Chemotherapy in Treating Children With Down Syndrome and Myeloproliferative Disorder, Acute Myelogenous Leukemia, or Myelodysplastic Syndrome
- Conditions
- LeukemiaMyelodysplastic SyndromesMyelodysplastic/Myeloproliferative Neoplasms
- Interventions
- Registration Number
- NCT00003593
- Lead Sponsor
- Children's Oncology Group
- Brief Summary
RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Combining more than one drug may kill more tumor cells.
PURPOSE: Phase III trial to study the effectiveness of combination chemotherapy in treating children who have Down syndrome and myeloproliferative disorder, acute myelogenous leukemia, or myelodysplastic syndrome.
- Detailed Description
OBJECTIVES:
* Evaluate the efficacy of reduced-dose induction and intensification chemotherapy, in terms of remission rate, disease-free survival rate, and acute morbidity and mortality, in children with Down syndrome and acute myelogenous leukemia or myelodysplastic syndromes.
* Define the understanding of the natural history of transient myeloproliferative disorder (TMD) in children with Down syndrome.
* Determine whether there is a reduction of sequelae in long-term survivors after treatment with this regimen.
* Determine the incidence of subsequent leukemia in patients with transient myeloproliferative disorder treated with this regimen.
* Determine the predictive risk factors for developing subsequent leukemia in patients with transient myeloproliferative disorder treated with this regimen.
OUTLINE: This is a multicenter study.
* Group I: Patients are observed if their transient myeloproliferative disorder (TMD) does not require intervention. Patients who require therapy for TMD undergo leukapheresis or exchange transfusion for up to 3 consecutive days. If the TMD does not resolve or there is significant organ involvement, patients receive low-dose cytarabine IV continuously on days 0-4. Treatment repeats at least every 2 weeks for up to 4 courses. Patients who experience a recurrence of TMD at least 8 weeks after resolution or have refractory disease may proceed to group II for further treatment.
* Group II (closed to accrual as of 6/24/04 except for patients first enrolled in group I): Patients receive induction therapy comprising cytarabine IV continuously, daunorubicin IV continuously, and oral thioguanine twice daily on days 0-3. Treatment repeats every 28 days for 4 courses. Patients with no CNS disease at diagnosis receive cytarabine intrathecally (IT) on day 0. Patients with CNS disease at diagnosis receive cytarabine IT on days 0, 5, and 7. If CNS disease persists on day 7, patients receive up to 6 courses of cytarabine IT, hydrocortisone IT, and methotrexate IT, twice weekly beginning on day 10.
Patients who achieve remission after induction therapy receive 2 courses of intensification therapy, for approximately 4 months. During the first course, patients receive cytarabine IV over 3 hours twice daily on days 0, 1, 7, and 8. Patients also receive asparaginase intramuscularly on days 1 and 8. The second course of therapy comprises CNS prophylaxis. Patients with no CNS disease at diagnosis or whose CNS disease resolved by day 7 of induction therapy receive cytarabine IT on days 0, 7, and 14. Patients with persistent CNS disease on day 7 of induction therapy receive cytarabine IT, hydrocortisone IT, and methotrexate IT on days 0, 7, and 14.
Patients are followed monthly for 18 months, every 3 months for 1 year, every 6 months for 2.5 years, and then annually thereafter.
PROJECTED ACCRUAL: A total of 70 patients with acute myeloid leukemia or myelodysplastic syndromes will be accrued for this study within 3.2 years. A total of 88 patients with transient myeloproliferative disorder who enter remission will be accrued for this study within 5 years.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 254
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Arm B: AML/MDS patients only daunorubicin hydrochloride (closed to accrual as of 6/24/04 except for patients first enrolled in group I): Patients receive induction therapy comprising cytarabine IV continuously, daunorubicin hydrochloride IV continuously, and oral thioguanine twice daily on days 0-3. Treatment repeats every 28 days for 4 courses. Patients with no CNS disease at diagnosis receive cytarabine intrathecally (IT) on day 0. Patients with CNS disease at diagnosis receive cytarabine IT on days 0, 5, and 7. If CNS disease persists on day 7, patients receive up to 6 courses of cytarabine IT, therapeutic hydrocortisone IT, and methotrexate IT, twice weekly beginning on day 10. Asparaginase during Intensification 1 day 1 hour 18. Arm B: AML/MDS patients only therapeutic hydrocortisone (closed to accrual as of 6/24/04 except for patients first enrolled in group I): Patients receive induction therapy comprising cytarabine IV continuously, daunorubicin hydrochloride IV continuously, and oral thioguanine twice daily on days 0-3. Treatment repeats every 28 days for 4 courses. Patients with no CNS disease at diagnosis receive cytarabine intrathecally (IT) on day 0. Patients with CNS disease at diagnosis receive cytarabine IT on days 0, 5, and 7. If CNS disease persists on day 7, patients receive up to 6 courses of cytarabine IT, therapeutic hydrocortisone IT, and methotrexate IT, twice weekly beginning on day 10. Asparaginase during Intensification 1 day 1 hour 18. Arm A: TMD patients only cytarabine Patients are observed if their transient myeloproliferative disorder (TMD) does not require intervention. Patients who require therapy for TMD undergo leukapheresis or exchange transfusion for up to 3 consecutive days. If the TMD does not resolve or there is significant organ involvement, patients receive low-dose cytarabine IV continuously on days 0-4. Treatment repeats at least every 2 weeks for up to 4 courses. Patients who experience a recurrence of TMD at least 8 weeks after resolution or have refractory disease may proceed to group II for further treatment. patients will continue to be followed for remission induction, EFS, DFS and OS regardless of the type of leukemia that develops. Arm B: AML/MDS patients only asparaginase (closed to accrual as of 6/24/04 except for patients first enrolled in group I): Patients receive induction therapy comprising cytarabine IV continuously, daunorubicin hydrochloride IV continuously, and oral thioguanine twice daily on days 0-3. Treatment repeats every 28 days for 4 courses. Patients with no CNS disease at diagnosis receive cytarabine intrathecally (IT) on day 0. Patients with CNS disease at diagnosis receive cytarabine IT on days 0, 5, and 7. If CNS disease persists on day 7, patients receive up to 6 courses of cytarabine IT, therapeutic hydrocortisone IT, and methotrexate IT, twice weekly beginning on day 10. Asparaginase during Intensification 1 day 1 hour 18. Arm B: AML/MDS patients only cytarabine (closed to accrual as of 6/24/04 except for patients first enrolled in group I): Patients receive induction therapy comprising cytarabine IV continuously, daunorubicin hydrochloride IV continuously, and oral thioguanine twice daily on days 0-3. Treatment repeats every 28 days for 4 courses. Patients with no CNS disease at diagnosis receive cytarabine intrathecally (IT) on day 0. Patients with CNS disease at diagnosis receive cytarabine IT on days 0, 5, and 7. If CNS disease persists on day 7, patients receive up to 6 courses of cytarabine IT, therapeutic hydrocortisone IT, and methotrexate IT, twice weekly beginning on day 10. Asparaginase during Intensification 1 day 1 hour 18. Arm B: AML/MDS patients only methotrexate (closed to accrual as of 6/24/04 except for patients first enrolled in group I): Patients receive induction therapy comprising cytarabine IV continuously, daunorubicin hydrochloride IV continuously, and oral thioguanine twice daily on days 0-3. Treatment repeats every 28 days for 4 courses. Patients with no CNS disease at diagnosis receive cytarabine intrathecally (IT) on day 0. Patients with CNS disease at diagnosis receive cytarabine IT on days 0, 5, and 7. If CNS disease persists on day 7, patients receive up to 6 courses of cytarabine IT, therapeutic hydrocortisone IT, and methotrexate IT, twice weekly beginning on day 10. Asparaginase during Intensification 1 day 1 hour 18. Arm B: AML/MDS patients only thioguanine (closed to accrual as of 6/24/04 except for patients first enrolled in group I): Patients receive induction therapy comprising cytarabine IV continuously, daunorubicin hydrochloride IV continuously, and oral thioguanine twice daily on days 0-3. Treatment repeats every 28 days for 4 courses. Patients with no CNS disease at diagnosis receive cytarabine intrathecally (IT) on day 0. Patients with CNS disease at diagnosis receive cytarabine IT on days 0, 5, and 7. If CNS disease persists on day 7, patients receive up to 6 courses of cytarabine IT, therapeutic hydrocortisone IT, and methotrexate IT, twice weekly beginning on day 10. Asparaginase during Intensification 1 day 1 hour 18.
- Primary Outcome Measures
Name Time Method Event Free Survival Length of study
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (236)
Greenebaum Cancer Center at University of Maryland Medical Center
🇺🇸Baltimore, Maryland, United States
Naval Medical Center, Portsmouth
🇺🇸Portsmouth, Virginia, United States
Children's Memorial Hospital - Chicago
🇺🇸Chicago, Illinois, United States
Floating Hospital for Children
🇺🇸Boston, Massachusetts, United States
Ireland Cancer Center
🇺🇸Cleveland, Ohio, United States
Children's Hospital and Regional Medical Center - Seattle
🇺🇸Seattle, Washington, United States
Baylor College of Medicine
🇺🇸Houston, Texas, United States
Fred Hutchinson Cancer Research Center
🇺🇸Seattle, Washington, United States
Group Health Central Hospital
🇺🇸Seattle, Washington, United States
Sunrise Hospital and Medical Center
🇺🇸Las Vegas, Nevada, United States
Jackson Memorial Hospital
🇺🇸Miami, Florida, United States
Riley Children Cancer Center at Riley Hospital for Children
🇺🇸Indianapolis, Indiana, United States
St. Vincent Hospital and Health Care Center
🇺🇸Indianapolis, Indiana, United States
Children's Hospital and Health Center, San Diego
🇺🇸San Diego, California, United States
Children's Hospitals and Clinics - Minneapolis
🇺🇸Minneapolis, Minnesota, United States
University of Texas Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
MBCCOP - South Texas Pediatrics
🇺🇸San Antonio, Texas, United States
Methodist Cancer Center at Methodist Specialty and Transplant Hospital
🇺🇸San Antonio, Texas, United States
UCSF Comprehensive Cancer Center
🇺🇸San Francisco, California, United States
Princess Margaret Hospital for Children
🇦🇺Perth, Western Australia, Australia
CancerCare Manitoba
🇨🇦Winnipeg, Manitoba, Canada
Children's Hospital of Orange County
🇺🇸Orange, California, United States
Wesley Medical Center
🇺🇸Wichita, Kansas, United States
Arkansas Cancer Research Center at University of Arkansas for Medical Sciences
🇺🇸Little Rock, Arkansas, United States
East Tennessee Children's Hospital
🇺🇸Knoxville, Tennessee, United States
University of Connecticut Comprehensive Cancer Center at University of Connecticut Health Center
🇺🇸Farmington, Connecticut, United States
Avera Cancer Institute
🇺🇸Sioux Falls, South Dakota, United States
Sioux Valley Hospital at University of South Dakota Medical Center
🇺🇸Sioux Falls, South Dakota, United States
Children's Hospital of Greenville Hospital System
🇺🇸Greenville, South Carolina, United States
CCOP - St. Vincent Hospital Cancer Center, Green Bay
🇺🇸Green Bay, Wisconsin, United States
CCOP - Beaumont
🇺🇸Royal Oak, Michigan, United States
Marshfield Clinic
🇺🇸Marshfield, Wisconsin, United States
Lombardi Cancer Center at Georgetown University Medical Center
🇺🇸Washington, District of Columbia, United States
Eastern Maine Medical Center
🇺🇸Bangor, Maine, United States
Baystate Regional Cancer Program at Baystate Medical Center
🇺🇸Springfield, Massachusetts, United States
Children's National Medical Center
🇺🇸Washington, District of Columbia, United States
Children's Hospital Los Angeles
🇺🇸Los Angeles, California, United States
McGill University Health Center - Montreal Children's Hospital
🇨🇦Montreal, Quebec, Canada
Academisch Ziekenhuis Groningen
🇳🇱Groningen, Netherlands
Swiss Pediatric Oncology Group Bern
🇨ðŸ‡Bern, Switzerland
University of Massachusetts Memorial Medical Center - University Campus
🇺🇸Worcester, Massachusetts, United States
Alberta Children's Hospital
🇨🇦Calgary, Alberta, Canada
British Columbia Children's Hospital
🇨🇦Vancouver, British Columbia, Canada
Spectrum Health and DeVos Children's Hospital
🇺🇸Grand Rapids, Michigan, United States
Maine Children's Cancer Program
🇺🇸Scarborough, Maine, United States
Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute
🇺🇸Boston, Massachusetts, United States
Vanderbilt Children's Hospital
🇺🇸Nashville, Tennessee, United States
Bellin Memorial Hospital
🇺🇸Green Bay, Wisconsin, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
William Beaumont Hospital - Royal Oak
🇺🇸Royal Oak, Michigan, United States
Vermont Cancer Center at University of Vermont
🇺🇸Burlington, Vermont, United States
Breslin Cancer Center at Ingham Regional Medical Center
🇺🇸Lansing, Michigan, United States
Alfred I. duPont Hospital for Children
🇺🇸Wilmington, Delaware, United States
Gundersen Lutheran Cancer Center at Gundersen Lutheran Medical Center
🇺🇸La Crosse, Wisconsin, United States
St. Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Swiss Pediatric Oncology Group Geneva
🇨ðŸ‡Geneva, Switzerland
Rhode Island Hospital
🇺🇸Providence, Rhode Island, United States
Royal Children's Hospital
🇦🇺Parkville, Victoria, Australia
Newark Beth Israel Medical Center
🇺🇸Newark, New Jersey, United States
St. Joseph's Hospital and Medical Center
🇺🇸Paterson, New Jersey, United States
East Tennessee State University Cancer Center at Johnson City Medical Center
🇺🇸Johnson City, Tennessee, United States
Centre de Recherche du Centre Hospitalier de l'Universite Laval
🇨🇦Sainte Foy, Quebec, Canada
Cabell Huntington Hospital
🇺🇸Huntington, West Virginia, United States
San Jorge Childrens Hospital
🇵🇷Santurce, Puerto Rico
Allan Blair Cancer Centre at Pasqua Hospital
🇨🇦Regina, Saskatchewan, Canada
IWK Health Centre
🇨🇦Halifax, Nova Scotia, Canada
Janeway Children's Health and Rehabilitation Centre
🇨🇦St. John's, Newfoundland and Labrador, Canada
Hopital Sainte Justine
🇨🇦Montreal, Quebec, Canada
Puerto Rico Cancer Center at University of Puerto Rico - Medical Sciences Campus
🇵🇷San Juan, Puerto Rico
Saskatoon Cancer Centre
🇨🇦Saskatoon, Saskatchewan, Canada
Phoenix Children's Hospital
🇺🇸Phoenix, Arizona, United States
Children's Hospital of Michigan
🇺🇸Detroit, Michigan, United States
Josephine Ford Cancer Center at Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Van Elslander Cancer Center at St. John Hospital and Medical Center
🇺🇸Detroit, Michigan, United States
Children's Hospital at Oklahoma University Medical Center
🇺🇸Oklahoma City, Oklahoma, United States
Children's Hospital of Denver
🇺🇸Denver, Colorado, United States
Presbyterian - St. Luke's Medical Center
🇺🇸Denver, Colorado, United States
CCOP - Columbia River Oncology Program
🇺🇸Portland, Oregon, United States
Legacy Emanuel Hospital and Health Center & Children's Hospital
🇺🇸Portland, Oregon, United States
Doernbecher Children's Hospital at Oregon Health & Science University
🇺🇸Portland, Oregon, United States
St. Louis Children's Hospital
🇺🇸Saint Louis, Missouri, United States
St. Joseph's Children's Hospital
🇺🇸Tampa, Florida, United States
Mayo Clinic Cancer Center
🇺🇸Rochester, Minnesota, United States
Children's Hospital of Omaha
🇺🇸Omaha, Nebraska, United States
UNMC Eppley Cancer Center at the University of Nebraska Medical Center
🇺🇸Omaha, Nebraska, United States
Midwest Children's Cancer Center
🇺🇸Milwaukee, Wisconsin, United States
Cedars-Sinai Comprehensive Cancer Center at Cedars-Sinai Medical Center
🇺🇸Los Angeles, California, United States
Jonsson Comprehensive Cancer Center, UCLA
🇺🇸Los Angeles, California, United States
Joe DiMaggio Children's Hospital at Memorial
🇺🇸Hollywood, Florida, United States
Miami Children's Hospital
🇺🇸Miami, Florida, United States
Curtis & Elizabeth Anderson Cancer Institute at Memorial Health University Medical Center
🇺🇸Savannah, Georgia, United States
Advocate Hope Children's Hospital
🇺🇸Oak Lawn, Illinois, United States
Holden Comprehensive Cancer Center at University of Iowa
🇺🇸Iowa City, Iowa, United States
Lutheran General Cancer Care Center
🇺🇸Park Ridge, Illinois, United States
Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
🇺🇸Baltimore, Maryland, United States
Southern Illinois University School of Medicine
🇺🇸Springfield, Illinois, United States
Saint Jude Midwest Affiliate
🇺🇸Peoria, Illinois, United States
Brooklyn Hospital Center
🇺🇸Brooklyn, New York, United States
Cancer Center at Hackensack University Medical Center
🇺🇸Hackensack, New Jersey, United States
Cincinnati Children's Hospital Medical Center
🇺🇸Cincinnati, Ohio, United States
Brookdale University Hospital and Medical Center
🇺🇸Brooklyn, New York, United States
New York Weill Cornell Cancer Center at Cornell University
🇺🇸New York, New York, United States
Cancer Institute of New Jersey at Robert Wood Johnson University Hospital
🇺🇸New Brunswick, New Jersey, United States
Leo W. Jenkins Cancer Center of University Health Systems of Eastern Carolina
🇺🇸Greenville, North Carolina, United States
University of New Mexico Cancer Research and Treatment Center
🇺🇸Albuquerque, New Mexico, United States
Cancer Center of Albany Medical Center
🇺🇸Albany, New York, United States
Blumenthal Cancer Center at Carolinas Medical Center
🇺🇸Charlotte, North Carolina, United States
Schneider Children's Hospital
🇺🇸New Hyde Park, New York, United States
University Hospital at State University of New York - Upstate Medical University
🇺🇸Syracuse, New York, United States
CCOP - Oklahoma
🇺🇸Tulsa, Oklahoma, United States
Children's Hospital Medical Center of Akron
🇺🇸Akron, Ohio, United States
Cleveland Clinic Taussig Cancer Center
🇺🇸Cleveland, Ohio, United States
Palmetto Health South Carolina Cancer Center
🇺🇸Columbia, South Carolina, United States
Toledo Children's Hospital
🇺🇸Toledo, Ohio, United States
Huntsman Cancer Institute
🇺🇸Salt Lake City, Utah, United States
Children's Hospital at Westmead
🇦🇺Westmead, New South Wales, Australia
West Virginia University Hospitals
🇺🇸Morgantown, West Virginia, United States
Madigan Army Medical Center
🇺🇸Tacoma, Washington, United States
Children's Hospital of Western Ontario
🇨🇦London, Ontario, Canada
McMaster Children's Hospital at Hamilton Health Sciences
🇨🇦Hamilton, Ontario, Canada
Sydney Children's Hospital
🇦🇺Randwick, New South Wales, Australia
Cross Cancer Institute
🇨🇦Edmonton, Alberta, Canada
Hospital for Sick Children
🇨🇦Toronto, Ontario, Canada
Starship Children's Hospital
🇳🇿Auckland, New Zealand
Children's Hospitals and Clinics - Minnesota
🇺🇸Saint Paul, Minnesota, United States
Children's Hospital of Southwest Florida
🇺🇸Fort Myers, Florida, United States
Nemours Children's Clinic
🇺🇸Jacksonville, Florida, United States
Sacred Heart Children's Hospital
🇺🇸Pensacola, Florida, United States
St. Mary's Hospital
🇺🇸West Palm Beach, Florida, United States
Mission Hospitals
🇺🇸Asheville, North Carolina, United States
Duke Comprehensive Cancer Center
🇺🇸Durham, North Carolina, United States
Children's Hospital of Columbus
🇺🇸Columbus, Ohio, United States
Children's Medical Center - Dayton
🇺🇸Dayton, Ohio, United States
St. Vincent Mercy Medical Center
🇺🇸Toledo, Ohio, United States
Forum Health-Tod Childrens Hospital
🇺🇸Youngstown, Ohio, United States
Penn State Cancer Institute at Milton S. Hershey Medical Center
🇺🇸Hershey, Pennsylvania, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
St. Christopher's Hospital for Children
🇺🇸Philadelphia, Pennsylvania, United States
Children's Hospital of Pittsburgh
🇺🇸Pittsburgh, Pennsylvania, United States
Medical City Dallas Hospital
🇺🇸Dallas, Texas, United States
University of Texas Medical Branch
🇺🇸Galveston, Texas, United States
Texas Tech University Health Sciences Center School of Medicine
🇺🇸Amarillo, Texas, United States
Cook Children's Medical Center - Fort Worth
🇺🇸Fort Worth, Texas, United States
University of Texas - MD Anderson Cancer Center
🇺🇸Houston, Texas, United States
Cancer Center at the University of Virginia
🇺🇸Charlottesville, Virginia, United States
Carilion Medical Center for Children
🇺🇸Roanoke, Virginia, United States
CCOP - Scott and White Hospital
🇺🇸Temple, Texas, United States
Center for Cancer Prevention and Care at Scott and White Clinic
🇺🇸Temple, Texas, United States
Deaconess Medical Center
🇺🇸Spokane, Washington, United States
SUNY Downstate Medical Center
🇺🇸Brooklyn, New York, United States
North Shore University Hospital
🇺🇸Manhasset, New York, United States
Memorial Sloan-Kettering Cancer Center
🇺🇸New York, New York, United States
James P. Wilmot Cancer Center at University of Rochester Medical Center
🇺🇸Rochester, New York, United States
Mount Sinai School of Medicine
🇺🇸New York, New York, United States
Herbert Irving Comprehensive Cancer Center at Columbia University
🇺🇸New York, New York, United States
Arizona Cancer Center at University of Arizona Health Sciences Center
🇺🇸Tucson, Arizona, United States
Cancer Research Center of Hawaii
🇺🇸Honolulu, Hawaii, United States
MBCCOP - Hawaii
🇺🇸Honolulu, Hawaii, United States
Blank Children's Hospital
🇺🇸Des Moines, Iowa, United States
Baptist Hospital of Miami
🇺🇸Miami, Florida, United States
Inova Fairfax Hospital
🇺🇸Falls Church, Virginia, United States
Mary Bridge Children's Hospital and Health Center
🇺🇸Tacoma, Washington, United States
University of South Alabama Cancer Research Institute
🇺🇸Mobile, Alabama, United States
University of Alabama at Birmingham Comprehensive Cancer Center
🇺🇸Birmingham, Alabama, United States
Southern California Permanente Medical Group
🇺🇸Downey, California, United States
City of Hope Comprehensive Cancer Center
🇺🇸Duarte, California, United States
Rebecca and John Moores UCSD Cancer Center
🇺🇸La Jolla, California, United States
Jonathan Jaques Children's Cancer Center at Miller Children's Hospital
🇺🇸Long Beach, California, United States
Loma Linda University Cancer Institute at Loma Linda University Medical Center
🇺🇸Loma Linda, California, United States
Children's Hospital and Research Center at Oakland
🇺🇸Oakland, California, United States
Chao Family Comprehensive Cancer Center at University of California Irvine Cancer Center
🇺🇸Orange, California, United States
Children's Hospital Central California
🇺🇸Madera, California, United States
Lucile Packard Children's Hospital at Stanford University Medical Center
🇺🇸Palo Alto, California, United States
Kaiser Permanente Medical Center/Kaiser Foundation Hospital - San Diego
🇺🇸San Diego, California, United States
Kaiser Permanente Medical Center - Santa Clara
🇺🇸Santa Clara, California, United States
Santa Barbara Cottage Hospital
🇺🇸Santa Barbara, California, United States
David Grant Medical Center
🇺🇸Travis Air Force Base, California, United States
Broward General Medical Center
🇺🇸Fort Lauderdale, Florida, United States
Walter Reed Army Medical Center
🇺🇸Washington, District of Columbia, United States
All Children's Hospital
🇺🇸St. Petersburg, Florida, United States
AFLAC Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta - Scottish RiteCampus
🇺🇸Atlanta, Georgia, United States
Medical Center of Central Georgia
🇺🇸Macon, Georgia, United States
MBCCOP-Medical College of Georgia Cancer Center
🇺🇸Augusta, Georgia, United States
University of Illinois Medical Center
🇺🇸Chicago, Illinois, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
Mountain States Tumor Institute - Boise
🇺🇸Boise, Idaho, United States
University of Chicago Cancer Research Center
🇺🇸Chicago, Illinois, United States
Cardinal Glennon Children's Hospital
🇺🇸Saint Louis, Missouri, United States
St. Mary's - Duluth Clinic Cancer Center
🇺🇸Duluth, Minnesota, United States
Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center
🇺🇸Lebanon, New Hampshire, United States
Valerie Fund Children's Center at Atlantic Health
🇺🇸Summit, New Jersey, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
Presbyterian Healthcare
🇺🇸Charlotte, North Carolina, United States
Long Island Cancer Center at Stony Brook University Hospital
🇺🇸Stony Brook, New York, United States
Dakota Cancer Institute at Innovis Health - Dakota Clinic
🇺🇸Fargo, North Dakota, United States
Natalie Warren Bryant Cancer Center
🇺🇸Tulsa, Oklahoma, United States
Children's Hospital of Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
St. Jude Children's Research Hospital
🇺🇸Memphis, Tennessee, United States
Simmons Cancer Center at University of Texas Southwestern Medical Center - Dallas
🇺🇸Dallas, Texas, United States
Covenant Children's Hospital
🇺🇸Lubbock, Texas, United States
San Antonio Military Pediatric Cancer and Blood Disorders Center
🇺🇸Lackland Air Force Base, Texas, United States
Children's Hospital of the King's Daughters
🇺🇸Norfolk, Virginia, United States
Women's and Children's Hospital
🇦🇺North Adelaide, South Australia, Australia
Children's Hospital of Eastern Ontario
🇨🇦Ottawa, Ontario, Canada
Swiss Pediatric Oncology Group Lausanne
🇨ðŸ‡Lausanne, Switzerland
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
New York Medical College
🇺🇸Valhalla, New York, United States
CCOP - Marshfield Clinic Research Foundation
🇺🇸Marshfield, Wisconsin, United States
West Virginia University - Robert C. Byrd Health Sciences Center - Charleston Division
🇺🇸Charleston, West Virginia, United States
Comprehensive Cancer Center at Maimonides Medical Center
🇺🇸Brooklyn, New York, United States
Sutter Cancer Center
🇺🇸Sacramento, California, United States
Yale Comprehensive Cancer Center
🇺🇸New Haven, Connecticut, United States
Nemours Children's Clinic-Orlando
🇺🇸Orlando, Florida, United States
University of California Davis Cancer Center
🇺🇸Sacramento, California, United States
Kaiser Permanente Medical Center - Sacramento
🇺🇸Sacramento, California, United States
University of Michigan Comprehensive Cancer Center
🇺🇸Ann Arbor, Michigan, United States
Kosair Children's Hospital
🇺🇸Louisville, Kentucky, United States
Florida Hospital Cancer Institute
🇺🇸Orlando, Florida, United States
Children's Mercy Hospital
🇺🇸Kansas City, Missouri, United States
Lineberger Comprehensive Cancer Center at University of North Carolina - Chapel Hill
🇺🇸Chapel Hill, North Carolina, United States
Comprehensive Cancer Center at Wake Forest University
🇺🇸Winston-Salem, North Carolina, United States
Hollings Cancer Center at Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Sinai Hospital of Baltimore
🇺🇸Baltimore, Maryland, United States
MBCCOP - LSU Health Sciences Center
🇺🇸New Orleans, Louisiana, United States
Tulane Cancer Center at Tulane University Hospital and Clinic
🇺🇸New Orleans, Louisiana, United States
Ochsner Clinic Foundation
🇺🇸New Orleans, Louisiana, United States
Children's Hospital of New Orleans
🇺🇸New Orleans, Louisiana, United States
Children's Hospital of Austin
🇺🇸Austin, Texas, United States
Massey Cancer Center at Virginia Commonwealth University
🇺🇸Richmond, Virginia, United States
Shands Cancer Center at the University of Florida Health Science Center
🇺🇸Gainesville, Florida, United States
Tripler Army Medical Center
🇺🇸Honolulu, Hawaii, United States
John Stoddard Cancer Center at Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Markey Cancer Center at University of Kentucky Chandler Medical Center
🇺🇸Lexington, Kentucky, United States
Albert Einstein Clinical Cancer Center
🇺🇸Bronx, New York, United States
University of Wisconsin Comprehensive Cancer Center
🇺🇸Madison, Wisconsin, United States