Risk-Based Classification System of Patients With Newly Diagnosed Acute Lymphoblastic Leukemia
- Conditions
- Acute Lymphoblastic Leukemia
- Interventions
- Other: Cytology Specimen Collection ProcedureOther: Laboratory Biomarker Analysis
- Registration Number
- NCT01142427
- Lead Sponsor
- Children's Oncology Group
- Brief Summary
This research trial studies a risk-based classification system for patients with newly diagnosed acute lymphoblastic leukemia. Gathering health information about patients with acute lymphoblastic leukemia may help doctors learn more about the disease and plan the best treatment.
- Detailed Description
PRIMARY OBJECTIVES:
I. To provide a risk classification scheme for all patients with newly diagnosed acute lymphoblastic leukemia (ALL), which will be used to assign treatment on Children?s Oncology Group (COG) frontline ALL treatment studies.
II. To capture classification data for correlative studies accompanying current COG ALL treatment protocols.
III. To provide a central reference guide for all required and research studies that will be conducted in local and reference laboratories for all newly diagnosed ALL patients.
IV. To provide a mechanism for optional banking of leukemia and germline specimens for current and future research.
OUTLINE:
Patients undergo blood sample collection and bone marrow biopsies at baseline and during and after induction therapy for immunophenotyping for ALL confirmation and classification, deoxyribonucleic acid (DNA) ploidy, genomic variation, and cytogenetic (BCR-ABL, trisomies 4+10, and molecular testing for translocations) analysis by flow cytometry and fluorescent in situ hybridization (FISH). Immunophenotype results obtained on this study are used to determine patient's assignment to specific clinical-trial treatments. Some samples (leukemic and germline) may be banked for current and/or future analyses.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 17463
-
Patient has newly diagnosed acute leukemia:
- > 25% blasts on a bone marrow (BM) aspirate or
- If a BM aspirate is not obtained or is not diagnostic of acute leukemia, the diagnosis can be established by a pathologic diagnosis of acute leukemia on a BM biopsy or
- A complete blood count (CBC) documenting the presence of at least 1,000/uL circulating leukemic blasts
-
Adequate samples must be provided to the reference and/or COG-approved cytogenetics laboratories to allow completion of the studies needed for risk-stratification
- If a BM aspirate is not performed, or adequate material cannot be obtained, peripheral blood (PB) can be substituted for BM if there are at least 1,000 circulating blasts/uL (i.e., a white blood cell [WBC] count of 10,000/uL with 10% blasts or a WBC count of 5,000/uL with 20% blasts); if only PB is submitted, please obtain and send twice the volume of PB as the recommended BM volume specified; the patient will remain on AALL08B1 as long as all required central laboratory tests can be successfully performed; as long as there are at least 1,000/uL PB blasts, institutions are encouraged to submit PB in addition to BM samples to make sure that adequate material is available to perform the required studies
- If an adequate BM aspirate cannot be obtained and there are fewer than 1,000/uL PB blasts, the patient is not eligible for AALL08B1 or a frontline COG ALL clinical trial (there are NO exceptions to this rule)
-
Patient has suspected ALL:
- Patients whose blast morphology is obviously myeloid, or whose blasts are myeloperoxidase positive, should not be enrolled on AALL08B1; however, patients with true biphenotypic or bilineage leukemia (i.e., patient presents with blasts with significant expression of multiple lymphoid and myeloid markers such that assignment to a single lineage is not possible) are eligible to enroll in AALL08B1 for cell banking
-
Samples must be sent to a COG-approved cytogenetics laboratory, and COG Reference Laboratory studies; if informative results needed for treatment stratification are not available at specified time-points during induction, patients will not be eligible to receive post-induction therapy on a COG ALL trial
-
All patients and/or their parents or legal guardians must sign a written informed consent
-
All institutional, Food and Drug Administration (FDA) and National Cancer Institute (NCI) requirements for human studies must be met
- Patient must not have received prior cytotoxic therapy except for steroids or intrathecal chemotherapy
- Patient must not have secondary ALL that developed after treatment of a prior malignancy with cytotoxic chemotherapy
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Arm && Interventions
Group Intervention Description Ancillary-Correlative (classification) Cytology Specimen Collection Procedure Patients undergo blood sample collection and bone marrow biopsies at baseline and during and after induction therapy for immunophenotyping for ALL confirmation and classification, DNA ploidy, genomic variation, and cytogenetic (BCR-ABL, trisomies 4+10, and molecular testing for translocations) analysis by flow cytometry and FISH. Immunophenotype results obtained on this study are used to determine patient's assignment to specific clinical-trial treatments. Some samples (leukemic and germline) may be banked for current and/or future analyses. Ancillary-Correlative (classification) Laboratory Biomarker Analysis Patients undergo blood sample collection and bone marrow biopsies at baseline and during and after induction therapy for immunophenotyping for ALL confirmation and classification, DNA ploidy, genomic variation, and cytogenetic (BCR-ABL, trisomies 4+10, and molecular testing for translocations) analysis by flow cytometry and FISH. Immunophenotype results obtained on this study are used to determine patient's assignment to specific clinical-trial treatments. Some samples (leukemic and germline) may be banked for current and/or future analyses.
- Primary Outcome Measures
Name Time Method Classification data for correlative studies Up to 5 years Development of mechanism for optional leukemia and germline specimens for current and future research Up to 5 years Development of a risk classification system to be used to assign patients to treatment on Children?s Oncology Group frontline acute lymphoblastic leukemia (ALL) treatment studies Up to 5 years Development of a central reference guide for required and research ALL studies Up to 5 years
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (244)
University of Maryland/Greenebaum Cancer Center
🇺🇸Baltimore, Maryland, United States
Children's Hospital Los Angeles
🇺🇸Los Angeles, California, United States
Cedars Sinai Medical Center
🇺🇸Los Angeles, California, United States
Mattel Children's Hospital UCLA
🇺🇸Los Angeles, California, United States
Sinai Hospital of Baltimore
🇺🇸Baltimore, Maryland, United States
Johns Hopkins University/Sidney Kimmel Cancer Center
🇺🇸Baltimore, Maryland, United States
Children's Hospital of Philadelphia
🇺🇸Philadelphia, Pennsylvania, United States
Valley Children's Hospital
🇺🇸Madera, California, United States
Children's Healthcare of Atlanta - Egleston
🇺🇸Atlanta, Georgia, United States
University of Chicago Comprehensive Cancer Center
🇺🇸Chicago, Illinois, United States
Cleveland Clinic Foundation
🇺🇸Cleveland, Ohio, United States
M D Anderson Cancer Center
🇺🇸Houston, Texas, United States
Floating Hospital for Children at Tufts Medical Center
🇺🇸Boston, Massachusetts, United States
Massachusetts General Hospital Cancer Center
🇺🇸Boston, Massachusetts, United States
Nevada Cancer Research Foundation CCOP
🇺🇸Las Vegas, Nevada, United States
Summerlin Hospital Medical Center
🇺🇸Las Vegas, Nevada, United States
University of Miami Miller School of Medicine-Sylvester Cancer Center
🇺🇸Miami, Florida, United States
Nicklaus Children's Hospital
🇺🇸Miami, Florida, United States
Miami Cancer Institute
🇺🇸Miami, Florida, United States
Riley Hospital for Children
🇺🇸Indianapolis, Indiana, United States
Saint Vincent Hospital and Health Care Center
🇺🇸Indianapolis, Indiana, United States
Rady Children's Hospital - San Diego
🇺🇸San Diego, California, United States
Naval Medical Center -San Diego
🇺🇸San Diego, California, United States
Cincinnati Children's Hospital Medical Center
🇺🇸Cincinnati, Ohio, United States
Children's Hospitals and Clinics of Minnesota - Minneapolis
🇺🇸Minneapolis, Minnesota, United States
University of Minnesota/Masonic Cancer Center
🇺🇸Minneapolis, Minnesota, United States
Methodist Children's Hospital of South Texas
🇺🇸San Antonio, Texas, United States
Duke University Medical Center
🇺🇸Durham, North Carolina, United States
Children's Hospital of San Antonio
🇺🇸San Antonio, Texas, United States
University of Texas Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
UCSF Medical Center-Parnassus
🇺🇸San Francisco, California, United States
UCSF Medical Center-Mission Bay
🇺🇸San Francisco, California, United States
The Children's Hospital at TriStar Centennial
🇺🇸Nashville, Tennessee, United States
Primary Children's Hospital
🇺🇸Salt Lake City, Utah, United States
Banner University Medical Center - Tucson
🇺🇸Tucson, Arizona, United States
City of Hope Comprehensive Cancer Center
🇺🇸Duarte, California, United States
Kaiser Permanente-Oakland
🇺🇸Oakland, California, United States
USA Health Strada Patient Care Center
🇺🇸Mobile, Alabama, United States
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
🇺🇸Torrance, California, United States
UCLA / Jonsson Comprehensive Cancer Center
🇺🇸Los Angeles, California, United States
Loma Linda University Medical Center
🇺🇸Loma Linda, California, United States
Lucile Packard Children's Hospital Stanford University
🇺🇸Palo Alto, California, United States
Children's Hospital and Research Center at Oakland
🇺🇸Oakland, California, United States
Children's Hospital of Orange County
🇺🇸Orange, California, United States
Arkansas Children's Hospital
🇺🇸Little Rock, Arkansas, United States
Cardon Children's Medical Center
🇺🇸Mesa, Arizona, United States
University of Arkansas for Medical Sciences
🇺🇸Little Rock, Arkansas, United States
Kaiser Permanente Downey Medical Center
🇺🇸Downey, California, United States
Alfred I duPont Hospital for Children
🇺🇸Wilmington, Delaware, United States
Providence Alaska Medical Center
🇺🇸Anchorage, Alaska, United States
Miller Children's and Women's Hospital Long Beach
🇺🇸Long Beach, California, United States
Broward Health Medical Center
🇺🇸Fort Lauderdale, Florida, United States
Children's National Medical Center
🇺🇸Washington, District of Columbia, United States
Saint Mary's Hospital
🇺🇸West Palm Beach, Florida, United States
Nemours Children's Clinic - Pensacola
🇺🇸Pensacola, Florida, United States
MedStar Georgetown University Hospital
🇺🇸Washington, District of Columbia, United States
Lurie Children's Hospital-Chicago
🇺🇸Chicago, Illinois, United States
Memorial Health University Medical Center
🇺🇸Savannah, Georgia, United States
Santa Barbara Cottage Hospital
🇺🇸Santa Barbara, California, United States
Lee Memorial Health System
🇺🇸Fort Myers, Florida, United States
Golisano Children's Hospital of Southwest Florida
🇺🇸Fort Myers, Florida, United States
Nemours Children's Clinic-Jacksonville
🇺🇸Jacksonville, Florida, United States
Connecticut Children's Medical Center
🇺🇸Hartford, Connecticut, United States
Memorial Regional Hospital/Joe DiMaggio Children's Hospital
🇺🇸Hollywood, Florida, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
Advocate Children's Hospital-Oak Lawn
🇺🇸Oak Lawn, Illinois, United States
Advocate Lutheran General Hospital
🇺🇸Park Ridge, Illinois, United States
Augusta University Medical Center
🇺🇸Augusta, Georgia, United States
Advocate Children's Hospital-Park Ridge
🇺🇸Park Ridge, Illinois, United States
University of Illinois
🇺🇸Chicago, Illinois, United States
Johns Hopkins All Children's Hospital
🇺🇸Saint Petersburg, Florida, United States
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸Iowa City, Iowa, United States
Saint Jude Midwest Affiliate
🇺🇸Peoria, Illinois, United States
Southern Illinois University School of Medicine
🇺🇸Springfield, Illinois, United States
Eastern Maine Medical Center
🇺🇸Bangor, Maine, United States
Alliance for Childhood Diseases/Cure 4 the Kids Foundation
🇺🇸Las Vegas, Nevada, United States
Saint Joseph's Regional Medical Center
🇺🇸Paterson, New Jersey, United States
William Beaumont Hospital-Royal Oak
🇺🇸Royal Oak, Michigan, United States
Maine Children's Cancer Program
🇺🇸Scarborough, Maine, United States
Cardinal Glennon Children's Medical Center
🇺🇸Saint Louis, Missouri, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
University Medical Center of Southern Nevada
🇺🇸Las Vegas, Nevada, United States
UMass Memorial Medical Center - University Campus
🇺🇸Worcester, Massachusetts, United States
Sunrise Hospital and Medical Center
🇺🇸Las Vegas, Nevada, United States
Helen DeVos Children's Hospital at Spectrum Health
🇺🇸Grand Rapids, Michigan, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Kalamazoo Center for Medical Studies
🇺🇸Kalamazoo, Michigan, United States
Baystate Medical Center
🇺🇸Springfield, Massachusetts, United States
Michigan State University Clinical Center
🇺🇸East Lansing, Michigan, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Mercy Hospital Saint Louis
🇺🇸Saint Louis, Missouri, United States
Saint Barnabas Medical Center
🇺🇸Livingston, New Jersey, United States
University of Rochester
🇺🇸Rochester, New York, United States
Morristown Medical Center
🇺🇸Morristown, New Jersey, United States
East Carolina University
🇺🇸Greenville, North Carolina, United States
Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
🇺🇸New Brunswick, New Jersey, United States
Penn State Children's Hospital
🇺🇸Hershey, Pennsylvania, United States
Stony Brook University Medical Center
🇺🇸Stony Brook, New York, United States
Sanford Broadway Medical Center
🇺🇸Fargo, North Dakota, United States
The Toledo Hospital/Toledo Children's Hospital
🇺🇸Toledo, Ohio, United States
Nationwide Children's Hospital
🇺🇸Columbus, Ohio, United States
Saint Peter's University Hospital
🇺🇸New Brunswick, New Jersey, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸Sioux Falls, South Dakota, United States
Newark Beth Israel Medical Center
🇺🇸Newark, New Jersey, United States
Albany Medical Center
🇺🇸Albany, New York, United States
Children's Hospital Medical Center of Akron
🇺🇸Akron, Ohio, United States
New York Medical College
🇺🇸Valhalla, New York, United States
Overlook Hospital
🇺🇸Summit, New Jersey, United States
Mount Sinai Hospital
🇺🇸New York, New York, United States
Dartmouth Hitchcock Medical Center
🇺🇸Lebanon, New Hampshire, United States
The Steven and Alexandra Cohen Children's Medical Center of New York
🇺🇸New Hyde Park, New York, United States
Lehigh Valley Hospital - Muhlenberg
🇺🇸Bethlehem, Pennsylvania, United States
Scott and White Memorial Hospital
🇺🇸Temple, Texas, United States
NYU Winthrop Hospital
🇺🇸Mineola, New York, United States
Laura and Isaac Perlmutter Cancer Center at NYU Langone
🇺🇸New York, New York, United States
Memorial Sloan Kettering Cancer Center
🇺🇸New York, New York, United States
Carolinas Medical Center/Levine Cancer Institute
🇺🇸Charlotte, North Carolina, United States
Novant Health Presbyterian Medical Center
🇺🇸Charlotte, North Carolina, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
University Pediatric Hospital
🇵🇷San Juan, Puerto Rico
NYP/Weill Cornell Medical Center
🇺🇸New York, New York, United States
Rainbow Babies and Childrens Hospital
🇺🇸Cleveland, Ohio, United States
Natalie Warren Bryant Cancer Center at Saint Francis
🇺🇸Tulsa, Oklahoma, United States
Dayton Children's Hospital
🇺🇸Dayton, Ohio, United States
Mercy Children's Hospital
🇺🇸Toledo, Ohio, United States
State University of New York Upstate Medical University
🇺🇸Syracuse, New York, United States
Mission Hospital Inc-Memorial Campus
🇺🇸Asheville, North Carolina, United States
Saint Christopher's Hospital for Children
🇺🇸Philadelphia, Pennsylvania, United States
Medical City Dallas Hospital
🇺🇸Dallas, Texas, United States
Brooke Army Medical Center
🇺🇸Fort Sam Houston, Texas, United States
East Tennessee Childrens Hospital
🇺🇸Knoxville, Tennessee, United States
T C Thompson Children's Hospital
🇺🇸Chattanooga, Tennessee, United States
Lehigh Valley Hospital-Cedar Crest
🇺🇸Allentown, Pennsylvania, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Children's Hospital of Pittsburgh of UPMC
🇺🇸Pittsburgh, Pennsylvania, United States
Covenant Children's Hospital
🇺🇸Lubbock, Texas, United States
UMC Cancer Center / UMC Health System
🇺🇸Lubbock, Texas, United States
The Montreal Children's Hospital of the MUHC
🇨🇦Montreal, Quebec, Canada
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸Dallas, Texas, United States
University of Alberta Hospital
🇨🇦Edmonton, Alberta, Canada
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸Green Bay, Wisconsin, United States
BI-LO Charities Children's Cancer Center
🇺🇸Greenville, South Carolina, United States
West Virginia University Healthcare
🇺🇸Morgantown, West Virginia, United States
Royal Children's Hospital-Brisbane
🇦🇺Herston, Queensland, Australia
Greenville Cancer Treatment Center
🇺🇸Greenville, South Carolina, United States
University of Virginia Cancer Center
🇺🇸Charlottesville, Virginia, United States
McMaster Children's Hospital at Hamilton Health Sciences
🇨🇦Hamilton, Ontario, Canada
Vannie Cook Children's Clinic
🇺🇸McAllen, Texas, United States
Vanderbilt University/Ingram Cancer Center
🇺🇸Nashville, Tennessee, United States
El Paso Children's Hospital
🇺🇸El Paso, Texas, United States
Texas Tech University Health Sciences Center-Amarillo
🇺🇸Amarillo, Texas, United States
Prisma Health Richland Hospital
🇺🇸Columbia, South Carolina, United States
Seattle Children's Hospital
🇺🇸Seattle, Washington, United States
Centre Hospitalier Universitaire Sainte-Justine
🇨🇦Montreal, Quebec, Canada
Swiss Pediatric Oncology Group - Lausanne
🇨ðŸ‡Lausanne, Switzerland
Alberta Children's Hospital
🇨🇦Calgary, Alberta, Canada
IWK Health Centre
🇨🇦Halifax, Nova Scotia, Canada
Driscoll Children's Hospital
🇺🇸Corpus Christi, Texas, United States
University of Vermont and State Agricultural College
🇺🇸Burlington, Vermont, United States
Royal Brisbane and Women's Hospital
🇦🇺Herston, Queensland, Australia
Naval Medical Center - Portsmouth
🇺🇸Portsmouth, Virginia, United States
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
🇺🇸Houston, Texas, United States
Providence Sacred Heart Medical Center and Children's Hospital
🇺🇸Spokane, Washington, United States
Saskatoon Cancer Centre
🇨🇦Saskatoon, Saskatchewan, Canada
Women's and Children's Hospital-Adelaide
🇦🇺North Adelaide, South Australia, Australia
Allan Blair Cancer Centre
🇨🇦Regina, Saskatchewan, Canada
Our Lady's Children's Hospital
🇮🇪Dublin, Co Dublin, Ireland
Starship Children's Hospital
🇳🇿Grafton, Auckland, New Zealand
Christchurch Hospital
🇳🇿Christchurch, New Zealand
Cook Children's Medical Center
🇺🇸Fort Worth, Texas, United States
CancerCare Manitoba
🇨🇦Winnipeg, Manitoba, Canada
Mary Bridge Children's Hospital and Health Center
🇺🇸Tacoma, Washington, United States
Royal Children's Hospital
🇦🇺Parkville, Victoria, Australia
Queensland Children's Hospital
🇦🇺South Brisbane, Queensland, Australia
Children's Hospital of The King's Daughters
🇺🇸Norfolk, Virginia, United States
West Virginia University Charleston Division
🇺🇸Charleston, West Virginia, United States
Inova Fairfax Hospital
🇺🇸Falls Church, Virginia, United States
Carilion Clinic Children's Hospital
🇺🇸Roanoke, Virginia, United States
John Hunter Children's Hospital
🇦🇺Hunter Regional Mail Centre, New South Wales, Australia
Madigan Army Medical Center
🇺🇸Tacoma, Washington, United States
Marshfield Medical Center-Marshfield
🇺🇸Marshfield, Wisconsin, United States
Princess Margaret Hospital for Children
🇦🇺Perth, Western Australia, Australia
Hospital for Sick Children
🇨🇦Toronto, Ontario, Canada
Swiss Pediatric Oncology Group - Geneva
🇨ðŸ‡Geneva, Switzerland
Kingston Health Sciences Centre
🇨🇦Kingston, Ontario, Canada
Janeway Child Health Centre
🇨🇦Saint John's, Newfoundland and Labrador, Canada
British Columbia Children's Hospital
🇨🇦Vancouver, British Columbia, Canada
Children's Hospital of Eastern Ontario
🇨🇦Ottawa, Ontario, Canada
San Jorge Children's Hospital
🇵🇷San Juan, Puerto Rico
Children's Hospital
🇨🇦London, Ontario, Canada
Phoenix Childrens Hospital
🇺🇸Phoenix, Arizona, United States
Wayne State University/Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
Ascension Saint John Hospital
🇺🇸Detroit, Michigan, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Children's Hospital of Alabama
🇺🇸Birmingham, Alabama, United States
University of Alabama at Birmingham Cancer Center
🇺🇸Birmingham, Alabama, United States
Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center
🇺🇸Denver, Colorado, United States
Legacy Emanuel Children's Hospital
🇺🇸Portland, Oregon, United States
Legacy Emanuel Hospital and Health Center
🇺🇸Portland, Oregon, United States
Oregon Health and Science University
🇺🇸Portland, Oregon, United States
Children's Hospital Colorado
🇺🇸Aurora, Colorado, United States
Tampa General Hospital
🇺🇸Tampa, Florida, United States
Saint Joseph's Hospital/Children's Hospital-Tampa
🇺🇸Tampa, Florida, United States
Walter Reed National Military Medical Center
🇺🇸Bethesda, Maryland, United States
Mayo Clinic
🇺🇸Rochester, Minnesota, United States
Children's Hospital and Medical Center of Omaha
🇺🇸Omaha, Nebraska, United States
University of Nebraska Medical Center
🇺🇸Omaha, Nebraska, United States
Children's Hospital of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Brooklyn Hospital Center
🇺🇸Brooklyn, New York, United States
Saint Luke's Mountain States Tumor Institute
🇺🇸Boise, Idaho, United States
Wake Forest University Health Sciences
🇺🇸Winston-Salem, North Carolina, United States
Sutter Medical Center Sacramento
🇺🇸Sacramento, California, United States
University of California Davis Comprehensive Cancer Center
🇺🇸Sacramento, California, United States
C S Mott Children's Hospital
🇺🇸Ann Arbor, Michigan, United States
Beaumont Children's Hospital-Royal Oak
🇺🇸Royal Oak, Michigan, United States
Columbia Regional
🇺🇸Columbia, Missouri, United States
Hackensack University Medical Center
🇺🇸Hackensack, New Jersey, United States
Yale University
🇺🇸New Haven, Connecticut, United States
AdventHealth Orlando
🇺🇸Orlando, Florida, United States
Arnold Palmer Hospital for Children
🇺🇸Orlando, Florida, United States
Nemours Children's Clinic - Orlando
🇺🇸Orlando, Florida, United States
UF Cancer Center at Orlando Health
🇺🇸Orlando, Florida, United States
Nemours Children's Hospital
🇺🇸Orlando, Florida, United States
Norton Children's Hospital
🇺🇸Louisville, Kentucky, United States
Children's Mercy Hospitals and Clinics
🇺🇸Kansas City, Missouri, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
UNC Lineberger Comprehensive Cancer Center
🇺🇸Chapel Hill, North Carolina, United States
University of Florida Health Science Center - Gainesville
🇺🇸Gainesville, Florida, United States
University of Hawaii Cancer Center
🇺🇸Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children
🇺🇸Honolulu, Hawaii, United States
Tripler Army Medical Center
🇺🇸Honolulu, Hawaii, United States
Tulane University Health Sciences Center
🇺🇸New Orleans, Louisiana, United States
Children's Hospital New Orleans
🇺🇸New Orleans, Louisiana, United States
Ochsner Medical Center Jefferson
🇺🇸New Orleans, Louisiana, United States
Montefiore Medical Center - Moses Campus
🇺🇸Bronx, New York, United States
Dell Children's Medical Center of Central Texas
🇺🇸Austin, Texas, United States
Virginia Commonwealth University/Massey Cancer Center
🇺🇸Richmond, Virginia, United States
Blank Children's Hospital
🇺🇸Des Moines, Iowa, United States
University of Kentucky/Markey Cancer Center
🇺🇸Lexington, Kentucky, United States
University of Wisconsin Hospital and Clinics
🇺🇸Madison, Wisconsin, United States
Monash Medical Center-Clayton Campus
🇦🇺Clayton, Victoria, Australia
Rhode Island Hospital
🇺🇸Providence, Rhode Island, United States