Study of Vidaza Versus Conventional Care Regimens for the Treatment of Acute Myeloid Leukemia (AML)

Phase 3

Completed

Conditions: Acute Myeloid Leukemia

Interventions: Drug: Azacitidine
Drug: Conventional Care Regimen

Registration Number: NCT01074047

Lead Sponsor: Celgene

Brief Summary: The purpose of this study is to compare the effect of azacitidine (Vidaza) to conventional care regimens on overall survival in elderly AML patients.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 488

Inclusion Criteria

Diagnosis of one of the following
- Newly diagnosed de novo acute myeloid leukemia (AML)
- AML secondary to myelodysplastic syndromes (MDS)
- AML secondary to exposure to leukemogenic therapy or agents with primary malignancy in remission for at least 2 years
Bone marrow blasts >30%
Age ≥ 65 years
Easter Cooperative Oncology Group (ECOG) 0-2

Exclusion Criteria

Previous cytotoxic or biologic treatment for AML (except hydroxyurea)
Previous treatment with azacitidine, decitabine or cytarabine
Prior use of targeted therapy agents (e.g., FLT3 inhibitors, other kinase inhibitors)
AML French American British subtype (FAB M3)
AML associated with inv(16), t(8;21), t(16;16), t(15:17), or t(9;22) karyotypes
Prior bone marrow or stem cell transplantation
Candidate for allogeneic bone marrow or stem cell transplant
Diagnosis of malignant disease within the previous 12 months (excluding base cell carcinoma, "in-situ" carcinoma of the cervix or breast or other local malignancy excised or irradiated with a high probability of cure)
Malignant hepatic tumors
Uncontrolled systemic infection
Active viral infection with Human Immunodeficiency Virus (HIV) or Hepatitis type B or C
Use of any experimental drug or therapy within 28 days prior to Day 1

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Azacitidine	Azacitidine	Azacitidine daily for 7 days for 28 day cycles until disease progression or unacceptable toxicity
Conventional Care Regimen	Conventional Care Regimen	Conventional Care Regimen

Primary Outcome Measures

Name	Time	Method
Kaplan-Meier Estimates for Overall Survival	Day 1 (randomization) to 40 months	Overall Survival was defined as the time from randomization to death from any cause. Overall survival was calculated by the formula: date of death - date of randomization + 1. Participants surviving at the end of the follow-up period or who withdrew consent to follow-up were censored at the date of last contact. Participants who were lost to follow-up were censored at the date last known alive.

Secondary Outcome Measures

Name	Time	Method
One-year Overall Survival Rate	From Day 1 (randomization) to 40 months	Kaplan Meier methods were used to estimate the 1-year survival probabilities for time to death from any cause. Estimates of the 1-year (365 day) survival probabilities and corresponding 95% confidence intervals (CI) were presented by treatment group. The CI for the difference in the 1-year survival probabilities was derived using Greenwoods variance estimate.
Event-free Survival (EFS)	Day 1 (randomization) to date of treatment failure, progressive disease, relapse after Complete Remission (CR) or Complete remission with incomplete blood count recovery (CRi), death from any cause. Day 1 (randomization) to 40 months	Event-free survival was defined as the interval from the date of randomization to the date of treatment failure, progressive disease, relapse after complete remission (CR) or complete remission with incomplete blood count recovery (CRi), death from any cause, or lost to follow-up, whichever occurs first. Participants who were still alive without any of these events were censored at the date of their last response assessment.
Relapse-Free Survival (RFS) for Participants Who Achieved a Complete Remission (CR) or Complete Remission With Incomplete Blood Count Recovery (CRi)	Day 1 of first documented CR or CRi to the date of relapse, death from any cause, or lost to follow-up. Day 1 (randomization) to 40 months	Relapse-free survival was defined as the interval from the date of first documented CR or CRi to the date of relapse, death from any cause, or lost to follow-up, whichever occurred first. Participants who were still alive and in continuous CR or CRi were censored at the date of their last response assessment.
Percentage of Participants Who Achieved a Morphologic CR + CRi as Determined by the Independent Review Committee (IRC) Based on International Working Group (IWG) Response Criteria for Acute Myeloid Leukemia (AML)	Day 1 (randomization) to 40 months	A complete remission (CR) is defined as a leukemia-free state defined as less than 5% blasts in a BM aspirate with marrow spicules and with at least 200 nucleated cells (there should be no blasts with Auer rods), an absolute neutrophil count (ANC) of ≥ 1 x 10\^9/L, a platelet count ≥ 100 x 10\^9/L, and transfusion independence (no transfusions for 1 week prior to each assessment). No duration of these findings is required for confirmation of this response. A CR with incomplete blood count recovery (CRi) is defined as \<5% BM blasts with the ANC count \< 1 x 10\^9/L and/or the platelet count may be \< 100 x 10\^9/L. Where the date of the hematology assessment used is the earliest on or following the date of the BM sample up to 8 days after the BM date.
Duration of Remission Assessed by the IRC Based on Kaplan-Meier Estimates	Day 1 (randomization) to 40 months; date of the first documented CR or CRi until date of first documented relapse.	The time from the date CR or CRi was first documented until the date of documented relapse from CR/CRi. Duration of remission was defined only for those participants who achieved a CR or CRi, as determined by the IRC. Participants who were lost to follow-up without documented relapse, or were alive at last follow-up without documented relapse were censored at the date of their last response assessment.
Number of Participants Who Achieved a Cytogenetic Complete Response (CRc-10) as Determined by the IRC.	Day 1 (randomization) to 40 months	The CRc is a normal karyotype defined as no clonal abnormalities after review of at least 10 metaphases using conventional cytogenetic techniques. Cytogenetic complete remission rate (CRc) is when the following criteria are met: 1) CR criteria met and 2) an abnormal karyotype is present at baseline and 3) there is reversion to normal karyotype at the time of CR (based on ≥ 10 metaphases), where date of cytogenetic sample = date of BM sample used for the CR assessment
Number of Participants With Adverse Events (AEs)	Day 1 (randomization) up to last visit completed; final data cut off of 28 Feb 2017	AEs = any noxious, unintended, or untoward medical occurrence that may appear or worsen during the course of a study. It may be a new intercurrent illness, a worsening concomitant illness, an injury, or any concomitant impairment of the participant's health, regardless of cause. Serious AE (SAE) = any AE which results in death; is life-threatening; requires inpatient hospitalization or prolongation of existing hospitalization; results in persistent or significant disability/incapacity; is a congenital anomaly/birth defect; constitutes an important medical event. The severity of AEs were graded based upon the participants symptoms according to the Common Terminology Criteria for Adverse Events (CTCAE, Version 4.0); AEs were evaluated for severity according to the following scale: Grade 1 = Mild - transient or mild discomfort; no medical intervention required; Grade 2 = Moderate - mild to moderate limitation in activity; Grade 3 = Severe; Grade 4 = Life threatening; Grade 5 = Death
Health Related Quality of Life (HRQoL): Change From Baseline in the European Organization for Research and Treatment of Cancer Cancer Quality of Life Questionnaire for Patients With Cancer (EORTC QLQ-C30) Fatigue Domain	Baseline to Cycle 3; at approximately 3 months	The European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life (QOL) questionnaire (EORTC QLQ-C30) is a 30-question tool used to assess the overall quality of life in cancer patients. It consists of 15 domains: 1 global health status (GHS) scale, 5 functional scales (Physical, Role, Cognitive, Emotional, Social), and 9 symptom scales/items (Fatigue, Nausea and Vomiting, Pain, Dyspnea, Sleep Disturbance, Appetite Loss, Constipation, Diarrhea, Financial Impact). The EORTC QLQ-C30 Fatigue Scale is scored between 0 and 100, with a high score indicating a higher level of symptoms. Negative change from Baseline values indicate reduction in fatigue (i.e. improvement in symptom) and positive values indicate increases in fatigue (i.e. worsening of symptom).
Health Related Quality of Life (HRQoL): Change From Baseline in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Patients With Cancer (EORTC QLQ-C30) Fatigue Domain	Baseline to End of Study; at approximately 11-12 months	The European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life (QOL) questionnaire (EORTC QLQ-C30) is a 30-question tool used to assess the overall quality of life in cancer patients. It consists of 15 domains: 1 global health status (GHS) scale, 5 functional scales (Physical, Role, Cognitive, Emotional, Social), and 9 symptom scales/items (Fatigue, Nausea and Vomiting, Pain, Dyspnea, Sleep Disturbance, Appetite Loss, Constipation, Diarrhea, Financial Impact). The EORTC QLQ-C30 Fatigue Scale is scored between 0 and 100, with a high score indicating a higher level of symptoms. Negative change from Baseline values indicate reduction in fatigue (i.e. improvement in symptom) and positive values indicate increases in fatigue (i.e. worsening of symptom).
HRQoL: Change From Baseline in the EORTC QLQ-C30 Dyspnea	Baseline to end of study, at approximately 11-12 months	The European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life (QOL) questionnaire (EORTC QLQ-C30) is a 30-question tool used to assess the overall quality of life in cancer patients. It consists of 15 domains: 1 global health status (GHS) scale, 5 functional scales (Physical, Role, Cognitive, Emotional, Social), and 9 symptom scales/items (Fatigue, Nausea and Vomiting, Pain, Dyspnea, Sleep Disturbance, Appetite Loss, Constipation, Diarrhea, Financial Impact). The EORTC QLQ-C30 Dyspnea scale is scored between 0 and 100, with a high score indicating a higher level of symptoms. Negative change from Baseline values indicate decreased dyspnea (i.e. improvement in symptom) and positive values indicate increased dyspnea (i.e. worsening of symptom).
HRQoL: Change From Baseline in the EORTC QLQ-C30 Physical Functioning Domain	Baseline to end of study, at approximately 11-12 months	The European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life (QOL) questionnaire (EORTC QLQ-C30) is a 30-question tool used to assess the overall quality of life in cancer patients. It consists of 15 domains: 1 global health status (GHS) scale, 5 functional scales (Physical, Role, Cognitive, Emotional, Social), and 9 symptom scales/items (Fatigue, Nausea and Vomiting, Pain, Dyspnea, Sleep Disturbance, Appetite Loss, Constipation, Diarrhea, Financial Impact). The EORTC QLQ-C30 PhysicalFunctioning Scale is scored between 0 and 100, with a high score indicating better functioning. Negative change from Baseline values indicate deterioration in functioning and positive values indicate improvement.
HRQoL: Change From Baseline in the EORTC QLQ-C30 Global Health Status-/Quality of Life Domain	Baseline to end of study, at approximately 11-12 months	The European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life (QOL) questionnaire (EORTC QLQ-C30) is a 30-question tool used to assess the overall quality of life in cancer patients. It consists of 15 domains: 1 global health status (GHS) scale, 5 functional scales (Physical, Role, Cognitive, Emotional, Social), and 9 symptom scales/items (Fatigue, Nausea and Vomiting, Pain, Dyspnea, Sleep Disturbance, Appetite Loss, Constipation, Diarrhea, Financial Impact). The EORTC QLQ-C30 Global Health Status/QOL scale is scored between 0 and 100, with a high score indicating better Global Health Status/QOL. Negative change from Baseline values indicate deterioration in Global Health Status/QOL and positive values indicate improvement.
Healthcare Resource Utilization (HRU): Number of Inpatient Hospitalizations	Day 1 (randomization) to 40 months	HRU was defined as any consumption of healthcare resources directly or indirectly related to the treatment of the patient. HRU Analysis may help in evaluating potential costs and budget impact of new treatments from a payer perspective.
Healthcare Resource Utilization (HRU): Rate of Inpatient Hospitalizations Per Year	Day 1 (randomization) to 40 months	HRU was defined as any consumption of healthcare resources directly or indirectly related to the treatment of the patient. HRU Analysis may help in evaluating potential costs and budget impact of new treatments from a payer perspective. The rate of inpatient hospitalizations per patient year was calculated as the total number of hospitalizations divided by the total number of patient-years followed in the study period. Patient-years (PY) were calculated as the duration from baseline to last available HRQL assessment for each patient.
HRU: Number of Participants Receiving Transfusions	Day 1 (randomization) to 40 months	Count of study participants who had transfusions during the treatment phase. HRU is defined as any consumption of healthcare resources directly or indirectly related to the treatment of the patient. HRU Analysis may help in evaluating potential costs and budget impact of new treatments from a payer perspective.
HRU: Rate of Transfusions Per Patient Year	Day 1 (randomization) to 40 months	HRU is defined as any consumption of healthcare resources directly or indirectly related to the treatment of the patient. HRU Analysis may help in evaluating potential costs and budget impact of new treatments from a payer perspective. The rate of transfusions per patient year was calculated as the total number of transfusions divided by the total number of patient-years followed in the study period. Patient-years (PY) were calculated as the duration from baseline to last available HRQL assessment for each patient.
Number of Participants in the Extension Phase With Treatment Emergent Adverse Events (TEAEs)	From the date of informed consent for the Extension Phase through to the date of last dose of study drug + 28 days up to last visit completed 24 July 2016; maximum duration of exposure to Azacitidine was 871 days	AEs = any noxious, unintended, or untoward medical occurrence that may appear or worsen during the course of a study. It may be a new intercurrent illness, a worsening concomitant illness, an injury, or any concomitant impairment of the participant's health, regardless of cause. Serious AE (SAE) = any AE which results in death; is life-threatening; requires inpatient hospitalization or prolongation of existing hospitalization; results in persistent or significant disability/incapacity; is a congenital anomaly/birth defect; constitutes an important medical event. The severity of AEs were graded based upon the participants symptoms according to the Common Terminology Criteria for Adverse Events (CTCAE, Version 4.0); AEs were evaluated for severity according to the following scale: Grade 1 = Mild - transient or mild discomfort; no medical intervention required; Grade 2 = Moderate - mild to moderate limitation in activity; Grade 3 = Severe; Grade 4 = Life threatening; Grade 5 = Death

Trial Locations

Locations (112): Grand Hôpital de Charleroi
🇧🇪
Charleroi, Hainaut, Belgium
Wilhelminenspital, I Medizinische Abt.
🇦🇹
Wien, Vienna, Austria
Katedra i Klinika Hematologii, Nowotworów Krwi i Transplantacji Szpiku
🇵🇱
Wroclaw, Dolnoslaskie, Poland
Saint Petersburg State Academician I.P. Pavlov Medical University
🇷🇺
Saint Petersburg, Russian Federation
Massachusetts General Hospital
🇺🇸
Boston, Massachusetts, United States
Royal Melbourne Hospital
🇦🇺
Melbourne, Victoria, Australia
St Vincent's Hospital
🇦🇺
Fitzroy, Australia
Landeskliniken Salzburg Saint Johanns-Spital, III Medizinische Abteilung
🇦🇹
Salzburg, Austria
Universitair Ziekenhuis Gent
🇧🇪
Ghent, Oost-vlaanderen, Belgium
Algemeen Ziekenhuis Sint-Jan
🇧🇪
Brugge, West-vlaanderen, Belgium
Sunnybrook Odette Cancer Centre
🇨🇦
Toronto, Ontario, Canada
Hopital Maisonneuve-Rosemont
🇨🇦
Montreal, Quebec, Canada
Centre Hospitalier de l'Université de Montréal pavilion Notre Dame
🇨🇦
Montreal, Quebec, Canada
Hospital Avicenne, Service d'hematologie Clinique
🇫🇷
Bobigny, ILE-DE-France, France
Centre Hospitalier Universitaire de Toulouse
🇫🇷
Toulouse Cedex 09, Midi-pyrénées, France
Centre Hopitalier Universitaire Dupuytren
🇫🇷
Limoges, Limousin Lorraine, France
Centre Hospitalier de la Cote Basque
🇫🇷
Aquitaine, France
Centre Hospitalier Universitaire Nantes, Hotel Dieu
🇫🇷
Nantes Cedex 1, Pays de La Loire, France
University of Rostock, Div. of Haematology and Oncology
🇩🇪
Rostock, Mecklenburg-vorpommern, Germany
Universitatsklinikum Heidelberg
🇩🇪
Heidelberg, Baden-wuerttemberg, Germany
Universitätsklinikum Ulm
🇩🇪
Ulm, Baden-wuerttemberg, Germany
Heinrich-Heine-Universität Düsseldorf
🇩🇪
Düesseldorf, Nordrhein-westfalen, Germany
Universitatsklinikum Essen, Zentrum fur Tumorforschung und Tumortherapie
🇩🇪
Essen, Nordrhein-Westfallen, Germany
Soroka Medical Center
🇮🇱
Beer Sheva, Beersheva, Israel
Rabin Medical Center
🇮🇱
Petach Tikva, Israel
Assaf Harofeh Medical Centre
🇮🇱
Beer Yaakov, Israel
Hadassah Medical Center
🇮🇱
Jerusalem, Israel
Shaare Zedek Medical Center
🇮🇱
Jerusalem, Israel
Seoul National University Hospital
🇰🇷
Jongno-gu, Seoul, Korea, Republic of
Samsung Medical Center
🇰🇷
Gangnam-gu, Seoul, Korea, Republic of
Kyungpook National University Hospital
🇰🇷
Daegu, Korea, Republic of
Asan Medical Center
🇰🇷
Seoul, Korea, Republic of
Seoul Saint Mary's Hospital Seocho-gu
🇰🇷
Seoul, Korea, Republic of
Universitair Medisch Centrum Groningen
🇳🇱
Groningen, Netherlands
Wojewodzki Szpital Specjalistczny im. Mikolaja Kopernika
🇵🇱
Lódz, Lodzkie, Poland
Dolnoslaskie Centrum Transplantacji Komórkowych z Krajowym Bankiem Dawców Szpiku
🇵🇱
Wroclaw, Dolnoslaskie, Poland
Central City Hospital # 7
🇷🇺
Ekaterinburg, Russian Federation
Hospital Central de Asturias
🇪🇸
Oviedo, Asturias, Spain
Hospital Clinic i Provincial de Barcelona
🇪🇸
Barcelona, Spain
Hospital General Universitario Gregorio Marañon
🇪🇸
Madrid, Spain
Hospital Universitario de Salamanca
🇪🇸
Salamanca, Spain
Hospital Universitario La Fe
🇪🇸
Valencia, Spain
Hospital Universitario Virgen del Rocío
🇪🇸
Sevilla, Spain
Taipei Veterans General Hospital Pei-Tou District
🇨🇳
Taipei, Taiwan
Barts and the London NHS Trust
🇬🇧
London, United Kingdom
King's College Hospital
🇬🇧
London, United Kingdom
Manchester Royal Infirmary
🇬🇧
Manchester, United Kingdom
New Cross Hospital
🇬🇧
Wolverhampton, United Kingdom
Cliniques Universitaires UCL de Mont-Godinne
🇧🇪
Yvoir, Namur, Belgium
MD Anderson Cancer Center
🇺🇸
Houston, Texas, United States
Azienda Ospedaliera Bianchi-Melacrino-Morelli
🇮🇹
Reggio Calabria, Italy
Azienda Policlinico Umberto I di Roma
🇮🇹
Roma, Italy
Azienda Ospedaliero Universitaria S. Maria della Misericordia di Udine
🇮🇹
Udine, Italy
Ospedale di Circolo e Fondazione Macchi
🇮🇹
Varese, Italy
Yonsei University Health System
🇰🇷
Seodaemun-gu, Seoul, Korea, Republic of
Peter MacCallum Cancer Centre
🇦🇺
East Melbourne, Victoria, Australia
Western Hospital
🇦🇺
Footscray, Victoria, Australia
Prince of Wales Hospital
🇦🇺
Randwick, New South Wales, Australia
Royal Adelaide Hospital
🇦🇺
Adelaide, South Australia, Australia
Princess Margaret Hospital
🇨🇦
Ontario, Canada
University of Alberta Hospital
🇨🇦
Edmonton, Alberta, Canada
The Third Hospital of Peking University
🇨🇳
Beijing, China
Centre Hospitalier de Jolimont-Lobbes
🇧🇪
La Louvière, Belgium
Klinikum Wels-Grieskirchen GmbH
🇦🇹
Wels, Upper Austria, Austria
Ottawa Hospital General Campus
🇨🇦
Ottawa, Ontario, Canada
Cancer Care Manitoba
🇨🇦
Winnipeg, Manitoba, Canada
Hopital du Sacre Coeur de Montréal
🇨🇦
Montreal, Quebec, Canada
Peking Union Medical College Hospital
🇨🇳
Beijing, China
Tom Baker Cancer Centre
🇨🇦
Calgary, Canada
Peoples Hospital of Jiangsu Province
🇨🇳
Jiangsu, China
Shanghai Ruijin Hospital
🇨🇳
Shanghai, China
Shanghai Changhai Hospital,the Second Military Medical University
🇨🇳
Shanghai, China
West China Hospital,Sichuan University
🇨🇳
Sichuan, China
Tianjin Blood Disease Hospital
🇨🇳
Tianjin, China
Fakultni nemocnice Brno
🇨🇿
Brno, Jihormoravsky Kraj, Czechia
Vseobecna Fakultni Nemocnice v Praze
🇨🇿
Praha 2, Praha, Czechia
Fakultni nemocnice Olomouc, hemato-onkologicka klinika
🇨🇿
Olomouc, Olomoucký Kraj, Czechia
Centre Hospitalier Régional Universitaire, Hôpital de Hautepierre
🇫🇷
Strasbourg, Alsace, France
Ustav hematologie a krevni transfuze
🇨🇿
Praha 2, Praha, Czechia
Centre Hospitalier Universitaire de Lyon-Hôpital Edouard Herriot
🇫🇷
Lyon Cedex 03, France
Universitätsklinikum Leipzig
🇩🇪
Leipzig, Sachsen, Germany
Hopital Percy Clamart
🇫🇷
Clamart Cedex, Ile-de-france, France
Hôpital Saint Louis
🇫🇷
Paris Cedex 10, Ile-de-france, France
Centre Hospitalier Universitaire de Nice
🇫🇷
Nice Cedex 3, Nice, France
CHRU d'Angers
🇫🇷
Angers cedex 09, Pays de La Loire, France
Centre Hospitalier Universitaire d'Amiens, Groupe Hospitalier Sud
🇫🇷
Amiens Cedex 1, Picardie, France
Hôpital de la Conception
🇫🇷
Marseille, Provence Alpes Cote D'azur, France
Chaim Sheba Medical Center - Tel Hashomer, Heart Institute
🇮🇱
Tel Hashomer, Israel
Universitätsklinikum Jena
🇩🇪
Jena, Thueringen, Germany
Sourasky Medical Center
🇮🇱
Tel Aviv, Israel
IRCCS Centro di Riferimento Oncologico di Basilicata di Rionero in Vulture
🇮🇹
Rionero in Vulture, Potenza, Italy
Azienda Sanitaria Ospedaliera "San Luigi Gonzaga"
🇮🇹
Orbassano, Turin, Italy
Azienda Ospedaliera Universitaria - Ospedali Riuniti di Ancona
🇮🇹
Ancona, Italy
Azienda Ospedaliera SS. Antonio E. Biagio E. Cesare Arrigo di Alessandria
🇮🇹
Alessandria, Italy
Azienda Ospedaliera Policlinico di Bari
🇮🇹
Bari, Italy
Azienda Ospedaliera Sant'Orsola Malpighi
🇮🇹
Bologna, Italy
Azienda Ospedaliero-Universitaria Careggi
🇮🇹
Firenze, Italy
Policlinico Universitario Agostino Gemelli
🇮🇹
Roma, Italy
Instytut Hematologii i Transfuzjologii
🇵🇱
Warszawa, Mazowieckie, Poland
Samodzielny Publiczny SK im. A. Mieleckiego Slaskiego Uniwersytetu Medycznego w Katowicach
🇵🇱
Katowice, Slaskie, Poland
State Healthcare Institution "Nizhny Novgorod N.A. Semashko Regional Clinical Hospital"
🇷🇺
Nizhniy Novgorod, Russian Federation
City Clinical Hospital n.a. S. P. Botkin
🇷🇺
Moscow, Russian Federation
Saratov State Medical University
🇷🇺
Saratov, Russian Federation
Hospital Son Llàtzer
🇪🇸
Palma de Mallorca, Baleares, Spain
Hospital Son Dureta
🇪🇸
Palma de Mallorca, Baleares, Spain
Chang Gung Memorial Hospital, Kaohsiung
🇨🇳
Niao-Sung Hsiang, Kaohsiung, Taiwan
Royal Marsden Hospital
🇬🇧
Sutton, Surrey, United Kingdom
National Taiwan University Hospital
🇨🇳
Taipei, Taiwan
Royal Bournemouth Hospital
🇬🇧
Bournemouth, United Kingdom
Churchill Hospital
🇬🇧
Oxford, United Kingdom
Korea University Hospital at Guro
🇰🇷
Seoul, Korea, Republic of
Queen Elizabeth II Health Sciences Centre
🇨🇦
Halifax, Nova Scotia, Canada