Quimioterapia combinada com ou sem Blinatumomabe no tratamento de pacientes com leucemia linfoblástica aguda recém-diagnosticada BCR-ABL-Linhagem B negativa
11 de novembro de 2026 atualizado por: National Cancer Institute (NCI)
Um estudo randomizado de Fase III de Blinatumomabe para leucemia linfoblástica aguda recém-diagnosticada BCR-ABL-Linhagem B negativa em adultos
This randomized phase III trial studies combination chemotherapy with blinatumomab to see how well it works compared to induction chemotherapy alone in treating patients with newly diagnosed breakpoint cluster region (BCR)-c-abl oncogene 1, non-receptor tyrosine kinase (ABL)-negative B lineage acute lymphoblastic leukemia. Drugs used in chemotherapy work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Immunotherapy with monoclonal antibodies, such as blinatumomab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. It is not yet known whether combination chemotherapy is more effective with or without blinatumomab in treating newly diagnosed acute lymphoblastic leukemia.
Visão geral do estudo
Status
Ativo, não recrutando
Condições
Intervenção / Tratamento
- Medicamento: Cyclophosphamide
- Medicamento: Prednisone
- Procedimento: Bone Marrow Biopsy
- Procedimento: Biospecimen Collection
- Biológico: Rituximab
- Medicamento: Vincristine
- Medicamento: Vincristine Sulfate
- Medicamento: Dexamethasone
- Procedimento: Allogeneic Hematopoietic Stem Cell Transplantation
- Biológico: Blinatumomab
- Procedimento: Bone Marrow Aspiration
- Medicamento: Cytarabine
- Medicamento: Daunorubicin
- Medicamento: Daunorubicin Hydrochloride
- Medicamento: Etoposide
- Medicamento: Leucovorin Calcium
- Procedimento: Lumbar Puncture
- Medicamento: Mercaptopurine
- Medicamento: Methotrexate
- Medicamento: Pegaspargase
- Procedimento: X-Ray Imaging
Descrição detalhada
PRIMARY OBJECTIVE:
I. To compare the overall survival (OS) of blinatumomab in conjunction with chemotherapy to chemotherapy alone in patients with BCR-ABL-negative B cell precursor acute lymphoblastic leukemia (ALL) who are minimal residual disease (MRD) negative after induction and intensification chemotherapy, based on multiparameter flow cytometric (MFC) assessment of residual blasts.
SECONDARY OBJECTIVES:
I. To compare the relapse-free survival (RFS) of blinatumomab in conjunction with chemotherapy to chemotherapy alone in MRD negative patients after induction and intensification chemotherapy.
II. To compare the OS and RFS of those patients who are MRD positive (+) at step 3 randomization/registration and then convert to MRD negative (-) after 2 cycles of blinatumomab to those patients who are MRD- at randomization and remain MRD- after 2 cycles of blinatumomab or consolidation chemotherapy.
III. To assess the toxicities of blinatumomab in this patient population. IV. To assess the toxicities of the modified E2993 chemotherapy regimen in this patient population.
V. To describe the outcome of patients who proceed to allogeneic blood or marrow transplant after treatment with or without blinatumomab.
LABORATORY OBJECTIVES:
I. To determine differences in MRD kinetics among patients with the BCR/ABL1-like B-lineage ALL, and to compare the OS (and RFS) of patients with BCR-ABL-like phenotype with those without BCR-ABL-like phenotype.
II. To evaluate the incidence of anti-blinatumomab antibody formation.
OUTLINE:
INDUCTION CHEMOTHERAPY: Patients receive cytarabine intrathecally (IT) on day 1; daunorubicin hydrochloride intravenously (IV) over 10-15 minutes on days 1, 8, 15, and 22; vincristine sulfate IV on days 1, 8, 15, and 22; dexamethasone orally (PO) daily on days 1-7 (and 15-21 for patients age < 55 years only); methotrexate IT on day 14; pegaspargase intramuscularly (IM) or IV on day 18 (patients age < 55 years); and CD20 positive patients may optionally receive rituximab IV on day 8 and 15. Beginning on day 29, patients with absolute neutrophil count (ANC) >= 0.75 x 10^9/L and platelets > 75 x 10^9/L (patients with delayed hematologic recovery) (patients with residual disease that is delaying count begin treatment immediately) receive cyclophosphamide IV over 30 minutes on days 1 and 29, cytarabine IV over 30 minutes or subcutaneously (SC) on days 1-4, 8-11, 29-32, and 36-39, mercaptopurine PO on days 1-14, 29-42, pegaspargase IM or IV on day 15 (patients age < 55 years), patients receiving treatment for central nervous system (CNS) 2 or 3 leukemia in cycle 1 receive methotrexate IT on days 1, 8, 15, and 22, and CD20 positive patients may optionally receive rituximab IV on days 8 and 15.
INTENSIFICATION THERAPY: Beginning 4 weeks after the completion of cycle 2 of induction therapy, patients receive intensification therapy comprising high-dose methotrexate IV over 2 hours on days 1 and 8, and pegaspargase IM or IV on day 9.
Patients are then randomized to 1 of 2 treatment arms.
Patients randomized to the blinatumomab group receive blinatumomab IV continuously on days 1-28. Treatment repeats every 6 weeks for 2 cycles in the absence of disease progression or unacceptable toxicity. Patients may then undergo allogeneic stem cell transplant (SCT) or proceed to consolidation therapy per investigator discretion.
CONSOLIDATION THERAPY: Beginning after the second cycle of blinatumomab (patients randomized to the blinatumomab group) or after intensification therapy (patients not randomized to blinatumomab), patients receive cytarabine IV over 30 minutes or SC on days 1-5, etoposide IV over 1 hour on days 1-5, methotrexate IT on day 1, and pegaspargase IM or IV on day 5, and CD20 positive patients may optionally receive rituximab IV on day 5. Beginning 4 weeks from day 1 of cycle 1, patients receive cytarabine, etoposide, methotrexate, and CD20 positive patients may receive rituximab as in cycle 1. Beginning 4 weeks from day 1 of cycle 2, patients receive daunorubicin hydrochloride IV over 10-15 minutes on day 1, 8, 15, and 22; vincristine sulfate IV on days 1, 8, 15, and 22; dexamethasone PO daily on days 1-7 (and 15-21 for patients age < 55 years); methotrexate IT on day 2; cyclophosphamide IV over 30 minutes on day 29; cytarabine IV over 30 minutes or SC on days 30-33 and 37-40; mercaptopurine PO on days 29-42 and CD20 positive patients may receive rituximab on day 8. Beginning 8 weeks from day 1 of cycle 3, patients receive cytarabine, etoposide, methotrexate, and CD20 positive patients may optionally receive rituximab as in cycle 1. Patients randomized to blinatumomab repeat cycle 4 and then receive blinatumomab IV continuously on days 1-28.
MAINTENANCE THERAPY: Within 6 weeks after beginning last cycle of consolidation therapy, patients receive mercaptopurine PO daily, methotrexate PO or IV over 2 hours once weekly for 2.5 years, vincristine sulfate IV on day 1 every 3 months, prednisone PO on days 1-5 every 3 months, and methotrexate IT on day 1 every 3 months. Treatment continues for up to 2.5 years in the absence of disease progression or unacceptable toxicity.
Patients undergo x-ray imaging during screening, lumbar puncture while on study, and bone marrow aspiration, bone marrow biopsy, and blood sample collection throughout the study.
After completion of study treatment, patients are followed up every 3 months for 2 years, every 6 months for 3 years, and then every 12 months for 5 years.
Tipo de estudo
Intervencional
Inscrição (Real)
488
Estágio
- Fase 3
Contactos e Locais
Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.
Locais de estudo
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Alberta
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Calgary, Alberta, Canadá, T2N 5G2
- Arthur J E Child Comprehensive Cancer Centre
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British Columbia
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Vancouver, British Columbia, Canadá, V5Z 3P1
- Clinical Research Unit at Vancouver Coastal Health Authority
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Nova Scotia
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Halifax, Nova Scotia, Canadá, B3H 2Y9
- QEII Health Sciences Centre/Nova Scotia Health Authority
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Ontario
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Kingston, Ontario, Canadá, K7L 2V7
- Kingston Health Sciences Centre
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Quebec
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Montreal, Quebec, Canadá, H1T 2M4
- CIUSSSEMTL-Hopital Maisonneuve-Rosemont
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Saskatchewan
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Regina, Saskatchewan, Canadá, S4T 7T1
- Allan Blair Cancer Centre
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Alabama
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Birmingham, Alabama, Estados Unidos, 35233
- University of Alabama at Birmingham Cancer Center
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Alaska
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Anchorage, Alaska, Estados Unidos, 98508
- Anchorage Associates in Radiation Medicine
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Anchorage, Alaska, Estados Unidos, 99508
- Alaska Breast Care and Surgery LLC
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Anchorage, Alaska, Estados Unidos, 99508
- Alaska Oncology and Hematology LLC
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Anchorage, Alaska, Estados Unidos, 99508
- Alaska Women's Cancer Care
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Anchorage, Alaska, Estados Unidos, 99508
- Anchorage Oncology Centre
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Anchorage, Alaska, Estados Unidos, 99508
- Katmai Oncology Group
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Anchorage, Alaska, Estados Unidos, 99508
- Providence Alaska Medical Center
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Anchorage, Alaska, Estados Unidos, 99504
- Anchorage Radiation Therapy Center
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Anchorage, Alaska, Estados Unidos, 99508
- Alaska Regional Hospital
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Fairbanks, Alaska, Estados Unidos, 99701
- Fairbanks Memorial Hospital
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Arizona
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Kingman, Arizona, Estados Unidos, 86401
- Kingman Regional Medical Center
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Tucson, Arizona, Estados Unidos, 85719
- Banner University Medical Center - Tucson
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Tucson, Arizona, Estados Unidos, 85719
- University of Arizona Cancer Center-North Campus
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Arkansas
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Fort Smith, Arkansas, Estados Unidos, 72903
- Mercy Hospital Fort Smith
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Little Rock, Arkansas, Estados Unidos, 72205
- University of Arkansas for Medical Sciences
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California
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Arroyo Grande, California, Estados Unidos, 93420
- PCR Oncology
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Burbank, California, Estados Unidos, 91505
- Providence Saint Joseph Medical Center/Disney Family Cancer Center
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Clovis, California, Estados Unidos, 93611
- Community Cancer Institute
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Clovis, California, Estados Unidos, 93611
- University Oncology Associates
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La Jolla, California, Estados Unidos, 92093
- UC San Diego Moores Cancer Center
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Orange, California, Estados Unidos, 92868
- UC Irvine Health/Chao Family Comprehensive Cancer Center
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Palo Alto, California, Estados Unidos, 94304
- Stanford Cancer Institute Palo Alto
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Colorado
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Aurora, Colorado, Estados Unidos, 80012
- Rocky Mountain Cancer Centers-Aurora
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Aurora, Colorado, Estados Unidos, 80012
- The Medical Center of Aurora
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Boulder, Colorado, Estados Unidos, 80303
- Boulder Community Foothills Hospital
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Boulder, Colorado, Estados Unidos, 80304
- Rocky Mountain Cancer Centers-Boulder
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Denver, Colorado, Estados Unidos, 80218
- Presbyterian - Saint Lukes Medical Center - Health One
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Denver, Colorado, Estados Unidos, 80220
- Rose Medical Center
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Denver, Colorado, Estados Unidos, 80218
- Rocky Mountain Cancer Centers-Midtown
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Denver, Colorado, Estados Unidos, 80220
- Rocky Mountain Cancer Centers-Rose
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Denver, Colorado, Estados Unidos, 80218
- Colorado Blood Cancer Institute
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Denver, Colorado, Estados Unidos, 80204
- Cancer Center of Colorado at Sloan's Lake
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Denver, Colorado, Estados Unidos, 80209
- The Women's Imaging Center
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Denver, Colorado, Estados Unidos, 80206
- National Jewish Health-Main Campus
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Denver, Colorado, Estados Unidos, 80220
- Western Surgical Care
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Denver, Colorado, Estados Unidos, 80218
- Saint Joseph Hospital - Cancer Centers of Colorado
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Englewood, Colorado, Estados Unidos, 80113
- Mountain Blue Cancer Care Center - Swedish
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Englewood, Colorado, Estados Unidos, 80113
- Swedish Medical Center
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Golden, Colorado, Estados Unidos, 80401
- National Jewish Health-Western Hematology Oncology
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Grand Junction, Colorado, Estados Unidos, 81501
- Saint Mary's Hospital and Regional Medical Center
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Grand Junction, Colorado, Estados Unidos, 81505
- Grand Valley Oncology
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Greeley, Colorado, Estados Unidos, 80631
- Banner North Colorado Medical Center
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Lafayette, Colorado, Estados Unidos, 80026
- Good Samaritan Hospital - Cancer Centers of Colorado
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Littleton, Colorado, Estados Unidos, 80120
- Rocky Mountain Cancer Centers-Littleton
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Lone Tree, Colorado, Estados Unidos, 80124
- Sky Ridge Medical Center
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Lone Tree, Colorado, Estados Unidos, 80124
- Rocky Mountain Cancer Centers-Sky Ridge
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Loveland, Colorado, Estados Unidos, 80539
- Banner North Colorado Medical Center - Loveland Campus
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Thornton, Colorado, Estados Unidos, 80260
- National Jewish Health-Northern Hematology Oncology
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Wheat Ridge, Colorado, Estados Unidos, 80401
- Intermountain Health Lutheran Hospital
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Connecticut
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Hartford, Connecticut, Estados Unidos, 06105
- Smilow Cancer Hospital Care Center at Saint Francis
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New Haven, Connecticut, Estados Unidos, 06520
- Yale University
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Torrington, Connecticut, Estados Unidos, 06790
- Smilow Cancer Hospital-Torrington Care Center
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District of Columbia
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Washington D.C., District of Columbia, Estados Unidos, 20016
- Sibley Memorial Hospital
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Florida
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Coral Springs, Florida, Estados Unidos, 33065
- UM Sylvester Comprehensive Cancer Center at Coral Springs
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Deerfield Beach, Florida, Estados Unidos, 33442
- UM Sylvester Comprehensive Cancer Center at Deerfield Beach
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Hollywood, Florida, Estados Unidos, 33021
- UM Sylvester Comprehensive Cancer Center at Hollywood
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Jacksonville, Florida, Estados Unidos, 32207
- Baptist MD Anderson Cancer Center
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Miami, Florida, Estados Unidos, 33136
- University of Miami Miller School of Medicine-Sylvester Cancer Center
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Miami, Florida, Estados Unidos, 33176
- UM Sylvester Comprehensive Cancer Center at Kendall
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Plantation, Florida, Estados Unidos, 33324
- UM Sylvester Comprehensive Cancer Center at Plantation
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Weston, Florida, Estados Unidos, 33331
- Cleveland Clinic-Weston
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Georgia
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Atlanta, Georgia, Estados Unidos, 30322
- Emory University Hospital/Winship Cancer Institute
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Atlanta, Georgia, Estados Unidos, 30342
- Northside Hospital
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Idaho
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Boise, Idaho, Estados Unidos, 83706
- Saint Alphonsus Cancer Care Center-Boise
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Boise, Idaho, Estados Unidos, 83712
- Saint Luke's Cancer Institute - Boise
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Caldwell, Idaho, Estados Unidos, 83605
- Saint Alphonsus Cancer Care Center-Caldwell
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Coeur d'Alene, Idaho, Estados Unidos, 83814
- Kootenai Health - Coeur d'Alene
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Emmett, Idaho, Estados Unidos, 83617
- Walter Knox Memorial Hospital
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Fruitland, Idaho, Estados Unidos, 83619
- Saint Luke's Cancer Institute - Fruitland
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Meridian, Idaho, Estados Unidos, 83642
- Idaho Urologic Institute-Meridian
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Meridian, Idaho, Estados Unidos, 83642
- Saint Luke's Cancer Institute - Meridian
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Nampa, Idaho, Estados Unidos, 83687
- Saint Alphonsus Cancer Care Center-Nampa
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Nampa, Idaho, Estados Unidos, 83687
- Saint Luke's Cancer Institute - Nampa
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Post Falls, Idaho, Estados Unidos, 83854
- Kootenai Clinic Cancer Services - Post Falls
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Sandpoint, Idaho, Estados Unidos, 83864
- Kootenai Clinic Cancer Services - Sandpoint
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Twin Falls, Idaho, Estados Unidos, 83301
- Saint Luke's Cancer Institute - Twin Falls
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Illinois
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Bloomington, Illinois, Estados Unidos, 61704
- Illinois CancerCare-Bloomington
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Bloomington, Illinois, Estados Unidos, 61701
- OSF Saint Joseph Medical Center
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Canton, Illinois, Estados Unidos, 61520
- Illinois CancerCare-Canton
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Carbondale, Illinois, Estados Unidos, 62902
- Memorial Hospital of Carbondale
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Carterville, Illinois, Estados Unidos, 62918
- SIH Cancer Institute
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Carthage, Illinois, Estados Unidos, 62321
- Illinois CancerCare-Carthage
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Centralia, Illinois, Estados Unidos, 62801
- Centralia Oncology Clinic
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Chicago, Illinois, Estados Unidos, 60611
- Northwestern University
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Chicago, Illinois, Estados Unidos, 60637
- University of Chicago Comprehensive Cancer Center
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Chicago, Illinois, Estados Unidos, 60612
- University of Illinois
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Chicago, Illinois, Estados Unidos, 60608
- Mount Sinai Hospital Medical Center
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Decatur, Illinois, Estados Unidos, 62526
- Decatur Memorial Hospital
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Decatur, Illinois, Estados Unidos, 62526
- Cancer Care Specialists of Illinois - Decatur
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Dixon, Illinois, Estados Unidos, 61021
- Illinois CancerCare-Dixon
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Effingham, Illinois, Estados Unidos, 62401
- Crossroads Cancer Center
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Eureka, Illinois, Estados Unidos, 61530
- Illinois CancerCare-Eureka
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Evanston, Illinois, Estados Unidos, 60201
- NorthShore University HealthSystem-Evanston Hospital
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Galesburg, Illinois, Estados Unidos, 61401
- Western Illinois Cancer Treatment Center
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Galesburg, Illinois, Estados Unidos, 61401
- Illinois CancerCare-Galesburg
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Glenview, Illinois, Estados Unidos, 60026
- NorthShore University HealthSystem-Glenbrook Hospital
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Highland Park, Illinois, Estados Unidos, 60035
- NorthShore University HealthSystem-Highland Park Hospital
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Highland Park, Illinois, Estados Unidos, 60035
- Hematology Oncology Associates of Illinois-Highland Park
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Kankakee, Illinois, Estados Unidos, 60901
- Presence Saint Mary's Hospital
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Kewanee, Illinois, Estados Unidos, 61443
- Illinois CancerCare-Kewanee Clinic
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Libertyville, Illinois, Estados Unidos, 60048
- AMG Libertyville - Oncology
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Macomb, Illinois, Estados Unidos, 61455
- Illinois CancerCare-Macomb
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Maywood, Illinois, Estados Unidos, 60153
- Loyola University Medical Center
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Mount Vernon, Illinois, Estados Unidos, 62864
- SSM Health Good Samaritan
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Niles, Illinois, Estados Unidos, 60714
- Illinois Cancer Specialists-Niles
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O'Fallon, Illinois, Estados Unidos, 62269
- Cancer Care Center of O'Fallon
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Ottawa, Illinois, Estados Unidos, 61350
- Illinois CancerCare-Ottawa Clinic
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Ottawa, Illinois, Estados Unidos, 61350
- Radiation Oncology of Northern Illinois
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Pekin, Illinois, Estados Unidos, 61554
- Illinois CancerCare-Pekin
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Pekin, Illinois, Estados Unidos, 61554
- OSF Saint Francis Radiation Oncology at Pekin
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Peoria, Illinois, Estados Unidos, 61636
- Methodist Medical Center of Illinois
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Peoria, Illinois, Estados Unidos, 61637
- OSF Saint Francis Medical Center
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Peoria, Illinois, Estados Unidos, 61615
- Illinois CancerCare-Peoria
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Peoria, Illinois, Estados Unidos, 61615
- OSF Saint Francis Radiation Oncology at Peoria Cancer Center
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Peru, Illinois, Estados Unidos, 61354
- Illinois CancerCare-Peru
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Peru, Illinois, Estados Unidos, 61354
- Valley Radiation Oncology
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Princeton, Illinois, Estados Unidos, 61356
- Illinois CancerCare-Princeton
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Skokie, Illinois, Estados Unidos, 60076
- Hematology Oncology Associates of Illinois - Skokie
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Skokie, Illinois, Estados Unidos, 60076
- North Shore Medical Center
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Springfield, Illinois, Estados Unidos, 62702
- Southern Illinois University School of Medicine
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Springfield, Illinois, Estados Unidos, 62702
- Springfield Clinic
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Springfield, Illinois, Estados Unidos, 62702
- Central Illinois Hematology Oncology Center
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Springfield, Illinois, Estados Unidos, 62781
- Springfield Memorial Hospital
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Swansea, Illinois, Estados Unidos, 62226
- Southwest Illinois Health Services LLP
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Indiana
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Fort Wayne, Indiana, Estados Unidos, 46805
- Parkview Hospital Randallia
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Fort Wayne, Indiana, Estados Unidos, 46845
- Parkview Regional Medical Center
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Indianapolis, Indiana, Estados Unidos, 46237
- Franciscan Health Indianapolis
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Mooresville, Indiana, Estados Unidos, 46158
- Franciscan Health Mooresville
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Richmond, Indiana, Estados Unidos, 47374
- Reid Health
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Iowa
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Ames, Iowa, Estados Unidos, 50010
- Mary Greeley Medical Center
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Ames, Iowa, Estados Unidos, 50010
- McFarland Clinic - Ames
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Boone, Iowa, Estados Unidos, 50036
- McFarland Clinic - Boone
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Fort Dodge, Iowa, Estados Unidos, 50501
- McFarland Clinic - Trinity Cancer Center
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Jefferson, Iowa, Estados Unidos, 50129
- McFarland Clinic - Jefferson
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Marshalltown, Iowa, Estados Unidos, 50158
- McFarland Clinic - Marshalltown
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Kansas
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Chanute, Kansas, Estados Unidos, 66720
- Cancer Center of Kansas - Chanute
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Dodge City, Kansas, Estados Unidos, 67801
- Cancer Center of Kansas - Dodge City
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El Dorado, Kansas, Estados Unidos, 67042
- Cancer Center of Kansas - El Dorado
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Fort Scott, Kansas, Estados Unidos, 66701
- Cancer Center of Kansas - Fort Scott
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Garden City, Kansas, Estados Unidos, 67846
- Central Care Cancer Center - Garden City
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Great Bend, Kansas, Estados Unidos, 67530
- Central Care Cancer Center - Great Bend
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Independence, Kansas, Estados Unidos, 67301
- Cancer Center of Kansas-Independence
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Kansas City, Kansas, Estados Unidos, 66160
- University of Kansas Cancer Center
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Kingman, Kansas, Estados Unidos, 67068
- Cancer Center of Kansas-Kingman
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Lawrence, Kansas, Estados Unidos, 66044
- Lawrence Memorial Hospital
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Lenexa, Kansas, Estados Unidos, 66219
- Kansas Institute of Medicine Cancer and Blood Center
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Lenexa, Kansas, Estados Unidos, 66219
- Minimally Invasive Surgery Hospital
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Liberal, Kansas, Estados Unidos, 67905
- Cancer Center of Kansas-Liberal
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Manhattan, Kansas, Estados Unidos, 66502
- Cancer Center of Kansas-Manhattan
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McPherson, Kansas, Estados Unidos, 67460
- Cancer Center of Kansas - McPherson
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Newton, Kansas, Estados Unidos, 67114
- Cancer Center of Kansas - Newton
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Olathe, Kansas, Estados Unidos, 66061
- The University of Kansas Cancer Center - Olathe
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Overland Park, Kansas, Estados Unidos, 66209
- Menorah Medical Center
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Overland Park, Kansas, Estados Unidos, 66213
- Saint Luke's South Hospital
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Parsons, Kansas, Estados Unidos, 67357
- Cancer Center of Kansas - Parsons
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Pratt, Kansas, Estados Unidos, 67124
- Cancer Center of Kansas - Pratt
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Salina, Kansas, Estados Unidos, 67401
- Cancer Center of Kansas - Salina
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Wellington, Kansas, Estados Unidos, 67152
- Cancer Center of Kansas - Wellington
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Westwood, Kansas, Estados Unidos, 66205
- University of Kansas Hospital-Westwood Cancer Center
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Wichita, Kansas, Estados Unidos, 67214
- Ascension Via Christi Hospitals Wichita
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Wichita, Kansas, Estados Unidos, 67208
- Cancer Center of Kansas-Wichita Medical Arts Tower
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Wichita, Kansas, Estados Unidos, 67214
- Cancer Center of Kansas - Wichita
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Wichita, Kansas, Estados Unidos, 67208
- Associates In Womens Health
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Wichita, Kansas, Estados Unidos, 67214
- Wesley Medical Center
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Winfield, Kansas, Estados Unidos, 67156
- Cancer Center of Kansas - Winfield
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Kentucky
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Crestview Hills, Kentucky, Estados Unidos, 41017
- Oncology Hematology Care Inc-Crestview
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Louisville, Kentucky, Estados Unidos, 40202
- The James Graham Brown Cancer Center at University of Louisville
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Louisiana
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Baton Rouge, Louisiana, Estados Unidos, 70809
- Ochsner Health Center-Summa
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Baton Rouge, Louisiana, Estados Unidos, 70816
- Medical Center of Baton Rouge
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Baton Rouge, Louisiana, Estados Unidos, 70836
- Ochsner High Grove
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Monroe, Louisiana, Estados Unidos, 71202
- Ochsner LSU Health Monroe Medical Center
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New Orleans, Louisiana, Estados Unidos, 70121
- Ochsner Medical Center Jefferson
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Shreveport, Louisiana, Estados Unidos, 71103
- LSU Health Sciences Center at Shreveport
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Maine
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Bangor, Maine, Estados Unidos, 04401
- Eastern Maine Medical Center
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Brewer, Maine, Estados Unidos, 04412
- Lafayette Family Cancer Center-EMMC
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Maryland
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Baltimore, Maryland, Estados Unidos, 21287
- Johns Hopkins University/Sidney Kimmel Cancer Center
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Baltimore, Maryland, Estados Unidos, 21201
- University of Maryland/Greenebaum Cancer Center
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Bethesda, Maryland, Estados Unidos, 20889-5600
- Walter Reed National Military Medical Center
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Massachusetts
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Boston, Massachusetts, Estados Unidos, 02215
- Beth Israel Deaconess Medical Center
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Boston, Massachusetts, Estados Unidos, 02215
- Dana-Farber Cancer Institute
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Boston, Massachusetts, Estados Unidos, 02114
- Massachusetts General Hospital Cancer Center
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Michigan
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Adrian, Michigan, Estados Unidos, 49221
- Bixby Medical Center
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Adrian, Michigan, Estados Unidos, 49221
- Hickman Cancer Center
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Ann Arbor, Michigan, Estados Unidos, 48106
- Trinity Health Saint Joseph Mercy Hospital Ann Arbor
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Battle Creek, Michigan, Estados Unidos, 49017
- Bronson Battle Creek
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Brownstown, Michigan, Estados Unidos, 48183
- Henry Ford Cancer Institute-Downriver
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Clinton Township, Michigan, Estados Unidos, 48038
- Henry Ford Macomb Hospital-Clinton Township
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Dearborn, Michigan, Estados Unidos, 48126
- Henry Ford Medical Center-Fairlane
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Dearborn, Michigan, Estados Unidos, 48124
- Corewell Health Dearborn Hospital
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Detroit, Michigan, Estados Unidos, 48202
- Henry Ford Hospital
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Detroit, Michigan, Estados Unidos, 48201
- Wayne State University/Karmanos Cancer Institute
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Detroit, Michigan, Estados Unidos, 48236
- Henry Ford Health Saint John Hospital
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Escanaba, Michigan, Estados Unidos, 49829
- OSF Saint Francis Hospital and Medical Group
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Farmington Hills, Michigan, Estados Unidos, 48334
- Weisberg Cancer Treatment Center
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Farmington Hills, Michigan, Estados Unidos, 48336
- Corewell Health Farmington Hills Hospital
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Flint, Michigan, Estados Unidos, 48503
- Hurley Medical Center
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Flint, Michigan, Estados Unidos, 48503
- Genesys Hurley Cancer Institute
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Grand Rapids, Michigan, Estados Unidos, 49503
- Trinity Health Grand Rapids Hospital
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Grand Rapids, Michigan, Estados Unidos, 49503
- Corewell Health Grand Rapids Hospitals - Butterworth Hospital
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Grand Rapids, Michigan, Estados Unidos, 49503
- Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
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Grosse Pointe, Michigan, Estados Unidos, 48230
- William Beaumont Hospital-Grosse Pointe
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Jackson, Michigan, Estados Unidos, 49201
- Allegiance Health
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Kalamazoo, Michigan, Estados Unidos, 49007
- West Michigan Cancer Center
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Kalamazoo, Michigan, Estados Unidos, 49007
- Bronson Methodist Hospital
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Kalamazoo, Michigan, Estados Unidos, 49048
- Beacon Kalamazoo
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Lansing, Michigan, Estados Unidos, 48912
- University of Michigan Health - Sparrow Lansing
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Livonia, Michigan, Estados Unidos, 48154
- Trinity Health Saint Mary Mercy Livonia Hospital
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Monroe, Michigan, Estados Unidos, 48162
- Mercy Memorial Hospital
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Monroe, Michigan, Estados Unidos, 48162
- Toledo Clinic Cancer Centers-Monroe
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Muskegon, Michigan, Estados Unidos, 49444
- Trinity Health Muskegon Hospital
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Niles, Michigan, Estados Unidos, 49120
- Corewell Health Lakeland Hospitals - Niles Hospital
-
Norton Shores, Michigan, Estados Unidos, 49444
- Cancer and Hematology Centers of Western Michigan - Norton Shores
-
Novi, Michigan, Estados Unidos, 48377
- Henry Ford Medical Center-Columbus
-
Pontiac, Michigan, Estados Unidos, 48341
- Trinity Health Saint Joseph Mercy Oakland Hospital
-
Port Huron, Michigan, Estados Unidos, 48060
- Lake Huron Medical Center
-
Port Huron, Michigan, Estados Unidos, 48060
- Huron Medical Center PC
-
Reed City, Michigan, Estados Unidos, 49677
- Corewell Health Reed City Hospital
-
Roseville, Michigan, Estados Unidos, 48066
- Michigan Cancer Specialists
-
Royal Oak, Michigan, Estados Unidos, 48073
- Cancer Care Associates PC
-
Royal Oak, Michigan, Estados Unidos, 48073
- Comprehensive Medical Center PLLC
-
Royal Oak, Michigan, Estados Unidos, 48073
- Oakland Medical Group
-
Royal Oak, Michigan, Estados Unidos, 48067
- Oakland Colon Rectal Associates
-
Royal Oak, Michigan, Estados Unidos, 48073
- Hematology Oncology Consultants PC-Royal Oak
-
Royal Oak, Michigan, Estados Unidos, 48073
- Corewell Health William Beaumont University Hospital
-
Saginaw, Michigan, Estados Unidos, 48601
- MyMichigan Medical Center Saginaw
-
Saint Joseph, Michigan, Estados Unidos, 49085
- Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center
-
Saint Joseph, Michigan, Estados Unidos, 49085
- Corewell Health Lakeland Hospitals - Saint Joseph Hospital
-
Sterling Heights, Michigan, Estados Unidos, 48312
- Premier Hematology Oncology Care
-
Sterling Heights, Michigan, Estados Unidos, 48314
- Mitchell Folbe MD PC
-
Traverse City, Michigan, Estados Unidos, 49684
- Munson Medical Center
-
Troy, Michigan, Estados Unidos, 48084
- Michigan Institute of Urology-Town Center
-
Troy, Michigan, Estados Unidos, 48085
- Claudia BR Herke MD PC
-
Troy, Michigan, Estados Unidos, 48098
- Hematology Oncology Consultants PC-Troy
-
Troy, Michigan, Estados Unidos, 48085
- Corewell Health Beaumont Troy Hospital
-
Warren, Michigan, Estados Unidos, 48093
- Henry Ford Health Warren Hospital
-
West Bloomfield, Michigan, Estados Unidos, 48322
- Henry Ford West Bloomfield Hospital
-
Wyoming, Michigan, Estados Unidos, 49519
- University of Michigan Health - West
-
-
Minnesota
-
Rochester, Minnesota, Estados Unidos, 55905
- Mayo Clinic in Rochester
-
-
Missouri
-
Ballwin, Missouri, Estados Unidos, 63011
- Mercy Oncology and Hematology - Clayton-Clarkson
-
Bolivar, Missouri, Estados Unidos, 65613
- Central Care Cancer Center - Bolivar
-
Bonne Terre, Missouri, Estados Unidos, 63628
- Parkland Health Center-Bonne Terre
-
Branson, Missouri, Estados Unidos, 65616
- Cox Cancer Center Branson
-
Cape Girardeau, Missouri, Estados Unidos, 63703
- Saint Francis Medical Center
-
Cape Girardeau, Missouri, Estados Unidos, 63703
- Mercy Cancer Center - Cape Girardeau
-
City of Saint Peters, Missouri, Estados Unidos, 63376
- Siteman Cancer Center at Saint Peters Hospital
-
Creve Coeur, Missouri, Estados Unidos, 63141
- Siteman Cancer Center at West County Hospital
-
Farmington, Missouri, Estados Unidos, 63640
- Parkland Health Center - Farmington
-
Independence, Missouri, Estados Unidos, 64057
- Centerpoint Medical Center LLC
-
Jefferson City, Missouri, Estados Unidos, 65109
- MU Health Care Goldschmidt Cancer Center
-
Joplin, Missouri, Estados Unidos, 64804
- Freeman Health System
-
Joplin, Missouri, Estados Unidos, 64804
- Mercy Hospital Joplin
-
Kansas City, Missouri, Estados Unidos, 64111
- Saint Luke's Hospital of Kansas City
-
Kansas City, Missouri, Estados Unidos, 64132
- Research Medical Center
-
Kansas City, Missouri, Estados Unidos, 64118
- Heartland Hematology and Oncology Associates Incorporated
-
Lee's Summit, Missouri, Estados Unidos, 64086
- Saint Luke's East - Lee's Summit
-
Liberty, Missouri, Estados Unidos, 64068
- Liberty Hospital
-
Rolla, Missouri, Estados Unidos, 65401
- Mercy Clinic-Rolla-Cancer and Hematology
-
Rolla, Missouri, Estados Unidos, 65401
- Phelps Health Delbert Day Cancer Institute
-
Saint Joseph, Missouri, Estados Unidos, 64506
- Heartland Regional Medical Center
-
Sainte Genevieve, Missouri, Estados Unidos, 63670
- Sainte Genevieve County Memorial Hospital
-
Springfield, Missouri, Estados Unidos, 65807
- CoxHealth South Hospital
-
Springfield, Missouri, Estados Unidos, 65804
- Mercy Hospital Springfield
-
St Louis, Missouri, Estados Unidos, 63110
- Washington University School of Medicine
-
St Louis, Missouri, Estados Unidos, 63129
- Siteman Cancer Center-South County
-
St Louis, Missouri, Estados Unidos, 63131
- Missouri Baptist Medical Center
-
St Louis, Missouri, Estados Unidos, 63109
- Mercy Infusion Center - Chippewa
-
St Louis, Missouri, Estados Unidos, 63141
- Mercy Hospital Saint Louis
-
St Louis, Missouri, Estados Unidos, 63128
- Mercy Hospital South
-
Sullivan, Missouri, Estados Unidos, 63080
- Missouri Baptist Sullivan Hospital
-
Washington, Missouri, Estados Unidos, 63090
- Mercy Hospital Washington
-
-
Montana
-
Anaconda, Montana, Estados Unidos, 59711
- Community Hospital of Anaconda
-
Billings, Montana, Estados Unidos, 59101
- Billings Clinic Cancer Center
-
Billings, Montana, Estados Unidos, 59101
- Saint Vincent Healthcare
-
Billings, Montana, Estados Unidos, 59102
- Saint Vincent Frontier Cancer Center
-
Bozeman, Montana, Estados Unidos, 59715
- Bozeman Health Deaconess Hospital
-
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
- Benefis Sletten Cancer Institute
-
Helena, Montana, Estados Unidos, 59601
- Saint Peter's Community Hospital
-
Kalispell, Montana, Estados Unidos, 59901
- Logan Health Medical Center
-
Missoula, Montana, Estados Unidos, 59802
- Saint Patrick Hospital - Community Hospital
-
Missoula, Montana, Estados Unidos, 59804
- Community Medical Center
-
-
Nebraska
-
Bellevue, Nebraska, Estados Unidos, 68123
- Nebraska Medicine-Bellevue
-
Omaha, Nebraska, Estados Unidos, 68198
- University of Nebraska Medical Center
-
Omaha, Nebraska, Estados Unidos, 68118
- Nebraska Medicine-Village Pointe
-
-
Nevada
-
Carson City, Nevada, Estados Unidos, 89703
- Carson Tahoe Regional Medical Center
-
Henderson, Nevada, Estados Unidos, 89052
- Comprehensive Cancer Centers of Nevada - Henderson
-
Henderson, Nevada, Estados Unidos, 89052
- Cancer and Blood Specialists-Henderson
-
Henderson, Nevada, Estados Unidos, 89052
- Las Vegas Cancer Center-Henderson
-
Henderson, Nevada, Estados Unidos, 89074
- Comprehensive Cancer Centers of Nevada-Southeast Henderson
-
Henderson, Nevada, Estados Unidos, 89052
- Comprehensive Cancer Centers of Nevada-Horizon Ridge
-
Henderson, Nevada, Estados Unidos, 89074
- Las Vegas Urology - Green Valley
-
Henderson, Nevada, Estados Unidos, 89074
- Las Vegas Urology - Pebble
-
Henderson, Nevada, Estados Unidos, 89074
- Urology Specialists of Nevada - Green Valley
-
Henderson, Nevada, Estados Unidos, 89074
- Oncology Las Vegas - Henderson
-
Las Vegas, Nevada, Estados Unidos, 89144
- Summerlin Hospital Medical Center
-
Las Vegas, Nevada, Estados Unidos, 89109
- Sunrise Hospital and Medical Center
-
Las Vegas, Nevada, Estados Unidos, 89102
- OptumCare Cancer Care at Charleston
-
Las Vegas, Nevada, Estados Unidos, 89106
- Radiation Oncology Centers of Nevada Central
-
Las Vegas, Nevada, Estados Unidos, 89119
- Radiation Oncology Centers of Nevada Southeast
-
Las Vegas, Nevada, Estados Unidos, 89128
- Comprehensive Cancer Centers of Nevada - Northwest
-
Las Vegas, Nevada, Estados Unidos, 89128
- OptumCare Cancer Care at MountainView
-
Las Vegas, Nevada, Estados Unidos, 89135
- Alliance for Childhood Diseases/Cure 4 the Kids Foundation
-
Las Vegas, Nevada, Estados Unidos, 89144
- Comprehensive Cancer Centers of Nevada - Town Center
-
Las Vegas, Nevada, Estados Unidos, 89144
- Comprehensive Cancer Centers of Nevada-Summerlin
-
Las Vegas, Nevada, Estados Unidos, 89148
- Comprehensive Cancer Centers of Nevada
-
Las Vegas, Nevada, Estados Unidos, 89169
- Comprehensive Cancer Centers of Nevada - Central Valley
-
Las Vegas, Nevada, Estados Unidos, 89102
- University Medical Center of Southern Nevada
-
Las Vegas, Nevada, Estados Unidos, 89106
- Cancer and Blood Specialists-Shadow
-
Las Vegas, Nevada, Estados Unidos, 89109
- HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway
-
Las Vegas, Nevada, Estados Unidos, 89113
- HealthCare Partners Medical Group Oncology/Hematology-San Martin
-
Las Vegas, Nevada, Estados Unidos, 89121
- Cancer Therapy and Integrative Medicine
-
Las Vegas, Nevada, Estados Unidos, 89128
- Cancer and Blood Specialists-Tenaya
-
Las Vegas, Nevada, Estados Unidos, 89128
- HealthCare Partners Medical Group Oncology/Hematology-Tenaya
-
Las Vegas, Nevada, Estados Unidos, 89148-2405
- Las Vegas Cancer Center-Medical Center
-
Las Vegas, Nevada, Estados Unidos, 89149
- HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills
-
Las Vegas, Nevada, Estados Unidos, 89128
- Ann M Wierman MD LTD
-
Las Vegas, Nevada, Estados Unidos, 89074
- Las Vegas Urology - Pecos
-
Las Vegas, Nevada, Estados Unidos, 89102
- Desert West Surgery
-
Las Vegas, Nevada, Estados Unidos, 89103
- Hope Cancer Care of Nevada
-
Las Vegas, Nevada, Estados Unidos, 89106
- Urology Specialists of Nevada - Central
-
Las Vegas, Nevada, Estados Unidos, 89113
- Las Vegas Prostate Cancer Center
-
Las Vegas, Nevada, Estados Unidos, 89113
- Las Vegas Urology - Sunset
-
Las Vegas, Nevada, Estados Unidos, 89128
- Las Vegas Urology - Cathedral Rock
-
Las Vegas, Nevada, Estados Unidos, 89128
- Las Vegas Urology - Smoke Ranch
-
Las Vegas, Nevada, Estados Unidos, 89128
- Urology Specialists of Nevada - Northwest
-
Las Vegas, Nevada, Estados Unidos, 89169
- University Cancer Center
-
Las Vegas, Nevada, Estados Unidos, 89113
- Urology Specialists of Nevada - Southwest
-
Las Vegas, Nevada, Estados Unidos, 89128
- Oncology Las Vegas - Tenaya
-
Las Vegas, Nevada, Estados Unidos, 89183
- OptumCare Cancer Care at Fort Apache
-
Pahrump, Nevada, Estados Unidos, 89048
- Hope Cancer Care of Nevada-Pahrump
-
Reno, Nevada, Estados Unidos, 89502
- Renown Regional Medical Center
-
Reno, Nevada, Estados Unidos, 89503
- Saint Mary's Regional Medical Center
-
Reno, Nevada, Estados Unidos, 89509
- Radiation Oncology Associates
-
-
New Hampshire
-
Lebanon, New Hampshire, Estados Unidos, 03756
- Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
-
-
New Jersey
-
Basking Ridge, New Jersey, Estados Unidos, 07920
- Memorial Sloan Kettering Basking Ridge
-
Middletown, New Jersey, Estados Unidos, 07748
- Memorial Sloan Kettering Monmouth
-
Montvale, New Jersey, Estados Unidos, 07645
- Memorial Sloan Kettering Bergen
-
New Brunswick, New Jersey, Estados Unidos, 08903
- Rutgers Cancer Institute of New Jersey
-
-
New York
-
Buffalo, New York, Estados Unidos, 14263
- Roswell Park Cancer Institute
-
Commack, New York, Estados Unidos, 11725
- Memorial Sloan Kettering Commack
-
Harrison, New York, Estados Unidos, 10604
- Memorial Sloan Kettering Westchester
-
Lake Success, New York, Estados Unidos, 11042
- Northwell Health/Center for Advanced Medicine
-
Manhasset, New York, Estados Unidos, 11030
- North Shore University Hospital
-
New Hyde Park, New York, Estados Unidos, 11040
- Long Island Jewish Medical Center
-
New York, New York, Estados Unidos, 10065
- Memorial Sloan Kettering Cancer Center
-
Rochester, New York, Estados Unidos, 14642
- University of Rochester
-
Stony Brook, New York, Estados Unidos, 11794
- Stony Brook University Medical Center
-
The Bronx, New York, Estados Unidos, 10461
- Montefiore Medical Center-Einstein Campus
-
The Bronx, New York, Estados Unidos, 10467
- Montefiore Medical Center - Moses Campus
-
The Bronx, New York, Estados Unidos, 10461
- Montefiore Medical Center-Weiler Hospital
-
Uniondale, New York, Estados Unidos, 11553
- Memorial Sloan Kettering Nassau
-
-
North Carolina
-
Asheville, North Carolina, Estados Unidos, 28803
- AdventHealth Infusion Center Asheville
-
Chapel Hill, North Carolina, Estados Unidos, 27599
- UNC Lineberger Comprehensive Cancer Center
-
Clyde, North Carolina, Estados Unidos, 28721
- AdventHealth Infusion Center Haywood
-
Hendersonville, North Carolina, Estados Unidos, 28792
- AdventHealth Hendersonville
-
Winston-Salem, North Carolina, Estados Unidos, 27157
- Wake Forest University Health Sciences
-
-
Ohio
-
Beavercreek, Ohio, Estados Unidos, 45431
- Indu and Raj Soin Medical Center
-
Boardman, Ohio, Estados Unidos, 44512
- Saint Elizabeth Boardman Hospital
-
Bowling Green, Ohio, Estados Unidos, 43402
- Toledo Clinic Cancer Centers-Bowling Green
-
Centerville, Ohio, Estados Unidos, 45459
- Miami Valley Hospital South
-
Centerville, Ohio, Estados Unidos, 45459
- Dayton Physicians LLC-Miami Valley South
-
Cincinnati, Ohio, Estados Unidos, 45219
- University of Cincinnati Cancer Center-UC Medical Center
-
Cincinnati, Ohio, Estados Unidos, 45242
- Oncology Hematology Care Inc-Blue Ash
-
Cincinnati, Ohio, Estados Unidos, 45202
- Oncology Hematology Care Inc-Eden Park
-
Cincinnati, Ohio, Estados Unidos, 45211
- Oncology Hematology Care Inc-Mercy West
-
Cincinnati, Ohio, Estados Unidos, 45230
- Oncology Hematology Care Inc-Anderson
-
Cincinnati, Ohio, Estados Unidos, 45236
- Oncology Hematology Care Inc-Kenwood
-
Cleveland, Ohio, Estados Unidos, 44106
- Case Western Reserve University
-
Cleveland, Ohio, Estados Unidos, 44195
- Cleveland Clinic Foundation
-
Columbus, Ohio, Estados Unidos, 43210
- Ohio State University Comprehensive Cancer Center
-
Dayton, Ohio, Estados Unidos, 45406
- Good Samaritan Hospital - Dayton
-
Dayton, Ohio, Estados Unidos, 45409
- Miami Valley Hospital
-
Dayton, Ohio, Estados Unidos, 45415
- Miami Valley Hospital North
-
Dayton, Ohio, Estados Unidos, 45415
- Dayton Physician LLC - Englewood
-
Fairfield, Ohio, Estados Unidos, 45014
- Oncology Hematology Care Inc-Healthplex
-
Findlay, Ohio, Estados Unidos, 45840
- Blanchard Valley Hospital
-
Findlay, Ohio, Estados Unidos, 45840
- Armes Family Cancer Center
-
Findlay, Ohio, Estados Unidos, 45840
- Orion Cancer Care
-
Franklin, Ohio, Estados Unidos, 45005-1066
- Atrium Medical Center-Middletown Regional Hospital
-
Franklin, Ohio, Estados Unidos, 45005
- Dayton Physicians LLC-Atrium
-
Greenville, Ohio, Estados Unidos, 45331
- Wayne Hospital
-
Greenville, Ohio, Estados Unidos, 45331
- Dayton Physicians LLC-Wayne
-
Kettering, Ohio, Estados Unidos, 45429
- Kettering Medical Center
-
Kettering, Ohio, Estados Unidos, 45409
- Greater Dayton Cancer Center
-
Kettering, Ohio, Estados Unidos, 45420
- First Dayton Cancer Care
-
Lima, Ohio, Estados Unidos, 45804
- Lima Memorial Hospital
-
Maumee, Ohio, Estados Unidos, 43537
- Toledo Clinic Cancer Centers-Maumee
-
Maumee, Ohio, Estados Unidos, 43537
- Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
-
Middletown, Ohio, Estados Unidos, 45042
- Dayton Physicians LLC-Signal Point
-
Oregon, Ohio, Estados Unidos, 43616
- Saint Charles Hospital
-
Oregon, Ohio, Estados Unidos, 43616
- Toledo Clinic Cancer Centers-Oregon
-
Sidney, Ohio, Estados Unidos, 45365
- Dayton Physicians LLC-Wilson
-
Springfield, Ohio, Estados Unidos, 45504
- Springfield Regional Cancer Center
-
Springfield, Ohio, Estados Unidos, 45504
- Springfield Regional Medical Center
-
Sylvania, Ohio, Estados Unidos, 43560
- ProMedica Flower Hospital
-
Tiffin, Ohio, Estados Unidos, 44883
- Mercy Hospital of Tiffin
-
Toledo, Ohio, Estados Unidos, 43606
- ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital
-
Toledo, Ohio, Estados Unidos, 43623
- Mercy Health - Saint Anne Hospital
-
Toledo, Ohio, Estados Unidos, 43623
- Toledo Clinic Cancer Centers-Toledo
-
Toledo, Ohio, Estados Unidos, 43614
- University of Toledo
-
Toledo, Ohio, Estados Unidos, 43617
- Toledo Community Hospital Oncology Program CCOP
-
Toledo, Ohio, Estados Unidos, 43608
- Mercy Health - Saint Vincent Hospital
-
Troy, Ohio, Estados Unidos, 45373
- Upper Valley Medical Center
-
Troy, Ohio, Estados Unidos, 45373
- Dayton Physicians LLC - Troy
-
Warren, Ohio, Estados Unidos, 44484
- Saint Joseph Warren Hospital
-
Wauseon, Ohio, Estados Unidos, 43567
- Fulton County Health Center
-
West Chester, Ohio, Estados Unidos, 45069
- University of Cincinnati Cancer Center-West Chester
-
Wright-Patterson Air Force Base, Ohio, Estados Unidos, 45433
- Wright-Patterson Medical Center
-
Youngstown, Ohio, Estados Unidos, 44501
- Saint Elizabeth Youngstown Hospital
-
-
Oklahoma
-
Oklahoma City, Oklahoma, Estados Unidos, 73104
- University of Oklahoma Health Sciences Center
-
Oklahoma City, Oklahoma, Estados Unidos, 73120
- Mercy Hospital Oklahoma City
-
-
Oregon
-
Baker City, Oregon, Estados Unidos, 97814
- Saint Alphonsus Cancer Care Center-Baker City
-
Bend, Oregon, Estados Unidos, 97701
- Saint Charles Health System
-
Clackamas, Oregon, Estados Unidos, 97015
- Clackamas Radiation Oncology Center
-
Clackamas, Oregon, Estados Unidos, 97015
- Providence Cancer Institute Clackamas Clinic
-
Coos Bay, Oregon, Estados Unidos, 97420
- Bay Area Hospital
-
Newberg, Oregon, Estados Unidos, 97132
- Providence Newberg Medical Center
-
Ontario, Oregon, Estados Unidos, 97914
- Saint Alphonsus Cancer Care Center-Ontario
-
Oregon City, Oregon, Estados Unidos, 97045
- Providence Willamette Falls Medical Center
-
Portland, Oregon, Estados Unidos, 97213
- Providence Portland Medical Center
-
Portland, Oregon, Estados Unidos, 97225
- Providence Saint Vincent Medical Center
-
Redmond, Oregon, Estados Unidos, 97756
- Saint Charles Health System-Redmond
-
-
Pennsylvania
-
Danville, Pennsylvania, Estados Unidos, 17822
- Geisinger Medical Center
-
Hershey, Pennsylvania, Estados Unidos, 17033-0850
- Penn State Milton S Hershey Medical Center
-
Philadelphia, Pennsylvania, Estados Unidos, 19111
- Fox Chase Cancer Center
-
Philadelphia, Pennsylvania, Estados Unidos, 19107
- Thomas Jefferson University Hospital
-
Philadelphia, Pennsylvania, Estados Unidos, 19104
- University of Pennsylvania/Abramson Cancer Center
-
Pittsburgh, Pennsylvania, Estados Unidos, 15232
- UPMC Hillman Cancer Center
-
Scranton, Pennsylvania, Estados Unidos, 18510
- Community Medical Center
-
-
South Carolina
-
Anderson, South Carolina, Estados Unidos, 29621
- AnMed Health Cancer Center
-
Boiling Springs, South Carolina, Estados Unidos, 29316
- Prisma Health Cancer Institute - Spartanburg
-
Easley, South Carolina, Estados Unidos, 29640
- Prisma Health Cancer Institute - Easley
-
Gaffney, South Carolina, Estados Unidos, 29341
- Gibbs Cancer Center-Gaffney
-
Greenville, South Carolina, Estados Unidos, 29605
- Prisma Health Cancer Institute - Faris
-
Greenville, South Carolina, Estados Unidos, 29607
- Saint Francis Cancer Center
-
Greenville, South Carolina, Estados Unidos, 29615
- Prisma Health Cancer Institute - Eastside
-
Greenville, South Carolina, Estados Unidos, 29605
- Prisma Health Cancer Institute - Butternut
-
Greenville, South Carolina, Estados Unidos, 29601
- Saint Francis Hospital
-
Greenville, South Carolina, Estados Unidos, 29605
- Prisma Health Greenville Memorial Hospital
-
Greenville, South Carolina, Estados Unidos, 29601
- Greenville Health System Cancer Institute-Andrews
-
Greer, South Carolina, Estados Unidos, 29650
- Prisma Health Cancer Institute - Greer
-
Greer, South Carolina, Estados Unidos, 29651
- Gibbs Cancer Center-Pelham
-
Lancaster, South Carolina, Estados Unidos, 29720
- Carolina Blood and Cancer Care Associates PA-Lancaster
-
Rock Hill, South Carolina, Estados Unidos, 29732
- Carolina Blood and Cancer Care Associates PA
-
Seneca, South Carolina, Estados Unidos, 29672
- Prisma Health Cancer Institute - Seneca
-
Spartanburg, South Carolina, Estados Unidos, 29303
- Spartanburg Medical Center
-
-
Tennessee
-
Franklin, Tennessee, Estados Unidos, 37067
- Vanderbilt-Ingram Cancer Center Cool Springs
-
Nashville, Tennessee, Estados Unidos, 37232
- Vanderbilt University/Ingram Cancer Center
-
Nashville, Tennessee, Estados Unidos, 37204
- Vanderbilt Breast Center at One Hundred Oaks
-
-
Texas
-
Dallas, Texas, Estados Unidos, 75235
- Parkland Memorial Hospital
-
Dallas, Texas, Estados Unidos, 75390
- UT Southwestern/Simmons Cancer Center-Dallas
-
Houston, Texas, Estados Unidos, 77030
- Houston Methodist Hospital
-
Houston, Texas, Estados Unidos, 77030
- Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
-
Houston, Texas, Estados Unidos, 77030
- Ben Taub General Hospital
-
-
Utah
-
American Fork, Utah, Estados Unidos, 84003
- American Fork Hospital / Huntsman Intermountain Cancer Center
-
Cedar City, Utah, Estados Unidos, 84720
- Sandra L Maxwell Cancer Center
-
Farmington, Utah, Estados Unidos, 84025
- Farmington Health Center
-
Logan, Utah, Estados Unidos, 84321
- Logan Regional Hospital
-
Murray, Utah, Estados Unidos, 84107
- Intermountain Medical Center
-
Ogden, Utah, Estados Unidos, 84403
- McKay-Dee Hospital Center
-
Provo, Utah, Estados Unidos, 84604
- Utah Valley Regional Medical Center
-
Riverton, Utah, Estados Unidos, 84065
- Riverton Hospital
-
Salt Lake City, Utah, Estados Unidos, 84112
- Huntsman Cancer Institute/University of Utah
-
Salt Lake City, Utah, Estados Unidos, 84106
- Utah Cancer Specialists-Salt Lake City
-
Salt Lake City, Utah, Estados Unidos, 84143
- LDS Hospital
-
South Jordan, Utah, Estados Unidos, 84009
- South Jordan Health Center
-
St. George, Utah, Estados Unidos, 84770
- Saint George Regional Medical Center
-
-
Virginia
-
Fredericksburg, Virginia, Estados Unidos, 22401
- Fredericksburg Oncology Inc
-
Richmond, Virginia, Estados Unidos, 23235
- VCU Massey Cancer Center at Stony Point
-
Richmond, Virginia, Estados Unidos, 23298
- VCU Massey Comprehensive Cancer Center
-
-
Washington
-
Aberdeen, Washington, Estados Unidos, 98520
- Providence Regional Cancer System-Aberdeen
-
Anacortes, Washington, Estados Unidos, 98221
- Cancer Care Center at Island Hospital
-
Auburn, Washington, Estados Unidos, 98001
- MultiCare Auburn Medical Center
-
Bellevue, Washington, Estados Unidos, 98004
- Overlake Medical Center
-
Bellevue, Washington, Estados Unidos, 98005
- Swedish Cancer Institute-Eastside Oncology Hematology
-
Bellingham, Washington, Estados Unidos, 98225
- PeaceHealth Saint Joseph Medical Center
-
Centralia, Washington, Estados Unidos, 98531
- Providence Regional Cancer System-Centralia
-
Edmonds, Washington, Estados Unidos, 98026
- Swedish Cancer Institute-Edmonds
-
Everett, Washington, Estados Unidos, 98201
- Providence Regional Cancer Partnership
-
Gig Harbor, Washington, Estados Unidos, 98335
- MultiCare Gig Harbor Medical Park
-
Issaquah, Washington, Estados Unidos, 98029
- Swedish Cancer Institute-Issaquah
-
Kennewick, Washington, Estados Unidos, 99336
- Kadlec Clinic Hematology and Oncology
-
Lacey, Washington, Estados Unidos, 98503
- Providence Regional Cancer System-Lacey
-
Longview, Washington, Estados Unidos, 98632
- PeaceHealth Saint John Medical Center
-
Port Townsend, Washington, Estados Unidos, 98368
- Jefferson Healthcare
-
Puyallup, Washington, Estados Unidos, 98372
- MultiCare Good Samaritan Hospital
-
Renton, Washington, Estados Unidos, 98055
- Valley Medical Center
-
Seattle, Washington, Estados Unidos, 98107
- Swedish Medical Center-Ballard Campus
-
Seattle, Washington, Estados Unidos, 98122
- Swedish Medical Center-First Hill
-
Seattle, Washington, Estados Unidos, 98112
- Kaiser Permanente Washington
-
Seattle, Washington, Estados Unidos, 98104
- Minor and James Medical PLLC
-
Seattle, Washington, Estados Unidos, 98104
- Pacific Gynecology Specialists
-
Seattle, Washington, Estados Unidos, 98122-5711
- Swedish Medical Center-Cherry Hill
-
Sedro-Woolley, Washington, Estados Unidos, 98284
- PeaceHealth United General Medical Center
-
Shelton, Washington, Estados Unidos, 98584
- Providence Regional Cancer System-Shelton
-
Spokane, Washington, Estados Unidos, 99218
- Evergreen Hematology and Oncology PS
-
Spokane, Washington, Estados Unidos, 99204
- MultiCare Deaconess Cancer and Blood Specialty Center - Downtown
-
Spokane, Washington, Estados Unidos, 99218
- MultiCare Deaconess Cancer and Blood Specialty Center - North
-
Spokane Valley, Washington, Estados Unidos, 99216
- MultiCare Deaconess Cancer and Blood Specialty Center - Valley
-
Tacoma, Washington, Estados Unidos, 98405
- Mary Bridge Children's Hospital and Health Center
-
Tacoma, Washington, Estados Unidos, 98405
- MultiCare Tacoma General Hospital
-
Vancouver, Washington, Estados Unidos, 98664
- PeaceHealth Southwest Medical Center
-
Walla Walla, Washington, Estados Unidos, 99362
- Providence Saint Mary Regional Cancer Center
-
Yakima, Washington, Estados Unidos, 98902
- North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
-
Yelm, Washington, Estados Unidos, 98597
- Providence Regional Cancer System-Yelm
-
-
Wisconsin
-
Eau Claire, Wisconsin, Estados Unidos, 54701
- Marshfield Medical Center-EC Cancer Center
-
Eau Claire, Wisconsin, Estados Unidos, 54701
- Marshfield Clinic Cancer Center at Sacred Heart
-
Green Bay, Wisconsin, Estados Unidos, 54301
- Saint Vincent Hospital Cancer Center Green Bay
-
Green Bay, Wisconsin, Estados Unidos, 54303
- Saint Vincent Hospital Cancer Center at Saint Mary's
-
La Crosse, Wisconsin, Estados Unidos, 54601
- Gundersen Lutheran Medical Center
-
Madison, Wisconsin, Estados Unidos, 53792
- University of Wisconsin Carbone Cancer Center - University Hospital
-
Manitowoc, Wisconsin, Estados Unidos, 54221
- Holy Family Memorial Hospital
-
Marinette, Wisconsin, Estados Unidos, 54143
- Saint Vincent Hospital Cancer Center at Marinette
-
Marshfield, Wisconsin, Estados Unidos, 54449
- Marshfield Medical Center-Marshfield
-
Marshfield, Wisconsin, Estados Unidos, 54449
- Marshfield Medical Center
-
Milwaukee, Wisconsin, Estados Unidos, 53226
- Medical College of Wisconsin
-
Minocqua, Wisconsin, Estados Unidos, 54548
- Marshfield Medical Center - Minocqua
-
Oconto Falls, Wisconsin, Estados Unidos, 54154
- Saint Vincent Hospital Cancer Center at Oconto Falls
-
Rice Lake, Wisconsin, Estados Unidos, 54868
- Marshfield Medical Center-Rice Lake
-
Sheboygan, Wisconsin, Estados Unidos, 53081
- HSHS Saint Nicholas Hospital
-
Stevens Point, Wisconsin, Estados Unidos, 54482
- Marshfield Medical Center-River Region at Stevens Point
-
Sturgeon Bay, Wisconsin, Estados Unidos, 54235-1495
- Saint Vincent Hospital Cancer Center at Sturgeon Bay
-
Wausau, Wisconsin, Estados Unidos, 54401
- Marshfield Clinic-Wausau Center
-
Weston, Wisconsin, Estados Unidos, 54476
- Marshfield Medical Center - Weston
-
-
Wyoming
-
Casper, Wyoming, Estados Unidos, 82609
- Rocky Mountain Oncology
-
Cheyenne, Wyoming, Estados Unidos, 82001
- Cheyenne Regional Medical Center-West
-
Cody, Wyoming, Estados Unidos, 82414
- Big Horn Basin Cancer Center
-
Cody, Wyoming, Estados Unidos, 82414
- Billings Clinic-Cody
-
Sheridan, Wyoming, Estados Unidos, 82801
- Welch Cancer Center
-
-
-
-
-
Haifa, Israel, 31096
- Rambam Medical Center
-
Jerusalem, Israel, 91031
- Shaare Zedek Medical Center
-
-
-
-
-
Bayamón, Porto Rico, 00959-5060
- Cancer Center-Metro Medical Center Bayamon
-
Manati, Porto Rico, 00674
- Doctors Cancer Center
-
San Juan, Porto Rico, 00917
- San Juan Community Oncology Group
-
San Juan, Porto Rico, 00927
- Centro Comprensivo de Cancer de UPR
-
San Juan, Porto Rico, 00936
- San Juan City Hospital
-
-
Critérios de participação
Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.
Critérios de elegibilidade
Idades elegíveis para estudo
30 anos a 70 anos (Adulto, Adulto mais velho)
Aceita Voluntários Saudáveis
Sim
Gêneros Elegíveis para o Estudo
Tudo
Descrição
Inclusion Criteria:
-
PRE-REGISTRATION
-
Diagnostic bone marrow and/or peripheral blood specimens must be submitted for immunophenotyping and selected molecular testing, and the establishment of BCR/ABL status; testing will be performed by the Eastern Cooperative Oncology Group (ECOG)-American College of Radiation Imaging Network (ACRIN) Leukemia Translational Research Laboratory (LTRL) and reported to the institution
- NOTE: IT IS ESSENTIAL THAT A SAMPLE CONTAINING SUFFICIENT BLAST CELLS BE SUBMITTED TO THE ECOG-ACRIN LTRL AT BASELINE SO THAT SUBSEQUENT BONE MARROW ASSESSMENTS OF MRD CAN BE DONE; IN ADDITION TO ALLOWING THE LTRL TO CONFIRM ELIGIBILITY BASED ON BLAST CELL IMMUNOPHENOTYPE AND BCR/ABL STATUS, IT IS ALSO IMPERATIVE THAT AN ADEQUATE NUMBER OF BLASTS BE BANKED FOR ANALYSIS BY DRS MULLIGHAN/WILLMAN. WITHOUT ADEQUATE BASELINE SAMPLES, PATIENTS WILL NOT BE ABLE TO BE TREATED AND RANDOMIZED ON THIS PROTOCOL; IF A BONE MARROW ASPIRATE IS NOT AVAILABLE FOR LTRL SUBMISSION AT BASELINE, IT IS IMPERATIVE THAT DR PAIETTA FROM THE LTRL IS CALLED TO DISCUSS THE PERIPHERAL BLOOD WHITE BLOOD CELL (WBC) AND BLAST COUNT BEFORE BLOOD ONLY IS SUBMITTED
- NOTE: Hydroxyurea can be given for up to 5 days prior to initiation of protocol therapy for control of leukocyte count and/or other symptoms or signs; corticosteroids can be given after pre-registration to the protocol and submission of baseline marrow and blood samples for control of leukocyte count and/or other symptoms or signs prior to initiation of protocol therapy if needed; if corticosteroids are given prior to pre-registration, contact the study chair as the patient may still be eligible to participate
-
INDUCTION ELIGIBILITY CRITERIA-STEP 1
-
Age >= 30 years and =< 70 years
-
New diagnosis of B lineage ALL must be made upon bone marrow or peripheral blood immunophenotyping; cases with myeloid antigen expression, but unequivocal lymphoid immunophenotype, are eligible
-
Negativity for the Philadelphia chromosome must be established by conventional cytogenetics, fluorescence in situ hybridization (FISH) and/or polymerase chain reaction (PCR); patients who are negative for the Philadelphia chromosome by conventional cytogenetics must have FISH or PCR performed for BCR/ABL to exclude occult translocations
-
Cytogenetic analysis must be performed from diagnostic bone marrow (preferred) or if adequate number of circulating blasts from peripheral blood; FISH testing for common B-lineage ALL abnormalities including t(9;22) (BCR/ABL1), t(12;21) (ETS-variant gene 6 [ETV6]/runt-related transcription factor 1 [RUNX1]), t(1;19) (pre-B-cell leukemia homeobox 1 [PBX1]/transcription factor 3 [TCF3]), +4,+10,+17, (centromeric [Cen]4/Cen10/Cen17), t(11q23;var), (myeloid/lymphoid or mixed lineage leukemia [MLL]), deletion (del)(9p) (cyclin-dependent kinase inhibitor 2A [CDKN2A]/Cen9), and t(14;var) (immunoglobulin heavy chain [IGH] is encouraged); if there are few or no circulating blasts and an adequate marrow sample cannot be obtained for cytogenetic analysis, the patient may still enroll on the trial
-
Serum direct bilirubin < 2 mg/dl or serum total bilirubin =< 3 (obtained =< 48 hours prior to registration); NOTE: the above stipulation for normal hepatic function does not apply if liver dysfunction is due to leukemia infiltration
-
Serum creatinine < 2 mg/dl (obtained =< 48 hours prior to registration); NOTE: the above stipulation for normal hepatic function does not apply if liver dysfunction is due to leukemia infiltration
-
Patient should be human leukocyte antigen (HLA) typed (A, B, C, DR and DQ) during induction therapy phase or a written explanation for not undergoing HLA typing on the flow sheet
-
Patients with known human immunodeficiency virus (HIV) infection are eligible if they meet all of the following criteria:
- No history of acquired immune deficiency syndrome (AIDS)-related complications other than a history of low CD4+ T-cell count (< 200/mm^3) prior to initiation of combination antiretroviral therapy; on study CD4+ T-cell count may not be informative due to leukemia and should not be used as an exclusion criterion if low
- Patient must be healthy on the basis of HIV disease with high likelihood of near normal life span were it not for the leukemia
- Patient must have serum HIV viral load of < 200 copies/mm^3
- Patient must be on combination antiretroviral therapy with minimal pharmacokinetic interactions with study therapy and minimal overlapping clinical toxicity with protocol therapy
- Patient must not be receiving protease inhibitors or once daily formulations containing cobicistat, stavudine, or on regimens containing stavudine or zidovudine
- It is recommended to utilize a regimen of the integrase inhibitor, dolutegravir, combined with either disoproxil fumarate/emtricitabine or dolutegravir combined with tenofovir alafenamide/emtricitabine
-
Patient must have no history of recent myocardial infarction (within three months), uncontrolled congestive heart failure, or uncontrolled cardiac arrhythmia
-
Patient must have a normal cardiac ejection fraction by pretreatment multigated acquisition scan (MUGA) or echocardiogram within 4 weeks prior to registration (resting ejection fraction >= 40% or >= 5% increase with exercise), shortening fraction by echocardiogram >= 24%, or to within the normal range of values for the institution
-
Women must not be pregnant or breast-feeding due to administration of teratogenic chemotherapy and must not become pregnant or breastfeed during protocol therapy and for at least 3 months after protocol therapy; woman of childbearing potential must abstain from sexual activity or be willing to use 2 highly effective forms of contraception throughout protocol therapy and for at least an additional 3 months after the last dose of protocol-specified therapy; all females of childbearing potential must have a blood test or urine study within 2 weeks prior to registration to rule out pregnancy; a female of childbearing potential is any woman, regardless of whether they have undergone tubal ligation, who meets the following criteria: has not undergone a hysterectomy or bilateral oophorectomy; or has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
-
Men who have a female partner of childbearing potential must be willing to use 2 highly effective forms of contraception throughout protocol therapy and for at least an additional 3 months after the last dose of protocol-specified therapy; men who have a pregnant partner must be willing to use a condom during sexual activity throughout protocol therapy and for 3 months after the last dose of protocol-specified therapy
-
ECOG performance score 0-3
-
Patient must have given written informed consent
-
POST-INDUCTION THERAPY ELIGIBILITY CRITERIA (PRIOR TO INTENSIFICATION-STEP 2)
-
ECOG performance status 0-2
-
Patients must have achieved a CR or CRi
-
Patients who have achieved a CR or CRi must have maintained peripheral blood evidence of a CR or CRi
-
Patient must be CNS (cerebrospinal fluid [CSF]) negative for leukemia
-
Patients must have resolved any serious infectious complications related to induction
-
Any significant medical complications related to induction must have resolved
-
Serum creatinine =< 2.0 mg/dl (obtained =< 48 hours prior to registration)
-
Serum direct bilirubin < 2 mg/dL or serum total bilirubin =< 3 (obtained =< 48 hours prior to registration)
-
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) < 3 x upper limit of normal (ULN) (obtained =< 48 hours prior to registration)
-
RANDOMIZATION OR ASSIGNMENT TO BLINATUMOMAB OR NO BLINATUMOMAB-STEP 3
-
Patients must have an ECOG performance status of 0-2
-
Patients must have maintained peripheral blood evidence of a remission and must have a CR or CRi, confirmed on restaging bone marrow (BM) aspirate and biopsy
-
Patients must have resolved any serious infectious complications related to therapy
-
Any significant medical complications related to therapy must have resolved
-
Direct or total bilirubin < 1.5 x ULN (unless related to Gilbert's or Meulengracht's syndrome); the values must be obtained within 48 hours prior to randomization
-
Serum creatinine < 1.5 x ULN; the values must be obtained within 48 hours prior to randomization
-
Bone marrow aspirates must be submitted for centralized minimal residual disease (MRD) assessment performed by the ECOG-ACRIN Leukemia Translational Research Laboratory
-
MRD results will be reported to the submitting institution
-
NOTE: FOR MRD ASSESSMENTS, AN ASPIRATE FROM A SEPARATE BONE MARROW ASPIRATION SITE MUST BE SUBMITTED (THE NEEDLE CAN BE RE-DIRECTED THROUGH THE SAME SKIN PUNCTURE SITE); ONLY SUBMIT ASPIRATES FROM THE FIRST PULL OF AN ASPIRATION SITE FOR MRD TESTING; DO NOT SUBMIT SAMPLES FROM THE SECOND OR THIRD PULL OF THE SAME ASPIRATION SITE
-
In B-lineage ALL, MRD levels in peripheral blood or from a dilute marrow aspiration can be 300% lower, on average, than those in bone marrow at a given time point; submitting a first pull from a separate aspiration site will ensure that MRD determinations used in randomization and trial interpretation are accurate
- NOTE: failure to submit bone marrow aspirates will result in a major violation at the time of an audit
-
-
CRITERIA FOR ALLOGENEIC TRANSPLANTATION
-
A suitable donor must be identified; there are no restrictions on donor type and can include a matched sibling, a matched or mismatched unrelated donor, a family haplotype matched donor or a cord blood donor (single or double)
-
Patients should meet the eligibility criteria for RANDOMIZATION OR ASSIGNMENT TO BLINATUMOMAB OR NO BLINATUMOMAB-STEP 3
-
Patients must be considered reliable enough to comply with the medication regimen and follow-up, and have social support necessary to allow this compliance
-
CRITERIA FOR MAINTENANCE THERAPY-STEP 4: Patients must have an ECOG performance status of 0-3
-
CRITERIA FOR MAINTENANCE THERAPY-STEP 4: Patients must have maintained peripheral blood evidence of a remission and must have a CR or CRi, confirmed on restaging BM aspirate and biopsy
-
CRITERIA FOR MAINTENANCE THERAPY-STEP 4: Patients must have resolved any serious infectious complications related to therapy
-
CRITERIA FOR MAINTENANCE THERAPY-STEP 4: Any significant medical complications related to therapy must have resolved
Exclusion Criteria:
- Mature B ALL (Burkitt's-like leukemia) is excluded from enrollment in this trial; pre-study bone marrow biopsy and aspirate must be completed =< 1 week prior to registration
- Patient must not have a concurrent active malignancy for which they are receiving treatment
- Patient must not have intercurrent organ damage or medical problems that will jeopardize the outcome of therapy (i.e., psychiatric disorder, drug abuse, pregnancy)
- Patient must not have an antecedent hematologic disorder
- Patient must not have a history or presence of clinically relevant central nervous system (CNS) pathology such as epilepsy, seizure, paresis, aphasia, stroke, severe brain injuries, dementia; Parkinson's disease, cerebellar disease, organic brain syndrome, psychosis, or other significant CNS abnormalities
- Patient must not have an active uncontrolled infection
Plano de estudo
Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Tratamento
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
|
Experimental: Arm I (blinatumomab, chemotherapy)
See Detailed Description |
Given IV
Outros nomes:
Given PO
Outros nomes:
Undergo bone marrow biopsy
Outros nomes:
Undergo blood sample collection
Outros nomes:
Given IV
Outros nomes:
Given IV
Outros nomes:
Given IV
Outros nomes:
Given PO
Outros nomes:
Undergo allogeneic hematopoietic SCT
Outros nomes:
Given IV
Outros nomes:
Undergo bone marrow aspiration Given IT, IV, or SC
Outros nomes:
Given IV
Outros nomes:
Given IV
Outros nomes:
Given IV
Outros nomes:
Given IV or PO
Outros nomes:
Undergo lumbar puncture
Outros nomes:
Given PO
Outros nomes:
Given PO, IT or IV
Outros nomes:
Given IM or IV
Outros nomes:
Undergo x-ray imaging
Outros nomes:
|
|
Comparador Ativo: Arm II (chemotherapy)
See Detailed Description |
Given IV
Outros nomes:
Given PO
Outros nomes:
Undergo bone marrow biopsy
Outros nomes:
Undergo blood sample collection
Outros nomes:
Given IV
Outros nomes:
Given IV
Outros nomes:
Given IV
Outros nomes:
Given PO
Outros nomes:
Undergo allogeneic hematopoietic SCT
Outros nomes:
Undergo bone marrow aspiration Given IT, IV, or SC
Outros nomes:
Given IV
Outros nomes:
Given IV
Outros nomes:
Given IV
Outros nomes:
Given IV or PO
Outros nomes:
Undergo lumbar puncture
Outros nomes:
Given PO
Outros nomes:
Given PO, IT or IV
Outros nomes:
Given IM or IV
Outros nomes:
Undergo x-ray imaging
Outros nomes:
|
O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Overall Survival (OS) Among Patients Who Were MRD Negative After Induction and Intensification Chemotherapy
Prazo: Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
|
Overall survival is defined as the time from randomization to death of any cause. |
Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
|
Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Relapse-free Survival (RFS) Among Patients Who Were MRD Negative After Induction and Intensification Chemotherapy
Prazo: Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
|
RFS was defined as time from randomization to relapse or to death without documentation of relapse. Patients without events were censored at the date of last disease assessment. Relapse/Persistent Disease Persistent disease/Relapse following complete remission (CR)/complete remission incomplete (CRi) is defined as:
|
Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
|
|
RFS Among of Those Who Are MRD+ at Randomization and Then Convert to MRD- After 2 Cycles of Blinatumomab to Those Patients Who Are MRD- at Randomization and Remain MRD- After 2 Cycles of Blinatumomab or Consolidation Chemotherapy
Prazo: Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
|
RFS was defined as time from end of 2 cycles of blinatumomab to relapse or to death without documentation of relapse. Patients without events were censored at the date of last disease assessment. Relapse/Persistent Disease Persistent disease/Relapse following complete remission (CR)/complete remission incomplete (CRi) is defined as:
|
Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
|
|
OS Among of Those Who Are MRD+ at Randomization and Then Convert to MRD- After 2 Cycles of Blinatumomab to Those Patients Who Are MRD- at Randomization and Remain MRD- After 2 Cycles of Blinatumomab or Consolidation Chemotherapy
Prazo: Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
|
OS was defined as time from end of 2 cycles of blinatumomab to death of any cause |
Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
|
|
OS Among MRD Negative Patients Who Proceed to Allogeneic Transplant on Study
Prazo: Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
|
OS was defined as time from allogeneic transplant to death of any cause. |
Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
|
Outras medidas de resultado
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
To Determine Differences in MRD Kinetics Among Patients With the BCR/ABL1-like B-lineage ALL, and to Compare the OS (and RFS) of Patients With BCR-ABL-like Phenotype With Those Without BCR-ABLlike Phenotype
Prazo: Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
|
To determine differences in MRD kinetics among patients with the BCR/ABL1-like B-lineage ALL, and to compare the OS (and RFS) of patients with BCR-ABL-like phenotype with those without BCR-ABLlike phenotype |
Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 5 years
|
|
Incidence of Anti-blinatumomab Antibody Formation
Prazo: Assessed at baseline, end of 2 cycles of blinatumomab, end of 4 cycles of blinatumomab, and end of blinatumomab treatment
|
To evaluate the incidence of anti-blinatumomab antibody formation |
Assessed at baseline, end of 2 cycles of blinatumomab, end of 4 cycles of blinatumomab, and end of blinatumomab treatment
|
Colaboradores e Investigadores
É aqui que você encontrará pessoas e organizações envolvidas com este estudo.
Patrocinador
Investigadores
- Investigador principal: Mark R Litzow, ECOG-ACRIN Cancer Research Group
Publicações e links úteis
A pessoa responsável por inserir informações sobre o estudo fornece voluntariamente essas publicações. Estes podem ser sobre qualquer coisa relacionada ao estudo.
Publicações Gerais
- Seftel MD. Hyper-CVAD: a regimen for all seasons. Lancet Haematol. 2020 Jul;7(7):e501-e502. doi: 10.1016/S2352-3026(20)30179-4. No abstract available.
- Litzow MR, Sun Z, Mattison RJ, Paietta EM, Roberts KG, Zhang Y, Racevskis J, Lazarus HM, Rowe JM, Arber DA, Wieduwilt MJ, Liedtke M, Bergeron J, Wood BL, Zhao Y, Wu G, Chang TC, Zhang W, Pratz KW, Dinner SN, Frey N, Gore SD, Bhatnagar B, Atallah EL, Uy GL, Jeyakumar D, Lin TL, Willman CL, DeAngelo DJ, Patel SB, Elliott MA, Advani AS, Tzachanis D, Vachhani P, Bhave RR, Sharon E, Little RF, Erba HP, Stone RM, Luger SM, Mullighan CG, Tallman MS. Blinatumomab for MRD-Negative Acute Lymphoblastic Leukemia in Adults. N Engl J Med. 2024 Jul 25;391(4):320-333. doi: 10.1056/NEJMoa2312948.
- Zhong X, Roberts KG, Wei H, Sun Z, Montefiori LE, Kumar A, Iacobucci I, Baviskar P, Gao Q, Polonen P, Pruett-Miller SM, Schreiber RM, Chang TC, Zhang W, Lei S, Rampersaud E, Fan Y, Wu G, Mattison RJ, Zhang Y, Racevskis J, Lazarus HM, Rowe JM, Arber DA, Wieduwilt MJ, Abou Mourad Y, Shami PJ, Baer MR, Asch AS, O'Dwyer KM, Hall A, Liedtke M, Bergeron J, Wood BL, Pratz KW, Dinner SN, Frey NV, Gore SD, Bhatnagar B, Atallah EL, Uy GL, Jeyakumar D, Lin TL, Willman CL, Podoltsev NA, DeAngelo DJ, Patel S, Elliott MA, Advani AS, Tzachanis D, Vachhani P, Bhave RR, Sharon E, Little RF, Erba HP, Stone RM, Tallman MS, Yang JJ, Luger SM, Paietta E, Litzow MR, Mullighan CG. Genomic drivers of leukemia and blinatumomab response in adult acute lymphoblastic leukemia - the ECOG-ACRIN E1910 study. Blood. 2026 Oct 5:blood.2026033793. doi: 10.1182/blood.2026033793. Online ahead of print.
Datas de registro do estudo
Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.
Datas Principais do Estudo
Início do estudo (Real)
19 de maio de 2014
Conclusão Primária (Real)
23 de junho de 2023
Conclusão do estudo (Estimado)
25 de fevereiro de 2027
Datas de inscrição no estudo
Enviado pela primeira vez
2 de dezembro de 2013
Enviado pela primeira vez que atendeu aos critérios de CQ
2 de dezembro de 2013
Primeira postagem (Estimado)
6 de dezembro de 2013
Atualizações de registro de estudo
Última Atualização Postada (Real)
13 de novembro de 2026
Última atualização enviada que atendeu aos critérios de controle de qualidade
11 de novembro de 2026
Última verificação
1 de setembro de 2026
Mais Informações
Termos relacionados a este estudo
Termos MeSH relevantes adicionais
- Neoplasias
- Doenças do sistema imunológico
- Infecções
- Doenças Virais
- Neoplasias por Tipo Histológico
- Doenças Hematológicas
- Infecções por vírus de DNA
- Doenças Linfáticas
- Distúrbios Linfoproliferativos
- Distúrbios imunoproliferativos
- Linfoma Não-Hodgkin
- Linfoma de Células B
- Linfoma
- Leucemia Linfóide
- Leucemia
- Infecções pelo vírus Epstein-Barr
- Infecções Herpesviridae
- Infecções por Vírus Tumorais
- Doenças hemic e linfáticas
- Leucemia-Linfoma Linfoblástico de Células Precursoras
- Linfoma de Burkitt
- Aminoácidos, peptídeos e proteínas
- Proteínas
- Compostos de enxofre
- Produtos químicos orgânicos
- Compostos heterocíclicos, 1 anel
- Compostos heterocíclicos
- Compostos heterocíclicos, 2 anel
- Compostos heterocíclicos, anel fundido
- Técnicas de investigação
- Terapêutica
- Técnicas de laboratório clínico
- Técnicas e procedimentos de diagnóstico
- Diagnóstico
- Perfurações
- Procedimentos cirúrgicos, operatórios
- Técnicas citológicas
- Ácidos nucleicos, nucleotídeos e nucleosídeos
- Citodiagnóstico
- Hidrocarbonetos
- Hidrocarbonetos, cíclicos
- Carboidratos
- Fenômenos físicos
- Alcalóides
- Podofillotoxina
- Tetra -hidonaftaleno
- Naftalenos
- Hidrocarbonetos aromáticos policíclicos
- Hidrocarbonetos, aromáticos
- Compostos policíclicos
- Glucosídeos
- Glicosídeos
- Transplantação
- Equipamentos e suprimentos
- Enzimas e coenzimas
- Indoles
- Anticorpos, monoclonais
- Anticorpos
- Imunoglobulinas
- Imunoproteínas
- Proteínas sanguíneas
- Globulinas de soro
- Globulins
- Purinas
- Citidina
- Nucleosídeos de pirimidina
- Pirimidinas
- Pregada
- Pregnas
- Esteróides
- Compostos de anel fundido
- Esteróides, fluorados
- Derivados de benzeno
- Técnicas de diagnóstico, cirúrgico
- Ácidos sulfônicos
- Ácidos de enxofre
- Mustarazas de fosforamida
- Compostos de mostarda de nitrogênio
- Compostos de mostarda
- Hidrocarbonetos, halogenados
- Fosforamidas
- Compostos organofosforos
- Nucleosídeos
- Formiltetra -hidrofolatos
- Tetra -hidrofolatos
- Ácido fólico
- Pterins
- Pteridinas
- Pregadienetriols
- PregadaDiols
- Alcalóides de Vinca
- Alcalóides de triptamina de secologanin
- Alcalóides indol
- Indolizidinas
- Indolizinas
- Arabinonucleosides
- Aminopterina
- Antraciclinas
- Nafthacenos
- Aminoglicosídeos
- Coenzimas
- Fenômenos eletromagnéticos
- Fenômenos magnéticos
- Anticorpos, monoclonais, derivados de murinos
- Transplante de células
- Terapia baseada em células e tecidos
- Terapia biológica
- Técnicas de diagnóstico, neurológico
- Radiação eletromagnética
- Radiação
- Radiação, ionizando
- Benzenosulfonatos
- Arilsulfonatos
- Ácidos arilsulfônicos
- Compostos sulfhidryl
- Rituximabe
- Dexametasona
- Metotrexato
- Prednisona
- Ciclofosfamida
- Citarabina
- Etoposídeo
- Leucovorina
- Vincristina
- Daunorrubicina
- Mercaptopurina
- Dobesilato de Cálcio
- Biópsia
- Manipulação de amostras
- blinatumomab
- Transplante de células -tronco
- Punção espinhal
- Dexametasona 21-fosfato
- Raios X
- CT-P10
- Deltacorteno
- prednilideno
- N, n-diciclohexil-isoborneol-10-sulfonamida
- Azatiopurina
- Merphos
- Pegaspargase
- Fantasmas, imagem
- Auricularum
- acetato de dexametasona
Outros números de identificação do estudo
- NCI-2013-02229
- U10CA180820 (Concessão/Contrato do NIH dos EUA)
- U24CA196172 (Concessão/Contrato do NIH dos EUA)
- U10CA021115 (Concessão/Contrato do NIH dos EUA)
- NCI-2013-02229 (Identificador de registro: CTRP (Clinical Trial Reporting Program))
- ECOG-E1910
- E1910 (Outro identificador: CTEP)
- PE1910_A08PAMDREVW01
- E1910 (Outro identificador: ECOG-ACRIN Cancer Research Group)
Informações sobre medicamentos e dispositivos, documentos de estudo
Estuda um medicamento regulamentado pela FDA dos EUA
Sim
Estuda um produto de dispositivo regulamentado pela FDA dos EUA
Não
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