Combination Chemotherapy in Treating Patients With Non-Hodgkin's Lymphoma or Acute Lymphocytic Leukemia
- Conditions
- LeukemiaLymphoma
- Interventions
- Registration Number
- NCT00005977
- Lead Sponsor
- Children's Oncology Group
- Brief Summary
RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Combining more than one drug may kill more cancer cells.
PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy in treating patients who have non-Hodgkin's lymphoma or acute lymphocytic leukemia.
- Detailed Description
OBJECTIVES:
* Determine if increasing the methotrexate dose in combination with standard treatment is feasible in patients with advanced small noncleaved cell non-Hodgkin's lymphoma or B-cell acute lymphocytic leukemia.
* Assess the toxicity of this intensified therapy in these patients.
* Assess the feasibility of treating these patients that have CNS disease at diagnosis with this intensified therapy plus etoposide and ifosfamide.
* Assess toxicities and late effects of this intensive therapy on the central nervous system, cardiac function, and fertility in these patients.
OUTLINE: This is a multicenter study. Patients are stratified according to stage and disease (stage III non-Hodgkin's lymphoma (NHL) vs stage IV NHL with no CNS involvement vs stage IV NHL with CNS involvement vs B-cell acute lymphocytic leukemia (B-ALL) with no CNS involvement vs B-ALL with CNS involvement).
Patients receive methotrexate and cytarabine intrathecally on days 1, 4, 11, and 36 (on day 40 for patients with stage IV NHL or B-ALL only) in combination with alternating courses of: A) cyclophosphamide IV every 12 hours for a total of six doses on days 1-3, doxorubicin IV over 30 minutes on day 4, vincristine IV on days 4 and 11, dexamethasone IV or orally twice daily on days 1-5, and filgrastim (G-CSF) subcutaneously (SQ) or IV over 30 minutes beginning on day 5 and continuing until blood counts recover and B) methotrexate IV over 24 hours on day 18, methotrexate intrathecally on day 18, dexamethasone IV or orally twice daily on days 18-22, leucovorin calcium IV or orally every 6 hours for a total of 6 doses on days 20-21, cytarabine IV over 48 hours on days 20-21, and G-CSF SQ or IV over 30 minutes beginning on day 22 and continuing until blood counts recover. Patients with stage III NHL receive at total of 5 courses of treatment (A-B-A-B-A) and patients with stage IV NHL or B-ALL with no CNS involvement receive a total of 6 courses of treatment (A-B-A-B-A-B).
Patients with CNS involvement receive a third course of treatment: C) etoposide IV over 1 hour on days 36-40, ifosfamide IV over 1 hour on days 36-40, oral dexamethasone twice daily on days 36-40, and G-CSF SQ or IV over 30 minutes beginning on day 41 and continuing until blood counts recover. Patients with CNS involvement receive a total of 7 courses of treatment (A-B-C-A-B-A-B).
Patients are followed every 6 months for 4 years and then annually thereafter.
PROJECTED ACCRUAL: A total of 27-80 patients will be accrued for this study over 24 months.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 83
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description STAGE III NHL (Trt 1) vincristine sulfate A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABA STAGE IV NHL, -CNS (Trt 2) filgrastim A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB STAGE IV NHL, -CNS (Trt 2) leucovorin calcium A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB STAGE IV NHL, -CNS (Trt 2) vincristine sulfate A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB STAGE III NHL (Trt 1) filgrastim A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABA STAGE III NHL (Trt 1) leucovorin calcium A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABA STAGE IV, +CNS (Trt 3) filgrastim A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB STAGE IV, +CNS (Trt 3) leucovorin calcium A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB STAGE IV, +CNS (Trt 3) vincristine sulfate A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB B-ALL, -CNS (Trt 2) filgrastim A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB B-ALL, -CNS (Trt 2) leucovorin calcium A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB B-ALL, -CNS (Trt 2) vincristine sulfate A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB B-ALL, +CNS (Trt 3) filgrastim A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB B-ALL, +CNS (Trt 3) leucovorin calcium A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB B-ALL, +CNS (Trt 3) vincristine sulfate A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB STAGE III NHL (Trt 1) cyclophosphamide A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABA STAGE III NHL (Trt 1) cytarabine A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABA STAGE III NHL (Trt 1) dexamethasone A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABA STAGE III NHL (Trt 1) doxorubicin hydrochloride A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABA STAGE III NHL (Trt 1) methotrexate A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABA STAGE IV NHL, -CNS (Trt 2) cyclophosphamide A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB STAGE IV NHL, -CNS (Trt 2) dexamethasone A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB STAGE IV NHL, -CNS (Trt 2) doxorubicin hydrochloride A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB STAGE IV NHL, -CNS (Trt 2) cytarabine A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB STAGE IV NHL, -CNS (Trt 2) methotrexate A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB STAGE IV, +CNS (Trt 3) cyclophosphamide A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB STAGE IV, +CNS (Trt 3) cytarabine A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB STAGE IV, +CNS (Trt 3) dexamethasone A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB STAGE IV, +CNS (Trt 3) etoposide A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB STAGE IV, +CNS (Trt 3) doxorubicin hydrochloride A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB STAGE IV, +CNS (Trt 3) methotrexate A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB STAGE IV, +CNS (Trt 3) ifosfamide A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB B-ALL, -CNS (Trt 2) dexamethasone A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB B-ALL, -CNS (Trt 2) cyclophosphamide A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB B-ALL, -CNS (Trt 2) cytarabine A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB B-ALL, -CNS (Trt 2) doxorubicin hydrochloride A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB B-ALL, -CNS (Trt 2) methotrexate A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. Treatment ABABAB B-ALL, +CNS (Trt 3) cyclophosphamide A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB B-ALL, +CNS (Trt 3) cytarabine A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB B-ALL, +CNS (Trt 3) dexamethasone A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB B-ALL, +CNS (Trt 3) doxorubicin hydrochloride A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB B-ALL, +CNS (Trt 3) etoposide A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB B-ALL, +CNS (Trt 3) ifosfamide A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB B-ALL, +CNS (Trt 3) methotrexate A: Cyclophosphamide (CTX), Doxorubicin hydrochloride, Vincristine sulfate (VCR), Dexamethasone IT Therapy. B: HD-Methotrexate(MTX), Cytarabine(Ara-C), Dexamethasone IT Therapy. C: Etoposide, Ifosfamide, Dexamethasone IT Therapy. Treatment ABCABAB
- Primary Outcome Measures
Name Time Method Event-free survival 1 year Assess the effect of high dose methotrexate in combination with standard treatment per the POG 9317 protocol on 1-year event-free survival (EFS), monitor and assess toxicity, and estimate the hospitalization costs for the treatment of toxicity related side effects.
- Secondary Outcome Measures
Name Time Method
Related Research Topics
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Trial Locations
- Locations (119)
Emory University Hospital - Atlanta
🇺🇸Atlanta, Georgia, United States
St. Christopher's Hospital for Children
🇺🇸Philadelphia, Pennsylvania, United States
Texas Oncology P.A.
🇺🇸Dallas, Texas, United States
Medical City Dallas Hospital
🇺🇸Dallas, Texas, United States
Children's Memorial Hospital, Chicago
🇺🇸Chicago, Illinois, United States
Boston Floating Hospital Infants and Children
🇺🇸Boston, Massachusetts, United States
Dana-Farber Cancer Institute
🇺🇸Boston, Massachusetts, United States
Baylor College of Medicine
🇺🇸Houston, Texas, United States
Miami Children's Hospital
🇺🇸Miami, Florida, United States
Baptist Hospital of Miami
🇺🇸Miami, Florida, United States
Children's Hospital and Health Center
🇺🇸San Diego, California, United States
Duke Comprehensive Cancer Center
🇺🇸Durham, North Carolina, United States
MBCCOP - South Texas Pediatric
🇺🇸San Antonio, Texas, United States
Centre Hospitalier Universitaire Vaudois
🇨🇭Lausanne, Switzerland
Swiss Pediatric Oncology Group Bern
🇨🇭Bern, Switzerland
St. Mary's Hospital
🇺🇸West Palm Beach, Florida, United States
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
Nemours Children's Clinic
🇺🇸Jacksonville, Florida, United States
University of Alabama at Birmingham Comprehensive Cancer Center
🇺🇸Birmingham, Alabama, United States
Children's Hospital of Michigan
🇺🇸Detroit, Michigan, United States
St. John Hospital and Medical Center
🇺🇸Detroit, Michigan, United States
Oklahoma Memorial Hospital
🇺🇸Oklahoma City, Oklahoma, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
University of Miami-Jackson Memorial Hospital Medical Center
🇺🇸Miami, Florida, United States
Kaiser Permanente-Southern California Permanente Medical Group
🇺🇸San Diego, California, United States
Via Christi Regional Medical Center
🇺🇸Wichita, Kansas, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Emory University School of Medicine
🇺🇸Atlanta, Georgia, United States
Kaiser Permanente Medical Center - Santa Clara
🇺🇸Santa Clara, California, United States
All Children's Hospital
🇺🇸St. Petersburg, Florida, United States
Norris Cotton Cancer Center
🇺🇸Lebanon, New Hampshire, United States
Sylvester Cancer Center, University of Miami
🇺🇸Miami, Florida, United States
University of California San Diego Cancer Center
🇺🇸La Jolla, California, United States
Lucile Packard Children's Hospital at Stanford
🇺🇸Palo Alto, California, United States
Hope Children's Hospital
🇺🇸Oak Lawn, Illinois, United States
Maine Children's Cancer Program
🇺🇸Portland, Maine, United States
Children's Hospital of Southwest Florida
🇺🇸Fort Myers, Florida, United States
Broward General Medical Center
🇺🇸Fort Lauderdale, Florida, United States
University of Arkansas for Medical Sciences
🇺🇸Little Rock, Arkansas, United States
Walter Reed Army Medical Center
🇺🇸Washington, District of Columbia, United States
East Carolina University School of Medicine
🇺🇸Greenville, North Carolina, United States
Marlene & Stewart Greenebaum Cancer Center, University of Maryland
🇺🇸Baltimore, Maryland, United States
CCOP - Illinois Oncology Research Association
🇺🇸Peoria, Illinois, United States
CCOP - Wichita
🇺🇸Wichita, Kansas, United States
Saint Jude Midwest Affiliate
🇺🇸Peoria, Illinois, United States
Eastern Maine Medical Center
🇺🇸Bangor, Maine, United States
University of Missouri-Columbia Hospital and Clinics
🇺🇸Columbia, Missouri, United States
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
🇺🇸Baltimore, Maryland, United States
Mount Sinai School of Medicine
🇺🇸New York, New York, United States
Keesler Medical Center - Keesler AFB
🇺🇸Keesler AFB, Mississippi, United States
CCOP - Northern New Jersey
🇺🇸Hackensack, New Jersey, United States
University of New Mexico School of Medicine
🇺🇸Albuquerque, New Mexico, United States
Presbyterian Healthcare
🇺🇸Charlotte, North Carolina, United States
Hackensack University Medical Center
🇺🇸Hackensack, New Jersey, United States
Naval Medical Center, Portsmouth
🇺🇸Portsmouth, Virginia, United States
Royal Children's Hospital
🇦🇺Parkville, Victoria, Australia
Natalie Warren Bryant Cancer Center
🇺🇸Tulsa, Oklahoma, United States
James H. Quillen College of Medicine
🇺🇸Johnson City, Tennessee, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
Schneider Children's Hospital
🇺🇸New Hyde Park, New York, United States
University of Rochester Cancer Center
🇺🇸Rochester, New York, United States
University of Texas Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
CCOP - Florida Pediatric
🇺🇸Tampa, Florida, United States
CCOP - Columbia River Program
🇺🇸Portland, Oregon, United States
Legacy Emanuel Hospital and Health Center
🇺🇸Portland, Oregon, United States
Midwest Children's Cancer Center
🇺🇸Milwaukee, Wisconsin, United States
State University of New York - Upstate Medical University
🇺🇸Syracuse, New York, United States
Rush-Presbyterian-St. Luke's Medical Center
🇺🇸Chicago, Illinois, United States
State University of New York Health Sciences Center - Stony Brook
🇺🇸Stony Brook, New York, United States
MBCCOP - Gulf Coast
🇺🇸Mobile, Alabama, United States
University of South Alabama Medical Center
🇺🇸Mobile, Alabama, United States
Arizona Cancer Center
🇺🇸Tucson, Arizona, United States
University of Massachusetts Memorial Medical Center
🇺🇸Worcester, Massachusetts, United States
Massachusetts General Hospital Cancer Center
🇺🇸Boston, Massachusetts, United States
Cardinal Glennon Children's Hospital
🇺🇸Saint Louis, Missouri, United States
Mission Saint Joseph's Health System
🇺🇸Asheville, North Carolina, United States
Carolinas Medical Center
🇺🇸Charlotte, North Carolina, United States
Children's Hospital of Greenville Hospital System
🇺🇸Greenville, South Carolina, United States
Driscoll Children's Hospital
🇺🇸Corpus Christi, Texas, United States
Simmons Cancer Center - Dallas
🇺🇸Dallas, Texas, United States
Saint Jude Children's Research Hospital
🇺🇸Memphis, Tennessee, United States
Cook Children's Medical Center - Fort Worth
🇺🇸Fort Worth, Texas, United States
San Antonio Military Pediatric Cancer and Blood Disorders Center
🇺🇸Lackland Air Force Base, Texas, United States
University of Texas Medical Branch
🇺🇸Galveston, Texas, United States
Vermont Cancer Center
🇺🇸Burlington, Vermont, United States
Scott and White Clinic
🇺🇸Temple, Texas, United States
Cancer Center at the University of Virginia
🇺🇸Charlottesville, Virginia, United States
Madigan Army Medical Center
🇺🇸Tacoma, Washington, United States
Carilion Roanoke Community Hospital
🇺🇸Roanoke, Virginia, United States
Inova Fairfax Hospital
🇺🇸Falls Church, Virginia, United States
West Virginia University Medical School-Charleston
🇺🇸Charleston, West Virginia, United States
Cross Cancer Institute
🇨🇦Edmonton, Alberta, Canada
St. Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
West Virginia University Hospitals
🇺🇸Morgantown, West Virginia, United States
Alberta Children's Hospital
🇨🇦Calgary, Alberta, Canada
Children's Hospital
🇨🇦Hamilton, Ontario, Canada
Hospital for Sick Children
🇨🇦Toronto, Ontario, Canada
Hopital Sainte Justine
🇨🇦Montreal, Quebec, Canada
Children's Hospital of Eastern Ontario
🇨🇦Ottawa, Ontario, Canada
McGill University Health Center - Montreal Children's Hospital
🇨🇦Montreal, Quebec, Canada
San Jorge Childrens Hospital
🇵🇷Santurce, Puerto Rico
Centre Hospitalier de L'Universite Laval
🇨🇦Sainte Foy, Quebec, Canada
Laval University Medical Center
🇨🇦Sainte-Foy, Quebec, Canada
Academisch Ziekenhuis Groningen
🇳🇱Groningen, Netherlands
Clinique de Pediatrie
🇨🇭Geneva, Switzerland
Massey Cancer Center
🇺🇸Richmond, Virginia, United States
Sutter Cancer Center
🇺🇸Sacramento, California, United States
University of California Davis Medical Center
🇺🇸Sacramento, California, United States
Yale Comprehensive Cancer Center
🇺🇸New Haven, Connecticut, United States
Florida Hospital Cancer Institute
🇺🇸Orlando, Florida, United States
Comprehensive Cancer Center at Wake Forest University
🇺🇸Winston-Salem, North Carolina, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Shands Hospital and Clinics, University of Florida
🇺🇸Gainesville, Florida, United States
Cancer Research Center of Hawaii
🇺🇸Honolulu, Hawaii, United States
Tripler Army Medical Center
🇺🇸Honolulu, Hawaii, United States
CCOP - Ochsner
🇺🇸New Orleans, Louisiana, United States
MBCCOP - LSU Health Sciences Center
🇺🇸New Orleans, Louisiana, United States
Tulane University School of Medicine
🇺🇸New Orleans, Louisiana, United States
University of Kansas Medical Center
🇺🇸Kansas City, Kansas, United States