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Chemotherapy, Imatinib Mesylate, and Peripheral Stem Cell Transplantation in Treating Patients With Newly Diagnosed Acute Lymphoblastic Leukemia

13 de noviembre de 2014 actualizado por: National Cancer Institute (NCI)

A Phase II Trial of Sequential Chemotherapy, Imatinib Mesylate (Gleevec, STI571) (NSC # 716051), and Transplantation for Adults With Newly Diagnosed Ph+ Acute Lymphoblastic Leukemia by the CALGB and SWOG

This phase II trial studies how well giving imatinib mesylate together with chemotherapy and peripheral stem cell transplantation works in treating patients with newly diagnosed acute lymphoblastic leukemia. Drugs used in chemotherapy use different ways to stop cancer cells from dividing so they stop growing or die. Imatinib mesylate may stop the growth of cancer cells by blocking the enzymes necessary for cancer cell growth. Giving imatinib mesylate together with chemotherapy and peripheral stem cell transplantation may be an effective treatment for acute lymphoblastic leukemia.

Descripción general del estudio

Estado

Terminado

Condiciones

Intervención / Tratamiento

Descripción detallada

PRIMARY OBJECTIVES:

I. Determine the activity of imatinib mesylate (Gleevec) to prolong disease-free survival (DFS) and overall survival in acute lymphoblastic leukemia (ALL) patients with t(9;22).

II. Determine the ability of imatinib mesylate (Gleevec) to produce or maintain a BCR-ABL-negative status, as judged by real-time-polymerase chain reaction (RT-PCR) following sequential chemotherapy, imatinib mesylate (Gleevec) and transplantation.

III. Determine the feasibility of collecting adequate peripheral blood stem cells for autologous transplantation following imatinib mesylate (Gleevec) therapy.

IV. Study the safety and efficacy of autologous peripheral stem cell transplantation following therapy with imatinib mesylate (Gleevec).

V. Study the safety and efficacy of allogeneic stem cell transplantation following therapy with imatinib mesylate (Gleevec).

VI. Study the safety and efficacy of imatinib mesylate (Gleevec) administered after allogeneic or autologous stem cell transplant.

OUTLINE:

COURSE I (remission induction): Patients receive 1 course of front-line induction therapy on a Cancer and Leukemia Group B (CALGB)/Southwest Oncology Group (SWOG) protocol prior to enrollment.

COURSE II (imatinib mesylate): Patients receive imatinib mesylate orally (PO) twice daily on days 1-28.

COURSE III (CNS prophylaxis): Within 7 days after completing course II, patients receive methotrexate intrathecally (IT), methotrexate intravenously (IV) over 3 hours, and vincristine sulfate IV on days 1, 8, and 15; methotrexate PO every 6 hours on days 1-2, 8-9, and 15-16; leucovorin calcium IV on days 2, 9, and 16; and leucovorin calcium PO every 6 hours on days 3, 4, 10, 11, 17, and 18.

COURSE IV (imatinib mesylate): After blood counts recover after completion of course III, patients receive imatinib mesylate as in course II.

COURSE V: Patients undergo allogeneic peripheral blood stem cell transplantation (PBSCT), autologous PBSCT, or no PBSCT.

COURSE Va (allogeneic PBSCT for patients with human leukocyte antigen [HLA]-matched sibling donor): Beginning 3-10 days after completion of course IV, patients with an HLA-matched sibling donor undergo total body irradiation (TBI) 2-3 times daily on days -7 to -4. Patients receive etoposide IV over 4 hours on day -3. Patients then undergo PBSCT on day 0. Patients then receive graft-vs-host disease prophylaxis with tacrolimus IV continuously on days -1 to 56 (or IV continuously on days -1 to 14 and then PO or IV every 12 hours on days 15-56) followed by a taper. Patients also receive methotrexate IV on days 1, 3, and 6, and filgrastim subcutaneously (SC) beginning on day 4 and continuing until blood counts recover.

COURSE Vb (autologous PBSCT for patients without HLA-matched sibling donor): Beginning 3-10 days after completion of course IV, patients without an HLA-matched sibling donor receive etoposide IV continuously and cytarabine IV over 2 hours on days 1-4. Patients also receive filgrastim SC beginning on day 14 and continuing until PBSC collection is complete. Patients receive imatinib mesylate PO twice daily beginning after completion of PBSC collection and continuing until 3 days before PBSCT. Patients then undergo TBI 2-3 times daily on days -8 to -5. Patients receive etoposide IV over 4 hours on day -4 and cyclophosphamide IV over 2 hours on day -2. Patients undergo PBSCT on day 0. Patients receive filgrastim SC beginning on day 0 and continuing until blood counts recover.

COURSE Vc (no transplantation for patients who are not transplant candidates): Beginning 3-10 days after completion of course IV, patients who are not candidates for PBSCT receive etoposide IV over 4 hours and cytarabine IV over 2 hours on days 1-4. Patients also receive filgrastim SC once or twice a day beginning on day 14 and continuing until blood counts recover.

COURSE VI: Patients receive imatinib mesylate PO once or twice daily beginning on day 30 post transplantation or on day 30 if no transplantation received and continuing for at least 1 year or until patient has 2 consecutive negative reverse transcriptase-polymerase chain reaction assays at least 3 months apart or until relapse.

After completion of study treatment, patients are followed up monthly for 1 year, every 3 months for 2 years, every 6 months for 2 years, then yearly for 5 years.

Tipo de estudio

Intervencionista

Inscripción (Actual)

58

Fase

  • Fase 2

Contactos y Ubicaciones

Esta sección proporciona los datos de contacto de quienes realizan el estudio e información sobre dónde se lleva a cabo este estudio.

Ubicaciones de estudio

  • Estados Unidos
    • Georgia
      • Atlanta, Georgia, Estados Unidos, 30342
        • Blood and Marrow Transplant Group of Georgia
    • Illinois
      • Bloomington, Illinois, Estados Unidos, 61701
        • Saint Joseph Medical Center
      • Canton, Illinois, Estados Unidos, 61520
        • Graham Hospital Association
      • Carthage, Illinois, Estados Unidos, 62321
        • Memorial Hospital
      • Chicago, Illinois, Estados Unidos, 60637
        • University of Chicago
      • Chicago, Illinois, Estados Unidos, 60640
        • Weiss Memorial Hospital
      • Eureka, Illinois, Estados Unidos, 61530
        • Eureka Hospital
      • Galesburg, Illinois, Estados Unidos, 61401
        • Galesburg Cottage Hospital
      • Galesburg, Illinois, Estados Unidos, 61401
        • Illinois CancerCare Galesburg
      • Havana, Illinois, Estados Unidos, 62644
        • Mason District Hospital
      • Hopedale, Illinois, Estados Unidos, 61747
        • Hopedale Medical Complex - Hospital
      • Macomb, Illinois, Estados Unidos, 61455
        • Mcdonough District Hospital
      • Maywood, Illinois, Estados Unidos, 60153
        • Loyola University Medical Center
      • Normal, Illinois, Estados Unidos, 61761
        • Community Cancer Center Foundation
      • Normal, Illinois, Estados Unidos, 61761
        • Bromenn Regional Medical Center
      • Ottawa, Illinois, Estados Unidos, 61350
        • Illinois CancerCare-Ottawa Clinic
      • Ottawa, Illinois, Estados Unidos, 61350
        • Ottawa Regional Hospital and Healthcare Center
      • Pekin, Illinois, Estados Unidos, 61554
        • Pekin Cancer Treatment Center
      • Pekin, Illinois, Estados Unidos, 61554
        • Pekin Hospital
      • Peoria, Illinois, Estados Unidos, 61637
        • OSF Saint Francis Medical Center
      • Peoria, Illinois, Estados Unidos, 61615
        • Illinois CancerCare-Peoria
      • Peoria, Illinois, Estados Unidos, 61614
        • Proctor Hospital
      • Peoria, Illinois, Estados Unidos, 61603
        • Methodist Medical Center of Illinois
      • Peoria, Illinois, Estados Unidos, 61615
        • Illinois Oncology Research Association CCOP
      • Peru, Illinois, Estados Unidos, 61354
        • Illinois Valley Hospital
      • Princeton, Illinois, Estados Unidos, 61356
        • Perry Memorial Hospital
      • Spring Valley, Illinois, Estados Unidos, 61362
        • Saint Margaret's Hospital
    • Indiana
      • Fort Wayne, Indiana, Estados Unidos, 46845
        • Fort Wayne Medical Oncology and Hematology Inc-Parkview
    • Kansas
      • Chanute, Kansas, Estados Unidos, 66720
        • Cancer Center of Kansas - Chanute
      • Dodge City, Kansas, Estados Unidos, 67801
        • Cancer Center of Kansas - Dodge City
      • El Dorado, Kansas, Estados Unidos, 67042
        • Cancer Center of Kansas - El Dorado
      • Kansas City, Kansas, Estados Unidos, 66112
        • Providence Medical Center
      • Kingman, Kansas, Estados Unidos, 67068
        • Cancer Center of Kansas-Kingman
      • Lawrence, Kansas, Estados Unidos, 66044
        • Lawrence Memorial Hospital
      • Newton, Kansas, Estados Unidos, 67114
        • Cancer Center of Kansas - Newton
      • Olathe, Kansas, Estados Unidos, 66061
        • Radiation Oncology Center of Olathe
      • Overland Park, Kansas, Estados Unidos, 66210
        • Radiation Oncology Practice Corporation Southwest
      • Parsons, Kansas, Estados Unidos, 67357
        • Cancer Center of Kansas - Parsons
      • Pratt, Kansas, Estados Unidos, 67124
        • Cancer Center of Kansas - Pratt
      • Salina, Kansas, Estados Unidos, 67401
        • Salina Regional Health Center
      • Salina, Kansas, Estados Unidos, 67401
        • Cancer Center of Kansas - Salina
      • Wellington, Kansas, Estados Unidos, 67152
        • Cancer Center of Kansas - Wellington
      • Wichita, Kansas, Estados Unidos, 67208
        • Cancer Center of Kansas-Wichita Medical Arts Tower
      • Wichita, Kansas, Estados Unidos, 67208
        • Associates In Womens Health
      • Wichita, Kansas, Estados Unidos, 67214
        • Cancer Center of Kansas - Main Office
      • Wichita, Kansas, Estados Unidos, 67214
        • Via Christi Regional Medical Center
      • Wichita, Kansas, Estados Unidos, 67214
        • Wichita CCOP
      • Winfield, Kansas, Estados Unidos, 67156
        • Cancer Center of Kansas - Winfield
    • Maine
      • Bangor, Maine, Estados Unidos, 04401
        • Eastern Maine Medical Center
    • Massachusetts
      • Beverly, Massachusetts, Estados Unidos, 01915
        • Beverly Hospital
      • Gloucester, Massachusetts, Estados Unidos, 01930
        • Addison Gilbert Hospital
      • Worcester, Massachusetts, Estados Unidos, 01605
        • Commonwealth Hematology Oncology PC-Worcester
    • Missouri
      • Independence, Missouri, Estados Unidos, 64057
        • Centerpoint Medical Center LLC
      • Kansas City, Missouri, Estados Unidos, 64111
        • Saint Luke's Cancer Institute
      • Kansas City, Missouri, Estados Unidos, 64114
        • Radiation Oncology Practice Corporation South
      • Kansas City, Missouri, Estados Unidos, 64154
        • Radiation Oncology Practice Corporation - North
      • Liberty, Missouri, Estados Unidos, 64068
        • Liberty Hospital
      • Saint Louis, Missouri, Estados Unidos, 63110
        • Washington University School of Medicine
    • Montana
      • Billings, Montana, Estados Unidos, 59101
        • Saint Vincent Healthcare
      • Billings, Montana, Estados Unidos, 59101
        • Northern Rockies Radiation Oncology Center
      • Billings, Montana, Estados Unidos, 59101
        • Montana Cancer Consortium CCOP
      • Billings, Montana, Estados Unidos, 59102
        • Hematology-Oncology Centers of the Northern Rockies PC
      • Billings, Montana, Estados Unidos, 59107-7000
        • Billings Clinic
      • Billings, Montana, Estados Unidos, 59107
        • Deaconess Medical Center
      • Bozeman, Montana, Estados Unidos, 59715
        • Bozeman Deaconess Hospital
      • Bozeman, Montana, Estados Unidos, 59715
        • Bozeman Deaconess Cancer Center
      • Bozeman, Montana, Estados Unidos, 59715
        • Internal Medicine of Bozeman
      • Butte, Montana, Estados Unidos, 59701
        • Saint James Community Hospital and Cancer Treatment Center
      • Great Falls, Montana, Estados Unidos, 59405
        • Great Falls Clinic
      • Great Falls, Montana, Estados Unidos, 59405
        • Berdeaux, Donald MD (UIA Investigator)
      • Helena, Montana, Estados Unidos, 59601
        • Saint Peter's Community Hospital
      • Kalispell, Montana, Estados Unidos, 59901
        • Kalispell Regional Medical Center
      • Kalispell, Montana, Estados Unidos, 59901
        • Glacier Oncology PLLC
      • Kalispell, Montana, Estados Unidos, 59901
        • Kalispell Medical Oncology
      • Missoula, Montana, Estados Unidos, 59802
        • Saint Patrick Hospital - Community Hospital
      • Missoula, Montana, Estados Unidos, 59804
        • Guardian Oncology and Center for Wellness
      • Missoula, Montana, Estados Unidos, 59801
        • Community Medical Hospital
      • Missoula, Montana, Estados Unidos, 59802
        • Montana Cancer Specialists
    • New Hampshire
      • Keene, New Hampshire, Estados Unidos, 03431
        • Cheshire Medical Center-Dartmouth-Hitchcock Keene
      • Rochester, New Hampshire, Estados Unidos, 03867
        • Frisbie Hospital
    • New York
      • Buffalo, New York, Estados Unidos, 14263
        • Roswell Park Cancer Institute
      • Manhasset, New York, Estados Unidos, 11030
        • North Shore University Hospital
      • Manhasset, New York, Estados Unidos, 11030
        • North Shore-LIJ Health System CCOP
      • New Hyde Park, New York, Estados Unidos, 11040
        • Long Island Jewish Medical Center
      • New Hyde Park, New York, Estados Unidos, 11040
        • North Shore-LIJ Health System/Center for Advanced Medicine
      • New York, New York, Estados Unidos, 10065
        • Weill Medical College of Cornell University
      • Oswego, New York, Estados Unidos, 13126
        • Oswego Hospital
      • Rochester, New York, Estados Unidos, 14642
        • University of Rochester
      • Syracuse, New York, Estados Unidos, 13210
        • State University of New York Upstate Medical University
    • North Carolina
      • Kinston, North Carolina, Estados Unidos, 28501
        • Kinston Medical Specialists PA
      • Winston-Salem, North Carolina, Estados Unidos, 27157
        • Wake Forest University Health Sciences
    • Ohio
      • Columbus, Ohio, Estados Unidos, 43210
        • Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical Center
    • Pennsylvania
      • Pittsburgh, Pennsylvania, Estados Unidos, 15224-1791
        • Western Pennsylvania Hospital
    • South Carolina
      • Charleston, South Carolina, Estados Unidos, 29425
        • Medical University of South Carolina
    • Vermont
      • St. Johnsbury, Vermont, Estados Unidos, 05819
        • Northeastern
    • Virginia
      • Richmond, Virginia, Estados Unidos, 23298
        • Virginia Commonwealth University
    • Wyoming
      • Sheridan, Wyoming, Estados Unidos, 82801
        • Welch Cancer Center

Criterios de participación

Los investigadores buscan personas que se ajusten a una determinada descripción, denominada criterio de elegibilidad. Algunos ejemplos de estos criterios son el estado de salud general de una persona o tratamientos previos.

Criterio de elegibilidad

Edades elegibles para estudiar

15 años a 59 años (Niño, Adulto)

Acepta Voluntarios Saludables

No

Géneros elegibles para el estudio

Todos

Descripción

Inclusion Criteria:

  • Unequivocal histologic diagnosis of ALL
  • Detection of the t(9;22)(q34;q11) or 3-way variant by metaphase cytogenetics or BCR-ABL positive by molecular analysis (RT-PCR or fluorescence in situ hybridization [FISH})

  • Prior Therapy:

    • Complete or partial remission following one course of induction chemotherapy with an intensive 4 or 5 drug regimen (with or without imatinib mesylate) on a CALGB or SWOG ALL protocol for previously untreated ALL patients

      • Note: The double induction regimen of SWOG S0333 is considered to be one course of induction chemotherapy for the purpose of this eligibility criterion; therefore, patients from S0333 may be eligible for this study only after completing the entire double induction regimen

    • Complete or partial remission following one course of therapy on any standard induction regimen (with or without imatinib mesylate) without prior enrollment on a cooperative group frontline protocol; in these instances, documentation of Philadelphia chromosome (Ph)+ positivity may occur outside a CALGB or SWOG laboratory

      • Note: CALGB institutions must enroll patients on CALGB 9862 and submission of an initial sample for the companion trial must occur at time of enrollment on CALGB C10001; enrollment on companion studies CALGB 8461 and 9665 is not required
  • No more than six weeks of prior imatinib mesylate during induction therapy before study enrollment
  • Non-pregnant and non-nursing; treatment under this protocol would expose an unborn child to significant risks; women and men of reproductive potential should agree to use an effective means of birth control and contraception should continue for three months after the last dose of imatinib mesylate (Gleevec) to allow complete clearance of drug and its principle metabolites from the body; in women of childbearing potential, a pregnancy test will be required at study entry

Plan de estudios

Esta sección proporciona detalles del plan de estudio, incluido cómo está diseñado el estudio y qué mide el estudio.

¿Cómo está diseñado el estudio?

Detalles de diseño

  • Propósito principal: Tratamiento
  • Asignación: N / A
  • Modelo Intervencionista: Asignación de un solo grupo
  • Enmascaramiento: Ninguno (etiqueta abierta)

Armas e Intervenciones

Grupo de participantes/brazo
Intervención / Tratamiento
Experimental: Treatment (imatinib mesylate, chemotherapy, PBSCT)
See Detailed Description.
Otro: análisis de biomarcadores de laboratorio
Estudios correlativos
Droga: ciclofosfamida
Dado IV
Otros nombres:
  • Citoxano
  • Endoxano
  • CPM
  • CTX
  • Endoxana
Droga: etopósido
Dado IV
Otros nombres:
  • EPEG
  • VP-16
  • VP-16-213
Droga: citarabina
Dado IV
Otros nombres:
  • Cytosar-U
  • arabinósido de citosina
  • ARA-C
  • arabinofuranosilcitosina
  • arabinosilcitosina
Droga: sulfato de vincristina
Dado IV
Otros nombres:
  • Vídeo
  • sulfato de leurocristina
  • Vincasar PFS
Biológico: filgrastim
Dado SC
Otros nombres:
  • G-CSF
  • Neupogen
Radiación: irradiación corporal total
Someterse a TBI
Otros nombres:
  • LCT
Droga: tacrolimus
Dado IV o PO
Otros nombres:
  • Programa
  • FK 506
Procedimiento: trasplante alogénico de células madre hematopoyéticas
Someterse a PBSCT alogénico
Procedimiento: trasplante de células madre de sangre periférica
Someterse a PBSCT
Otros nombres:
  • Trasplante de PBPC
  • Trasplante de CMSP
  • trasplante de células progenitoras de sangre periférica
  • trasplante de células madre de sangre periférica
Procedimiento: trasplante autólogo de células madre hematopoyéticas
Someterse a PBSCT autólogo
Droga: mesilato de imatinib
Orden de compra dada
Otros nombres:
  • Gleevec
  • CGP 57148
  • Glivec
Droga: leucovorina cálcica
Dado IV y PO
Otros nombres:
  • FC
  • CFR
  • LV
Droga: methotrexate
Given IT and IV
Otros nombres:
  • ametopterina
  • Folex
  • metilaminopterina
  • Mexato
  • MTX

¿Qué mide el estudio?

Medidas de resultado primarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Disease Free Survival
Periodo de tiempo: Duration of treatment (up to 10 years)

Disease-free survival (DFS) was measured as the interval from achievement of complete remission (CR) until relapse or death, regardless of cause; patients alive and in CR were censored at last follow-up. DFS was estimated using the Kaplan Meier method.

A complete remission (CR) was defined as recovery of morphologically normal bone marrow and blood counts (i.e., neutrophils >= 1.5 x 10^9/L and platelets > 100 x 10^9/L) and no circulating leukemic blasts or evidence of extramedullary leukemia and persisting for at least one month.
Duration of treatment (up to 10 years)

Medidas de resultado secundarias

Medida de resultado
Medida Descripción
Periodo de tiempo
Sobrevivencia promedio
Periodo de tiempo: Duración del estudio (hasta 10 años)
Supervivencia general (SG) como el intervalo desde la fecha del estudio hasta la muerte. OS se estimó utilizando el método de Kaplan Meier.
Duración del estudio (hasta 10 años)
Number of Participants Who Achieved a BCR-ABL Response at 12 Months
Periodo de tiempo: 12 months

BCR-ABL response is defined in two ways: complete molecular response (CMR) and major molecular response (MMR).

Complete Molecular Response is defined as a Bcr-Abl (a fusion of gene of Bcr and ABl genes) ratio ≤0.0032% on the International Scale Bcr = breakpoint cluster gene Abl = abelson proto-oncogene

MMR is defined as Bcr-Abl (A fusion gene of the breakpoint cluster region [Bcr] gene and Abelson proto-oncogene [Abl] genes) transcript ratio ≤0.1% (≥ 3 log reduction of BCR-ABL transcripts from a standardized baseline), as detected by reverse transcriptase polymerase chain reaction [RT-PCR] (performed centrally).
12 months
5 Year Disease-free Survival for Autologous & Allogeneic Transplant Groups
Periodo de tiempo: 5 years from CR
Percentage of patients who achieved a complete remission (CR) and were alive and relapse free at 5 years. The 5-year progression free survival was estimated using the Kaplan Meier method.
5 years from CR
5 Year Overall Survival for Autologous & Allogeneic Transplant Groups
Periodo de tiempo: 5 years from registration
Percentage of patients who were alive at 5 years. The 5-year progression free survival was estimated using the Kaplan Meier method.
5 years from registration

Colaboradores e Investigadores

Aquí es donde encontrará personas y organizaciones involucradas en este estudio.

Patrocinador

National Cancer Institute (NCI)

Investigadores

  • Investigador principal: Meir Wetzler, Cancer and Leukemia Group B

Publicaciones y enlaces útiles

La persona responsable de ingresar información sobre el estudio proporciona voluntariamente estas publicaciones. Estos pueden ser sobre cualquier cosa relacionada con el estudio.

Publicaciones Generales

Fechas de registro del estudio

Estas fechas rastrean el progreso del registro del estudio y los envíos de resultados resumidos a ClinicalTrials.gov. Los registros del estudio y los resultados informados son revisados ​​por la Biblioteca Nacional de Medicina (NLM) para asegurarse de que cumplan con los estándares de control de calidad específicos antes de publicarlos en el sitio web público.

Fechas importantes del estudio

Inicio del estudio

1 de abril de 2002

Finalización primaria (Actual)

1 de abril de 2012

Finalización del estudio (Actual)

1 de febrero de 2014

Fechas de registro del estudio

Enviado por primera vez

6 de junio de 2002

Primero enviado que cumplió con los criterios de control de calidad

26 de enero de 2003

Publicado por primera vez (Estimar)

27 de enero de 2003

Actualizaciones de registros de estudio

Última actualización publicada (Estimar)

24 de noviembre de 2014

Última actualización enviada que cumplió con los criterios de control de calidad

13 de noviembre de 2014

Última verificación

1 de junio de 2014

Más información

Términos relacionados con este estudio

Términos MeSH relevantes adicionales

Otros números de identificación del estudio

  • NCI-2009-00436 (Identificador de registro: CTRP (Clinical Trial Reporting Program))
  • U10CA031946 (Subvención/contrato del NIH de EE. UU.)
  • CDR0000069378
  • CALGB 10001/SWOG C10001 (Otro identificador: Cancer and Leukemia Group B)
  • CALGB-10001 (Otro identificador: CTEP)

Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .

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