Ixazomib Citrate, Lenalidomide, Dexamethasone, and Zoledronic Acid or Zoledronic Acid Alone After Radiation Therapy in Treating Patients With Solitary Plasmacytoma of Bone
- Conditions
- Solitary Osseous Plasmacytoma
- Interventions
- Registration Number
- NCT02516423
- Lead Sponsor
- Alliance for Clinical Trials in Oncology
- Brief Summary
This randomized phase III trial compares ixazomib citrate, lenalidomide, dexamethasone and zoledronic acid with zoledronic acid alone to see how well they work when given after radiation therapy in treating patients with solitary plasmacytoma of bone. Ixazomib citrate may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Lenalidomide may help the immune system kill abnormal blood cells or cancer cells. Dexamethasone is a drug used in chemotherapy that may cause tumor cells to die. Zoledronic acid may prevent bone fractures and reduce bone pain, and may also improve survival. Standard treatment for this cancer is radiation therapy alone. It is not yet known whether ixazomib citrate, lenalidomide, dexamethasone and zoledronic acid or zoledronic acid alone is more effective, and whether adding these treatments after radiation therapy is more effective than radiation therapy alone in treating patients with solitary plasmacytoma of bone.
- Detailed Description
This phase III randomized clinical trial was designed to assess the impact of the addition of ixazomib, lenalidomide, and dexamethasone to zoledronic acid the multiple myeloma progression rate at 5 years. A dynamic allocation procedure will be used to allocate an equal number of patients to each of the treatment arms. This procedure will balance the number of patients which falls into each of the following categories between the two treatment arms:
1. % of abnormal plasma cells in the bone marrow: 5-9%
2. age \< 60; % of abnormal plasma cells in the bone marrow \< 5%; and monoclonal protein/clonal light chains present in the blood or urine
3. age \< 60; % of abnormal plasma cells in the bone marrow \< 5% and no monoclonal protein/clonal light chains present in the blood or urine, (MRD+) minimal residual disease
4. age ≥ 60; % of abnormal plasma cells in the bone marrow \< 5%; and monoclonal protein/clonal light chains present in the blood or urine
5. age ≥ 60; % of abnormal plasma cells in the bone marrow \< 5% and no monoclonal protein/clonal light chains present in the blood or urine, (MRD+) minimal residual disease
The primary and secondary objectives are described below.
Primary objective
To assess whether ixazomib, lenalidomide, dexamethasone with zoledronic acid is more promising than zoledronic acid alone in increasing the time before progression to multiple myeloma.
Secondary objectives
1. To assess changes in minimal residual disease \[MRD\] by flow cytometry from study entry, at the completion of treatment, and at 1 year post registration.
2. To assess whether ixazomib, lenalidomide, dexamethasone with zoledronic acid is more promising than zoledronic acid alone in extending overall survival.
3. To examine the pharmacodynamics effects of treatment on biochemical markers of bone formation (osteocalcin bone-specific alkaline phosphatase), resorption (serum CTX), and metabolism (OPG).
Follow-up requirements after documentation of progression to multiple myeloma includes a maximum of five years following registration.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 11
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description ixazomib + lenalidomide + dexamethasone + zoledronic acid ixazomib Patients receive 4 mg ixazomib by mouth on days 1, 8 and 15. Patients also receive 15 mg lenalidomide by mouth on days 1-21, 12 mg dexamethasone by mouth on days 1, 8, 15, and 22 and zoledronic acid (dose based on creatinine clearance on day 1) IV infusion on day 1. Patients receive treatment every 28 days for a maximum of 6 cycles. ixazomib + lenalidomide + dexamethasone + zoledronic acid lenalidomide Patients receive 4 mg ixazomib by mouth on days 1, 8 and 15. Patients also receive 15 mg lenalidomide by mouth on days 1-21, 12 mg dexamethasone by mouth on days 1, 8, 15, and 22 and zoledronic acid (dose based on creatinine clearance on day 1) IV infusion on day 1. Patients receive treatment every 28 days for a maximum of 6 cycles. ixazomib + lenalidomide + dexamethasone + zoledronic acid dexamethasone Patients receive 4 mg ixazomib by mouth on days 1, 8 and 15. Patients also receive 15 mg lenalidomide by mouth on days 1-21, 12 mg dexamethasone by mouth on days 1, 8, 15, and 22 and zoledronic acid (dose based on creatinine clearance on day 1) IV infusion on day 1. Patients receive treatment every 28 days for a maximum of 6 cycles. ixazomib + lenalidomide + dexamethasone + zoledronic acid zoledronic acid Patients receive 4 mg ixazomib by mouth on days 1, 8 and 15. Patients also receive 15 mg lenalidomide by mouth on days 1-21, 12 mg dexamethasone by mouth on days 1, 8, 15, and 22 and zoledronic acid (dose based on creatinine clearance on day 1) IV infusion on day 1. Patients receive treatment every 28 days for a maximum of 6 cycles. zoledronic acid zoledronic acid Patients receive zoledronic acid (dose based on creatinine clearance on day 1) IV on day 1. Patients receive treatment every 28 days for a maximum of 6 cycles.
- Primary Outcome Measures
Name Time Method Progression-free survival rate at 5 years
- Secondary Outcome Measures
Name Time Method Changes in minimal residual disease from study entry to the completion of adjuvant treatment (approximately six months post-registration) and at 1 year post-registration at 6 and 12 months post-registration Clinical response rate at 12 months post-registration using whole body PET/CT at 12 months post-registration
Trial Locations
- Locations (388)
Saint Luke's Mountain States Tumor Institute - Nampa
🇺🇸Nampa, Idaho, United States
Illinois CancerCare-Carthage
🇺🇸Carthage, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸Galesburg, Illinois, United States
Carle Physician Group-Mattoon/Charleston
🇺🇸Mattoon, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸Princeton, Illinois, United States
Freeman Health System
🇺🇸Joplin, Missouri, United States
Bhadresh Nayak MD PC-Sterling Heights
🇺🇸Sterling Heights, Michigan, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸Burbank, California, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
Doctors Hospital
🇺🇸Columbus, Ohio, United States
Dayton Physicians LLC-Wayne
🇺🇸Greenville, Ohio, United States
Kettering Medical Center
🇺🇸Kettering, Ohio, United States
Providence Newberg Medical Center
🇺🇸Newberg, Oregon, United States
Swedish Medical Center-Edmonds
🇺🇸Edmonds, Washington, United States
Vince Lombardi Cancer Clinic - Oshkosh
🇺🇸Oshkosh, Wisconsin, United States
Aurora Bay Area Medical Group-Marinette
🇺🇸Marinette, Wisconsin, United States
Minor and James Medical PLLC
🇺🇸Seattle, Washington, United States
Pacific Gynecology Specialists
🇺🇸Seattle, Washington, United States
Kaiser Permanente Washington
🇺🇸Seattle, Washington, United States
Swedish Medical Center-First Hill
🇺🇸Seattle, Washington, United States
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
Dana-Farber Cancer Institute
🇺🇸Boston, Massachusetts, United States
Springmill Medical Center
🇺🇸Indianapolis, Indiana, United States
Oncology Hematology Care Inc - Anderson
🇺🇸Cincinnati, Ohio, United States
Oncology Hematology Care Inc-Eden Park
🇺🇸Cincinnati, Ohio, United States
Oncology Hematology Care Inc-Kenwood
🇺🇸Cincinnati, Ohio, United States
Alaska Breast Care and Surgery LLC
🇺🇸Anchorage, Alaska, United States
Katmai Oncology Group
🇺🇸Anchorage, Alaska, United States
University Oncology Associates
🇺🇸Clovis, California, United States
Epic Care-Dublin
🇺🇸Dublin, California, United States
Contra Costa Regional Medical Center
🇺🇸Martinez, California, United States
Saint Alphonsus Medical Center-Nampa
🇺🇸Nampa, Idaho, United States
Rush - Copley Medical Center
🇺🇸Aurora, Illinois, United States
Saint Luke's Mountain States Tumor Institute - Meridian
🇺🇸Meridian, Idaho, United States
Kootenai Medical Center
🇺🇸Coeur d'Alene, Idaho, United States
California Cancer Center - Fresno
🇺🇸Fresno, California, United States
Illinois CancerCare-Canton
🇺🇸Canton, Illinois, United States
Scripps Cancer Center
🇺🇸La Jolla, California, United States
Alta Bates Summit Medical Center - Summit Campus
🇺🇸Oakland, California, United States
Bay Area Tumor Institute
🇺🇸Oakland, California, United States
Idaho Urologic Institute-Meridian
🇺🇸Meridian, Idaho, United States
Memorial Hospital of Carbondale
🇺🇸Carbondale, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸Eureka, Illinois, United States
Grand Valley Oncology
🇺🇸Grand Junction, Colorado, United States
Walter Knox Memorial Hospital
🇺🇸Emmett, Idaho, United States
SIH Cancer Institute
🇺🇸Carterville, Illinois, United States
Kootenai Cancer Center
🇺🇸Post Falls, Idaho, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸Macomb, Illinois, United States
Illinois CancerCare-Peru
🇺🇸Peru, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center
🇺🇸Pekin, Illinois, United States
Centralia Oncology Clinic
🇺🇸Centralia, Illinois, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸Boise, Idaho, United States
Mercy Health Saint Mary's
🇺🇸Grand Rapids, Michigan, United States
Cancer Care Specialists of Illinois-Swansea
🇺🇸Swansea, Illinois, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸Decatur, Illinois, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Good Samaritan Regional Health Center
🇺🇸Mount Vernon, Illinois, United States
Radiation Oncology of Northern Illinois
🇺🇸Ottawa, Illinois, United States
Hickman Cancer Center
🇺🇸Adrian, Michigan, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸Peoria, Illinois, United States
OSF Saint Francis Radiation Oncology at Peoria Cancer Center
🇺🇸Peoria, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸Pekin, Illinois, United States
Chancellor Center for Oncology
🇺🇸Newburgh, Indiana, United States
Memorial Regional Cancer Center Day Road
🇺🇸Mishawaka, Indiana, United States
Reid Health
🇺🇸Richmond, Indiana, United States
Indiana University/Melvin and Bren Simon Cancer Center
🇺🇸Indianapolis, Indiana, United States
Cancer Center of Kansas - Chanute
🇺🇸Chanute, Kansas, United States
Deaconess Clinic Downtown
🇺🇸Evansville, Indiana, United States
Franciscan Saint Anthony Health-Michigan City
🇺🇸Michigan City, Indiana, United States
Cancer Center of Kansas-Liberal
🇺🇸Liberal, Kansas, United States
Memorial Hospital of South Bend
🇺🇸South Bend, Indiana, United States
Saint Ann's Hospital
🇺🇸Westerville, Ohio, United States
Mercy Health Mercy Campus
🇺🇸Muskegon, Michigan, United States
Henry Ford Medical Center-Columbus
🇺🇸Novi, Michigan, United States
Sanford Joe Lueken Cancer Center
🇺🇸Bemidji, Minnesota, United States
Miller-Dwan Hospital
🇺🇸Duluth, Minnesota, United States
Newland Medical Associates-Pontiac
🇺🇸Pontiac, Michigan, United States
Saint Francis Medical Center
🇺🇸Cape Girardeau, Missouri, United States
Michigan Breast Specialists-Grosse Pointe Woods
🇺🇸Grosse Pointe Woods, Michigan, United States
Toledo Clinic Cancer Centers-Monroe
🇺🇸Monroe, Michigan, United States
Essentia Health Saint Mary's - Detroit Lakes Clinic
🇺🇸Detroit Lakes, Minnesota, United States
Cox Cancer Center Branson
🇺🇸Branson, Missouri, United States
Ascension Providence Hospitals - Novi
🇺🇸Novi, Michigan, United States
Central Care Cancer Center - Bolivar
🇺🇸Bolivar, Missouri, United States
Essentia Health Cancer Center
🇺🇸Duluth, Minnesota, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Great Lakes Cancer Management Specialists-Rochester Hills
🇺🇸Rochester Hills, Michigan, United States
Sanford Thief River Falls Medical Center
🇺🇸Thief River Falls, Minnesota, United States
Parkland Health Center-Bonne Terre
🇺🇸Bonne Terre, Missouri, United States
Ascension Providence Hospitals - Southfield
🇺🇸Southfield, Michigan, United States
Lake Region Healthcare Corporation-Cancer Care
🇺🇸Fergus Falls, Minnesota, United States
Macomb Hematology Oncology PC
🇺🇸Warren, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸Warren, Michigan, United States
21st Century Oncology-Pontiac
🇺🇸Pontiac, Michigan, United States
Essentia Health Saint Mary's Medical Center
🇺🇸Duluth, Minnesota, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸Butte, Montana, United States
Hope Cancer Center
🇺🇸Pontiac, Michigan, United States
Essentia Health Saint Joseph's Medical Center
🇺🇸Brainerd, Minnesota, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
Bhadresh Nayak MD PC-Warren
🇺🇸Warren, Michigan, United States
Michigan Breast Specialists-Macomb Township
🇺🇸Macomb, Michigan, United States
Heartland Regional Medical Center
🇺🇸Saint Joseph, Missouri, United States
Michigan Breast Specialists-Warren
🇺🇸Warren, Michigan, United States
Southeast Cancer Center
🇺🇸Cape Girardeau, Missouri, United States
Huron Gastroenterology PC
🇺🇸Ypsilanti, Michigan, United States
Essentia Health Hibbing Clinic
🇺🇸Hibbing, Minnesota, United States
Sainte Genevieve County Memorial Hospital
🇺🇸Sainte Genevieve, Missouri, United States
Saint Peter's Community Hospital
🇺🇸Helena, Montana, United States
Essentia Health - Deer River Clinic
🇺🇸Deer River, Minnesota, United States
Community Medical Hospital
🇺🇸Missoula, Montana, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Missouri Baptist Sullivan Hospital
🇺🇸Sullivan, Missouri, United States
Norris Cotton Cancer Center-Nashua
🇺🇸Nashua, New Hampshire, United States
Essentia Health - Jamestown Clinic
🇺🇸Jamestown, North Dakota, United States
Indu and Raj Soin Medical Center
🇺🇸Beavercreek, Ohio, United States
Great Falls Clinic
🇺🇸Great Falls, Montana, United States
Mount Carmel East Hospital
🇺🇸Columbus, Ohio, United States
The Mark H Zangmeister Center
🇺🇸Columbus, Ohio, United States
Billings Clinic Cancer Center
🇺🇸Billings, Montana, United States
Sanford Broadway Medical Center
🇺🇸Fargo, North Dakota, United States
Missouri Baptist Medical Center
🇺🇸Saint Louis, Missouri, United States
Sanford Bismarck Medical Center
🇺🇸Bismarck, North Dakota, United States
Sanford South University Medical Center
🇺🇸Fargo, North Dakota, United States
Adena Regional Medical Center
🇺🇸Chillicothe, Ohio, United States
Dartmouth Hitchcock Medical Center
🇺🇸Lebanon, New Hampshire, United States
Grant Medical Center
🇺🇸Columbus, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸Franklin, Ohio, United States
First Dayton Cancer Care
🇺🇸Kettering, Ohio, United States
Toledo Clinic Cancer Centers-Maumee
🇺🇸Maumee, Ohio, United States
Oncology Hematology Care Inc-Blue Ash
🇺🇸Cincinnati, Ohio, United States
Dayton Physicians LLC-Wilson
🇺🇸Sidney, Ohio, United States
Southern Ohio Medical Center
🇺🇸Portsmouth, Ohio, United States
Saint Alphonsus Medical Center-Baker City
🇺🇸Baker City, Oregon, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸Hazleton, Pennsylvania, United States
Wayne Hospital
🇺🇸Greenville, Ohio, United States
Licking Memorial Hospital
🇺🇸Newark, Ohio, United States
Fairfield Medical Center
🇺🇸Lancaster, Ohio, United States
Saint Charles Health System
🇺🇸Bend, Oregon, United States
Dayton Physicians LLC-Signal Point
🇺🇸Middletown, Ohio, United States
Saint Alphonsus Medical Center-Ontario
🇺🇸Ontario, Oregon, United States
Upper Valley Medical Center
🇺🇸Troy, Ohio, United States
Danville Regional Medical Center
🇺🇸Danville, Virginia, United States
Bay Area Hospital
🇺🇸Coos Bay, Oregon, United States
Saint Charles Health System-Redmond
🇺🇸Redmond, Oregon, United States
Cancer Care Center at Island Hospital
🇺🇸Anacortes, Washington, United States
Duluth Clinic Ashland
🇺🇸Ashland, Wisconsin, United States
Vince Lombardi Cancer Clinic-Two Rivers
🇺🇸Two Rivers, Wisconsin, United States
Spartanburg Medical Center
🇺🇸Spartanburg, South Carolina, United States
Newark Radiation Oncology
🇺🇸Newark, Ohio, United States
Springfield Regional Cancer Center
🇺🇸Springfield, Ohio, United States
Gibbs Cancer Center-Pelham
🇺🇸Greer, South Carolina, United States
OhioHealth Marion General Hospital
🇺🇸Marion, Ohio, United States
Kadlec Clinic Hematology and Oncology
🇺🇸Kennewick, Washington, United States
Cancer Centers of Southwest Oklahoma Research
🇺🇸Lawton, Oklahoma, United States
Geisinger Cancer Services-Pottsville
🇺🇸Pottsville, Pennsylvania, United States
Providence Regional Cancer System-Aberdeen
🇺🇸Aberdeen, Washington, United States
Lehigh Valley Hospital-Cedar Crest
🇺🇸Allentown, Pennsylvania, United States
Rockwood Cancer Treatment Center-DHEC-Downtown
🇺🇸Spokane, Washington, United States
MGC Hematology Oncology-Union
🇺🇸Union, South Carolina, United States
Aurora Health Center-Fond du Lac
🇺🇸Fond Du Lac, Wisconsin, United States
Gibbs Cancer Center-Gaffney
🇺🇸Gaffney, South Carolina, United States
PeaceHealth Saint John Medical Center
🇺🇸Longview, Washington, United States
Providence Regional Cancer System-Yelm
🇺🇸Yelm, Washington, United States
Aurora Health Care Germantown Health Center
🇺🇸Germantown, Wisconsin, United States
Aurora Medical Center in Summit
🇺🇸Summit, Wisconsin, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸Dallas, Texas, United States
Saint Francis Cancer Center
🇺🇸Greenville, South Carolina, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸Sioux Falls, South Dakota, United States
Geisinger Medical Oncology-Selinsgrove
🇺🇸Selinsgrove, Pennsylvania, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸Bellingham, Washington, United States
Community Medical Center
🇺🇸Scranton, Pennsylvania, United States
UT Southwestern/Simmons Cancer Center-Fort Worth
🇺🇸Fort Worth, Texas, United States
Lewistown Hospital
🇺🇸Lewistown, Pennsylvania, United States
M D Anderson Cancer Center
🇺🇸Houston, Texas, United States
Swedish Medical Center-Ballard Campus
🇺🇸Seattle, Washington, United States
Saint Francis Hospital
🇺🇸Greenville, South Carolina, United States
Swedish Cancer Institute-Issaquah
🇺🇸Issaquah, Washington, United States
Vince Lombardi Cancer Clinic-Sheboygan
🇺🇸Sheboygan, Wisconsin, United States
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
🇺🇸Yakima, Washington, United States
Providence Regional Cancer System-Shelton
🇺🇸Shelton, Washington, United States
Aurora Cancer Care-Grafton
🇺🇸Grafton, Wisconsin, United States
Swedish Medical Center-Cherry Hill
🇺🇸Seattle, Washington, United States
Ashland Memorial Medical Center
🇺🇸Ashland, Wisconsin, United States
Aurora BayCare Medical Center
🇺🇸Green Bay, Wisconsin, United States
Aurora Cancer Care-Kenosha South
🇺🇸Kenosha, Wisconsin, United States
Rockwood North Cancer Treatment Center
🇺🇸Spokane, Washington, United States
PeaceHealth United General Medical Center
🇺🇸Sedro-Woolley, Washington, United States
Aurora Cancer Care-Southern Lakes VLCC
🇺🇸Burlington, Wisconsin, United States
Billings Clinic-Cody
🇺🇸Cody, Wyoming, United States
Welch Cancer Center
🇺🇸Sheridan, Wyoming, United States
Big Horn Basin Cancer Center
🇺🇸Cody, Wyoming, United States
Huntsman Cancer Institute/University of Utah
🇺🇸Salt Lake City, Utah, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Mercy Hospital Oklahoma City
🇺🇸Oklahoma City, Oklahoma, United States
Providence Portland Medical Center
🇺🇸Portland, Oregon, United States
Providence Saint Vincent Medical Center
🇺🇸Portland, Oregon, United States
Capital Region Southwest Campus
🇺🇸Jefferson City, Missouri, United States
Farmington Health Center
🇺🇸Farmington, Utah, United States
Roger Maris Cancer Center
🇺🇸Fargo, North Dakota, United States
Cancer Center of Kansas - McPherson
🇺🇸McPherson, Kansas, United States
Cancer Center of Kansas-Manhattan
🇺🇸Manhattan, Kansas, United States
Providence Regional Cancer System-Lacey
🇺🇸Lacey, Washington, United States
Kootenai Cancer Clinic
🇺🇸Sandpoint, Idaho, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸Wilkes-Barre, Pennsylvania, United States
Newland Medical Associates-Clarkston
🇺🇸Clarkston, Michigan, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Saint Mary's Oncology/Hematology Associates of Marlette
🇺🇸Marlette, Michigan, United States
Lakeland Hospital Niles
🇺🇸Niles, Michigan, United States
Oncology Hematology Associates of Saginaw Valley PC
🇺🇸Saginaw, Michigan, United States
Saint Joseph Health System-Tawas City
🇺🇸Tawas City, Michigan, United States
Munson Medical Center
🇺🇸Traverse City, Michigan, United States
Henry Ford West Bloomfield Hospital
🇺🇸West Bloomfield, Michigan, United States
Saint Mary's Oncology/Hematology Associates of West Branch
🇺🇸West Branch, Michigan, United States
Metro Health Hospital
🇺🇸Wyoming, Michigan, United States
Providence Willamette Falls Medical Center
🇺🇸Oregon City, Oregon, United States
The Carle Foundation Hospital
🇺🇸Urbana, Illinois, United States
Springfield Regional Medical Center
🇺🇸Springfield, Ohio, United States
Aurora Cancer Care-Racine
🇺🇸Racine, Wisconsin, United States
Mercy Hospital Washington
🇺🇸Washington, Missouri, United States
Advanced Breast Care Center PLLC
🇺🇸Warren, Michigan, United States
Southwest Illinois Health Services LLP
🇺🇸Swansea, Illinois, United States
Delbert Day Cancer Institute at PCRMC
🇺🇸Rolla, Missouri, United States
Saint Louis Cancer and Breast Institute-Ballwin
🇺🇸Ballwin, Missouri, United States
Mercy Hospital Joplin
🇺🇸Joplin, Missouri, United States
Dayton Physicians LLC-Samaritan North
🇺🇸Dayton, Ohio, United States
Mercy Clinic-Rolla-Cancer and Hematology
🇺🇸Rolla, Missouri, United States
Miami Valley Hospital South
🇺🇸Centerville, Ohio, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸Saint Louis, Missouri, United States
Strecker Cancer Center-Belpre
🇺🇸Belpre, Ohio, United States
Dayton Physicians LLC-Atrium
🇺🇸Franklin, Ohio, United States
Oncology Hematology Care Inc-Mercy West
🇺🇸Cincinnati, Ohio, United States
Mount Carmel Health Center West
🇺🇸Columbus, Ohio, United States
Oncology Hematology Care Inc-Healthplex
🇺🇸Fairfield, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸Dayton, Ohio, United States
Miami Valley Hospital North
🇺🇸Dayton, Ohio, United States
Grady Memorial Hospital
🇺🇸Delaware, Ohio, United States
Greater Dayton Cancer Center
🇺🇸Kettering, Ohio, United States
Blanchard Valley Hospital
🇺🇸Findlay, Ohio, United States
Orion Cancer Care
🇺🇸Findlay, Ohio, United States
Saint Charles Hospital
🇺🇸Oregon, Ohio, United States
Mercy Health Perrysburg Cancer Center
🇺🇸Perrysburg, Ohio, United States
Mercy Saint Anne Hospital
🇺🇸Toledo, Ohio, United States
Knox Community Hospital
🇺🇸Mount Vernon, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸Zanesville, Ohio, United States
Anchorage Radiation Therapy Center
🇺🇸Anchorage, Alaska, United States
Anchorage Associates in Radiation Medicine
🇺🇸Anchorage, Alaska, United States
Alaska Oncology and Hematology LLC
🇺🇸Anchorage, Alaska, United States
Anchorage Oncology Centre
🇺🇸Anchorage, Alaska, United States
Bay Area Breast Surgeons Inc
🇺🇸Emeryville, California, United States
Alaska Women's Cancer Care
🇺🇸Anchorage, Alaska, United States
Epic Care Partners in Cancer Care
🇺🇸Emeryville, California, United States
Saint Luke's Mountain States Tumor Institute
🇺🇸Boise, Idaho, United States
Epic Care Cyberknife Center
🇺🇸Walnut Creek, California, United States
Saint Alphonsus Cancer Care Center-Caldwell
🇺🇸Caldwell, Idaho, United States
Saint Luke's Mountain States Tumor Institute - Fruitland
🇺🇸Fruitland, Idaho, United States
Saint Luke's Mountain States Tumor Institute-Twin Falls
🇺🇸Twin Falls, Idaho, United States
Saint Joseph Medical Center
🇺🇸Bloomington, Illinois, United States
Illinois CancerCare-Bloomington
🇺🇸Bloomington, Illinois, United States
Carle Physician Group-Effingham
🇺🇸Effingham, Illinois, United States
Carle on Vermilion
🇺🇸Danville, Illinois, United States
Southern Illinois University School of Medicine
🇺🇸Springfield, Illinois, United States
Crossroads Cancer Center
🇺🇸Effingham, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸Ottawa, Illinois, United States
Western Illinois Cancer Treatment Center
🇺🇸Galesburg, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸Kewanee, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸Peoria, Illinois, United States
Central Illinois Hematology Oncology Center
🇺🇸Springfield, Illinois, United States
Springfield Clinic
🇺🇸Springfield, Illinois, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Rush-Copley Healthcare Center
🇺🇸Yorkville, Illinois, United States
Parkview Hospital Randallia
🇺🇸Fort Wayne, Indiana, United States
Woodland Cancer Care Center
🇺🇸Michigan City, Indiana, United States
Cancer Center of Kansas - Dodge City
🇺🇸Dodge City, Kansas, United States
Cancer Center of Kansas - El Dorado
🇺🇸El Dorado, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸Fort Scott, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸Independence, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸Kingman, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸Newton, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸Parsons, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸Pratt, Kansas, United States
Associates In Womens Health
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Wesley Medical Center
🇺🇸Wichita, Kansas, United States
Oncology Hematology Care Inc-Crestview
🇺🇸Crestview Hills, Kentucky, United States
Eastern Maine Medical Center
🇺🇸Bangor, Maine, United States
Massachusetts General Hospital Cancer Center
🇺🇸Boston, Massachusetts, United States
Harold Alfond Center for Cancer Care
🇺🇸Augusta, Maine, United States
Lafayette Family Cancer Center-EMMC
🇺🇸Brewer, Maine, United States
Mercy Medical Center
🇺🇸Springfield, Massachusetts, United States
Bronson Battle Creek
🇺🇸Battle Creek, Michigan, United States
IHA Hematology Oncology Consultants-Brighton
🇺🇸Brighton, Michigan, United States
Saint Joseph Mercy Brighton
🇺🇸Brighton, Michigan, United States
Henry Ford Cancer Institute?Downriver
🇺🇸Brownstown, Michigan, United States
IHA Hematology Oncology Consultants-Canton
🇺🇸Canton, Michigan, United States
Saint Joseph Mercy Canton
🇺🇸Canton, Michigan, United States
Caro Cancer Center
🇺🇸Caro, Michigan, United States
IHA Hematology Oncology Consultants-Chelsea
🇺🇸Chelsea, Michigan, United States
Saint Joseph Mercy Chelsea
🇺🇸Chelsea, Michigan, United States
Hematology Oncology Consultants-Clarkston
🇺🇸Clarkston, Michigan, United States
Henry Ford Macomb Hospital-Clinton Township
🇺🇸Clinton Township, Michigan, United States
Beaumont Hospital-Dearborn
🇺🇸Dearborn, Michigan, United States
Henry Ford Medical Center-Fairlane
🇺🇸Dearborn, Michigan, United States
Ascension Saint John Hospital
🇺🇸Detroit, Michigan, United States
Great Lakes Cancer Management Specialists-Doctors Park
🇺🇸East China Township, Michigan, United States
Genesee Cancer and Blood Disease Treatment Center
🇺🇸Flint, Michigan, United States
Genesee Hematology Oncology PC
🇺🇸Flint, Michigan, United States
Genesys Hurley Cancer Institute
🇺🇸Flint, Michigan, United States
Lymphoma Clinic of Michigan
🇺🇸Grosse Pointe Woods, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
Great Lakes Cancer Management Specialists-Van Elslander Cancer Center
🇺🇸Grosse Pointe Woods, Michigan, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Hope Cancer Clinic
🇺🇸Livonia, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
Great Lakes Cancer Management Specialists-Macomb Medical Campus
🇺🇸Macomb, Michigan, United States
Saint Mary's of Michigan
🇺🇸Saginaw, Michigan, United States
Spectrum Health Reed City Hospital
🇺🇸Reed City, Michigan, United States
Lakeland Medical Center Saint Joseph
🇺🇸Saint Joseph, Michigan, United States
Marie Yeager Cancer Center
🇺🇸Saint Joseph, Michigan, United States
Great Lakes Cancer Management Specialists-Macomb Professional Building
🇺🇸Warren, Michigan, United States
IHA Hematology Oncology Consultants-Ann Arbor
🇺🇸Ypsilanti, Michigan, United States
Essentia Health Virginia Clinic
🇺🇸Virginia, Minnesota, United States
Community Hospital of Anaconda
🇺🇸Anaconda, Montana, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Missouri Baptist Outpatient Center-Sunset Hills
🇺🇸Sunset Hills, Missouri, United States
Saint Vincent Healthcare
🇺🇸Billings, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸Missoula, Montana, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
Essentia Health Cancer Center-South University Clinic
🇺🇸Fargo, North Dakota, United States
Dayton Physicians LLC-Miami Valley South
🇺🇸Centerville, Ohio, United States
Columbus Oncology and Hematology Associates Inc
🇺🇸Columbus, Ohio, United States
Delaware Health Center-Grady Cancer Center
🇺🇸Delaware, Ohio, United States
Delaware Radiation Oncology
🇺🇸Delaware, Ohio, United States
Armes Family Cancer Center
🇺🇸Findlay, Ohio, United States
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
🇺🇸Maumee, Ohio, United States
OhioHealth Mansfield Hospital
🇺🇸Mansfield, Ohio, United States
Marietta Memorial Hospital
🇺🇸Marietta, Ohio, United States
Dayton Physicians LLC-Upper Valley
🇺🇸Troy, Ohio, United States
Toledo Clinic Cancer Centers-Toledo
🇺🇸Toledo, Ohio, United States
Clackamas Radiation Oncology Center
🇺🇸Clackamas, Oregon, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Providence Oncology and Hematology Care Southeast
🇺🇸Clackamas, Oregon, United States
Lehigh Valley Hospital - Muhlenberg
🇺🇸Bethlehem, Pennsylvania, United States
Geisinger Medical Oncology-Lewisburg
🇺🇸Lewisburg, Pennsylvania, United States
Geisinger Medical Group
🇺🇸State College, Pennsylvania, United States
Parkland Memorial Hospital
🇺🇸Dallas, Texas, United States
Sanford Cancer Center Oncology Clinic
🇺🇸Sioux Falls, South Dakota, United States
Danville Hematology Oncology
🇺🇸Danville, Virginia, United States
South Jordan Health Center
🇺🇸South Jordan, Utah, United States
Swedish Cancer Institute-Eastside Oncology Hematology
🇺🇸Bellevue, Washington, United States
Providence Regional Cancer Partnership
🇺🇸Everett, Washington, United States
Providence Regional Cancer System-Centralia
🇺🇸Centralia, Washington, United States
Norris Cotton Cancer Center-North
🇺🇸Saint Johnsbury, Vermont, United States
PeaceHealth Southwest Medical Center
🇺🇸Vancouver, Washington, United States
Rockwood Clinic Cancer Treatment Center-Valley
🇺🇸Spokane Valley, Washington, United States
Providence Saint Mary Regional Cancer Center
🇺🇸Walla Walla, Washington, United States
Gundersen Lutheran Medical Center
🇺🇸La Crosse, Wisconsin, United States
Aurora West Allis Medical Center
🇺🇸West Allis, Wisconsin, United States
Aurora Cancer Care-Milwaukee West
🇺🇸Wauwatosa, Wisconsin, United States
Providence Alaska Medical Center
🇺🇸Anchorage, Alaska, United States
Ochsner Medical Center Jefferson
🇺🇸New Orleans, Louisiana, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
Mayo Clinic
🇺🇸Rochester, Minnesota, United States
Wake Forest University Health Sciences
🇺🇸Winston-Salem, North Carolina, United States
Aurora Cancer Care-Milwaukee
🇺🇸Milwaukee, Wisconsin, United States
Aurora Saint Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Aurora Sinai Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Miami Valley Hospital
🇺🇸Dayton, Ohio, United States
Valley Radiation Oncology
🇺🇸Peru, Illinois, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Spectrum Health at Butterworth Campus
🇺🇸Grand Rapids, Michigan, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States
Essentia Health - Fosston
🇺🇸Fosston, Minnesota, United States
Essentia Health - Park Rapids
🇺🇸Park Rapids, Minnesota, United States
Essentia Health Sandstone
🇺🇸Sandstone, Minnesota, United States
Sanford Cancer Center Worthington
🇺🇸Worthington, Minnesota, United States
Mercy Hospital Saint Louis
🇺🇸Saint Louis, Missouri, United States