A Safety and Efficacy Study of Obinutuzumab Alone or in Combination With Chemotherapy in Participants With Chronic Lymphocytic Leukemia
- Conditions
- Chronic Lymphocytic Leukemia
- Interventions
- Registration Number
- NCT01905943
- Lead Sponsor
- Hoffmann-La Roche
- Brief Summary
This multicenter, open-label, single-arm study will evaluate the safety and efficacy of obinutuzumab alone or in combination with chemotherapy in participants with previously untreated or relapsed/refractory chronic lymphocytic leukemia (CLL). This is a Post-Authorization Safety Study. Participants will receive 6 cycles of single-agent obinutuzumab or obinutuzumab in combination with chemotherapy at the investigator's discretion. Each participant will be followed until 30 months after the last participant has been enrolled. Total length of the study is anticipated to be approximately 5 years.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 979
- Previously untreated documented CLL according to National Cancer Institute/international workshop on CLL (NCI/iwCLL) criteria OR relapsed and/or refractory documented CLL participants requiring treatment according to NCI/iwCLL criteria; participants with up to 3 relapses are eligible
- Refractory participants if last treatment was with single-agent therapy, single-agent chemotherapy, or single-agent antibody
- Participants with 17p-deletion and/or p53 mutation may be included at the investigator's discretion
- Eastern Cooperative Oncology Group (ECOG) performance status 0-2
- Life expectancy greater than (>) 6 months according to the investigator's opinion
- Adequate hematological function
- Participants who have received more than 3 previous CLL treatment lines
- Documented transformation of CLL to aggressive lymphoma (Richter's transformation)
- Participants who are refractory to immunochemotherapy
- Participants with abnormal laboratory values
- One or more individual organ/system impairment score of 4 as assessed by the cumulative illness rating scale (CIRS) definition, excluding the eyes, ears, nose, throat and larynx organ systems
- Participants with a history of progressive multifocal leukoencephalopathy (PML)
- History of severe allergic or anaphylactic reactions to monoclonal antibody therapy
- Known hypersensitivity to the study drugs
- History of prior malignancy unless the malignancy has been treated with a curative intent and in remission without treatment for greater than or equal to (>/=) 5 years prior to enrollment and with the exception of curatively-treated basal cell carcinoma, squamous cell carcinoma of the skin, low grade in situ carcinoma of the cervix, or low grade, early stage localized prostate cancer treated surgically with curative intent
- Regular treatment with corticosteroids during the 28 days prior to the start of Cycle 1, Day 1, unless administered for indications other than CLL at a dose equivalent to less than or equal to (</=) 30 milligrams per day (mg/day) prednisone
- Regular treatment with immunosuppressive medications following previous organ transplantation
- Evidence of significant, uncontrolled concomitant diseases
- Known active bacterial, viral, fungal, mycobacterial, parasitic, or other infection (excluding fungal infections of the nail beds) or a major episode of infection requiring treatment with intravenous (IV) antibiotics or hospitalization within 28 days prior to the start of Cycle 1, Day 1
- Vaccination with live vaccines within 28 days prior to start of Cycle 1, Day 1
- Major surgery (within 28 days prior to the start of Cycle 1, Day 1), other than for diagnosis
- Positive for chronic hepatitis B, hepatitis C, human T-lymphotropic virus 1 (HTLV 1) or human immunodeficiency virus (HIV) infection
- Pregnant or lactating women
- Fertile men or women of childbearing potential
- Participation in another clinical trial with drug intervention within 28 days prior to start of Cycle 1, Day 1 and during the study
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Obinutuzumab Obinutuzumab Participants will receive obinutuzumab either alone as single agent or in combination with chemotherapy (Fludarabine/Cyclophosphamide \[FC\], Bendamustine or Chlorambucil) at the investigator's discretion. Each cycle is of 28-days duration. Obinutuzumab Bendamustine Participants will receive obinutuzumab either alone as single agent or in combination with chemotherapy (Fludarabine/Cyclophosphamide \[FC\], Bendamustine or Chlorambucil) at the investigator's discretion. Each cycle is of 28-days duration. Obinutuzumab Chlorambucil Participants will receive obinutuzumab either alone as single agent or in combination with chemotherapy (Fludarabine/Cyclophosphamide \[FC\], Bendamustine or Chlorambucil) at the investigator's discretion. Each cycle is of 28-days duration. Obinutuzumab Cyclophosphamide Participants will receive obinutuzumab either alone as single agent or in combination with chemotherapy (Fludarabine/Cyclophosphamide \[FC\], Bendamustine or Chlorambucil) at the investigator's discretion. Each cycle is of 28-days duration. Obinutuzumab Fludarabine Participants will receive obinutuzumab either alone as single agent or in combination with chemotherapy (Fludarabine/Cyclophosphamide \[FC\], Bendamustine or Chlorambucil) at the investigator's discretion. Each cycle is of 28-days duration.
- Primary Outcome Measures
Name Time Method Number of Participants With Adverse Events (AEs) Baseline up to time of primary completion (3 years) An adverse event is any untoward medical occurrence in a participant administered a pharmaceutical product and which does not necessarily have to have a causal relationship with the treatment. An adverse event can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporally associated with the use of a pharmaceutical product, whether or not considered related to the pharmaceutical product. Preexisting conditions which worsen during a study are also considered as adverse events. AEs, including AEs of Special Interest and AEs of Particular Interest, were reported based on the national cancer institute common terminology criteria for AEs, Version 4.0 (NCI-CTCAE, v4.0). Reported are the number of subjects with AEs, Grade 3-5 AEs, and Serious Adverse Events (SAEs).
Number of Participants With Adverse Events of Special Interest (AESIs) Baseline up to time of primary completion (3 years) The following AEs were defined as AESIs: AEs with the preferred term Tumour Lysis Syndrome (TLS), Infusion-Related Reactions (IRRs) defined as AEs that occurred during or within 24 hours of the completion of obinutuzumab infusion and were assessed as related to obinutuzumab by the Investigator, Infections defined as AEs from System Organ Class (SOC) "Infections and infestations" and AEs with the preferred term Neutropenia. Reported are number of participants with total AESIs, IRRs, Infections, Neutropenia and TLS.
Number of Participants With Adverse Events of Particular Interest (AEPIs) Baseline up to time of primary completion (3 years) The following AEs were defined as AEPIs: AEs with the preferred term Progressive multifocal leukoencephalopathy (PML), hepatitis B reactivation defined as AEs with preferred term containing "Hepatitis B" or "hepatitis acute", thrombocytopenia defined via Roche MedDRA basket subgroup "haematopoietic thrombocytopenia", second malignancies defined as AEs from the SOC "Neoplasms benign, malignant and unspecified" starting 6 months after the first study drug intake, second malignancies based on standardised MedDRA queries (SMQ) starting 6 months after the first study drug intake based on the MedDRA SMQ "Malignant or unspecified tumours", in which benign neoplasms are not included, Cardiac events including AEs from the SOC "Cardiac disorders", and hemorrhagic events defined via Roche MedDRA basket subgroup "Haemorrhagic events". Reported are number of participants with total AEPIs and each of the AEPI categories.
- Secondary Outcome Measures
Name Time Method Percentage of Participants With Minimal Residual Disease (MRD)-Negativity as Assessed by Flow Cytometry 3 months after the last dose of study treatment (up to approximately 5 years) MRD-negativity was defined as the presence of less than 1 chronic lymphocytic leukemia (CLL) cell per 10,000 leukocytes in blood and bone marrow as assessed by flow cytometry 3 months after last dose of study treatment (i.e. at final response assessment \[FRA\] visit).
Median Time to Response (TTR) Baseline, Day 85, end of treatment or early termination, and follow-up, assessed up to disease progression or death, whichever occurs first (up to approximately 5 years) Kaplan Meier estimate of median TTR was defined as the time at which half of the participants reached CR or PR based on IWCLL tumor response criteria. CR: Peripheral blood lymphocytes 4,000/mcL, no significant lymphadenopathy, no hepatomegaly and splenomegaly, no disease symptoms, blood counts: neutrophils \>1,500/mcL, platelets \> 100,000/mcL, hemoglobin \> 110 g/L and bone marrow normocellular for age. PR: \>/= 50% decrease in peripheral blood lymphocyte count AND \>/= 50% reduction in lymphadenopathy OR \>/= 50% reduction of liver enlargement OR \>/= 50% reduction of spleen PLUS one of the following: neutrophils \>1,500/mcL, platelets \> 100,000/mcL, hemoglobin \> 110 g/L OR \>/= 50% increase in neutrophils, platelets or hemoglobin.
Median Time to Progression-Free Survival (PFS) Baseline, Day 85, end of treatment or early termination, and follow-up, assessed up to disease progression or death, whichever occurs first (up to approximately 5 years) Kaplan Meier estimate of the median PFS was defined as the time at which half of the participants have progressed (progressive disease \[PD\]) based on IWCLL tumor response criteria or died from any cause, whichever occurred first. PD: at least one of the following: \>/= 50% increase in the absolute number of circulating lymphocytes to at least 5,000/mcL, appearance of new palpable lymph nodes, \>/= 50% increase in the longest diameter of any previous site of clinically significant lymphadenopathy, \>/= 50% increase in the enlargement of the liver and/or spleen, transformation to more aggressive histology, progression of any cytopenia, decrease of hemoglobin levels by more than 20 g/L or to less than 100 g/L, decrease of platelet counts by more than 50% or to less than 100,000 /mcL, decrease of neutrophil counts by more than 50% or to less than 1,000/mcL.
Percentage of Participants With Overall Response (OR) at Final Response Assessment (FRA) 3 months after the last dose of study treatment (up to approximately 5 years) OR: percentage of participants with complete response (CR) or CR with incomplete marrow recovery (CRi), or partial response (PR), as determined by the investigator based on International Workshop on Chronic Lymphocytic Leukemia (IWCLL) tumor response criteria. CR: Peripheral blood lymphocytes 4,000/mcL, no significant lymphadenopathy, no hepatomegaly and splenomegaly, no disease symptoms, blood counts: neutrophils \>1,500/mcL, platelets \> 100,000/mcL, hemoglobin \> 110 g/L and bone marrow normocellular for age. Cri: CR with persistent cytopenia. PR: \>/= 50% decrease in peripheral blood lymphocyte count AND \>/= 50% reduction in lymphadenopathy OR \>/= 50% reduction of liver enlargement OR \>/= 50% reduction of spleen PLUS one of the following: neutrophils \>1,500/mcL, platelets \> 100,000/mcL, hemoglobin \> 110 g/L OR \>/= 50% increase in neutrophils, platelets or hemoglobin.
Median Time to Duration of Response (DoR) Baseline, Day 85, end of treatment or early termination, and follow-up, assessed up to disease progression or death, whichever occurs first (up to approximately 5 years) Kaplan Meier estimate of median DoR was defined as the time at which half of the responding (PR or CR) participants had progressed (PD) or died from any cause, whichever occurred first. PR: \>/= 50% decrease in peripheral blood lymphocyte count AND \>/= 50% reduction in lymphadenopathy OR \>/= 50% reduction of liver enlargement OR \>/= 50% reduction of spleen PLUS one of the following: neutrophils \>1,500/mcL, platelets \> 100,000/mcL, hemoglobin \> 110 g/L OR \>/= 50% increase in neutrophils, platelets or hemoglobin. CR: Peripheral blood lymphocytes 4,000/mcL, no significant lymphadenopathy, no hepatomegaly and splenomegaly, no disease symptoms, blood counts: neutrophils \>1,500/mcL, platelets \> 100,000/mcL, hemoglobin \> 110 g/L and bone marrow normocellular for age. PD: as defined in the description for Event-Free Survival outcome measure.
Percentage of Participants With Best Overall Response (BOR) Baseline, Day 85, end of treatment or early termination, and follow-up, assessed up to disease progression or death, whichever occurs first (up to approximately 5 years) BOR was defined as the percentage of participants with the best response obtained throughout the trial with CR, CRi, or PR, as determined by the investigator based on IWCLL tumor response criteria. CR: Peripheral blood lymphocytes 4,000/mcL, no significant lymphadenopathy, no hepatomegaly and splenomegaly, no disease symptoms, blood counts: neutrophils \>1,500/mcL, platelets \> 100,000/mcL, hemoglobin \> 110 g/L and bone marrow normocellular for age. Cri: CR with persistent cytopenia. PR: \>/= 50% decrease in peripheral blood lymphocyte count AND \>/= 50% reduction in lymphadenopathy OR \>/= 50% reduction of liver enlargement OR \>/= 50% reduction of spleen PLUS one of the following: neutrophils \>1,500/mcL, platelets \> 100,000/mcL, hemoglobin \> 110 g/L OR \>/= 50% increase in neutrophils, platelets or hemoglobin.
Median Time to New Anti-Leukemia Therapy (TTNT) Baseline until end of study (up to approximately 5 years) Kaplan Meier estimate of median TTNT was defined as the time at which half of the participants have initiated a new anti-leukemic therapy.
Median Time to Event-Free Survival (EFS) Baseline, Day 85, end of treatment or early termination, and follow-up, assessed up to disease progression or death, whichever occurs first (up to approximately 5 years) Kaplan Meier estimate of median EFS is the time at which half of the participants have progressed as assessed by investigator based on IWCLL tumor response criteria, or have initiated a non-protocol-specified anti-leukemia therapy or died, whichever occurs first. PD: at least 1 of the following: \>/= 50% increase in absolute number of circulating lymphocytes to at least 5,000/mcL, appearance of new palpable lymph nodes, \>/= 50% increase in longest diameter of any previous site of clinically significant lymphadenopathy, \>/= 50% increase in enlargement of liver and/or spleen, transformation to more aggressive histology, progression of any cytopenia, decrease of hemoglobin levels by more than 20 g/L or to less than 100 g/L, decrease of platelet counts by more than 50% or to less than 100,000 /mcL, decrease of neutrophil counts by more than 50% or to less than 1,000/mcL.
Median Time to Overall Survival (OS) Baseline until death (Approximately up to 5 years) Kaplan Meier estimate of median OS was defined as the time at which half of the participants had died, regardless of the cause of death.
Trial Locations
- Locations (174)
Hospital das Clinicas - UFRGS
🇧🇷Porto Alegre, RS, Brazil
Hospital de Cancer de Barretos
🇧🇷Barretos, SP, Brazil
Hospital Amaral Carvalho
🇧🇷Jau, SP, Brazil
Instituto de Ensino e Pesquisa Sao Lucas - IEP
🇧🇷Sao Paulo, SP, Brazil
Hospital Sirio Libanes; Centro de Oncologia
🇧🇷Sao Paulo, SP, Brazil
Hospital Estadual do Servidor Publico; Hematologia
🇧🇷Sao Paulo, SP, Brazil
Hospital das Clinicas - FMUSP; Hematologia
🇧🇷Sao Paulo, SP, Brazil
Hospital Santa Marcelina;Oncologia
🇧🇷Sao Paulo, SP, Brazil
Royal Victoria Regional Health Centre; c/o Oncology Clinical Trials
🇨🇦Barrie, Ontario, Canada
Centre de sante et de services sociaux Rimouski Neigette
🇨🇦Rimouski, Quebec, Canada
CHU de Quebec - Hopital de l'Enfant-Jesus; Unite de Recherche en Hematologie et Oncologie
🇨🇦Quebec, Canada
Cairo University Hospital Al Kasr El Ainy
🇪🇬Cairo, Egypt
Tampere University Hospital; Hematology
🇫🇮Tampere, Finland
Ch Victor Dupouy; Hematologie
🇫🇷Argenteuil, France
Hotel Dieu; Medecine D
🇫🇷Angers, France
Hopital Augustin Morvan; Hematologie
🇫🇷Brest, France
Hopital Cote De Nacre; Hematologie Biologique
🇫🇷Caen, France
Chu Estaing; Hematologie Clinique Adultes
🇫🇷Clermont Ferrand, France
Hopital Henri Mondor; Hematologie Clinique
🇫🇷Creteil, France
Chu Site Du Bocage;Hematologie Clinique
🇫🇷Dijon, France
Centre Hospitalier Departemental Les Oudairies
🇫🇷La Roche Sur Yon, France
Ch Du Mans; Medecine Hematologie Oncologie
🇫🇷Le Mans, France
Hopital Claude Huriez; Hematologie
🇫🇷Lille, France
Hopital Uni Ire Dupuytren; Hematologie
🇫🇷Limoges, France
Hopital Saint Eloi; Hematologie Oncologie Medicale
🇫🇷Montpellier, France
Hopital Hotel Dieu Et Hme;Hopital De Jour
🇫🇷Nantes, France
Hopital Emile Muller; Hematologie
🇫🇷Mulhouse, France
Hopital Saint Louis ; Service d Oncologie Medicale Fougere 6 (Pr Misset)
🇫🇷Paris, France
Hopital Pitie Salpetriere; Hematologie Clinique
🇫🇷Paris, France
Hopital Saint Antoine; Hematologie Clinique
🇫🇷Paris, France
Hopital Saint Jean; Hematologie
🇫🇷Perpignan, France
Hopital De Haut Leveque; Hematologie Clinique
🇫🇷Pessac, France
Centre Hospitalier René Dubos; Hematologie
🇫🇷Pontoise, France
Ch Lyon Sud; Hemato Secteur Jules Courmont
🇫🇷Pierre Benite, France
Hopital Robert Debre; Hematologie Clinique
🇫🇷Reims, France
Centre Henri Becquerel; Hematologie
🇫🇷Rouen, France
Centre Hospitalier de Saint Brieuc - Hôpital Yves Le Foll
🇫🇷St Brieuc, France
Hopital Bretonneau; Hematologie Therapie Cellulaire
🇫🇷Tours, France
Hämatologisch-onkologische Praxis Dr. med. - Heinrich, - Bangerter
🇩🇪Augsburg, Germany
BAG Freiberg-Richter, Jacobasch, Illmer, Wolf; Gemeinschaftspraxis Hämatologie-Onkologie
🇩🇪Dresden, Germany
Gemeinschaftspraxis; Prof. Dr. Michael Kiehl und Dr.med. Wolfgang Stein
🇩🇪Frankfurt an der Oder, Germany
Onkologische Gemeinschaftspraxis
🇩🇪Magdeburg, Germany
Onkologisches Zentrum am Bethanien-Kankenhaus
🇩🇪Frankfurt, Germany
OncoResearch Lerchenfeld GmbH
🇩🇪Hamburg, Germany
Dres.Andreas Ammon und Dirk Meyer
🇩🇪Göttingen, Germany
Onkologische Schwerpunktpraxis Lübeck
🇩🇪Lübeck, Germany
Kliniken Ostalb, Stauferklinikum Schwäbisch-Gmünd; Zentrum für Innere Medizin
🇩🇪Mutlangen, Germany
Gemeinschaftspraxis Dr. med. Holger Klaproth / Dr. med. Anca Astrid Cura
🇩🇪Neunkirchen/Saar, Germany
Schwerpunktpraxis & Tagesklinik f. Hämatologie & Onkologie Regensdorf / Schwandorf / Wörth
🇩🇪Regensburg, Germany
eps - early phase GmbH
🇩🇪Pößneck, Germany
Dres. Hans-Dieter Schick Dorothea Schick Burkhard Schmidt u.w.
🇩🇪München, Germany
Oncologianova GmbH - Gesellschaft für Innovationen in der Onkologie
🇩🇪Recklinghausen, Germany
Universitätsklinikum Ulm; Medizinische Uni-Klinik III Abt. Innere Medizin III Hämatologie u. Onkolo.
🇩🇪Ulm, Germany
Laiko General Hospital of Athens; A Propedeutical Clinic of Internal Medicine
🇬🇷Athens, Greece
Onkologische Schwerpunktpraxis Dres. Rudolf Schlag und Björn Schöttker
🇩🇪Würzburg, Germany
University Hospital Limerick - Oncology
🇮🇪Limerick, Ireland
Bnei-Zion Medical Center; Hematology Dept
🇮🇱Haifa, Israel
Ospedale Cardarelli; Divisione Di Ematologia
🇮🇹Napoli, Campania, Italy
Arcispedale S. Anna; Sezione Di Ematologia
🇮🇹Ferrara, Emilia-Romagna, Italy
IRST Istituto Scientifico Romagnolo Per Lo Studio E Cura Dei Tumori, Sede Meldola; Oncologia Medica
🇮🇹Meldola, Emilia-Romagna, Italy
A.O. Universitaria Policlinico Di Modena; Ematologia
🇮🇹Modena, Emilia-Romagna, Italy
AUSL di Piacenza - Ospedale "Guglielmo da Saliceto";U.O. Ematologia
🇮🇹Piacenza, Emilia-Romagna, Italy
Az. Osp. S. Maria Delle Croci; U.O. Di Ematologia
🇮🇹Ravenna, Emilia-Romagna, Italy
Ospedale Infermi Di Rimini; Unità Operativa di Oncologia e Oncoematologia
🇮🇹Rimini, Emilia-Romagna, Italy
Uni Degli Studi Di Genova; 1A Divisione Di Ematologia
🇮🇹Genova, Liguria, Italy
Ospedale Maggiore Di Milano; U.O. Ematologia I - Padiglione Marcora
🇮🇹Milano, Lombardia, Italy
Univ. Piemonte Est Amedeo Avogadro; Div.Ematologia- Dip.Clinica Med.Sperim.& Ircad
🇮🇹Novara, Piemonte, Italy
ASST GRANDE OSPEDALE METROPOLITANO NIGUARDA; Struttura Complessa di Ematologia
🇮🇹Milano, Lombardia, Italy
Ospedale Molinette - Universita' Di Torino; Cliniche Universitarie Ematologia I
🇮🇹Torino, Piemonte, Italy
Azienda ospedaliera oo rr di foggi; Hematology
🇮🇹Foggia, Puglia, Italy
Ospedale Vito Fazzi; Div. Oncoematologia
🇮🇹Lecce, Puglia, Italy
Ospedale Oncologico A Businco-Cagliari; Ematologia Sez.
🇮🇹Cagliari, Sardegna, Italy
Azienda USL 6 Livorno - P.O. Livorno; U.O. Ematologia Clinica
🇮🇹Livorno, Toscana, Italy
Seoul National Uni Hospital; Dept. of Internal Medicine/Hematology/Oncology
🇰🇷Seoul, Korea, Republic of
Pusan University Hospital
🇰🇷Busan, Korea, Republic of
Samsung Medical Centre; Division of Hematology/Oncology
🇰🇷Seoul, Korea, Republic of
RECUH, Oncology Centre of Latvia; Clinic of Chemotherapy and Heamatology
🇱🇻Riga, Latvia
Hospital de Santa Maria; Servico de Hematologia e Transplantacao de Medula
🇵🇹Lisboa, Portugal
National Oncology Inst. ; Dept. of Haematology
🇸🇰Bratislava, Slovakia
Hospital Celje; Haematology Dept
🇸🇮Celje, Slovenia
Hospital De Txagorritxu; Servicio de Hematologia
🇪🇸Vitoria, Alava, Spain
Hospital Universitario Son Espases
🇪🇸Palma De Mallorca, Islas Baleares, Spain
Hospital Universitario Clínico San Carlos; Servicio de Hematología
🇪🇸Madrid, Spain
Hospital Infanta Leonor; Servicio de Hematologia
🇪🇸Madrid, Spain
Hospital Quiron de Madrid; Servicio de Hematologia
🇪🇸Pozuelo de Alarcon, Madrid, Spain
Hospital San Pedro De Alcantara; Servicio de Hematologia
🇪🇸Caceres, Spain
Hospital Universitario Reina Sofia; Servicio de Hematologia
🇪🇸Cordoba, Spain
Complejo Hospitalario Universitario de Ourense, Servicio de Hematologia
🇪🇸Orense, Spain
Hospital Universitario Virgen del Rocio; Servicio de Hematologia
🇪🇸Sevilla, Spain
Hospital Universitario la Fe; Servicio de Hematologia
🇪🇸Valencia, Spain
Uddevalla Sjukhus; Medicinkliniken
🇸🇪Uddevalla, Sweden
Universitetssjukhuset i Linköping, Hematologkliniken
🇸🇪Linkoeping, Sweden
Skane University Hospital Malmo/Lund, Dept.of Hematology and Coagulation Disorders
🇸🇪Malmö, Sweden
Akademiska Sjukhuset
🇸🇪Uppsala, Sweden
Kantonsspital Graubünden;Onkologie und Hämatologie
🇨🇭Chur, Switzerland
HUG; Hématologie
🇨🇭Geneve, Switzerland
Siriraj Hospital; Division of Hematology, Department of Medicine
🇹🇭Bangkok, Thailand
Srinagarind Hospital, Khon Kaen Uni ; Dept of Medicine
🇹🇭Khon Kaen, Thailand
Ankara University; Hematology
🇹🇷Ankara, Turkey
Cukurova Uni ; Hematology
🇹🇷Adana, Turkey
Ankara Numune Egitim Ve Arastirma Hastanesi; Hematoloji Klinigi
🇹🇷Ankara, Turkey
Gaziantep University Medical School; Hematology
🇹🇷Gaziantep, Turkey
Pamukkale Uni. Med. Fac.
🇹🇷Denizli, Turkey
Istanbul Uni Capa Hospital; Hematology
🇹🇷Istanbul, Turkey
Dokuz Eylul Uni ; Hematology
🇹🇷Izmir, Turkey
Erciyes Uni ; Hematology
🇹🇷Kayseri, Turkey
Ondokuzmayis University Medical Faculty Heamatology Department
🇹🇷Samsun, Turkey
Karadeniz Technical Uni School of Medicine; Hematology
🇹🇷Trabzon, Turkey
Hospital Iturraspe
🇦🇷Santa Fé, Argentina
University Clinical Center of the Republic of Srpska, Clinic for Internal Disease, Hematology Dept
🇧🇦Banja Luka, Bosnia and Herzegovina
Turku Uni Central Hospital; Dept of Internal Medicine
🇫🇮Turku, Finland
Hospital Erasme; Neurologie
🇧🇪Bruxelles, Belgium
Cliniques Universitaires St-Luc
🇧🇪Bruxelles, Belgium
Jessa Zkh (Campus Virga Jesse)
🇧🇪Hasselt, Belgium
CHU Sart-Tilman
🇧🇪Liège, Belgium
Sint Augustinus Wilrijk
🇧🇪Wilrijk, Belgium
University Clinical Center Sarajevo, Clinic for Hematology
🇧🇦Sarajevo, Bosnia and Herzegovina
Regional health authority A vitalite health network
🇨🇦Moncton, New Brunswick, Canada
Hopital Charles Lemoyne; Centre Integre de Lutte Contre Le Cancer de La Monteregie
🇨🇦Greenfield Park, Quebec, Canada
Queen Elizabeth II Health Sciences Centre; Oncology
🇨🇦Halifax, Nova Scotia, Canada
Hopital Maisonneuve- Rosemont; Oncology
🇨🇦Montreal, Quebec, Canada
Saskatoon Cancer Centre; Uni of Saskatoon Campus
🇨🇦Saskatoon, Saskatchewan, Canada
North Estonia Regional Hospital; Hematology
🇪🇪Tallinn, Estonia
Tartu Uni Hospital; Hematology - Oncology Clinic
🇪🇪Tartu, Estonia
Kuopio University Hospital
🇫🇮Kuopio, Finland
National Cancer Institute
🇪🇬Cairo, Egypt
General Hospital of Athens Evangelismos; Hematology
🇬🇷Athens, Greece
Laiko General Hospital; Hematology Clinic
🇬🇷Athens, Greece
University Hospital of Ioannina; Hematology
🇬🇷Ioannina, Greece
Mater Misericordiae Uni Hospital; Oncology
🇮🇪Dublin, Ireland
Georgios Papanikolaou Hospital; Hematology Department
🇬🇷Thessaloniki, Greece
Waterford Regional Hospital; Department Of Medical Oncology
🇮🇪Waterford, Ireland
Soroka Medical Center; Hematology Deptartment
🇮🇱Beer Sheva, Israel
Hadassah Ein Karem Hospital; Haematology
🇮🇱Jerusalem, Israel
Kaplan Medical Center
🇮🇱Rehovot, Israel
Az. Osp. Pugliese; Divisione de Ematologia
🇮🇹Catanzaro, Calabria, Italy
Ichilov Sourasky Medical Center; Heamatology
🇮🇱Tel Aviv, Israel
Hospital of Lithuanian University of Health. Sciences Kaunas Clinics
🇱🇹Kaunas, Lithuania
Vilnius University Hospital Santariskiu Clinic, Hematology, Oncology and Tranfusion Medicine Center
🇱🇹Vilnius, Lithuania
Hospital General De Culiacan; Servicio De Hematologia
🇲🇽Culiacan, Mexico
University Clinic of Hematology Skopje, Hospital Care Department
🇲🇰Skopje, North Macedonia
Universita' Degli Studi La Sapienza-Ist.Di Ematologia; Dip Biot Cel e Ematol
🇮🇹Roma, Lazio, Italy
Katedra i Klinika Hematoonkologii i Transplantacji Szpiku; Uniwersytetu Medycznego w Lublinie
🇵🇱Lublin, Poland
Oddzial Kliniczny Hematologii SPZOZ MSWiA z Warminsko-Mazurskim Centrum Onkologii w Olsztynie
🇵🇱Olsztyn, Poland
Szpital Wojewodzki w Opolu, Oddzial Hematologii i Onkologii Hematologicznej
🇵🇱Opole, Poland
Spitalul Clinic municipal de Urgenta Timisoara; Clinica de Hematologie
🇷🇴Timisoara, Romania
Fakultna Nemocnica Roosevelta; Dept. of Haematology
🇸🇰Banska Bystrica, Slovakia
Kantonsspital Aarau; Zentrum Für Onkologie, Hämatologie & Transfusionsmedizin
🇨🇭Aarau, Switzerland
Universitätsspital Basel; Hämatologie
🇨🇭Basel, Switzerland
Istituto Oncologico della Svizzera Italiana (IOSI)
🇨🇭Bellinzona, Switzerland
Luzerner Kantonsspital, Hämatologie
🇨🇭Luzern, Switzerland
Centro Medico Nacional Sxxi - Imss; Haematology
🇲🇽Mexico City, Mexico
Hospital Universitario Dr. Jose E. Gonzalez; Haematology
🇲🇽Monterrey, Mexico
Hospital General de México; Haematology
🇲🇽Mexico City, Mexico
Centro de Estudios Clinicos de Queretaro (CECLIQ)
🇲🇽Queretaro, Mexico
Wojewodzki Szpital Specjalistyczny im. J. Korczaka; Oddział Chorób Wewnetrznych/Hematologiczny
🇵🇱Slupsk, Poland
Spitalul Clinic Judetean de Urgenta Brasov; Clinica de Hematologie
🇷🇴Brasov, Romania
FSBI Russian Oncology Research Center n.a. Blokhin of MOH RF
🇷🇺Moscow, Russian Federation
Spitalul Clinic Coltea; Clinica de Hematologie
🇷🇴Bucuresti, Romania
IPO do Porto; Servico de Onco-Hematologia
🇵🇹Porto, Portugal
Complejo Hospitalario San Millan - San Pedro; Servicio Hematologia
🇪🇸Logroño, LA Rioja, Spain
Policlinica de Diagnostic Rapid
🇷🇴Brasov, Romania
Almazov Federal Heart, Blood and Endocrinilogy Centre; Hematology department
🇷🇺Saint-Petersburg, Russian Federation
Regional Oncology Center
🇷🇺Volgograd, Russian Federation
Clinical Center Ljubljana; Haematology Dept
🇸🇮Ljubljana, Slovenia
Vladimirskiy Regional Scientific Research Inst. ; Hematology
🇷🇺Moscow, Russian Federation
Institute of Hematology
🇷🇸Belgrade, Serbia
Hospital Maribor; Haematology Dept
🇸🇮Maribor, Slovenia
Hospital Universitari Germans Trias i Pujol; Servicio de Hematologia
🇪🇸Badalona, Barcelona, Spain
OnkoZentrum Zuerich
🇨🇭Zürich, Switzerland
King Chulalongkorn Memorial Hospital; Division of Hematology, Department of Medicine
🇹🇭Bangkok, Thailand
Ramathibodi Hospital; Division of Hematology, Department of Medicine
🇹🇭Bangkok, Thailand
Chiang Mai Uni Hospital; Division of Hematology,Dept of Medicine,Faculty of Medicine
🇹🇭Chiang Mai, Thailand
Cancer Care Manitoba
🇨🇦Winnipeg, Manitoba, Canada