Bortezomib and Dexamethasone With or Without Lenalidomide in Treating Patients With Multiple Myeloma Previously Treated With Dexamethasone
- Conditions
- Stage I Multiple MyelomaStage II Multiple MyelomaStage III Multiple Myeloma
- Interventions
- Registration Number
- NCT00522392
- Lead Sponsor
- National Cancer Institute (NCI)
- Brief Summary
This randomized phase III trial compares bortezomib, dexamethasone, and lenalidomide with bortezomib and dexamethasone to see how well they work in treating patients with multiple myeloma previously treated with dexamethasone. Bortezomib may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as dexamethasone, work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Lenalidomide may stimulate the immune system in different ways and stop cancer cells from growing. It is not yet known whether giving bortezomib and dexamethasone is more effective with or without lenalidomide in treating multiple myeloma.
- Detailed Description
PRIMARY OBJECTIVES:
I. To compare the progression-free survival (PFS) for two consolidation regimens: bortezomib, lenalidomide, and dexamethasone (VRD) versus bortezomib and dexamethasone (VD) only.
SECONDARY OBJECTIVES:
I. To determine the incremental ability of VRD versus VD in attaining a complete response or a very good partial response (VGPR) in patients receiving induction therapy with a dexamethasone based induction regimen.
II. To compare the overall survival, measured from the time of study entry.
III. Evaluate response rate and PFS according to cytogenetic category (by gene expression and fluorescence in situ hybridization \[FISH\]).
IV. To evaluate the toxicity of the two regimens.
V. To compare quality of life (QOL) based on the Functional Assessment of Cancer Therapy (FACT)-Neurotoxicity (Ntx) Trial Outcome Index (TOI) of patients receiving VD to those receiving VRD from registration to 6 months post consolidation treatment.
VI. To examine the impact of differential treatment response (PFS), if observed, on QOL based on the FACT-Ntx TOI up to 12 months post consolidation treatment.
VII. To obtain prospective data on multiple myeloma specific QOL attributes.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM A: Patients receive bortezomib at 1.3 mg/m2 intravenously (IV) on days 1, 4, 8, and 11, lenalidomide orally (PO) once daily (QD) at 15 mg on days 1-14, and dexamethasone at 40 mg total dose per day PO QD on days 1, 8, and 15. Treatment repeats every 21 days for 8 courses in the absence of disease progression or unacceptable toxicity.
ARM B: Patients receive bortezomib at 1.3 mg/m2 IV on days 1, 4, 8, and 11 and dexamethasone at 40 mg total dose per day PO QD on days 1, 8, and 15. Treatment repeats every 21 days for 8 courses in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed every 3 months for 2 years, every 6 months for 3 years, and then every 12 months for 5 years.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 48
-
Symptomatic multiple myeloma, that was symptomatic at time of initial diagnosis, but may be asymptomatic at the time of registration based on induction therapy
-
For the original diagnosis of myeloma, patients must have met the following criteria at one point in their disease course: bone marrow plasmacytosis (>10% plasma cells or sheets of plasma cells) or a biopsy proven plasmacytoma, and evidence of end-organ damage due to multiple myeloma including anemia, hypercalcemia, bone disease (lytic bone lesions or pathologic fractures) or renal dysfunction.
-
Patients may have prior exposure to bortezomib
-
Patients must have received a minimum of 1 cycle, maximum of 6 cycles, of a dexamethasone-based regimen; patient must not have experienced progressive disease on such therapy
-
The following induction regimens were considered adequate for enrollment: dexamethasone alone; vincristine, doxorubicin and dexamethasone; thalidomide and dexamethasone; lenalidomide and dexamethasone; liposomal doxorubicin and dexamethasone; the combination of any of the above agents and dexamethasone; or cyclophosphamide, lenalidomide and dexamethasone
-
Patients must have received the minimum cumulative dose of dexamethasone of 160 mg (sum of induction treatment) with no maximum dose specified
-
Patients must have been offered and refused front-line stem cell transplant OR not have been eligible for front-line stem cell transplant.
-
Bone marrow aspiration and/or biopsy must be obtained =< 28 days prior to randomization
-
All tests below must be performed =< 28 days prior to randomization:
- Kappa free light chain mg/dL
- Lambda free light chain mg/dL
- Serum M-protein by serum protein electrophoresis (SPEP)
- Urine M-protein light chain excretion by urine protein electrophoresis (UPEP)
-
Adequate laboratory levels within 7 days prior to randomization: hemoglobin > 7 g/dL, platelet count > 75,000 cells/mm^3, absolute neutrophil count > 1000 cells/mm^3, creatinine < 2.5 mg/dL, creatinine clearance (measured or calculated) >= 60 mL/min, direct bilirubin =< 1.5 mg/dL, serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) and serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) =< 2.5 times the upper limit of normal
-
Patients may be receiving bisphosphonates or erythropoietin growth factors (erythropoietic agents) for multiple myeloma
-
Prior palliative and/or localized radiation therapy is permitted, provided at least 14 days have passed from date of last radiation therapy to date of randomization
-
Patients must be willing and able to take prophylaxis with either aspirin at 325 mg/day or alternative prophylaxis with either low molecular weight heparin or coumadin (patients with prior deep vein thrombosis [DVT] are eligible provided they remain on the anticoagulation regimen that was prescribed for treatment of the DVT throughout the protocol therapy)
-
Patients must be competent to understand the study as explained in the consent form
-
Eastern Cooperative Oncology Group (ECOG) performance status 0, 1, or 2
-
Sexually active males must be willing to use a condom (even if they have undergone a prior vasectomy) while having intercourse with any woman, while taking lenalidomide, and for 4 weeks after stopping treatment
-
Patients with a history of prior malignancy are eligible provided there is no active malignancy and a low expectation of recurrence within 6 months
-
Age >=18 years
- More than 8 weeks from the last day of last cycle of induction treatment
- Active, uncontrolled seizure disorder; seizures in the last 6 months
- Uncontrolled inter-current illness that would limit compliance with the study including uncontrolled hypertension, symptomatic congestive heart failure, unstable angina, uncontrolled cardiac arrhythmia, uncontrolled psychiatric illness or social situation, prior history of Stevens Johnson syndrome
- Grade 2 or higher peripheral neuropathy by Common Terminology Criteria for Adverse Events (CTCAE) version 3.0
- Active, uncontrolled infection
- Smoldering myeloma or monoclonal gammopathy of undetermined significance
- Pregnant or nursing women were not eligible. Women of child-bearing potential unwilling to use a dual method of contraception and men who were unwilling to use a condom were not eligible
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm A (VRD) bortezomib Patients were given consolidation therapy for 8 cycles (1 cycle = 21 days) with the combination bortezomib, dexamethasone and lenalidomide. Patients received each cycle: the standard dose of bortezomib (1.3 mg/m2) on days 1, 4, 8 and 11; fixed dose of lenalidomide at 15 mg orally on days 1-14; and 3 days of dexamethasone at 40 mg total dose per day given on days 1, 8 and 15. Aspirin 325 mg/day orally on days 1-21 of each cycle was required unless the patient was treated with alternate prophylaxis of either low molecular weight heparin or coumadin. Arm A (VRD) dexamethasone Patients were given consolidation therapy for 8 cycles (1 cycle = 21 days) with the combination bortezomib, dexamethasone and lenalidomide. Patients received each cycle: the standard dose of bortezomib (1.3 mg/m2) on days 1, 4, 8 and 11; fixed dose of lenalidomide at 15 mg orally on days 1-14; and 3 days of dexamethasone at 40 mg total dose per day given on days 1, 8 and 15. Aspirin 325 mg/day orally on days 1-21 of each cycle was required unless the patient was treated with alternate prophylaxis of either low molecular weight heparin or coumadin. Arm A (VRD) lenalidomide Patients were given consolidation therapy for 8 cycles (1 cycle = 21 days) with the combination bortezomib, dexamethasone and lenalidomide. Patients received each cycle: the standard dose of bortezomib (1.3 mg/m2) on days 1, 4, 8 and 11; fixed dose of lenalidomide at 15 mg orally on days 1-14; and 3 days of dexamethasone at 40 mg total dose per day given on days 1, 8 and 15. Aspirin 325 mg/day orally on days 1-21 of each cycle was required unless the patient was treated with alternate prophylaxis of either low molecular weight heparin or coumadin. Arm B (VD) bortezomib Patients were given consolidation therapy for 8 cycles (1 cycle = 21 days) with the combination bortezomib plus dexamethasone. Patients received each cycle: the standard dose of bortezomib (1.3 mg/m2) on days 1, 4, 8 and 11 and 3 days of dexamethasone at 40 mg total dose per day given on days 1, 8 and 15. Arm B (VD) dexamethasone Patients were given consolidation therapy for 8 cycles (1 cycle = 21 days) with the combination bortezomib plus dexamethasone. Patients received each cycle: the standard dose of bortezomib (1.3 mg/m2) on days 1, 4, 8 and 11 and 3 days of dexamethasone at 40 mg total dose per day given on days 1, 8 and 15.
- Primary Outcome Measures
Name Time Method Progression-free Survival (PFS) Assessed every 3 months if patient is < 2 years from study entry, every 6 months if patient is 2-5 years from study entry, every 12 months if patient is 6-10 years from study entry, up to 10 years Progression-free survival was defined as the time from randomization to the earliest documentation of disease progression (PD) or death. If a patient died without evidence of PD, the patient was considered an event if death occurred within 3 months of the last disease assessment. Patients who died outside of the specified interval or patients who were alive without evidence of PD were censored at the date of last disease assessment.
The PFS results are based on data as of August 2012, while overall survival (OS) was updated in April 2014. Given the early termination and limited sample size, data management efforts to update PFS were not pursued.
- Secondary Outcome Measures
Name Time Method Response Rates (Complete Response [CR] or Very Good Partial Response [VGPR]) Assessed at the end of each cycle, every 3 months if patient is < 2 years from study entry, every 6 months if patient is 2-5 years from study entry, every 12 months if patient is 6-10 years from study entry, up to 10 years CR:
Patients with complete disappearance of an M-protein and no evidence of myeloma in the bone marrow are considered to have CR. To be considered CR, patients must meet all of the following criteria:
* Negative immunofixation on the serum and urine at two consecutive times
* Disappearance of any soft tissue plasmacytomas
* ≤5% plasma cells in bone marrow
* If serum and urine M protein are unmeasurable and the immunoglobulin free light chain (FLC) parameter is being used, patients must have a normal ratio of 0.26-1.65 at two consecutive times
VGPR:
* Serum and urine M-component detectable by immunofixation but not on electrophoresis OR
* \>=90% reduction in serum M-component plus urine M-component \<100 mg per 24 hours (by SPEP and UPEP)
* If the serum and urine M protein are unmeasurable and the immunoglobulin FLC parameter is being used, a \>90% decrease in the difference between involved and uninvolved FLC levels is required in place of the M protein criteriaOverall Survival (OS) Assessed every 3 months if patient is < 2 years from study entry, every 6 months if patient is 2-5 years from study entry, every 12 months if patient is 6-10 years from study entry, up to 10 years Overall survival is defined as the time from randomization to death or date of last known alive. The OS results are based on data as of April 2014.
Change in Quality of Life (QOL) From Baseline to 6 Months Post Consolidation as Assessed by the Functional Assessment of Cancer Therapy-Neurotoxicity Trial Outcome Index (FACT-Ntx TOI) Baseline and 6 months post consolidation treatment The combined score on the FACT-Ntx TOI is of interest. The FACT-Ntx TOI has 25 items and the score ranges from 0 (worst possible quality of life) -100 (best possible quality of life). The primary QOL endpoint is defined as the change in the FACT-Ntx TOI score from registration to 6 months post consolidation treatment.
Trial Locations
- Locations (276)
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
🇺🇸Maumee, Ohio, United States
Illinois Oncology Research Association CCOP
🇺🇸Peoria, Illinois, United States
Saint Francis Hospital and Health Centers
🇺🇸Beech Grove, Indiana, United States
Covenant Medical Center
🇺🇸Waterloo, Iowa, United States
Proctor Hospital
🇺🇸Peoria, Illinois, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸Ottawa, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
Pekin Cancer Treatment Center
🇺🇸Pekin, Illinois, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
Hickman Cancer Center
🇺🇸Adrian, Michigan, United States
Saint Mary's of Michigan
🇺🇸Saginaw, Michigan, United States
Galesburg Cottage Hospital
🇺🇸Galesburg, Illinois, United States
Sky Ridge Medical Center
🇺🇸Lone Tree, Colorado, United States
Mayo Clinic in Arizona
🇺🇸Scottsdale, Arizona, United States
Saint Mary Corwin Medical Center
🇺🇸Pueblo, Colorado, United States
Memorial Hospital
🇺🇸Carthage, Illinois, United States
Saint Francis Hospital
🇺🇸Evanston, Illinois, United States
Illinois CancerCare Galesburg
🇺🇸Galesburg, Illinois, United States
Stanford University Hospitals and Clinics
🇺🇸Stanford, California, United States
North Suburban Medical Center
🇺🇸Thornton, Colorado, United States
Exempla Lutheran Medical Center
🇺🇸Wheat Ridge, Colorado, United States
Beebe Medical Center
🇺🇸Lewes, Delaware, United States
Garneau, Stewart C MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Penrose-Saint Francis Healthcare
🇺🇸Colorado Springs, Colorado, United States
Mcdonough District Hospital
🇺🇸Macomb, Illinois, United States
Harbin Clinic Medical Oncology and Clinical Research
🇺🇸Rome, Georgia, United States
Saint Anthony's Health
🇺🇸Alton, Illinois, United States
John B Amos Cancer Center
🇺🇸Columbus, Georgia, United States
Saint Joseph Medical Center
🇺🇸Bloomington, Illinois, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
Eureka Hospital
🇺🇸Eureka, Illinois, United States
Western Illinois Cancer Treatment Center
🇺🇸Galesburg, Illinois, United States
Mayo Clinic in Florida
🇺🇸Jacksonville, Florida, United States
Saint Luke's Regional Medical Center
🇺🇸Sioux City, Iowa, United States
Oakwood Hospital
🇺🇸Dearborn, Michigan, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
Reid Hospital and Health Care Services
🇺🇸Richmond, Indiana, United States
Mercy Memorial Hospital
🇺🇸Monroe, Michigan, United States
Carle Clinic-Urbana Main
🇺🇸Urbana, Illinois, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸Flint, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸Warren, Michigan, United States
Illinois Valley Hospital
🇺🇸Peru, Illinois, United States
Valley Radiation Oncology
🇺🇸Peru, Illinois, United States
Saint Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
Mason District Hospital
🇺🇸Havana, Illinois, United States
Stoffel, Thomas J MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Bixby Medical Center
🇺🇸Adrian, Michigan, United States
Green Bay Oncology - Escanaba
🇺🇸Escanaba, Michigan, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Sanford Clinic North-Bemidgi
🇺🇸Bemidji, Minnesota, United States
Southeast Missouri Hospital
🇺🇸Cape Girardeau, Missouri, United States
Good Samaritan Hospital
🇺🇸Kearney, Nebraska, United States
Virtua West Jersey Hospital Voorhees
🇺🇸Voorhees, New Jersey, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Montana Cancer Consortium CCOP
🇺🇸Billings, Montana, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
Hutchinson Area Health Care
🇺🇸Hutchinson, Minnesota, United States
Fox Chase Cancer Center at Virtua Memorial Hospital of Burlington County
🇺🇸Mount Holly, New Jersey, United States
Essentia Health Saint Mary's Medical Center
🇺🇸Duluth, Minnesota, United States
Meeker County Memorial Hospital
🇺🇸Litchfield, Minnesota, United States
Woodwinds Health Campus
🇺🇸Woodbury, Minnesota, United States
Cooper Hospital University Medical Center
🇺🇸Camden, New Jersey, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
Veterans Adminstration New Jersey Health Care System
🇺🇸East Orange, New Jersey, United States
Montana Cancer Specialists
🇺🇸Missoula, Montana, United States
Guardian Oncology and Center for Wellness
🇺🇸Missoula, Montana, United States
Minnesota Oncology and Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Sanford Medical Center-Fargo
🇺🇸Fargo, North Dakota, United States
Community Medical Hospital
🇺🇸Missoula, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸Missoula, Montana, United States
Orange Regional Medical Center
🇺🇸Middletown, New York, United States
Ozark Health Ventures LLC dba Cancer Research for The Ozarks Springfield
🇺🇸Springfield, Missouri, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
University of Missouri - Ellis Fischel
🇺🇸Columbia, Missouri, United States
Mary Rutan Hospital
🇺🇸Bellefontaine, Ohio, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Toledo Clinic Cancer Centers-Bowling Green
🇺🇸Bowling Green, Ohio, United States
Saint Luke's Hospital
🇺🇸Maumee, Ohio, United States
Toledo Clinic Cancer Centers-Maumee
🇺🇸Maumee, Ohio, United States
Fisher-Titus Medical Center
🇺🇸Norwalk, Ohio, United States
Mercy Saint Anne Hospital
🇺🇸Toledo, Ohio, United States
Flower Hospital
🇺🇸Sylvania, Ohio, United States
University Hospital of Brooklyn
🇺🇸Brooklyn, New York, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Geisinger Wyoming Valley
🇺🇸Wilkes-Barre, Pennsylvania, United States
Toledo Clinic Cancer Centers-Toledo
🇺🇸Toledo, Ohio, United States
Mary Imogene Bassett Hospital
🇺🇸Cooperstown, New York, United States
Toledo Clinic Cancer Centers-Oregon
🇺🇸Oregon, Ohio, United States
Pottstown Memorial Medical Center
🇺🇸Pottstown, Pennsylvania, United States
State University of New York Downstate Medical Center
🇺🇸Brooklyn, New York, United States
The Toledo Hospital/Toledo Children's Hospital
🇺🇸Toledo, Ohio, United States
Blanchard Valley Hospital
🇺🇸Findlay, Ohio, United States
Fairfield Medical Center
🇺🇸Lancaster, Ohio, United States
Lima Memorial Hospital
🇺🇸Lima, Ohio, United States
Saint Charles Hospital
🇺🇸Oregon, Ohio, United States
Geisinger Medical Group
🇺🇸State College, Pennsylvania, United States
University of Toledo
🇺🇸Toledo, Ohio, United States
Toledo Community Hospital Oncology Program CCOP
🇺🇸Toledo, Ohio, United States
Rapid City Regional Hospital
🇺🇸Rapid City, South Dakota, United States
Marietta Memorial Hospital
🇺🇸Marietta, Ohio, United States
North Coast Cancer Care
🇺🇸Sandusky, Ohio, United States
Mercy Hospital of Tiffin
🇺🇸Tiffin, Ohio, United States
Clinton Memorial Hospital
🇺🇸Wilmington, Ohio, United States
Kettering Medical Center
🇺🇸Kettering, Ohio, United States
Licking Memorial Hospital
🇺🇸Newark, Ohio, United States
Fredericksburg Oncology Inc
🇺🇸Fredericksburg, Virginia, United States
Saint Michael's Hospital
🇺🇸Stevens Point, Wisconsin, United States
Bryn Mawr Hospital
🇺🇸Bryn Mawr, Pennsylvania, United States
Saint Vincent Mercy Medical Center
🇺🇸Toledo, Ohio, United States
Mayo Clinic Health System-Franciscan Healthcare
🇺🇸La Crosse, Wisconsin, United States
Harrison HealthPartners Hematology and Oncology-Bremerton
🇺🇸Bremerton, Washington, United States
Marshfield Clinic-Rice Lake Center
🇺🇸Rice Lake, Wisconsin, United States
Paoli Memorial Hospital
🇺🇸Paoli, Pennsylvania, United States
Marshfield Clinic Cancer Center at Sacred Heart
🇺🇸Eau Claire, Wisconsin, United States
Wenatchee Valley Medical Center
🇺🇸Wenatchee, Washington, United States
Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
Lancaster General Hospital
🇺🇸Lancaster, Pennsylvania, United States
Columbia Basin Hematology and Oncology PLLC
🇺🇸Kennewick, Washington, United States
Doylestown Hospital
🇺🇸Doylestown, Pennsylvania, United States
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
Lankenau Hospital
🇺🇸Wynnewood, Pennsylvania, United States
Saint Joseph's Hospital
🇺🇸Marshfield, Wisconsin, United States
Marshfield Clinic-Chippewa Center
🇺🇸Chippewa Falls, Wisconsin, United States
Marshfield Clinic-Minocqua Center
🇺🇸Minocqua, Wisconsin, United States
Green Bay Oncology at Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Gundersen Lutheran
🇺🇸La Crosse, Wisconsin, United States
The Schiffler Cancer Center of Wheeling Hospital
🇺🇸Wheeling, West Virginia, United States
Marshfield Clinic at James Beck Cancer Center
🇺🇸Rhinelander, Wisconsin, United States
University of Tennessee - Knoxville
🇺🇸Knoxville, Tennessee, United States
University Of Pretoria
🇿🇦Pretoria, South Africa
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
Doctors Hospital
🇺🇸Columbus, Ohio, United States
Grant Medical Center
🇺🇸Columbus, Ohio, United States
Harborview Medical Center
🇺🇸Seattle, Washington, United States
Swedish Medical Center-First Hill
🇺🇸Seattle, Washington, United States
The Polyclinic
🇺🇸Seattle, Washington, United States
University of Washington Medical Center
🇺🇸Seattle, Washington, United States
Kaiser Permanente
🇺🇸San Diego, California, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Virginia Piper Cancer Institute
🇺🇸Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
University Medical Center of Southern Nevada
🇺🇸Las Vegas, Nevada, United States
Nevada Cancer Research Foundation CCOP
🇺🇸Las Vegas, Nevada, United States
Welch Cancer Center
🇺🇸Sheridan, Wyoming, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
Graham Hospital Association
🇺🇸Canton, Illinois, United States
Abington Memorial Hospital
🇺🇸Abington, Pennsylvania, United States
Porter Adventist Hospital
🇺🇸Denver, Colorado, United States
Exempla Saint Joseph Hospital
🇺🇸Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸Denver, Colorado, United States
Colorado Cancer Research Program CCOP
🇺🇸Denver, Colorado, United States
Rose Medical Center
🇺🇸Denver, Colorado, United States
Saint John Hospital and Medical Center
🇺🇸Detroit, Michigan, United States
Adventist Medical Center
🇺🇸Portland, Oregon, United States
Missouri Baptist Medical Center
🇺🇸Saint Louis, Missouri, United States
Saint Louis-Cape Girardeau CCOP
🇺🇸Saint Louis, Missouri, United States
Essentia Health Duluth Clinic CCOP
🇺🇸Duluth, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
Swedish Medical Center
🇺🇸Englewood, Colorado, United States
Hopedale Medical Complex - Hospital
🇺🇸Hopedale, Illinois, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Joliet Oncology-Hematology Associates Limited
🇺🇸Joliet, Illinois, United States
Mayo Clinic
🇺🇸Rochester, Minnesota, United States
Mercy Medical Center-Sioux City
🇺🇸Sioux City, Iowa, United States
Northbay Cancer Center
🇺🇸Fairfield, California, United States
The Medical Center of Aurora
🇺🇸Aurora, Colorado, United States
Boulder Community Hospital
🇺🇸Boulder, Colorado, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸Grand Junction, Colorado, United States
Longmont United Hospital
🇺🇸Longmont, Colorado, United States
Saint Anthony Hospital
🇺🇸Lakewood, Colorado, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Porubcin, Michael MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Good Samaritan Regional Health Center
🇺🇸Mount Vernon, Illinois, United States
Bromenn Regional Medical Center
🇺🇸Normal, Illinois, United States
Community Cancer Center Foundation
🇺🇸Normal, Illinois, United States
Sharis, Christine M MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸Ottawa, Illinois, United States
Pekin Hospital
🇺🇸Pekin, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸Peoria, Illinois, United States
Perry Memorial Hospital
🇺🇸Princeton, Illinois, United States
Saint Margaret's Hospital
🇺🇸Spring Valley, Illinois, United States
McFarland Clinic PC-William R Bliss Cancer Center
🇺🇸Ames, Iowa, United States
Mercy Capitol
🇺🇸Des Moines, Iowa, United States
Constantinou, Costas L MD (UIA Investigator)
🇺🇸Bettendorf, Iowa, United States
Siouxland Hematology Oncology Associates
🇺🇸Sioux City, Iowa, United States
Union Hospital of Cecil County
🇺🇸Elkton MD, Maryland, United States
Green Bay Oncology - Iron Mountain
🇺🇸Iron Mountain, Michigan, United States
Community Cancer Center of Monroe
🇺🇸Monroe, Michigan, United States
Miller-Dwan Hospital
🇺🇸Duluth, Minnesota, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Fairview-Southdale Hospital
🇺🇸Edina, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Metro-Minnesota CCOP
🇺🇸Saint Louis Park, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Saint Francis Medical Center
🇺🇸Cape Girardeau, Missouri, United States
Capital Regional Medical Center
🇺🇸Jefferson City, Missouri, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸Saint Louis, Missouri, United States
Center for Cancer Care and Research
🇺🇸Saint Louis, Missouri, United States
Saint John's Mercy Medical Center
🇺🇸Saint Louis, Missouri, United States
Northern Rockies Radiation Oncology Center
🇺🇸Billings, Montana, United States
Saint Vincent Healthcare
🇺🇸Billings, Montana, United States
Billings Clinic
🇺🇸Billings, Montana, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸Butte, Montana, United States
Bozeman Deaconess Cancer Center
🇺🇸Bozeman, Montana, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Northern Montana Hospital
🇺🇸Havre, Montana, United States
Glacier Oncology PLLC
🇺🇸Kalispell, Montana, United States
Kalispell Medical Oncology
🇺🇸Kalispell, Montana, United States
Sanford Clinic North-Fargo
🇺🇸Fargo, North Dakota, United States
Adirondack Cancer Center
🇺🇸Glens Falls, New York, United States
Kings County Hospital
🇺🇸Brooklyn, New York, United States
Mercy Medical Center
🇺🇸Canton, Ohio, United States
Mount Carmel Health Center West
🇺🇸Columbus, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸Franklin, Ohio, United States
Fremont Memorial Hospital
🇺🇸Fremont, Ohio, United States
Grady Memorial Hospital
🇺🇸Delaware, Ohio, United States
Wayne Hospital
🇺🇸Greenville, Ohio, United States
Hematology Oncology Center Incorporated
🇺🇸Elyria, Ohio, United States
Firelands Regional Medical Center
🇺🇸Sandusky, Ohio, United States
Upper Valley Medical Center
🇺🇸Troy, Ohio, United States
Saint Ann's Hospital
🇺🇸Westerville, Ohio, United States
Greene Memorial Hospital
🇺🇸Xenia, Ohio, United States
Genesis HealthCare System
🇺🇸Zanesville, Ohio, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸Hazleton, Pennsylvania, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸Bellingham, Washington, United States
Reading Hospital
🇺🇸West Reading, Pennsylvania, United States
McLeod Regional Medical Center
🇺🇸Florence, South Carolina, United States
Mainline Health CCOP
🇺🇸Wynnewood, Pennsylvania, United States
Minor and James Medical PLLC
🇺🇸Seattle, Washington, United States
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
🇺🇸Seattle, Washington, United States
Sacred Heart Hospital
🇺🇸Eau Claire, Wisconsin, United States
Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
Marshfield Clinic
🇺🇸Marshfield, Wisconsin, United States
Green Bay Oncology - Oconto Falls
🇺🇸Oconto Falls, Wisconsin, United States
Marshfield Clinic-Wausau Center
🇺🇸Wausau, Wisconsin, United States
Marshfield Clinic - Weston Center
🇺🇸Weston, Wisconsin, United States
Green Bay Oncology - Sturgeon Bay
🇺🇸Sturgeon Bay, Wisconsin, United States
Marshfield Clinic - Wisconsin Rapids Center
🇺🇸Wisconsin Rapids, Wisconsin, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Saint Joseph's Hospital - Healtheast
🇺🇸Saint Paul, Minnesota, United States
Fulton County Health Center
🇺🇸Wauseon, Ohio, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
Michigan Cancer Research Consortium Community Clinical Oncology Program
🇺🇸Ann Arbor, Michigan, United States
Doctors Carrol, Sheth, Raghavan
🇺🇸Louisville, Kentucky, United States
Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Berdeaux, Donald MD (UIA Investigator)
🇺🇸Great Falls, Montana, United States
Great Falls Clinic
🇺🇸Great Falls, Montana, United States
Hematology-Oncology Centers of the Northern Rockies PC
🇺🇸Billings, Montana, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
Saint Peter's Community Hospital
🇺🇸Helena, Montana, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Iowa Oncology Research Association CCOP
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
University of Wisconsin Hospital and Clinics
🇺🇸Madison, Wisconsin, United States
Wesley Medical Center
🇺🇸Wichita, Kansas, United States
Grandview Hospital
🇺🇸Dayton, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸Dayton, Ohio, United States
Miami Valley Hospital
🇺🇸Dayton, Ohio, United States
Samaritan North Health Center
🇺🇸Dayton, Ohio, United States
Dayton CCOP
🇺🇸Dayton, Ohio, United States
Veteran Affairs Medical Center
🇺🇸Dayton, Ohio, United States
Alexian Brothers Medical and Cancer Center
🇺🇸Elk Grove Village, Illinois, United States
Saint Joseph Mercy Port Huron
🇺🇸Port Huron, Michigan, United States
Wheeling Hospital
🇺🇸Wheeling, West Virginia, United States
UW Cancer Center Johnson Creek
🇺🇸Johnson Creek, Wisconsin, United States
Montefiore Medical Center
🇺🇸Bronx, New York, United States