Rituximab and Combination Chemotherapy in Treating Older Patients With Previously Untreated B-Cell Lymphoma
- Conditions
- Lymphoma
- Interventions
- Biological: pegfilgrastimBiological: rituximabOther: pharmacological studyRadiation: radiation therapy
- Registration Number
- NCT00290667
- Lead Sponsor
- German High-Grade Non-Hodgkin's Lymphoma Study Group
- Brief Summary
RATIONALE: Monoclonal antibodies, such as rituximab, can block cancer growth in different ways. Some find cancer cells and kill them or carry cancer-killing substances to them. Others interfere with the ability of cancer cells to grow and spread. Drugs used in chemotherapy, such as cyclophosphamide, doxorubicin, vincristine, and prednisone, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Giving rituximab together with combination chemotherapy may kill more cancer cells.
PURPOSE: This phase II trial is studying how well giving rituximab together with combination chemotherapy works in treating older patients with previously untreated B-cell lymphoma.
- Detailed Description
OBJECTIVES:
Primary
* Determine a pharmacokinetic profile for pharmacokinetics-based or rituximab within a CHOP-14 regimen comprising cyclophosphamide, doxorubicin hydrochloride, vincristine, and prednisone in elderly patients with previously untreated aggressive B-cell lymphoma.
* To determine whether increased single-doses of rituximab for males can compensate their lower serum levels.
* Evaluate the safety and toxicity profile of this regimen in male patients.
Secondary
* Determine the rate of complete responses, primary progressions under therapy, event-free survival, progression-free survival, and overall survival in patients treated with this regimen.
* Determine the rate of primary progression in patients treated with this regimen.
OUTLINE: This is a multicenter study. All patients undergo the following treatment.
* Prephase treatment: Patients receive vincristine subcutaneously on day -6 and oral prednisone on days -6 to 0.
* Immunochemotherapy and radiotherapy: Patients receive CHOP chemotherapy comprising cyclophosphamide IV over 15 minutes, doxorubicin hydrochloride IV, and vincristine IV on day 1 and oral prednisone once daily on days 1-5. Patients also receive pegfilgrastim subcutaneously on days 4, 18, 32, 46, 60, and 74. Treatment with CHOP chemotherapy repeats every 14 days for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients who show no response after course 4 of CHOP chemotherapy proceed to salvage chemotherapy off study.
Patients are evaluated 2-4 weeks after completion of CHOP. Patients with initial bulky disease (i.e., diameter ≥ 7.5 cm) or extranodal involvement AND achieving complete remission (CR), unconfirmed CR (CRu), or partial remission undergo radiotherapy 5 days a week for 4 weeks. Patients who do not achieve CR or CRu 2 months after completion of radiotherapy proceed to salvage chemotherapy off study.
Patients are then stratified according to center, International Prognostic Index (1-2 vs 3-5), disease involvement (bulky vs extranodal vs bulky and/or extranodal), age (61-70 years old vs 71-80 years old), and gender. Patients are randomized to 1 of 2 treatment arms.
* Arm I (2-weekly rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days 0, 14, 28, 42, 56, 70, 84, and 98. Patients also receive pegfilgrastim subcutaneously on day 4 of each course.
* Arm II (pharmacokinetic-based dose-dense rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days -1, 0, 3, 7, 14, 21, 28, and 42. Patients also receive pegfilgrastim subcutaneously on day 4 of each course.
Some patients undergo blood sample collection periodically during and after treatment for pharmacokinetic studies.
After completion of study treatment, patients are followed every 3 months for 2 years, every 6 months for 3 years, and then once a year therafter.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 586
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Interventional: CHOP-14 + 8 x 2-weekly rituximab rituximab Arm I (2-weekly rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days 0, 14, 28, 42, 56, 70, 84, and 98. Patients also receive pegfilgrastim subcutaneously on day 4 of each course. Interventional: CHOP-14 + 8 x 2-weekly rituximab radiation therapy Arm I (2-weekly rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days 0, 14, 28, 42, 56, 70, 84, and 98. Patients also receive pegfilgrastim subcutaneously on day 4 of each course. Interventional: CHOP-14 + 8 x dose-dense rituximab prednisone Arm II (pharmacokinetic-based dose-dense rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days -1, 0, 3, 7, 14, 21, 28, and 42. Patients also receive pegfilgrastim subcutaneously on day 4 of each course. Interventional: CHOP-14 + 8 x 2-weekly rituximab pegfilgrastim Arm I (2-weekly rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days 0, 14, 28, 42, 56, 70, 84, and 98. Patients also receive pegfilgrastim subcutaneously on day 4 of each course. Interventional: CHOP-14 + 8 x 2-weekly rituximab pharmacological study Arm I (2-weekly rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days 0, 14, 28, 42, 56, 70, 84, and 98. Patients also receive pegfilgrastim subcutaneously on day 4 of each course. Interventional: CHOP-14 + 8 x dose-dense rituximab pegfilgrastim Arm II (pharmacokinetic-based dose-dense rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days -1, 0, 3, 7, 14, 21, 28, and 42. Patients also receive pegfilgrastim subcutaneously on day 4 of each course. Interventional: CHOP-14 + 8 x dose-dense rituximab doxorubicin hydrochloride Arm II (pharmacokinetic-based dose-dense rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days -1, 0, 3, 7, 14, 21, 28, and 42. Patients also receive pegfilgrastim subcutaneously on day 4 of each course. Interventional: CHOP-14 + 8 x dose-dense rituximab pharmacological study Arm II (pharmacokinetic-based dose-dense rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days -1, 0, 3, 7, 14, 21, 28, and 42. Patients also receive pegfilgrastim subcutaneously on day 4 of each course. Interventional: CHOP-14 + 8 x dose-dense rituximab rituximab Arm II (pharmacokinetic-based dose-dense rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days -1, 0, 3, 7, 14, 21, 28, and 42. Patients also receive pegfilgrastim subcutaneously on day 4 of each course. Interventional: CHOP-14 + 8 x 2-weekly rituximab vincristine sulfate Arm I (2-weekly rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days 0, 14, 28, 42, 56, 70, 84, and 98. Patients also receive pegfilgrastim subcutaneously on day 4 of each course. Interventional: CHOP-14 + 8 x dose-dense rituximab cyclophosphamide Arm II (pharmacokinetic-based dose-dense rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days -1, 0, 3, 7, 14, 21, 28, and 42. Patients also receive pegfilgrastim subcutaneously on day 4 of each course. Interventional: CHOP-14 + 8 x dose-dense rituximab vincristine sulfate Arm II (pharmacokinetic-based dose-dense rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days -1, 0, 3, 7, 14, 21, 28, and 42. Patients also receive pegfilgrastim subcutaneously on day 4 of each course. Interventional: CHOP-14 + 8 x dose-dense rituximab radiation therapy Arm II (pharmacokinetic-based dose-dense rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days -1, 0, 3, 7, 14, 21, 28, and 42. Patients also receive pegfilgrastim subcutaneously on day 4 of each course. Interventional: CHOP-14 + 8 x 2-weekly rituximab doxorubicin hydrochloride Arm I (2-weekly rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days 0, 14, 28, 42, 56, 70, 84, and 98. Patients also receive pegfilgrastim subcutaneously on day 4 of each course. Interventional: CHOP-14 + 8 x 2-weekly rituximab cyclophosphamide Arm I (2-weekly rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days 0, 14, 28, 42, 56, 70, 84, and 98. Patients also receive pegfilgrastim subcutaneously on day 4 of each course. Interventional: CHOP-14 + 8 x 2-weekly rituximab prednisone Arm I (2-weekly rituximab): Patients receive rituximab IV 375 mg/m\^2 (females) and 500 mg/m\^2 (males) over 4 hours on days 0, 14, 28, 42, 56, 70, 84, and 98. Patients also receive pegfilgrastim subcutaneously on day 4 of each course.
- Primary Outcome Measures
Name Time Method Pharmacokinetics (in first 20 patients of each cohort with a distinct variation of the rituximab schedule) assessed on days -4, -1, 10, 29, 57, 99, 155, 239, 267, 295, 407, and 491 of treatment -4 to 491 days of treatment Toxicity assessed by NCI criteria, adverse events, serious adverse events, protocol adherence, and treatment-related deaths at 3 months after study completion 3 months after study completion Safety and treatment related deaths at 3 months after study completion 3 months after study completion
- Secondary Outcome Measures
Name Time Method Survival time life-long Progression-free survival life-long Time to treatment failure assessed at 2 years within the study and periodically thereafter at 2 years within the study and periodically thereafterlif Complete response rate assessed at 2 years within the study and periodically thereafter at 2 years within the study and periodically thereafter Progression rate life-long
Trial Locations
- Locations (331)
University Hospital Brno
🇨🇿Brno, Czechia
Hopital Debrousse
🇫🇷Lyon, France
Charles University Hospital
🇨🇿Prague 5, Czechia
Haematologisch Onkologische Praxis
🇩🇪Aachen, Germany
Ostalb-Klinikum Aalen
🇩🇪Aalen, Germany
Gemeinschaftspraxis Fuer Innere Medizin, Haematologie Und Internistische Onkologie
🇩🇪Ansbach, Germany
Klinikum St. Marien
🇩🇪Amberg, Germany
Haematologische Praxis
🇩🇪Weiden, Germany
II. Medizinische Klinik
🇩🇪Aschaffenburg, Germany
Specialist Practice for Oncology
🇩🇪Aschaffenburg, Germany
Hamatologische/Onkologische Gemeinschaftspraxis - Augsburg
🇩🇪Augsburg, Germany
Klinikum Augsburg
🇩🇪Augsburg, Germany
Kreiskrankenhaus Aurich
🇩🇪Aurich, Germany
HELIOS Klinikum Bad Saarow
🇩🇪Bad Saarow, Germany
Kreiskrankenhaus Bad Saeckingen
🇩🇪Bad Säckingen, Germany
Onkologische Schwerpunktpraxis und Tagesklinik Dres
🇩🇪Bad Soden, Germany
Klinikum am Bamberg
🇩🇪Bamberg, Germany
Regional Hospital Bad Hersfeld
🇩🇪Bad Hersfeld, Germany
Internistische Praxis - Bad Salzuflen
🇩🇪Bad Salzuflen, Germany
Ermstalklinik Bad Urach
🇩🇪Bad Urach, Germany
Krankenhaus Hohe Warte Mediziniche Klinik
🇩🇪Bayreuth, Germany
Klinikum Bayreuth
🇩🇪Bayreuth, Germany
Praxis Dr. med. Stefan Korsten
🇩🇪Bergisch Gladbach, Germany
Onkologisches Versorgungszentrum Friedrichshain
🇩🇪Berlin, Germany
Internistische Gemeinschaftspraxis - Berlin
🇩🇪Berlin, Germany
Haematologisch-Onkologische Schwerpunktpraxis
🇩🇪Berlin, Germany
Evang. Waldkrankenhaus Spandau
🇩🇪Berlin, Germany
Charite - Campus Charite Mitte
🇩🇪Berlin, Germany
Onkolog - Haematolog Schwerpunktpraxis
🇩🇪Berlin, Germany
Charite - Universitaetsmedizin Berlin - Campus Benjamin Franklin
🇩🇪Berlin, Germany
Vivantes Klinikum Neukoelln
🇩🇪Berlin, Germany
Robert Roessle Comprehensive Cancer Center - Charite Campus Buch
🇩🇪Berlin, Germany
Hospital Complex Bernburg
🇩🇪Bernburg, Germany
Franziskus Hospital
🇩🇪Bielefeld, Germany
Krankenhaus Bietigheim
🇩🇪Bietigheim, Germany
Augusta-Kranken-Anstalt gGmbH
🇩🇪Bochum, Germany
Saint Agnes Hospital
🇩🇪Bocholt, Germany
St. Josef-Hospital - Bochum
🇩🇪Bochum, Germany
Knappschaftskrankenhaus Bochum-Langendreer
🇩🇪Bochum, Germany
Johanniter-Krankenhaus Bonn
🇩🇪Bonn, Germany
Universitaetsklinikum Bonn
🇩🇪Bonn, Germany
Praxis fuer Haematologie und Internistische Onkologie - Borken
🇩🇪Borken, Germany
Medizinische Poliklinik
🇩🇪Bonn, Germany
Praxis Dres. F.& G. Doering
🇩🇪Bremen, Germany
Knappschaftskrankenhaus Bottrop
🇩🇪Bottrop, Germany
Hamatologische Sprechstunde
🇩🇪Brandenburg, Germany
Staedtisches Klinikum Braunschweig
🇩🇪Braunschweig, Germany
Praxis fuer Haematologie und Onkologie - Burgwedel
🇩🇪Burgwedel, Germany
Klinikum Bremen-Mitte
🇩🇪Bremen, Germany
DIAKO Ev. Diakonie Krankenhaus gGmbH
🇩🇪Bremen, Germany
St. Joseph Hospital
🇩🇪Bremerhaven, Germany
Zentralkrankenhaus
🇩🇪Bremerhaven, Germany
Medizinische Klinik am Lukas - Krankenhaus
🇩🇪Bünde, Germany
Klinikum Coburg
🇩🇪Coburg, Germany
Hospital Kuchwald Chemnitz
🇩🇪Chemnitz, Germany
Onkologische Schwerpunktpraxis Celle
🇩🇪Celle, Germany
Praxis Internistischer Onkologie und Haematologie - Koeln
🇩🇪Cologne, Germany
Lung Clinic Cologne-Merheim
🇩🇪Cologne-Merheim, Germany
Internistische Praxis - Coesfeld
🇩🇪Coesfeld, Germany
Kliniken der Stadt Koeln gGmbH - Krankenhaus Holweide
🇩🇪Cologne, Germany
Praxis Fuer Haematologie Internistische Onkologie
🇩🇪Cologne, Germany
Praxis fuer Onkologie - Kalk
🇩🇪Cologne, Germany
Medizinische Universitaetsklinik I at the University of Cologne
🇩🇪Cologne, Germany
Staedtisches Klinikum Dessau
🇩🇪Dessau, Germany
Klinikum Darmstadt
🇩🇪Darmstadt, Germany
Carl - Thiem - Klinkum Cottbus
🇩🇪Cottbus, Germany
Praxis Dr. Rheinhold Siegmund - Dr. Matthias Penke
🇩🇪Damme, Germany
Saint Johannes Hospital Dortmund
🇩🇪Dortmund, Germany
Internistische Praxis
🇩🇪Detmold, Germany
Klinikum Dortmund
🇩🇪Dortmund, Germany
Universitatsklinikum Carl Gustav Carus
🇩🇪Dresden, Germany
St. Johannes Hospital - Medical Klinik II
🇩🇪Duisburg, Germany
Universitaetsklinikum Duesseldorf
🇩🇪Duesseldorf, Germany
Johanniter-Krankenhaus Rheinhausen GmbH
🇩🇪Duisburg, Germany
Franz Hospital Dulmen
🇩🇪Dulmen, Germany
Klinikum Barnim GmbH, Werner Forssmann Krankenhaus
🇩🇪Eberswalde, Germany
Florence-Nightingale-Krankenhause, Deaconess Kaiserswerth
🇩🇪Dusseldorf, Germany
Universitaetsklinikum Essen
🇩🇪Essen, Germany
Virngrund-Klinik Ellwangen
🇩🇪Ellwangen, Germany
Hans - Susemihl - Krankenhaus
🇩🇪Emden, Germany
Medizinische Klinik III - Universitaetsklinikum Erlangen
🇩🇪Erlangen, Germany
Helios Klinikum Erfurt
🇩🇪Erfurt, Germany
Evangelisches Krankenhaus Essen Werden
🇩🇪Essen, Germany
St. Antonius Hospital
🇩🇪Eschweiler, Germany
Schwerpunktpraxis fuer Haematologie und Onkologie - Flensburg
🇩🇪Flensburg, Germany
Staedtische Kliniken Esslingen
🇩🇪Esslingen, Germany
Klinikum Frankfurt (Oder) GmbH
🇩🇪Frankfurt (Oder), Germany
Gemeinschaftspraxis fuer Internistische - Frankenthal
🇩🇪Frankenthal, Germany
Onkologie Bethanien
🇩🇪Frankfurt, Germany
Praxis Internistischer Onkologie und Haematologie - Frechen
🇩🇪Frechen, Germany
Krankenhaus Nordwest
🇩🇪Frankfurt, Germany
St. Marienkrankenhaus - Frankfurt am Main
🇩🇪Frankfurt am Main, Germany
Klinikum der J.W. Goethe Universitaet
🇩🇪Frankfurt, Germany
Evang. Deaconess Hospital Freiburg
🇩🇪Freiburg, Germany
Gemeinschaftspraxis - Freiburg
🇩🇪Freiburg, Germany
Praxis fur Interdisziplinaere Onkologie
🇩🇪Freiburg, Germany
Municipal Hospital Complex
🇩🇪Villingen-Schwenningen, Germany
Universitaetsklinikum Freiburg
🇩🇪Freiburg, Germany
Klinikum Garmisch - Partenkirchen GmbH
🇩🇪Garmisch-Partenkirchen, Germany
Robert - Koch Hospital
🇩🇪Gehrden, Germany
Saint Josef Hospital
🇩🇪Gelsenkirchen, Germany
Internistische Praxisgemeinschaft
🇩🇪Germering, Germany
Centre for Internal Medicine Giessen
🇩🇪Giessen, Germany
Gemeinschaftspraxis Fuer Innere Medizin, Hematologie Und Onkologie
🇩🇪Giessen, Germany
DR Herbert - Nieper Krankenhaus Goslar
🇩🇪Goslar, Germany
Wilhelm-Anton-Hospital gGmbH, Goch
🇩🇪Goch, Germany
Klinik Fuer Innere Medizin, Hematology/Oncology, Ernst Moritz Armdt Universitaet
🇩🇪Greifswald, Germany
Kreiskrankenhaus Gummersbach GMBH
🇩🇪Gummersbach, Germany
Staedtisches Klinikum Görlitz GmbH
🇩🇪Görlitz, Germany
Internistisch-Haematologische Gemeinschaftspraxis - Gustrow
🇩🇪Gustrow, Germany
Universitaetsklinikum Göttingen
🇩🇪Göttingen, Germany
Staedtisches Klinikum Gütersloh
🇩🇪Gütersloh, Germany
Allgemeines Krankenhaus Hagen
🇩🇪Hagen, Germany
St. Marien Hospital - Katholisches Krankenhaus Hagen gGmbH
🇩🇪Hagen, Germany
St. Salvator Krankenhaus
🇩🇪Halberstadt, Germany
Internistische Gemeinschaftspraxis - Halle
🇩🇪Halle, Germany
Universitaetsklinikum Halle
🇩🇪Halle, Germany
Krankenhaus St. Elisabeth und St. Barbara
🇩🇪Halle, Germany
St. Sixtus Hospital
🇩🇪Haltern, Germany
Krankenhaus Martha-Maria Halle-Doelau gGmbH
🇩🇪Halle, Germany
Praxis fuer Innere Medizin - Bergedorf
🇩🇪Hamburg, Germany
Allgemeines Krankenhaus Altona
🇩🇪Hamburg, Germany
Marienkrankenhaus
🇩🇪Hamburg, Germany
Onkologische Schwerpunktpraxis Dr. med. Verpoort, PD Dr. med. Zeller and Dr. med. Wierecky
🇩🇪Hamburg, Germany
Asklepios Klinik St. Georg
🇩🇪Hamburg, Germany
University Medical Center Hamburg - Eppendorf
🇩🇪Hamburg, Germany
Asklepios Klinik Nord Heidberg
🇩🇪Hamburg, Germany
Haematologisch-Onkologische Praxis Altona
🇩🇪Hamburg, Germany
St. Marien Hospital
🇩🇪Hamm, Germany
Klinikum Stadt Hanau
🇩🇪Hanau, Germany
Evangelische Krankenhaus Hamm
🇩🇪Hamm, Germany
Schwerpunktpraxis Haematologie/Onkologie - Hannover
🇩🇪Hannover, Germany
Krankenhaus Siloah - Medizinische Klinik II
🇩🇪Hannover, Germany
Henriettenstiftung Frauenklinik
🇩🇪Hannover, Germany
Medizinische Hochschule Hannover
🇩🇪Hannover, Germany
Oncology Specialists Clinic
🇩🇪Harrislee, Germany
Ruprecht - Karls - Universitaet Heidelberg
🇩🇪Heidelberg, Germany
Thoraxklinik Heidelberg
🇩🇪Heidelberg, Germany
Regional Hospital Heidenheim
🇩🇪Heidenheim, Germany
Klinikum Herford
🇩🇪Herford, Germany
Regional Hospital Am Plattenwald Bad Friedrichshall
🇩🇪Heilbronn, Germany
Marienhospital at Ruhr University Bochum
🇩🇪Herne, Germany
Privatklinik Dr. R. Schindlbeck GmbH & Co. KG
🇩🇪Herrsching Am Ammersee, Germany
St. Bernward Krankenhaus
🇩🇪Hildesheim, Germany
Onkologische Schwerpunktpraxis
🇩🇪Wendlingen, Germany
Staedtisches Krankenhaus Hildesheim
🇩🇪Hildesheim, Germany
Evang. Hospital
🇩🇪Holzminden, Germany
Haematologie und Internistische Onkologie Praxis
🇩🇪Homberg, Germany
Universitaetsklinikum des Saarlandes
🇩🇪Homburg, Germany
Hospital Complex Hoyerswerda
🇩🇪Hoyerswerda, Germany
Clinic for Bone Marrow Transplantation and Hematology and Oncology
🇩🇪Idar-Oberstein, Germany
Internistische Gemeinschaftspraxis - Jena
🇩🇪Jena, Germany
Klinikum der Friedrich-Schiller Universitaet Jena
🇩🇪Jena, Germany
Westpfalz-Klinikum GmbH
🇩🇪Kaiserslautern, Germany
Onkologische Gemeinschaftspraxis - Kaiserslautern
🇩🇪Kaiserslautern, Germany
St. Vincentius - Kliniken
🇩🇪Karlsruhe, Germany
Red Cross Hospital Kassel
🇩🇪Kassel, Germany
Internistische Gemeinschaftspraxis - Kassel
🇩🇪Kassel, Germany
Klinikum Kempten Oberallgaeu
🇩🇪Kempten, Germany
Staedtisches Krankenhaus Kiel
🇩🇪Kiel, Germany
Praxis fuer Haematologie und Onkologie
🇩🇪Twistringen, Germany
Stiftungsklinikum Mittelrhein - Gesundheitszentrum Evangelisches Stift Sankt Martin Koblenz gGmbH
🇩🇪Koblenz, Germany
Leonardis Clinic
🇩🇪Kornwestheim, Germany
Haematologische / Onkologische Schwerpunktpraxis
🇩🇪Krefeld, Germany
Internistische Praxis - Landshut
🇩🇪Landshut, Germany
Internistische Onkologische Praxis - Kronach
🇩🇪Kronach, Germany
Klinikum Krefeld GmbH
🇩🇪Krefeld, Germany
Frankenwald Klinik
🇩🇪Kronach, Germany
Caritas - Krakenhaus Lebach
🇩🇪Lebach, Germany
Klinikum Landshut
🇩🇪Landshut, Germany
Onkologische Schwerpunktpraxis - Leer
🇩🇪Leer, Germany
Praxis fuer Onkologie am Diakonissenhaus
🇩🇪Leipzig, Germany
University Leipzig Clinic of Internal Medicine
🇩🇪Leipzig, Germany
Forschungsgesellschaft mbH
🇩🇪Leipzig, Germany
Gemeinschaftspraxis fuer Dres. Aldaoud und Schwarzer
🇩🇪Leipzig, Germany
Klinikum "St. Georg" Leipzig
🇩🇪Leipzig, Germany
Klinikum Lippe - Lemgo
🇩🇪Lemgo, Germany
St. Vincenz Hospital Limburg
🇩🇪Limburg, Germany
St. Bonifatius Hospital Lingen
🇩🇪Lingen, Germany
Dreifaltigkeits Hospital
🇩🇪Lippstadt, Germany
Kreiskrankenhaus Loerrach
🇩🇪Loerrach, Germany
Klinikum Ludwigsburg
🇩🇪Ludwigsburg, Germany
St. Marien Hospital Ludwighafen
🇩🇪Ludwigshafen, Germany
Klinikum der Stadt Ludwigshafen am Rhein
🇩🇪Ludwigshafen am Rhein, Germany
Schwerpunktpraxis fuer Haematologie und Onkologie - Luebeck
🇩🇪Luebeck, Germany
Universitaetsklinikum Schleswig-Holstein - Campus Luebeck
🇩🇪Luebeck, Germany
Kreiskrankenhaus Luedenscheid
🇩🇪Luedenscheid, Germany
Sana Kliniken Luebeck
🇩🇪Luebeck, Germany
Universitatsklinikum der MA
🇩🇪Magdeburg, Germany
Internistische Gemeinschaftspraxis - Magdeburg
🇩🇪Magdeburg, Germany
Staedtisches Klinikum Magdeburg - Altstadt
🇩🇪Magdeburg, Germany
Johannes Gutenberg University
🇩🇪Mainz, Germany
St. Vincenz und Elisabeth Hospital
🇩🇪Mainz, Germany
Gemeinschaftspraxis
🇩🇪Mannheim, Germany
Schwerpunktpraxis Internist Onkologie - Marburg
🇩🇪Marburg, Germany
III Medizinische Klinik Mannheim
🇩🇪Mannheim, Germany
Regional Hospital Mayen
🇩🇪Mayen, Germany
Universitaetsklinikum Giessen und Marburg GmbH - Marburg
🇩🇪Marburg, Germany
Gemeinschaftspraxis Dres. med. Ellbrueck/Goeller/Kraenzle/Niedermeier/Jocham
🇩🇪Memmingen, Germany
Krankenhaus Ludmillenstift
🇩🇪Meppen, Germany
Gemeinschaftspraxis - Minden
🇩🇪Minden, Germany
Klinikum Minden
🇩🇪Minden, Germany
Krankenhaus Maria Hilf GmbH
🇩🇪Moenchengladbach, Germany
Ev. Hospital Bethesda
🇩🇪Monchengladbach, Germany
Haematologische Praxis - Moenchengladbach
🇩🇪Moenchengladbach, Germany
Evangelisches Krankenhaus - Muelheim
🇩🇪Muelheim an der Ruhr, Germany
Gemeinschaftspraxis - Muenster
🇩🇪Muenster, Germany
Haematologisch - Onkologische Gemeinschaftspraxis - Muenster
🇩🇪Muenster, Germany
St. Marien Hospital - Muelheim an der Ruhr
🇩🇪Muelheim An Der Ruhr, Germany
Universitaets - Kinderpoliklinik
🇩🇪Munich, Germany
Klinik und Poliklinik fuer Kinder und Jugendmedizin - Universitaetsklinikum Muenster
🇩🇪Muenster, Germany
Krankenhaus Muenchen Schwabing
🇩🇪Munich, Germany
Munich Oncologic Practice at Elisenhof
🇩🇪Munich, Germany
Klinikum Rechts Der Isar - Technische Universitaet Muenchen
🇩🇪Munich, Germany
Klinikum der Universitaet Muenchen - Grosshadern Campus
🇩🇪Munich, Germany
Staedtisches Krankenhaus Muenchen - Harlaching
🇩🇪Munich, Germany
Municipal Hospital Munich
🇩🇪Munich, Germany
Staedtisches Krankenhaus Nettetal GmbH
🇩🇪Nettetal, Germany
Klinikum Schwaebisch Gmuend Stauferklinik
🇩🇪Mutlangen, Germany
Kreiskrankenhaus Muenchberg
🇩🇪Münchberg, Germany
Regional Hospital Neumarkt
🇩🇪Neumarkt, Germany
Klinikum Neubrandenburg
🇩🇪Neubrandenburg, Germany
Onkologische Schwerpunktpraxis Dr. Schmidt
🇩🇪Neunkirchen, Germany
Staedtisches Klinikum Neunkirchen gGmbH
🇩🇪Neunkirchen, Germany
Internistische Praxis - Neuss
🇩🇪Neuss, Germany
Lukaskrankenhaus Neuss
🇩🇪Neuss, Germany
DRK Krankenhaus Neuwied
🇩🇪Neuwied, Germany
Praxis fuer Haematologie und Interne Onkologie
🇩🇪Norderstedt, Germany
Gemeinschaftspraxis fuer Onkologie - Nordhorn
🇩🇪Nordhorn, Germany
Gemeinschaftspraxis fuer Haematologie - Northeim
🇩🇪Northeim, Germany
Praxisklinik fuer Innere Medizin - Nuernberg
🇩🇪Nuremberg, Germany
Klinikum Nuernberg - Klinikum Nord
🇩🇪Nuremberg, Germany
Schlossbergkliniken Oberstaufen
🇩🇪Oberstaufen, Germany
Internistische Gemeinschaftspraxis - Offenbach
🇩🇪Offenbach, Germany
Klinikum Offenburg
🇩🇪Offenburg, Germany
Pius Hospital - Oldenburg
🇩🇪Oldenburg, Germany
Internistische Gemeinschaftspraxis - Oldenburg
🇩🇪Oldenburg, Germany
Ev. Hospital Oldenburg
🇩🇪Oldenburg, Germany
Klinikum Oldenburg
🇩🇪Oldenburg, Germany
Marien Hospital
🇩🇪Osnabrück, Germany
St. Martinus Hospital - Olpe
🇩🇪Olpe, Germany
Klinikum Osnabrück GmbH
🇩🇪Osnabrück, Germany
Paracelsus - Klinik Osnabrück
🇩🇪Osnabrück, Germany
Bruederkrankenhaus St. Josef Paderborn
🇩🇪Paderborn, Germany
Asklepios Klinik - Parchim
🇩🇪Parchim, Germany
Staedtisches Krankenhaus
🇩🇪Pforzheim, Germany
Kreiskrankenhaus Radebeul
🇩🇪Radebeul, Germany
Praxis fuer Innere Medizin am Krankenhaus Siloah - Pforzheim
🇩🇪Pforzheim, Germany
Krankenhaus Siloah - Pforzheim
🇩🇪Pforzheim, Germany
Gemeinschaftspraxis - Pinneberg
🇩🇪Pinneberg, Germany
Klinikum Ernst Von Bergmann
🇩🇪Potsdam, Germany
Gemeinschaftspraxis - Ravensburg
🇩🇪Ravensburg, Germany
Krankenhaus St. Elisabeth - Ravensburg
🇩🇪Ravensburg, Germany
Elisabeth Krankenhaus
🇩🇪Recklinghausen, Germany
Prosper-Hospital Recklinghausen
🇩🇪Recklinghausen, Germany
Hematologische Onkologische Praxis
🇩🇪Regensburg, Germany
Klinikum der Universitaet Regensburg
🇩🇪Regensburg, Germany
Krankenhaus Barmherzige Brueder Regensburg
🇩🇪Regensburg, Germany
Internistische Praxis Dres. Hempel und Hochdorfer
🇩🇪Rehling, Germany
Klinikum Remscheid GmbH
🇩🇪Remscheid, Germany
Klinikum Suedstadt Rostock
🇩🇪Rostock, Germany
Jakobi Krankenhaus
🇩🇪Rheine, Germany
Haematologische/Onkologische Schwerpunktpraxis - Rostock
🇩🇪Rostock, Germany
Klinik und Poliklinik fuer Innere Medizin - Universitaet Rostock
🇩🇪Rostock, Germany
Diakonie - Krankenhaus
🇩🇪Rotenburg, Germany
Internistische Schwerpunktpraxis
🇩🇪Russelsheim, Germany
Caritasklinik St. Theresia
🇩🇪Saarbrucken, Germany
St. Elizabeth-Klinik Saarlouis
🇩🇪Saarlouis, Germany
Gemeinschaftspraxis - Saarbruecken
🇩🇪Saarbruecken, Germany
Martin - Luther Hospital
🇩🇪Schleswig, Germany
Deaconess Hospital
🇩🇪Schwabisch Hall, Germany
Praxis fur Innere Medizin - Schmiedeberg
🇩🇪Schmiedeberg, Germany
Gemeinschaftspraxis fuer Haematologie und Internist - Schweinfurt
🇩🇪Schweinfurt, Germany
Leopoldina - Krankenhaus
🇩🇪Schweinfurt, Germany
HELIOS Klinikum - Schwelm
🇩🇪Schwelm, Germany
Klinikum Schwerin
🇩🇪Schwerin, Germany
St. Marien - Krankenhaus Siegen GMBH
🇩🇪Siegen, Germany
Evang. Jung-Stilling Hospital
🇩🇪Siegen, Germany
St. Lukas - Clinic Solingen
🇩🇪Solingen, Germany
Krankenhaus Maria-Hilf - Stadtlohn
🇩🇪Stadtlohn, Germany
Klinik fuer Onkologie - Katharinenhospital Stuttgart
🇩🇪Stuttgart, Germany
Onkologische Schwerpunktpraxis - Straubing
🇩🇪Straubing, Germany
Hospital Bad Cannstatt
🇩🇪Stuttgart, Germany
Diakonie Klinikum Stuttgart
🇩🇪Stuttgart, Germany
Gastroenterologische und Haematologisch-Onkologische Praxis E. M. Dr. Hoering von Ehr Respondek
🇩🇪Stuttgart, Germany
Klinikum Stuttgart - Buergerhospital
🇩🇪Stuttgart, Germany
Robert-Bosch-Krankenhaus
🇩🇪Stuttgart, Germany
St. Elisabeth Hospital Thuine
🇩🇪Thuine, Germany
Regional Hospital Traunstein
🇩🇪Traunstein, Germany
Onkologische Gemeinschaftspraxis - Trier
🇩🇪Trier, Germany
Krankenanstalt Mutterhaus der Borromaerinnen
🇩🇪Trier, Germany
Hospital Tutzing
🇩🇪Tutzing, Germany
Krankenhaus Der Barmherzigen Brueder
🇩🇪Trier, Germany
Universitaetsklinikum Tuebingen
🇩🇪Tuebingen, Germany
Praxis Fuer Internistische Haematologie / Onkologie
🇩🇪Troisdorf, Germany
Comprehensive Cancer Center Ulm at Universitaetsklinikum Ulm
🇩🇪Ulm, Germany
Ev. Hospital Unna
🇩🇪Unna, Germany
Onkologische Schwerpunktpraxis - Villingen
🇩🇪Villingen, Germany
Regional Hospital Waldbrol
🇩🇪Waldbrol, Germany
Sophien - und Hufeland - Klinikum Weimar gGmbH
🇩🇪Weimar, Germany
St. Marienhospital - Vechta
🇩🇪Vechta, Germany
Gemeinschaftspraxis feur Haemotologie und Onkologie - Weilheim
🇩🇪Weilheim, Germany
Asklepios Nordseeklinik Westerland GmbH
🇩🇪Westerland, Germany
Harz-Klinikum Wernigerode-Blankenburg GmbH
🇩🇪Wernigerode, Germany
Hospital Wetzler
🇩🇪Wetzlar, Germany
Deutsche Klinik fuer Diagnostik
🇩🇪Wiesbaden, Germany
Ammerland-Klinik GmbH
🇩🇪Westerstede, Germany
Dr. Horst-Schmidt-Kliniken
🇩🇪Wiesbaden, Germany
Evangelisches Krankenhaus - Lutherstadt Wittenberg
🇩🇪Wittenberg, Germany
Ev. Hospital Witten-Herdecke
🇩🇪Witten, Germany
Burkhard and Reimann Gemeinschaftspraxis
🇩🇪Worms, Germany
Klinikum der Stadt Wolfsburg
🇩🇪Wolfsburg, Germany
Kliniken St. Antonius
🇩🇪Wuppertal 2, Germany
Medizinische Poliklinik, Universitaet Wuerzburg
🇩🇪Wuerzburg, Germany
Helios Kliniken Wuppertal University Hospital
🇩🇪Wuppertal, Germany
Azienda Ospedaliera di Padova
🇮🇹Padova, Italy
Heinrich-Braun-Krankenhaus Zwickau
🇩🇪Zwickau, Germany
Kantonsspital Aarau
🇨🇭Aarau, Switzerland
Goeteborg University
🇸🇪Goeteborg, Sweden
University Children's Hospital
🇨🇭Zurich, Switzerland
Kinderspital Luzern
🇨🇭Lucerne 16, Switzerland
Ostschweizer Kinderspital
🇨🇭St. Gallen, Switzerland
General Hospital
🇩🇪Celle, Germany
Onkologische Schwerwpunktpraxis Dr. Ladda
🇩🇪Neumarkt, Germany
Universitaets-Kinderspital beider Basel
🇨🇭Basel, Switzerland
Erasmus MC - Sophia Children's Hospital
🇳🇱Rotterdam, Netherlands
Ospedale "la Carita", Locarno
🇨🇭Locarno, Switzerland
Akademia Medyczna im. Piastow Slaskich
🇵🇱Wroclaw, Poland
Royal Manchester Children's Hospital
🇬🇧Manchester, England, United Kingdom
DRK Kliniken Berlin - Koepenick
🇩🇪Berlin, Germany
Staedtisches Klinikum Karlsruhe gGmbH
🇩🇪Karlsruhe, Germany