SWOG-9320 Combination Chemotherapy, Radiation Therapy, and Antiviral Therapy in Treating Patients With AIDS-Related Lymphoma
- Conditions
- Lymphoma
- Interventions
- Biological: bleomycin sulfateBiological: filgrastimDrug: trimethoprim-sulfamethoxazoleRadiation: radiation therapy
- Registration Number
- NCT00002571
- Lead Sponsor
- SWOG Cancer Research Network
- Brief Summary
RATIONALE: Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage cancer cells. Antiviral therapy may be effective treatment for AIDS-related lymphoma.
PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy, radiation therapy, and antiviral therapy in treating patients who have AIDS-related lymphoma.
- Detailed Description
OBJECTIVES: I. Assess the response rate of AIDS-related lymphoma to ProMACE-CytaBOM (cyclophosphamide, doxorubicin, etoposide, prednisone, cytarabine, bleomycin, vincristine, methotrexate). II. Assess the toxic effects of ProMACE-CytaBOM in patients with AIDS-related lymphoma. III. Evaluate whether the incorporation of filgrastim (G-CSF) into the regimen allows treatment with full doses of the myelotoxic agents in these patients. IV. Determine whether intensive CNS treatment with intrathecal cytarabine and whole-brain irradiation prevents meningeal relapse or controls meningeal lymphomatous involvement in these patients.
OUTLINE: Patients are stratified according to participating institution and descriptive factors: histopathology (diffuse large cleaved/noncleaved and immunoblastic lymphomas vs all others), CD4 count (less than 50 vs 50 or more cells/mm3), prior opportunistic infection (yes vs no), performance status (0 and 1 vs 2), concurrent AZT (yes vs no), concurrent protease inhibitors (yes vs no), marrow involvement (yes vs no). Patients receive ProMACE-CytaBOM regimen as follows: Cyclophosphamide, doxorubicin, and etoposide IV on day 1 Cytarabine, bleomycin, vincristine, and methotrexate IV on day 8 Oral prednisone on days 1-14 Oral leucovorin calcium every 6 hours for 4 doses on day 9 Patients also receive filgrastim (G-CSF) subcutaneously on days 9-20 and oral co-trimoxazole 3 days a week throughout treatment, plus antiretroviral therapy at the discretion of the treating physician. Treatment repeats every 21 days for a maximum of 6 courses. Patients with progressive disease are removed from study after 2 courses. Remaining patients receive an additional 2 treatment courses and are then restaged. Patients without stable or progressive disease receive 2 more courses in the absence of unacceptable toxicity. Patients with positive bone marrow at study entry receive CNS prophylaxis with 5 evenly spaced doses of intrathecal cytarabine during the first 2 treatment courses and on day 1 of each subsequent course. Patients with positive CSF cytology at study entry receive intrathecal cytarabine on days 1-5 of the first treatment course and on day 1 of each subsequent course if CSF negative after 5 daily doses. Patients whose CSF remains positive after 5 days receive 5 evenly spaced doses of intrathecal methotrexate during the second treatment course. Patients with negative bone marrow and CSF cytology at study entry receive 5 evenly spaced doses of intrathecal cytarabine within 1 month of systemic therapy. All patients achieving a complete or partial response following systemic therapy and intrathecal cytarabine receive cranial irradiation to all meningeal surfaces. Patients are followed monthly for 1 year, every 2 months for 1 year, every 3 months for 1 year, then annually thereafter.
PROJECTED ACCRUAL: A total of 50 patients will be accrued for this study over approximately 2 years.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 52
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description ProMACE-CytaBOM + G-CSF bleomycin sulfate 6 cycles of 21 days each of ProMACE-CytaBOM (cyclophosphamide 490 mg/m\^2 on day 1, doxorubicin 19 mg/m\^2 on day 1, etoposide 90 mg/m\^2 on day 1, cytarabine 225 mg/m\^2 on day 8, bleomycin 5 u/m\^2 on day 8, methotrexate 90 mg/m\^2 on day 8, leucovorin 25 mg/m\^2 q 6 hours on days 8-9, vincristine 1.4 mg/m\^2 on day 8, prednisone 60 mg/m\^2 on days 1-14, allopurinol 300 mg on days 1-21 of cycle 1 and days 1-8 of cycle 2 only) plus 1 double strength tablet TMP/SMX 3 days a week plus G-CSF 5 ug/kg on days 9-20. Patients also receive intrathecal cytarabine 30 mg/m\^2 (BM positive: 5 doses spaced evenly during 1st 2 cycles, then on day 1 of cycles 3-6; CSF cytology positive: 5 doses spaced evenly during 1st cycle, then on day 1 of cycles 2-6; BM and CSF negative: 5 doses spaced evenly within 1 month of completion of cycle 6). All patients with CR or PR after systemic therapy and IT cytarabine receive 2400 cGy RT to the whole brain in 12 fractions. ProMACE-CytaBOM + G-CSF filgrastim 6 cycles of 21 days each of ProMACE-CytaBOM (cyclophosphamide 490 mg/m\^2 on day 1, doxorubicin 19 mg/m\^2 on day 1, etoposide 90 mg/m\^2 on day 1, cytarabine 225 mg/m\^2 on day 8, bleomycin 5 u/m\^2 on day 8, methotrexate 90 mg/m\^2 on day 8, leucovorin 25 mg/m\^2 q 6 hours on days 8-9, vincristine 1.4 mg/m\^2 on day 8, prednisone 60 mg/m\^2 on days 1-14, allopurinol 300 mg on days 1-21 of cycle 1 and days 1-8 of cycle 2 only) plus 1 double strength tablet TMP/SMX 3 days a week plus G-CSF 5 ug/kg on days 9-20. Patients also receive intrathecal cytarabine 30 mg/m\^2 (BM positive: 5 doses spaced evenly during 1st 2 cycles, then on day 1 of cycles 3-6; CSF cytology positive: 5 doses spaced evenly during 1st cycle, then on day 1 of cycles 2-6; BM and CSF negative: 5 doses spaced evenly within 1 month of completion of cycle 6). All patients with CR or PR after systemic therapy and IT cytarabine receive 2400 cGy RT to the whole brain in 12 fractions. ProMACE-CytaBOM + G-CSF cyclophosphamide 6 cycles of 21 days each of ProMACE-CytaBOM (cyclophosphamide 490 mg/m\^2 on day 1, doxorubicin 19 mg/m\^2 on day 1, etoposide 90 mg/m\^2 on day 1, cytarabine 225 mg/m\^2 on day 8, bleomycin 5 u/m\^2 on day 8, methotrexate 90 mg/m\^2 on day 8, leucovorin 25 mg/m\^2 q 6 hours on days 8-9, vincristine 1.4 mg/m\^2 on day 8, prednisone 60 mg/m\^2 on days 1-14, allopurinol 300 mg on days 1-21 of cycle 1 and days 1-8 of cycle 2 only) plus 1 double strength tablet TMP/SMX 3 days a week plus G-CSF 5 ug/kg on days 9-20. Patients also receive intrathecal cytarabine 30 mg/m\^2 (BM positive: 5 doses spaced evenly during 1st 2 cycles, then on day 1 of cycles 3-6; CSF cytology positive: 5 doses spaced evenly during 1st cycle, then on day 1 of cycles 2-6; BM and CSF negative: 5 doses spaced evenly within 1 month of completion of cycle 6). All patients with CR or PR after systemic therapy and IT cytarabine receive 2400 cGy RT to the whole brain in 12 fractions. ProMACE-CytaBOM + G-CSF doxorubicin hydrochloride 6 cycles of 21 days each of ProMACE-CytaBOM (cyclophosphamide 490 mg/m\^2 on day 1, doxorubicin 19 mg/m\^2 on day 1, etoposide 90 mg/m\^2 on day 1, cytarabine 225 mg/m\^2 on day 8, bleomycin 5 u/m\^2 on day 8, methotrexate 90 mg/m\^2 on day 8, leucovorin 25 mg/m\^2 q 6 hours on days 8-9, vincristine 1.4 mg/m\^2 on day 8, prednisone 60 mg/m\^2 on days 1-14, allopurinol 300 mg on days 1-21 of cycle 1 and days 1-8 of cycle 2 only) plus 1 double strength tablet TMP/SMX 3 days a week plus G-CSF 5 ug/kg on days 9-20. Patients also receive intrathecal cytarabine 30 mg/m\^2 (BM positive: 5 doses spaced evenly during 1st 2 cycles, then on day 1 of cycles 3-6; CSF cytology positive: 5 doses spaced evenly during 1st cycle, then on day 1 of cycles 2-6; BM and CSF negative: 5 doses spaced evenly within 1 month of completion of cycle 6). All patients with CR or PR after systemic therapy and IT cytarabine receive 2400 cGy RT to the whole brain in 12 fractions. ProMACE-CytaBOM + G-CSF leucovorin calcium 6 cycles of 21 days each of ProMACE-CytaBOM (cyclophosphamide 490 mg/m\^2 on day 1, doxorubicin 19 mg/m\^2 on day 1, etoposide 90 mg/m\^2 on day 1, cytarabine 225 mg/m\^2 on day 8, bleomycin 5 u/m\^2 on day 8, methotrexate 90 mg/m\^2 on day 8, leucovorin 25 mg/m\^2 q 6 hours on days 8-9, vincristine 1.4 mg/m\^2 on day 8, prednisone 60 mg/m\^2 on days 1-14, allopurinol 300 mg on days 1-21 of cycle 1 and days 1-8 of cycle 2 only) plus 1 double strength tablet TMP/SMX 3 days a week plus G-CSF 5 ug/kg on days 9-20. Patients also receive intrathecal cytarabine 30 mg/m\^2 (BM positive: 5 doses spaced evenly during 1st 2 cycles, then on day 1 of cycles 3-6; CSF cytology positive: 5 doses spaced evenly during 1st cycle, then on day 1 of cycles 2-6; BM and CSF negative: 5 doses spaced evenly within 1 month of completion of cycle 6). All patients with CR or PR after systemic therapy and IT cytarabine receive 2400 cGy RT to the whole brain in 12 fractions. ProMACE-CytaBOM + G-CSF prednisone 6 cycles of 21 days each of ProMACE-CytaBOM (cyclophosphamide 490 mg/m\^2 on day 1, doxorubicin 19 mg/m\^2 on day 1, etoposide 90 mg/m\^2 on day 1, cytarabine 225 mg/m\^2 on day 8, bleomycin 5 u/m\^2 on day 8, methotrexate 90 mg/m\^2 on day 8, leucovorin 25 mg/m\^2 q 6 hours on days 8-9, vincristine 1.4 mg/m\^2 on day 8, prednisone 60 mg/m\^2 on days 1-14, allopurinol 300 mg on days 1-21 of cycle 1 and days 1-8 of cycle 2 only) plus 1 double strength tablet TMP/SMX 3 days a week plus G-CSF 5 ug/kg on days 9-20. Patients also receive intrathecal cytarabine 30 mg/m\^2 (BM positive: 5 doses spaced evenly during 1st 2 cycles, then on day 1 of cycles 3-6; CSF cytology positive: 5 doses spaced evenly during 1st cycle, then on day 1 of cycles 2-6; BM and CSF negative: 5 doses spaced evenly within 1 month of completion of cycle 6). All patients with CR or PR after systemic therapy and IT cytarabine receive 2400 cGy RT to the whole brain in 12 fractions. ProMACE-CytaBOM + G-CSF trimethoprim-sulfamethoxazole 6 cycles of 21 days each of ProMACE-CytaBOM (cyclophosphamide 490 mg/m\^2 on day 1, doxorubicin 19 mg/m\^2 on day 1, etoposide 90 mg/m\^2 on day 1, cytarabine 225 mg/m\^2 on day 8, bleomycin 5 u/m\^2 on day 8, methotrexate 90 mg/m\^2 on day 8, leucovorin 25 mg/m\^2 q 6 hours on days 8-9, vincristine 1.4 mg/m\^2 on day 8, prednisone 60 mg/m\^2 on days 1-14, allopurinol 300 mg on days 1-21 of cycle 1 and days 1-8 of cycle 2 only) plus 1 double strength tablet TMP/SMX 3 days a week plus G-CSF 5 ug/kg on days 9-20. Patients also receive intrathecal cytarabine 30 mg/m\^2 (BM positive: 5 doses spaced evenly during 1st 2 cycles, then on day 1 of cycles 3-6; CSF cytology positive: 5 doses spaced evenly during 1st cycle, then on day 1 of cycles 2-6; BM and CSF negative: 5 doses spaced evenly within 1 month of completion of cycle 6). All patients with CR or PR after systemic therapy and IT cytarabine receive 2400 cGy RT to the whole brain in 12 fractions. ProMACE-CytaBOM + G-CSF vincristine sulfate 6 cycles of 21 days each of ProMACE-CytaBOM (cyclophosphamide 490 mg/m\^2 on day 1, doxorubicin 19 mg/m\^2 on day 1, etoposide 90 mg/m\^2 on day 1, cytarabine 225 mg/m\^2 on day 8, bleomycin 5 u/m\^2 on day 8, methotrexate 90 mg/m\^2 on day 8, leucovorin 25 mg/m\^2 q 6 hours on days 8-9, vincristine 1.4 mg/m\^2 on day 8, prednisone 60 mg/m\^2 on days 1-14, allopurinol 300 mg on days 1-21 of cycle 1 and days 1-8 of cycle 2 only) plus 1 double strength tablet TMP/SMX 3 days a week plus G-CSF 5 ug/kg on days 9-20. Patients also receive intrathecal cytarabine 30 mg/m\^2 (BM positive: 5 doses spaced evenly during 1st 2 cycles, then on day 1 of cycles 3-6; CSF cytology positive: 5 doses spaced evenly during 1st cycle, then on day 1 of cycles 2-6; BM and CSF negative: 5 doses spaced evenly within 1 month of completion of cycle 6). All patients with CR or PR after systemic therapy and IT cytarabine receive 2400 cGy RT to the whole brain in 12 fractions. ProMACE-CytaBOM + G-CSF radiation therapy 6 cycles of 21 days each of ProMACE-CytaBOM (cyclophosphamide 490 mg/m\^2 on day 1, doxorubicin 19 mg/m\^2 on day 1, etoposide 90 mg/m\^2 on day 1, cytarabine 225 mg/m\^2 on day 8, bleomycin 5 u/m\^2 on day 8, methotrexate 90 mg/m\^2 on day 8, leucovorin 25 mg/m\^2 q 6 hours on days 8-9, vincristine 1.4 mg/m\^2 on day 8, prednisone 60 mg/m\^2 on days 1-14, allopurinol 300 mg on days 1-21 of cycle 1 and days 1-8 of cycle 2 only) plus 1 double strength tablet TMP/SMX 3 days a week plus G-CSF 5 ug/kg on days 9-20. Patients also receive intrathecal cytarabine 30 mg/m\^2 (BM positive: 5 doses spaced evenly during 1st 2 cycles, then on day 1 of cycles 3-6; CSF cytology positive: 5 doses spaced evenly during 1st cycle, then on day 1 of cycles 2-6; BM and CSF negative: 5 doses spaced evenly within 1 month of completion of cycle 6). All patients with CR or PR after systemic therapy and IT cytarabine receive 2400 cGy RT to the whole brain in 12 fractions. ProMACE-CytaBOM + G-CSF Intrathecal cytarabine 6 cycles of 21 days each of ProMACE-CytaBOM (cyclophosphamide 490 mg/m\^2 on day 1, doxorubicin 19 mg/m\^2 on day 1, etoposide 90 mg/m\^2 on day 1, cytarabine 225 mg/m\^2 on day 8, bleomycin 5 u/m\^2 on day 8, methotrexate 90 mg/m\^2 on day 8, leucovorin 25 mg/m\^2 q 6 hours on days 8-9, vincristine 1.4 mg/m\^2 on day 8, prednisone 60 mg/m\^2 on days 1-14, allopurinol 300 mg on days 1-21 of cycle 1 and days 1-8 of cycle 2 only) plus 1 double strength tablet TMP/SMX 3 days a week plus G-CSF 5 ug/kg on days 9-20. Patients also receive intrathecal cytarabine 30 mg/m\^2 (BM positive: 5 doses spaced evenly during 1st 2 cycles, then on day 1 of cycles 3-6; CSF cytology positive: 5 doses spaced evenly during 1st cycle, then on day 1 of cycles 2-6; BM and CSF negative: 5 doses spaced evenly within 1 month of completion of cycle 6). All patients with CR or PR after systemic therapy and IT cytarabine receive 2400 cGy RT to the whole brain in 12 fractions. ProMACE-CytaBOM + G-CSF cytarabine 6 cycles of 21 days each of ProMACE-CytaBOM (cyclophosphamide 490 mg/m\^2 on day 1, doxorubicin 19 mg/m\^2 on day 1, etoposide 90 mg/m\^2 on day 1, cytarabine 225 mg/m\^2 on day 8, bleomycin 5 u/m\^2 on day 8, methotrexate 90 mg/m\^2 on day 8, leucovorin 25 mg/m\^2 q 6 hours on days 8-9, vincristine 1.4 mg/m\^2 on day 8, prednisone 60 mg/m\^2 on days 1-14, allopurinol 300 mg on days 1-21 of cycle 1 and days 1-8 of cycle 2 only) plus 1 double strength tablet TMP/SMX 3 days a week plus G-CSF 5 ug/kg on days 9-20. Patients also receive intrathecal cytarabine 30 mg/m\^2 (BM positive: 5 doses spaced evenly during 1st 2 cycles, then on day 1 of cycles 3-6; CSF cytology positive: 5 doses spaced evenly during 1st cycle, then on day 1 of cycles 2-6; BM and CSF negative: 5 doses spaced evenly within 1 month of completion of cycle 6). All patients with CR or PR after systemic therapy and IT cytarabine receive 2400 cGy RT to the whole brain in 12 fractions. ProMACE-CytaBOM + G-CSF etoposide 6 cycles of 21 days each of ProMACE-CytaBOM (cyclophosphamide 490 mg/m\^2 on day 1, doxorubicin 19 mg/m\^2 on day 1, etoposide 90 mg/m\^2 on day 1, cytarabine 225 mg/m\^2 on day 8, bleomycin 5 u/m\^2 on day 8, methotrexate 90 mg/m\^2 on day 8, leucovorin 25 mg/m\^2 q 6 hours on days 8-9, vincristine 1.4 mg/m\^2 on day 8, prednisone 60 mg/m\^2 on days 1-14, allopurinol 300 mg on days 1-21 of cycle 1 and days 1-8 of cycle 2 only) plus 1 double strength tablet TMP/SMX 3 days a week plus G-CSF 5 ug/kg on days 9-20. Patients also receive intrathecal cytarabine 30 mg/m\^2 (BM positive: 5 doses spaced evenly during 1st 2 cycles, then on day 1 of cycles 3-6; CSF cytology positive: 5 doses spaced evenly during 1st cycle, then on day 1 of cycles 2-6; BM and CSF negative: 5 doses spaced evenly within 1 month of completion of cycle 6). All patients with CR or PR after systemic therapy and IT cytarabine receive 2400 cGy RT to the whole brain in 12 fractions. ProMACE-CytaBOM + G-CSF methotrexate 6 cycles of 21 days each of ProMACE-CytaBOM (cyclophosphamide 490 mg/m\^2 on day 1, doxorubicin 19 mg/m\^2 on day 1, etoposide 90 mg/m\^2 on day 1, cytarabine 225 mg/m\^2 on day 8, bleomycin 5 u/m\^2 on day 8, methotrexate 90 mg/m\^2 on day 8, leucovorin 25 mg/m\^2 q 6 hours on days 8-9, vincristine 1.4 mg/m\^2 on day 8, prednisone 60 mg/m\^2 on days 1-14, allopurinol 300 mg on days 1-21 of cycle 1 and days 1-8 of cycle 2 only) plus 1 double strength tablet TMP/SMX 3 days a week plus G-CSF 5 ug/kg on days 9-20. Patients also receive intrathecal cytarabine 30 mg/m\^2 (BM positive: 5 doses spaced evenly during 1st 2 cycles, then on day 1 of cycles 3-6; CSF cytology positive: 5 doses spaced evenly during 1st cycle, then on day 1 of cycles 2-6; BM and CSF negative: 5 doses spaced evenly within 1 month of completion of cycle 6). All patients with CR or PR after systemic therapy and IT cytarabine receive 2400 cGy RT to the whole brain in 12 fractions.
- Primary Outcome Measures
Name Time Method Response every 3 months while on protocol treatment
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (85)
MBCCOP - University of South Alabama
🇺🇸Mobile, Alabama, United States
USC/Norris Comprehensive Cancer Center
🇺🇸Los Angeles, California, United States
Jonsson Comprehensive Cancer Center, UCLA
🇺🇸Los Angeles, California, United States
Beckman Research Institute, City of Hope
🇺🇸Los Angeles, California, United States
Veterans Affairs Outpatient Clinic - Martinez
🇺🇸Martinez, California, United States
Cleveland Clinic Cancer Center
🇺🇸Cleveland, Ohio, United States
CCOP - Atlanta Regional
🇺🇸Atlanta, Georgia, United States
Louisiana State University Health Sciences Center - Shreveport
🇺🇸Shreveport, Louisiana, United States
CCOP - Dayton
🇺🇸Kettering, Ohio, United States
Simmons Cancer Center - Dallas
🇺🇸Dallas, Texas, United States
University of Texas Medical Branch
🇺🇸Galveston, Texas, United States
CCOP - Virginia Mason Research Center
🇺🇸Seattle, Washington, United States
Puget Sound Oncology Consortium
🇺🇸Seattle, Washington, United States
Veterans Affairs Medical Center - Wichita
🇺🇸Wichita, Kansas, United States
Barrett Cancer Center, The University Hospital
🇺🇸Cincinnati, Ohio, United States
Veterans Affairs Medical Center - Cincinnati
🇺🇸Cincinnati, Ohio, United States
University of Texas Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
Veterans Affairs Medical Center - San Antonio (Murphy)
🇺🇸San Antonio, Texas, United States
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
Veterans Affairs Medical Center - Little Rock (McClellan)
🇺🇸Little Rock, Arkansas, United States
Veterans Affairs Medical Center - Tucson
🇺🇸Tucson, Arizona, United States
CCOP - Bay Area Tumor Institute
🇺🇸Oakland, California, United States
David Grant Medical Center
🇺🇸Travis Air Force Base, California, United States
University of Arkansas for Medical Sciences
🇺🇸Little Rock, Arkansas, United States
CCOP - Central Illinois
🇺🇸Decatur, Illinois, United States
Veterans Affairs Medical Center - Lexington
🇺🇸Lexington, Kentucky, United States
Veterans Affairs Medical Center - Hines (Hines Junior VA Hospital)
🇺🇸Hines, Illinois, United States
Veterans Affairs Medical Center - Boston (Jamaica Plain)
🇺🇸Jamaica Plain, Massachusetts, United States
CCOP - Wichita
🇺🇸Wichita, Kansas, United States
Albert B. Chandler Medical Center, University of Kentucky
🇺🇸Lexington, Kentucky, United States
MBCCOP - LSU Medical Center
🇺🇸New Orleans, Louisiana, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
Veterans Affairs Medical Center - Kansas City
🇺🇸Kansas City, Missouri, United States
MBCCOP - University of New Mexico HSC
🇺🇸Albuquerque, New Mexico, United States
Veterans Affairs Medical Center - Jackson
🇺🇸Jackson, Mississippi, United States
CCOP - Kansas City
🇺🇸Kansas City, Missouri, United States
Providence Hospital - Southfield
🇺🇸Southfield, Michigan, United States
Herbert Irving Comprehensive Cancer Center
🇺🇸New York, New York, United States
CCOP - St. Louis-Cape Girardeau
🇺🇸Saint Louis, Missouri, United States
CCOP - Greenville
🇺🇸Greenville, South Carolina, United States
Tulane University School of Medicine
🇺🇸New Orleans, Louisiana, United States
Veterans Affairs Medical Center - New Orleans
🇺🇸New Orleans, Louisiana, United States
Veterans Affairs Medical Center - Shreveport
🇺🇸Shreveport, Louisiana, United States
Boston Medical Center
🇺🇸Boston, Massachusetts, United States
CCOP - Grand Rapids Clinical Oncology Program
🇺🇸Grand Rapids, Michigan, United States
Arizona Cancer Center
🇺🇸Tucson, Arizona, United States
Cancer Research Center of Hawaii
🇺🇸Honolulu, Hawaii, United States
Tripler Army Medical Center
🇺🇸Honolulu, Hawaii, United States
Keesler Medical Center - Keesler AFB
🇺🇸Keesler AFB, Mississippi, United States
Veterans Affairs Medical Center - Dayton
🇺🇸Dayton, Ohio, United States
Brooke Army Medical Center
🇺🇸Fort Sam Houston, Texas, United States
Veterans Affairs Medical Center - Temple
🇺🇸Temple, Texas, United States
Texas Tech University Health Science Center
🇺🇸Lubbock, Texas, United States
Veterans Affairs Medical Center - Long Beach
🇺🇸Long Beach, California, United States
CCOP - Cancer Research for the Ozarks
🇺🇸Springfield, Missouri, United States
Chao Family Comprehensive Cancer Center
🇺🇸Orange, California, United States
CCOP - Santa Rosa Memorial Hospital
🇺🇸Santa Rosa, California, United States
Veterans Affairs Medical Center - Biloxi
🇺🇸Biloxi, Mississippi, United States
St. Louis University Health Sciences Center
🇺🇸Saint Louis, Missouri, United States
Veterans Affairs Medical Center - Albuquerque
🇺🇸Albuquerque, New Mexico, United States
CCOP - Columbus
🇺🇸Columbus, Ohio, United States
CCOP - Upstate Carolina
🇺🇸Spartanburg, South Carolina, United States
Veterans Affairs Medical Center - Salt Lake City
🇺🇸Salt Lake City, Utah, United States
CCOP - Scott and White Hospital
🇺🇸Temple, Texas, United States
Huntsman Cancer Institute
🇺🇸Salt Lake City, Utah, United States
Swedish Cancer Institute
🇺🇸Seattle, Washington, United States
Veterans Affairs Medical Center - Seattle
🇺🇸Seattle, Washington, United States
CCOP - Northwest
🇺🇸Tacoma, Washington, United States
CCOP - Greater Phoenix
🇺🇸Phoenix, Arizona, United States
Veterans Affairs Medical Center - Phoenix (Hayden)
🇺🇸Phoenix, Arizona, United States
University of California Davis Medical Center
🇺🇸Sacramento, California, United States
Veterans Affairs Medical Center - Denver
🇺🇸Denver, Colorado, United States
University of Colorado Cancer Center
🇺🇸Denver, Colorado, United States
Veterans Affairs Medical Center - Ann Arbor
🇺🇸Ann Arbor, Michigan, United States
Veterans Affairs Medical Center - Detroit
🇺🇸Detroit, Michigan, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
University of Michigan Comprehensive Cancer Center
🇺🇸Ann Arbor, Michigan, United States
Barbara Ann Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
Oklahoma Medical Research Foundation
🇺🇸Oklahoma City, Oklahoma, United States
Veterans Affairs Medical Center - Oklahoma City
🇺🇸Oklahoma City, Oklahoma, United States
CCOP - Columbia River Program
🇺🇸Portland, Oregon, United States
Oregon Cancer Center at Oregon Health Sciences University
🇺🇸Portland, Oregon, United States
Veterans Affairs Medical Center - Portland
🇺🇸Portland, Oregon, United States
CCOP - Montana Cancer Consortium
🇺🇸Billings, Montana, United States
University of Kansas Medical Center
🇺🇸Kansas City, Kansas, United States