Study of Oral Navitoclax Tablet in Combination With Oral Ruxolitinib Tablet to Assess Change in Spleen Volume in Adult Participants With Relapsed/Refractory Myelofibrosis
- Conditions
- Myelofibrosis (MF)
- Interventions
- Registration Number
- NCT04468984
- Lead Sponsor
- AbbVie
- Brief Summary
Myelofibrosis (MF) is a rare blood cancer, notable for scarring of the bone marrow (the spongy tissue inside bones) and the spleen becoming larger. The purpose of this study is to assess safety and change in spleen volume when navitoclax is given in combination with ruxolitinib, compared to best available therapy, for adult participants with MF.
Navitoclax is an investigational drug (not yet approved) being developed for the treatment of MF. Participants in this study will be randomly selected (like picking numbers out of a hat) to be in 1 of 2 treatment arms. Neither participants nor the study doctor will be able to pick which treatment arm a participants enters. In Arm A, participants will receive navitoclax in combination with ruxolitinib. In Arm B, participants will receive the best available therapy (BAT) for MF. Adult participants with a diagnosis of MF that came back or did not get better after earlier treatment will be enrolled. Approximately 330 participants will be enrolled in approximately 210 sites across the world.
In Arm A, participants will receive navitoclax tablet by mouth once daily with by mouth ruxolitinib tablet twice daily. In Arm B, participants will receive the BAT available to the investigator. Participants will receive the study drug until they experience no benefit (determined by the investigator), participants cannot tolerate the study drugs, or participants withdraw consent. The approximate treatment duration is about 3 years.
There may be higher treatment burden for participants in this trial compared to their standard of care. Participants will attend regular visits during the study at a hospital or clinic. The effect of treatment will be checked by medical assessments, blood and bone marrow tests, checking for side effects, and completing questionnaires.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 295
-
Must complete the Myelofibrosis Symptom Assessment Form (MFSAF) v4.0 on at least 4 out of the 7 days immediately prior to the date of randomization and must agree to collect MFSAF data daily by ePRO device during the study collection window.
-- Has at least 2 symptoms each with an average score >= 3 or an average total score of >= 12, as measured by the MFSAF v4.0.
-
Documented diagnosis of primary myelofibrosis (MF) as defined by the World Health Organization (WHO) classification, post polycythemia vera (PPV)-MF, or post essential thrombocytopenia (PET)-MF, characterized by bone marrow fibrosis grades 2 or 3.
-
Classified as intermediate-2 or high-risk MF, as defined by the Dynamic International Prognostic Scoring System Plus (DIPSS+).
-
Must currently be on treatment or have received prior treatment with a single Janus Kinase 2 (JAK2) inhibitor, ruxolitinib, and meet one of the following criteria (in addition to the minimum splenomegaly and symptom burden also required for eligibility):
-
Treatment with ruxolitinib for >= 24 weeks that was stopped due to lack of spleen response (refractory), or loss of spleen response or symptom control after a previous response (relapsed), or was continued despite relapsed/refractory status.
-
Treatment with ruxolitinib for < 24 weeks with documented disease progression while on therapy as defined by any of the following:
- Appearance of new splenomegaly that is palpable to at least 5 cm below the left costal margin (LCM) in participants with no evidence of splenomegaly prior to the initiation of ruxolitinib.
- A >= 100% increase in the palpable distance below the LCM in participants with measurable spleen distance 5 to 10 centimeters (cm) prior to the initiation of ruxolitinib.
- A >= 50% increase in the palpable distance below the LCM in participants with measurable spleen distance > 10 cm prior to the initiation of ruxolitinib.
- A spleen volume increase of >= 25% (as assessed by Magnetic Resonance Imaging [MRI] or Computed Tomography [CT] scan) in participants with a spleen volume assessment prior to the initiation of ruxolitinib.
-
Prior treatment with ruxolitinib of at least 10 mg twice daily (BID) for >= 28 days with intolerance defined as new RBC transfusion requirement (at least 2 units/month for 2 months) while receiving a total daily ruxolitinib dose of >= 30 mg but unable to reduce dose further due to lack of efficacy.
-
Note: Participant must not require a ruxolitinib dose less than 10 mg BID (20 mg daily) due to prior history of ruxolitinibrelated ≥ Grade 3 toxicity.
- Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2.
- Splenomegaly defined as palpable spleen measurement >= 5 cm below left costal margin or spleen volume >= 450 cm3 as assessed centrally by MRI or CT scan.
- Baseline platelet count >= 100 × 10^9/L.
- Received prior treatment with a BH3-mimetic compound, bromodomain and extra-terminal (BET) inhibitor, or prior use of > 1 JAK2 inhibitor or stem cell transplant.
- Eligible for stem cell transplantation at the time of study entry.
- Receiving medication that interferes with coagulation or platelet function within 3 days prior to the first dose of study drug or during the study treatment period except for low dose aspirin (up to 100 mg daily) and low molecular weight heparin (LMWH).
- Receiving anticancer therapy for an active malignancy or MF including chemotherapy, radiation therapy, hormonal therapy such that at least 5 half-lives of that medication is completed at least 7 days prior to the first dose of study drug or within 30 days prior to first dose of study drug, whichever is shorter, and during the study treatment period (other than any overlapping therapy as part of the selected BAT).
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm B: Best Available Therapy (BAT) Best Available Therapy (BAT) Participants will receive one of the BAT options, per the investigator's discretion. Arm A: Navitoclax + Ruxolitinib Navitoclax Participants will receive navitoclax tablets once daily and ruxolitinib tablets twice daily. Arm A: Navitoclax + Ruxolitinib Ruxolitinib Participants will receive navitoclax tablets once daily and ruxolitinib tablets twice daily.
- Primary Outcome Measures
Name Time Method Percentage of Participants who achieve Spleen Volume Reduction of at least 35% at Week 24 (SVR35W24) At Week 24 Reduction in spleen volume is measured by Magnetic Resonance Imaging (MRI) or Computed Tomography (CT), per International Working Group (IWG) criteria.
- Secondary Outcome Measures
Name Time Method Percentage of Participants with Overall Survival Last Visit Up to 5 Years Overall survival is defined as the time from start of study to the date of death from any cause.
Percentage of Participants with Anemia Response Baseline (Week 0) Up to Week 97 Anemia response per International Working Group (IWG) criteria will be assessed.
Percentage of Participants with Change in Fatigue Baseline (Week 0) Up to Week 24 Change in fatigue will be assessed using the Patient Reported Outcomes Measurement Information System (PROMIS) Fatigue Short Form (SF) 7a.
Percentage of Participants who achieve at least 50% Reduction in Total Symptom Score (TSS) Baseline (Week 0) Up to Week 24 Reduction in TSS is measured by Myelofibrosis Symptom Assessment Form (MFSAF) v4.0.
Percentage of Participants who achieve Spleen Volume Reduction of at least 35% at any time Baseline (Week 0) Up to Week 97 Reduction in spleen volume is measured by Magnetic Resonance Imaging (MRI) or Computed Tomography (CT), per International Working Group (IWG) criteria.
Percentage of Participants with Reduction in Grade of Bone Marrow Fibrosis Baseline (Week 0) Up to Week 97 Reduction in grade of bone marrow fibrosis from baseline as measured by the European consensus grading system will be assessed.
Percentage of Participants with Leukemia-free Survival Last Visit Up to 5 Years Leukemia free survival is the time from start of study to the date of development of leukemia.
Time to Deterioration of Physical Functioning Baseline (Week 0) Up to Week 97 Time to deterioration of physical functioning is measured by the physical functioning domain of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30, or death.
Percentage of Participants with at Least 50% Reduction in TSS Baseline (Week 0) Up to Week 97 At least 50% reduction in TSS from baseline (at any time) as measured by MFSAF v4.0.
Trial Locations
- Locations (215)
Hospital of the University of Pennsylvania /ID# 219001
🇺🇸Philadelphia, Pennsylvania, United States
Princess Margaret Cancer Centre /ID# 253942
🇨🇦Toronto, Ontario, Canada
Klinikum Wels-Grieskirchen GmbH /ID# 220915
🇦🇹Wels, Oberoesterreich, Austria
UMHAT Dr Georgi Stranski EAD /ID# 231650
🇧🇬Pleven, Bulgaria
CISSS-CA (Centre Integre de sante et de services sociaux de Chaudiere-Appalache) /ID# 222433
🇨🇦Levis, Quebec, Canada
Chu de Nice-Hopital Larchet Ii /Id# 256291
🇫🇷Nice, Alpes-Maritimes, France
CHU NIMES - Hopital Caremeau /ID# 219128
🇫🇷Nimes CEDEX 9, Gard, France
Centre Hospitalier Métropole Savoie - Site Hôpital de Chambéry /ID# 223771
🇫🇷Chambery CEDEX, Savoie, France
CHU de Nantes, Hotel Dieu -HME /ID# 219127
🇫🇷Nantes, Pays-de-la-Loire, France
Olympion General Clinic /ID# 261423
🇬🇷Patras, Achaia, Greece
Fejér Vármegyei Szent György Egyetemi Oktató Kórház /ID# 220949
🇭🇺Szekesfehervar, Fejer, Hungary
Szabolcs-Szatmar-Bereg Varmegyei Oktatokorhaz /ID# 220946
🇭🇺Nyiregyhaza, Szabolcs-Szatmar-Bereg, Hungary
Szegedi Tudományegyetem /ID# 220955
🇭🇺Szeged, Hungary
HaEmek Medical Center /ID# 220839
🇮🇱Afula, H_efa, Israel
Rambam Health Care Campus /ID# 219121
🇮🇱Haifa, H_efa, Israel
Yitzhak Shamir Medical Center /ID# 222972
🇮🇱Zerifin, HaMerkaz, Israel
Galilee Medical Center /ID# 225280
🇮🇱Nahariya, HaTsafon, Israel
The Chaim Sheba Medical Center /ID# 219136
🇮🇱Ramat Gan, Tel-Aviv, Israel
Tel Aviv Sourasky Medical Center /ID# 219135
🇮🇱Tel Aviv, Tel-Aviv, Israel
Hadassah Medical Center-Hebrew University /ID# 219111
🇮🇱Jerusalem, Yerushalayim, Israel
Hadassah Mt. Scopus /ID# 253394
🇮🇱Jerusalem, Yerushalayim, Israel
Rabin Medical Center /ID# 219139
🇮🇱Haifa, Israel
Azienda Ospedaliero Universitaria Ospedali Riuniti Do Ancona /ID# 238438
🇮🇹Torette, Ancona, Italy
Fondazione Policlinico Universitario Agostino Gemelli IRCCS-Universita Cattolica /ID# 219087
🇮🇹Rome, Lazio, Italy
Fujita Health University Hospital /ID# 221598
🇯🇵Toyoake, Aichi, Japan
Aomori Prefectural Central Hospital /ID# 221778
🇯🇵Aomori-shi, Aomori, Japan
Kobe City Medical Center General Hospital /ID# 221156
🇯🇵Kobe-shi, Hyogo, Japan
Kanazawa University Hospital /ID# 223028
🇯🇵Kanazawa-shi, Ishikawa, Japan
Mie University Hospital /ID# 221665
🇯🇵Tsu-shi, Mie, Japan
Niigata University Medical & Dental Hospital /ID# 223034
🇯🇵Niigata-shi, Niigata, Japan
Osaka University Hospital /ID# 221159
🇯🇵Suita-shi, Osaka, Japan
SP ZOZ Szpital Uniwersytecki w Krakowie /ID# 221160
🇵🇱Krakow, Malopolskie, Poland
Szpital Kliniczny im. Heliodora Swiecickiego Uniwersytetu Medycznego im. Karola /ID# 241031
🇵🇱Poznan, Wielkopolskie, Poland
Almazov National Medical Research Centre /ID# 221114
🇷🇺Sankt-Peterburg, Russian Federation
Nippon Medical School Hospital /ID# 221676
🇯🇵Bunkyo-ku, Tokyo, Japan
University of Yamanashi Hospital /ID# 221706
🇯🇵Chuo-shi, Yamanashi, Japan
IMSUT Hospital, The Institute of Medical Science, The University of Tokyo /ID# 257944
🇯🇵Tokyo, Japan
Wojewódzkie Wielospecjalistyczne Centrum Onkologii i Traumatologii im. M. Kopern /ID# 221161
🇵🇱Lodz, Lodzkie, Poland
University Clinical Center Serbia /ID# 231058
🇷🇸Belgrade, Beograd, Serbia
University Clinical Center Vojvodina /ID# 231057
🇷🇸Novi Sad, Serbia
Kaohsiung Medical University Chung-Ho Memorial Hospital /ID# 218980
🇨🇳Kaohsiung, Taiwan
Dana-Farber Cancer Institute /ID# 218998
🇺🇸Boston, Massachusetts, United States
MetroHealth Medical Center /ID# 222650
🇺🇸Cleveland, Ohio, United States
Columbus Regional Research Institute /ID# 224410
🇺🇸Columbus, Georgia, United States
Cliniques Universitaires UCL Saint-Luc /ID# 224221
🇧🇪Woluwe-Saint-Lambert, Bruxelles-Capitale, Belgium
UZ Gent /ID# 220841
🇧🇪Gent, Oost-Vlaanderen, Belgium
Vitaz /Id# 228150
🇧🇪Sint-Niklaas, Belgium
Acibadem City Clinic Tokuda University Hospital EAD /ID# 231649
🇧🇬Sofia, Bulgaria
Hopital Avicenne - APHP /ID# 221287
🇫🇷Bobigny, Ile-de-France, France
Universitaetsmedizin Rostock /ID# 224157
🇩🇪Rostock, Mecklenburg-Vorpommern, Germany
BAG Freiberg-Richter, Jacobasch, Illmer, Wolf /ID# 221346
🇩🇪Dresden, Sachsen, Germany
Ordensklinikum Linz GmbH Elisabethinen /ID# 220914
🇦🇹Linz, Oberoesterreich, Austria
Medizinische Universitaet Graz /ID# 220919
🇦🇹Graz, Steiermark, Austria
Ottawa Hospital Research Institute /ID# 238858
🇨🇦Ottawa, Ontario, Canada
Medizinische Universitaet Wien /ID# 220911
🇦🇹Vienna, Wien, Austria
UMHAT Alexandrovska EAD /ID# 231652
🇧🇬Sofiya, Sofia, Bulgaria
Virginia Cancer Specialists - Fairfax /ID# 223016
🇺🇸Fairfax, Virginia, United States
ZNA Cadix /ID# 221468
🇧🇪Antwerp, Antwerpen, Belgium
AZ-Delta /ID# 221469
🇧🇪Roeselare, West-Vlaanderen, Belgium
UMHAT Sveti Ivan Rilski /ID# 231651
🇧🇬Sofia, Bulgaria
HSHS St. Vincent Hospital /ID# 224468
🇺🇸Green Bay, Wisconsin, United States
Border Medical Oncology Research Unit Albury Wodonga Regiona /ID# 223848
🇦🇺East Albury, New South Wales, Australia
Juravinski Cancer Centre /ID# 220887
🇨🇦Hamilton, Ontario, Canada
The Alfred Hospital /ID# 221096
🇦🇺Melbourne, Victoria, Australia
Yakima Valley Memorial Hosp /ID# 224368
🇺🇸Yakima, Washington, United States
Universitaetsklinikum St. Poelten /ID# 221709
🇦🇹Sankt Poelten, Niederoesterreich, Austria
Hanusch Krankenhaus /ID# 220912
🇦🇹Wien, Austria
Grand Hopital de Charleroi /ID# 224827
🇧🇪Charleroi, Hainaut, Belgium
UMHAT Sveta Marina /ID# 234119
🇧🇬Varna, Bulgaria
Providence Everett /ID# 223130
🇺🇸Everett, Washington, United States
The Kinghorn Cancer Centre /ID# 221097
🇦🇺Darlinghurst, New South Wales, Australia
Augusta-Kranken-Anstalt gGmbH, Bochum-Mitte /ID# 224695
🇩🇪Bochum, Germany
Fakultni nemocnice Brno /ID# 220959
🇨🇿Brno, Czechia
HCL - Hopital Lyon Sud /ID# 222695
🇫🇷Pierre Benite CEDEX, Rhone, France
Calvary Mater Newcastle /ID# 224324
🇦🇺Waratah, New South Wales, Australia
Tula Regional Clinical Hospital /ID# 221302
🇷🇺Tula, Russian Federation
McGill University Health Center Research Institute /ID# 222614
🇨🇦Montreal, Quebec, Canada
Klinicka bolnica Merkur /ID# 230799
🇭🇷Zagreb, Grad Zagreb, Croatia
Klinicki bolnicki centar Osijek /ID# 231503
🇭🇷Osijek, Croatia
Universitatsklinikum Mannheim /ID# 221529
🇩🇪Mannheim, Baden-Wuerttemberg, Germany
Stauferklinikum Schwaebisch Gmuend /ID# 223948
🇩🇪Mutlangen, Baden-Wuerttemberg, Germany
Klinikum Chemnitz gGmbH /ID# 224575
🇩🇪Chemnitz, Germany
Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII (Presidio Papa Giovanni /ID# 221222
🇮🇹Bergamo, Italy
ASST Sette Laghi /ID# 234183
🇮🇹Varese, Italy
Clinical Hospital Dubrava /ID# 230801
🇭🇷Zagreb, Grad Zagreb, Croatia
Klinicki bolnicki centar Zagreb /ID# 230798
🇭🇷Zagreb, Grad Zagreb, Croatia
University General Hospital of Patras /ID# 221178
🇬🇷RION Patras Achaia, Greece
AP-HP - Hopital Saint-Louis /ID# 221390
🇫🇷Paris, France
OncoResearch Lerchenfeld GmbH /ID# 225034
🇩🇪Hamburg, Germany
Vseobecna fakultni nemocnice v Praze /ID# 220969
🇨🇿Praha, Czechia
Klinicki Bolnicki Centar (KBC) Split /ID# 230800
🇭🇷Split, Splitsko-dalmatinska Zupanija, Croatia
Centre Hospitalier Universitaire de Bordeaux /ID# 222696
🇫🇷Pessac CEDEX, Gironde, France
Debreceni Egyetem-Klinikai Kozpont /ID# 220947
🇭🇺Debrecen, Hajdu-Bihar, Hungary
ASST Monza/Ospedale San Gerardo /ID# 225113
🇮🇹Monza, Monza E Brianza, Italy
Chu Angers /Id# 219129
🇫🇷Angers, France
Gemeinschaftspraxis Dr. Heinrich und Prof. Bangerter /ID# 225025
🇩🇪Augsburg, Bayern, Germany
General Hospital of Athens Laiko /ID# 221175
🇬🇷Athens, Attiki, Greece
General Hospital of Athens Evaggelismos and Ophthalmiatrio of Athens Polyclinic /ID# 221179
🇬🇷Athens, Greece
General Hospital of Thessaloniki George Papanikolaou /ID# 221463
🇬🇷Thessaloniki, Greece
Somogy Varmegyei Kaposi Mor Oktato Korhaz /ID# 220948
🇭🇺Kaposvár, Somogy, Hungary
Ehime University Hospital /ID# 221158
🇯🇵Toon-shi, Ehime, Japan
Sapporo Hokuyu Hospital /ID# 221149
🇯🇵Sapporo-shi, Hokkaido, Japan
Iwate Medical University Hospital /ID# 222044
🇯🇵Shiwa-gun, Iwate, Japan
Samsung Medical Center /ID# 221091
🇰🇷Seoul, Seoul Teugbyeolsi, Korea, Republic of
The Lady Davis Carmel Medical Center /ID# 222973
🇮🇱Haifa, H_efa, Israel
Assuta Ashdod Medical Center /ID# 225281
🇮🇱Ashdod, HaDarom, Israel
Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital /ID# 221150
🇯🇵Nagoya-shi, Aichi, Japan
Sapienza University /ID# 225731
🇮🇹Rome, Roma, Italy
IRCCS Azienda Ospedaliero-Universitaria di Bologna /ID# 221077
🇮🇹Bologna, Italy
Azienda Ospedaliera Universitaria Paolo Giaccone /ID# 221078
🇮🇹Palermo, Italy
Chiba University Hospital /ID# 224546
🇯🇵Chiba-shi, Chiba, Japan
Kyushu University Hospital /ID# 221606
🇯🇵Fukuoka-shi, Fukuoka, Japan
Fukushima Medical University Hospital /ID# 221877
🇯🇵Fukushima-shi, Fukushima, Japan
Kumamoto Shinto General Hospital /ID# 255645
🇯🇵Kumamoto-shi, Kumamoto, Japan
Kyoto University Hospital /ID# 223008
🇯🇵Kyoto-shi, Kyoto, Japan
Uniwersyteckie Centrum Kliniczne /ID# 221298
🇵🇱Gdansk, Pomorskie, Poland
Pratia Onkologia Katowice /ID# 224526
🇵🇱Katowice, Poland
Presidio Ospedaliero Gaspare Rodolico /ID# 219089
🇮🇹Catania, Italy
Pusan National University Hospital /ID# 220980
🇰🇷Busan, Busan Gwang Yeogsi, Korea, Republic of
Hospital Universitario La Paz /ID# 224813
🇪🇸Madrid, Spain
National Cancer Center Hospital East /ID# 226653
🇯🇵Kashiwa-shi, Chiba, Japan
Azienda Ospedaliero Universitaria Careggi /ID# 219090
🇮🇹Florence, Italy
Shonan Kamakura General Hospital /ID# 223030
🇯🇵Kamakura-shi, Kanagawa, Japan
Lux Med Onkologia - Szpital Szamocka /Id# 221265
🇵🇱Warszawa, Mazowieckie, Poland
Azienda Ospedaliera Universitaria Federico II /ID# 224673
🇮🇹Napoli, Italy
Gachon University Gil Medical Center /ID# 220972
🇰🇷Incheon, Gyeonggido, Korea, Republic of
Azienda ULSS 8 Berica/Ospedale San Bortolo di Vicenza /ID# 221079
🇮🇹Vicenza, Italy
Gifu University Hospital /ID# 224371
🇯🇵Gifu-shi, Gifu, Japan
University of Miyazaki Hospital /ID# 221821
🇯🇵Miyazaki-shi, Miyazaki, Japan
Dokkyo Medical University Saitama Medical Center /ID# 222334
🇯🇵Koshigaya, Saitama, Japan
Hospital Clinico Universitario de Valencia /ID# 220920
🇪🇸Valencia, Spain
Uniwersytecki Szpital Kliniczny Nr 1 w Lublinie /ID# 221124
🇵🇱Lublin, Lubelskie, Poland
MTZ Clinical Research Powered by Pratia /ID# 221759
🇵🇱Warszawa, Mazowieckie, Poland
ARS-MEDICAL Sp. z o.o. /ID# 238336
🇵🇱Pila, Wielkopolskie, Poland
Tokyo Metropolitan Bokutoh Hospital /ID# 254774
🇯🇵Sumida-ku, Tokyo, Japan
Hospital Parc de Salut del Mar /ID# 220922
🇪🇸Barcelona, Spain
Aotearoa Clinical Trials /ID# 232201
🇳🇿Papatoetoe, Auckland, New Zealand
Duplicate_Wits Clinical Research Site /ID# 231554
🇿🇦Johannesburg, Gauteng, South Africa
Moscow State budget healthcare /ID# 221116
🇷🇺Moscow, Moskva, Russian Federation
Hospital Universitario Vall d'Hebron /ID# 240979
🇪🇸Barcelona, Spain
United Lincolnshire Hospitals NHS Trust /ID# 224613
🇬🇧Lincoln, Lincolnshire, United Kingdom
Alberts Cellular Therapy /ID# 231556
🇿🇦Pretoria, Gauteng, South Africa
Trakya University Medical Facu /ID# 224572
🇹🇷Edirne, Istanbul, Turkey
Complejo Hospitalario Universitario A Coruña /ID# 224617
🇪🇸A Coruña, A Coruna, Spain
Hospital n.a. V.V. Veresaev /ID# 225221
🇷🇺Moscow, Russian Federation
Russian Research Institute of Hematology and Transfusiology of the FMBA /ID# 221115
🇷🇺Sankt-Peterburg, Russian Federation
Hospital Universitario Central de Asturias /ID# 224815
🇪🇸Oviedo, Asturias, Spain
Inselspital, Universitaetsspital Bern /ID# 223439
🇨🇭Bern, Switzerland
China Medical University Hospital /ID# 218979
🇨🇳Taichung, Taiwan
The Newcastle Upon Tyne Hospitals NHS Foundation Trust /ID# 221335
🇬🇧Newcastle upon Tyne, United Kingdom
Hospital Clínico Universitario de Santiago-CHUS /ID# 221616
🇪🇸Santiago de Compostela, A Coruna, Spain
Hospital Universitario Virgen de las Nieves /ID# 253936
🇪🇸Granada, Spain
Hospital Universitario Dr. Negrin /ID# 220923
🇪🇸Las Palmas de Gran Canaria, Las Palmas, Spain
Taipei Veterans General Hosp /ID# 221147
🇨🇳Taipei, Taiwan
Kaohsiung Chang Gung Memorial Hospital /ID# 218985
🇨🇳Kaohsiung City, Kaohsiung, Taiwan
Chi Mei Hospital - Liouying /ID# 221144
🇨🇳Tainan City, Taiwan
Linkou Chang Gung Memorial Hospital /ID# 218982
🇨🇳Taoyuan City, Taiwan
James Paget University Hospitals NHS Foundation Trust /ID# 221219
🇬🇧Great Yarmouth, Norfolk, United Kingdom
Gulhane Askeri Tip Academy /ID# 224568
🇹🇷Ankara, Turkey
NHS Lothian /ID# 224378
🇬🇧Edinburgh, United Kingdom
Hospital Universitario Virgen del Rocio /ID# 221932
🇪🇸Sevilla, Spain
Hospital Regional Universitario de Malaga /ID# 221906
🇪🇸Malaga, Spain
Mersin University Medical /ID# 224571
🇹🇷Mersin, Turkey
University Hospitals Birmingham NHS Foundation Trust /ID# 221334
🇬🇧Birmingham, United Kingdom
Ondokuz mayis University Facul /ID# 224567
🇹🇷Samsun, Turkey
Royal Perth Hospital /ID# 221099
🇦🇺Perth, Western Australia, Australia
Duplicate_Universitätsspital Basel /ID# 221261
🇨🇭Basel, Basel-Stadt, Switzerland
Aalborg University Hospital /ID# 224391
🇩🇰Aalborg, Nordjylland, Denmark
Roskilde Sygehus /ID# 224456
🇩🇰Roskilde, Sjælland, Denmark
Skane University Hospital Lund /ID# 220834
🇸🇪Lund, Skane Lan, Sweden
Ege University Medical Faculty /ID# 224570
🇹🇷Izmir, Turkey
Guys and St Thomas NHS Foundation Trust /ID# 221041
🇬🇧London, London, City Of, United Kingdom
Klinikum rechts der Isar /ID# 221526
🇩🇪Munich, Germany
Hospital Universitario Germans Trias i Pujol /ID# 233727
🇪🇸Badalona, Barcelona, Spain
Hospital Universitario 12 de Octubre /ID# 233726
🇪🇸Madrid, Spain
Hospital Universitario de Salamanca /ID# 221904
🇪🇸Salamanca, Spain
The Catholic University of Korea, Seoul St. Marys Hospital /ID# 219061
🇰🇷Seoul, Seoul Teugbyeolsi, Korea, Republic of
Utah Cancer Specialists Salt Lake Clinic /ID# 221962
🇺🇸Salt Lake City, Utah, United States
University of Michigan /ID# 218463
🇺🇸Ann Arbor, Michigan, United States
Indiana Blood & Marrow Transpl /ID# 221587
🇺🇸Indianapolis, Indiana, United States
Atrium Health Wake Forest Baptist Medical Center /ID# 222899
🇺🇸Winston-Salem, North Carolina, United States
University of Texas Health San Antonio MD Anderson Cancer Center /ID# 233942
🇺🇸San Antonio, Texas, United States
Moores Cancer Center at UC San Diego /ID# 219009
🇺🇸La Jolla, California, United States
Ironwood Cancer & Res Ctr /ID# 222162
🇺🇸Chandler, Arizona, United States
Long Beach Memorial Medical Ct /ID# 224542
🇺🇸Long Beach, California, United States
Highlands Oncology Group, PA /ID# 221826
🇺🇸Springdale, Arkansas, United States
Icri /Id# 221967
🇺🇸Whittier, California, United States
Augusta University Georgia Cancer Center /ID# 219051
🇺🇸Augusta, Georgia, United States
St. Mary's Hospital Regional Cancer Center /ID# 224229
🇺🇸Grand Junction, Colorado, United States
Northwest Oncology & Hematology - Elk Grove Village /ID# 222818
🇺🇸Elk Grove Village, Illinois, United States
American Oncology Partners of Maryland /ID# 222836
🇺🇸Bethesda, Maryland, United States
William Beaumont Hospital /ID# 222705
🇺🇸Royal Oak, Michigan, United States
Henry Ford Health System /ID# 221190
🇺🇸Detroit, Michigan, United States
Saint Louis University Cancer Center /ID# 222287
🇺🇸Saint Louis, Missouri, United States
Memorial Sloan Kettering Cancer Center-Koch Center /ID# 221081
🇺🇸New York, New York, United States
The Cancer Institute at St. Francis Hospital /ID# 231782
🇺🇸Greenvale, New York, United States
Summit Medical Group-Florham Park /ID# 222620
🇺🇸Florham Park, New Jersey, United States
Hackensack Univ Med Ctr /ID# 219047
🇺🇸Hackensack, New Jersey, United States
Manhattan Hematology Oncology MHO Associates /ID# 223193
🇺🇸New York, New York, United States
Fox Chase Cancer Center /ID# 223955
🇺🇸Philadelphia, Pennsylvania, United States
Duplicate_Houston Methodist Hospital /ID# 223103
🇺🇸Houston, Texas, United States
AOU Citta della Salute e della Scienza di Torino /ID# 221223
🇮🇹Torino, Piemonte, Italy
Azienda Ospedaliera Universitaria Friuli Centrale/Presidio Ospedaliero Universit /ID# 221241
🇮🇹Udine, Italy
Grande Ospedale Metropolitano Bianchi Melacrino Morelli /ID# 221220
🇮🇹Reggio Calabria, Italy
Juntendo University Hospital /ID# 221154
🇯🇵Bunkyo-ku, Tokyo, Japan
Kurashiki Central Hospital /ID# 221690
🇯🇵Kurashiki-shi, Okayama, Japan
Kansai Medical University Hospital /ID# 257289
🇯🇵Hirakata-shi, Osaka, Japan
Juntendo University Shizuoka Hospital /ID# 221780
🇯🇵Izunokuni-shi, Shizuoka, Japan
Seoul National University Hospital /ID# 219060
🇰🇷Seoul, Seoul Teugbyeolsi, Korea, Republic of
Clin Hosp Ctr Bezanijska Kosa /ID# 231059
🇷🇸Belgrade, Beograd, Serbia
Hospital del Centro Comprensivo de Cancer de la UPR /ID# 223281
🇵🇷San Juan, Puerto Rico
Loyola University Medical Ctr /ID# 219048
🇺🇸Maywood, Illinois, United States
Tulane Medical Center - New Orleans /ID# 222940
🇺🇸New Orleans, Louisiana, United States
Ochsner Clinic Foundation-New Orleans /ID# 222777
🇺🇸New Orleans, Louisiana, United States
Tokyo Medical University Hospital /ID# 221540
🇯🇵Shinjuku-ku, Tokyo, Japan