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Ibrutinib og Rituximab sammenlignet med Fludarabin Phosphate, Cyclophosphamid og Rituximab til behandling af patienter med ubehandlet kronisk lymfatisk leukæmi eller lille lymfatisk lymfom

3. april 2024 opdateret af: National Cancer Institute (NCI)

Et randomiseret fase III-studie af Ibrutinib (PCI-32765)-baseret terapi vs standard fludarabin, cyclophosphamid og rituximab (FCR) kemoimmunterapi hos ubehandlede yngre patienter med kronisk lymfatisk leukæmi (CLL)

Dette fase III-studie undersøger ibrutinib og rituximab for at se, hvor godt de virker sammenlignet med fludarabinphosphat, cyclophosphamid og rituximab til behandling af patienter med ubehandlet kronisk lymfatisk leukæmi eller lille lymfatisk lymfom. Ibrutinib kan stoppe væksten af ​​kræftceller ved at blokere nogle af de enzymer, der er nødvendige for cellevækst. Kemoterapimedicin, såsom fludarabinphosphat og cyclophosphamid, virker på forskellige måder for at stoppe væksten af ​​kræftceller, enten ved at dræbe cellerne, ved at stoppe dem i at dele sig eller ved at stoppe dem i at sprede sig. Rituximab er et monoklonalt antistof. Det binder sig til et protein kaldet CD20, som findes på B-celler (en type hvide blodlegemer) og nogle typer kræftceller. Dette kan hjælpe immunsystemet med at dræbe kræftceller. Det vides endnu ikke, om fludarabinphosphat, cyclophosphamid og rituximab kan virke bedre end ibrutinib og rituximab til behandling af patienter med ubehandlet kronisk lymfatisk leukæmi eller lille lymfatisk lymfom.

Studieoversigt

Status

Aktiv, ikke rekrutterende

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

PRIMÆR MÅL:

I. At evaluere evnen af ​​ibrutinib-baseret induktionsterapi til at forlænge progressionsfri overlevelse (PFS) sammenlignet med standard fludarabinphosphat, cyclophosphamid og rituximab (FCR) kemoimmunoterapi til yngre patienter med kronisk lymfatisk leukæmi (CLL).

SEKUNDÆRE MÅL:

I. Evaluer den samlede overlevelse (OS) af patienter baseret på behandlingsarm. II. Overvåg og vurder toksicitet af behandling med ibrutinib-baseret induktion i forhold til standard FCR-kemoterapi.

III. At sammenligne livskvalitet (QOL) hos CLL-patienter i løbet af de første 6 måneders behandling blandt patienter, der får ibrutinib-baseret induktionsterapi i forhold til standard FCR-kemoimmunterapi.

IV. At sammenligne QOL på lang sigt hos CLL-patienter, der modtager kontinuerlig behandling med ibrutinib, med den for CLL-patienter, der fuldførte FCR-behandling.

V. Bestem effekten af ​​forbehandlingens kliniske og biologiske karakteristika (f.eks. sygdomsstadium, immunoglobulin tung kæde variabel region gen [IGHV] mutationsstatus, fluorescerende in situ hybridisering [FISH]) på kliniske resultater (f.eks. komplet respons, PFS) af de forskellige arme.

VI. Bestem, om den minimale restsygdomsstatus (MRD) vurderet ved flowcytometri på forskellige tidspunkter under og efter behandlingen er en effektiv surrogatmarkør for forlænget PFS og samlet overlevelse.

VII. Sammenlign de genetiske abnormiteter og dynamikken i intraklonal arkitektur hos CLL-patienter før og efter behandling med kemoimmunterapi (CIT) og ikke-CIT-tilgange, og udforsk sammenhænge med behandlingsresistens.

VIII. Udforsk virkningerne af FCR og ibrutinib-baseret terapi på T-cellernes immunfunktion.

IX. Udfør bekræftende valideringsgenotypebestemmelse af enkeltnukleotidpolymorfier (SNP'er) forbundet med effektiviteten og toksiciteten af ​​fludarabin-baseret terapi som i en tidligere Eastern Cooperative Oncology Group (ECOG) genom-wide association study (GWAS) analyse i E2997-forsøget.

X. Evaluer evnen af ​​en prognostisk model, der inkorporerer kliniske og biologiske karakterer, til at forudsige et respons på terapi og klinisk resultat (PFS, OS).

XI. Evaluer signalnetværk nedstrøms for B-cellereceptoren hos patienter, der modtager ibrutinib-baseret behandling.

XII. Indsaml tilbagefaldsprøver for at studere mekanismer for resistens over for både FCR og ibrutinib-baseret behandling.

OVERSIGT: Patienterne randomiseres til 1 ud af 2 behandlingsarme.

ARM A: Patienterne får ibrutinib oralt (PO) én gang dagligt (QD) på dag 1-28. Fra cyklus 2 får patienterne også rituximab intravenøst ​​(IV) over 4 timer på dag 1 og 2 i cyklus 2 og dag 1 i cyklus 3-7. Behandlingen gentages hver 28. dag i 7 cyklusser i fravær af uacceptabel toksicitet. I fravær af sygdomsprogression kan patienter fortsætte med ibrutinib PO QD.

ARM B: Patienter får rituximab IV over 4 timer på dag 1 og 2 i cyklus 1 og dag 1 i cyklus 2-6. Patienterne får også fludarabinphosphat IV over 30 minutter og cyclophosphamid IV over 30 minutter på dag 1-3. Behandlingen gentages hver 28. dag i 6 cyklusser i fravær af uacceptabel toksicitet.

Efter afsluttet studiebehandling følges patienterne op i 10 år.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

529

Fase

  • Fase 3

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Forenede Stater
    • Alabama
      • Birmingham, Alabama, Forenede Stater, 35233
        • University of Alabama at Birmingham Cancer Center
    • Alaska
      • Anchorage, Alaska, Forenede Stater, 98508
        • Anchorage Associates in Radiation Medicine
      • Anchorage, Alaska, Forenede Stater, 99508
        • Alaska Breast Care and Surgery LLC
      • Anchorage, Alaska, Forenede Stater, 99508
        • Alaska Oncology and Hematology LLC
      • Anchorage, Alaska, Forenede Stater, 99508
        • Alaska Women's Cancer Care
      • Anchorage, Alaska, Forenede Stater, 99508
        • Anchorage Oncology Centre
      • Anchorage, Alaska, Forenede Stater, 99508
        • Katmai Oncology Group
      • Anchorage, Alaska, Forenede Stater, 99508
        • Providence Alaska Medical Center
      • Anchorage, Alaska, Forenede Stater, 99504
        • Anchorage Radiation Therapy Center
      • Anchorage, Alaska, Forenede Stater, 99508
        • Alaska Regional Hospital
      • Fairbanks, Alaska, Forenede Stater, 99701
        • Fairbanks Memorial Hospital
    • Arizona
      • Scottsdale, Arizona, Forenede Stater, 85259
        • Mayo Clinic in Arizona
    • Arkansas
      • Hot Springs, Arkansas, Forenede Stater, 71913
        • CHI Saint Vincent Cancer Center Hot Springs
      • Jonesboro, Arkansas, Forenede Stater, 72401
        • NEA Baptist Memorial Hospital and Fowler Family Cancer Center - Jonesboro
      • Little Rock, Arkansas, Forenede Stater, 72205
        • University of Arkansas for Medical Sciences
    • California
      • Anaheim, California, Forenede Stater, 92806
        • Kaiser Permanente-Anaheim
      • Antioch, California, Forenede Stater, 94531
        • Kaiser Permanente-Deer Valley Medical Center
      • Arroyo Grande, California, Forenede Stater, 93420
        • PCR Oncology
      • Auburn, California, Forenede Stater, 95602
        • Sutter Auburn Faith Hospital
      • Auburn, California, Forenede Stater, 95603
        • Sutter Cancer Centers Radiation Oncology Services-Auburn
      • Baldwin Park, California, Forenede Stater, 91706
        • Kaiser Permanente-Baldwin Park
      • Bellflower, California, Forenede Stater, 90706
        • Kaiser Permanente-Bellflower
      • Berkeley, California, Forenede Stater, 94704
        • Alta Bates Summit Medical Center-Herrick Campus
      • Burbank, California, Forenede Stater, 91505
        • Providence Saint Joseph Medical Center/Disney Family Cancer Center
      • Burlingame, California, Forenede Stater, 94010
        • Mills-Peninsula Medical Center
      • Cameron Park, California, Forenede Stater, 95682
        • Sutter Cancer Centers Radiation Oncology Services-Cameron Park
      • Castro Valley, California, Forenede Stater, 94546
        • Eden Hospital Medical Center
      • Chico, California, Forenede Stater, 95973
        • Adventist Health Cancer Care Center Chico
      • Concord, California, Forenede Stater, 94520
        • John Muir Medical Center-Concord Campus
      • Davis, California, Forenede Stater, 95616
        • Sutter Davis Hospital
      • Fontana, California, Forenede Stater, 92335
        • Kaiser Permanente-Fontana
      • Fremont, California, Forenede Stater, 94538
        • Kaiser Permanente-Fremont
      • Fresno, California, Forenede Stater, 93720
        • Kaiser Permanente-Fresno
      • Greenbrae, California, Forenede Stater, 94904
        • Marin Cancer Care Inc
      • Greenbrae, California, Forenede Stater, 94904
        • Marin General Hospital
      • Harbor City, California, Forenede Stater, 90710
        • Kaiser Permanente - Harbor City
      • Irvine, California, Forenede Stater, 92618
        • Kaiser Permanente-Irvine
      • Los Angeles, California, Forenede Stater, 90027
        • Kaiser Permanente Los Angeles Medical Center
      • Los Angeles, California, Forenede Stater, 90034
        • Kaiser Permanente West Los Angeles
      • Modesto, California, Forenede Stater, 95355
        • Memorial Medical Center
      • Modesto, California, Forenede Stater, 95356
        • Kaiser Permanente-Modesto
      • Mountain View, California, Forenede Stater, 94040
        • Palo Alto Medical Foundation-Camino Division
      • Mountain View, California, Forenede Stater, 94040
        • Palo Alto Medical Foundation-Gynecologic Oncology
      • Novato, California, Forenede Stater, 94945
        • Sutter Cancer Research Consortium
      • Oakland, California, Forenede Stater, 94611
        • Kaiser Permanente-Oakland
      • Orange, California, Forenede Stater, 92868
        • UC Irvine Health/Chao Family Comprehensive Cancer Center
      • Palo Alto, California, Forenede Stater, 94304
        • Stanford Cancer Institute Palo Alto
      • Palo Alto, California, Forenede Stater, 94301
        • Palo Alto Medical Foundation Health Care
      • Panorama City, California, Forenede Stater, 91402
        • Kaiser Permanente - Panorama City
      • Redwood City, California, Forenede Stater, 94063
        • Kaiser Permanente-Redwood City
      • Richmond, California, Forenede Stater, 94801
        • Kaiser Permanente-Richmond
      • Riverside, California, Forenede Stater, 92505
        • Kaiser Permanente-Riverside
      • Roseville, California, Forenede Stater, 95661
        • Kaiser Permanente-Roseville
      • Roseville, California, Forenede Stater, 95661
        • Sutter Cancer Centers Radiation Oncology Services-Roseville
      • Roseville, California, Forenede Stater, 95661
        • Sutter Roseville Medical Center
      • Sacramento, California, Forenede Stater, 95816
        • Sutter Medical Center Sacramento
      • Sacramento, California, Forenede Stater, 95823
        • Kaiser Permanente-South Sacramento
      • Sacramento, California, Forenede Stater, 95825
        • Kaiser Permanente - Sacramento
      • San Diego, California, Forenede Stater, 92120
        • Kaiser Permanente-San Diego Zion
      • San Diego, California, Forenede Stater, 92108
        • Kaiser Permanente-San Diego Mission
      • San Francisco, California, Forenede Stater, 94115
        • Kaiser Permanente-San Francisco
      • San Francisco, California, Forenede Stater, 94115
        • California Pacific Medical Center-Pacific Campus
      • San Jose, California, Forenede Stater, 95119
        • Kaiser Permanente-Santa Teresa-San Jose
      • San Jose, California, Forenede Stater, 95124
        • Stanford Cancer Center South Bay
      • San Leandro, California, Forenede Stater, 94577
        • Kaiser Permanente San Leandro
      • San Luis Obispo, California, Forenede Stater, 93401
        • Pacific Central Coast Health Center-San Luis Obispo
      • San Marcos, California, Forenede Stater, 92078
        • Kaiser Permanente-San Marcos
      • San Rafael, California, Forenede Stater, 94903
        • Kaiser Permanente-San Rafael
      • Santa Clara, California, Forenede Stater, 95051
        • Kaiser Permanente Medical Center - Santa Clara
      • Santa Cruz, California, Forenede Stater, 95065
        • Palo Alto Medical Foundation-Santa Cruz
      • Santa Rosa, California, Forenede Stater, 95403
        • Kaiser Permanente-Santa Rosa
      • Santa Rosa, California, Forenede Stater, 95403
        • Sutter Pacific Medical Foundation
      • South San Francisco, California, Forenede Stater, 94080
        • Kaiser Permanente-South San Francisco
      • Stockton, California, Forenede Stater, 95210
        • Kaiser Permanente-Stockton
      • Sunnyvale, California, Forenede Stater, 94086
        • Palo Alto Medical Foundation-Sunnyvale
      • Vacaville, California, Forenede Stater, 95688
        • Kaiser Permanente Medical Center-Vacaville
      • Vacaville, California, Forenede Stater, 95687
        • Sutter Cancer Centers Radiation Oncology Services-Vacaville
      • Vallejo, California, Forenede Stater, 94589
        • Kaiser Permanente-Vallejo
      • Vallejo, California, Forenede Stater, 94589
        • Sutter Solano Medical Center/Cancer Center
      • Walnut Creek, California, Forenede Stater, 94596
        • Kaiser Permanente-Walnut Creek
      • Walnut Creek, California, Forenede Stater, 94598
        • John Muir Medical Center-Walnut Creek
      • Woodland Hills, California, Forenede Stater, 91367
        • Kaiser Permanente-Woodland Hills
    • Colorado
      • Aurora, Colorado, Forenede Stater, 80012
        • Rocky Mountain Cancer Centers-Aurora
      • Aurora, Colorado, Forenede Stater, 80012
        • The Medical Center of Aurora
      • Boulder, Colorado, Forenede Stater, 80301
        • Boulder Community Hospital
      • Boulder, Colorado, Forenede Stater, 80304
        • Rocky Mountain Cancer Centers-Boulder
      • Colorado Springs, Colorado, Forenede Stater, 80907
        • Penrose-Saint Francis Healthcare
      • Colorado Springs, Colorado, Forenede Stater, 80907
        • Rocky Mountain Cancer Centers-Penrose
      • Denver, Colorado, Forenede Stater, 80210
        • Porter Adventist Hospital
      • Denver, Colorado, Forenede Stater, 80205
        • Kaiser Permanente-Franklin
      • Denver, Colorado, Forenede Stater, 80218
        • Presbyterian - Saint Lukes Medical Center - Health One
      • Denver, Colorado, Forenede Stater, 80218
        • SCL Health Saint Joseph Hospital
      • Denver, Colorado, Forenede Stater, 80220
        • Rose Medical Center
      • Denver, Colorado, Forenede Stater, 80218
        • Rocky Mountain Cancer Centers-Midtown
      • Denver, Colorado, Forenede Stater, 80220
        • Rocky Mountain Cancer Centers-Rose
      • Denver, Colorado, Forenede Stater, 80204
        • Denver Health Medical Center
      • Denver, Colorado, Forenede Stater, 80218
        • Colorado Blood Cancer Institute
      • Denver, Colorado, Forenede Stater, 80222
        • Western States Cancer Research NCORP
      • Denver, Colorado, Forenede Stater, 80206
        • National Jewish Health-Main Campus
      • Durango, Colorado, Forenede Stater, 81301
        • Mercy Medical Center
      • Durango, Colorado, Forenede Stater, 81301
        • Southwest Oncology PC
      • Englewood, Colorado, Forenede Stater, 80113
        • Mountain Blue Cancer Care Center - Swedish
      • Englewood, Colorado, Forenede Stater, 80113
        • Swedish Medical Center
      • Golden, Colorado, Forenede Stater, 80401
        • Mountain Blue Cancer Care Center
      • Golden, Colorado, Forenede Stater, 80401
        • National Jewish Health-Western Hematology Oncology
      • Greeley, Colorado, Forenede Stater, 80631
        • North Colorado Medical Center
      • Greenwood Village, Colorado, Forenede Stater, 80111
        • Rocky Mountain Cancer Centers-Greenwood Village
      • Lafayette, Colorado, Forenede Stater, 80026
        • Kaiser Permanente-Rock Creek
      • Lakewood, Colorado, Forenede Stater, 80228
        • Saint Anthony Hospital
      • Lakewood, Colorado, Forenede Stater, 80228
        • Rocky Mountain Cancer Centers-Lakewood
      • Littleton, Colorado, Forenede Stater, 80120
        • Rocky Mountain Cancer Centers-Littleton
      • Littleton, Colorado, Forenede Stater, 80122
        • Littleton Adventist Hospital
      • Lone Tree, Colorado, Forenede Stater, 80124
        • Kaiser Permanente-Lone Tree
      • Lone Tree, Colorado, Forenede Stater, 80124
        • Sky Ridge Medical Center
      • Lone Tree, Colorado, Forenede Stater, 80124
        • Rocky Mountain Cancer Centers-Sky Ridge
      • Longmont, Colorado, Forenede Stater, 80501
        • Longmont United Hospital
      • Longmont, Colorado, Forenede Stater, 80501
        • Rocky Mountain Cancer Centers-Longmont
      • Loveland, Colorado, Forenede Stater, 80539
        • McKee Medical Center
      • Parker, Colorado, Forenede Stater, 80138
        • Parker Adventist Hospital
      • Parker, Colorado, Forenede Stater, 80138
        • Rocky Mountain Cancer Centers-Parker
      • Pueblo, Colorado, Forenede Stater, 81004
        • Saint Mary Corwin Medical Center
      • Pueblo, Colorado, Forenede Stater, 81008
        • Rocky Mountain Cancer Centers - Pueblo
      • Thornton, Colorado, Forenede Stater, 80260
        • Rocky Mountain Cancer Centers-Thornton
      • Wheat Ridge, Colorado, Forenede Stater, 80033
        • SCL Health Lutheran Medical Center
    • Connecticut
      • Derby, Connecticut, Forenede Stater, 06418
        • Smilow Cancer Hospital-Derby Care Center
      • Fairfield, Connecticut, Forenede Stater, 06824
        • Smilow Cancer Hospital Care Center-Fairfield
      • Hartford, Connecticut, Forenede Stater, 06105
        • Smilow Cancer Hospital Care Center at Saint Francis
      • Middletown, Connecticut, Forenede Stater, 06457
        • Middlesex Hospital
      • New Haven, Connecticut, Forenede Stater, 06520
        • Yale University
      • New Haven, Connecticut, Forenede Stater, 06510
        • Smilow Cancer Center/Yale-New Haven Hospital
      • North Haven, Connecticut, Forenede Stater, 06473
        • Yale-New Haven Hospital North Haven Medical Center
      • Orange, Connecticut, Forenede Stater, 06477
        • Smilow Cancer Hospital-Orange Care Center
      • Torrington, Connecticut, Forenede Stater, 06790
        • Smilow Cancer Hospital-Torrington Care Center
      • Trumbull, Connecticut, Forenede Stater, 06611
        • Smilow Cancer Hospital Care Center-Trumbull
      • Waterbury, Connecticut, Forenede Stater, 06708
        • Smilow Cancer Hospital-Waterbury Care Center
    • Delaware
      • Lewes, Delaware, Forenede Stater, 19958
        • Beebe Medical Center
      • Newark, Delaware, Forenede Stater, 19713
        • Helen F Graham Cancer Center
      • Newark, Delaware, Forenede Stater, 19713
        • Delaware Clinical and Laboratory Physicians PA
      • Newark, Delaware, Forenede Stater, 19713
        • Medical Oncology Hematology Consultants PA
      • Newark, Delaware, Forenede Stater, 19718
        • Christiana Care Health System-Christiana Hospital
      • Newark, Delaware, Forenede Stater, 19713
        • Christiana Gynecologic Oncology LLC
      • Rehoboth Beach, Delaware, Forenede Stater, 19971
        • Beebe Health Campus
      • Seaford, Delaware, Forenede Stater, 19973
        • TidalHealth Nanticoke / Allen Cancer Center
      • Wilmington, Delaware, Forenede Stater, 19801
        • Christiana Care Health System-Wilmington Hospital
    • Florida
      • Jacksonville, Florida, Forenede Stater, 32207
        • Baptist MD Anderson Cancer Center
      • Lakeland, Florida, Forenede Stater, 33805
        • Lakeland Regional Health Hollis Cancer Center
      • Orlando, Florida, Forenede Stater, 32806
        • Orlando Health Cancer Institute
    • Georgia
      • Albany, Georgia, Forenede Stater, 31701
        • Phoebe Putney Memorial Hospital
      • Atlanta, Georgia, Forenede Stater, 30322
        • Emory University Hospital/Winship Cancer Institute
      • Columbus, Georgia, Forenede Stater, 31904
        • John B Amos Cancer Center
      • Macon, Georgia, Forenede Stater, 31201
        • Medical Center of Central Georgia
      • Macon, Georgia, Forenede Stater, 31201
        • Central Georgia Gynecologic Oncology
      • Savannah, Georgia, Forenede Stater, 31405
        • Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
    • Hawaii
      • Honolulu, Hawaii, Forenede Stater, 96819
        • Kaiser Permanente Moanalua Medical Center
    • Idaho
      • Boise, Idaho, Forenede Stater, 83706
        • Saint Alphonsus Cancer Care Center-Boise
      • Boise, Idaho, Forenede Stater, 83712
        • Saint Luke's Cancer Institute - Boise
      • Coeur d'Alene, Idaho, Forenede Stater, 83814
        • Kootenai Health - Coeur d'Alene
      • Fruitland, Idaho, Forenede Stater, 83619
        • Saint Luke's Cancer Institute - Fruitland
      • Meridian, Idaho, Forenede Stater, 83642
        • Saint Luke's Cancer Institute - Meridian
      • Nampa, Idaho, Forenede Stater, 83686
        • Saint Luke's Cancer Institute - Nampa
      • Post Falls, Idaho, Forenede Stater, 83854
        • Kootenai Clinic Cancer Services - Post Falls
      • Sandpoint, Idaho, Forenede Stater, 83864
        • Kootenai Cancer Clinic
      • Twin Falls, Idaho, Forenede Stater, 83301
        • Saint Luke's Cancer Institute - Twin Falls
    • Illinois
      • Aurora, Illinois, Forenede Stater, 60504
        • Rush - Copley Medical Center
      • Bloomington, Illinois, Forenede Stater, 61704
        • Illinois CancerCare-Bloomington
      • Bloomington, Illinois, Forenede Stater, 61701
        • Saint Joseph Medical Center
      • Canton, Illinois, Forenede Stater, 61520
        • Illinois CancerCare-Canton
      • Carbondale, Illinois, Forenede Stater, 62902
        • Memorial Hospital of Carbondale
      • Carthage, Illinois, Forenede Stater, 62321
        • Illinois CancerCare-Carthage
      • Centralia, Illinois, Forenede Stater, 62801
        • Centralia Oncology Clinic
      • Chicago, Illinois, Forenede Stater, 60611
        • Northwestern University
      • Chicago, Illinois, Forenede Stater, 60637
        • University of Chicago Comprehensive Cancer Center
      • Danville, Illinois, Forenede Stater, 61832
        • Carle at The Riverfront
      • Decatur, Illinois, Forenede Stater, 62526
        • Decatur Memorial Hospital
      • Decatur, Illinois, Forenede Stater, 62526
        • Cancer Care Specialists of Illinois - Decatur
      • Effingham, Illinois, Forenede Stater, 62401
        • Crossroads Cancer Center
      • Effingham, Illinois, Forenede Stater, 62401
        • Carle Physician Group-Effingham
      • Elk Grove Village, Illinois, Forenede Stater, 60007
        • Ascension Alexian Brothers - Elk Grove Village
      • Eureka, Illinois, Forenede Stater, 61530
        • Illinois CancerCare-Eureka
      • Evanston, Illinois, Forenede Stater, 60201
        • NorthShore University HealthSystem-Evanston Hospital
      • Galesburg, Illinois, Forenede Stater, 61401
        • Western Illinois Cancer Treatment Center
      • Galesburg, Illinois, Forenede Stater, 61401
        • Illinois CancerCare-Galesburg
      • Geneva, Illinois, Forenede Stater, 60134
        • Northwestern Medicine Cancer Center Delnor
      • Glenview, Illinois, Forenede Stater, 60026
        • NorthShore University HealthSystem-Glenbrook Hospital
      • Highland Park, Illinois, Forenede Stater, 60035
        • NorthShore University HealthSystem-Highland Park Hospital
      • Highland Park, Illinois, Forenede Stater, 60035
        • Hematology Oncology Associates of Illinois-Highland Park
      • Joliet, Illinois, Forenede Stater, 60435
        • Duly Health and Care Joliet
      • Kankakee, Illinois, Forenede Stater, 60901
        • Presence Saint Mary's Hospital
      • Kewanee, Illinois, Forenede Stater, 61443
        • Illinois CancerCare-Kewanee Clinic
      • Libertyville, Illinois, Forenede Stater, 60048
        • AMG Libertyville - Oncology
      • Macomb, Illinois, Forenede Stater, 61455
        • Illinois CancerCare-Macomb
      • Mattoon, Illinois, Forenede Stater, 61938
        • Carle Physician Group-Mattoon/Charleston
      • Maywood, Illinois, Forenede Stater, 60153
        • Loyola University Medical Center
      • Moline, Illinois, Forenede Stater, 61265
        • Trinity Medical Center
      • Mount Vernon, Illinois, Forenede Stater, 62864
        • Good Samaritan Regional Health Center
      • New Lenox, Illinois, Forenede Stater, 60451
        • UC Comprehensive Cancer Center at Silver Cross
      • Niles, Illinois, Forenede Stater, 60714
        • Illinois Cancer Specialists-Niles
      • Normal, Illinois, Forenede Stater, 61761
        • Carle Cancer Institute Normal
      • O'Fallon, Illinois, Forenede Stater, 62269
        • Cancer Care Center of O'Fallon
      • Oak Lawn, Illinois, Forenede Stater, 60453-2699
        • Advocate Christ Medical Center
      • Ottawa, Illinois, Forenede Stater, 61350
        • Illinois CancerCare-Ottawa Clinic
      • Ottawa, Illinois, Forenede Stater, 61350
        • Radiation Oncology of Northern Illinois
      • Pekin, Illinois, Forenede Stater, 61554
        • Illinois CancerCare-Pekin
      • Pekin, Illinois, Forenede Stater, 61554
        • OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center
      • Peoria, Illinois, Forenede Stater, 61636
        • Methodist Medical Center of Illinois
      • Peoria, Illinois, Forenede Stater, 61637
        • OSF Saint Francis Medical Center
      • Peoria, Illinois, Forenede Stater, 61615
        • Illinois CancerCare-Peoria
      • Peoria, Illinois, Forenede Stater, 61615
        • OSF Saint Francis Radiation Oncology at Peoria Cancer Center
      • Peru, Illinois, Forenede Stater, 61354
        • Illinois CancerCare-Peru
      • Peru, Illinois, Forenede Stater, 61354
        • Valley Radiation Oncology
      • Princeton, Illinois, Forenede Stater, 61356
        • Illinois CancerCare-Princeton
      • Rockford, Illinois, Forenede Stater, 61114
        • SwedishAmerican Regional Cancer Center/ACT
      • Skokie, Illinois, Forenede Stater, 60076
        • Hematology Oncology Associates of Illinois - Skokie
      • Skokie, Illinois, Forenede Stater, 60076
        • North Shore Medical Center
      • Springfield, Illinois, Forenede Stater, 62781
        • Memorial Medical Center
      • Springfield, Illinois, Forenede Stater, 62702
        • Southern Illinois University School of Medicine
      • Springfield, Illinois, Forenede Stater, 62702
        • Springfield Clinic
      • Springfield, Illinois, Forenede Stater, 62702
        • Central Illinois Hematology Oncology Center
      • Urbana, Illinois, Forenede Stater, 61801
        • Carle Cancer Center
      • Urbana, Illinois, Forenede Stater, 61801
        • The Carle Foundation Hospital
      • Warrenville, Illinois, Forenede Stater, 60555
        • Northwestern Medicine Cancer Center Warrenville
      • Yorkville, Illinois, Forenede Stater, 60560
        • Rush-Copley Healthcare Center
    • Indiana
      • Anderson, Indiana, Forenede Stater, 46016
        • Ascension Saint Vincent Anderson
      • Michigan City, Indiana, Forenede Stater, 46360
        • Franciscan Saint Anthony Health-Michigan City
      • Michigan City, Indiana, Forenede Stater, 46360
        • Woodland Cancer Care Center
      • Mishawaka, Indiana, Forenede Stater, 46545
        • Memorial Regional Cancer Center Day Road
      • Richmond, Indiana, Forenede Stater, 47374
        • Reid Health
      • South Bend, Indiana, Forenede Stater, 46601
        • Memorial Hospital of South Bend
    • Iowa
      • Ames, Iowa, Forenede Stater, 50010
        • Mary Greeley Medical Center
      • Ames, Iowa, Forenede Stater, 50010
        • McFarland Clinic - Ames
      • Boone, Iowa, Forenede Stater, 50036
        • McFarland Clinic - Boone
      • Clive, Iowa, Forenede Stater, 50325
        • Mercy Cancer Center-West Lakes
      • Clive, Iowa, Forenede Stater, 50325
        • Medical Oncology and Hematology Associates-West Des Moines
      • Council Bluffs, Iowa, Forenede Stater, 51503
        • Alegent Health Mercy Hospital
      • Creston, Iowa, Forenede Stater, 50801
        • Greater Regional Medical Center
      • Des Moines, Iowa, Forenede Stater, 50314
        • Mercy Medical Center - Des Moines
      • Des Moines, Iowa, Forenede Stater, 50314
        • Mission Cancer and Blood - Laurel
      • Fort Dodge, Iowa, Forenede Stater, 50501
        • McFarland Clinic - Trinity Cancer Center
      • Jefferson, Iowa, Forenede Stater, 50129
        • McFarland Clinic - Jefferson
      • Marshalltown, Iowa, Forenede Stater, 50158
        • McFarland Clinic - Marshalltown
      • Mason City, Iowa, Forenede Stater, 50401
        • Mercy Medical Center - North Iowa
      • Sioux City, Iowa, Forenede Stater, 51101
        • Siouxland Regional Cancer Center
      • Sioux City, Iowa, Forenede Stater, 51102
        • Mercy Medical Center-Sioux City
      • Sioux City, Iowa, Forenede Stater, 51104
        • Saint Luke's Regional Medical Center
      • Spencer, Iowa, Forenede Stater, 51301
        • Abben Cancer Center
      • Waterloo, Iowa, Forenede Stater, 50702
        • MercyOne Waterloo Cancer Center
      • West Des Moines, Iowa, Forenede Stater, 50266
        • Mercy Medical Center-West Lakes
    • Kansas
      • Chanute, Kansas, Forenede Stater, 66720
        • Cancer Center of Kansas - Chanute
      • Dodge City, Kansas, Forenede Stater, 67801
        • Cancer Center of Kansas - Dodge City
      • El Dorado, Kansas, Forenede Stater, 67042
        • Cancer Center of Kansas - El Dorado
      • Fort Scott, Kansas, Forenede Stater, 66701
        • Cancer Center of Kansas - Fort Scott
      • Independence, Kansas, Forenede Stater, 67301
        • Cancer Center of Kansas-Independence
      • Kingman, Kansas, Forenede Stater, 67068
        • Cancer Center of Kansas-Kingman
      • Lawrence, Kansas, Forenede Stater, 66044
        • Lawrence Memorial Hospital
      • Lenexa, Kansas, Forenede Stater, 66219
        • Kansas Institute of Medicine Cancer and Blood Center
      • Lenexa, Kansas, Forenede Stater, 66219
        • Minimally Invasive Surgery Hospital
      • Liberal, Kansas, Forenede Stater, 67905
        • Cancer Center of Kansas-Liberal
      • Newton, Kansas, Forenede Stater, 67114
        • Cancer Center of Kansas - Newton
      • Overland Park, Kansas, Forenede Stater, 66209
        • Menorah Medical Center
      • Overland Park, Kansas, Forenede Stater, 66213
        • Saint Luke's South Hospital
      • Parsons, Kansas, Forenede Stater, 67357
        • Cancer Center of Kansas - Parsons
      • Prairie Village, Kansas, Forenede Stater, 66208
        • Kansas City NCI Community Oncology Research Program
      • Pratt, Kansas, Forenede Stater, 67124
        • Cancer Center of Kansas - Pratt
      • Salina, Kansas, Forenede Stater, 67401
        • Cancer Center of Kansas - Salina
      • Topeka, Kansas, Forenede Stater, 66606
        • Cotton O'Neil Cancer Center / Stormont Vail Health
      • Wellington, Kansas, Forenede Stater, 67152
        • Cancer Center of Kansas - Wellington
      • Wichita, Kansas, Forenede Stater, 67214
        • Ascension Via Christi Hospitals Wichita
      • Wichita, Kansas, Forenede Stater, 67208
        • Cancer Center of Kansas-Wichita Medical Arts Tower
      • Wichita, Kansas, Forenede Stater, 67214
        • Cancer Center of Kansas - Wichita
      • Wichita, Kansas, Forenede Stater, 67208
        • Associates In Womens Health
      • Winfield, Kansas, Forenede Stater, 67156
        • Cancer Center of Kansas - Winfield
    • Kentucky
      • Bardstown, Kentucky, Forenede Stater, 40004
        • Flaget Memorial Hospital
      • Corbin, Kentucky, Forenede Stater, 40701
        • Commonwealth Cancer Center-Corbin
      • Crestview Hills, Kentucky, Forenede Stater, 41017
        • Oncology Hematology Care Inc-Crestview
      • Lexington, Kentucky, Forenede Stater, 40504
        • Saint Joseph Radiation Oncology Resource Center
      • Lexington, Kentucky, Forenede Stater, 40509
        • Saint Joseph Hospital East
      • Louisville, Kentucky, Forenede Stater, 40202
        • Jewish Hospital
      • Louisville, Kentucky, Forenede Stater, 40245
        • UofL Health Medical Center Northeast
      • Louisville, Kentucky, Forenede Stater, 40215
        • Saints Mary and Elizabeth Hospital
      • Shepherdsville, Kentucky, Forenede Stater, 40165
        • Jewish Hospital Medical Center South
    • Louisiana
      • Baton Rouge, Louisiana, Forenede Stater, 70809
        • Ochsner Health Center-Summa
      • Kenner, Louisiana, Forenede Stater, 70065
        • Ochsner Medical Center Kenner
      • Monroe, Louisiana, Forenede Stater, 71202
        • Ochsner LSU Health Monroe Medical Center
      • New Orleans, Louisiana, Forenede Stater, 70121
        • Ochsner Medical Center Jefferson
      • Shreveport, Louisiana, Forenede Stater, 71103
        • LSU Health Sciences Center at Shreveport
      • Shreveport, Louisiana, Forenede Stater, 71105
        • CHRISTUS Highland Medical Center
    • Maine
      • Augusta, Maine, Forenede Stater, 04330
        • Harold Alfond Center for Cancer Care
      • Bangor, Maine, Forenede Stater, 04401
        • Eastern Maine Medical Center
      • Brewer, Maine, Forenede Stater, 04412
        • Lafayette Family Cancer Center-EMMC
      • Rockport, Maine, Forenede Stater, 04856
        • Penobscot Bay Medical Center
    • Maryland
      • Baltimore, Maryland, Forenede Stater, 21201
        • University of Maryland/Greenebaum Cancer Center
      • Baltimore, Maryland, Forenede Stater, 21229
        • Saint Agnes Hospital
    • Massachusetts
      • Beverly, Massachusetts, Forenede Stater, 01915
        • Beverly Hospital
      • Boston, Massachusetts, Forenede Stater, 02111
        • Tufts Medical Center
      • Boston, Massachusetts, Forenede Stater, 02215
        • Eastern Cooperative Oncology Group
      • Burlington, Massachusetts, Forenede Stater, 01805
        • Lahey Hospital and Medical Center
      • Gloucester, Massachusetts, Forenede Stater, 01930
        • Addison Gilbert Hospital
      • Springfield, Massachusetts, Forenede Stater, 01199
        • Baystate Medical Center
      • Winchester, Massachusetts, Forenede Stater, 01890
        • Winchester Hospital
      • Worcester, Massachusetts, Forenede Stater, 01655
        • UMass Memorial Medical Center - University Campus
    • Michigan
      • Adrian, Michigan, Forenede Stater, 49221
        • Bixby Medical Center
      • Adrian, Michigan, Forenede Stater, 49221
        • Hickman Cancer Center
      • Ann Arbor, Michigan, Forenede Stater, 48106
        • Saint Joseph Mercy Hospital
      • Ann Arbor, Michigan, Forenede Stater, 48106
        • Michigan Cancer Research Consortium NCORP
      • Brownstown, Michigan, Forenede Stater, 48183
        • Henry Ford Cancer Institute-Downriver
      • Clinton Township, Michigan, Forenede Stater, 48038
        • Henry Ford Macomb Hospital-Clinton Township
      • Dearborn, Michigan, Forenede Stater, 48124
        • Beaumont Hospital - Dearborn
      • Dearborn, Michigan, Forenede Stater, 48126
        • Henry Ford Medical Center-Fairlane
      • Detroit, Michigan, Forenede Stater, 48202
        • Henry Ford Hospital
      • Detroit, Michigan, Forenede Stater, 48201
        • Wayne State University/Karmanos Cancer Institute
      • Detroit, Michigan, Forenede Stater, 48236
        • Ascension Saint John Hospital
      • Escanaba, Michigan, Forenede Stater, 49829
        • Green Bay Oncology - Escanaba
      • Farmington Hills, Michigan, Forenede Stater, 48334
        • Weisberg Cancer Treatment Center
      • Farmington Hills, Michigan, Forenede Stater, 48336
        • Beaumont Hospital - Farmington Hills
      • Flint, Michigan, Forenede Stater, 48503
        • Hurley Medical Center
      • Flint, Michigan, Forenede Stater, 48503
        • Genesys Hurley Cancer Institute
      • Grosse Pointe, Michigan, Forenede Stater, 48230
        • William Beaumont Hospital-Grosse Pointe
      • Iron Mountain, Michigan, Forenede Stater, 49801
        • Green Bay Oncology - Iron Mountain
      • Jackson, Michigan, Forenede Stater, 49201
        • Allegiance Health
      • Kalamazoo, Michigan, Forenede Stater, 49007
        • West Michigan Cancer Center
      • Lansing, Michigan, Forenede Stater, 48912
        • University of Michigan Health - Sparrow Lansing
      • Livonia, Michigan, Forenede Stater, 48154
        • Trinity Health Saint Mary Mercy Livonia Hospital
      • Monroe, Michigan, Forenede Stater, 48162
        • Mercy Memorial Hospital
      • Monroe, Michigan, Forenede Stater, 48162
        • Toledo Clinic Cancer Centers-Monroe
      • Monroe, Michigan, Forenede Stater, 48162
        • Monroe Cancer Center
      • Novi, Michigan, Forenede Stater, 48374
        • Ascension Providence Hospitals - Novi
      • Novi, Michigan, Forenede Stater, 48377
        • Henry Ford Medical Center-Columbus
      • Pontiac, Michigan, Forenede Stater, 48341
        • Saint Joseph Mercy Oakland
      • Port Huron, Michigan, Forenede Stater, 48060
        • Lake Huron Medical Center
      • Roseville, Michigan, Forenede Stater, 48066
        • Michigan Cancer Specialists
      • Royal Oak, Michigan, Forenede Stater, 48073
        • William Beaumont Hospital-Royal Oak
      • Royal Oak, Michigan, Forenede Stater, 48073
        • Cancer Care Associates PC
      • Royal Oak, Michigan, Forenede Stater, 48073
        • Comprehensive Medical Center PLLC
      • Royal Oak, Michigan, Forenede Stater, 48073
        • Hematology Oncology Consultants PC
      • Royal Oak, Michigan, Forenede Stater, 48073
        • Oakland Medical Group
      • Royal Oak, Michigan, Forenede Stater, 48067
        • Oakland Colon Rectal Associates
      • Saginaw, Michigan, Forenede Stater, 48601
        • Ascension Saint Mary's Hospital
      • Southfield, Michigan, Forenede Stater, 48075
        • Ascension Providence Hospitals - Southfield
      • Sterling Heights, Michigan, Forenede Stater, 48312
        • Premier Hematology Oncology Care
      • Sterling Heights, Michigan, Forenede Stater, 48314
        • Mitchell Folbe MD PC
      • Troy, Michigan, Forenede Stater, 48085
        • William Beaumont Hospital - Troy
      • Troy, Michigan, Forenede Stater, 48084
        • Michigan Institute of Urology-Town Center
      • Troy, Michigan, Forenede Stater, 48085
        • Claudia BR Herke MD PC
      • Troy, Michigan, Forenede Stater, 48098
        • Hematology Oncology Consultants PC-Troy
      • Warren, Michigan, Forenede Stater, 48093
        • Saint John Macomb-Oakland Hospital
      • West Bloomfield, Michigan, Forenede Stater, 48322
        • Henry Ford West Bloomfield Hospital
    • Minnesota
      • Bemidji, Minnesota, Forenede Stater, 56601
        • Sanford Joe Lueken Cancer Center
      • Brainerd, Minnesota, Forenede Stater, 56401
        • Essentia Health Saint Joseph's Medical Center
      • Burnsville, Minnesota, Forenede Stater, 55337
        • Fairview Ridges Hospital
      • Coon Rapids, Minnesota, Forenede Stater, 55433
        • Mercy Hospital
      • Duluth, Minnesota, Forenede Stater, 55805
        • Essentia Health Cancer Center
      • Duluth, Minnesota, Forenede Stater, 55805
        • Essentia Health Saint Mary's Medical Center
      • Duluth, Minnesota, Forenede Stater, 55805
        • Miller-Dwan Hospital
      • Edina, Minnesota, Forenede Stater, 55435
        • Fairview Southdale Hospital
      • Fergus Falls, Minnesota, Forenede Stater, 56537
        • Lake Region Healthcare Corporation-Cancer Care
      • Fridley, Minnesota, Forenede Stater, 55432
        • Unity Hospital
      • Hutchinson, Minnesota, Forenede Stater, 55350
        • Hutchinson Area Health Care
      • Maplewood, Minnesota, Forenede Stater, 55109
        • Saint John's Hospital - Healtheast
      • Maplewood, Minnesota, Forenede Stater, 55109
        • Minnesota Oncology Hematology PA-Maplewood
      • Minneapolis, Minnesota, Forenede Stater, 55415
        • Hennepin County Medical Center
      • Minneapolis, Minnesota, Forenede Stater, 55407
        • Abbott-Northwestern Hospital
      • Minneapolis, Minnesota, Forenede Stater, 55454
        • Health Partners Inc
      • New Ulm, Minnesota, Forenede Stater, 56073
        • New Ulm Medical Center
      • Robbinsdale, Minnesota, Forenede Stater, 55422
        • North Memorial Medical Health Center
      • Rochester, Minnesota, Forenede Stater, 55905
        • Mayo Clinic in Rochester
      • Saint Louis Park, Minnesota, Forenede Stater, 55416
        • Park Nicollet Clinic - Saint Louis Park
      • Saint Louis Park, Minnesota, Forenede Stater, 55416
        • Metro Minnesota Community Oncology Research Consortium
      • Saint Paul, Minnesota, Forenede Stater, 55101
        • Regions Hospital
      • Saint Paul, Minnesota, Forenede Stater, 55102
        • United Hospital
      • Shakopee, Minnesota, Forenede Stater, 55379
        • Saint Francis Regional Medical Center
      • Stillwater, Minnesota, Forenede Stater, 55082
        • Lakeview Hospital
      • Waconia, Minnesota, Forenede Stater, 55387
        • Ridgeview Medical Center
      • Willmar, Minnesota, Forenede Stater, 56201
        • Rice Memorial Hospital
      • Woodbury, Minnesota, Forenede Stater, 55125
        • Minnesota Oncology Hematology PA-Woodbury
    • Missouri
      • Bolivar, Missouri, Forenede Stater, 65613
        • Central Care Cancer Center - Bolivar
      • Bonne Terre, Missouri, Forenede Stater, 63628
        • Parkland Health Center-Bonne Terre
      • Branson, Missouri, Forenede Stater, 65616
        • Cox Cancer Center Branson
      • Cape Girardeau, Missouri, Forenede Stater, 63703
        • Saint Francis Medical Center
      • Cape Girardeau, Missouri, Forenede Stater, 63703
        • Southeast Cancer Center
      • Creve Coeur, Missouri, Forenede Stater, 63141
        • Siteman Cancer Center at West County Hospital
      • Independence, Missouri, Forenede Stater, 64057
        • Centerpoint Medical Center LLC
      • Jefferson City, Missouri, Forenede Stater, 65109
        • Capital Region Southwest Campus
      • Joplin, Missouri, Forenede Stater, 64804
        • Freeman Health System
      • Joplin, Missouri, Forenede Stater, 64804
        • Mercy Hospital Joplin
      • Kansas City, Missouri, Forenede Stater, 64111
        • Saint Luke's Hospital of Kansas City
      • Kansas City, Missouri, Forenede Stater, 64132
        • Research Medical Center
      • Kansas City, Missouri, Forenede Stater, 64118
        • Heartland Hematology and Oncology Associates Incorporated
      • Lee's Summit, Missouri, Forenede Stater, 64086
        • Saint Luke's East - Lee's Summit
      • Liberty, Missouri, Forenede Stater, 64068
        • Liberty Radiation Oncology Center
      • Rolla, Missouri, Forenede Stater, 65401
        • Delbert Day Cancer Institute at PCRMC
      • Rolla, Missouri, Forenede Stater, 65401
        • Mercy Clinic-Rolla-Cancer and Hematology
      • Saint Joseph, Missouri, Forenede Stater, 64506
        • Heartland Regional Medical Center
      • Saint Louis, Missouri, Forenede Stater, 63110
        • Washington University School of Medicine
      • Saint Louis, Missouri, Forenede Stater, 63131
        • Missouri Baptist Medical Center
      • Saint Louis, Missouri, Forenede Stater, 63141
        • Mercy Hospital Saint Louis
      • Saint Louis, Missouri, Forenede Stater, 63129
        • Siteman Cancer Center-South County
      • Saint Louis, Missouri, Forenede Stater, 63109
        • Saint Louis Cancer and Breast Institute-South City
      • Saint Peters, Missouri, Forenede Stater, 63376
        • Siteman Cancer Center at Saint Peters Hospital
      • Sainte Genevieve, Missouri, Forenede Stater, 63670
        • Sainte Genevieve County Memorial Hospital
      • Springfield, Missouri, Forenede Stater, 65807
        • CoxHealth South Hospital
      • Springfield, Missouri, Forenede Stater, 65804
        • Mercy Hospital Springfield
      • Sullivan, Missouri, Forenede Stater, 63080
        • Missouri Baptist Sullivan Hospital
      • Sunset Hills, Missouri, Forenede Stater, 63127
        • BJC Outpatient Center at Sunset Hills
    • Montana
      • Anaconda, Montana, Forenede Stater, 59711
        • Community Hospital of Anaconda
      • Billings, Montana, Forenede Stater, 59101
        • Billings Clinic Cancer Center
      • Billings, Montana, Forenede Stater, 59101
        • Saint Vincent Healthcare
      • Billings, Montana, Forenede Stater, 59102
        • Montana Cancer Consortium NCORP
      • Bozeman, Montana, Forenede Stater, 59715
        • Bozeman Deaconess Hospital
      • Butte, Montana, Forenede Stater, 59701
        • Saint James Community Hospital and Cancer Treatment Center
      • Great Falls, Montana, Forenede Stater, 59405
        • Great Falls Clinic
      • Great Falls, Montana, Forenede Stater, 59405
        • Benefis Healthcare- Sletten Cancer Institute
      • Helena, Montana, Forenede Stater, 59601
        • Saint Peter's Community Hospital
      • Kalispell, Montana, Forenede Stater, 59901
        • Kalispell Regional Medical Center
      • Missoula, Montana, Forenede Stater, 59804
        • Community Medical Hospital
      • Missoula, Montana, Forenede Stater, 59802
        • Saint Patrick Hospital - Community Hospital
    • Nebraska
      • Grand Island, Nebraska, Forenede Stater, 68803
        • CHI Health Saint Francis
      • Kearney, Nebraska, Forenede Stater, 68847
        • CHI Health Good Samaritan
      • Kearney, Nebraska, Forenede Stater, 68845
        • Heartland Hematology and Oncology
      • Lincoln, Nebraska, Forenede Stater, 68506
        • Nebraska Hematology and Oncology
      • Lincoln, Nebraska, Forenede Stater, 68510
        • Nebraska Cancer Research Center
      • Lincoln, Nebraska, Forenede Stater, 68516
        • Southeast Nebraska Cancer Center - 68th Street Place
      • Lincoln, Nebraska, Forenede Stater, 68510
        • Saint Elizabeth Regional Medical Center
      • Norfolk, Nebraska, Forenede Stater, 68701
        • Faith Regional Health Services Carson Cancer Center
      • North Platte, Nebraska, Forenede Stater, 69101
        • Great Plains Health Callahan Cancer Center
      • Omaha, Nebraska, Forenede Stater, 68198
        • University of Nebraska Medical Center
      • Omaha, Nebraska, Forenede Stater, 68124
        • Alegent Health Bergan Mercy Medical Center
      • Omaha, Nebraska, Forenede Stater, 68122
        • Alegent Health Immanuel Medical Center
      • Omaha, Nebraska, Forenede Stater, 68130
        • Alegent Health Lakeside Hospital
      • Omaha, Nebraska, Forenede Stater, 68131
        • Creighton University Medical Center
      • Omaha, Nebraska, Forenede Stater, 68106
        • Missouri Valley Cancer Consortium
      • Omaha, Nebraska, Forenede Stater, 68124
        • Nebraska Cancer Specialists - Omaha
      • Omaha, Nebraska, Forenede Stater, 68130
        • Oncology Hematology West PC
      • Omaha, Nebraska, Forenede Stater, 68122
        • Hematology and Oncology Consultants PC
      • Papillion, Nebraska, Forenede Stater, 68046
        • Midlands Community Hospital
      • Scottsbluff, Nebraska, Forenede Stater, 69361
        • Regional West Medical Center Cancer Center
    • Nevada
      • Henderson, Nevada, Forenede Stater, 89052
        • Comprehensive Cancer Centers of Nevada - Henderson
      • Henderson, Nevada, Forenede Stater, 89052
        • Cancer and Blood Specialists-Henderson
      • Henderson, Nevada, Forenede Stater, 89052
        • Las Vegas Cancer Center-Henderson
      • Henderson, Nevada, Forenede Stater, 89074
        • Comprehensive Cancer Centers of Nevada-Southeast Henderson
      • Henderson, Nevada, Forenede Stater, 89074
        • GenesisCare USA - Henderson
      • Las Vegas, Nevada, Forenede Stater, 89144
        • Summerlin Hospital Medical Center
      • Las Vegas, Nevada, Forenede Stater, 89106
        • Radiation Oncology Centers of Nevada Central
      • Las Vegas, Nevada, Forenede Stater, 89109
        • GenesisCare USA - Las Vegas
      • Las Vegas, Nevada, Forenede Stater, 89119
        • Radiation Oncology Centers of Nevada Southeast
      • Las Vegas, Nevada, Forenede Stater, 89128
        • Comprehensive Cancer Centers of Nevada - Northwest
      • Las Vegas, Nevada, Forenede Stater, 89144
        • Comprehensive Cancer Centers of Nevada-Summerlin
      • Las Vegas, Nevada, Forenede Stater, 89148
        • Comprehensive Cancer Centers of Nevada
      • Las Vegas, Nevada, Forenede Stater, 89148
        • OptumCare Cancer Care at Fort Apache
      • Las Vegas, Nevada, Forenede Stater, 89169
        • Comprehensive Cancer Centers of Nevada - Central Valley
      • Las Vegas, Nevada, Forenede Stater, 89106
        • Cancer and Blood Specialists-Shadow
      • Las Vegas, Nevada, Forenede Stater, 89109
        • HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway
      • Las Vegas, Nevada, Forenede Stater, 89113
        • HealthCare Partners Medical Group Oncology/Hematology-San Martin
      • Las Vegas, Nevada, Forenede Stater, 89121
        • Cancer Therapy and Integrative Medicine
      • Las Vegas, Nevada, Forenede Stater, 89128
        • Cancer and Blood Specialists-Tenaya
      • Las Vegas, Nevada, Forenede Stater, 89128
        • GenesisCare USA - Vegas Tenaya
      • Las Vegas, Nevada, Forenede Stater, 89128
        • HealthCare Partners Medical Group Oncology/Hematology-Tenaya
      • Las Vegas, Nevada, Forenede Stater, 89148-2405
        • Las Vegas Cancer Center-Medical Center
      • Las Vegas, Nevada, Forenede Stater, 89148
        • GenesisCare USA - Fort Apache
      • Las Vegas, Nevada, Forenede Stater, 89149
        • HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills
      • Las Vegas, Nevada, Forenede Stater, 89169
        • Nevada Cancer Research Foundation NCORP
      • Reno, Nevada, Forenede Stater, 89503
        • Saint Mary's Regional Medical Center
    • New Hampshire
      • Dover, New Hampshire, Forenede Stater, 03820
        • Wentworth-Douglass Hospital
    • New Jersey
      • East Orange, New Jersey, Forenede Stater, 07018-1095
        • Veterans Adminstration New Jersey Health Care System
      • Newark, New Jersey, Forenede Stater, 07112
        • Newark Beth Israel Medical Center
    • New Mexico
      • Albuquerque, New Mexico, Forenede Stater, 87102
        • University of New Mexico Cancer Center
    • New York
      • Albany, New York, Forenede Stater, 12208
        • New York Oncology Hematology PC - Albany Medical Center
      • Auburn, New York, Forenede Stater, 13021
        • Hematology Oncology Associates of Central New York-Auburn
      • Buffalo, New York, Forenede Stater, 14263
        • Roswell Park Cancer Institute
      • Glens Falls, New York, Forenede Stater, 12801
        • Glens Falls Hospital
      • Lake Success, New York, Forenede Stater, 11042
        • Northwell Health/Center for Advanced Medicine
      • Liverpool, New York, Forenede Stater, 13088
        • Hematology Oncology Associates of Central New York-Liverpool
      • Manhasset, New York, Forenede Stater, 11030
        • North Shore University Hospital
      • Middletown, New York, Forenede Stater, 10940
        • Garnet Health Medical Center
      • New Hyde Park, New York, Forenede Stater, 11040
        • Long Island Jewish Medical Center
      • Rochester, New York, Forenede Stater, 14642
        • University of Rochester
      • Rome, New York, Forenede Stater, 13440
        • Hematology Oncology Associates of Central New York-Rome
      • Syracuse, New York, Forenede Stater, 13210
        • State University of New York Upstate Medical University
      • Syracuse, New York, Forenede Stater, 13215
        • Hematology Oncology Associates of Central New York-Onondaga Hill
    • North Carolina
      • Asheville, North Carolina, Forenede Stater, 28801
        • Mission Hospital
      • Asheville, North Carolina, Forenede Stater, 28806
        • Messino Cancer Centers
      • Asheville, North Carolina, Forenede Stater, 28803
        • AdventHealth Infusion Center Asheville
      • Clinton, North Carolina, Forenede Stater, 28328
        • Southeastern Medical Oncology Center-Clinton
      • Clinton, North Carolina, Forenede Stater, 28328
        • Sampson Radiation Oncology
      • Goldsboro, North Carolina, Forenede Stater, 27534
        • Southeastern Medical Oncology Center-Goldsboro
      • Goldsboro, North Carolina, Forenede Stater, 27534
        • Wayne Memorial Hospital
      • Goldsboro, North Carolina, Forenede Stater, 27534
        • Wayne Radiation Oncology
      • Hendersonville, North Carolina, Forenede Stater, 28791
        • Hendersonville Hematology and Oncology at Pardee
      • Hendersonville, North Carolina, Forenede Stater, 28791
        • Margaret R Pardee Memorial Hospital
      • Hendersonville, North Carolina, Forenede Stater, 28792
        • AdventHealth Hendersonville
      • Jacksonville, North Carolina, Forenede Stater, 28546
        • Southeastern Medical Oncology Center-Jacksonville
      • Jacksonville, North Carolina, Forenede Stater, 28546
        • Onslow Memorial Hospital
      • Kinston, North Carolina, Forenede Stater, 28501
        • Vidant Oncology-Kinston
      • Winston-Salem, North Carolina, Forenede Stater, 27157
        • Wake Forest University Health Sciences
    • North Dakota
      • Bismarck, North Dakota, Forenede Stater, 58501
        • Sanford Bismarck Medical Center
      • Fargo, North Dakota, Forenede Stater, 58122
        • Sanford Roger Maris Cancer Center
      • Fargo, North Dakota, Forenede Stater, 58103
        • Essentia Health Cancer Center-South University Clinic
      • Fargo, North Dakota, Forenede Stater, 58122
        • Sanford Broadway Medical Center
      • Fargo, North Dakota, Forenede Stater, 58122
        • Sanford Clinic North-Fargo
    • Ohio
      • Akron, Ohio, Forenede Stater, 44307
        • Cleveland Clinic Akron General
      • Beachwood, Ohio, Forenede Stater, 44122
        • UHHS-Chagrin Highlands Medical Center
      • Belpre, Ohio, Forenede Stater, 45714
        • Strecker Cancer Center-Belpre
      • Bowling Green, Ohio, Forenede Stater, 43402
        • Toledo Clinic Cancer Centers-Bowling Green
      • Centerville, Ohio, Forenede Stater, 45459
        • Miami Valley Hospital South
      • Centerville, Ohio, Forenede Stater, 45459
        • Dayton Physicians LLC-Miami Valley South
      • Chardon, Ohio, Forenede Stater, 44024
        • Geauga Hospital
      • Chillicothe, Ohio, Forenede Stater, 45601
        • Adena Regional Medical Center
      • Cincinnati, Ohio, Forenede Stater, 45219
        • University of Cincinnati Cancer Center-UC Medical Center
      • Cincinnati, Ohio, Forenede Stater, 45220
        • Good Samaritan Hospital - Cincinnati
      • Cincinnati, Ohio, Forenede Stater, 45242
        • Bethesda North Hospital
      • Cincinnati, Ohio, Forenede Stater, 45242
        • Oncology Hematology Care Inc-Blue Ash
      • Cincinnati, Ohio, Forenede Stater, 45202
        • Oncology Hematology Care Inc-Eden Park
      • Cincinnati, Ohio, Forenede Stater, 45211
        • Oncology Hematology Care Inc-Mercy West
      • Cincinnati, Ohio, Forenede Stater, 45230
        • Oncology Hematology Care Inc-Anderson
      • Cincinnati, Ohio, Forenede Stater, 45236
        • Oncology Hematology Care Inc-Kenwood
      • Cincinnati, Ohio, Forenede Stater, 45247
        • TriHealth Cancer Institute-Westside
      • Cincinnati, Ohio, Forenede Stater, 45255
        • TriHealth Cancer Institute-Anderson
      • Cleveland, Ohio, Forenede Stater, 44106
        • Case Western Reserve University
      • Cleveland, Ohio, Forenede Stater, 44109
        • MetroHealth Medical Center
      • Columbus, Ohio, Forenede Stater, 43214
        • Riverside Methodist Hospital
      • Columbus, Ohio, Forenede Stater, 43219
        • The Mark H Zangmeister Center
      • Columbus, Ohio, Forenede Stater, 43214
        • Columbus Oncology and Hematology Associates Inc
      • Columbus, Ohio, Forenede Stater, 43228
        • Doctors Hospital
      • Columbus, Ohio, Forenede Stater, 43213
        • Mount Carmel East Hospital
      • Columbus, Ohio, Forenede Stater, 43215
        • Grant Medical Center
      • Columbus, Ohio, Forenede Stater, 43222
        • Mount Carmel Health Center West
      • Columbus, Ohio, Forenede Stater, 43215
        • Columbus NCI Community Oncology Research Program
      • Dayton, Ohio, Forenede Stater, 45406
        • Good Samaritan Hospital - Dayton
      • Dayton, Ohio, Forenede Stater, 45409
        • Miami Valley Hospital
      • Dayton, Ohio, Forenede Stater, 45415
        • Dayton Physician LLC-Miami Valley Hospital North
      • Dayton, Ohio, Forenede Stater, 45415
        • Miami Valley Hospital North
      • Dayton, Ohio, Forenede Stater, 45459
        • Dayton NCI Community Oncology Research Program
      • Dayton, Ohio, Forenede Stater, 45428
        • Dayton Veterans Affairs Medical Center
      • Delaware, Ohio, Forenede Stater, 43015
        • Delaware Health Center-Grady Cancer Center
      • Delaware, Ohio, Forenede Stater, 43015
        • Delaware Radiation Oncology
      • Delaware, Ohio, Forenede Stater, 43015
        • Grady Memorial Hospital
      • Elyria, Ohio, Forenede Stater, 44035
        • Mercy Cancer Center-Elyria
      • Fairfield, Ohio, Forenede Stater, 45014
        • Oncology Hematology Care Inc-Healthplex
      • Findlay, Ohio, Forenede Stater, 45840
        • Blanchard Valley Hospital
      • Findlay, Ohio, Forenede Stater, 45840
        • Armes Family Cancer Center
      • Findlay, Ohio, Forenede Stater, 45840
        • Orion Cancer Care
      • Franklin, Ohio, Forenede Stater, 45005-1066
        • Atrium Medical Center-Middletown Regional Hospital
      • Franklin, Ohio, Forenede Stater, 45005
        • Dayton Physicians LLC-Atrium
      • Greenville, Ohio, Forenede Stater, 45331
        • Wayne Hospital
      • Greenville, Ohio, Forenede Stater, 45331
        • Dayton Physicians LLC-Wayne
      • Kettering, Ohio, Forenede Stater, 45429
        • Kettering Medical Center
      • Kettering, Ohio, Forenede Stater, 45409
        • Greater Dayton Cancer Center
      • Lancaster, Ohio, Forenede Stater, 43130
        • Fairfield Medical Center
      • Lancaster, Ohio, Forenede Stater, 43130
        • Lancaster Radiation Oncology
      • Lima, Ohio, Forenede Stater, 45804
        • Lima Memorial Hospital
      • Mansfield, Ohio, Forenede Stater, 44903
        • OhioHealth Mansfield Hospital
      • Marietta, Ohio, Forenede Stater, 45750
        • Marietta Memorial Hospital
      • Marion, Ohio, Forenede Stater, 43302
        • OhioHealth Marion General Hospital
      • Maumee, Ohio, Forenede Stater, 43537
        • Toledo Clinic Cancer Centers-Maumee
      • Maumee, Ohio, Forenede Stater, 43537
        • Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
      • Mayfield Heights, Ohio, Forenede Stater, 44124
        • UH Seidman Cancer Center at Landerbrook Health Center
      • Mentor, Ohio, Forenede Stater, 44060
        • UH Seidman Cancer Center at Lake Health Mentor Campus
      • Middleburg Heights, Ohio, Forenede Stater, 44130
        • UH Seidman Cancer Center at Southwest General Hospital
      • Middletown, Ohio, Forenede Stater, 45042
        • Dayton Physicians LLC-Signal Point
      • Mount Vernon, Ohio, Forenede Stater, 43050
        • Knox Community Hospital
      • Newark, Ohio, Forenede Stater, 43055
        • Licking Memorial Hospital
      • Newark, Ohio, Forenede Stater, 43055
        • Newark Radiation Oncology
      • Oregon, Ohio, Forenede Stater, 43616
        • Saint Charles Hospital
      • Oregon, Ohio, Forenede Stater, 43616
        • Toledo Clinic Cancer Centers-Oregon
      • Parma, Ohio, Forenede Stater, 44129
        • University Hospitals Parma Medical Center
      • Portsmouth, Ohio, Forenede Stater, 45662
        • Southern Ohio Medical Center
      • Sidney, Ohio, Forenede Stater, 45365
        • Dayton Physicians LLC-Wilson
      • Springfield, Ohio, Forenede Stater, 45505
        • Springfield Regional Medical Center
      • Springfield, Ohio, Forenede Stater, 45504
        • Springfield Regional Cancer Center
      • Sylvania, Ohio, Forenede Stater, 43560
        • ProMedica Flower Hospital
      • Tiffin, Ohio, Forenede Stater, 44883
        • Mercy Hospital of Tiffin
      • Toledo, Ohio, Forenede Stater, 43608
        • Saint Vincent Mercy Medical Center
      • Toledo, Ohio, Forenede Stater, 43623
        • Mercy Health - Saint Anne Hospital
      • Toledo, Ohio, Forenede Stater, 43623
        • Toledo Clinic Cancer Centers-Toledo
      • Toledo, Ohio, Forenede Stater, 43614
        • University of Toledo
      • Toledo, Ohio, Forenede Stater, 43617
        • Toledo Community Hospital Oncology Program CCOP
      • Troy, Ohio, Forenede Stater, 45373
        • Upper Valley Medical Center
      • Troy, Ohio, Forenede Stater, 45373
        • Dayton Physicians LLC - Troy
      • Wadsworth, Ohio, Forenede Stater, 44281
        • University Hospitals Sharon Health Center
      • Wauseon, Ohio, Forenede Stater, 43567
        • Fulton County Health Center
      • West Chester, Ohio, Forenede Stater, 45069
        • University of Cincinnati Cancer Center-West Chester
      • Westerville, Ohio, Forenede Stater, 43081
        • Saint Ann's Hospital
      • Westlake, Ohio, Forenede Stater, 44145
        • UH Seidman Cancer Center at Saint John Medical Center
      • Wright-Patterson Air Force Base, Ohio, Forenede Stater, 45433
        • Wright-Patterson Medical Center
      • Zanesville, Ohio, Forenede Stater, 43701
        • Genesis Healthcare System Cancer Care Center
    • Oklahoma
      • Lawton, Oklahoma, Forenede Stater, 73505
        • Cancer Centers of Southwest Oklahoma Research
      • Oklahoma City, Oklahoma, Forenede Stater, 73104
        • University of Oklahoma Health Sciences Center
    • Oregon
      • Bend, Oregon, Forenede Stater, 97701
        • Saint Charles Health System
      • Clackamas, Oregon, Forenede Stater, 97015
        • Clackamas Radiation Oncology Center
      • Clackamas, Oregon, Forenede Stater, 97015
        • Providence Cancer Institute Clackamas Clinic
      • Coos Bay, Oregon, Forenede Stater, 97420
        • Bay Area Hospital
      • Milwaukie, Oregon, Forenede Stater, 97222
        • Providence Milwaukie Hospital
      • Newberg, Oregon, Forenede Stater, 97132
        • Providence Newberg Medical Center
      • Oregon City, Oregon, Forenede Stater, 97045
        • Providence Willamette Falls Medical Center
      • Portland, Oregon, Forenede Stater, 97213
        • Providence Portland Medical Center
      • Portland, Oregon, Forenede Stater, 97225
        • Providence Saint Vincent Medical Center
      • Portland, Oregon, Forenede Stater, 97227
        • Kaiser Permanente Northwest
    • Pennsylvania
      • Allentown, Pennsylvania, Forenede Stater, 18103
        • Lehigh Valley Hospital-Cedar Crest
      • Beaver, Pennsylvania, Forenede Stater, 15009
        • UPMC-Heritage Valley Health System Beaver
      • Bethlehem, Pennsylvania, Forenede Stater, 18017
        • Lehigh Valley Hospital - Muhlenberg
      • Bryn Mawr, Pennsylvania, Forenede Stater, 19010
        • Bryn Mawr Hospital
      • Chadds Ford, Pennsylvania, Forenede Stater, 19317
        • Christiana Care Health System-Concord Health Center
      • Danville, Pennsylvania, Forenede Stater, 17822
        • Geisinger Medical Center
      • Erie, Pennsylvania, Forenede Stater, 16505
        • UPMC Hillman Cancer Center Erie
      • Greensburg, Pennsylvania, Forenede Stater, 15601
        • UPMC Cancer Centers - Arnold Palmer Pavilion
      • Hazleton, Pennsylvania, Forenede Stater, 18201
        • Geisinger Medical Center-Cancer Center Hazleton
      • Hershey, Pennsylvania, Forenede Stater, 17033-0850
        • Penn State Milton S Hershey Medical Center
      • Johnstown, Pennsylvania, Forenede Stater, 15901
        • UPMC-Johnstown/John P. Murtha Regional Cancer Center
      • Lancaster, Pennsylvania, Forenede Stater, 17602
        • Lancaster General Hospital
      • Lewisburg, Pennsylvania, Forenede Stater, 17837
        • Geisinger Medical Oncology-Lewisburg
      • Lewistown, Pennsylvania, Forenede Stater, 17044
        • Lewistown Hospital
      • McKeesport, Pennsylvania, Forenede Stater, 15132
        • UPMC Cancer Center at UPMC McKeesport
      • Media, Pennsylvania, Forenede Stater, 19063
        • Riddle Memorial Hospital
      • Moon, Pennsylvania, Forenede Stater, 15108
        • UPMC Hillman Cancer Center in Coraopolis
      • Paoli, Pennsylvania, Forenede Stater, 19301
        • Paoli Memorial Hospital
      • Philadelphia, Pennsylvania, Forenede Stater, 19107
        • Thomas Jefferson University Hospital
      • Philadelphia, Pennsylvania, Forenede Stater, 19104
        • University of Pennsylvania/Abramson Cancer Center
      • Philadelphia, Pennsylvania, Forenede Stater, 19102
        • Drexel University School of Medicine
      • Pittsburgh, Pennsylvania, Forenede Stater, 15213
        • UPMC-Magee Womens Hospital
      • Pittsburgh, Pennsylvania, Forenede Stater, 15232
        • University of Pittsburgh Cancer Institute (UPCI)
      • Pittsburgh, Pennsylvania, Forenede Stater, 15232
        • UPMC-Shadyside Hospital
      • Pittsburgh, Pennsylvania, Forenede Stater, 15213
        • UPMC-Presbyterian Hospital
      • Pittsburgh, Pennsylvania, Forenede Stater, 15215
        • UPMC-Saint Margaret
      • Pittsburgh, Pennsylvania, Forenede Stater, 15236
        • UPMC Jefferson Regional Radiation Oncology
      • Pittsburgh, Pennsylvania, Forenede Stater, 15237
        • UPMC-Passavant Hospital
      • Pittsburgh, Pennsylvania, Forenede Stater, 15243
        • UPMC-Saint Clair Hospital Cancer Center
      • Pottstown, Pennsylvania, Forenede Stater, 19464
        • Pottstown Hospital
      • Pottsville, Pennsylvania, Forenede Stater, 17901
        • Geisinger Cancer Services-Pottsville
      • Scranton, Pennsylvania, Forenede Stater, 18508
        • Hematology and Oncology Associates of North East Pennsylvania
      • Seneca, Pennsylvania, Forenede Stater, 16346
        • UPMC Cancer Center at UPMC Northwest
      • State College, Pennsylvania, Forenede Stater, 16801
        • Geisinger Medical Group
      • Uniontown, Pennsylvania, Forenede Stater, 15401
        • UPMC Uniontown Hospital Radiation Oncology
      • Washington, Pennsylvania, Forenede Stater, 15301
        • UPMC Washington Hospital Radiation Oncology
      • West Reading, Pennsylvania, Forenede Stater, 19611
        • Reading Hospital
      • Wilkes-Barre, Pennsylvania, Forenede Stater, 18711
        • Geisinger Wyoming Valley/Henry Cancer Center
      • Williamsport, Pennsylvania, Forenede Stater, 17701
        • UPMC Susquehanna
      • Wynnewood, Pennsylvania, Forenede Stater, 19096
        • Lankenau Medical Center
    • South Carolina
      • Boiling Springs, South Carolina, Forenede Stater, 29316
        • Prisma Health Cancer Institute - Spartanburg
      • Easley, South Carolina, Forenede Stater, 29640
        • Prisma Health Cancer Institute - Easley
      • Gaffney, South Carolina, Forenede Stater, 29341
        • Gibbs Cancer Center-Gaffney
      • Greenville, South Carolina, Forenede Stater, 29605
        • Prisma Health Cancer Institute - Faris
      • Greenville, South Carolina, Forenede Stater, 29607
        • Saint Francis Cancer Center
      • Greenville, South Carolina, Forenede Stater, 29615
        • Prisma Health Cancer Institute - Eastside
      • Greenville, South Carolina, Forenede Stater, 29605
        • Prisma Health Cancer Institute - Butternut
      • Greenville, South Carolina, Forenede Stater, 29601
        • Saint Francis Hospital
      • Greenville, South Carolina, Forenede Stater, 29605
        • Prisma Health Greenville Memorial Hospital
      • Greenville, South Carolina, Forenede Stater, 29601
        • Greenville Health System Cancer Institute-Andrews
      • Greer, South Carolina, Forenede Stater, 29650
        • Prisma Health Cancer Institute - Greer
      • Greer, South Carolina, Forenede Stater, 29651
        • Gibbs Cancer Center-Pelham
      • Seneca, South Carolina, Forenede Stater, 29672
        • Prisma Health Cancer Institute - Seneca
      • Spartanburg, South Carolina, Forenede Stater, 29303
        • Spartanburg Medical Center
      • Union, South Carolina, Forenede Stater, 29379
        • MGC Hematology Oncology-Union
    • South Dakota
      • Rapid City, South Dakota, Forenede Stater, 57701
        • Rapid City Regional Hospital
      • Sioux Falls, South Dakota, Forenede Stater, 57105
        • Avera Cancer Institute
      • Sioux Falls, South Dakota, Forenede Stater, 57117-5134
        • Sanford USD Medical Center - Sioux Falls
      • Sioux Falls, South Dakota, Forenede Stater, 57104
        • Sanford Cancer Center Oncology Clinic
    • Tennessee
      • Bristol, Tennessee, Forenede Stater, 37620
        • Bristol Regional Medical Center
      • Chattanooga, Tennessee, Forenede Stater, 37404
        • Memorial Hospital
      • Hixson, Tennessee, Forenede Stater, 37343
        • Pulmonary Medicine Center of Chattanooga-Hixson
      • Johnson City, Tennessee, Forenede Stater, 37604
        • Wellmont Medical Associates Oncology and Hematology-Johnson City
      • Kingsport, Tennessee, Forenede Stater, 37660
        • Ballad Health Cancer Care - Kingsport
      • Kingsport, Tennessee, Forenede Stater, 37660
        • Wellmont Holston Valley Hospital and Medical Center
      • Nashville, Tennessee, Forenede Stater, 37208
        • Meharry Medical College
      • Ooltewah, Tennessee, Forenede Stater, 37363
        • Memorial GYN Plus
    • Texas
      • Amarillo, Texas, Forenede Stater, 79106
        • The Don and Sybil Harrington Cancer Center
      • Dallas, Texas, Forenede Stater, 75235
        • Parkland Memorial Hospital
      • Dallas, Texas, Forenede Stater, 75390
        • UT Southwestern/Simmons Cancer Center-Dallas
      • Lubbock, Texas, Forenede Stater, 79410
        • Covenant Medical Center-Lakeside
      • San Antonio, Texas, Forenede Stater, 78229
        • University Hospital
      • San Antonio, Texas, Forenede Stater, 78229
        • University of Texas Health Science Center at San Antonio
    • Vermont
      • Berlin, Vermont, Forenede Stater, 05602
        • Central Vermont Medical Center/National Life Cancer Treatment
      • Burlington, Vermont, Forenede Stater, 05401
        • University of Vermont Medical Center
      • Burlington, Vermont, Forenede Stater, 05405
        • University of Vermont and State Agricultural College
    • Virginia
      • Danville, Virginia, Forenede Stater, 24541
        • Danville Regional Medical Center
      • Fredericksburg, Virginia, Forenede Stater, 22401
        • Fredericksburg Oncology Inc
      • Fredericksburg, Virginia, Forenede Stater, 22408
        • Hematology Oncology Associates of Fredericksburg Inc
      • Lynchburg, Virginia, Forenede Stater, 24501
        • Centra Lynchburg Hematology-Oncology Clinic Inc
      • Martinsville, Virginia, Forenede Stater, 24115
        • Sovah Health Martinsville
      • Norton, Virginia, Forenede Stater, 24273
        • Southwest VA Regional Cancer Center
      • Richmond, Virginia, Forenede Stater, 23298
        • Virginia Commonwealth University/Massey Cancer Center
      • Richmond, Virginia, Forenede Stater, 23229
        • Virginia Cancer Institute
      • South Hill, Virginia, Forenede Stater, 23970
        • VCU Community Memorial Health Center
    • Washington
      • Aberdeen, Washington, Forenede Stater, 98520
        • Providence Regional Cancer System-Aberdeen
      • Anacortes, Washington, Forenede Stater, 98221
        • Cancer Care Center at Island Hospital
      • Auburn, Washington, Forenede Stater, 98001
        • MultiCare Auburn Medical Center
      • Bainbridge Island, Washington, Forenede Stater, 98110
        • Virginia Mason Bainbridge Island Medical Center
      • Bellevue, Washington, Forenede Stater, 98004
        • Overlake Medical Center
      • Bellevue, Washington, Forenede Stater, 98005
        • Swedish Cancer Institute-Eastside Oncology Hematology
      • Bellingham, Washington, Forenede Stater, 98225
        • PeaceHealth Saint Joseph Medical Center
      • Bremerton, Washington, Forenede Stater, 98310
        • Harrison HealthPartners Hematology and Oncology-Bremerton
      • Bremerton, Washington, Forenede Stater, 98310
        • Harrison Medical Center
      • Burien, Washington, Forenede Stater, 98166
        • Highline Medical Center-Main Campus
      • Centralia, Washington, Forenede Stater, 98531
        • Providence Regional Cancer System-Centralia
      • Edmonds, Washington, Forenede Stater, 98026
        • Swedish Cancer Institute-Edmonds
      • Enumclaw, Washington, Forenede Stater, 98022
        • Saint Elizabeth Hospital
      • Everett, Washington, Forenede Stater, 98201
        • Providence Regional Cancer Partnership
      • Federal Way, Washington, Forenede Stater, 98002
        • Virginia Mason Federal Way Medical Center
      • Federal Way, Washington, Forenede Stater, 98003
        • Saint Francis Hospital
      • Gig Harbor, Washington, Forenede Stater, 98332
        • Tacoma/Valley Radiation Oncology Centers-Gig Harbor
      • Gig Harbor, Washington, Forenede Stater, 98335
        • MultiCare Gig Harbor Medical Park
      • Issaquah, Washington, Forenede Stater, 98029
        • Swedish Cancer Institute-Issaquah
      • Kennewick, Washington, Forenede Stater, 99336
        • Northwest Cancer Clinic
      • Lacey, Washington, Forenede Stater, 98503
        • Providence Regional Cancer System-Lacey
      • Lakewood, Washington, Forenede Stater, 98499
        • Saint Clare Hospital
      • Longview, Washington, Forenede Stater, 98632
        • PeaceHealth Saint John Medical Center
      • Lynnwood, Washington, Forenede Stater, 98036
        • Virginia Mason Lynnwood Medical Center
      • Port Townsend, Washington, Forenede Stater, 98368
        • Jefferson Healthcare
      • Poulsbo, Washington, Forenede Stater, 98370
        • Harrison HealthPartners Hematology and Oncology-Poulsbo
      • Poulsbo, Washington, Forenede Stater, 98370
        • Peninsula Cancer Center
      • Puyallup, Washington, Forenede Stater, 98372
        • MultiCare Good Samaritan Hospital
      • Puyallup, Washington, Forenede Stater, 98372
        • Tacoma/Valley Radiation Oncology Centers-Puyallup
      • Seattle, Washington, Forenede Stater, 98109
        • Fred Hutchinson Cancer Research Center
      • Seattle, Washington, Forenede Stater, 98101
        • Virginia Mason Medical Center
      • Seattle, Washington, Forenede Stater, 98107
        • Swedish Medical Center-Ballard Campus
      • Seattle, Washington, Forenede Stater, 98122
        • Swedish Medical Center-First Hill
      • Seattle, Washington, Forenede Stater, 98195
        • University of Washington Medical Center - Montlake
      • Seattle, Washington, Forenede Stater, 98109
        • FHCC South Lake Union
      • Seattle, Washington, Forenede Stater, 98112
        • Kaiser Permanente Washington
      • Seattle, Washington, Forenede Stater, 98104
        • Minor and James Medical PLLC
      • Seattle, Washington, Forenede Stater, 98104
        • Pacific Gynecology Specialists
      • Shelton, Washington, Forenede Stater, 98584
        • Providence Regional Cancer System-Shelton
      • Spokane, Washington, Forenede Stater, 99218
        • Evergreen Hematology and Oncology PS
      • Spokane, Washington, Forenede Stater, 99204
        • MultiCare Deaconess Cancer and Blood Specialty Center - Downtown
      • Spokane Valley, Washington, Forenede Stater, 99216
        • MultiCare Deaconess Cancer and Blood Specialty Center - Valley
      • Tacoma, Washington, Forenede Stater, 98405
        • Northwest Medical Specialties PLLC
      • Tacoma, Washington, Forenede Stater, 98405
        • MultiCare Tacoma General Hospital
      • Tacoma, Washington, Forenede Stater, 98405
        • Tacoma/Valley Radiation Oncology Centers-Saint Joe's
      • Tacoma, Washington, Forenede Stater, 97405
        • Tacoma/Valley Radiation Oncology Centers-Jackson Hall
      • Tacoma, Washington, Forenede Stater, 98405
        • Franciscan Research Center-Northwest Medical Plaza
      • Tacoma, Washington, Forenede Stater, 98405
        • Northwest NCI Community Oncology Research Program
      • Vancouver, Washington, Forenede Stater, 98664
        • PeaceHealth Southwest Medical Center
      • Walla Walla, Washington, Forenede Stater, 99362
        • Providence Saint Mary Regional Cancer Center
      • Yakima, Washington, Forenede Stater, 98902
        • North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
      • Yelm, Washington, Forenede Stater, 98597
        • Providence Regional Cancer System-Yelm
    • West Virginia
      • Bridgeport, West Virginia, Forenede Stater, 26330
        • United Hospital Center
      • Martinsburg, West Virginia, Forenede Stater, 25401
        • WVUH-Berkely Medical Center
      • Morgantown, West Virginia, Forenede Stater, 26506
        • West Virginia University Healthcare
      • Parkersburg, West Virginia, Forenede Stater, 26101
        • Camden Clark Medical Center
    • Wisconsin
      • Antigo, Wisconsin, Forenede Stater, 54409
        • Langlade Hospital and Cancer Center
      • Burlington, Wisconsin, Forenede Stater, 53105
        • Aurora Cancer Care-Southern Lakes VLCC
      • Chippewa Falls, Wisconsin, Forenede Stater, 54729
        • Marshfield Clinic-Chippewa Center
      • Eau Claire, Wisconsin, Forenede Stater, 54701
        • HSHS Sacred Heart Hospital
      • Eau Claire, Wisconsin, Forenede Stater, 54701
        • Marshfield Clinic Cancer Center at Sacred Heart
      • Fond Du Lac, Wisconsin, Forenede Stater, 54937
        • Aurora Health Center-Fond du Lac
      • Germantown, Wisconsin, Forenede Stater, 53022
        • Aurora Health Care Germantown Health Center
      • Grafton, Wisconsin, Forenede Stater, 53024
        • Aurora Cancer Care-Grafton
      • Green Bay, Wisconsin, Forenede Stater, 54311
        • Aurora BayCare Medical Center
      • Green Bay, Wisconsin, Forenede Stater, 54301
        • Saint Vincent Hospital Cancer Center Green Bay
      • Green Bay, Wisconsin, Forenede Stater, 54303
        • Saint Vincent Hospital Cancer Center at Saint Mary's
      • Green Bay, Wisconsin, Forenede Stater, 54301
        • Bellin Memorial Hospital
      • Green Bay, Wisconsin, Forenede Stater, 54303
        • Green Bay Oncology Limited at Saint Mary's Hospital
      • Green Bay, Wisconsin, Forenede Stater, 54301-3526
        • Green Bay Oncology at Saint Vincent Hospital
      • Janesville, Wisconsin, Forenede Stater, 53548
        • Mercyhealth Hospital and Cancer Center - Janesville
      • Kenosha, Wisconsin, Forenede Stater, 53142
        • Aurora Cancer Care-Kenosha South
      • La Crosse, Wisconsin, Forenede Stater, 54601
        • Gundersen Lutheran Medical Center
      • Ladysmith, Wisconsin, Forenede Stater, 54848
        • Marshfield Clinic - Ladysmith Center
      • Manitowoc, Wisconsin, Forenede Stater, 54221
        • Holy Family Memorial Hospital
      • Marinette, Wisconsin, Forenede Stater, 54143
        • Aurora Bay Area Medical Group-Marinette
      • Marshfield, Wisconsin, Forenede Stater, 54449
        • Marshfield Medical Center-Marshfield
      • Marshfield, Wisconsin, Forenede Stater, 54449
        • Marshfield Medical Center
      • Milwaukee, Wisconsin, Forenede Stater, 53226
        • Medical College of Wisconsin
      • Milwaukee, Wisconsin, Forenede Stater, 53209
        • Aurora Cancer Care-Milwaukee
      • Milwaukee, Wisconsin, Forenede Stater, 53215
        • Aurora Saint Luke's Medical Center
      • Milwaukee, Wisconsin, Forenede Stater, 53233
        • Aurora Sinai Medical Center
      • Minocqua, Wisconsin, Forenede Stater, 54548
        • Marshfield Clinic-Minocqua Center
      • Mukwonago, Wisconsin, Forenede Stater, 53149
        • ProHealth D N Greenwald Center
      • New Richmond, Wisconsin, Forenede Stater, 54017
        • Cancer Center of Western Wisconsin
      • Oconomowoc, Wisconsin, Forenede Stater, 53066
        • ProHealth Oconomowoc Memorial Hospital
      • Oconto Falls, Wisconsin, Forenede Stater, 54154
        • Saint Vincent Hospital Cancer Center at Oconto Falls
      • Oshkosh, Wisconsin, Forenede Stater, 54904
        • Vince Lombardi Cancer Clinic - Oshkosh
      • Racine, Wisconsin, Forenede Stater, 53406
        • Aurora Cancer Care-Racine
      • Rhinelander, Wisconsin, Forenede Stater, 54501
        • Ascension Saint Mary's Hospital
      • Rhinelander, Wisconsin, Forenede Stater, 54501
        • Saint Mary's Hospital
      • Rice Lake, Wisconsin, Forenede Stater, 54868
        • Marshfield Medical Center-Rice Lake
      • Sheboygan, Wisconsin, Forenede Stater, 53081
        • Vince Lombardi Cancer Clinic-Sheboygan
      • Sheboygan, Wisconsin, Forenede Stater, 53081
        • HSHS Saint Nicholas Hospital
      • Stevens Point, Wisconsin, Forenede Stater, 54481
        • Ascension Saint Michael's Hospital
      • Sturgeon Bay, Wisconsin, Forenede Stater, 54235
        • Green Bay Oncology - Sturgeon Bay
      • Summit, Wisconsin, Forenede Stater, 53066
        • Aurora Medical Center in Summit
      • Two Rivers, Wisconsin, Forenede Stater, 54241
        • Vince Lombardi Cancer Clinic-Two Rivers
      • Waukesha, Wisconsin, Forenede Stater, 53188
        • UW Cancer Center at ProHealth Care
      • Waukesha, Wisconsin, Forenede Stater, 53188
        • ProHealth Waukesha Memorial Hospital
      • Waukesha, Wisconsin, Forenede Stater, 53188
        • Aurora Cancer Care-Waukesha
      • Wausau, Wisconsin, Forenede Stater, 54401
        • Aspirus Regional Cancer Center
      • Wausau, Wisconsin, Forenede Stater, 54401
        • Marshfield Clinic-Wausau Center
      • Wauwatosa, Wisconsin, Forenede Stater, 53226
        • Aurora Cancer Care-Milwaukee West
      • West Allis, Wisconsin, Forenede Stater, 53227
        • Aurora West Allis Medical Center
      • Weston, Wisconsin, Forenede Stater, 54476
        • Marshfield Medical Center - Weston
      • Weston, Wisconsin, Forenede Stater, 54476
        • Diagnostic and Treatment Center
      • Weston, Wisconsin, Forenede Stater, 54476
        • Ascension Saint Clare's Hospital
      • Wisconsin Rapids, Wisconsin, Forenede Stater, 54494
        • Aspirus Cancer Care - Wisconsin Rapids
      • Wisconsin Rapids, Wisconsin, Forenede Stater, 54494
        • Marshfield Clinic - Wisconsin Rapids Center
    • Wyoming
      • Casper, Wyoming, Forenede Stater, 82609
        • Rocky Mountain Oncology
      • Cheyenne, Wyoming, Forenede Stater, 82001
        • Cheyenne Regional Medical Center-West
      • Cody, Wyoming, Forenede Stater, 82414
        • Big Horn Basin Cancer Center
      • Cody, Wyoming, Forenede Stater, 82414
        • Billings Clinic-Cody
      • Sheridan, Wyoming, Forenede Stater, 82801
        • Welch Cancer Center

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år til 70 år (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Beskrivelse

Inklusionskriterier:

  • Diagnose af CLL i henhold til National Cancer Institute (NCI)/Intern Workshop om kronisk lymfatisk leukæmi (IWCLL) kriterier eller små lymfatiske lymfomer (SLL) i henhold til Verdenssundhedsorganisationens (WHO) kriterier; dette inkluderer tidligere dokumentation af:

    • Biopsi-påvist lille lymfatisk lymfom el

    • Diagnose af CLL i henhold til NCI/IWCLL-kriterierne som dokumenteret af alle følgende:

      • Lymfocyttal i perifert blod på mere end 5 x 10^9/L

      • Immunfænotype i overensstemmelse med CLL defineret som:

        • Den dominerende population af lymfocytter deler både B-celle-antigener (differentieringsklynge [CD]19, CD20 [typisk svagt udtryk] eller CD23) såvel som CD5 i fravær af andre pan-T-cellemarkører (CD3, CD2, etc)
        • Klonalitet som påvist af kappa eller lambda let kæde restriktion (typisk svag immunglobulin ekspression)
    • Negativ FISH-analyse for t(11;14)(immunoglobulin tung locus [IgH]/cyclin D1 [CCND1]) på perifert blod eller vævsbiopsi (f.eks. marvaspirat) eller negative immunhistokemiske farvninger til cyclin D1-farvning på involveret vævsbiopsi (f.eks. marv aspirat eller lymfeknudebiopsi)
  • Ingen tidligere kemoterapi, Brutons tyrosinkinase (BTK)-hæmmerbehandling eller monoklonal antistofterapi til behandling af CLL eller SLL

  • Har opfyldt mindst én af følgende indikationer for behandling:

    • Tegn på progressiv marvsvigt som manifesteret ved udvikling af forværret anæmi (hæmoglobin [Hg] < 11 g/dl) og/eller trombocytopeni (blodplader < 100 x 10^9/L)
    • Symptomatisk eller progressiv lymfadenopati, splenomegali eller hepatomegali

    • Et eller flere af følgende sygdomsrelaterede symptomer:

      • Vægttab >= 10 % inden for de foregående 6 måneder
      • Grad 2 eller 3 træthed tilskrevet CLL
      • Feber > 100,5 Fahrenheit (F) i 2 uger uden tegn på infektion
      • Klinisk signifikant nattesved uden tegn på infektion
    • Progressiv lymfocytose (ikke på grund af virkningerne af kortikosteroider) med en stigning på > 50 % over en periode på to måneder eller en forventet fordoblingstid på mindre end seks måneder
  • ECOG-ydelsesstatus mellem 0-2
  • Forventet levetid på >= 12 måneder
  • Evne til at tolerere FCR baseret terapi
  • Ingen deletion af 17p13 på cytogenetisk analyse af FISH
  • Glomerulær filtrationshastighed (GFR) > 40 ml/minut beregnet ved Cockcroft-Gault-formlen (opnået =< 14 dage før registrering)

  • Total bilirubin =< 2,5 x øvre normalgrænse (ULN) (opnået =< 14 dage før registrering), medmindre det skyldes Gilberts sygdom; for dem med en total bilirubin > 2,5 x ULN, bør en direkte bilirubin udføres og skal være < 1,5 mg/dL, for at Gilbert kan blive diagnosticeret

    • Hvis værdien er højere på grund af leverinvolvering af CLL, er patienten berettiget

  • Serumglutamin-oxaloeddikesyretransaminase (SGOT) (aspartattransaminase [AST])/serumglutamat-pyruvattransaminase (SGPT) (alanintransaminase [ALT]) =< 3,0 x den institutionelle ULN (opnået =< 14 dage før registrering)

    • Hvis værdien er højere på grund af leverinvolvering af CLL, er patienten berettiget

  • Protrombintid (PT)/international normaliseret ratio (INR) < 1,5 ULN og partiel tromboplastintid (PTT) (aktiveret partiel tromboplastintid [aPTT]) < 1,5 X ULN (opnået =< 14 dage før registrering)

    • Hvis værdien er højere på grund af leverinvolvering af CLL, er patienten berettiget
  • Ingen aktiv hæmolytisk anæmi, der kræver immunsuppressiv terapi eller anden farmakologisk behandling; patienter, der har en positiv Coombs-test, men ingen tegn på hæmolyse, er IKKE udelukket fra deltagelse
  • Ingen aktuel brug af kortikosteroider; UNDTAGELSE: lave doser af steroider (< 10 mg prednison eller tilsvarende dosis af andet steroid), der anvendes til behandling af ikke-hæmatologisk medicinsk tilstand (f.eks. kronisk binyrebarkinsufficiens) er tilladt
  • Ingen tidligere brug af kortikosteroider til autoimmune komplikationer, der er udviklet siden den første diagnose af CLL; forudgående brug af kortikosteroider af andre årsager end behandling af autoimmune komplikationer er tilladt
  • Ingen anden aktiv primær malignitet (bortset fra ikke-melanomatøs hudkræft eller carcinom in situ i livmoderhalsen), der kræver behandling eller begrænser forventet overlevelse til =< 2 år; BEMÆRK: hvis der er en historie med tidligere malignitet, må de ikke modtage anden specifik behandling (ud over hormonbehandling for deres kræft)
  • I stand til at overholde studiebesøgsplanen og andre protokolkrav
  • Ingen større operation inden for de sidste 4 uger (28 dage) efter første dosis af undersøgelseslægemidlet eller mindre operation inden for 3 dage efter første dosis af undersøgelseslægemidlet
  • Ingen strålebehandling =< 4 uger før registrering

  • Patienter med human immundefektvirus (HIV) infektion kan være berettiget, forudsat at de opfylder følgende kriterier:

    • CD4-positivt celletal >= nedre grænse for institutionel normal
    • HIV-virusmængde < 10.000 kopier HIV-ribonukleinsyre (RNA)/ml (hvis ikke i anti-HIV-behandling) ELLER < 50 kopier HIV-RNA/ml (hvis i anti-HIV-behandling)
    • Ingen tegn på hepatitis B eller C infektion
    • Ingen tegn på resistente stammer af HIV
    • Ingen historie med erhvervet immundefektsyndrom (AIDS)-definerende tilstand

  • Patienter må ikke have nogen af ​​følgende tilstande:

    • Kongestiv hjerteinsufficiens eller New York Heart Association Functional Classification III eller IV kongestiv hjertesvigt
    • Anamnese med myokardieinfarkt, ustabil angina eller akut koronarsyndrom inden for 6 måneder før registrering
    • Nylige infektioner, der kræver systemisk behandling; skal have afsluttet antibiotisk behandling > 14 dage før den første dosis af undersøgelseslægemidlet
    • Cerebral vaskulær ulykke eller intrakraniel blødning inden for de sidste 6 måneder
    • Infektion med kendt kronisk, aktiv hepatitis C
    • Serologisk status, der afspejler aktiv hepatitis B- eller C-infektion; Patienter, der er positive for hepatitis B-kerneantistof, hepatitis B-overfladeantigen (HBsAg) eller hepatitis C-antistof, skal have en negativ polymerasekædereaktion (PCR) før tilmelding (PCR-positive patienter vil blive udelukket)
  • Patienter er ikke kvalificerede, hvis de har behov for behandling med en stærk cytokrom P450 (CYP) familie 3, underfamilie A (3A) hæmmer
  • Patienter må ikke være på andre undersøgelsesmidler
  • Patienter har muligvis ikke fået warfarin eller en anden vitamin K-antagonist i de foregående 30 dage
  • Kvinder må ikke være gravide eller ammende, da denne undersøgelse involverer et forsøgsmiddel, hvis genotoksiske, mutagene og teratogene virkninger på det udviklende foster og nyfødte er ukendte; kvindelige patienter i den fødedygtige alder skal have en negativ serumgraviditetstest inden for 2 uger før registrering for at udelukke graviditet; kvindelige patienter, som har ikke-reproduktivt potentiale, er dem, der er postmenopausale efter historie (dvs. ingen menstruation i >= 1 år); ELLER historie med hysterektomi; ELLER historie med bilateral tubal ligering; ELLER historie med bilateral ooforektomi)
  • Kvinder i den fødedygtige alder og seksuelt aktive mænd skal kraftigt rådes til at bruge en accepteret og effektiv præventionsmetode eller at afholde sig fra samleje i 90 dage efter den sidste dosis af undersøgelseslægemidlet

  • Patienten skal være i stand til at sluge kapsler og ikke have følgende tilstande:

    • Sygdom, der signifikant påvirker mave-tarmfunktionen
    • Resektion af maven eller tyndtarmen
    • Symptomatisk inflammatorisk tarmsygdom
    • Colitis ulcerosa
    • Delvis eller fuldstændig tarmobstruktion
  • Patienten må ikke være i anden systemisk immunsuppressiv behandling end kortikosteroider inden for 28 dage efter den første dosis af undersøgelseslægemidlet
  • Patienten må ikke vaccineres med levende, svækkede vacciner inden for 4 uger efter første dosis af forsøgslægemidlet
  • Patienten må ikke have nogen kendte blødningsforstyrrelser (f.eks. von Willebrands sygdom) eller hæmofili
  • Patienten må ikke have aktuelt aktiv, klinisk signifikant nedsat leverfunktion (>= moderat nedsat leverfunktion ifølge NCI/Child Pugh)

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Arm A (ibrutinib, rituximab)
Patienterne får ibrutinib PO QD på dag 1-28. Fra cyklus 2 får patienterne også rituximab IV over 4 timer på dag 1 og 2 i cyklus 2 og dag 1 i cyklus 3-7. Behandlingen gentages hver 28. dag i 7 cyklusser i fravær af uacceptabel toksicitet. I fravær af sygdomsprogression kan patienter fortsætte med ibrutinib PO QD.
Andet: Laboratoriebiomarkøranalyse
Korrelative undersøgelser
Andet: Livskvalitetsvurdering
Hjælpestudier
Andre navne:
  • Livskvalitetsvurdering
Andet: Farmakogenomisk undersøgelse
Korrelative undersøgelser
Andre navne:
  • FARMAKOGENOMISK
Biologisk: Rituximab
Givet IV
Andre navne:
  • Rituxan
  • MabThera
  • ABP 798
  • BI 695500
  • C2B8 monoklonalt antistof
  • Kimærisk anti-CD20 antistof
  • CT-P10
  • IDEC-102
  • IDEC-C2B8
  • IDEC-C2B8 monoklonalt antistof
  • Monoklonalt antistof IDEC-C2B8
  • PF-05280586
  • Riabni
  • Rituximab ABBS
  • Rituximab ARRX
  • Rituximab Biosimilar ABP 798
  • Rituximab Biosimilar BI 695500
  • Rituximab Biosimilar CT-P10
  • Rituximab Biosimilar GB241
  • Rituximab Biosimilar IBI301
  • Rituximab Biosimilar JHL1101
  • Rituximab Biosimilar PF-05280586
  • Rituximab Biosimilar RTXM83
  • Rituximab Biosimilar SAIT101
  • Rituximab Biosimilar SIBP-02
  • rituximab biosimilær TQB2303
  • Rituximab PVVR
  • Rituximab-arrx
  • Rituximab-pvvr
  • RTXM83
  • Ruxience
  • Truxima
  • Ikgdar
  • Mabtas
  • Rituximab-abbs
Medicin: Ibrutinib
Givet PO
Andre navne:
  • PCI-32765
  • Imbruvica
  • BTK-hæmmer PCI-32765
  • CRA-032765
Aktiv komparator: Arm B (rituximab, fludarabinphosphat, cyclophosphamid)
Patienterne får rituximab IV over 4 timer på dag 1 og 2 i cyklus 1 og dag 1 i cyklus 2-6. Patienterne får også fludarabinphosphat IV over 30 minutter og cyclophosphamid IV over 30 minutter på dag 1-3. Behandlingen gentages hver 28. dag i 6 cyklusser i fravær af uacceptabel toksicitet.
Andet: Laboratoriebiomarkøranalyse
Korrelative undersøgelser
Andet: Livskvalitetsvurdering
Hjælpestudier
Andre navne:
  • Livskvalitetsvurdering
Andet: Farmakogenomisk undersøgelse
Korrelative undersøgelser
Andre navne:
  • FARMAKOGENOMISK
Medicin: Cyclofosfamid
Givet IV
Andre navne:
  • Cytoxan
  • CTX
  • (-)-Cyclophosphamid
  • 2H-1,3,2-Oxazaphosphorin, 2-[bis(2-chlorethyl)amino]tetrahydro-, 2-oxid, monohydrat
  • Carloxan
  • Ciclofosfamida
  • Ciclofosfamid
  • Cicloxal
  • Clafen
  • Claphene
  • CP monohydrat
  • CYCLO-celle
  • Cykloblastin
  • Cycloblastin
  • Cyclofosfam
  • Cyclophosphamid monohydrat
  • Cyclophosphamid Monohydrat
  • Cyclophospamidum
  • Cyclofosfan
  • Cyclophosphanum
  • Cyclostin
  • Cytophosphan
  • Cytofosfan
  • Fosfaseron
  • Genoxal
  • Genuxal
  • Ledoxina
  • Mitoxan
  • Neosar
  • Revimune
  • Syklofosfamid
  • WR- 138719
  • Asta B 518
  • B-518
  • WR-138719
Biologisk: Rituximab
Givet IV
Andre navne:
  • Rituxan
  • MabThera
  • ABP 798
  • BI 695500
  • C2B8 monoklonalt antistof
  • Kimærisk anti-CD20 antistof
  • CT-P10
  • IDEC-102
  • IDEC-C2B8
  • IDEC-C2B8 monoklonalt antistof
  • Monoklonalt antistof IDEC-C2B8
  • PF-05280586
  • Riabni
  • Rituximab ABBS
  • Rituximab ARRX
  • Rituximab Biosimilar ABP 798
  • Rituximab Biosimilar BI 695500
  • Rituximab Biosimilar CT-P10
  • Rituximab Biosimilar GB241
  • Rituximab Biosimilar IBI301
  • Rituximab Biosimilar JHL1101
  • Rituximab Biosimilar PF-05280586
  • Rituximab Biosimilar RTXM83
  • Rituximab Biosimilar SAIT101
  • Rituximab Biosimilar SIBP-02
  • rituximab biosimilær TQB2303
  • Rituximab PVVR
  • Rituximab-arrx
  • Rituximab-pvvr
  • RTXM83
  • Ruxience
  • Truxima
  • Ikgdar
  • Mabtas
  • Rituximab-abbs
Medicin: Fludarabin fosfat
Givet IV
Andre navne:
  • 2-F-ara-AMP
  • Beneflur
  • Fludara
  • 9H-Purin-6-amin, 2-fluor-9-(5-O-phosphono-β-D-arabinofuranosyl)-
  • SH T 586

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Progressionsfri overlevelse (PFS) rate ved 3 år
Tidsramme: Vurderes hver 3. måned indtil progression op til 4 år og 8 måneder

PFS blev defineret som tiden fra randomisering til CLL-progression eller død, alt efter hvad der indtrådte først. Progression er karakteriseret ved et af følgende:

  • ≥ 50 % stigning fra nadir siden behandlingsstart (tx) i summen af ​​produkterne fra mindst 2 lymfeknuder ved 2 på hinanden følgende undersøgelser med 2 ugers mellemrum
  • ≥ 50 % stigning fra nadir siden start af tx i størrelsen af ​​lever og/eller milt
  • ≥ 50 % stigning i det absolutte antal af cirkulerende lymfocytter, der ikke skyldes tumorflare-reaktion. Det absolutte lymfocyttal skal være ≥ 5x10^9/L for at kvalificere som sygdomsprogression.
  • Transformation til en mere aggressiv histologi (f.eks. Richters syndrom eller prolymfocytisk leukæmi med > 55 % prolymfocytter). For patienter, som opnår et fuldstændigt respons eller nodulært partielt respons, defineres progression som recidiv af cirkulerende leukæmicelleklon i det perifere blod og et absolut lymfocyttal > 5x10^9/L og/eller recidiv af palpabel lymfadenopati > 1,5 cm ved fysisk undersøgelse .
Vurderes hver 3. måned indtil progression op til 4 år og 8 måneder

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Samlet overlevelse (OS) rate ved 3 år
Tidsramme: Vurderet hver 3. måned indtil progression; efter progression, vurderet hver 3. måned i de første 2 år, hver 6. måned i 3-5 år, op til 4 år og 8 måneder
Samlet overlevelse blev defineret som tiden fra randomisering til død af enhver årsag eller dato sidst kendt i live. Samlet overlevelsesrate efter 3 år blev estimeret ved hjælp af metoden fra Kaplan-Meier.
Vurderet hver 3. måned indtil progression; efter progression, vurderet hver 3. måned i de første 2 år, hver 6. måned i 3-5 år, op til 4 år og 8 måneder
Den funktionelle vurdering af kræftterapi - leukæmi (FACT-Leu) Trial Outcome Index (TOI) score efter 6 måneder
Tidsramme: Vurderet til 6 måneder
Den funktionelle vurdering af kræftterapi - leukæmi (FACT-Leu) Trial Outcome Index (TOI) består af komponenterne fysisk velvære (PWB) og funktionelt velvære (FWB) i FACT-General (FACT-G) og leukæmi underskalaen. FACT-Leu TOI indeholder i alt 31 elementer, med score fra 0 til 124. Jo højere score, jo bedre livskvalitet (QOL).
Vurderet til 6 måneder
Den funktionelle vurdering af kræftterapi - leukæmi (FACT-Leu) Trial Outcome Index (TOI) score efter 12 måneder
Tidsramme: Vurderet til 12 måneder
Den funktionelle vurdering af kræftterapi - leukæmi (FACT-Leu) Trial Outcome Index (TOI) består af komponenterne fysisk velvære (PWB) og funktionelt velvære (FWB) i FACT-General (FACT-G) og leukæmi underskalaen. FACT-Leu TOI indeholder i alt 31 elementer, med score fra 0 til 124. Jo højere score, jo bedre livskvalitet (QOL).
Vurderet til 12 måneder
Sammenhængen mellem baseline Rai Stage og Complete Response (CR) Rate
Tidsramme: Vurderet ved baseline, hver 3. måned i de første 2 år og hver 6. måned i 3-5.

Patienter er klassificeret som trin 0-IV i henhold til Rai-systemet og kategoriseret i en af ​​de tre risikogrupper:

Lav risiko - Fase 0 Mellemrisiko - Fase I eller II Høj risiko - Fase III eller IV

CR kræver alt af følgende i mindst 2 måneder:

  • Fravær af lymfadenopati ved fysisk undersøgelse 2 gange med mindst 4 ugers mellemrum og passende røntgenteknikker. For patienter, hvis eneste målbare sygdom på indskrivningstidspunktet er på CT-scanning, er en CT-scanning påkrævet, og alle lymfeknuder skal være ≤ 1,5 cm før klassificering af patienten en CR.
  • Fravær af hepatomegali eller splenomegali ved fysisk undersøgelse
  • Fravær af konstitutionelle symptomer på grund af sygdom
  • Normal fuldstændig blodtælling
  • Én marv-aspirat og biopsi bør udføres 52 uger efter dag 1 i cyklus 1 blandt patienter med klinisk og laboratoriebevis for en CR for at dokumentere en CR. Marvprøven skal mindst være normocellulær, hvor < 30 % af kerneceller er lymfocytter.
Vurderet ved baseline, hver 3. måned i de første 2 år og hver 6. måned i 3-5.
Progressionsfri overlevelse (PFS) efter målbar restsygdom (MDR) status ved 2 år
Tidsramme: Vurderes hver 3. måned indtil progression op til 5 år

PFS blev defineret som tiden fra randomisering til progression eller død. Progression er karakteriseret ved et af følgende:

  • ≥ 50 % stigning fra nadir siden behandlingsstart (tx) i summen af ​​produkterne af ≥ 2 lymfeknuder ved 2 på hinanden følgende undersøgelser med 2 ugers mellemrum
  • ≥ 50 % stigning fra nadir siden start af tx i størrelsen af ​​lever og/eller milt
  • ≥ 50 % stigning i det absolutte antal af cirkulerende lymfocytter, der ikke skyldes tumorflare-reaktion. Det absolutte lymfocyttal skal være ≥ 5x10^9/L for at kvalificeres som progression.
  • Transformation til en mere aggressiv histologi. For patienter med et fuldstændigt respons eller nodulært partielt respons defineres progression som recidiv af cirkulerende leukæmicelleklon i det perifere blod og et absolut lymfocyttal > 5x10^9/L og/eller recidiv af palpabel lymfadenopati >1,5 cm ved fysisk undersøgelse.

MRD-status blev evalueret efter 2 år, og prøver med <=20 monotypiske hændelser eller et MRD-niveau på <10^-4 blev klassificeret som upåviselig MRD.
Vurderes hver 3. måned indtil progression op til 5 år

Andre resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Fordeling af genetiske abnormiteter før og efter behandling
Tidsramme: Vurderet ved baseline og 3, 6, 12, 15, 18, 24, 36 måneder
Genetiske abnormiteter vurderes ved baseline og longitudinelt under behandlingen såvel som efter behandlingen. Fordeling af genetiske abnormiteter er rapporteret.
Vurderet ved baseline og 3, 6, 12, 15, 18, 24, 36 måneder
T-celle tæller ved 12 måneder
Tidsramme: Vurderet til 12 måneder
T-celletal vil blive målt efter 12 måneder.
Vurderet til 12 måneder
Sammenhæng mellem Single Nucleotide Polymorphisms (SNP'er) og PFS
Tidsramme: Vurderet hver 3. måned indtil progression; efter progression, vurderet hver 3. måned de første 2 år, hver 6. måned i 3-5 år

PFS blev defineret som tiden fra randomisering til progression eller død, alt efter hvad der skete først. Progression er karakteriseret ved et af følgende:

  • ≥ 50 % stigning fra nadir siden behandlingsstart (tx) i summen af ​​produkterne af ≥ 2 lymfeknuder ved 2 på hinanden følgende undersøgelser med 2 ugers mellemrum
  • ≥ 50 % stigning fra nadir siden start af tx i størrelsen af ​​lever og/eller milt
  • ≥ 50 % stigning i det absolutte antal af cirkulerende lymfocytter, der ikke skyldes tumorflare-reaktion. Det absolutte lymfocyttal skal være ≥ 5x10^9/L for at kvalificeres som progression.
  • Transformation til en mere aggressiv histologi. For patienter, som opnår et fuldstændigt respons eller nodulært partielt respons, defineres progression som recidiv af cirkulerende leukæmicelleklon i det perifere blod og et absolut lymfocyttal > 5x10^9/L og/eller recidiv af palpabel lymfadenopati > 1,5 cm ved fysisk undersøgelse .

Fordelingen af ​​PFS af SNP'er vil blive rapporteret.
Vurderet hver 3. måned indtil progression; efter progression, vurderet hver 3. måned de første 2 år, hver 6. måned i 3-5 år
Prognostisk model til at forudsige PFS
Tidsramme: Vurderet hver 3. måned indtil progression; efter progression, vurderet hver 3. måned de første 2 år, hver 6. måned i 3-5 år
En prognostisk model, der inkorporerer kliniske og biologiske karakterer til at forudsige PFS, vil blive udviklet.
Vurderet hver 3. måned indtil progression; efter progression, vurderet hver 3. måned de første 2 år, hver 6. måned i 3-5 år
Signalnetværk nedstrøms for B-celle-receptoren
Tidsramme: Vurderet ved baseline og 3, 6, 12, 15, 18, 24, 36 måneder
Evaluering af signalnetværk nedstrøms for B-cellereceptoren hos patienter, der modtager Ibrutinib-baseret behandling.
Vurderet ved baseline og 3, 6, 12, 15, 18, 24, 36 måneder
Indsamling af tilbagefaldsprøver
Tidsramme: Vurderet ved tilbagefald
Indsamling af tilbagefaldsprøver for at studere mekanismer for resistens over for protokolbehandlinger.
Vurderet ved tilbagefald

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

National Cancer Institute (NCI)

Efterforskere

  • Ledende efterforsker: Tait D Shanafelt, ECOG-ACRIN Cancer Research Group

Publikationer og nyttige links

Den person, der er ansvarlig for at indtaste oplysninger om undersøgelsen, leverer frivilligt disse publikationer. Disse kan handle om alt relateret til undersøgelsen.

Generelle publikationer

Hjælpsomme links

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

20. februar 2014

Primær færdiggørelse (Faktiske)

24. oktober 2018

Studieafslutning (Anslået)

31. december 2024

Datoer for studieregistrering

Først indsendt

27. januar 2014

Først indsendt, der opfyldte QC-kriterier

27. januar 2014

Først opslået (Anslået)

29. januar 2014

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

4. april 2024

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

3. april 2024

Sidst verificeret

1. februar 2024

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • NCI-2014-00118 (Registry Identifier: CTRP (Clinical Trial Reporting Program))
  • U10CA180820 (U.S. NIH-bevilling/kontrakt)
  • U24CA196172 (U.S. NIH-bevilling/kontrakt)
  • U10CA021115 (U.S. NIH-bevilling/kontrakt)
  • E1912 (Anden identifikator: CTEP)
  • ECOG-E1912
  • R01CA193541 (U.S. NIH-bevilling/kontrakt)

Plan for individuelle deltagerdata (IPD)

IPD-planbeskrivelse

Individuelle deltagerdata kan stilles til rådighed efter anmodning i henhold til ECOG-ACRINs datadelingspolitik.

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Ja

Studerer et amerikansk FDA-reguleret enhedsprodukt

Ingen

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

Kliniske forsøg med Laboratoriebiomarkøranalyse

Søg i lignende forsøg

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

CROs by country

CROs in Bahamas

Betingelser

Sjældne sygdomme

Narkotikainterventioner

Kosttilskud

Sponsor / samarbejdspartnere

Placeringer

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