A Study Evaluating Venetoclax (ABT-199) in Multiple Myeloma Subjects Who Are Receiving Bortezomib and Dexamethasone as Standard Therapy

Phase 3

Completed

Conditions: Relapsed/Refractory Multiple Myeloma

Interventions: Drug: Venetoclax
Drug: Bortezomib
Drug: Placebo for venetoclax
Drug: Dexamethasone

Registration Number: NCT02755597

Lead Sponsor: AbbVie

Brief Summary: This was a Phase 3, multicenter, randomized, double blind, placebo-controlled study evaluating the efficacy and safety of venetoclax plus bortezomib and dexamethasone in participants with relapsed or refractory multiple myeloma who are considered sensitive or naïve to proteasome inhibitors and received 1 to 3 prior lines of therapy for multiple myeloma.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 291

Inclusion Criteria

Eastern Cooperative Oncology Group (ECOG) performance score ≤ 2
Participant has documented relapsed or progressive multiple myeloma on or after any regimen or who are refractory to the most recent line of therapy. Relapsed myeloma is defined as previously treated myeloma that progresses and requires initiation of salvage therapy, but does not meet the criteria for refractory myeloma. Refractory myeloma is defined as disease that is nonresponsive (failure to achieve minimal response or development of progressive disease [PD]) while on primary or salvage therapy, or progresses within 60 days of last therapy.
Participant must have received prior treatment with at least one, but no more than three, prior lines of therapy for multiple myeloma. A line of therapy consists of ≥ 1 complete cycle of a single agent, a regimen consisting of combination of several drugs, or a planned sequential therapy of various regimens.
Prior treatment with bortezomib or other proteasome inhibitor is allowed, provided ALL of the following criteria are met: Disease is NOT refractory to any proteasome inhibitor, defined as no disease progression (i.e., PD, per International Myeloma Working Group [IMWG] or European Society for Blood and Marrow Transplantation [EBMT] criteria) while receiving proteasome inhibitor therapy or within 60 days after the last dose, AND best response achieved with any proteasome inhibitor therapy (alone or in combination) was at least a Partial Response (PR), AND participant did not discontinue any proteasome inhibitor due to intolerance or ≥ Grade 3 related toxicity.
Participant has measurable disease at Screening, defined as at least one of the following: Serum M-protein ≥ 0.5 g/dL, OR Urine M-protein ≥ 200 mg in 24-hours, OR serum immunoglobulin free light chain (FLC) ≥ 10 mg/dL provided serum FLC ratio is abnormal.

Exclusion Criteria

Participant is refractory to any proteasome inhibitor, defined as progression on or within 60 days of the last dose of a proteasome inhibitor-containing regimen.
Participant has had prior treatment with proteasome inhibitor within 60 days prior to first dose of study drug.
Participant has any of the following conditions:

Non-secretory multiple myeloma, active plasma cell leukemia i.e., either 20% of peripheral white blood cells or greater than 2.0 X 10^9/liter (L) circulating plasma cells by standard differential, Waldenstrom's macroglobulinemia, amyloidosis, POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes), known Human Immunodeficiency Viral (HIV) infection, active hepatitis B or C infection based on blood screen tests, significant cardiovascular disease, including uncontrolled angina, severe or uncontrolled arrhythmia, recent myocardial infarction within 6 months of randomization, or congestive heart failure New York Heart Association (NYHA) Class ≥ 3, major surgery within 4 weeks prior to randomization, acute infections requiring parenteral therapy (antibiotic, antifungal, or antiviral) within 14 days prior to randomization, peripheral neuropathy ≥ Grade 3 or ≥ Grade 2 with pain within 2 weeks prior to randomization, uncontrolled diabetes or uncontrolled hypertension within 14 days prior to randomization, any other medical condition that, in the opinion of the Investigator, would adversely affect the participant's participation in the study

Participant has a history of other active malignancies, including myelodysplastic syndrome (MDS), within the past 3 years prior to study entry, with the following exceptions: Adequately treated in situ carcinoma of the cervix uteri or the breast, basal cell carcinoma of the skin or localized squamous cell carcinoma of the skin, prostate cancer Gleason grade 6 or lower AND with stable Prostate Specific Antigen (PSA) levels off treatment, previous malignancy with no evidence of disease confined and surgically resected (or treated with other modalities) with curative intent and unlikely to impact survival during the duration of the study
If participant had prior allogeneic stem cell transplant (SCT), participant has evidence of ongoing graft-versus-host disease (GvHD)

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Placebo + Bortezomib and Dexamethasone	Placebo for venetoclax	Cycles 1-8: Placebo (to match venetoclax 100 mg tablet) 800 mg orally every day (QD) on Days 1 - 21 plus bortezomib 1.3 mg/m\^2 subcutaneously or IV on Days 1, 4, 8 \& 11 and dexamethasone 20 mg orally on Days 1, 2, 4, 5, 8, 9, 11 \& 12; Cycles 9 and beyond: Placebo (to match venetoclax 100 mg tablet) 800 mg orally every day (QD) on Days 1 - 35 plus bortezomib 1.3 mg/m\^2 subcutaneously or IV on Days 1, 8, 15 and 22 and dexamethasone 20 mg orally on Days 1, 2, 8, 9, 15, 16, 22 \& 23
Venetoclax + Bortezomib and Dexamethasone	Venetoclax	Cycles 1-8: Venetoclax 800 mg orally every day (QD) on Days 1 - 21 plus bortezomib 1.3 mg/m\^2 subcutaneously or IV on Days 1, 4, 8 \& 11 and dexamethasone 20 mg orally on Days 1, 2, 4, 5, 8, 9, 11 \& 12; Cycles 9 and beyond: Venetoclax 800 mg orally every day (QD) on Days 1 - 35 plus bortezomib 1.3 mg/m\^2 subcutaneously or IV on Days 1, 8, 15 and 22 and dexamethasone 20 mg orally on Days 1, 2, 8, 9, 15, 16, 22 and 23
Venetoclax + Bortezomib and Dexamethasone	Bortezomib	Cycles 1-8: Venetoclax 800 mg orally every day (QD) on Days 1 - 21 plus bortezomib 1.3 mg/m\^2 subcutaneously or IV on Days 1, 4, 8 \& 11 and dexamethasone 20 mg orally on Days 1, 2, 4, 5, 8, 9, 11 \& 12; Cycles 9 and beyond: Venetoclax 800 mg orally every day (QD) on Days 1 - 35 plus bortezomib 1.3 mg/m\^2 subcutaneously or IV on Days 1, 8, 15 and 22 and dexamethasone 20 mg orally on Days 1, 2, 8, 9, 15, 16, 22 and 23
Venetoclax + Bortezomib and Dexamethasone	Dexamethasone	Cycles 1-8: Venetoclax 800 mg orally every day (QD) on Days 1 - 21 plus bortezomib 1.3 mg/m\^2 subcutaneously or IV on Days 1, 4, 8 \& 11 and dexamethasone 20 mg orally on Days 1, 2, 4, 5, 8, 9, 11 \& 12; Cycles 9 and beyond: Venetoclax 800 mg orally every day (QD) on Days 1 - 35 plus bortezomib 1.3 mg/m\^2 subcutaneously or IV on Days 1, 8, 15 and 22 and dexamethasone 20 mg orally on Days 1, 2, 8, 9, 15, 16, 22 and 23
Placebo + Bortezomib and Dexamethasone	Bortezomib	Cycles 1-8: Placebo (to match venetoclax 100 mg tablet) 800 mg orally every day (QD) on Days 1 - 21 plus bortezomib 1.3 mg/m\^2 subcutaneously or IV on Days 1, 4, 8 \& 11 and dexamethasone 20 mg orally on Days 1, 2, 4, 5, 8, 9, 11 \& 12; Cycles 9 and beyond: Placebo (to match venetoclax 100 mg tablet) 800 mg orally every day (QD) on Days 1 - 35 plus bortezomib 1.3 mg/m\^2 subcutaneously or IV on Days 1, 8, 15 and 22 and dexamethasone 20 mg orally on Days 1, 2, 8, 9, 15, 16, 22 \& 23
Placebo + Bortezomib and Dexamethasone	Dexamethasone	Cycles 1-8: Placebo (to match venetoclax 100 mg tablet) 800 mg orally every day (QD) on Days 1 - 21 plus bortezomib 1.3 mg/m\^2 subcutaneously or IV on Days 1, 4, 8 \& 11 and dexamethasone 20 mg orally on Days 1, 2, 4, 5, 8, 9, 11 \& 12; Cycles 9 and beyond: Placebo (to match venetoclax 100 mg tablet) 800 mg orally every day (QD) on Days 1 - 35 plus bortezomib 1.3 mg/m\^2 subcutaneously or IV on Days 1, 8, 15 and 22 and dexamethasone 20 mg orally on Days 1, 2, 8, 9, 15, 16, 22 \& 23

Primary Outcome Measures

Name	Time	Method
Progression-free Survival (PFS)	Median duration of follow-up was 28.6 months for the venetoclax group and 28.6 months for the placebo group	PFS is defined as the number of days from the date the participant was randomized to the date of the first documented progressive disease (PD) as determined by an Independent Review Committee (IRC) or death due to any cause, whichever occurs first. PFS was analyzed by Kaplan-Meier methodology.

Secondary Outcome Measures

Name	Time	Method
Mean Change From Baseline in Physical Functioning Scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)	Baseline; Cycle 3 (Cycles 1 - 8 are 21 days, Cycles 9 and beyond are 35 days) through Cycle 47, collected on Day 1 of every other cycle and at the Treatment Completion Visit (TCV) while participant is on treatment	The QLQ-C30 is a 30-item subject self-report questionnaire composed of both multi-item and single scales, including five functional scales (physical, role, emotional, social, and cognitive), three symptom scales (fatigue, nausea and vomiting, and pain), a global health status/quality of life scale, and six single items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). For the Physical Functioning scale, participants rate five items on a four-point scale, with 1 as "not at all" and 4 as "very much." The Physical Functioning Scale scores range from 0 to 100 and were calculated per the EORTC QLQ-C30 Scoring Manual (3rd edition), version 3.0. A high scale score represents high/healthy level of functioning. Positive changes from baseline indicate improvement.
Very Good Partial Response (VGPR) or Better Response Rate	Response was assessed at Cycle 1, Day 1, and on Day 1 of every cycle thereafter; median time on follow-up was 28.6 months for the venetoclax group and 28.6 months for the placebo group	The percentage of participants with documented best overall response of Very Good Partial Response (VGPR) or better (VGPR, Complete response \[CR\], or Stringent complete response \[sCR\]) per 2016 standard International Myeloma Working Group (IMWG) criteria as determined by an Independent Review Committee (IRC) was computed.
Progression-Free Survival (PFS) in Participants With High B-cell Lymphoma 2 (BCL-2) Expression	Median duration of follow-up was 28.6 months for the venetoclax group and 28.6 months for the placebo group	PFS is defined as the number of days from the date the participant was randomized to the date of the first documented progressive disease (PD) per investigator assessment or death due to any cause, whichever occurs first. PFS was analyzed by Kaplan-Meier methodology. BCL-2 expression was determined through central laboratory testing by immunohistochemistry (IHC) and based on a pre-specified scoring algorithm. High clinical score of 2+: ≥50% of tumor cells with moderate or higher cytoplasmic staining but \< 50% of tumor cells with strong staining intensity; high clinical score of 3+: ≥50% of tumor cells with strong cytoplasmic staining.
Duration of Response (DOR)	Response was assessed at Cycle 1, Day 1, and on Day 1 of every cycle thereafter; median time on follow-up was 28.6 months for the venetoclax group and 28.6 months for the placebo group	DOR is defined as the number of days from the participant's date of first documented response (partial response \[PR\] or better) to the date of first documented progressive disease (PD) as determined by an Independent Review Committee (IRC) or death due to multiple myeloma, whichever occurs first. DOR was analyzed by Kaplan-Meier methodology.
Mean Change From Baseline in Brief Pain Inventory - Short Form (BPI-SF) Worst Pain	Baseline; Cycle 3 (Cycles 1 - 8 are 21 days, Cycles 9 and beyond are 35 days) through Cycle 47, collected on Day 1 of every other cycle and at the Treatment Completion Visit (TCV) while participant is on treatment	The BPI-SF is a pain-specific measure developed to assess patient-reported severity (or intensity) of pain (4 items) and the impact of pain on daily functioning (7 items) in patients with cancer pain. The four pain severity items assess pain at its "worst in last 24 hours," "least in last 24 hours," "average," and "now" (current pain). For these items, participants are asked to rate their pain on an 11-point numeric rating scale with anchors of 0 (no pain) and 10 (pain as bad as you can imagine). The Worst Pain scores range from 0 to 10, with higher scores indicating severe pain. Negative changes from baseline indicate improvement.
Time to Progression (TTP)	Median time on follow-up up was 28.6 months for the venetoclax group and 28.6 months for the placebo group	TTP is defined as the number of days from the date of randomization to the date of first documented progressive disease (PD) as determined by an Independent Review Committee (IRC) or death due to multiple myeloma, whichever occurs first. TTP was analyzed by Kaplan-Meier methodology.
Overall Survival (OS).	Median duration of follow-up was 45.6 months for the venetoclax group and 45.6 months for the placebo group	OS is defined as the number of days from the date of randomization to the date of death due to any cause. All events of death were to be included, regardless of whether the event occurred while the participant was still taking study drug or after the participant discontinued study drug. If a participant is not known to have died, OS was censored at the date of last contact. The distribution of OS was estimated using Kaplan-Meier methodology.
Minimal Residual Disease (MRD) Negativity Rate	Assessed at Screening; to confirm a stringent Complete Response (sCR) or Complete Response (CR); at 6 months and 12 months post-confirmed CR/sCR	MRD negativity rate is defined as the percentage of participants who have negative MRD by bone marrow aspirate at any time point after randomization and before progression or starting subsequent therapy. MRD negativity was defined at 10\^-5 threshold (less than one residual myeloma cell per 10\^5 total nucleated cells) as measured by centralized testing of bone marrow aspirate by Next Generation Sequencing (NGS). MRD positive participants include those of which all tested samples were found to be MRD positive or indeterminate. Participants with missing or unevaluable MRD status were considered as MRD positive.
Mean Change From Baseline in Global Health Status/Quality of Life Scale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30)	Baseline; Cycle 3 (Cycles 1 - 8 are 21 days, Cycles 9 and beyond are 35 days) through Cycle 47, collected on Day 1 of every other cycle and at the Treatment Completion Visit (TCV) while participant is on treatment	The QLQ-C30 is a 30-item subject self-report questionnaire composed of both multi-item and single scales, including five functional scales (physical, role, emotional, social, and cognitive), three symptom scales (fatigue, nausea and vomiting, and pain), a global health status/quality of life scale, and six single items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). For the Global Health Status/Quality of Life scale, participants rate two items on a seven point scale, with 1 as "very poor" and 7 as "excellent." The Global Health Status/Quality of Life scale ranges from 0 to 100 and was calculated per the EORTC QLQ-C30 Scoring Manual (3rd edition), version 3.0. A high score for the global health status/QoL represents a high QoL. Positive changes from baseline indicate improvement.
Mean Change From Baseline in Patient Reported Outcomes Measurement Information System [PROMIS] Cancer Fatigue Short Form [SF] Score	Baseline; Cycle 3 (Cycles 1 - 8 are 21 days, Cycles 9 and beyond are 35 days) through Cycle 47, collected on Day 1 of every other cycle and at the Treatment Completion Visit (TCV) while participant is on treatment	PROMIS Cancer Fatigue SF is a seven item questionnaire that assesses the impact and experience of fatigue over the past 7 days. All questions employ the following five response options: 1 = Not at all, 2 = A little bit, 3 = Somewhat, 4 = Quite a bit, and 5 = Very much. The total raw score is the sum of the responses to each question and is converted to a T-score. The T-score re-scales the total raw score to a standardized score with a mean of 50 and a standard deviation of 10. The \[PROMIS\] Cancer Fatigue Short Form \[SF\] 7a T-Scores range from 29.4 to 83.2, with higher scores indicating more fatigue. Negative changes from baseline indicate improvement.
Overall Response Rate (ORR)	Response was assessed at Cycle 1, Day 1, and on Day 1 of every cycle thereafter; median time on follow-up was 28.6 months for the venetoclax group and 28.6 months for the placebo group	Overall response rate is defined as the percentage of participants with documented best overall response of Partial Response (PR) or better (PR, Very good partial response \[VGPR\], Complete response \[CR\], or Stringent complete response \[sCR\]) per International Myeloma Working Group (IMWG) criteria as determined by an Independent Review Committee (IRC).

Trial Locations

Locations (97): CHU Limoges - Dupuytren 1 /ID# 149292
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Limoges CEDEX 1, Franche-Comte, France
Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona /ID# 148942
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Ancona, Italy
Box Hill Hospital /ID# 149112
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Box Hill, Victoria, Australia
Duke Cancer Center /ID# 149099
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Durham, North Carolina, United States
Clinica Sao Germano /ID# 149851
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São Paulo, Sao Paulo, Brazil
Royal Prince Alfred Hospital /ID# 149108
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Camperdown, New South Wales, Australia
IRCCS Azienda Ospedaliero-Universitaria di Bologna /ID# 148936
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Bologna, Italy
A.O.U. Città della Salute e della Scienza di Torino/Ospedale Molinette /ID# 148943
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Turin, Italy
Hospital das Clinicas da Universidade Federal de Goiás /ID# 149290
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Goiania, Goias, Brazil
Universitaetsklinikum Carl Gustav Carus an der TU Dresden /ID# 148948
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Dresden, Germany
Gabrail Cancer Center Research /ID# 149098
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Canton, Ohio, United States
The Queen Elizabeth Hospital /ID# 149104
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Woodville South, South Australia, Australia
Chonnam National University Hospital /ID# 150894
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Gwangju, Korea, Republic of
Asklepios Klinik Altona /ID# 150116
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Hamburg, Germany
Seoul National University Bundang Hospital /ID# 150888
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Seongnam, Gyeonggido, Korea, Republic of
Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA) /ID# 149020
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Rio de Janeiro, Brazil
CHRU de Brest - Hopital Morvan /ID# 149299
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Brest, France
National Cancer Center /ID# 150889
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Goyang, Gyeonggido, Korea, Republic of
Samsung Medical Center /ID# 150892
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Seoul, Korea, Republic of
Univ of Colorado Cancer Center /ID# 149130
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Aurora, Colorado, United States
Liverpool Hospital /ID# 149110
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Liverpool, New South Wales, Australia
Royal Brisbane and Women's Hospital /ID# 149105
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Herston, Queensland, Australia
Ospedale S.Eugenio /ID# 148938
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Rome, Italy
Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo /ID# 149025
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Sao Paulo, Brazil
Charite Universitaetsmedizin Berlin - Campus Mitte /ID# 148949
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Berlin, Germany
Gachon University Gil Medical Center /ID# 150893
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Incheon, Korea, Republic of
Seoul National University Hospital /ID# 150890
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Seoul, Korea, Republic of
Duplicate_Yonsei University Health System, Severance hospital. /ID# 150891
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Seoul, Seoul Teugbyeolsi, Korea, Republic of
Hospital Universitario de la Princesa /ID# 148980
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Madrid, Spain
Hospital Universitario 12 de Octubre /ID# 148981
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Madrid, Spain
Hospital Universitario Dr. Peset /ID# 148986
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Valencia, Spain
Rocky Mountain Regional VA Medical Center/Eastern Colorado Health Care System /ID# 156524
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Aurora, Colorado, United States
Concord Repatriation General Hospital /ID# 149106
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Concord, New South Wales, Australia
Peter MacCallum Cancer Ctr /ID# 149107
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Melbourne, Victoria, Australia
Perth Blood Institute Ltd /ID# 148966
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Nedlands, Western Australia, Australia
Victoria Hospital /ID# 149846
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London, Ontario, Canada
CISSS de la Monteregie /ID# 149844
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Greenfield Park, Quebec, Canada
Duplicate_Centre Hospitalier Lyon Sud /ID# 149300
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Pierre Benite CEDEX, Rhone, France
CHU de Nantes, Hotel Dieu -HME /ID# 149294
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Nantes, Pays-de-la-Loire, France
Debreceni Egyetem Klinikai Kozpont /ID# 152517
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Debrecen, Hajdu-Bihar, Hungary
JCHO Kyoto Kuramaguchi Medical /ID# 150781
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Kyoto-shi, Kyoto, Japan
National Hospital Organization Mito Medical Center /ID# 151051
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Higashi Ibaraki-gun, Ibaraki, Japan
Duplicate_Kyoto Prefectural University of Medicine /ID# 150719
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Kyoto-shi, Kyoto, Japan
Tochigi Cancer Center /ID# 150192
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Utsunomiya-shi, Tochigi, Japan
The Catholic University of Korea, Seoul St. Mary's Hospital /ID# 150895
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Seoul, Korea, Republic of
LLC Novaya Klinika /ID# 148974
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Pyatigorsk, Stavropol Skiy Kray, Russian Federation
Hospital Duran i Reynals /ID# 148989
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Hospitalet de Llobregat, Barcelona, Spain
National Taiwan University Hospital /ID# 154444
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Taipei City, Taiwan
China Medical University Hospital /ID# 154446
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Taichung City, Taiwan
Barts Health NHS Trust /ID# 149050
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London, London, City Of, United Kingdom
Blackpool Teaching Hospitals NHS Foundation Trust /ID# 149058
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Blackpool, United Kingdom
East Kent Hospitals University NHS Foundation Trust /ID# 149059
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Canterbury, United Kingdom
University College London Hospitals NHS Foundation Trust /ID# 149044
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London, United Kingdom
King's College Hospital NHS Foundation Trust /ID# 149045
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London, United Kingdom
Manchester University NHS Foundation Trust /ID# 149046
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Manchester, United Kingdom
Barking, Havering and Redbridge University Hospitals NHS Trust /ID# 149055
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Romford, United Kingdom
The Royal Wolverhampton NHS Trust /ID# 149043
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Wolverhampton, United Kingdom
Hospital Sao Lucas da PUCRS /ID# 149027
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Porto Alegre, Rio Grande Do Sul, Brazil
Liga Norte Riograndense Contra o Câncer /ID# 149023
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Natal, Rio Grande Do Norte, Brazil
Fiona Stanley Hospital /ID# 148967
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Murdoch, Western Australia, Australia
Ogaki Municipal Hospital /ID# 150783
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Ogaki-shi, Gifu, Japan
Japanese Red Cross Osaka Hospital /ID# 150716
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Osaka-shi, Osaka, Japan
Bashkir State Medical University /ID# 151206
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Ufa, Russian Federation
Royal Hobart Hospital /ID# 149111
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Hobart, Tasmania, Australia
Semmelweis Egyetem /ID# 152520
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Budapest, Hungary
Central Clinical Hospital RZHD Medicine /ID# 148954
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Moscow, Russian Federation
Nagoya City University Hospital /ID# 150943
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Nagoya shi, Aichi, Japan
Okayama Medical Center /ID# 150717
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Okayama-shi, Okayama, Japan
Taipei Veterans General Hosp /ID# 154445
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Taipei City, Taiwan
National Cancer Institute /ID# 152413
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Kyiv, Ukraine
University Hospital Galway /ID# 149061
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Galway, Ireland
National Hospital Organization Shibukawa Medical Center /ID# 150281
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Shibukawa-shi, Gunma, Japan
Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital /ID# 150242
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Hiroshima-shi, Hiroshima, Japan
Kobe City Medical Center General Hospital /ID# 150944
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Kobe-shi, Hyogo, Japan
Saitama Medical Center /ID# 151044
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Kawagoe-shi, Saitama, Japan
National Cancer Center Hospital /ID# 151039
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Chuo-ku, Tokyo, Japan
The Cancer Institute Hospital Of JFCR /ID# 150780
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Koto-ku, Tokyo, Japan
Kuzbass Regional Clinical Hospital /ID# 148955
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Kemerovo, Kemerovskaya Oblast, Russian Federation
Clinical Oncology Dispensary of Omsk /ID# 148953
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Omsk, Russian Federation
Samara State Medical University /ID# 148952
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Samara, Russian Federation
Japanese Red Cross Medical Center /ID# 149902
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Shibuya-ku, Tokyo, Japan
Somogy Megyei Kaposi Mor Oktato Korhaz /ID# 152516
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Kaposvár, Somogy, Hungary
Alfred Health /ID# 150085
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Melbourne, Victoria, Australia
Semmelweis Egyetem /ID# 152519
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Budapest, Hungary
Del-pesti Centrumkorhaz Orszagos Hematologiai es Infektologiai Intezet /ID# 152518
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Budapest, Hungary
Kyushu University Hospital /ID# 150896
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Fukuoka-shi, Fukuoka, Japan
Gunma University Hospital /ID# 150275
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Maebashi-shi, Gunma, Japan
Tohoku University Hospital /ID# 150945
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Sendai-shi, Miyagi, Japan
State Institution of Health of the Ryazan Regional Clinical Hospital /ID# 148956
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Ryazan, Ryazanskaya Oblast, Russian Federation
Azienda Ospedaliero-Universitaria Policlinico Umberto I /ID# 148939
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Rome, Lazio, Italy
Leicester Royal Infirmary /ID# 149057
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Leicester, England, United Kingdom
National Hospital Organization Disaster Medical Center /ID# 150784
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Tachikawa-shi, Tokyo, Japan
Changhua Christian Hospital /ID# 154447
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Changhua City, Changhua County, Taiwan
Communal Nonprofit Enterprise Cherkasy Regional Oncology Dispensary /ID# 152414
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Cherkasy, Ukraine
Municipal Non-Profit Enterprise City Clinical Hospital 4 of Dnipro City Council /ID# 152411
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Dnipro, Ukraine
Nottingham University Hospitals NHS Trust /ID# 149047
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Nottingham, Nottinghamshire, United Kingdom
CHU Grenoble - Hopital Michallon /ID# 149301
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La Tronche, France