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A Study of Nemtabrutinib Plus Venetoclax vs Venetoclax + Rituximab (VR) in Second-line (2L) + Relapsed/Refractory (R/R) Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL) (MK-1026-010/BELLWAVE-010).

Phase 3
Recruiting
Conditions
CLL
Small-Cell Lymphoma
Lymphoma, Small Lymphocytic
SLL
Leukemia, Chronic Lymphocytic
Leukemia, Lymphocytic, Chronic, B-Cell
Interventions
Registration Number
NCT05947851
Lead Sponsor
Merck Sharp & Dohme LLC
Brief Summary

The purpose of this study is to assess the safety and tolerability and to confirm the dose of nemtabrutinib in combination with venetoclax in participants with R/R CLL/SLL. The primary study hypotheses are that the combination of nemtabrutinib plus venetoclax is superior to VR with respect to progression-free survival (PFS) per 2018 International Workshop on Chronic Lymphocytic Leukemia (iwCLL) criteria as assessed by blinded independent central review (BICR).

Detailed Description

Not available

Recruitment & Eligibility

Status
RECRUITING
Sex
All
Target Recruitment
720
Inclusion Criteria
  • Confirmed diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and active disease clearly documented to initiate therapy.
  • Deletion (Del) (17p) status, tumor protein 53 (TP53) mutation status, immunoglobulin heavy chain gene (IGHV) mutation status and Bruton's tyrosine kinase (BTK)-C481 mutation status results required before randomization for Part 2 participants only.
  • Relapsed or refractory to at least 1 prior available therapy.
  • Have at least 1 marker of disease burden.
  • Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2 within 7 days before randomization.
  • Has a life expectancy of at least 3 months.
  • Has the ability to swallow and retain oral medication.
  • Participants who are hepatitis B surface antigen (HBsAg) positive are eligible if they have received hepatitis B virus (HBV) antiviral therapy for at least 4 weeks and have undetectable HBV deoxyribonucleic acid (DNA) viral load before randomization.
  • Participants with history of hepatitis C virus (HCV) infection are eligible if HCV ribonucleic acid (RNA) viral load is undetectable at screening.
  • Participants with human immunodeficiency virus (HIV) who meet ALL eligibility criteria.
  • Participants with adequate organ function with specimens collected within 7 days before the start of study intervention.
  • If capable of producing sperm, participant agrees to eliminate Nemtabrutinib: 12 days, Venetoclax: 1 month (30 days), Rituximab (rituximab biosimilar): not applicable; abstains from penile-vaginal intercourse as their preferred and usual lifestyle; OR uses prescribed contraception.
  • Participant assigned female sex at birth are eligible to participate if not pregnant or breastfeeding and are not a person of childbearing potential (POCBP) OR is a POCBP and uses a contraceptive method that is highly effective, has a negative highly sensitive pregnancy test, and abstains from breastfeeding.
Exclusion Criteria
  • Has an active hepatitis B virus/ hepatitis C virus (HBV/HCV) infection.
  • Has gastrointestinal (GI) dysfunction that may affect drug absorption.
  • Has a known additional malignancy that is progressing or has required active treatment within the past 3 years.
  • Has diagnosis of Richter Transformation or active central nervous system (CNS) involvement by CLL/SLL.
  • Has an active infection requiring systemic therapy, such as intravenous (IV) antibiotics, during screening.
  • HIV-infected participants with a history of Kaposi's sarcoma and/or Multicentric Castleman's Disease and/or acquired immune deficiency syndrome (AIDS)-defining opportunistic infection in the past 12 months before screening.
  • Has QT interval corrected (QTc) prolongation or other significant electrocardiogram (ECG) abnormalities.
  • Has a known allergy/sensitivity to nemtabrutinib or contraindication to venetoclax/rituximab (or rituximab biosimilar), or any of the excipients.
  • Has history of severe bleeding disorders (eg, hemophilia).
  • Has received prior systemic anticancer therapy within 5 half-lives or 4 weeks (if prior therapy was a monoclonal antibody) before randomization.
  • Has received prior B-cell lymphoma 2 inhibitor(s) (BCL2i) including venetoclax or Non-covalent Bruton's tyrosine kinase inhibitor (BTKi).
  • Is currently being treated with p-glycoprotein (P-gp) substrates with a narrow therapeutic index, cytochrome P450 3A (CYP3A) strong or moderate inducers or CYP3A strong inhibitors.
  • Has received a live or live attenuated vaccine within 30 days before the first dose of study intervention.
  • Has received an investigational agent or has used an investigational device within 4 weeks before study intervention administration.
  • Has a known psychiatric or substance use disorder that would interfere with the participant's ability to cooperate with the requirements of the study.
  • Participants who have not adequately recovered from major surgery or have ongoing surgical complications.

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
Nemtabrutinib + VenetoclaxNemtabrutinibParticipants will receive nemtrabrutinib oral tablets at specified doses daily starting at Cycle 1 Day 1 (C1D1) and venetoclax oral tablets at doses of 20 mg up to 400 mg daily starting at Cycle 2 Day 1 (C2D1) up to 2 years post C2D1 or until progressive disease (PD) or discontinuation. A cycle = 4 weeks.
Venetoclax + RituximabVenetoclaxParticipants will receive venetoclax oral tablets at doses from 20 mg up to 400 mg daily starting at C1D1 on 4-week cycles up to 2 years and rituximab or biosimilar at 375 mg/m\^2 up to 500 mg/m2 intravenous infusion once per 28-day cycle starting at C2D1, for 6 total cycles. Treatment will continue until progressive disease (PD) or discontinuation.
Nemtabrutinib + VenetoclaxVenetoclaxParticipants will receive nemtrabrutinib oral tablets at specified doses daily starting at Cycle 1 Day 1 (C1D1) and venetoclax oral tablets at doses of 20 mg up to 400 mg daily starting at Cycle 2 Day 1 (C2D1) up to 2 years post C2D1 or until progressive disease (PD) or discontinuation. A cycle = 4 weeks.
Venetoclax + RituximabRituximabParticipants will receive venetoclax oral tablets at doses from 20 mg up to 400 mg daily starting at C1D1 on 4-week cycles up to 2 years and rituximab or biosimilar at 375 mg/m\^2 up to 500 mg/m2 intravenous infusion once per 28-day cycle starting at C2D1, for 6 total cycles. Treatment will continue until progressive disease (PD) or discontinuation.
Primary Outcome Measures
NameTimeMethod
Part 2: PFS per the 2018 International Workshop on Chronic Lymphocytic Leukemia (iwCLL) Criteria as assessed by Blinded Independent Central Review (BICR)Up to approximately 71 months

PFS is defined as the time from randomization to the first documented disease progression per iwCLL criteria 2018 as accessed by BICR, or death due to any cause, whichever occurs first. PFS will be presented.

Part 1: Number of participants experiencing adverse events (AEs)Up to approximately 28 months

An AE is any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. The number of participants experiencing AEs will be reported for Part 1.

Part 1: Number of participants experiencing dose-limiting toxicities (DLTs)Up to approximately 12 Weeks

DLT evaluation period is defined as 8 weeks after the first dose of the combination treatment of nemtabrutinib plus venetoclax Cycle 2 Day 1 in Part 1 + 4 weeks follow up. Each cycle is 4 weeks. DLTs are: Grade ≥3 nonhematologic toxicity (except Grade 3 nausea, vomiting, diarrhea, rash, fatigue, and uncontrolled hypertension which will not be considered a DLT unless lasting ≥72 hours despite optimal supportive care); Grade 4 hematologic toxicity lasting \>7 days (except Grade 3 lymphocytosis, Grade 4 platelet count decreased of any duration, or Grade 3 platelet count decreased if associated with bleeding); any Grade 3 or Grade 4 nonhematologic laboratory abnormality if values result in drug-induced liver injury, or medical intervention is required, or the abnormality leads to hospitalization, or the abnormality persists for \>1 week (with exceptions); missing \>25% of nemtabrutinib or venetoclax doses as a result of drug-related adverse events during the first 2 cycles; Grade 5 toxicity.

Part 1: Number of participants discontinuing study treatment due to AEsUp to approximately 25 months

An AE is any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. The number of participants discontinuing study treatment due to AEs will be reported for Part 1.

Secondary Outcome Measures
NameTimeMethod
Part 2: Undetectable minimal residual disease (MRD) rate in bone marrow as assessed by central laboratoryMonth 14

Undetectable MRD, defined as \<1 leukemic cell per 10,000 cells (MRD \<10-4) in bone marrow. The MRD rate will be presented.

Part 2: Overall Survival (OS)Up to approximately 108 months

OS, defined as the time from randomization to death due to any cause. OS will be presented.

Part 2: Number of participants discontinuing study treatment due to AEsUp to approximately 25 months

An AE is any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. The number of participants discontinuing study treatment due to AEs will be reported for Part 2.

Part 2: Duration of Response (DOR) per iwCLL Criteria 2018 as assessed by BICRUp to approximately 108 months

DOR, defined as the time from the first documented evidence of CR, CRi, nPR, or PR that led to response until disease progression or death due to any cause, whichever occurs first. CR is defined as meeting the following criteria: no lymph nodes \>1.5 cm, spleen size \<13 cm, liver normal; no constitutional symptoms, normal lymphocyte count, platelets ≥100 x 10\^9/L; hemoglobin ≥11 g/dL; and normocellular marrow (no CLL cells or B lymphoid nodules). CRi is defined as meeting CR criteria but with hypocellular bone marrow. nPR is defined as having features of CR but with lymphoid nodules in the marrow. PR is defined as ≥50% decrease in ≥2 of the following: lymph nodes, liver and/or spleen size, lymphocytes PLUS ≥1 of the following met: platelets ≥100 x 10\^9/L or ≥50% increase from screening, hemoglobin \>11 g/dL or ≥50% increase from screening, CLL cells or B lymphoid nodules in marrow. DOR will be presented.

Part 2: Objective Response Rate (ORR) per iwCLL Criteria 2018 as assessed by BICRUp to approximately 108 months

OR, defined as complete response/remission (CR), complete response with incomplete count recovery (CRi), nodular partial remission (nPR), or partial remission (PR). CR is defined as meeting the following criteria: no lymph nodes \>1.5 cm, spleen size \<13 cm, liver normal; no constitutional symptoms, normal lymphocyte count, platelets ≥100 x 10\^9/L; hemoglobin ≥11 g/dL; and normocellular marrow (no CLL cells or B lymphoid nodules). CRi is defined as meeting CR criteria but with hypocellular bone marrow. nPR is defined as having features of CR but with lymphoid nodules in the marrow. PR is defined as ≥50% decrease in ≥2 of the following: lymph nodes, liver and/or spleen size, lymphocytes PLUS ≥1 of the following met: platelets ≥100 x 10\^9/L or ≥50% increase from screening, hemoglobin \>11 g/dL or ≥50% increase from screening, CLL cells or B lymphoid nodules in marrow. ORR will be presented.

Part 2: Number of participants experiencing AEsUp to approximately 28 months

An AE is any untoward medical occurrence in a participant, temporally associated with the use of study treatment, whether or not considered related to the study treatment. The number of participants experiencing AEs will be reported for Part 2.

Trial Locations

Locations (109)

Memorial Hospital West ( Site 5410)

🇺🇸

Pembroke Pines, Florida, United States

Oregon Health and Science University ( Site 5425)

🇺🇸

Portland, Oregon, United States

ICESP - INSTITUTO DO CÂNCER DO ESTADO DE SÃO PAULO-Pesquisa Clinica ( Site 1308)

🇧🇷

Sao Paulo, Brazil

The Moncton Hospital ( Site 1414)

🇨🇦

Moncton, New Brunswick, Canada

Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre ( Site 1402)

🇨🇦

Greenfield Park, Quebec, Canada

Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre Hospitalier Univer

🇨🇦

Sherbrooke, Quebec, Canada

Biocenter ( Site 1507)

🇨🇱

Concepcion., Biobio, Chile

IC La Serena Research ( Site 1506)

🇨🇱

La Serena., Coquimbo, Chile

Centro de Estudios Clínicos SAGA-CECSAGA ( Site 1509)

🇨🇱

Santiago, Region M. De Santiago, Chile

Universitätsklinikum Leipzig-Medical Department I - Hematology and Celltherapy ( Site 2201)

🇩🇪

Leipzig, Sachsen, Germany

Rambam Health Care Campus ( Site 2801)

🇮🇱

Haifa, Israel

Sheba Medical Center-Hemato Oncology ( Site 2809)

🇮🇱

Ramat Gan, Israel

Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare -Azienda Ospedaliera Nazionale SS. Ant

🇮🇹

Alessandria, Italy

Ospedale San Raffaele-Programma di Ricerca Strategica sulla LLC ( Site 2902)

🇮🇹

Milano, Italy

Arcispedale Santa Maria Nuova-Hematology ( Site 2900)

🇮🇹

Reggio Emilia, Italy

Auxilio Mutuo Cancer Center ( Site 3900)

🇵🇷

San Juan, Puerto Rico

Namik Kemal University Medical Faculty-Hematology ( Site 4912)

🇹🇷

Tekirdag, Tekirdas, Turkey

Ankara Universitesi Tip Fakultesi Hastanesi-hematology ( Site 4913)

🇹🇷

Ankara, Turkey

Mega Medipol-Hematology ( Site 4904)

🇹🇷

İstanbul, Turkey

TC Saglik Bakanligi Goztepe Prof. Dr. Suleyman Yalcin Sehir Hastanesi ( Site 4906)

🇹🇷

Istanbul, Turkey

Ege Universitesi Hastanesi ( Site 4902)

🇹🇷

İzmir, Turkey

City Hospital, Nottingham University Hospitals-Hematology ( Site 5002)

🇬🇧

Nottingham, England, United Kingdom

University College London Hospital-Cancer Clinical Trials Unit ( Site 5001)

🇬🇧

London-Camden, London, City Of, United Kingdom

Highlands Oncology Group ( Site 5405)

🇺🇸

Springdale, Arkansas, United States

MemorialCare Health System - Long Beach Medical Center ( Site 5421)

🇺🇸

Long Beach, California, United States

Centre Hospitalier Universitaire Estaing ( Site 2105)

🇫🇷

Clermont-Ferrand, Puy-de-Dome, France

CHD Vendee ( Site 2100)

🇫🇷

La Roche-sur-Yon, Vendee, France

Klinikum Mutterhaus der Borromäerinnen-Innere Medizin I ( Site 2203)

🇩🇪

Trier, Rheinland-Pfalz, Germany

Hadassah Medical Center-Hemato-Oncology ( Site 2812)

🇮🇱

Jerusalem, Israel

Centro de Infusion Superare ( Site 3314)

🇲🇽

Ciudad de México, Distrito Federal, Mexico

Health Pharma Professional Research S.A. de C.V: ( Site 3301)

🇲🇽

Ciudad de México, Distrito Federal, Mexico

Netcare Pretoria East Hospital-Albert Alberts Stem Cell Transplant Centre ( Site 4401)

🇿🇦

Moreletta Park, Gauteng, South Africa

Groote Schuur Hospital ( Site 4400)

🇿🇦

Cape Town, Western Cape, South Africa

Haemalife ( Site 4407)

🇿🇦

Kuilsriver, Western Cape, South Africa

Instituto Catalan de Oncologia - Hospital Duran i Reynals-Haematology Department ( Site 4601)

🇪🇸

L'Hospitalet Del Llobregat, Barcelona, Spain

HOSPITAL UNIVERSITARIO QUIRONSALUD MADRID ( Site 4602)

🇪🇸

Pozuelo de Alarcon, Madrid, Spain

HOSPITAL CLINICO DE VALENCIA-HEMATOLOGY ( Site 4603)

🇪🇸

Valencia, Valenciana, Comunitat, Spain

Medical Oncology Associates, PS ( Site 5406)

🇺🇸

Spokane, Washington, United States

Instituto Alexander Fleming ( Site 1005)

🇦🇷

Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina

University of Wisconsin Hospital and Clinics-Carbone Cancer Center ( Site 5423)

🇺🇸

Madison, Wisconsin, United States

Instituto de Investigaciones Clínicas Mar del Plata ( Site 1007)

🇦🇷

Mar del Plata, Buenos Aires, Argentina

Centro de Educación Médica e Investigaciones Clínicas (CEMIC)-Hematology ( Site 1002)

🇦🇷

Buenos Aires, Caba, Argentina

Sanatorio Parque ( Site 1003)

🇦🇷

Rosario, Santa Fe, Argentina

Centro Medico Fleischer ( Site 1006)

🇦🇷

Buenos Aires, Argentina

Hospital Aleman-oncohematologic diseases ( Site 1001)

🇦🇷

Buenos Aires, Argentina

Royal Adelaide Hospital ( Site 1104)

🇦🇺

Adelaide, South Australia, Australia

Western Health-Sunshine & Footscray Hospitals-Cancer Services-Cancer Research ( Site 1103)

🇦🇺

Melbourne, Victoria, Australia

UZ Leuven-Hematology ( Site 1200)

🇧🇪

Leuven, Vlaams-Brabant, Belgium

ZAS Cadix ( Site 1203)

🇧🇪

Antwerpen, Belgium

FALP-UIDO ( Site 1500)

🇨🇱

Santiago, Region M. De Santiago, Chile

Clínica Inmunocel ( Site 1511)

🇨🇱

Santiago, Region M. De Santiago, Chile

Fundación Valle del Lili ( Site 1703)

🇨🇴

Cali, Valle Del Cauca, Colombia

Hopital Claude Huriez - CHU de Lille ( Site 2107)

🇫🇷

Lille, Nord, France

Sourasky Medical Center ( Site 2811)

🇮🇱

Tel Aviv, Israel

Highlands Oncology Group ( Site 5405)

🇺🇸

Springdale, Arkansas, United States

MemorialCare Health System - Long Beach Medical Center ( Site 5421)

🇺🇸

Long Beach, California, United States

Memorial Hospital West ( Site 5410)

🇺🇸

Pembroke Pines, Florida, United States

Oregon Health and Science University ( Site 5425)

🇺🇸

Portland, Oregon, United States

Medical Oncology Associates, PS ( Site 5406)

🇺🇸

Spokane, Washington, United States

University of Wisconsin Hospital and Clinics-Carbone Cancer Center ( Site 5423)

🇺🇸

Madison, Wisconsin, United States

Instituto Alexander Fleming ( Site 1005)

🇦🇷

Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina

Instituto de Investigaciones Clínicas Mar del Plata ( Site 1007)

🇦🇷

Mar del Plata, Buenos Aires, Argentina

Centro de Educación Médica e Investigaciones Clínicas (CEMIC)-Hematology ( Site 1002)

🇦🇷

Buenos Aires, Caba, Argentina

Sanatorio Parque ( Site 1003)

🇦🇷

Rosario, Santa Fe, Argentina

Centro Medico Fleischer ( Site 1006)

🇦🇷

Buenos Aires, Argentina

Hospital Aleman-oncohematologic diseases ( Site 1001)

🇦🇷

Buenos Aires, Argentina

Royal Adelaide Hospital ( Site 1104)

🇦🇺

Adelaide, South Australia, Australia

Western Health-Sunshine & Footscray Hospitals-Cancer Services-Cancer Research ( Site 1103)

🇦🇺

Melbourne, Victoria, Australia

UZ Leuven-Hematology ( Site 1200)

🇧🇪

Leuven, Vlaams-Brabant, Belgium

ZAS Cadix ( Site 1203)

🇧🇪

Antwerpen, Belgium

ICESP - INSTITUTO DO CÂNCER DO ESTADO DE SÃO PAULO-Pesquisa Clinica ( Site 1308)

🇧🇷

Sao Paulo, Brazil

Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre Hospitalier Univer ( Site 1410)

🇨🇦

Sherbrooke, Quebec, Canada

Hopital Claude Huriez - CHU de Lille ( Site 2107)

🇫🇷

Lille, Nord, France

Centre Hospitalier Universitaire Estaing ( Site 2105)

🇫🇷

Clermont-Ferrand, Puy-de-Dome, France

The Moncton Hospital ( Site 1414)

🇨🇦

Moncton, New Brunswick, Canada

Centro de Estudios Clínicos SAGA-CECSAGA ( Site 1509)

🇨🇱

Santiago, Region M. De Santiago, Chile

Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre ( Site 1402)

🇨🇦

Greenfield Park, Quebec, Canada

Biocenter ( Site 1507)

🇨🇱

Concepcion., Biobio, Chile

IC La Serena Research ( Site 1506)

🇨🇱

La Serena., Coquimbo, Chile

FALP-UIDO ( Site 1500)

🇨🇱

Santiago, Region M. De Santiago, Chile

Clínica Inmunocel ( Site 1511)

🇨🇱

Santiago, Region M. De Santiago, Chile

CHD Vendee ( Site 2100)

🇫🇷

La Roche-sur-Yon, Vendee, France

Klinikum Mutterhaus der Borromäerinnen-Innere Medizin I ( Site 2203)

🇩🇪

Trier, Rheinland-Pfalz, Germany

Arcispedale Santa Maria Nuova-Hematology ( Site 2900)

🇮🇹

Reggio Emilia, Italy

Fundación Valle del Lili ( Site 1703)

🇨🇴

Cali, Valle Del Cauca, Colombia

Universitätsklinikum Leipzig-Medical Department I - Hematology and Celltherapy ( Site 2201)

🇩🇪

Leipzig, Sachsen, Germany

Rambam Health Care Campus ( Site 2801)

🇮🇱

Haifa, Israel

Hadassah Medical Center-Hemato-Oncology ( Site 2812)

🇮🇱

Jerusalem, Israel

Sheba Medical Center-Hemato Oncology ( Site 2809)

🇮🇱

Ramat Gan, Israel

Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo ( Site 2906)

🇮🇹

Alessandria, Ancona, Italy

Sourasky Medical Center ( Site 2811)

🇮🇱

Tel Aviv, Israel

Ospedale San Raffaele-Programma di Ricerca Strategica sulla LLC ( Site 2902)

🇮🇹

Milano, Italy

Centro de Infusion Superare ( Site 3314)

🇲🇽

Ciudad de México, Distrito Federal, Mexico

Health Pharma Professional Research S.A. de C.V: ( Site 3301)

🇲🇽

Ciudad de México, Distrito Federal, Mexico

Centro de Investigacion Clinica Chapultepec ( Site 3309)

🇲🇽

Morelia, Michoacan, Mexico

Auxilio Mutuo Cancer Center ( Site 3900)

🇵🇷

San Juan, Puerto Rico

HOSPITAL CLINICO DE VALENCIA-HEMATOLOGY ( Site 4603)

🇪🇸

Valencia, Valenciana, Comunitat, Spain

Netcare Pretoria East Hospital-Albert Alberts Stem Cell Transplant Centre ( Site 4401)

🇿🇦

Moreletta Park, Gauteng, South Africa

Groote Schuur Hospital ( Site 4400)

🇿🇦

Cape Town, Western Cape, South Africa

Namik Kemal University Medical Faculty-Hematology ( Site 4912)

🇹🇷

Tekirdag, Tekirdas, Turkey

Ankara Universitesi Tip Fakultesi Hastanesi-hematology ( Site 4913)

🇹🇷

Ankara, Turkey

Mega Medipol-Hematology ( Site 4904)

🇹🇷

İstanbul, Turkey

Haemalife ( Site 4407)

🇿🇦

Kuilsriver, Western Cape, South Africa

HOSPITAL UNIVERSITARIO QUIRONSALUD MADRID ( Site 4602)

🇪🇸

Pozuelo de Alarcon, Madrid, Spain

Instituto Catalan de Oncologia - Hospital Duran i Reynals-Haematology Department ( Site 4601)

🇪🇸

L'Hospitalet Del Llobregat, Barcelona, Spain

TC Saglik Bakanligi Goztepe Prof. Dr. Suleyman Yalcin Sehir Hastanesi ( Site 4906)

🇹🇷

Istanbul, Turkey

Ege Universitesi Hastanesi ( Site 4902)

🇹🇷

İzmir, Turkey

City Hospital, Nottingham University Hospitals-Hematology ( Site 5002)

🇬🇧

Nottingham, England, United Kingdom

University College London Hospital-Cancer Clinical Trials Unit ( Site 5001)

🇬🇧

London-Camden, London, City Of, United Kingdom

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