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Randomized Phase III Trial Comparing the Frequency of Major Erythroid Response (MER) to Treatment With Lenalidomide (Revlimid®) Alone and in Combination With Epoetin Alfa (Procrit®) in Subjects With Low- or Intermediate-1 Risk MDS and Symptomatic Anemia


Phase 3
18 Years
N/A
Not Enrolling
Both
Anemia, Chronic Myelomonocytic Leukemia, de Novo Myelodysplastic Syndromes, Previously Treated Myelodysplastic Syndromes

Thank you

Trial Information

Randomized Phase III Trial Comparing the Frequency of Major Erythroid Response (MER) to Treatment With Lenalidomide (Revlimid®) Alone and in Combination With Epoetin Alfa (Procrit®) in Subjects With Low- or Intermediate-1 Risk MDS and Symptomatic Anemia


PRIMARY OBJECTIVES:

I. To compare the rate of major erythroid response (MER) in patients with low- or
intermediate-1-risk myelodysplastic syndromes treated with lenalidomide with vs without
epoetin alfa.

SECONDARY OBJECTIVES:

I. To compare the time to MER in patients treated with these regimens. II. To evaluate the
duration of MER in patients treated with these regimens. III. To estimate the frequency of
MER to salvage combination chemotherapy in patients who fail to experience an MER after
treatment with lenalidomide alone.

IV. To evaluate and compare the frequency of minor erythroid response in patients treated
with these regimens.

V. To investigate the mechanism and target of lenalidomide action in patients with
chromosome 5q31.1 deletion.

VI. To evaluate the frequency of cytogenetic response and progression, and the relationship
between cytogenetic pattern and erythroid response.

VII. To evaluate the frequency of bone marrow response (complete response and partial
response) in patients treated with these regimens.

OUTLINE: This is a multicenter study. Patients are stratified according to erythropoietin
level (=< 500 mU/mL vs > 500 mU/mL) and prior erythropoietic growth factor (yes vs no).
Patients are randomized to 1 of 2 treatment arms. Patients with del 5q31.1 karyotype are
assigned to treatment arm I.

ARM I: Patients receive lenalidomide orally (PO) once daily (QD) on days 1-21.

ARM II: Patients receive lenalidomide PO QD on days 1-21 and epoetin alfa subcutaneously
(SC) once weekly.

In both arms, treatment repeats every 28 days for 4 courses. Patients who achieve a major
erythroid response (MER) may continue treatment beyond 4 courses in the absence of disease
progression, disease conversion to acute myeloid leukemia, or unacceptable toxicity.
Patients in arm I who fail to achieve MER or who achieve MER but relapse after 16 weeks of
treatment with lenalidomide may crossover and receive treatment in arm II.

After completion of study treatment, patients are followed for 6 months.


Inclusion Criteria:



- Documented diagnosis of 1 of the following:

- Myelodysplastic syndromes (MDS) lasting at least 3 months (MDS duration >= 3
months) according to World Health Organization (WHO) criteria or
non-proliferative chronic myelomonocytic leukemia (CMML) (white blood cells
[WBC] < 12,000/mcL)

- International prognostic scoring system (IPSS) category of low- or
intermediate-1-risk MDS as determined by cytogenetic analysis

- Cytogenetic analysis required if current bone marrow biopsy is a dry tap

- Patients with cytogenetic failure and < 10% marrow blasts are eligible

- Patients with cytogenetic failure must have prior cytogenetic results
(fluorescence in situ hybridization [FISH] is not a substitute) within 6
months after completion of the last type of MDS treatment (in this case,
growth factors are not considered a type of MDS treatment)

- Must have symptomatic anemia with hemoglobin < 9.5 g/dL =< 8 weeks prior to
randomization or with red blood cells (RBC) transfusion dependence (i.e., >= 2
units/month) confirmed for =< 8 weeks before randomization

- For patients without the deletion 5q 31.1, must have failed treatment with an
erythropoietic growth factor OR have a low probability of response to
rhu-erythropoietin, as defined by the following:

- Prior erythropoietin failure: requires ≥ 40,000 units epoetin alfa/week for 8
weeks or equivalent dose of darbepoetin alfa for 8 weeks and failed to achieve
transfusion independence (in transfusion-dependent patients) or failed to
achieve ≥ 2 g rise in hemoglobin sustained for ≥4 weeks (in
transfusion-independent patients)

- Low erythropoietin response profile: rhu-erythropoietin and epoetin alfa-naive
patients receiving ≥ 2 U pRBC/month for ≥ 8 weeks and serum erythropoietin ≥ 500
mU/mL in the 8 weeks prior to study randomization for a hemoglobin < 9.5 g/dL

- Patients must be off all non-transfusion therapy for MDS for 28 days prior to
initiation of study treatment, including all types of growth factors; patients may
receive hydrocortisone prophylactically to prevent transfusion reactions

- Patients must have a serum erythropoietin level documented before randomization and
=< 56 days before Day 1 of study treatment; NOTE: hemoglobin must be < 9.5 g/dL at
time that serum erythropoietin is drawn

- No documented iron deficiency

- Must have documented bone marrow iron stores (if marrow iron stain is not
available, transferrin saturation must be > 20% or serum ferritin > 100 ng/mL)

- Women must not pregnant or breastfeeding; females of childbearing potential must have
a negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL
within 10-14 days and again within 24 hours prior to starting Cycle 1 of
lenalidomide; a female of childbearing potential(FCBP) is any woman, regardless of
sexual orientation or whether they have undergone tubal ligation, who meets the
following criteria: 1) has not undergone a hysterectomy or bilateral oophorectomy; or
2) 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; FCBP must also
agree to ongoing pregnancy testing

- Effective contraception must be used by patients participating in lenalidomide
therapy, and all patients must agree to counseling by a trained counselor every 28
days about pregnancy precautions and risks of fetal exposure; females of childbearing
potential (FCBP) must either commit to continued abstinence from heterosexual
intercourse or begin TWO acceptable methods of birth control: one highly effective
method and one additional effective method AT THE SAME TIME, at least 28 days before
starting lenalidomide, during lenalidomide therapy, during dose interruptions, and
for at least 28 days following childbearing potential should be referred to a
qualified provider of contraceptive methods, if needed; males receiving lenalidomide
must agree to use a latex condom during any sexual contact with females of
childbearing potential even if they have undergone a successful vasectomy

- Patients must not have prior therapy with lenalidomide

- Patients must not have a diagnosis of uncontrolled seizures or uncontrolled
hypertension

- Patients must not have proliferative (WBC >= 12,000/mcL) chronic myelomonocytic
leukemia (CMML); WBC must be < 12,000/mcL

- Patients must not have MDS secondary to treatment with radiotherapy, chemotherapy,
and/or immunotherapy for malignant or autoimmune diseases

- Platelet count >= 50,000/mcL (without platelet transfusion)

- Absolute neutrophil count (ANC) >= 500 cells/mcL (must be >= 500/mcL without myeloid
growth factor support)

- Serum creatinine =< 1.5 times upper limit of normal (ULN)

- Serum glutamic oxaloacetic transaminase (SGOT)/aspartate aminotransferase (AST) or
serum glutamic pyruvate transaminase (SGPT)/alanine aminotransferase (ALT) =< 2.0 x
ULN

- Serum total bilirubin < 3.0 mg/dL

- Prior thalidomide allowed, however, patients must not have prior >= grade-3 allergic
reactions to thalidomide

- Patients must not have prior history of desquamating rash from thalidomide at time of
study entry

- Patients must not have clinically significant anemia resulting from iron, B12 or
folate deficiencies, autoimmune or hereditary hemolysis, or gastrointestinal bleeding

- Patients must not have used cytotoxic chemotherapeutic agents or experimental agents
(agents that are not commercially available) for the treatment of MDS within 8 weeks
of randomization

- Patients must not have prior history of malignancy other than MDS (except basal cell
or squamous skin cell carcinoma or carcinoma in situ of the cervix or breast) unless
the subject has been confirmed free of disease for >= 3 years

- Patients must not have any serious medical condition or any other unstable medical
co-morbidity, or psychiatric illness that will prevent the subject from signing the
informed consent form or will place the subject at unacceptable risk if he/she
participates in the study

- Patients must not have a history of thrombo-embolic events within 3 years prior to
study randomization

- Patients must not have known human immunodeficiency virus (HIV)-1 seropositivity
because HIV can be an alternate cause of anemia

- Patients must not have a known allergic reaction to epoetin alfa (Procrit) or human
serum albumin

- Patients must have completed 16 weeks of monotherapy with lenalidomide

- Patients must show failure to achieve MER (major erythroid response) or have achieved
MER but relapsed on Arm A

- Patients must not have a limiting unresolved grade 3 or greater toxicity from
lenalidomide monotherapy or drug intolerance preventing continuation of lenalidomide
treatment

Type of Study:

Interventional

Study Design:

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment

Outcome Measure:

MER defined as sustained transfusion independence in transfusion-dependent patients or a rise in hemoglobin > 2 g/dL in transfusion-independent patients with anemia for a minimum of 8 consecutive weeks

Outcome Time Frame:

At 16 weeks

Safety Issue:

No

Principal Investigator

Alan List

Investigator Role:

Principal Investigator

Investigator Affiliation:

Eastern Cooperative Oncology Group

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2009-01173

NCT ID:

NCT00843882

Start Date:

January 2009

Completion Date:

Related Keywords:

  • Anemia
  • Chronic Myelomonocytic Leukemia
  • de Novo Myelodysplastic Syndromes
  • Previously Treated Myelodysplastic Syndromes
  • Anemia
  • Leukemia
  • Leukemia, Myelomonocytic, Chronic
  • Myelodysplastic Syndromes
  • Preleukemia
  • Leukemia, Myelomonocytic, Acute

Name

Location

Albert Einstein College of Medicine Bronx, New York  10461
Johns Hopkins University Baltimore, Maryland  21205
Memorial Sloan Kettering Cancer Center New York, New York  10021
Mayo Clinic Rochester, Minnesota  55905
H. Lee Moffitt Cancer Center and Research Institute Tampa, Florida  33612
Abington Memorial Hospital Abington, Pennsylvania  19001
University of Washington Medical Center Seattle, Washington  98195-6043
Hurley Medical Center Flint, Michigan  48503
Pennsylvania Hospital Philadelphia, Pennsylvania  19107
Boulder Community Hospital Boulder, Colorado  80301-9019
Porter Adventist Hospital Denver, Colorado  80210
Rose Medical Center Denver, Colorado  80220
Swedish Medical Center Englewood, Colorado  80110
Sky Ridge Medical Center Lone Tree, Colorado  80124
North Suburban Medical Center Thornton, Colorado  80229
Bronson Methodist Hospital Kalamazoo, Michigan  49007
West Michigan Cancer Center Kalamazoo, Michigan  49007-3731
Borgess Medical Center Kalamazooaa, Michigan  49001
Fairview Ridges Hospital Burnsville, Minnesota  55337
Hutchinson Area Health Care Hutchinson, Minnesota  55350
United Hospital St. Paul, Minnesota  55102
Ridgeview Medical Center Waconia, Minnesota  55387
Geisinger Medical Center Danville, Pennsylvania  17822-0001
Abramson Cancer Center of the University of Pennsylvania Philadelphia, Pennsylvania  19104-4283
Avera Cancer Institute Sioux Falls, South Dakota  57105
CentraCare Clinic Saint Cloud, Minnesota  56303
Marshfield Clinic Marshfield, Wisconsin  54449
Baptist Hospital of Miami Miami, Florida  33176-2197
Memorial Hospital of South Bend South Bend, Indiana  46601
Marquette General Hospital Marquette, Michigan  49855
Newark Beth Israel Medical Center Newark, New Jersey  07112
Community Medical Center Toms River, New Jersey  08755
Reading Hospital and Medical Center Reading, Pennsylvania  19612-6052
Virginia Mason Medical Center Seattle, Washington  98111
Waukesha Memorial Hospital Waukesha, Wisconsin  53188
University of Nebraska Medical Center Omaha, Nebraska  68198-3330
Wesley Medical Center Wichita, Kansas  67214
Iowa Methodist Medical Center Des Moines, Iowa  50309
Iowa Lutheran Hospital Des Moines, Iowa  50316-2301
Southern California Permanente Medical Group Downey, California  90242
Group Health Cooperative Seattle, Washington  98112
University of Wisconsin Hospital and Clinics Madison, Wisconsin  53792-0001
Great Falls Clinic Great Falls, Montana  59405
Thompson Cancer Survival Center Knoxville, Tennessee  37916
Winthrop University Hospital Mineola, New York  11501
MetroHealth Medical Center Cleveland, Ohio  44109
Montefiore Medical Center Bronx, New York  10467-2490
Lewistown Hospital Lewistown, Pennsylvania  17044
Mount Nittany Medical Center State College, Pennsylvania  16803
North Colorado Medical Center Greeley, Colorado  80631
McKee Medical Center Loveland, Colorado  80539
Northern Rockies Radiation Oncology Center Billings, Montana  59101
Bozeman Deaconess Hospital Bozeman, Montana  59715
Kalispell Medical Oncology Kalispell, Montana  59901
Kalispell Regional Medical Center Kalispell, Montana  59901
Avera McKennan Hospital and University Health Center Sioux Falls, South Dakota  57105
Cancer Care Northwest - Spokane South Spokane, Washington  99202
Welch Cancer Center Sheridan, Wyoming  82801
Cancer Centers of the Carolinas Greenville, South Carolina  29605
Mercy Health System Janesville, Wisconsin  53545
Paoli Memorial Hospital Paoli, Pennsylvania  19301-1792
Elkhart General Hospital Elkhart, Indiana  46515
South Bend Clinic South Bend, Indiana  46617
University Medical Center of Southern Nevada Las Vegas, Nevada  89102
Poudre Valley Hospital Fort Collins, Colorado  80524
Beebe Medical Center Lewes, Delaware  19958
Hematology and Oncology Associates Chicago, Illinois  60611
Community Cancer Center of Monroe Monroe, Michigan  48162
Creighton University Medical Center Omaha, Nebraska  68131-2197
Bismarck Cancer Center Bismarck, North Dakota  58501
Grandview Hospital Dayton, Ohio  45405
Lima Memorial Hospital Lima, Ohio  45804
Mercy Medical Center Springfield, Ohio  45504
Mercy Hospital of Tiffin Tiffin, Ohio  44883
Fulton County Health Center Wauseon, Ohio  43567
Bryn Mawr Hospital Bryn Mawr, Pennsylvania  19010
Danville Regional Medical Center Danville, Virginia  24541
Exempla Lutheran Medical Center Wheat Ridge, Colorado  80033
Mercy Hospital Coon Rapids, Minnesota  55433
Hematology Oncology Associates of Illinois-Highland Park Highland Park, Illinois  60035
Medical Oncology and Hematology Associates Des Moines, Iowa  50309
Ottumwa Regional Health Center Ottumwa, Iowa  52501
Bixby Medical Center Adrian, Michigan  49221
Saint Joseph Mercy Hospital Ann Arbor, Michigan  48106
Fairview-Southdale Hospital Edina, Minnesota  55435
Abbott-Northwestern Hospital Minneapolis, Minnesota  55407
Regions Hospital Saint Paul, Minnesota  55101
Saint Francis Regional Medical Center Shakopee, Minnesota  55379
Rice Memorial Hospital Willmar, Minnesota  56201
Saint Luke's Hospital Maumee, Ohio  43537
Geisinger Medical Group State College, Pennsylvania  16801
Fox Valley Hematology and Oncology Appleton, Wisconsin  54911
Swedish American Hospital Rockford, Illinois  61104
Center for Cancer Care and Research St. Louis, Missouri  63141
Miami Valley Hospital Dayton, Ohio  45409
Lawrence Memorial Hospital Lawrence, Kansas  66044
Menorah Medical Center Overland Park, Kansas  66209
Shawnee Mission Medical Center Shawnee Mission, Kansas  66204
North Kansas City Hospital Kansas City, Missouri  64116
Research Medical Center Kansas City, Missouri  64132
Saint Luke's East - Lee's Summit Lee's Summit, Missouri  64086
Liberty Hospital Liberty, Missouri  64068
Heartland Regional Medical Center Saint Joseph, Missouri  64506
Bozeman Deaconess Cancer Center Bozeman, Montana  59715
Northern Montana Hospital Havre, Montana  59501
Wayne Hospital Greenville, Ohio  45331
Fisher-Titus Medical Center Norwalk, Ohio  44857
Clinton Memorial Hospital Wilmington, Ohio  45177
Wenatchee Valley Medical Center Wenatchee, Washington  98801-2028
UW Cancer Center Johnson Creek Johnson Creek, Wisconsin  53038
Saint Joseph's Hospital Marshfield, Wisconsin  54449
Marshfield Clinic - Weston Center Weston, Wisconsin  54476
Marshfield Clinic - Wisconsin Rapids Center Wisconsin Rapids, Wisconsin  54494
Rocky Mountain Oncology Casper, Wyoming  82609
Longmont United Hospital Longmont, Colorado  80501
Singing River Hospital Pascagoula, Mississippi  39581
Greene Memorial Hospital Xenia, Ohio  45385
Union Hospital of Cecil County Elkton MD, Maryland  21921
Cancer Centers of the Carolinas - Grove Commons Greenville, South Carolina  29605
Cancer Centers of the Carolinas - Seneca Seneca, South Carolina  29672
Cancer Centers of the Carolinas - Spartanburg Spartanburg, South Carolina  29307
Mayo Clinic in Arizona Scottsdale, Arizona  85259-5404
Mayo Clinic in Florida Jacksonville, Florida  32224
Memorial Medical Center Springfield, Illinois  62781
Saint Francis Medical Center Grand Island, Nebraska  68802
Guardian Oncology and Center for Wellness Missoula, Montana  59804
University of Virginia Charlottesville, Virginia  22908
University of Alabama at Birmingham Birmingham, Alabama  35294-3300
Northwestern University Chicago, Illinois  60611
Elmhurst Memorial Hospital Elmhurst, Illinois  60126
Bay Area Hospital Coos Bay, Oregon  97420
Hennepin County Medical Center Minneapolis, Minnesota  
University of Rochester Rochester, New York  14642
Glens Falls Hospital Glens Falls, New York  12801
Holy Cross Hospital Fort Lauderdale, Florida  33308
Case Western Reserve University Cleveland, Ohio  44106
Wayne State University Detroit, Michigan  48202
Kaiser Permanente Medical Center Vallejo, California  94589
University of Arizona Health Sciences Center Tucson, Arizona  85724
University of Massachusetts Medical School Worcester, Massachusetts  01605
Mid Dakota Clinic Bismarck, North Dakota  58501
Weiss Memorial Hospital Chicago,, Illinois  60640
Presbyterian - Saint Lukes Medical Center - Health One Denver, Colorado  80218
Kaiser Permanente Sacramento, California  
Montana Cancer Consortium CCOP Billings, Montana  59101
Alegent Health Immanuel Medical Center Omaha, Nebraska  68122
Alegent Health Bergan Mercy Medical Center Omaha, Nebraska  68124
Flower Hospital Sylvania, Ohio  43560-2197
Virginia Mason CCOP Seattle, Washington  98101
Metro-Minnesota CCOP St. Louis Park, Minnesota  
UC Davis Comprehensive Cancer Center Sacramento, California  95817
Providence Hospital Southfield, Michigan  48075
Cancer Centers of the Carolinas - Easley Easley, South Carolina  29640
Lakeview Hospital Stillwater, Minnesota  55082
Jersey Shore Medical Center Neptune, New Jersey  07754
Decatur Memorial Hospital Decatur, Illinois  62526
Frederick Memorial Hospital Frederick, Maryland  21701
Lankenau Hospital Wynnewood, Pennsylvania  19096
Princeton Community Hospital Princeton, West Virginia  24740
Montana Cancer Specialists Missoula, Montana  59807-7877
Phoenixville Hospital Phoenixville, Pennsylvania  19460
University of Chicago Comprehensive Cancer Center Chicago, Illinois  60637-1470
Northern Indiana Cancer Research Consortium South Bend, Indiana  
Penn State Milton S Hershey Medical Center Hershey, Pennsylvania  17033
Southeast Cancer Center Cape Girardeau, Missouri  63703
Butler Memorial Hospital Butler, Pennsylvania  16001
Parker Adventist Hospital Parker, Colorado  80138
Froedtert and the Medical College of Wisconsin Milwaukee, Wisconsin  53226
Saint Helena Hospital Saint Helena, California  94574
Leesburg Regional Medical Center Leesburg, Florida  34748
Fremont - Rideout Cancer Center Marysville, California  95901
The Medical Center of Aurora Aurora, Colorado  80012
Penrose-Saint Francis Healthcare Colorado Springs, Colorado  80907
Saint Anthony Central Hospital Denver, Colorado  80204
Exempla Saint Joseph Hospital Denver, Colorado  80218
Colorado Cancer Research Program CCOP Denver, Colorado  80224-2522
Saint Mary's Hospital and Regional Medical Center Grand Junction, Colorado  81502
Saint Mary Corwin Medical Center Pueblo, Colorado  81004
Saint Francis Hospital and Medical Center Hartford, Connecticut  06105
The Hospital of Central Connecticut New Britain, Connecticut  06050
Edna Williams Cancer Center at the Baptist Cancer Institute Jacksonville, Florida  32207
Saint Luke's Mountain States Tumor Institute Boise, Idaho  83712
Resurrection Healthcare Chicago, Illinois  60631
Saint Francis Hospital Evanston, Illinois  60202
Evanston CCOP-NorthShore University HealthSystem Evanston, Illinois  60201
Joliet Oncology-Hematology Associates Limited Joliet, Illinois  60435
Midwest Center for Hematology Oncology Joliet, Illinois  60432
North Shore Hematology Oncology Libertyville, Illinois  60048
Hematology Oncology Associates of Illinois - Skokie Skokie, Illinois  60076
Saint Francis Hospital and Health Centers Beech Grove, Indiana  46107
Fort Wayne Medical Oncology and Hematology Inc - State Boulevard Fort Wayne, Indiana  46845
Premier Oncology Hematology Associates Merrillville, Indiana  46410
Reid Hospital and Health Care Services Richmond, Indiana  47374
McFarland Clinic Ames, Iowa  50010
Cedar Rapids Oncology Association Cedar Rapids, Iowa  52403
Mercy Hospital Cedar Rapids, Iowa  52403
Medical Oncology and Hematology Associates-West Des Moines Clive, Iowa  50325
Iowa Oncology Research Association CCOP Des Moines, Iowa  50309
Mercy Capitol Des Moines, Iowa  50307
Mercy Medical Center - Des Moines Des Moines, Iowa  50314
Medical Oncology and Hematology Associates-Des Moines Des Moines, Iowa  50309
Mercy Medical Center - North Iowa Mason City, Iowa  50401
Mercy Medical Center-Sioux City Sioux City, Iowa  51104
Saint Luke's Regional Medical Center Sioux City, Iowa  51104
Caritas Saint Elizabeth's Medical Center Brighton, Massachusetts  02135-2997
Holy Family Hospital Methuen, Massachusetts  01844
Hickman Cancer Center Adrian, Michigan  49221
Michigan Cancer Research Consortium Community Clinical Oncology Program Ann Arbor, Michigan  48106
Oakwood Hospital Dearborn, Michigan  48123
Saint John Hospital and Medical Center Detroit, Michigan  48236
Green Bay Oncology - Escanaba Escanaba, Michigan  49431
Green Bay Oncology - Iron Mountain Iron Mountain, Michigan  49801
Allegiance Health Jackson, Michigan  49201
Sparrow Hospital Lansing, Michigan  48912
Saint Mary Mercy Hospital Livonia, Michigan  48154
Mercy Memorial Hospital Monroe, Michigan  48162
Saint Joseph Mercy Oakland Pontiac, Michigan  48341-2985
Saint Joseph Mercy Port Huron Port Huron, Michigan  48060
Saint Mary's of Michigan Saginaw, Michigan  48601
Lakeland Hospital St. Joseph, Michigan  49085
Saint John Macomb-Oakland Hospital Warren, Michigan  48093
Medini, Eitan MD (UIA Investigator) Alexandria, Minnesota  56308
Unity Hospital Fridley, Minnesota  55432
Saint John's Hospital - Healtheast Maplewood, Minnesota  55109
Minnesota Oncology Hematology PA-Maplewood Maplewood, Minnesota  55109
Minneapolis Veterans Medical Center Minneapolis, Minnesota  55417
North Memorial Medical Health Center Robbinsdale, Minnesota  55422
Saint Cloud Hospital Saint Cloud, Minnesota  56303
Park Nicollet Clinic - Saint Louis Park Saint Louis Park, Minnesota  55416
Minnesota Oncology and Hematology PA-Woodbury Woodbury, Minnesota  55125
Keesler Medical Center Kessler AFB, Mississippi  39534
Kansas City Veterans Affairs Medical Center Kansas City, Missouri  64128
Saint Luke's Cancer Institute Kansas City, Missouri  64111
Saint Luke's Hospital of Kansas City Kansas City, Missouri  64111
Saint Joseph Health Center Kansas City, Missouri  64114
Liberty Radiation Oncology Clinic Kansas City, Missouri  64116
Truman Medical Center Kansas City, Missouri  64108
Missouri Baptist Medical Center Saint Louis, Missouri  63131
Saint John's Hospital Springfield, Missouri  65804
Hematology-Oncology Centers of the Northern Rockies PC Billings, Montana  59101
Saint Vincent Healthcare Billings, Montana  59101
Billings Clinic Billings, Montana  59107-7000
Saint James Community Hospital and Cancer Treatment Center Butte, Montana  59701
Benefis Healthcare- Sletten Cancer Institute Great Falls, Montana  59405
Berdeaux, Donald MD (UIA Investigator) Great Falls, Montana  59405
Saint Peter's Community Hospital Helena, Montana  59601
Glacier Oncology PLLC Kalispell, Montana  59901
Saint Patrick Hospital - Community Hospital Missoula, Montana  59802
Lincoln Medical Education Foundation Cancer Resource Center Lincoln, Nebraska  68510
Missouri Valley Cancer Consortium CCOP Omaha, Nebraska  68106
Nevada Cancer Research Foundation CCOP Las Vegas, Nevada  89106
Cheshire Medical Center-Dartmouth-Hitchcock Keene Keene, New Hampshire  03431
Cooper Hospital University Medical Center Camden, New Jersey  08103
Veterans Adminstration New Jersey Health Care System East Orange, New Jersey  07018-1095
Fox Chase Cancer Center at Virtua Memorial Hospital of Burlington County Mount Holly, New Jersey  08060
South Jersey Healthcare Vineland, New Jersey  08360
Virtua West Jersey Hospital Voorhees Voorhees, New Jersey  08043
Orange Regional Medical Center Middletown, New York  10940
New York University Langone Medical Center New York, New York  10016
Highland Hospital Rochester, New York  14620
Mission Hospitals Inc Asheville, North Carolina  28801
Wayne Memorial Hospital Goldsboro, North Carolina  27534
Saint Alexius Medical Center Bismarck, North Dakota  58501
Aultman Health Foundation Canton, Ohio  44710
Good Samaritan Hospital - Dayton Dayton, Ohio  45406
Dayton CCOP Dayton, Ohio  45429
Samaritan North Health Center Dayton, Ohio  45415
Hematology Oncology Center Incorporated Elyria, Ohio  44035
Blanchard Valley Hospital Findlay, Ohio  45840
Atrium Medical Center-Middletown Regional Hospital Franklin, Ohio  45005-1066
Kettering Medical Center Kettering, Ohio  45429
Saint Rita's Medical Center Lima, Ohio  45801
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center Maumee, Ohio  43537
Saint Charles Hospital Oregon, Ohio  43616
North Coast Cancer Care Sandusky, Ohio  44870
Toledo Community Hospital Oncology Program CCOP Toledo, Ohio  43617
Mercy Cancer Center at Saint Anne Mercy Hospital Toledo, Ohio  43623
University of Toledo Toledo, Ohio  43614
Saint Vincent Mercy Medical Center Toledo, Ohio  43608
Upper Valley Medical Center Troy, Ohio  45373
Ephrata Cancer Center Ephrata, Pennsylvania  17522
Riddle Hospital Media, Pennsylvania  19063
Geisinger Wyoming Valley Wilkes-Barre, Pennsylvania  18711
Mainline Health CCOP Wynnewood, Pennsylvania  19096
Greenville CCOP Greenville, South Carolina  29615
Greenville Memorial Hospital Greenville, South Carolina  29605
The Don and Sybil Harrington Cancer Center Amarillo, Texas  79106
Fredericksburg Oncology Inc Fredericksburg, Virginia  22401
Harrison Bremerton Hematology and Oncology Bremerton, Washington  98310
Columbia Basin Hematology and Oncology PLLC Kennewick, Washington  99336
Evergreen Hospital Medical Center Kirkland, Washington  98033
Minor and James Medical PLLC Seattle, Washington  98104
Swedish Medical Center-First Hill Seattle, Washington  98122-4307
West Virginia University Morgantown, West Virginia  26506
Saint Vincent Hospital Green Bay, Wisconsin  54301
Green Bay Oncology Limited at Saint Mary's Hospital Green Bay, Wisconsin  54303
Saint Mary's Hospital Green Bay, Wisconsin  54303
Green Bay Oncology at Saint Vincent Hospital Green Bay, Wisconsin  54301-3526
Aurora BayCare Medical Center Green Bay, Wisconsin  54311-6519
Dean Hematology and Oncology Clinic Madison, Wisconsin  53717
Vince Lombardi Cancer Clinic-Marinette Marinette, Wisconsin  54143
Bay Area Medical Center Marinette, Wisconsin  54143
Marshfield Clinic-Minocqua Center Minocqua, Wisconsin  54548
Oconomowoc Memorial Hospital-ProHealth Care Inc Oconomowoc, Wisconsin  53066-3896
Green Bay Oncology - Oconto Falls Oconto Falls, Wisconsin  54154
Marshfield Clinic at James Beck Cancer Center Rhinelander, Wisconsin  54501
Marshfield Clinic-Rice Lake Center Rice Lake, Wisconsin  54868
Saint Michael's Hospital Stevens Point, Wisconsin  54481
Green Bay Oncology - Sturgeon Bay Sturgeon Bay, Wisconsin  54235
Aspirus Regional Cancer Center Wausau, Wisconsin  54401
University of Maryland Greenebaum Cancer Center Baltimore, Maryland  21201
Jupiter Medical Center Jupiter, Florida  33458
Elkhart Clinic Elkhart, Indiana  46515
Memorial Healthcare System - Joe DiMaggio Children's Hospital Hollywood, Florida  33021
Mount Sinai Medical Center CCOP Miami Beach, Florida  33140
Michiana Hematology Oncology PC-Elkhart Elkhart, Indiana  46514
Michiana Hematology Oncology PC-Plymouth Plymouth, Indiana  46563
Michiana Hematology Oncology PC-South Bend South Bend, Indiana  46601
Michiana Hematology Oncology-PC Westville Westville, Indiana  46391
Saint Agnes Hospital Baltimore, Maryland  21229
University of Michigan University Hospital Ann Arbor, Michigan  48109
Michiana Hematology Oncology PC-Niles Niles, Michigan  49120
University of Missouri - Ellis Fischel Columbia, Missouri  65203
Rex Cancer Center Raleigh, North Carolina  27607
North Coast Cancer Care-Clyde Clyde, Ohio  43410
Community Health Partners Regional Medical Center Elyria, Ohio  44035
Cancer Centers of the Carolinas - Faris Greenville, South Carolina  29605
Cancer Centers of the Carolinas-Greer Radiation Oncology Greer, South Carolina  29650
Cancer Centers of the Carolinas-Greer Medical Oncology Greer, South Carolina  29650
Skagit Valley Hospital Mt. Vernon, Washington  98273
Evergreen Hematology and Oncology PS Spokane, Washington  99218
Marshfield Clinic-Chippewa Center Chippewa Falls, Wisconsin  54729
Holy Family Memorial Hospital Manitowoc, Wisconsin  54221
Vince Lombardi Cancer Clinic-Sheboygan Sheboygan, Wisconsin  53081
Marshfield Clinic Cancer Care at Saint Michael's Hospital Stevens Point, Wisconsin  54481
Aurora Medical Center in Summit Summit, Wisconsin  53066
Vince Lombardi Cancer Clinic Two Rivers, Wisconsin  54241
Riverview Hospital Wisconsin Rapids, Wisconsin  54494
University of Miami Miller School of Medicine-Sylvester Cancer Center Miami, Florida  33136
Arizona Cancer Center at University Medical Center North Tucson, Arizona  85719
Saint Luke's Mountain States Tumor Institute - Fruitland Fruitland, Idaho  83619
Kaiser Anaheim Medical Center Anaheim, California  92807
Kaiser Permanente Medical Group - Baldwin Park Baldwin Park, California  91706
Kaiser Foundation Hospital Bellflower, California  90706
Kaiser Permanente Hospital Fontana, California  92335
Kaiser Permanente - Harbor City Harbor City, California  90710
Kaiser Permanente-West Los Angeles Los Angeles, California  90034
Kaiser Permanente - Panorama City Panorama City, California  91402
Kaiser Permanente at San Diego San Diego, California  92120
Kaiser Permanente Health Care San Marcos, California  92069
Saint Luke's Mountain States Tumor Institute - Meridian Meridian, Idaho  83642
Saint Luke's Mountain States Tumor Institute - Nampa Nampa, Idaho  83686
Central DuPage Hospital Cancer Center Warrenville, Illinois  60555
Saint Luke's South Hospital Overland Park, Kansas  66213
Kansas City CCOP Prairie Village, Kansas  66208
King's Daughter's Medical Center Ashland, Kentucky  41101
Capital Region Medical Center-Goldschmidt Cancer Center Jefferson City, Missouri  65109
Heartland Hematology and Oncology Associates Incorporated Kansas City, Missouri  64118
Saint Joseph Oncology Inc Saint Joseph, Missouri  64507
Comprehensive Cancer Care PC Saint Louis, Missouri  63141
Susquehanna Cancer Center Williamsport, Pennsylvania  17701
Memorial Hospital Of Martinsville Martinsville, Virginia  24115
Pacific Medical Center-First Hill Seattle, Washington  98104
Gundersen Lutheran La Crosse, Wisconsin  54601
Saint Nicholas Hospital Madison, Wisconsin  53715
Fairbanks Memorial Hospital Fairbanks, Alaska  99701
Stanford University Hospitals and Clinics Stanford, California  94305
Siouxland Hematology Oncology Associates Sioux City, Iowa  51101
Walter Reed National Military Medical Center Bethesda, Maryland  20889
Kaiser Permanente-Mission San Diego, California  92108
IU Health Arnett Lafayette, Indiana  
Michiana Hematology Oncology PC-Mishawaka Mishawaka, Indiana  46545-1470
Oncology Associates at Mercy Medical Center Cedar Rapids, Iowa  52403
Marie Yeager Cancer Center Saint Joseph, Michigan  49085
Hematology Oncology Associates of Central New York PC East Syracuse, New York  13057
Door County Cancer Center Sturgeon Bay, Wisconsin  54235-1495
The Toledo Hospital/Toledo Children's Hospital Toledo, Ohio  43606
Genesys Regional Medical Center-West Flint Campus Flint, Michigan  48532
Sanford Bismarck Medical Center Bismarck, North Dakota  58501
Toledo Clinic Cancer Centers-Oregon Oregon, Ohio  43616
Geisinger Medical Center-Cancer Center Hazelton Hazleton, Pennsylvania  18201
Presbyterian Intercommunity Hospital Whittier, California  90602
Community Howard Regional Health Kokomo, Indiana  46904
Indiana University Health La Porte Hospital La Porte, Indiana  46350
Saint Joseph Regional Medical Center-Mishawaka Mishawaka, Indiana  46545-1470
PeaceHealth Saint Joseph Medical Center Bellingham, Washington  98225
Christiana Care Health System-Christiana Hospital Newark, Delaware  19718
Illinois Cancer Specialists-Niles Niles, Illinois  60714
Riverview Medical Center/Booker Cancer Center Red Bank, New Jersey  07701
Georgia Regents University Augusta, Georgia  30912
Marin Cancer Care Inc Greenbrae, California  94904
Toledo Clinic Cancer Centers-Bowling Green Bowling Green, Ohio  43402
Toledo Clinic Cancer Centers-Maumee Maumee, Ohio  43537-1839
Toledo Clinic Cancer Centers-Toledo Toledo, Ohio  43623
Self Regional Healthcare Greenwood, South Carolina  29646
Harrison Poulsbo Hematology and Oncology Poulsbo, Washington  98370
Aurora Cancer Care-Southern Lakes Elkhorn, Wisconsin  53121
Saint Luke's Mountain States Tumor Institute-Twin Falls Twin Falls, Idaho  83301
D N Greenwald Center Mukwonago, Wisconsin  53149
Presence Saint Mary's Hospital Kankakee, Illinois  60901
Rex Cancer Center of Wakefield Raleigh, North Carolina  27614
Marshfield Clinic Cancer Center at Sacred Heart Eau Claire, Wisconsin  54701