Treatment Protocol of the NHL-BFM and the NOPHO Study Groups for Mature Aggressive B-cell Lymphoma and Leukemia in Children and Adolescents
- Conditions
- Mature B-cell Non-Hodgkin Lymphoma
- Interventions
- Registration Number
- NCT03206671
- Lead Sponsor
- University Hospital Muenster
- Brief Summary
The trial B-NHL 2013 is a collaborative prospective, multi-national, multi-center, randomized trial with participating centers of the NHL-BFM group (Austria, Switzerland, Czech Republic, Germany) and the Scandinavian NOPHO group (Denmark, Finland, Norway, Sweden). The aim of the trial is to evaluate the role of rituximab in the treatment of mature aggressive B-cell Non-Hodgkin lymphoma and leukemia (B-NHL and B-AL) in children and adolescents.
The following primary study questions are going to be analyzed:
* the effectiveness (event-free survival) in pediatric patients with very limited mature B-NHL (R1 and R2 stage I and II) of substituting anthracyclines by the rituximab window without compromising survival rates.
* the effectiveness (event-free survival) in pediatric patients with limited mature B-NHL (R2 stage III) randomly assigned to receive the rituximab window plus standard chemotherapy or standard chemotherapy without the rituximab window.
* the effectiveness (event-free survival) and the immune reconstitution (recovery of CD19+ B-cells, IR) in pediatric patients with advanced mature B-NHL/B-AL (R3 and R4 incl. R4 CNS+) treated with BFM-type chemotherapy and randomly assigned schedules of one versus seven doses rituximab.
Secondary study questions will address
* additional parameters for immune reconstitution, lymphocyte subpopulations, immunoglobulin levels, vaccination titers and infection rates
* kinetics of immune reconstitution after treatment
* adverse event and severe adverse event profile
* inter-individual variability of rituximab response
* role of different mechanisms of action of rituximab in advanced B-NHL/B-AL
- Detailed Description
Risk group stratification:
R1/R2 stage I+II:
* R1: resection status: complete
* R2: resection status: incomplete, stage I and II
R2 III:
- R 2: resection status: incomplete, stage III and LDH \< 2 x ULN (according to local reference value for adults)
R3/R4:
* R3: resection status: incomplete, stage III and LDH ≥ 2 x ULN but \< 4 x ULN or stage IV/B-AL and LDH \< 4 x ULN and CNS negative
* R4: resection status: incomplete, Stage III and LDH ≥ 4 x ULN or stage IV/B-AL and LDH ≥ 4 x ULN and CNS negative
* R4 CNS +: stage IV/B-AL and CNS positive
For patients with very limited disease (R1/R2 stage I/II), the addition of rituximab might allow the omission of anthracyclines without jeopardizing survival rates but reducing acute and long term toxicities. In this treatment arm, it is tested whether the event-free survival is similar to that of the historical control when all patients receive one dose of rituximab as monotherapeutic agent in the rituximab window R five days prior to the start of standard chemotherapy as a substitute for anthracyclines.
For patients with limited disease (R2 stage III) it is tested whether the event-free survival can be improved by adding rituximab to the standard chemotherapy. Two different treatment regimens will be evaluated in a randomized design: Patients in the standard arm will receive the standard chemotherapy. Patients of the rituximab plus arm will receive one dose of rituximab as monotherapeutic agent in the rituximab window R five days prior to the start of standard chemotherapy.
For patients with advanced disease (R3/R4) it is tested whether the event-free survival can be improved by adding rituximab to the standard chemotherapy. Two different rituximab regimens will be evaluated in a randomized design: Patients in the standard arm will receive one dose of rituximab as monotherapeutic agent in the rituximab window R five days prior to the start of standard chemotherapy. Patients of the rituximab plus arm will receive the rituximab window and additional six doses of rituximab added to the first four courses of chemotherapy. In addition the immune reconstitution will be analyzed comparing the effect of the two regimens of rituximab added to standard chemotherapy.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 650
-
Newly diagnosed, histological or cytological and immunological proven aggressive mature B-cell Non-Hodgkin lymphoma including Burkitt lymphoma (BL), Burkitt leukemia (B-AL), diffuse large B-cell lymphoma (DLBCL), or mature B-cell NHL not further classified according to current WHO classification124. For rare subtypes (e.g. primary mediastinal large B-NHL, PMLBL, double hit lymphoma or high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements), consultation of the study center is recommended.
-
availability of slides/blocks for reference pathology and international pathology panel (except in cases with immunological and cytomorphological assurance of diagnosis)
-
age at diagnosis < 18 years
-
diagnostics and treatment in one of the participating centers of the trial
-
no previous chemotherapy, no previous lymphoma-directed treatment. No application of steroids for more than two days during the last month
-
adequate hepatic, renal and cardiac function, except if alteration is due to lymphoma infiltration. Please contact the study center in case of unclear cases.
-
signed informed consent of patient and/or parents/guardians for treatment according to the protocol, participation and transfer of data
-
follow-up of at least two years after initial diagnosis is expected
-
Certificate of vaccination against hepatitis B or negative serology, defined as
- evidence of immunization with HBs-antigen negative, anti-HBs positive and anti-HBc negative or
- negative hepatitis B serology with HBs-antigen negative, anti-HBs and anti- HBc negative
- patients with insufficient work up not allowing a correct stratification into the risk groups
- B-cell neoplasia as second malignancy
- any other medical, psychiatric or social condition prohibiting treatment according to the protocol (e.g. previous malignancy, prior organ transplant, HIV infection or AIDS or severe immunodeficiency, etc.)
- participation within a different trial for treatment of B-cell malignancies and/or concurrent treatment within any other clinical trial. Exceptions to this are the NHL-BFM Registry 2012 and trials with different endpoints, involving aspects of supportive treatment which can run parallel to B-NHL 2013 without influencing the outcome of this trial e.g. trials on antiemetics, antibiotics, strategies for psychosocial support etc.
- overt hepatitis B or history of hepatitis B
- hypersensitivity to rituximab or to murine proteins or to any of the other excipients of the Investigational Medicinal Product rituximab (MabThera®) or to ingredients of other IMPs.
- lack of CD20 expression of the lymphoma cells
- pregnancy and lactation
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description R3/R4 standard arm Rituximab window Rituximab window + standard chemotherapy R1/R2 stage I+II Rituximab window Rituximab window + standard chemotherapy without anthracyclines (Vincristine not in R1) R3/R4 rituximab plus arm Vindesine Sulfate Rituximab window + standard chemotherapy plus six additional doses of rituximab R2 stage III experimental arm Rituximab window Rituximab window + Standard chemotherapy R2 stage III experimental arm Methotrexate Rituximab window + Standard chemotherapy R2 stage III standard arm Cyclophosphamide Standard chemotherapy R3/R4 rituximab plus arm Rituximab window Rituximab window + standard chemotherapy plus six additional doses of rituximab R3/R4 rituximab plus arm Methotrexate Rituximab window + standard chemotherapy plus six additional doses of rituximab R3/R4 rituximab plus arm Prednisolone Rituximab window + standard chemotherapy plus six additional doses of rituximab R3/R4 standard arm Dexamethasone Rituximab window + standard chemotherapy R3/R4 rituximab plus arm Additional doses of Rituximab Rituximab window + standard chemotherapy plus six additional doses of rituximab R3/R4 standard arm Vindesine Sulfate Rituximab window + standard chemotherapy R3/R4 standard arm Vincristine Rituximab window + standard chemotherapy R1/R2 stage I+II Cyclophosphamide Rituximab window + standard chemotherapy without anthracyclines (Vincristine not in R1) R1/R2 stage I+II Cytarabine Rituximab window + standard chemotherapy without anthracyclines (Vincristine not in R1) R1/R2 stage I+II Dexamethasone Rituximab window + standard chemotherapy without anthracyclines (Vincristine not in R1) R1/R2 stage I+II Etoposide Rituximab window + standard chemotherapy without anthracyclines (Vincristine not in R1) R1/R2 stage I+II Ifosfamide Rituximab window + standard chemotherapy without anthracyclines (Vincristine not in R1) R1/R2 stage I+II Vincristine Rituximab window + standard chemotherapy without anthracyclines (Vincristine not in R1) R1/R2 stage I+II Methotrexate Rituximab window + standard chemotherapy without anthracyclines (Vincristine not in R1) R1/R2 stage I+II Prednisolone Rituximab window + standard chemotherapy without anthracyclines (Vincristine not in R1) R2 stage III experimental arm Cyclophosphamide Rituximab window + Standard chemotherapy R2 stage III experimental arm Etoposide Rituximab window + Standard chemotherapy R2 stage III experimental arm Dexamethasone Rituximab window + Standard chemotherapy R2 stage III experimental arm Doxorubicin hydrochloride Rituximab window + Standard chemotherapy R2 stage III experimental arm Cytarabine Rituximab window + Standard chemotherapy R2 stage III experimental arm Ifosfamide Rituximab window + Standard chemotherapy R2 stage III standard arm Cytarabine Standard chemotherapy R2 stage III experimental arm Prednisolone Rituximab window + Standard chemotherapy R2 stage III experimental arm Vincristine Rituximab window + Standard chemotherapy R2 stage III standard arm Dexamethasone Standard chemotherapy R2 stage III standard arm Doxorubicin hydrochloride Standard chemotherapy R2 stage III standard arm Etoposide Standard chemotherapy R2 stage III standard arm Ifosfamide Standard chemotherapy R2 stage III standard arm Prednisolone Standard chemotherapy R2 stage III standard arm Methotrexate Standard chemotherapy R2 stage III standard arm Vincristine Standard chemotherapy R3/R4 rituximab plus arm Cyclophosphamide Rituximab window + standard chemotherapy plus six additional doses of rituximab R3/R4 rituximab plus arm Cytarabine Rituximab window + standard chemotherapy plus six additional doses of rituximab R3/R4 rituximab plus arm Dexamethasone Rituximab window + standard chemotherapy plus six additional doses of rituximab R3/R4 rituximab plus arm Doxorubicin hydrochloride Rituximab window + standard chemotherapy plus six additional doses of rituximab R3/R4 rituximab plus arm Etoposide Rituximab window + standard chemotherapy plus six additional doses of rituximab R3/R4 rituximab plus arm Ifosfamide Rituximab window + standard chemotherapy plus six additional doses of rituximab R3/R4 rituximab plus arm Vincristine Rituximab window + standard chemotherapy plus six additional doses of rituximab R3/R4 standard arm Cytarabine Rituximab window + standard chemotherapy R3/R4 standard arm Cyclophosphamide Rituximab window + standard chemotherapy R3/R4 standard arm Doxorubicin hydrochloride Rituximab window + standard chemotherapy R3/R4 standard arm Etoposide Rituximab window + standard chemotherapy R3/R4 standard arm Ifosfamide Rituximab window + standard chemotherapy R3/R4 standard arm Methotrexate Rituximab window + standard chemotherapy R3/R4 standard arm Prednisolone Rituximab window + standard chemotherapy
- Primary Outcome Measures
Name Time Method Event-free survival (EFS) through study completion, maximal seven years EFS is defined as time from start of treatment/randomization up to event or to date of last contact for patients without event. The following occurrences are defined as an event: non-response, progressive disease or relapse, treatment related death, death of any other cause or diagnosis of secondary malignancies.
Immune reconstitution rate (only in R3/R4 patients) 12 months after start of treatment Immune reconstitution rate is defined as percentage of patients achieving age adjusted normal B-cell counts (CD19 positive subpopulations) 12 months after start of treatment.
- Secondary Outcome Measures
Name Time Method Relapse-free survival (RFS) through study completion, maximal seven years RFS is defined as time from start of treatment/randomization up to event or to date of last contact for patients without event. The following occurrences are defined as an event: non-response, progressive disease, or relapse.
Adverse event rate from the first day of protocol defined treatment until two years after start of protocol defined treatment Rate of patients with acute toxicity defined as grade III/IV/V AE
Time interval from start of treatment to normal CD19 positive B-cells in the peripheral blood. through study completion, maximal seven years Overall survival (OS) through study completion, maximal seven years OS is defined as time from start of treatment/randomization up to death of any cause or to date of last contact for patients alive.
Rate of patients with normal lymphocyte subpopulations in the peripheral blood 12 months after start of treatment 12 months after start of treatment Interval to normal lymphocyte subpopulations in the peripheral blood. through study completion, maximal seven years Rate of infections (defined by CTCAE V4) in the time interval from start of treatment until 24 months after start of treatment 24 months after start of treatment Rate of infections (defined by CTCAE V4) in the time interval from start of treatment until immune reconstitution (achievement of age adjusted normal B-cell counts) through study completion, maximal seven years Rate of patients with sufficient titers after vaccination one year after start of treatment 1 year after start of treatment Response rate (RR) after rituximab window on day 5, after prephase (patients with rituximab window on day 10, patients without rituximab window on day 6) and after second course (on an average 5 to 6 weeks after start of treatment) Complete response, partial remission, objective effect, stable disease or progressive disease
Rate of patients achieving normal immunoglobulin level 12 months after start of treatment 12 months after start of treatment Time interval to normal immunoglobulin level through study completion, maximal seven years Immune reconstitution rate (only in R1/R2 patients) 12 months after start of treatment Immune reconstitution rate is defined as percentage of patients achieving age adjusted normal B-cell counts (CD19 positive subpopulations) 12 months after start of treatment.
Trial Locations
- Locations (92)
Turku University Hospital, Paediatric and Adolescent Haematology and Oncology
🇫🇮Turku, Finland
Universitäts-Kinderspital, Pädiatrische Onkologie
🇨🇭Zürich, Switzerland
Kinderspital Pädiatrische Hämatologie/ Onkologie
🇨🇭Luzern, Switzerland
Oslo University Hospital, Rikshospitalet
🇳🇴Oslo, Norway
Ospedale San Giovanni, Reparto die Pediatria
🇨🇭Bellinzona, Switzerland
Centre hospitalier universitaire vaudois, Unité d'hémato-oncologie pédiatrique
🇨🇭Lausanne, Switzerland
Universitäts - Kinderspital beider Basel
🇨🇭Basel, Switzerland
Universitätsklinik für Kinderheilkunde, Pädiatrische Hämatologie/ Onkologie, Inselspital
🇨🇭Bern, Switzerland
LKH Salzburg, Universitätsklinik für Kinder- und Jugendheilkunde, Kinderonkologie
🇦🇹Salzburg, Austria
University Hospital of Oulu, Paediatric Haematology and Oncology
🇫🇮Oulu, Finland
Tampere University Hospital, Paediatric Haematology and Oncology
🇫🇮Tampere, Finland
Universitätsklinikum Aachen, Klinik für Kinder - und Jugendmedizin, Hämatologie / Onkologie
🇩🇪Aachen, Germany
Klinikum Augsburg, Schwäbisches Kinderkrebszentrum, I. Klinik für Kinder und Jugendliche, Hämatologie / Onkologie
🇩🇪Augsburg, Germany
Vestische Kinderklinik, Universität Witten / Herdecke
🇩🇪Datteln, Germany
Städtisches Klinikum Braunschweig gGmbH, Klinik für Kinder- und Jugendmedizin, Station K5 / Päd. Hämato- und Onkologie
🇩🇪Braunschweig, Germany
HELIOS Klinikum Erfurt GmbH, Klinik für Kinder- und Jugendmedizin, Päd. Onkologie / Hämatologie
🇩🇪Erfurt, Germany
Universitätsklinikum Essen, Zentrum für Kinder- und Jugendmedizin, Hämatologie / Onkologie
🇩🇪Essen, Germany
Universitätskliniken für Kinder- und Jugendmedizin, Päd. Hämatologie und Onkologie, Geb. 9
🇩🇪Homburg, Germany
Georg-August-Universität Universitäts-Kinderklinik, Pädiatrie I
🇩🇪Göttingen, Germany
Universitätsklinikum Schleswig Holstein Campus Kiel, Klinik für Allgemeine Pädiatrie, Päd. Onkologie / Hämatologie
🇩🇪Kiel, Germany
Universitätsklinikum Leipzig, Klinik für Kinder und Jugendliche, Abt. Päd. Hämatologie / Onkologie
🇩🇪Leipzig, Germany
Klinikum Kassel Gesundheit Nordhessen Holding AG, Klinik für pädiatrische Hämatologie und Onkologie
🇩🇪Kassel, Germany
University Hospital Northern Norway
🇳🇴Tromsø, Norway
Universitätsklinikum Regensburg, Klinik für Kinder- und Jugendmedizin, Abt. Päd. Hämatologie, Onkologie, SZT
🇩🇪Regensburg, Germany
Asklepios Klinik St. Augustin GmbH, Kinder- und Jugendmedizin, Kinder-Hämatologie und Onkologie
🇩🇪Sankt Augustin, Germany
Universitätsklinikum Schleswig Holstein Campus Lübeck, Klinik für Kinder- und Jugendmedizin, Hämatologie und Onkologie
🇩🇪Lübeck, Germany
Universitätsklinikum Magdeburg A. ö. R., Kinderklinik, Päd. Hämatologie / Onkologie
🇩🇪Magdeburg, Germany
Johannes Wesling Klinikum Minden, Klinik für Kinder- und Jugendmedizin, Päd. Hämatologie / Onkologie, Station E 22
🇩🇪Minden, Germany
Haukeland University Hospital, National Study Center Norway
🇳🇴Bergen, Norway
St Olavs Hospital
🇳🇴Trondheim, Norway
Universitätskinderklinik Würzburg, Päd. Onkologie und Hämatologie
🇩🇪Würzburg, Germany
Sahlgrenska Universitetssjukhuset, Drottning Silvias Barn och Ungdomssjukhus, Barncancercentrum
🇸🇪Göteborg, Sweden
Universitätsklinikum Ulm, Klinik für Kinder- und Jugendmedizin, Päd. Hämatologie und Onkologie
🇩🇪Ulm, Germany
Kantonsspital Aarau, Kinderklinik
🇨🇭Aarau, Switzerland
Skåne Universitetssjukhus, Barnonkologi
🇸🇪Lund, Sweden
Karolinska Universitetssjukhuset, Astrid Lindgrens Barnsjukhus, Barnonkologen
🇸🇪Stockholm, Sweden
Charité Campus Virchow-Klinikum, Zentrum für Kinder- und Jugendmedizin, Abt. Hämatologie / Onkologie
🇩🇪Berg, Germany
Universitätsklinik Carl Gustav Carus der TU Dresden, Klinik für Kinder- und Jugendmedizin
🇩🇪Dresden, Germany
Universitätsklinikum Düsseldorf, Zentrum für Kinder- und Jugendmedizin, Klinik für Päd. Hämatologie und Onkologie
🇩🇪Düsseldorf, Germany
Universitätsklinikum Erlangen, Klinik für Kinder- und Jugendmedizin, Pädiatrische Onkologie / Hämatologie
🇩🇪Erlangen, Germany
Universitätsklinikum Freiburg, Zentrum für Kinder- und Jugendmedizin, Klinik IV: Päd. Hämatologie und Onkologie
🇩🇪Freiburg, Germany
Universitätsklinikum Frankfurt, Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie
🇩🇪Frankfurt am Main, Germany
Universitätsklinikum Gießen und Marburg, Standort Gießen, Zentrum für Kinderhämatologie und -onkologie
🇩🇪Gießen, Germany
Klinikum Schwabing, Kinderklinik der TU Päd. Hämatologie / Onkologie, Station 24d
🇩🇪München, Germany
Universitätsklinikum Münster, Klinik für Kinder- und Jugendmedizin, Abt. Pädiatrische Hämatologie und Onkologie
🇩🇪Münster, Germany
Klinikum Mannheim gGmbH, Universitäts-Kinderklinik, Päd. Onkologie /Hämatologie
🇩🇪Mannheim, Germany
Universitätsklinikum Rostock, Kinder- und Jugendklinik, Päd. Hämatologie und Onkologie
🇩🇪Rostock, Germany
HELIOS Klinikum Berlin-Buch, Kinderklinik, Pädiatrische Hämatologie und Onkologie
🇩🇪Berlin, Germany
Univ.Klinik für Kinder- und Jugendheilkunde Innsbruck, Universitätsklinik für Pädiatrie I
🇦🇹Innsbruck, Austria
Klinikum Klagenfurt am Wörthersee, Abteilung für Kinder- und Jugendheilkunde
🇦🇹Klagenfurt, Austria
Kepler Universitätsklinikum, Med Campus IV / Onkologie
🇦🇹Linz, Austria
St. Anna Kinderspital
🇦🇹Wien, Austria
LKH Leoben, Abteilung für Kinder- und Jugendheilkunde
🇦🇹Leoben, Austria
Børneonkologisk afsnit 303B, Børneafdelingen, Aalborg Universitetshospital Nord
🇩🇰Aalborg, Denmark
Department of Pediatric Oncology, University Hospital Brno
🇨🇿Brno, Czechia
Department of Pediatric Hematology and Oncology, University Hospital Motol
🇨🇿Prague, Czechia
Børn og Unge afsnit 4, Børneafdelingen, Aarhus Universitetshospital Skejby
🇩🇰Aarhus, Denmark
Børneonkologisk afsnit 5054, BørneUngeKlinikken, Juliane Marie Centret, Rigshospitalet
🇩🇰Kobenhavn, Denmark
Børneonkologisk afsnit H2, H. C. Andersen Børnehospital, Odense Universitetshospital
🇩🇰Odense, Denmark
Helsinki University Hospital, Children´s Hospital, Dept of Pediatric Hematology and Oncology
🇫🇮Helsinki, Finland
Kuopio University Hospital, Paediatric Haematology and Oncology
🇫🇮Kuopio, Finland
Evangelisches Krankenhaus Bielefeld GmbH, Klinik für Kinder- und Jugendmedizin, Hämatologie und Onkologie
🇩🇪Bielefeld, Germany
Univ.Klinik für Kinder- und Jugendheilkunde Graz, Klin. Abteilung für pädiatrische Hämato-Onkologie
🇦🇹Graz, Austria
Klinikum Chemnitz gGmbH, Klinik für Kinder- und Jugendmedizin, Päd. Hämatologie und Onkologie
🇩🇪Chemnitz, Germany
Carl-Thieme-Klinikum Cottbus gGmbH, Klinik für Kinder- und Jugendmedizin
🇩🇪Cottbus, Germany
Zentrum für Kinderheilkunde der Universität Bonn, Abt. Päd. Hämatologie / Onkologie
🇩🇪Bonn, Germany
Klinikum Dortmund gGmbH, Klinik für Kinder- und Jugendmedizin, Station K1, Abt. Päd. Onkologie / Hämatologie
🇩🇪Dortmund, Germany
Klinikum Bremen-Mitte gGmbH, Prof.-Hess-Kinderklinik,Pädiatrische Onkologie und Hämatologie
🇩🇪Bremen, Germany
Universitäts-Kinderklinik Heidelberg, Abt. Hämatologie / Onkologie
🇩🇪Heidelberg, Germany
Universitätsklinikum Halle (Saale), Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie / Onkologie
🇩🇪Halle (Saale), Germany
Universitätsklinikum Greifswald KdöR, Klinik und Poliklinik für Kinder- und Jugendmedizin, Abt. Pädiatrische Onkologie und Hämatologie
🇩🇪Greifswald, Germany
Medizinische Hochschule Hannover, Kinderheilkunde, Päd. Hämatologie / Onkologie
🇩🇪Hannover, Germany
Gemeinschaftskrankenhaus Herdecke, Kinder- und Jugendmedizin, Päd. Hämatologie / Onkologie
🇩🇪Herdecke, Germany
Universitätsklinikum Jena, Klinik für Kinder- und Jugendmedizin
🇩🇪Jena, Germany
Universitätsklinikum Hamburg Eppendorf, Zentrum für Kinder- und Jugendmedizin, Abt. Pädiatrische Hämatologie und Onkologie
🇩🇪Hamburg, Germany
Städtisches Klinikum Karlsruhe gGmbH, Kinderklinik, Station S 24
🇩🇪Karlsruhe, Germany
Gemeinschaftsklinikum Mittelrhein Kemperhof, Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie
🇩🇪Koblenz, Germany
HELIOS Klinikum Krefeld, Zentrum für Kinder- und Jugendmedizin, Päd. Hämatologie/Onkologie
🇩🇪Krefeld, Germany
Klinikum der Universität zu Köln, Klinik für Kinder- und Jugendmedizin, Abt. Kinderonkologie und -hämatologie
🇩🇪Köln, Germany
Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Zentrum für Kinder- und Jugendmedizin, Pädiatrische Hämatologie / Onkologie
🇩🇪Mainz, Germany
Klinikum Oldenburg AöR, Zentrum für Kinder- und Jugendmedizin, Abt. Hämatologie / Onkologie
🇩🇪Oldenburg, Germany
Diakonie Neuendettelsau, Kliniken Hallerwiese / Cnopf'sche Kinderklinik, Pädiatrische Hämatologie /Onkologie
🇩🇪Nürnberg, Germany
Klinikum der LMU, Dr. von Haunersches Kinderspital, Pädiatrische Hämatologie / Onkologie
🇩🇪München, Germany
HELIOS Kliniken Schwerin GmbH, Klinik für Kinder- und Jugendmedizin, Station A1
🇩🇪Schwerin, Germany
Universitätsklinik Tübingen Klinik für Kinderheilkunde und Jugendmedizin, Päd. Hämatologie / Onkologie
🇩🇪Tübingen, Germany
Klinikum Stuttgart, Olgahospital Zentrum für Kinder- und Jugendmedizin Pädiatrie 5 (Onkologie, Hämatologie, Immunologie)
🇩🇪Stuttgart, Germany
Klinikum Mutterhaus der Borromäerinnen gGmbH, Pädiatrische Abteilung
🇩🇪Trier, Germany
Universitetssjukhus Umeå, Barnonkologiska avdelningen, Barn 3 Norrlands
🇸🇪Umeå, Sweden
Akademiska sjukhuset, Barnavdelningen för blod- och tumörsjukdomar
🇸🇪Uppsala, Sweden
Universitetssjukhuset i Linköping, Barn och Ungdomsmedicinska kliniken, Barnonkologiska enheten
🇸🇪Linköping, Sweden
Ostschweizer Kinderspital, Hämatologie/ Onkologie
🇨🇭Saint Gallen, Switzerland
Hôpital des Enfants, Unité d'Oncologie Hématologie
🇨🇭Geneva, Switzerland