To Evaluate Efficacy and Safety of Parsaclisib and Ruxolitinib in Participants With Myelofibrosis Who Have Suboptimal Response to Ruxolitinib (LIMBER-304)
- Conditions
- MyelofibrosisPost Polycythemia Vera MyelofibrosisPrimary MyelofibrosisPost Essential Thrombocythemia Myelofibrosis
- Interventions
- Registration Number
- NCT04551053
- Lead Sponsor
- Incyte Corporation
- Brief Summary
The purpose of the study is to compare the efficacy and safety of parsaclisib when combined with ruxolitinb versus placebo combined with ruxolitinib in participants with myelofibrosis who have suboptimal response while receiving ruxolitinib monotherapy.
- Detailed Description
Prospective participants must be on stable doses of ruxolitinib ranging from 5 mg BID to 25 mg BID and will have been on that dose for at least the last 8 weeks prior to Day 1. At least 3 months duration of prior ruxolitinib is required. Participants must meet Protocol-defined criteria for suboptimal response to ruxolitinib monotherapy. After participants have been determined to be eligible for the study and completed the baseline symptom diary assessment for 7 days, they will be randomized to 1 of 2 treatment groups, with stratification for platelet count (≥ 100 × 10\^9/L vs 50 to \< 100 × 10\^9/L inclusive) and DIPSS risk category (high vs intermediate-2 vs intermediate-1).
Once a participant has completed the week 24 assessments, the participant's treatment assignment will then be unblinded and if found to be placebo, the participant will have the opportunity to crossover to begin receiving parsaclisib, together with continued ruxolitinib, as long as hematology parameters are adequate.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 177
- Diagnosis of PMF, PPV-MF, or PET-MF.
- DIPSS risk category of intermediate-1, intermediate-2, or high.
- Treated with ruxolitinib for ≥ 3 months with a stable dose for at least the last 8 weeks prior to Day 1
- Palpable spleen of ≥ 5 cm below the left costal margin on physical examination at the screening visit.
- Active symptoms of MF at the screening visit, as demonstrated by the presence of a TSS of ≥ 10 using the Screening Symptom Form.
- Participants with an ECOG performance status score of 0, 1, or 2.
- Screening bone marrow biopsy specimen and pathology report(s) available that was obtained within the prior 2 months or willingness to undergo a bone marrow biopsy at screening/baseline; willingness to undergo bone marrow biopsy at Week 24 and every 24 weeks there after. Screening/baseline biopsy specimen must show diagnosis of MF.
- Life expectancy of at least 24 weeks.
- Willingness to avoid pregnancy or fathering children.
- Prior therapy with any drug that inhibits PI3K (examples of drugs targeting this pathway include but are not limited to INCB040093, idelalisib, duvelisib, buparlisib, copanlisib, and umbralisib).
- Use of experimental drug therapy for MF or any other standard drug used for MF (whether for treatment of MF or another indication) with the exception of ruxolitinib, within 3 months of starting study drug, and/or lack of recovery from all toxicities from previous therapy (except ruxolitinib) to Grade 1 or better.
- Inability to swallow food or any condition of the upper gastrointestinal tract that precludes administration of oral medications.
- Recent history of inadequate bone marrow reserve.
- Inadequate liver and renal function at screening.
- Active bacterial, fungal, parasitic, or viral infection that requires therapy.
- Active HBV or HCV infection that requires treatment or at risk for HBV reactivation.
- Known HIV infection.
- Uncontrolled, severe, or unstable cardiac disease that in the investigator's opinion may jeopardize the safety of the participant or compliance with the Protocol.
- Active invasive malignancy over the previous 2 years.
- Splenic irradiation within 6 months before receiving the first dose of study drug.
- Concurrent use of any prohibited medications.
- Active alcohol or drug addiction that would interfere with the ability to comply with the study requirements.
- Use of any potent CYP3A4 inhibitors or inducers within 14 days or 5 half lives(whichever is longer) before the first dose of study drug or anticipated during the study.
- Inadequate recovery from toxicity and/or complications from a major surgery before starting therapy.
- Currently breastfeeding or pregnant.
- Any condition that would, in the investigator's judgment, interfere with full participation in the study, including administration of study drug and attending required study visits; pose a significant risk to the participant; or interfere with interpretation of study data.
- History of Grade 3 or 4 irAEs from prior immunotherapy.
- Receipt of any live vaccine within 30 days of the first dose of study drug
- Unwillingness to receive RBC transfusions to treat low hemoglobin levels.
- Known hypersensitivity or severe reaction to parsaclisib or ruxolitinib or excipients of parsaclisib/matching placebo or ruxolitinib formulations.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Group A : ruxolitinib +parsaclisib parsaclisib Participants will receive parsaclisib starting from Day 1 for the duration of study, while continuing to receive the stable dose of ruxolitinib they were taking for the 8 weeks prior to Day 1. Group B : ruxolitinib + placebo placebo Participants will receive placebo starting from Day 1 for the duration of study, while continuing to receive the stable dose of ruxolitinib they were taking for the 8 weeks prior to Day 1. Group A : ruxolitinib +parsaclisib ruxolitinib Participants will receive parsaclisib starting from Day 1 for the duration of study, while continuing to receive the stable dose of ruxolitinib they were taking for the 8 weeks prior to Day 1. Group B : ruxolitinib + placebo ruxolitinib Participants will receive placebo starting from Day 1 for the duration of study, while continuing to receive the stable dose of ruxolitinib they were taking for the 8 weeks prior to Day 1.
- Primary Outcome Measures
Name Time Method Percentage of Participants Achieving ≥25% Reduction in Spleen Volume From Baseline to Week 24 as Measured by Magnetic Resonance Imaging (MRI) (or Computed Tomography [CT] Scan in Applicable Participants) Baseline; Week 24 Participants had an MRI of the upper and lower abdomen and pelvis to determine the spleen volume. A CT scan was substituted for participants who were not candidates for MRI or when MRI was not readily available.
- Secondary Outcome Measures
Name Time Method Time to the First ≥50% Reduction in TSS as Measured by the MFSAF v4.0 Diary Baseline; up to Week 24 Symptoms were assessed using the MFSAF v4.0 diary. The MFSAF v4.0 is composed of 7 individual symptom scores (fatigue, night sweats, itchiness, abdominal discomfort, pain under left ribs, early satiety, bone pain), each collected daily using a 0- (no symptoms) to 10-point (worst imaginable symptoms) scale. The daily TSS (0 to 70) is the sum of the 7 individual symptom scores collected in a day. A higher TSS corresponds to more severe symptoms. The TSS was marked as missing if there were any missing individual scores. Observations with missing dates were excluded from the analysis. The Baseline/Week 24 total score was defined as the average of the daily total scores from the last 7 days before the first dose of parsaclisib, placebo, or ruxolitinib/the Week 24 visit. The Baseline/Week 24 total scores was marked as missing if there were ≥4 out of the 7 daily TSSs missing. The 95% confidence interval was calculated using the Brookmeyer and Crowley's method with log-log transformation.
Percentage of Participants Who Have a ≥50% Reduction in Total Symptom Score (TSS) From Baseline to Week 24 as Measured by the Myelofibrosis Symptom Assessment Form v.4.0 (MFSAF v4.0) Diary Baseline; Week 24 Symptoms of myelofibrosis were assessed using the MFSAF v4.0 diary. The MFSAF v4.0 is composed of 7 individual symptom scores (fatigue, night sweats, itchiness, abdominal discomfort, pain under left ribs, early satiety, bone pain), each collected daily using a 0- (no symptoms) to 10-point (worst imaginable symptoms) scale. The daily TSS (0 to 70) is the sum of the 7 individual symptom scores collected in a day. A higher TSS corresponds to more severe symptoms. The TSS was marked as missing if there were any missing individual scores. Observations with missing dates were excluded from the analysis. The Baseline/Week 24 total score was defined as the average of the daily total scores from the last 7 days before the first dose of parsaclisib, placebo, or ruxolitinib/the Week 24 visit. The Baseline/Week 24 total score was marked as missing if there were ≥4 out of the 7 daily TSSs missing.
Change in TSS From Baseline to Week 24 as Measured by the MFSAF v4.0 Diary Baseline; Week 24 Symptoms of myelofibrosis were assessed using the MFSAF v4.0 diary. The MFSAF v4.0 is composed of 7 individual symptom scores (fatigue, night sweats, itchiness, abdominal discomfort, pain under left ribs, early satiety, bone pain), each collected daily using a 0- (no symptoms) to 10-point (worst imaginable symptoms) scale. The daily TSS (0 to 70) is the sum of the 7 individual symptom scores collected in a day. A higher TSS corresponds to more severe symptoms. The TSS was marked as missing if there were any missing individual scores. Observations with missing dates were excluded from the analysis. The Baseline/Week 24 total score was defined as the average of the daily total scores from the last 7 days before the first dose of parsaclisib, placebo, or ruxolitinib/the Week 24 visit. The Baseline/Week 24 total score was marked as missing if there were ≥4 out of the 7 daily TSSs missing. Change from Baseline was calculated as the Week 24 value minus the Baseline value.
Overall Survival up to 879 days Overall survival was defined as the interval between the randomization date and the date of death due to any cause.
Number of Participants With Any Treatment-emergent Adverse Event (TEAE) up to 879 days An adverse event (AE) is defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not it is considered drug related. An AE could therefore be any unfavorable or unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study treatment. A TEAE is defined as an AE reported for the first time or the worsening of a pre-existing event after the first dose of study treatment.
Number of Participants With Any Grade 3 or Higher TEAE up to 879 days An AE is defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not it is considered drug related. A TEAE is defined as an AE reported for the first time or the worsening of a pre-existing event after the first dose of study treatment. The severity of AEs was assessed using Common Terminology Criteria for Adverse Events (CTCAE) v5.0 Grades 1 through 5. Grade 1: mild; asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated. Grade 2: moderate; minimal, local or noninvasive intervention indicated; limiting instrumental activities of daily living (ADL). Grade 3: severe or medically significant but not immediately life-threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self care ADL. Grade 4: life-threatening urgent intervention indicated. Grade 5: death related to AE.
Time to the First ≥25% Reduction in Spleen Volume up to 879 days The time to the first ≥25% reduction in spleen volume is defined as the time from randomization to the first time participants had ≥25% reduction in spleen volume. Participants with a Baseline and post-Baseline MRI or CT scan who did not have ≥25% reduction in spleen volume at the time of analysis were censored at the time of the last MRI or CT scan. If the participants had no Baseline or post-Baseline MRI or CT scan, they were censored at the date of randomization.
Duration of Maintenance of a ≥25% Reduction in Spleen Volume up to 879 days The duration of ≥25% reduction from Baseline in spleen volume was defined as the interval between the first spleen volume measurement that was a ≥25% reduction from Baseline and the date of the first measurement that was no longer a ≥25% reduction from Baseline. If the end date was not observed before the database cutoff, the duration was censored at the last
Trial Locations
- Locations (170)
Emory University
🇺🇸Atlanta, Georgia, United States
Beth Israel Deaconess Medical Center
🇺🇸Boston, Massachusetts, United States
Cleveland Clinic
🇺🇸Cleveland, Ohio, United States
Renovatio Clinical
🇺🇸Houston, Texas, United States
Indiana University Melvin and Bren Simon Cancer Center
🇺🇸Indianapolis, Indiana, United States
Jinan Central Hospital
🇨🇳Jinan, China
The First Affiliated Hospital of Nanchang University
🇨🇳Nanchang, China
The Second Affiliated Hospital of Xi an Jiaotong University
🇨🇳Xi'an, China
University of Kansas Hospital Authority
🇺🇸Westwood, Kansas, United States
Azienda Ospedaliera Di Rilievo Nazionale E Di Alta Specializzazione Garibaldi
🇮🇹Catania, Italy
Irccs Azienda Ospedaliera Universitaria San Martino
🇮🇹Genova, Italy
Fondazione Irccs Ca Granda Ospedale Maggiore
🇮🇹Milano, Italy
Universita Di Napoli Federico Ii
🇮🇹Napoli, Italy
Azienda Ospedaliero Universitaria Maggiore Della Carita Di Novara
🇮🇹Novara, Italy
Ospedale S.Maria Della Misericordia
🇮🇹Perugia, Italy
Presidio Ospedaliero Pescara
🇮🇹Pescara, Italy
Azienda Ospedaliero Universitaria Pisana
🇮🇹Pisa, Italy
Azienda Ospedaliera Universitaria Senese Policlinico Santa Maria Alle Scotte
🇮🇹Siena, Italy
Azienda Sanitaria Universitaria Friuli Centrale Asu Fc
🇮🇹Udine, Italy
Oregon Health & Science University
🇺🇸Portland, Oregon, United States
CCARE
🇺🇸Fresno, California, United States
California Research Institute (Cri)
🇺🇸Los Angeles, California, United States
Coastal Integrated Cancer Care - Cicc
🇺🇸San Luis Obispo, California, United States
Texas Oncology - Medical City Dallas
🇺🇸Dallas, Texas, United States
Scripps Clinic
🇺🇸San Diego, California, United States
Samodzielny Publiczny Szpital Kliniczny Nr 1
🇵🇱Lublin, Poland
Kyushu University Hospital
🇯🇵Fukuoka, Japan
Emad Ibrahim Md Inc
🇺🇸Redlands, California, United States
Sutter Health Alta Bates Summit Medical Center Absmc Alta Bates Summit Comprehensive Cancer Center
🇺🇸Berkeley, California, United States
Massachusetts General Hospital
🇺🇸Boston, Massachusetts, United States
Westchester Medical Center Advanced Oncology
🇺🇸Hawthorne, New York, United States
Mount Sinai School of Medicine
🇺🇸New York, New York, United States
Memorial Sloan Kettering Cancer Center
🇺🇸New York, New York, United States
Duke Cancer Center
🇺🇸Durham, North Carolina, United States
Advent Health Hendersonville Park Ridge Hospital Hendersonville
🇺🇸Clyde, North Carolina, United States
Hillman Cancer Center
🇺🇸Pittsburgh, Pennsylvania, United States
Baptist Cancer Center
🇺🇸Memphis, Tennessee, United States
University of Texas Southwestern Medical Center
🇺🇸Dallas, Texas, United States
Texas Oncology - Baylor Sammons Cancer Center
🇺🇸Dallas, Texas, United States
Providence Regional Medical Center Everett
🇺🇸Everett, Washington, United States
AZ Delta
🇧🇪Roeselare, Belgium
Chu Ucl Namur University Hospital Mont-Godinne
🇧🇪Yvoir, Belgium
Peking University People'S Hospital (Pkuph) - Institute of Hematology
🇨🇳Beijing SHI, China
Xuanwu Hospital Capital Medical University
🇨🇳Beijing, China
The First Peoples Hospital of Changzhou
🇨🇳Changzhou, China
Harbin Institute of Hematology and Oncology
🇨🇳Harbin, China
The First Hospital of Jilin University
🇨🇳Changchun, China
Peking University Third Hospital
🇨🇳Beijing, China
The First Affiliated Hospital of Zhejiang University
🇨🇳Hangzhou, China
Nanfang Hospital
🇨🇳Guangzhou, China
Fujian Medical University Union Hospital
🇨🇳Fuzhou, China
University of Science and Technology of China-First Affiliated Hospital (Anhui Provincial Hospital)
🇨🇳Hefei, China
The Affiliated Hospital of Inner Mongolia Medical University
🇨🇳Hohhot, China
The Second Affiliated Hospital of Kunming Medical University
🇨🇳Kunming, China
The First Hospital of Lanzhou University
🇨🇳Lanzhou, China
Lanzhou University Second Hospital
🇨🇳Lanzhou, China
Jiangxi Provincial of People Hospital
🇨🇳Nanchang, China
Jiangsu Province Hospital
🇨🇳Nanjing, China
The Affiliated Hospital of Qingdao University
🇨🇳Qingdao, China
The First Hospital of China Medical University
🇨🇳Shenyang, China
Shenzhen University Hospital
🇨🇳Shenzhen, China
Tianjin Medical University General Hospital
🇨🇳Tianjin, China
Institute of Hematology and Hospital of Blood Diseases, Chinese Academy of Medical Sciences and Pek
🇨🇳Tianjin, China
Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology
🇨🇳Wuhan, China
Tongji Hospital Huazhong University of Science and Technology
🇨🇳Wuhan, China
Yantai Yuhuangding Hospital
🇨🇳Yantai, China
Henan Provincial Peoples Hospital
🇨🇳Zhengzhou, China
Helsinki University Central Hospital
🇫🇮Helsinki, Finland
Henan Cancer Hostipal
🇨🇳Zhengzhou, China
Centre Hospitalier Universitaire Grenoble Alpes (Chu Grenoble Alpes) - Hopital Albert Michallon
🇫🇷La Tronche, France
Chu de Limoges
🇫🇷Limoges Cedex, France
CHU Limoges - Hopital Duputren
🇫🇷Limoges Cedex, France
Centre Hospitalier Universitaire de Nantes (Chu de Nantes) - Hotel-Dieu
🇫🇷Nantes, France
Hospital Saint Antoine
🇫🇷Paris, France
Hospices Civils de Lyon Centre Hospitalier Lyon Sud
🇫🇷Pierre-Benite, France
Ap-Hp Groupe Hospitalier Saint-Louis Lariboisiere Fernand-Widal Site Saint Louis (Paris)
🇫🇷Paris, France
Chu Nimes
🇫🇷Nimes, France
Institut Universitaire Du Cancer de Toulouse Oncopole
🇫🇷Toulouse, France
Chu Vandoeuvre-Les-Nancy Hopital Brabois
🇫🇷Vandoeuvre-les-nancy, France
Universitatsklinikum Bonn Aoer
🇩🇪Bonn, Germany
Universitaetsmedizin Greifswald
🇩🇪Greifswald, Germany
Universitaetsmedizin Rostock
🇩🇪Rostock, Germany
Universitatsklinikum Halle (Saale)
🇩🇪Halle (saale), Germany
Samson Assuta Ashdod University Hospital
🇮🇱Ashdod, Israel
Hadassah Hebrew University Medical Center Ein Karem Hadassah
🇮🇱Jerusalem, Israel
Petz Aladar County Teaching Hospital
🇭🇺Gyor, Hungary
Kaplan Medical Center
🇮🇱Rehovot, Israel
Azienda Ospedaliera San Giuseppe Moscati
🇮🇹Taranto, Italy
Aou Policlinico Consorziale Di Bari
🇮🇹Bari, Italy
Lstituto Di Ematologia Lorenzo Ea.Seragnoli Universita Degli Studi Di Bologna - Policlinico S. Or
🇮🇹Bologna, Italy
University of Florence
🇮🇹Florence, Italy
Azienda Ospedaliera Ospedali Riuniti Villa Sofia - Cervello
🇮🇹Palermo, Italy
Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli
🇮🇹Reggio Calabria, Italy
Univ. Di Roma Facolta Di Armacia E Medicina
🇮🇹Roma, Italy
Policlinico Universitario Agostino Gemelli Universita Cattolica Del Sacro Cuore
🇮🇹Rome, Italy
Ospedale Sant. Eugenio
🇮🇹Roma, Italy
A.O. Universitaria Ospedale Di Circolo E Fondazione Macchi
🇮🇹Varese, Italy
Japanese Red Cross Society Himeji Hospital
🇯🇵Himeji-shi, Japan
Tokai University Hospital
🇯🇵Isehara, Japan
Kansai Medical University Hospital
🇯🇵Hirakata, Japan
Kagoshima University Hospital
🇯🇵Kagoshima, Japan
Hospital of the University of Occupation and Environmental Health
🇯🇵Kitakyushu-shi, Japan
Kumamoto Shinto General Hospital
🇯🇵Kumamoto-shi, Japan
Japanese Red Cross Nagoya Daini Hospital
🇯🇵Nagoya-shi, Japan
Osaka Metropolitan University Hospital
🇯🇵Osaka, Japan
Dokkyo Medical University Saitama Medical Center
🇯🇵Saitama, Japan
University of Yamanashi Hospital
🇯🇵Yamanashi, Japan
Pusan National University Yangsan Hospital
🇰🇷Busan, Korea, Republic of
Samsung Medical Center
🇰🇷Seoul, Korea, Republic of
Seoul National University Hospital
🇰🇷Seoul, Korea, Republic of
The Catholic University of Korea Seoul St. Mary?S Hospital
🇰🇷Seoul, Korea, Republic of
Haukeland University Hospital
🇳🇴Bergen, Norway
Akershus University Hospital
🇳🇴Lorenskog, Norway
Pratia Hematologia Katowice
🇵🇱Katowice, Poland
Samodzielny Publiczny Zoz Szpital Uniwersytecki W Krakowie
🇵🇱Krakow, Poland
Institute of Hematology and Transfusion Medicine
🇵🇱Warszawa, Poland
Spitalul Clinic Coltea - Clinica Hematologie
🇷🇴Bucharest,, Romania
Ico Hospital Germans Trias I Pujol
🇪🇸Badalona, Spain
Hospital General Unviersitario de Alicante
🇪🇸Alicante, Spain
Hospital Del Mar
🇪🇸Barcelona, Spain
Hospital General Universitario Vall D Hebron
🇪🇸Barcelona, Spain
Institut Catala Doncologia Ico - Hospital Duran I Reynals Location
🇪🇸Barcelona, Spain
Hospital Universitario 12 de Octubre
🇪🇸Madrid, Spain
Hospital General Universitario Morales Meseguer
🇪🇸Murcia, Spain
Hospital Universitario Insular de Gran Canaria
🇪🇸Las Palmas de Gran Canaria, Spain
Fundacion Jimenez Diaz University Hospital
🇪🇸Madrid, Spain
Hospital Clinico Universitario de Salamanca
🇪🇸Salamanca, Spain
Hospital Universitario Virgen de La Arrixaca
🇪🇸Murcia, Spain
Hospital Universitari I Politecnic La Fe
🇪🇸Valencia, Spain
Hospital Universitario Virgen Del Rocio
🇪🇸Sevilla, Spain
Hospital Universitario Miguel Servet
🇪🇸Zaragoza, Spain
Hospital Universitario Doctor Peset
🇪🇸Valencia, Spain
China Medical University Hospital
🇨🇳Taichung, Taiwan
National Cheng Kung University (Ncku) Hospital
🇨🇳Tainan, Taiwan
Gazi University Hospital Gazi University Faculty of Medicine
🇹🇷Ankara, Turkey
Istanbul Medipol Universitesi Ibagcilar Medipol Mega Universitesi Hastanesi
🇹🇷Istanbul, Turkey
Baskent University Istanbul Hospital
🇹🇷Istanbul, Turkey
Baskent University Adana Hospital
🇹🇷Adana, Turkey
Ege University Hospital
🇹🇷Izmir, Turkey
United Lincolnshire Hospitals
🇬🇧Boston, United Kingdom
Gloucestershire Royal Hospital
🇬🇧Gloucester, United Kingdom
James Cook University Hospital
🇬🇧Middlesbrough, United Kingdom
Grampian Health Board
🇬🇧Aberdeen, United Kingdom
Ondokuz Mayis University Medicine Faculty
🇹🇷Samsun, Turkey
University College London Hospitals Nhs Foundation Trust
🇬🇧London, United Kingdom
Kelsey Seybold Clinic
🇺🇸Houston, Texas, United States
Augusta University - Medical College of Georgia
🇺🇸Augusta, Georgia, United States
Kaohsiung Chang Gung Memorial Hospital
🇨🇳Kaohsiung City, Taiwan
New Jersey Hematology Oncology Associates Llc
🇺🇸Brick, New Jersey, United States
Assuta Ramat Hahayal
🇮🇱Tel Aviv, Israel
Rambam Health Care Campus
🇮🇱Haifa, Israel
University of Miyazaki Hospital
🇯🇵Miyazaki, Japan
Spitalul Clinic Judetean de Urgenta Targu Mures
🇷🇴Targu, Romania
Stamford Hospital - Medical Oncology Hematology
🇺🇸Stamford, Connecticut, United States
Jessa Ziekenhuis
🇧🇪Hasselt, Belgium
Semmelweis Egyetem
🇭🇺Budapest, Hungary
Hanusch-Krankenhaus Wiener Gebietskrankenkasse
🇦🇹Wien, Austria
A.Z. St.-Jan A.V.
🇧🇪Brugge, Belgium
Juntendo University Hospital
🇯🇵Tokyo, Japan
Kobe City Medical Center General Hospital
🇯🇵Kobe-shi, Japan
Hokuyukai Sapporo Hokuyu Hospital
🇯🇵Sapporo, Japan
Nippon Medical School Hospital
🇯🇵Tokyo, Japan
Georgetown University
🇺🇸Washington, District of Columbia, United States
Markhot Ferenc Korhaz
🇭🇺Eger, Hungary
Tel Aviv Sourasky Medical Center
🇮🇱Tel Aviv, Israel
Ogaki Municipal Hospital
🇯🇵Ogaki, Japan
Morristown Medical Center - Atlantic Health System
🇺🇸Morristown, New Jersey, United States
Tulane University
🇺🇸New Orleans, Louisiana, United States
Midamerica Cancer Care
🇺🇸Kansas City, Missouri, United States
Montefiore Medical Center
🇺🇸Bronx, New York, United States