignot
🇫🇷LE Chesnay-rocquencourt, France
Chu Limoges - Hopital Dupuytren
🇫🇷Limoges, France
Centre Hospitalier Universitaire de Nantes (Chu de Nantes) - Hotel-Dieu
🇫🇷Nantes, France
Chu Nimes
🇫🇷Nimes, France
Ap-Hp Groupe Hospitalier Saint-Louis Lariboisiere Fernand-Widal Site Saint Louis (Paris)
🇫🇷Paris, France
Chu de Rennes - Hospital Pontchaillou
🇫🇷Rennes, France
Hospices Civils de Lyon Centre Hospitalier Lyon Sud
🇫🇷Pierre-benite, France
Hospital de La Miletrie
🇫🇷Poitiers, France
Universitatsklinikum Halle (Saale)
🇩🇪Halle (saale), Germany
Centre Hospitalier de Roubaix
🇫🇷Roubaix, France
Klinikum Kassel Gmbh
🇩🇪Kassel, Germany
Universitaetsmedizin Rostock
🇩🇪Rostock, Germany
Hadassah Hebrew University Medical Center Ein Karem Hadassah
🇮🇱Jerusalem, Israel
Shamir Medical Center Formerly Assaf Harofeh Medical Center
🇮🇱Beer Yaaqov, Israel
Rambam Health Care Campus
🇮🇱Haifa, Israel
Davidoff Cancer Center Rabin Medical Center
🇮🇱Petah-tikva, Israel
Kaplan Medical Center
🇮🇱Rehovot, Israel
Assuta Ramat Hahayal
🇮🇱Tel Aviv, Israel
Lstituto Di Ematologia Lorenzo Ea.Seragnoli Universita Degli Studi Di Bologna - Policlinico S. Or
🇮🇹Bologna, Italy
Azienda Policlinico Vittorio Emanuele
🇮🇹Catania, Italy
Universita Degli Studi Di Genova - Facolta Di Medicina E Chirurgia
🇮🇹Genova, Italy
Istituto Romagnolo Per Lo Studio Dei Tumori Dino Amadori
🇮🇹Meldola, Italy
Fondazione Irccs Ca Granda Ospedale Maggiore
🇮🇹Milano, Italy
Universita Di Napoli Federico Ii
🇮🇹Napoli, Italy
Istituto Di Ricovero E Cura A Carattere Scientifico (Irccs) Ospedale San Raffaele
🇮🇹Milan, Italy
Azienda Ospedaliera Ospedali Riuniti Villa Sofia - Cervello
🇮🇹Palermo, Italy
Aormn Hospital Hematology and Bmt Center
🇮🇹Pesaro, Italy
Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli
🇮🇹Reggio Calabria, Italy
Universita Di Roma
🇮🇹Roma, Italy
Policlinico Universitario Agostino Gemelli Universita Cattolica Del Sacro Cuore
🇮🇹Rome, Italy
Aou San Giovanni Di Dio E Ruggi D'Aragona
🇮🇹Salerno, Italy
Azienda Ospedaliera San Giuseppe Moscati
🇮🇹Taranto, Italy
Azienda Sanitaria Universitaria Friuli Centrale Asu Fc
🇮🇹Udine, Italy
A.O. Universitaria Ospedale Di Circolo E Fondazione Macchi
🇮🇹Varese, Italy
University of Yamanashi Hospital
🇯🇵Chuo, Japan
Azienda Ospedaliera Universitaria Integrata Verona (Ospedale Borgo Roma)
🇮🇹Verona, Italy
Chiba Cancer Center
🇯🇵Chiba, Japan
Kyushu University Hospital
🇯🇵Fukuoka, Japan
Japanese Red Cross Society Himeji Hospital
🇯🇵Himeji-shi, Japan
Kansai Medical University Hospital
🇯🇵Hirakata, Japan
Tokai University Hospital
🇯🇵Isehara, Japan
Kagoshima University Hospital
🇯🇵Kagoshima-shi, Japan
Hospital of the University of Occupation and Environmental Health
🇯🇵Kitakyushu-shi, Japan
Kobe City Medical Center General Hospital
🇯🇵Kobe-shi, Japan
Kumamoto Shinto General Hospital
🇯🇵Kumamoto-shi, Japan
Ogaki Municipal Hospital
🇯🇵Ogaki, Japan
Japanese Red Cross Nagoya Daini Hospital
🇯🇵Nagoya-shi, Japan
Osaka Metropolitan University Hospital
🇯🇵Osaka, Japan
Tohoku University Hospital
🇯🇵Sendai, Japan
Dokkyo Medical University Saitama Medical Center
🇯🇵Saitama, Japan
Samsung Medical Center
🇰🇷Seoul, Korea, Republic of
Mie University Hospital
🇯🇵TSU, Japan
Wonju Severance Christian Hospital
🇰🇷Wonju, Korea, Republic of
Samodzielny Publiczny Szpital Kliniczny Im. Andrzeja Mielckiego
🇵🇱Katowice, Poland
Haukeland University Hospital
🇳🇴Bergen, Norway
Uniwersyteckie Centrum Kliniczne
🇵🇱Gdansk, Poland
Pratia Hematologia Katowice
🇵🇱Katowice, Poland
Sp Zoz Szpital Uniwersytecki
🇵🇱Krakow, Poland
Samodzielny Publiczny Szpital Kliniczny Nr 1
🇵🇱Lublin, Poland
Institute of Hematology and Transfusion Medicine
🇵🇱Warszawa, Poland
Hospital General Unviersitario de Alicante
🇪🇸Alicante, Spain
Hospital Del Mar
🇪🇸Barcelona, Spain
Ico Hospital Germans Trias I Pujol
🇪🇸Barcelona, Spain
Hospital de Basurto
🇪🇸Bilbao, Spain
Hospital Universitario Virgen de Las Nieves
🇪🇸Granada, Spain
Hospital General Universitario Morales Meseguer
🇪🇸Murcia, Spain
Hospital Universitario Insular de Gran Canaria
🇪🇸Las Palmas de Gran Canaria, Spain
Hospital Universitario 12 de Octubre
🇪🇸Madrid, Spain
Hospital Clinico Universitario de Salamanca
🇪🇸Salamanca, Spain
Hospital Universitari I Politecnic La Fe
🇪🇸Valencia, Spain
Gazi University Hospital Gazi University Faculty of Medicine
🇹🇷Ankara, Turkey
Istanbul Medipol Universitesi Ibagcilar Medipol Mega Universitesi Hastanesi
🇹🇷Istanbul, Turkey
Baskent University Adana Hospital
🇹🇷Adana, Turkey
Baskent University Istanbul Hospital
🇹🇷Istanbul, Turkey
Ege University Hospital
🇹🇷Izmir, Turkey
Ondokuz Mayis University Medicine Faculty
🇹🇷Samsun, Turkey
Dokuz Eylul University
🇹🇷Izmir, Turkey
Barts Health Nhs Trust - St Bartholomews Hospital
🇬🇧London, United Kingdom
Gloucestershire Royal Hospital
🇬🇧Gloucester, United Kingdom
United Lincolnshire Hospitals
🇬🇧Boston, United Kingdom
Sheffield Teaching Hospitals Nhs Foundation Trust - Weston Park Hospital
🇬🇧Sheffield, United Kingdom
University Hospital of North Midlands Nhs Trust
🇬🇧Stoke-on-trent, United Kingdom
Ico-Hospital Duran I Reynals
🇪🇸Barcelona, Spain
Institut Catala Doncologia Ico - Hospital Duran I Reynals Location
🇪🇸Barcelona, Spain
Hospital Universitario Virgen de La Arrixaca
🇪🇸El Palmar, Spain
Hospital Universitario Doctor Peset
🇪🇸Valencia, Spain
Fundacian Jimnez Diaz
🇪🇸Madrid, Spain
Mount Sinai School of Medicine
🇺🇸New York, New York, United States
Memorial Sloan Kettering Cancer Center
🇺🇸New York, New York, United States
CCARE
🇺🇸Fresno, California, United States
Scripps Clinic
🇺🇸San Diego, California, United States
Hospital General Universitario Vall D Hebron
🇪🇸Barcelona, Spain
Alaska Oncology and Hematology
🇺🇸Anchorage, Alaska, United States
UCLA School of Medicine
🇺🇸Los Angeles, California, United States
University of Kansas Hospital Authority
🇺🇸Westwood, Kansas, United States
Coastal Integrated Cancer Care-Cicc
🇺🇸San Luis Obispo, California, United States
Stamford Hospital-Medical Oncology Hematology
🇺🇸Stamford, Connecticut, United States
Johns Hopkins University
🇺🇸Baltimore, Maryland, United States
Duke Cancer Center
🇺🇸Durham, North Carolina, United States
Seattle Cancer Care Alliance
🇺🇸Seattle, Washington, United States
Providence Regional Medical Center Everett
🇺🇸Everett, Washington, United States
Affiliated Hospital of Hebei University
🇨🇳Baoding, China
Peking University People'S Hospital (Pkuph) - Institute of Hematology
🇨🇳Beijing SHI, China
Guangdong Provincial of People Hospital
🇨🇳Guangzhou, China
Xiangya Hospital Central South University
🇨🇳Changsha, China
The First Affiliated Hospital of Wenzhou Medical University
🇨🇳Wenzhou, China
Jiangxi Provincial of People Hospital
🇨🇳Nanchang, China
Universitatsklinikum Magdeburg A.O.R.
🇩🇪Magdeburg, Germany
Tel Aviv Sourasky Medical Center
🇮🇱Tel Aviv-yafo, Israel
Universita Di Roma Tor Vergata
🇮🇹Roma, Italy
University of Miyazaki Hospital
🇯🇵Miyazaki, Japan
Juntendo University Hospital
🇯🇵Tokyo, Japan
Hokuyukai Sapporo Hokuyu Hospital
🇯🇵Sapporo, Japan
Nippon Medical School Hospital
🇯🇵Tokyo, Japan
Seoul National University Hospital
🇰🇷Seoul, Korea, Republic of
Yokohama Municipal Citizens Hospital
🇯🇵Yokohama-shi, Japan
THE CATHOLIC UNIVERSITY OF KOREA SEOUL ST. MARY�S HOSPITAL
🇰🇷Seoul, Korea, Republic of
Ordensklinikum Linz Gmbh Elisabethinen
🇦🇹Linz, Austria
Universitaetsklinikum St. Poelten
🇦🇹Saint P�LTEN, Austria
Akershus University Hospital
🇳🇴L�RENSKOG, Norway
Helsinki University Central Hospital
🇫🇮Helsinki, Finland
University College London Hospitals Nhs Foundation Trust
🇬🇧London, United Kingdom
Hanusch-Krankenhaus Der Wiener Gebietskrankenkasse
🇦🇹Wien, Austria
Hanusch-Krankenhaus Wiener Gebietskrankenkasse
🇦🇹Wien, Austria
Midamerica Cancer Care
🇺🇸Kansas City, Missouri, United States
Tulane University
🇺🇸New Orleans, Louisiana, United States
Wake Forest Baptist Medical Center
🇺🇸Winston-Salem, North Carolina, United States
Montefiore Medical Center
🇺🇸Bronx, New York, United States