GRAVITAS-309: Itacitinib and Corticosteroids as Initial Treatment for Chronic Graft-Versus-Host Disease
- Conditions
- Chronic Graft-versus-host Disease
- Interventions
- Registration Number
- NCT03584516
- Lead Sponsor
- Incyte Corporation
- Brief Summary
The purpose of this study is to assess the efficacy and safety of itacitinib in combination with corticosteroids as first-line treatment for moderate or severe chronic graft-versus-host disease (cGVHD).
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 155
- Active, clinically diagnosed, moderate or severe cGVHD per NIH Consensus Criteria
- Underwent allogeneic stem cell transplantation (allo-HCT)
- Karnofsky Performance Status score ≥ 60%.
- Evidence of myeloid and platelet engraftment.
- Willingness to avoid pregnancy or fathering children based on protocol-defined criteria.
- Has received more than 3 days/72 hours of systemic corticosteroid treatment for cGVHD.
- Has received any other systemic treatment for cGVHD, including extracorporeal photopheresis (ECP).
- Prior treatment with a Janus kinase (JAK) inhibitor for acute GVHD, unless the participant achieved complete or partial response and has been off JAK inhibitor treatment for at least 8 weeks before randomization.
- cGVHD occurring after a nonscheduled donor lymphocyte infusion (DLI) administered for pre-emptive treatment of malignancy recurrence.
- Evidence of relapsed primary malignancy.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- CROSSOVER
- Arm && Interventions
Group Intervention Description Part 1 : Dose determination of itacitinib Itacitinib itacitinib administered in combination with corticosteroids. Part 1 : Dose determination of itacitinib Methylprednisolone itacitinib administered in combination with corticosteroids. Part 1 : Dose expansion of itacitinib Itacitinib itacitinib administered in combination with corticosteroids or corticosteroids alone. Part 1 : Dose expansion of itacitinib Placebo itacitinib administered in combination with corticosteroids or corticosteroids alone. Part 1 : Dose expansion of itacitinib Prednisone itacitinib administered in combination with corticosteroids or corticosteroids alone. Part 2 : itacitinib recommended dose from part 1 Itacitinib itacitinib or placebo administered in combination with corticosteroids Part 2 : itacitinib recommended dose from part 1 Methylprednisolone itacitinib or placebo administered in combination with corticosteroids Part 1 : Dose determination of itacitinib Prednisone itacitinib administered in combination with corticosteroids. Part 2 : itacitinib recommended dose from part 1 Prednisone itacitinib or placebo administered in combination with corticosteroids Part 1 : Dose expansion of itacitinib Methylprednisolone itacitinib administered in combination with corticosteroids or corticosteroids alone.
- Primary Outcome Measures
Name Time Method Part 1: Number of Participants With Dose-limiting Toxicities (DLTs) up to Day 28 A DLT was defined as the occurrence of any protocol-defined toxicity with onset up to and including Day 28, except those with a clear alternative explanation. Participants who received at least 21 of 28 doses of study drug at the level assigned or had a DLT were considered evaluable for determining tolerability of the dose. Participants who did not achieve this duration of exposure and did not have a DLT were to be replaced for purposes of toxicity identification.
Part 1 Expansion: Number of Participants With Any Treatment-emergent Adverse Event (TEAE) until at least 30 days after the last dose of study treatment (up to 1103 days) An adverse event (AE) was defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not considered drug related. An AE could therefore have been any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study treatment. A TEAE was defined as any AE either reported for the first time or the worsening of a pre-existing event after the first dose of study drug.
Part 2: Response Rate at Month 6 Month 6 Response rate was defined as the percentage of participants that had complete response (CR) or partial response (PR), per National Institutes of Health (NIH) Consensus Criteria, as determined by the investigator, within 14 days of the post-Baseline visit date until new anti-GVHD therapy or overall response-progression or relapse/progression of underlying disease. CR was defined as the complete resolution of all signs and symptoms of cGvHD in all evaluable organs. PR was defined as an improvement in at least one organ without progression in other organs.
- Secondary Outcome Measures
Name Time Method Part 1 Expansion: Percentage of Participants With a ≥50% Reduction in Daily Corticosteroid Dose at Day 180 From the Corticosteroid Dose on Day 1 Day 1; Day 180 The corticosteroid dose at Day 180 was compared to the corticosteroid dose on Day 1 to assess reduction.
Part 1 Expansion: Response Rate at Months 3 and 6 Months 3 and 6 Response rate was defined as the percentage of participants that had CR or PR, per NIH Consensus Criteria, as determined by the investigator, within 14 days of the post-Baseline visit date until new anti-GVHD therapy or overall response-progression or relapse/progression of underlying disease. CR was defined as the complete resolution of all signs and symptoms of cGvHD in all evaluable organs. PR was defined as an improvement in at least one organ without progression in other organs.
Parts 1 and 1 Expansion: Cmax of Itacitinib Days 1, 7, and 28: predose and 1, 2, and 5 hours post-dose Cmax was defined as the maximum observed concentration of itacitinib.
Parts 1 and 1 Expansion: Ctau of Itacitinib Day 1: predose, and 1, 2, and 5 hours post-dose. Days 7 and 28: predose, and 1, 2, 5, 12 (for BID dosing), and 24 hours post-dose (for QD dosing) Ctau was defined as the trough concentration of itacitinib over the dose interval. For pharmacokinetic steady state Day 7 and Day 28, for the calculation of NCA exposure estimates (as more than 3 PK data points are necessary for the estimation beyond Cmax) it was assumed, that PK concentration returns to the predose value (at 12 hours post-dose for BID dosing; at 24 hours post-dose for QD dosing). Predose PK samples were transposed to 24 hours post-dose for QD administration and to 12 hours post-dose for BID administration to allow the steady-state NCA PK estimates on Day 7 and Day 28.
Parts 1 and 1 Expansion: Tmax of Itacitinib Day 1: predose, and 1, 2, and 5 hours post-dose. Days 7 and 28: predose, and 1, 2, 5, 12 (for BID dosing), and 24 hours post-dose (for QD dosing) tmax was defined as the time to the maximum concentration of itacitinib. For pharmacokinetic steady state Day 7 and Day 28, for the calculation of NCA exposure estimates (as more than 3 PK data points are necessary for the estimation beyond Cmax) it was assumed, that PK concentration returns to the predose value (at 12 hours post-dose for BID dosing; at 24 hours post-dose for QD dosing). Predose PK samples were transposed to 24 hours post-dose for QD administration and to 12 hours post-dose for BID administration to allow the steady-state NCA PK estimates on Day 7 and Day 28.
Parts 1 and 1 Expansion: Cl/F of Itacitinib Day 1: predose, and 1, 2, and 5 hours post-dose. Days 7 and 28: predose, and 1, 2, 5, 12 (for BID dosing), and 24 hours post-dose (for QD dosing) Cl/F was defined as the apparent oral dose clearance of itacitinib. For pharmacokinetic steady state Day 7 and Day 28, for the calculation of NCA exposure estimates (as more than 3 PK data points are necessary for the estimation beyond Cmax) it was assumed, that PK concentration returns to the predose value (at 12 hours post-dose for BID dosing; at 24 hours post-dose for QD dosing). Predose PK samples were transposed to 24 hours post-dose for QD administration and to 12 hours post-dose for BID administration to allow the steady-state NCA PK estimates on Day 7 and Day 28.
Part 2: Cmax of Itacitinib Days 1, 7, and 28: predose and 1, 2, and 5 hours post-dose Cmax was defined as the maximum observed concentration of itacitinib.
Part 2: Cmin of Itacitinib Days 1, 7, and 28: predose and 1, 2, and 5 hours post-dose Cmin was defined as the minimum observed plasma or serum concentration of itacitinib over the dose interval.
Part 2: Tmax of Itacitinib Days 1, 7, and 28: predose and 1, 2, and 5 hours post-dose tmax was defined as the time to the maximum concentration of itacitinib.
Part 2: AUC0-t of Itacitinib Days 1, 7, and 28: predose and 1, 2, and 5 hours post-dose AUC0-t was defined as the area under the plasma or serum concentration-time curve from time = 0 to the last measurable concentration at time = t.
Part 2: Cl/F of Itacitinib Days 1, 7, and 28: predose and 1, 2, and 5 hours post-dose Cl/F was defined as the apparent oral dose clearance of itacitinib.
Part 1: Response Rate at Months 3, 6, and 12 Months 3, 6, and 12 Response rate was defined as the percentage of participants that had CR or PR, per NIH Consensus Criteria, as determined by the investigator, within 14 days of the post-Baseline visit date until new anti-GVHD therapy or overall response-progression or relapse/progression of underlying disease. CR was defined as the complete resolution of all signs and symptoms of cGvHD in all evaluable organs. PR was defined as an improvement in at least one organ without progression in other organs.
Part 1 Expansion: Response Rate at Month 12 Month 12 Response rate was defined as the percentage of participants that had CR or PR, per NIH Consensus Criteria, as determined by the investigator, within 14 days of the post-Baseline visit date until new anti-GVHD therapy or overall response-progression or relapse/progression of underlying disease. CR was defined as the complete resolution of all signs and symptoms of cGvHD in all evaluable organs. PR was defined as an improvement in at least one organ without progression in other organs.
Part 1 Expansion: Time to Response up to Month 12 Time to response was defined as the interval between randomization and the first response (CR or PR) before initiation of new therapy. CR was defined as the complete resolution of all signs and symptoms of cGvHD in all evaluable organs. PR was defined as an improvement in at least one organ without progression in other organs.
Part 1 Expansion: Duration of Response up to 24 months Duration to response was defined as the interval between the first response and cGVHD progression, death, or the initiation of a new systemic cGVHD therapy.
Part 1 Expansion: Overall Survival up to 36 months Overall survival was defined as the interval between the date of randomization and the date of death due to any cause.
Part 1 Expansion: Nonrelapse Mortality (NRM) Rate up to 24 months NRM was defined as the percentage of participants who died due to causes other than a relapse of their primary hematologic disease.
Part 1 Expansion: Percentage of Participants Successfully Tapered Off All Corticosteroids at Day 180 Day 180 The percentage of participants who were not taking any corticosteroids at Day 180 was assessed.
Part 2: Percentage of Participants Successfully Tapered Off All Corticosteroids at Day 180 Day 180 The percentage of participants who were not taking any corticosteroids at Day 180 was assessed.
Part 1 Expansion: Relapse Rate of Malignant and Nonmalignant Hematologic Diseases up to 1073 days The relapse rate was defined as the percentage of participants whose underlying disease relapsed at any time during the course of the study.
Part 1 Expansion: Time to Primary Hematologic Disease Relapse up to 24 months Time to primary hematologic disease relapse was defined as the interval between the date of randomization and the date of relapse.
Part 2: Change From Baseline in Lee cGVHD Symptom Scale (LLS) Scores Baseline; End of Treatment in Phase 2 The LSS consists of 30 items in 7 subscales (skin, eye, mouth, lung, nutrition, energy, and psychological). It was to be used to assess patient-reported changes in health status, symptoms, and well being.
Part 2: Change From Baseline in Quality of Life-Short Form-36 Version 2 (QOL-SF-36 v2) Scores Baseline; End of Treatment in Phase 2 The QOL-SF-36 v2 is 36-item scale that captures changes in health status during the course of treatment. The SF-36 assesses 8 health concepts related to limitations in physical activities, social activities, bodily pain, general mental and physical health, and vitality. It was to be used to assess patient-reported changes in health status, symptoms, and well being.
Part 2: Change From Baseline in Patient Global Impression of Change (PGIC) Responses Baseline; End of Treatment in Phase 2 The PGIC is 1 question that captures the overall change in symptoms over the course of treatment. It was to be used to assess patient-reported changes in health status, symptoms, and well being.
Part 2: Change From Baseline in EQ-5D-3L Scores Baseline; End of Treatment in Phase 2 The EQ-5D-3L is a descriptive classification consisting of 5 dimensions of health: mobility, self-care, usual activities, anxiety/depression, and pain/discomfort. It was to be used to assess patient-reported changes in health status, symptoms, and well being.
Part 2: Change From Baseline in Patient Global Impression of Severity (PGIS) Responses Baseline; End of Treatment in Phase 2 The PGIS is 1 question that captures the overall change in the severity of symptoms over the previous week. It was to be used to assess patient-reported changes in health status, symptoms, and well being.
Part 2: Response Rate at Months 3 and 12 Months 3 and 12 Response rate was defined as the percentage of participants that had CR or PR, per NIH Consensus Criteria, as determined by the investigator, within 14 days of the post-Baseline visit date until new anti-GVHD therapy or overall response-progression or relapse/progression of underlying disease. CR was defined as the complete resolution of all signs and symptoms of cGvHD in all evaluable organs. PR was defined as an improvement in at least one organ without progression in other organs.
Part 2: Duration of Response up to 24 months Duration to response was defined as the interval between the first response and cGVHD progression, death, or the initiation of a new systemic cGVHD therapy.
Part 2: Overall Survival up to 36 months Overall survival was defined as the interval between the date of randomization and the date of death due to any cause.
Part 2: NRM Rate up to 24 months NRM was defined as the percentage of participants who died due to causes other than a relapse of their primary hematologic disease.
Part 2: Percentage of Participants With a ≥50% Reduction in Daily Corticosteroid Dose at Day 180 From the Corticosteroid Dose on Day 1 Day 1; Day 180 The corticosteroid dose at Day 180 was compared to the corticosteroid dose on Day 1 to assess reduction.
Part 2: Relapse Rate of Malignant and Nonmalignant Hematologic Diseases up to 24 months The relapse rate was defined as the defined as the percentage of participants whose underlying disease relapsed at any time during the course of the study.
Part 2: Time to Primary Hematologic Disease Relapse up to 24 months Time to primary hematologic disease relapse was defined as the interval between the date of randomization and the date of relapse.
Part 2: Number of Participants With Any TEAE up to 30 days after the last dose in Phase 2 An AE was defined as any untoward medical occurrence associated with the use of a drug in humans, whether or not considered drug related. An AE could therefore have been any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease (new or exacerbated) temporally associated with the use of study treatment. A TEAE was defined as any AE either reported for the first time or the worsening of a pre-existing event after the first dose of study drug.
Trial Locations
- Locations (133)
Winship Cancer Institute of Emory University
🇺🇸Atlanta, Georgia, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
Jefferson University Hospitals
🇺🇸Philadelphia, Pennsylvania, United States
Texas Oncology - Baylor Sammons Cancer Center
🇺🇸Dallas, Texas, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
Illinois Cancer Specialists
🇺🇸Chicago, Illinois, United States
Fred Hutchinson Cancer Research Center
🇺🇸Seattle, Washington, United States
Massachusetts General Hospital
🇺🇸Boston, Massachusetts, United States
University Hospitals Cleveland Medical Center
🇺🇸Cleveland, Ohio, United States
University of Miami Sylvester Comprehensive Cancer Center
🇺🇸Miami, Florida, United States
Indiana University Melvin and Bren Simon Cancer Center
🇺🇸Indianapolis, Indiana, United States
Narodowy Instytut Onkologii Im. Marii Sklodowskiej-Curie Panstwowy Instytut Badawczy Oddzial W Gliwi
🇵🇱Gliwice, Poland
Szpital Kliniczny Przemienienia Panskiego
🇵🇱Poznan, Poland
City of Hope National Medical Center
🇺🇸Duarte, California, United States
Hackensack University Medical Center
🇺🇸Hackensack, New Jersey, United States
Advocate Lutheran General Hospital - Oncology Specislists Sc
🇺🇸Park Ridge, Illinois, United States
Spectrum Health
🇺🇸Grand Rapids, Michigan, United States
Saint Louis University Cancer Center
🇺🇸Saint Louis, Missouri, United States
Western Pennsylvania Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
CENTRE HOSPITALIER UNIVERSITAIRE DE LI�GE - SART TILMAN
🇧🇪Liege, Belgium
The Finsen Centre National Hospital
🇩🇰Copenhagen, Denmark
Chu Amiens Picardie - Hopital Sud
🇫🇷Amiens, France
University of Maryland - Greenebaum Cancer Center
🇺🇸Baltimore, Maryland, United States
Stony Brook University Medical Center
🇺🇸Stony Brook, New York, United States
Universitair Ziekenhuis Gent
🇧🇪Gent, Belgium
University of Pittsburgh
🇺🇸Pittsburgh, Pennsylvania, United States
University of Kansas Hospital Authority
🇺🇸Westwood, Kansas, United States
University of Pennsylvania Abramson Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Ordensklinikum Linz Gmbh Elisabethinen
🇦🇹Linz, Austria
Universitair Ziekenhuis Antwerpen (Uza)
🇧🇪Edegem, Belgium
Universitaire Ziekenhuis Leuven - Gasthuisberg
🇧🇪Leuven, Belgium
Institut Jules Bordet
🇧🇪Brussels, Belgium
AZ DELTA
🇧🇪Roeselare, Belgium
Charite Berlin
🇩🇪Berlin, Germany
Texas Oncology - Medical City Dallas
🇺🇸Dallas, Texas, United States
Saskatchewan Cancer
🇨🇦Saskatoon, Saskatchewan, Canada
Azienda Policlinico Vittorio Emanuele
🇮🇹Catania, Italy
Policlinico Universitario Agostino Gemelli Universita Cattolica Del Sacro Cuore
🇮🇹Roma, Italy
Mtz Clinical Research Sp. Zo.O.
🇵🇱Warszawa, Poland
University of Minnesota, Masonic Cancer Center
🇺🇸Minneapolis, Minnesota, United States
Duke University Medical Center
🇺🇸Durham, North Carolina, United States
Oncology Hematology Care, Inc
🇺🇸Cincinnati, Ohio, United States
Azienda Socio Sanitaria Territoriale Degli Spedali Civili Di Brescia
🇮🇹Brescia, Italy
Centre Henri Becquerel
🇫🇷Rouen, France
Universitaetsklinikum Jena
🇩🇪Jena, Germany
Tufts Medical Center
🇺🇸Boston, Massachusetts, United States
University of Arkansas For Medical Sciences - Winthrop P Rockefeller Cancer Institute
🇺🇸Little Rock, Arkansas, United States
University of California San Diego Medical Center, Moores Cancer Center
🇺🇸La Jolla, California, United States
University of Arizona Cancer Center - Out Pt.
🇺🇸Tucson, Arizona, United States
Augusta University - Medical College of Georgia
🇺🇸Augusta, Georgia, United States
University of Rochester, James P. Wilmot Cancer Center
🇺🇸Rochester, New York, United States
Avera Cancer Institute
🇺🇸Sioux Falls, South Dakota, United States
Zna Stuivenberg
🇧🇪Antwerpen, Belgium
University of Alberta
🇨🇦Edmonton, Alberta, Canada
Hospital Maisonneuve Rosemont
🇨🇦Montreal, Quebec, Canada
Chu de Grenoble - Hopital Albert Michallon
🇫🇷Grenoble Cedex, France
Turku University Hospital
🇫🇮Turku, Finland
Centre Hospitalier D'Angers
🇫🇷Angers, France
Chru Hopitaux de Tours Hospital Bretonneau
🇫🇷Tours, France
Chu de Rennes - Hospital Pontchaillou
🇫🇷Rennes, France
Chu de Nice - Hospital L Archet
🇫🇷Nice, France
Institut Paoli-Calmettes
🇫🇷Marseille, France
Centre Hospitalier Universitaire de Nantes (Chu de Nantes) - Hotel-Dieu
🇫🇷Nantes, France
Universitatsklinikum Bonn Aoer
🇩🇪Bonn, Germany
University Medical Centre Hamburg-Eppendorf Centre of Oncology
🇩🇪Hamburg, Germany
Hopitaux de Brabois
🇫🇷Vandoeuvre Les Nancy, France
University Clinic Carl Gustav Carus Technical University Dresden
🇩🇪Dresden, Germany
UNIVERSIT�TSKLINIKUM HALLE (SAALE)
🇩🇪Halle, Germany
Universitatsklinikum Essen
🇩🇪Essen, Germany
Universitaetsklinikum Erlangen - Medizinische Klinik 5
🇩🇪Erlangen, Germany
Universitatsklinikum Koln
🇩🇪Koeln, Germany
A.O.U. Federico Ii
🇮🇹Napoli, Italy
University Hospital Mannheim
🇩🇪Mannheim, Germany
Selbststandige Abteilung Fur Hamatologie Und Internistische Onkologie
🇩🇪Leipzig, Germany
Universitatsmedizin Der Johannes Gutenberg-Universitat Mainz Iii
🇩🇪Mainz, Germany
Universitatsklinikum Munster
🇩🇪Muenster, Germany
Universitaetsmedizin Rostock
🇩🇪Rostock, Germany
University Hospital of West Attica - Attikon
🇬🇷Chaidari, Greece
Universitaetsklinikum in Tubingen
🇩🇪Tubingen, Germany
Iii Medizinische Klinik Und Poliklinik Klinikum Rechts Der Isar Technische Universitat Munchen
🇩🇪Munich, Germany
General Hospital of Thessaloniki G. Papanikolaou
🇬🇷Thessaloniki, Greece
Rabin Medical Center - Beilinson Hospital
🇮🇱Petach Tiqwa, Israel
Hadassah Hebrew University Medical Center Ein Karem Hadassah
🇮🇱Jerusalem, Israel
Rambam Medical Center
🇮🇱Haifa, Israel
CLINICA DI EMATOLOGIA, UNIVERSIT� POLITECNICA DELLE MARCHE
🇮🇹Ancona, Italy
Tel Aviv Sourasky Medical Center
🇮🇱Tel Aviv-yafo, Israel
Azienda Ospedaliera Papa Giovanni Xxiii
🇮🇹Bergamo, Italy
L AZIENDA OSPEDALIERO-UNIVERSITARIA DI BOLOGNA POLICLINICO S. ORSOLA � MALPIGHI
🇮🇹Bologna, Italy
Istituto Di Ricovero E Cura A Carattere Scientifico (Irccs) Ospedale San Raffaele
🇮🇹Milano, Italy
Fondazione Irccs Ca Granda Ospedale Maggiore
🇮🇹Milan, Italy
A.O.U. Di Modena - Policlinico
🇮🇹Modena, Italy
Azienda Ospedaliera Bianchi-Melacrino-Morelli Ospedali Riuniti
🇮🇹Reggio Calabria, Italy
Azienda Ospedaliera Ospedali Riuniti "Villa Sofia - Cervello"
🇮🇹Palermo, Italy
Comitato Di Bioetica Della Fondazione Irccs Policlinico San Matteo
🇮🇹Pavia, Italy
Universita Degli Studi Di Roma La Sapienza - Umberto I Policlinico Di Roma - Centro Di Ematologia
🇮🇹Roma, Italy
Irrcs Instituto Clinico Humanitas
🇮🇹Rozzano, Italy
I.R.C.C.S. Casa Sollievo Della Sofferenza
🇮🇹San Giovanni Rotondo, Italy
Azienda Ospedaliero Universitaria Citta Della Salute E Della Scienza
🇮🇹Torino, Italy
Azienda Ospedaliero-Universitaria Santa Maria Della Misericordia
🇮🇹Udine, Italy
Centro Ricerche Cliniche Di Verona (Crc)
🇮🇹Verona, Italy
Hospital de La Santa Creu I Sant Pau
🇪🇸Barcelona, Spain
Institut Catala D Oncologia
🇪🇸Badalona, Spain
Hospital General Universitario Gregorio Maranon
🇪🇸Madrid, Spain
Hospital Universitario Virgen de Las Nieves
🇪🇸Granada, Spain
Ico Institut Catala D Oncologia
🇪🇸L'hospitalet de Llobregat, Spain
Hospital Universitario Ramon Y Cajal
🇪🇸Madrid, Spain
Son Espases University Hospital
🇪🇸Palma, Spain
Hospital Regional Universitario de Malaga
🇪🇸Malaga, Spain
Hospital Clinico de Santiago de Compostela
🇪🇸Santiago de Compostela, Spain
Clinica Universidad de Navarra (Cun)
🇪🇸Pamplona, Spain
Hospital Universitario Y Politcnico de La Fe
🇪🇸Valencia, Spain
Hospital Universitario Marques de Valdecilla
🇪🇸Santander, Spain
Hospital Clinico Universitario de Salamanca
🇪🇸Salamanca, Spain
Karolinska University Hospital Huddinge
🇸🇪Huddinge, Sweden
Hospital Clinico Universitario de Valencia
🇪🇸Valencia, Spain
Skane University Hospital Lund
🇸🇪Lund, Sweden
University Hospital of Wales
🇬🇧Cardiff, United Kingdom
Bristol Haematology & Oncology Centre
🇬🇧Bristol, United Kingdom
Barts Health Nhs Trust - St Bartholomews Hospital
🇬🇧London, United Kingdom
Nottingham University Hospitals Nhs Trust
🇬🇧Nottingham, United Kingdom
King'S College Hospital (Nhs Foundation)
🇬🇧London, United Kingdom
Imperial College Healthcare Nhs Trust - Hammersmith Hospital
🇬🇧London, United Kingdom
St. George'S University Hospitals Nhs Foundation Trust
🇬🇧Tooting, United Kingdom
The Royal Marsden Nhs Foundation Trust - Sutton
🇬🇧Sutton, United Kingdom
University of Michigan
🇺🇸Ann Arbor, Michigan, United States
Henry Ford Health System
🇺🇸Detroit, Michigan, United States
Tri Star Bone Marrow Transplant
🇺🇸Nashville, Tennessee, United States
Vanderbilt-Ingram Cancer Center
🇺🇸Nashville, Tennessee, United States
Universitatsspital Zurich
🇨🇭Zurich, Switzerland
Uniwersyteckie Centrum Kliniczne
🇵🇱Gdansk, Poland
University Health Network
🇨🇦Toronto, Ontario, Canada
Tulane University
🇺🇸New Orleans, Louisiana, United States
St David'S South Austin Medical Center
🇺🇸Austin, Texas, United States