Study of the Combination of Rituximab, Cyclophosphamide, Doxorubicin, VELCADE, and Prednisone or Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone in Patients With Newly Diagnosed Mantle Cell Lymphoma
- Conditions
- Mantle Cell Lymphoma
- Interventions
- Registration Number
- NCT00722137
- Lead Sponsor
- Millennium Pharmaceuticals, Inc.
- Brief Summary
This is a randomized, open-label, multicenter, prospective study to compare the efficacy and safety of the combination of VcR-CAP to that of R-CHOP in participants who have newly diagnosed mantle cell lymphoma grade II, III or IV and who are ineligible to undergo bone marrow transplantation.
- Detailed Description
The drug being tested in this study were combination of VcR-CAP and R-CHOP. Combination of VcR-CAP and R-CHOP is being tested to treat people who had mantle cell lymphoma (MCL).
The study enrolled 487 patients. Participants were randomly assigned (by chance, like flipping a coin) to one of the two treatment groups in a 1:1 ratio:
Treatment Group A (VcR-CAP) Treatment Group B (R-CHOP)
The study included a screening phase, a treatment phase, a short-term follow-up phase, and a long-term follow-up phase. The screening phase was up to 28 days (56 days for bone marrow evaluation) prior to randomization.
This multi-center trial was conducted worldwide. The total study duration from randomization of the first patient until the last progression-free survival (PFS) event required for the final analysis was expected to be approximately 42 months (24 months for enrollment and 18 months for follow-up) and survival follow-up every 12 weeks until death.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 487
-
Male or female patients 18 years or older (the patient must be at least the legal age limit to be able to give informed consent within the jurisdiction the study is taking place)
-
Diagnosis of mantle cell lymphoma MCL (Stage II, III or IV) as evidenced by lymph node histology and either expression of cyclin D1 (in association with CD20 and CD5) or evidence of t(11;14) translocation, such as by cytogenetics, fluorescent in situ hybridization (FISH) or polymerase chain reaction (PCR). Patients with a diagnosis of Stage I MCL will not be permitted to enter study.
- Paraffin embedded biopsy tissue block (preferably of lymph node origin) must be sent to the central laboratory for confirmation of MCL diagnosis prior to randomization. In China, a paraffin embedded lymph node biopsy tissue block must be sent for central confirmation of sample adequacy, prior to randomization
-
At least 1 measurable site of disease
-
No prior therapies for MCL
-
Not eligible for bone marrow transplantation as assessed by the treating physician (e.g., age or the presence of co-morbid conditions that may have a negative impact on the tolerability to transplantation).
-
Eastern Cooperative Oncology Group ECOG status ≤2
-
Absolute neutrophil count (ANC) ≥1500 cells/µL,
-
Platelets ≥100,000 cells/µL or ≥75,000 cells/µL if thrombocytopenia is considered by the investigator to be secondary to MCL (e.g., due to bone marrow infiltration or sequestration from splenomegaly).
-
Alanine transaminase ≤3 x upper limit of normal (ULN)
-
Aspartate transaminase ≤3 x ULN
-
Total bilirubin ≤1.5 x ULN,
-
Calculated creatinine clearance ≥20 mL/min.
-
Female patients must be post menopausal for at least 1 year (must not have had a natural menses for at least 12 months), surgically sterile, or practicing an effective method of birth control (e.g., prescription oral contraceptives, contraceptive injections, intrauterine device, double-barrier method, contraceptive patch, male partner sterilization) and have a negative serum βHCG or urine pregnancy test at screening. They must also be prepared to continue birth control measures for at least 6 months after terminating treatment.
-
Male patients must agree to use an acceptable method of contraception (for themselves or female partners as listed above) for the duration of the study.
-
All patients (or their legally acceptable representatives) must have signed an informed consent document indicating that they understand the purpose of and procedures required for the study and are willing to participate in the study.
-
In order to participate in the pharmacogenomics component of this study, patients (or their legally acceptable representative) must have signed the informed consent form for pharmacogenomics research indicating willingness to participate in the pharmacogenomics component of the study. Acquisition of tumor sample collections is required for all patients (where available); all other sample collections are optional
-
Prior treatment with VELCADE
-
Prior antineoplastic (including unconjugated therapeutic antibodies), experimental or radiation therapy, radioimmunoconjugates or toxin immunoconjugates for the treatment of MCL. In the event that a patient has received doxorubicin for the treatment of any condition, other than MCL, the maximum dose and exposure received prior to entry into this study should not exceed 150 mg/m2.
- short course (maximum of 10 days, not exceeding 100 mg/day) prednisone or equivalent steroids are allowed to treat symptoms in patients with advanced disease who enter the screening phase and are waiting to be randomized.
-
Major surgery (at the discretion of the treating physician and in consultation with the sponsor's medical monitor) within 2 weeks before randomization
-
Peripheral neuropathy or neuropathic pain of Grade 2 or worse (as per the investigators assessment)
-
Diagnosed or treated for a malignancy other than MCL within 1 year of randomization, or who were previously diagnosed with a malignancy other than MCL and have any radiographic or biochemical marker evidence of malignancy. Patients with completely resected basal cell carcinoma, squamous cell carcinoma of the skin, or in situ malignancy are not excluded.
-
Active systemic infection requiring treatment and patients with known diagnosis of human immunodeficiency virus HIV or active hepatitis B (carriers of hepatitis B are permitted to enter study)
-
History of allergic reaction attributable to compounds containing boron, mannitol, or hydroxybenzoates
-
Known anaphylaxis or immunoglobulin E (IgE)-mediated hypersensitivity to murine proteins or to any component of rituximab including polysorbate 80 and sodium citrate dihydrate
-
Female or male patients of child-bearing potential who will not use adequate contraception during the course of the study.
-
Serious medical (e.g., pericardial disease, cardiac failure [New York Heart Association; NYHA Class III or IV, Attachment 12 or left ventricular ejection fraction; LVEF <50%], active peptic ulceration, uncontrolled diabetes mellitus, or acute diffuse infiltrative pulmonary disease), or psychiatric illness likely to interfere with participation in this clinical study
-
Concurrent treatment with another investigational agent.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description VcR-CAP Rituximab 375 mg/m^2 Rituximab 375 mg/m\^2, Cyclophosphamide 750 mg/m\^2, Doxorubicin 50 mg/m\^2, VELCADE 1.3 mg/m\^2, and Prednisone 100 mg/m\^2 VcR-CAP Cyclophosphamide 750 mg/m^2 Rituximab 375 mg/m\^2, Cyclophosphamide 750 mg/m\^2, Doxorubicin 50 mg/m\^2, VELCADE 1.3 mg/m\^2, and Prednisone 100 mg/m\^2 R-CHOP Doxorubicin 50 mg/m^2 Rituximab 375 mg/m\^2, Cyclophosphamide 750 mg/m\^2, Doxorubicin 50 mg/m\^2, Vincristine 1.4 mg/m\^2, and Prednisone 100 mg/m\^2 VcR-CAP Doxorubicin 50 mg/m^2 Rituximab 375 mg/m\^2, Cyclophosphamide 750 mg/m\^2, Doxorubicin 50 mg/m\^2, VELCADE 1.3 mg/m\^2, and Prednisone 100 mg/m\^2 R-CHOP Rituximab 375 mg/m^2 Rituximab 375 mg/m\^2, Cyclophosphamide 750 mg/m\^2, Doxorubicin 50 mg/m\^2, Vincristine 1.4 mg/m\^2, and Prednisone 100 mg/m\^2 R-CHOP Cyclophosphamide 750 mg/m^2 Rituximab 375 mg/m\^2, Cyclophosphamide 750 mg/m\^2, Doxorubicin 50 mg/m\^2, Vincristine 1.4 mg/m\^2, and Prednisone 100 mg/m\^2 R-CHOP Vincristine 1.4 mg/m^2 Rituximab 375 mg/m\^2, Cyclophosphamide 750 mg/m\^2, Doxorubicin 50 mg/m\^2, Vincristine 1.4 mg/m\^2, and Prednisone 100 mg/m\^2 VcR-CAP VELCADE 1.3 mg/m^2 Rituximab 375 mg/m\^2, Cyclophosphamide 750 mg/m\^2, Doxorubicin 50 mg/m\^2, VELCADE 1.3 mg/m\^2, and Prednisone 100 mg/m\^2 R-CHOP Prednisone 100 mg/m^2 Rituximab 375 mg/m\^2, Cyclophosphamide 750 mg/m\^2, Doxorubicin 50 mg/m\^2, Vincristine 1.4 mg/m\^2, and Prednisone 100 mg/m\^2 VcR-CAP Prednisone 100 mg/m^2 Rituximab 375 mg/m\^2, Cyclophosphamide 750 mg/m\^2, Doxorubicin 50 mg/m\^2, VELCADE 1.3 mg/m\^2, and Prednisone 100 mg/m\^2
- Primary Outcome Measures
Name Time Method Progression Free Survival (PFS) Median duration of follow-up of 40 months PFS was defined as the interval between the date of randomization and the date of progressive disease (PD) or death, whichever occurred first. PD was based on the assessment of an Independent Review Committee.
- Secondary Outcome Measures
Name Time Method Time to Progression (TTP) Median duration of follow-up of 40 months Time to progression was defined as the duration from the date of randomization until the date of first documented evidence of progressive disease (PD) or date of relapse for subjects who experienced complete response (CR) or complete response, unconfirmed (CRu). PD and response were based on the assessment of an Independent Review Committee.
Overall Complete Response (CR + CRu) Median duration of follow-up of 40 months Overall complete response was defined as the number of participants with complete response (CR) and those with unconfirmed complete response (CRu). Response assessment was carried out every 6 weeks for 18 weeks; thereafter, every 8 weeks until PD/initiation of alternate therapy/withdrawal from study/death.
Duration of Response Median duration of follow-up of 40 months The duration of treatment response was defined as the time from the date of the first response to the date of PD or death due to PD for those participants with a best response of CR, CRu, or PR as determined by the Independent Review Committee. The duration of response for complete responders was defined as the time from the date of the first response to the date of PD or death due to PD for those participants with a best response of CR or CRu verified by bone marrow and lactate dehydrogenase (LDH).
Time to Next Anti-lymphoma Treatment (TTNT) : Median duration of follow-up of 40 months The time to next anti-lymphomatreatment was measured from the date of initiation of study treatment as per protocol to the start date of new anti-lymphoma treatment. Death due to disease progression prior to subsequent therapy was considered as an event. Otherwise, time to next anti lymphoma treatment was censored at the date of death or the last date known to be alive.
Treatment-free Interval (TFI) Median duration of follow-up of 40 months The TFI was defined as the duration from the date of last dose plus 1 day to the start date of the new treatment. Death due to disease progression prior to subsequent therapy was considered as an event. Otherwise, treatment-free interval was censored at the date of death or the last date known to be alive.
Overall Response Rate (ORR) Median duration of follow-up of 40 months ORR was defined as complete response (CR) + complete response, unconfirmed (CRu) + partial response (PR) as determined by the Independent Review Committee. Response assessment was carried out every 6 weeks for 18 weeks; thereafter, every 8 weeks until PD/initiation of alternate therapy/withdrawal from study/death.
Overall Survival (OS) Median duration of follow-up of 40 months OS was measured from the date of randomization to the date of the participant's death. If the participant was alive or the vital status was unknown, OS was censored at the date that the subject was last known to be alive.
Number of Participants Experiencing an Adverse Event (AE) Up to 107.4 months An AE was defined as any untoward medical occurrence associated with the use of a drug, whether or not considered drug related. AEs were collected from the first dose of study drug through 30 days after the last dose of study drug. Treatment was administered for up to 8 cycles (24 weeks) and AEs were collected for up to 30 days following the last dose of study drug.
18-Month Survival Up to month 18 from the time of randomization 18-month survival was defined as the estimated probability of survival at 18 months (Kaplan-Meier estimate).
Overall Survival (OS) in Long Term Follow-up Period Up to 107.4 months OS was measured from the date of randomization to the date of the participant's death. If the participant was alive or the vital status was unknown, OS was censored at the date that the subject was last known to be alive.
Trial Locations
- Locations (150)
Chris Hani Baragwanath Hospital
🇿🇦Johannesburg, Gauteng, South Africa
Medical Oncology Center of Rosebank
🇿🇦Johannesburg, Gauteng, South Africa
University of the Witwatersrand Oncology
🇿🇦Johannesburg, Gauteng, South Africa
Cancer Institute & Cancer Hospital, CAMS&PUMC
🇨🇳Beijing, China
Sir Ganga Ram Hospital
🇮🇳New Delhi- 110060, Delhi, India
Apollo Speciality Hospital, Chennai
🇮🇳Chennai-600035, Tamil Nadu, India
UZ Brussel Department Medical Oncology
🇧🇪Brussels, Belgium
Universitair Ziekenhuis Gent - UZ GENT, Hematologie, 9K12IE 9de verdiep- polikliniek Hematologie
🇧🇪Gent, Belgium
St.Johanns Spital/Landeskrankenhaus Salzburg
🇦🇹Salzburg, Austria
Institut National D'oncologie
🇲🇦Rabat, Morocco
Hospital de Santa Maria
🇵🇹Lisboa, Portugal
Jehangir Hospital
🇮🇳Pune-411002, Maharashtra, India
Hospital Universitario San Vicente de Paul
🇨🇴Medellin, Colombia
National Kidney and Transplant Institute
🇵🇭Quezon City, Philippines
1st Republican Clinical Hospital of Udmurtia
🇷🇺Izhevsk, Russian Federation
Rostov Research Institute of Oncology
🇷🇺Rostov-on-Don, Russian Federation
National Cancer Centre
🇸🇬Singapore, Singapore
St Lukes Medical Center
🇵🇭Quezon City, Philippines
Belgorod Regional Oncology Center
🇷🇺Belgorod, Russian Federation
Central Res. Inst. of Roentgen-Radiology
🇷🇺St-Petersburg, Russian Federation
City Clinical Oncology Dispensary
🇷🇺St Petersburg, Russian Federation
Hôpital Aziza Othmana
🇹🇳Tunis, Tunisia
Institute of Urgent and Recovery Surgery named after V.K.Gusaka of AMS of Ukraine, Haematology Dept.
🇺🇦Donetsk, Ukraine
Cancer Research Center RAMS - N.N. Blokhin - Academy of Medical Science
🇷🇺Moscow, Russian Federation
Moscow Regional Clinical Research Institute
🇷🇺Moscow, Russian Federation
Nizhniy Novgorod Region Clinical Hospital
🇷🇺Nizhniy Novgorod, Russian Federation
Hôpital Farhat Hached
🇹🇳Sousse, Tunisia
Cherkassy Regional Oncology Center, Dept. of Hematology
🇺🇦Cherkassy, Ukraine
S.P. Botkin Moscow City Clinical Hospital
🇷🇺Moscow, Russian Federation
Hospital das Clínicas da Faculdade de Medicina da USP
🇧🇷Sao Paulo, Brazil
Centre D'oncologie Al Azhar
🇲🇦Rabat, Morocco
"Katedra i Klinika Hematologii i Chorob Rozrostowych Ukladu Krwiotworczego
🇵🇱Poznan, Poland
Szpital Morski im. PCK w Gdyni Gdynskie Centrum Onkologii Oddzial Chemioterapii
🇵🇱Gdynia, Poland
Klinika Hematologii Uniwersytetu Medycznego w Lodzi
🇵🇱Lodz, Poland
Klinika Hematologii Nowotworow Krwi i Transplantacji Szpiku Akademii Medycznej we Wroclawiu
🇵🇱Wroclaw, Poland
Hospital Sao Marcos
🇵🇹Braga, Portugal
Hospitais da Universidade de Coimbra
🇵🇹Coimbra, Portugal
Spitalul Clinic Judetean de Urgenta "Sf. Spiridon" Iasi, Oncologie Medicala
🇷🇴Iasi, Romania
Arkhangelsk Regional Clinical Hospital
🇷🇺Arkhangelsk, Russian Federation
Instituto Portugues de Oncologia
🇵🇹Porto, Portugal
Spitalul Clinic Coltea, Clinica Hematologie
🇷🇴Bucuresti, Romania
Spitalul Judetean de Urgenta "Dr. Constantin Opris", Hematologie
🇷🇴Baia Mare, Romania
Spitalul Clinic Universitar de Urgenta Bucuresti, Hematologie
🇷🇴Bucuresti, Romania
Institutul Clinic Fundeni, Hematologie
🇷🇴Bucuresti, Romania
Chelyabinsk Regional Oncology Center
🇷🇺Chelyabinsk, Russian Federation
Hematology Scientific Center
🇷🇺Moscow, Russian Federation
St.-Petersburg Clinical Research Institute of Hematology and Transfusiology
🇷🇺St. Petersburg, Russian Federation
Pretoria Academic Hospital-Dr. Savage Road, 3rd Floor Radiotherapy Building, Prinshof
🇿🇦Pretoria, Gauteng, South Africa
Hospital de la Princesa
🇪🇸Madrid, Spain
Institut Salah Azaiz
🇹🇳Tunis, Tunisia
Dnepropetrovsk City Clinical Hospital #4, Regional Hematology Center
🇺🇦Dnepropetrovsk, Ukraine
Centre National de Greffe de Moelle osseuse
🇹🇳Tunis, Tunisia
Dokuz Eylul University Med. Fac.
🇹🇷Izmir, Turkey
Crimean Republic Clinical Oncology Dispensary, Haematology Department
🇺🇦Simferopol, Ukraine
Institute of Blood Pathology and Transfusion Medicine, Lviv Clinical Hospital #5, Hematology Dept.
🇺🇦Lviv, Ukraine
UZA Hematologie, 1e verdiep
🇧🇪Edegem, Belgium
St. Francis Hosptial and Medical Center
🇺🇸Hartford, Connecticut, United States
Sinai Hospital
🇺🇸Baltimore, Maryland, United States
Nebraska Cancer Specialists
🇺🇸Omaha, Nebraska, United States
Capitol Comp. Cancer Center
🇺🇸Jefferson City, Missouri, United States
Legacy Pharma Research
🇺🇸Bismarck, North Dakota, United States
Division of Hematology and Oncology Vanderbilt University
🇺🇸Nashville, Tennessee, United States
Cancer Outreach Associates, PC
🇺🇸Abingdon, Virginia, United States
Allgemeines Krankenhaus der Stadt Wien
🇦🇹Wien, Austria
AZ Stuivenberg Oncologie/ Hematologie
🇧🇪Antwerpen, Belgium
AZ St Jan AV
🇧🇪Brugge, Belgium
C.H.R. Citadelle
🇧🇪Liege, Belgium
UZ Leuven Gasthuisberg Hematologie
🇧🇪Leuven, Belgium
Fundacao Hospital Amaral Carvalho
🇧🇷Jau, Brazil
Centro de Hematologia E Hemoterapia - Unicamp
🇧🇷Campinas, Brazil
Ucl de Mont-Godinne
🇧🇪Yvoir, Belgium
Centre Hospitalier Universitaire
🇧🇪Liege, Belgium
Hospital Nossa Senhora da Conceicao
🇧🇷Porto Alegre, Brazil
Centro de Estudos de Hematologia E Oncologia Da Fmabc
🇧🇷Sao Paulo, Brazil
Fundacao Pio XII - Hospital de Cancer de Barretos
🇧🇷Sao Paulo, Brazil
Hospital Ac Camargo
🇧🇷Sao Paulo, Brazil
Inca - Instituto Nacional Do Cancêr
🇧🇷Rio de Janeiro, Brazil
Hospital Alemao Oswaldo Cruz
🇧🇷Sao Paulo, Brazil
Cross Cancer Institute
🇨🇦Edmonton, Alberta, Canada
Santa Casa de Misericórida de São Paulo
🇧🇷Sao Paulo, Brazil
University Health Network, Princess Margaret Hospital
🇨🇦Toronto, Ontario, Canada
Hospital Clinico Universidad Catolica de Chile
🇨🇱Santiago, Chile
Hospital Del Salvador
🇨🇱Santiago, Chile
Instituto Nacional Del Cancer
🇨🇱Santiago, Chile
West China Hospital, Sichuan University
🇨🇳Chengdu, Sichuan, China
Sun Yat-sen University Cancer Center
🇨🇳Guangzhou, Guangdong, China
Zhejiang University First Hospital
🇨🇳Hangzhou, Zhejiang, China
Beijing Cancer Hospital
🇨🇳Beijing, China
Peking University Third Hospital
🇨🇳Beijing, China
Cancer hospital, Fudan University
🇨🇳Shanghai, China
Ruijin Hospital
🇨🇳Shanghai, China
Tianjin Medical University Cancer Hospital and Institute
🇨🇳Tianjin, China
Clinica Reina Sofia
🇨🇴Bogota, Colombia
Hospital Pablo Tobon Uribe
🇨🇴Medellin, Colombia
Oddeleni klinicke hematologie, Fakultni nemocnice Kralovske Vinohrady
🇨🇿Praha, Czechia
Interni hematoonkoligicka klinika
🇨🇿Brno, Czechia
Interni klinika - Oddeleni klin. hematologie Fakultni nemocnice Hradec Kralove
🇨🇿Hradec Kralove, Czechia
Vivantes Klinikum Spandau Klinik für Innere Medizin - Hämatologie, Onkologie und Gastroenterologie
🇩🇪Berlin, Germany
Vivantes Klinikum Neukölln Klinik für Innere Medizin Hämatologie und Onkologie
🇩🇪Berlin, Germany
Städt. Kliniken Frankfurt-Hoechst Med. Klinik II - Hämatologie und Onkologie
🇩🇪Frankfurt, Germany
Tumorklinik SANAFONTIS Alpine GmbH
🇩🇪Freiburg, Germany
Klinikum Lippe-Lemgo Med. Klinik II - Hämatologie und Onkologie
🇩🇪Lemgo, Germany
Johannes-Gutenberg-Universität Mainz III. Med. Klinik
🇩🇪Mainz, Germany
Schwarzwald-Baar-Kliniken Innere Med. II
🇩🇪Villingen, Germany
Mutterhaus der Borromäerinnen Med. Klinik I
🇩🇪Trier, Germany
Petz Aladár Kórház, II. Belgyógyászat
🇭🇺Győr, Hungary
Debreceni Egyetem Orvos- es Egeszsegtudomanyi Centrum, III. sz. Belgyogyaszati Klinika
🇭🇺Debrecen, Hungary
Kaposi Mor Megyei Korhaz, Belgyogyaszat
🇭🇺Kaposvar, Hungary
Apollo Hospital and Research Foundation, Apollo Hospitals
🇮🇳Hyderabad 500033, Andhra Pradesh, India
Kidwai Memorial Institute of Oncology
🇮🇳Bangalore 560 029, Karnataka, India
Regional Cancer Centre, Medical Oncology
🇮🇳Thiruvananthapuram, Kerala-695011, India
Netaji Subash Chanda Bose Cancer Research Institute
🇮🇳Kolkata- 700016, West Bengal, India
Rambam Medical Center-Hematology department
🇮🇱Haifa, Israel
Hadassah Medical Center - Hematology department
🇮🇱Jerusalem, Israel
Rabin Medical Center, Beilinson Campus
🇮🇱Petach Tiqva, Israel
Kaplan Medical Center - Hematology Institute
🇮🇱Rechovot, Israel
Sheba Medical Center
🇮🇱Ramat-Gan, Israel
Spedali Civili di Brescia
🇮🇹Brescia, Italy
Azienda Ospedaliera Universitaria di Bologna Policlinico S.Orsola-Malpighi Dipartimento di Ematologia e Scienze Oncologiche "L. e A. Seragnoli"
🇮🇹Bologna, Italy
Dipartimento di Oncologia ed Ematologia Università di Modena e Reggio Emilia
🇮🇹Modena, Italy
AZIENDA OSPEDALIERA UNIVERSITARIA POLICLINICO TOR VERGATA DIPARTIMENTO DI MEDICINA U.O.C. Ematologia
🇮🇹Roma, Italy
Azienda Ospedaliera San Giovanni Battista "Molinette" Struttura Complessa Ematologia 2
🇮🇹Torino, Italy
Gleneagles Medical Centre
🇲🇾Pulau Pinang, Malaysia
University Malaya Medical Centre
🇲🇾Kuala Lumpur, Malaysia
Hopital Du 20 Aout 1953
🇲🇦Casablanca, Morocco
Sverdlovsk Regional Oncology Dispensary
🇷🇺Ekaterinburg, Russian Federation
Medical Scientific Radiology - Center
🇷🇺Obninsk, Russian Federation
Omsk Regional Oncology Dispensary
🇷🇺Omsk, Russian Federation
Republikan Hospital named after V.A/ Baranov
🇷🇺Petrozavodsk, Russian Federation
Medical Sanitary Unit # 1
🇷🇺Perm, Russian Federation
Leningrad Region Clinical Hospital
🇷🇺St. Petersburg, Russian Federation
Pavlov State Medical Univercity
🇷🇺St-Petersburg, Russian Federation
Singapore General Hospital - Hematology
🇸🇬Singapore, Singapore
Hospital Clinic I Provincial de Barcelona
🇪🇸Barcelona, Spain
Dr AI Pirjol & Dr WM Szpak Inc.
🇿🇦Durban, Kwazulu Natal, South Africa
Hospital Universitario Germans Trias i Pujol
🇪🇸Badalona, Barcelona, Spain
Chang Gung Memorial Hospital, Linkou
🇨🇳Tao-Yuan, Taiwan
Hospital Universitario 12 de Octubre
🇪🇸Madrid, Spain
Hospital Clinico Universitario Salamanca
🇪🇸Salamanca, Spain
King Chulalongkorn Memorial Hospital
🇹🇭Bangkok, Thailand
Ramathibodi Hospital
🇹🇭Bangkok, Thailand
Siriraj Hospital-Hematology Unit
🇹🇭Bangkok, Thailand
Maharaj Nakorn Chiang Mai hospital - Faculty of Medicine
🇹🇭Chiang Mai, Thailand
National Cancer Institute, Department of chemotherapy of hemoblastosis
🇺🇦Kiev, Ukraine
Hacettepe University Medical Faculty
🇹🇷Ankara, Turkey
Khmelnitskiy Regional Hospital, Hematology Department
🇺🇦Khmelnitsky, Ukraine
Hematology-Oncology Associates of Northern NJ
🇺🇸Morristown, New Jersey, United States
Hospital Sao Lucas Puc-Rs
🇧🇷Porto Alegre, Brazil
Center for Cancer Care at Goshen Hospital
🇺🇸Goshen, Indiana, United States
Wilhelm-Anton-Hospital Goch gGmbH Klinik für Hämatologie und internistische Onkologie
🇩🇪Goch, Germany
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