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Brief Title: Inotuzumab Ozogamicin and Frontline Chemotherapy in Treating Young Adults With Newly Diagnosed B Acute Lymphoblastic Leukemia
Official Title: A Phase III Trial to Evaluate the Efficacy of the Addition of Inotuzumab Ozogamicin (a Conjugated Anti-CD22 Monoclonal Antibody) to Frontline Therapy in Young Adults (Ages 18-39 Years) With Newly Diagnosed Precursor B-Cell ALL
Study ID: NCT03150693
Brief Summary: This partially randomized phase III trial studies the side effects of inotuzumab ozogamicin and how well it works when given with frontline chemotherapy in treating patients with newly diagnosed B acute lymphoblastic leukemia. Monoclonal antibodies, such as inotuzumab ozogamicin, may block cancer growth in different ways by targeting certain cells. Drugs used in chemotherapy work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving inotuzumab ozogamicin with chemotherapy may work better in treating young adults with B acute lymphoblastic leukemia.
Detailed Description: PRIMARY OBJECTIVES: I. To confirm tolerability of the combination regimen with the addition of inotuzumab ozogamicin to the pediatric-inspired regimen of cancer and leukemia group B (CALGB) 10403. II. To determine whether the addition of inotuzumab ozogamicin significantly improves the event-free survival (EFS) in patients who achieve an induction response achieved with the pediatric-inspired regimen of CALGB 10403, without censoring for transplant. (Phase III) SECONDARY OBJECTIVES: I. To determine the impact of inotuzumab ozogamicin on disease-free (DFS) and overall survival (OS) in patients who achieve an induction response. II. To determine whether the addition of inotuzumab ozogamicin significantly improves the event-free survival (EFS) in patients who achieve an induction response achieved with the pediatric-inspired regimen of CALGB 10403, with censoring for transplant. III. To determine the impact of inotuzumab ozogamicin on minimal residual disease (MRD) and correlate this with the EFS, DFS and OS. IV. To determine the prognosis based on patients' low-density array (LDA) gene signature in terms of EFS, DFS, and OS after treatment with or without inotuzumab ozogamicin when added to the C10403 backbone regimen. V. To evaluate the toxicity and tolerability of the addition of inotuzumab ozogamicin to the pediatric-inspired regimen of CALGB 10403. TERTIARY OBJECTIVES: I. To assess both the correlation of MRD post-induction and at sequential timepoints with LDA signature. II. To evaluate the influence of MRD status (detectable vs. not and as a continuous measure) in relation to EFS both in the univariate setting as well as adjusting for other clinical features including initial white blood cell (WBC), ethnicity, gender and age at diagnosis. III. To evaluate the impact of inotuzumab ozogamicin (inotuzumab) on the kinetics of MRD during treatment with inotuzumab in patients randomized to the experimental treatment arm. IV. To perform genomic analyses to identify and evaluate the incidence and clinical significance of recurring novel fusion genes including those associated with the BCR-ABL1-like signature and to correlate with MRD status, CR rate, EFS and OS. V. To assess whether rs4958351 is correlated with L-asp allergic reaction in the adolescent and young adult (AYA) population. VI. To assess the incidence of inherited genetic variants in the GR1A1, CEP72, CPA2, TPMT, NUDT15, GRIN3A, GRIK1, and other genes (which can be found using a whole genome association study \[GWAS\]), are correlated with increased rates of target toxicities including peripheral neuropathy, hepatotoxicity, pancreatitis, myelosuppression, neurotoxicity, thrombosis, and osteonecrosis, and correlate with treatment discontinuation and other clinical response parameters including complete response (CR) rate, EFS, and OS. VII. To evaluate asparaginase pharmacokinetics in adolescents and young adults, and investigate its correlation with toxicities and treatment outcomes. VIII. To investigate the effect of anti-polyethylene glycol (PEG) and anti-agouti signaling protein (ASP) antibodies (PEG-ASP) on ASP enzyme activity. IX. To measure adherence to oral 6 mercaptopurine (MP) and methotrexate in AYAs with acute lymphoblastic leukemia (ALL) and to examine sociodemographic and behavioral determinants of adherence. X. To determine the impact of adherence on risk of relapse among AYAs with ALL. OUTLINE: COURSE I (REMISSION INDUCTION THERAPY): All patients receive allopurinol orally (PO) once daily until peripheral blasts and extramedullary disease are reduced and cytarabine intrathecally (IT) over 1 minute on day 1. Patients also receive daunorubicin hydrochloride intravenously (IV) and vincristine sulfate IV on days 1, 8, 15 and 22, dexamethasone PO or IV twice daily (BID) on days 1-7 and 15-21, pegylated L-aspiraginase IV on day 4, 5, or 6, and methotrexate IT over 1 minute on days 8 and 29. Patients with central nervous system (CNS) 3 disease receive methotrexate IT over 1 minute also on days 15 and 22. All patients then undergo bone marrow aspirate and biopsy on day 29. Patients with response to remission induction therapy are randomized to 1 of 2 arms. Patients with no response are omitted from the study. ARM I: COURSE II (REMISSION CONSOLIDATION CHEMOTHERAPY): Patients receive cyclophosphamide IV on days 1 and 29, cytarabine IV or SC on days 1-4, 8-11, 29-32, and 36-39, mercaptopurine PO on days 1-14 and 29-42, and vincristine sulfate IV on days 15, 22, 43, and 50. Patients also receive pegylated L-aspiraginase IV on days 15 and 43, and methotrexate IT on days 1, 8, 15, and 22. Patients with CNS3 receive methotrexate IT only on days 1 and 8. CD20 positive (+) patients receive rituximab IV on days 1, 8, 29, and 36. Patients then undergo bone marrow aspirate and biopsy on day 56. COURSE III (INTERIM MAINTENANCE CHEMOTHERAPY): Patients receive vincristine sulfate IV on days 1, 11, 21, 31, and 41, methotrexate IV and IT on days 1, 11, 21, 31, and 41, and pegylated L-aspiraginase IV on days 2 and 22. CD20+ patients receive rituximab IV on days 1 and 11. COURSE IV (DELAYED INTENSIFICATION): Patients receive vincristine sulfate IV on days 1, 8, 15, 43, and 50, dexamethasone PO or IV BID on days 1-7 and 15-21, doxorubicin IV on days 1, 8, and 15, and pegylated L-aspiraginase IV on day 4, 5, or 6 and day 43. Patients also receive cyclophosphamide IV on day 29, cytarabine IV or SC on days 29-32 and 36-39, thioguanine PO on days 29-42 and methotrexate IT on days 1, 29, and 36. CD20+ patients receive rituximab IV on days 1 and 8. Patients then undergo bone marrow aspirate and biopsy on day 50. COURSE V (MAINTENANCE THERAPY): Patients receive vincristine sulfate IV on days 1, 29, and 57, dexamethasone PO or IV BID on days 1-5, 29-33, and 57-61, and mercaptopurine PO on days 1-84. Patients also receive methotrexate IT or PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78. Treatment repeats every 12 weeks for up to 3 years in the absence of disease progression or unacceptable toxicity. ARM II: Patients receive inotuzumab ozogamicin IV on days 1, 8, and 15 and undergo bone marrow aspirate and biopsy on day 28. Treatment repeats every 28 days for up to 2 courses in the absence of disease progression or unacceptable toxicity. Patients also receive remission consolidated chemotherapy, interim maintenance chemotherapy, delayed intensification, and maintenance therapy as in Arm I. After completion of study treatment, patients are followed up every month for the first year, every 2 months for the second year, every 3 months for the third year, and every 6 months for the fourth through tenth year.
Minimum Age: 18 Years
Eligible Ages: ADULT
Sex: ALL
Healthy Volunteers: No
University of Alabama at Birmingham Cancer Center, Birmingham, Alabama, United States
Anchorage Associates in Radiation Medicine, Anchorage, Alaska, United States
Anchorage Radiation Therapy Center, Anchorage, Alaska, United States
Alaska Breast Care and Surgery LLC, Anchorage, Alaska, United States
Alaska Oncology and Hematology LLC, Anchorage, Alaska, United States
Alaska Women's Cancer Care, Anchorage, Alaska, United States
Anchorage Oncology Centre, Anchorage, Alaska, United States
Katmai Oncology Group, Anchorage, Alaska, United States
Providence Alaska Medical Center, Anchorage, Alaska, United States
Fairbanks Memorial Hospital, Fairbanks, Alaska, United States
Kingman Regional Medical Center, Kingman, Arizona, United States
Mayo Clinic Hospital in Arizona, Phoenix, Arizona, United States
Mayo Clinic in Arizona, Scottsdale, Arizona, United States
Mercy Hospital Fort Smith, Fort Smith, Arkansas, United States
Kaiser Permanente-Deer Valley Medical Center, Antioch, California, United States
PCR Oncology, Arroyo Grande, California, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center, Burbank, California, United States
Community Cancer Institute, Clovis, California, United States
University Oncology Associates, Clovis, California, United States
UC Irvine Health Cancer Center-Newport, Costa Mesa, California, United States
Kaiser Permanente Dublin, Dublin, California, United States
Kaiser Permanente-Fremont, Fremont, California, United States
Fresno Cancer Center, Fresno, California, United States
Kaiser Permanente-Fresno, Fresno, California, United States
Kaiser Permanente-Modesto, Modesto, California, United States
Kaiser Permanente Oakland-Broadway, Oakland, California, United States
Kaiser Permanente-Oakland, Oakland, California, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center, Orange, California, United States
Stanford Cancer Institute Palo Alto, Palo Alto, California, United States
Kaiser Permanente-Rancho Cordova Cancer Center, Rancho Cordova, California, United States
Kaiser Permanente- Marshall Medical Offices, Redwood City, California, United States
Kaiser Permanente-Redwood City, Redwood City, California, United States
Kaiser Permanente-Richmond, Richmond, California, United States
Rohnert Park Cancer Center, Rohnert Park, California, United States
Kaiser Permanente-Roseville, Roseville, California, United States
The Permanente Medical Group-Roseville Radiation Oncology, Roseville, California, United States
Kaiser Permanente Downtown Commons, Sacramento, California, United States
University of California Davis Comprehensive Cancer Center, Sacramento, California, United States
Kaiser Permanente-South Sacramento, Sacramento, California, United States
South Sacramento Cancer Center, Sacramento, California, United States
Kaiser Permanente - Sacramento, Sacramento, California, United States
Kaiser Permanente-San Francisco, San Francisco, California, United States
Kaiser Permanente-Santa Teresa-San Jose, San Jose, California, United States
Kaiser Permanente San Leandro, San Leandro, California, United States
Kaiser Permanente-San Rafael, San Rafael, California, United States
Kaiser San Rafael-Gallinas, San Rafael, California, United States
Kaiser Permanente Medical Center - Santa Clara, Santa Clara, California, United States
Kaiser Permanente-Santa Rosa, Santa Rosa, California, United States
Kaiser Permanente Cancer Treatment Center, South San Francisco, California, United States
Kaiser Permanente-South San Francisco, South San Francisco, California, United States
Kaiser Permanente-Stockton, Stockton, California, United States
Kaiser Permanente Medical Center-Vacaville, Vacaville, California, United States
Kaiser Permanente-Vallejo, Vallejo, California, United States
Kaiser Permanente-Walnut Creek, Walnut Creek, California, United States
Rocky Mountain Cancer Centers-Aurora, Aurora, Colorado, United States
The Medical Center of Aurora, Aurora, Colorado, United States
Boulder Community Hospital, Boulder, Colorado, United States
Boulder Community Foothills Hospital, Boulder, Colorado, United States
Rocky Mountain Cancer Centers-Boulder, Boulder, Colorado, United States
Rocky Mountain Cancer Centers - Centennial, Centennial, Colorado, United States
Cancer Center of Colorado at Sloan's Lake, Denver, Colorado, United States
National Jewish Health-Main Campus, Denver, Colorado, United States
The Women's Imaging Center, Denver, Colorado, United States
Colorado Blood Cancer Institute, Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One, Denver, Colorado, United States
Rocky Mountain Cancer Centers-Midtown, Denver, Colorado, United States
SCL Health Saint Joseph Hospital, Denver, Colorado, United States
Rocky Mountain Cancer Centers-Rose, Denver, Colorado, United States
Rose Medical Center, Denver, Colorado, United States
Western Surgical Care, Denver, Colorado, United States
Mountain Blue Cancer Care Center - Swedish, Englewood, Colorado, United States
Rocky Mountain Cancer Centers - Swedish, Englewood, Colorado, United States
Swedish Medical Center, Englewood, Colorado, United States
The Melanoma and Skin Cancer Institute, Englewood, Colorado, United States
National Jewish Health-Western Hematology Oncology, Golden, Colorado, United States
Saint Mary's Hospital and Regional Medical Center, Grand Junction, Colorado, United States
Banner North Colorado Medical Center, Greeley, Colorado, United States
Good Samaritan Medical Center, Lafayette, Colorado, United States
Rocky Mountain Cancer Centers-Lakewood, Lakewood, Colorado, United States
Rocky Mountain Cancer Centers-Littleton, Littleton, Colorado, United States
Rocky Mountain Cancer Centers-Sky Ridge, Lone Tree, Colorado, United States
Sky Ridge Medical Center, Lone Tree, Colorado, United States
Banner McKee Medical Center, Loveland, Colorado, United States
National Jewish Health-Northern Hematology Oncology, Thornton, Colorado, United States
Rocky Mountain Cancer Centers-Thornton, Thornton, Colorado, United States
SCL Health Lutheran Medical Center, Wheat Ridge, Colorado, United States
Smilow Cancer Hospital Care Center at Saint Francis, Hartford, Connecticut, United States
Smilow Cancer Center/Yale-New Haven Hospital, New Haven, Connecticut, United States
Yale University, New Haven, Connecticut, United States
Holy Cross Hospital, Fort Lauderdale, Florida, United States
Memorial Regional Hospital/Joe DiMaggio Children's Hospital, Hollywood, Florida, United States
Miami Cancer Institute, Miami, Florida, United States
Orlando Health Cancer Institute, Orlando, Florida, United States
Memorial Hospital West, Pembroke Pines, Florida, United States
Emory University Hospital/Winship Cancer Institute, Atlanta, Georgia, United States
Augusta University Medical Center, Augusta, Georgia, United States
Hawaii Cancer Care - Westridge, 'Aiea, Hawaii, United States
Pali Momi Medical Center, 'Aiea, Hawaii, United States
Queen's Cancer Center - Pearlridge, 'Aiea, Hawaii, United States
The Cancer Center of Hawaii-Pali Momi, 'Aiea, Hawaii, United States
Island Urology-Hilo, Hilo, Hawaii, United States
Hawaii Cancer Care Inc - Waterfront Plaza, Honolulu, Hawaii, United States
Island Urology, Honolulu, Hawaii, United States
Queen's Cancer Cenrer - POB I, Honolulu, Hawaii, United States
Queen's Medical Center, Honolulu, Hawaii, United States
Straub Clinic and Hospital, Honolulu, Hawaii, United States
University of Hawaii Cancer Center, Honolulu, Hawaii, United States
Hawaii Cancer Care Inc-Liliha, Honolulu, Hawaii, United States
Kuakini Medical Center, Honolulu, Hawaii, United States
Queen's Cancer Center - Kuakini, Honolulu, Hawaii, United States
The Cancer Center of Hawaii-Liliha, Honolulu, Hawaii, United States
Kaiser Permanente Moanalua Medical Center, Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, United States
Wilcox Memorial Hospital and Kauai Medical Clinic, Lihue, Hawaii, United States
Saint Alphonsus Cancer Care Center-Boise, Boise, Idaho, United States
Saint Luke's Cancer Institute - Boise, Boise, Idaho, United States
Saint Alphonsus Cancer Care Center-Caldwell, Caldwell, Idaho, United States
Kootenai Health - Coeur d'Alene, Coeur d'Alene, Idaho, United States
Walter Knox Memorial Hospital, Emmett, Idaho, United States
Saint Luke's Cancer Institute - Fruitland, Fruitland, Idaho, United States
Idaho Urologic Institute-Meridian, Meridian, Idaho, United States
Saint Luke's Cancer Institute - Meridian, Meridian, Idaho, United States
Saint Luke's Cancer Institute - Nampa, Nampa, Idaho, United States
Saint Alphonsus Cancer Care Center-Nampa, Nampa, Idaho, United States
Kootenai Clinic Cancer Services - Post Falls, Post Falls, Idaho, United States
Kootenai Cancer Clinic, Sandpoint, Idaho, United States
Saint Luke's Cancer Institute - Twin Falls, Twin Falls, Idaho, United States
Saint Anthony's Health, Alton, Illinois, United States
Loyola Center for Health at Burr Ridge, Burr Ridge, Illinois, United States
Northwestern University, Chicago, Illinois, United States
Rush University Medical Center, Chicago, Illinois, United States
University of Illinois, Chicago, Illinois, United States
University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States
NorthShore University HealthSystem-Evanston Hospital, Evanston, Illinois, United States
NorthShore University HealthSystem-Glenbrook Hospital, Glenview, Illinois, United States
NorthShore University HealthSystem-Highland Park Hospital, Highland Park, Illinois, United States
Loyola Medicine Homer Glen, Homer Glen, Illinois, United States
Northwestern Medicine Lake Forest Hospital, Lake Forest, Illinois, United States
Rush Cancer Care in Lisle, Lisle, Illinois, United States
Loyola University Medical Center, Maywood, Illinois, United States
Marjorie Weinberg Cancer Center at Loyola-Gottlieb, Melrose Park, Illinois, United States
Good Samaritan Regional Health Center, Mount Vernon, Illinois, United States
UC Comprehensive Cancer Center at Silver Cross, New Lenox, Illinois, United States
University of Chicago Medicine-Orland Park, Orland Park, Illinois, United States
Saint Anthony Regional Hospital, Carroll, Iowa, United States
Blank Children's Hospital, Des Moines, Iowa, United States
Iowa Methodist Medical Center, Des Moines, Iowa, United States
Mission Cancer and Blood - Des Moines, Des Moines, Iowa, United States
Broadlawns Medical Center, Des Moines, Iowa, United States
Iowa Lutheran Hospital, Des Moines, Iowa, United States
Trinity Regional Medical Center, Fort Dodge, Iowa, United States
University of Iowa/Holden Comprehensive Cancer Center, Iowa City, Iowa, United States
Methodist West Hospital, West Des Moines, Iowa, United States
Central Care Cancer Center - Garden City, Garden City, Kansas, United States
Central Care Cancer Center - Great Bend, Great Bend, Kansas, United States
University of Kansas Cancer Center, Kansas City, Kansas, United States
Lawrence Memorial Hospital, Lawrence, Kansas, United States
University of Kansas Hospital-Westwood Cancer Center, Westwood, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower, Wichita, Kansas, United States
Ascension Via Christi Hospitals Wichita, Wichita, Kansas, United States
Cancer Center of Kansas - Wichita, Wichita, Kansas, United States
Wesley Medical Center, Wichita, Kansas, United States
University of Kentucky/Markey Cancer Center, Lexington, Kentucky, United States
Ochsner Health Center-Summa, Baton Rouge, Louisiana, United States
Medical Center of Baton Rouge, Baton Rouge, Louisiana, United States
Ochsner High Grove, Baton Rouge, Louisiana, United States
Ochsner Medical Center Jefferson, New Orleans, Louisiana, United States
University of Maryland/Greenebaum Cancer Center, Baltimore, Maryland, United States
Massachusetts General Hospital Cancer Center, Boston, Massachusetts, United States
Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
Dana-Farber Cancer Institute, Boston, Massachusetts, United States
Trinity Health Saint Joseph Mercy Hospital Ann Arbor, Ann Arbor, Michigan, United States
Bronson Battle Creek, Battle Creek, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Brighton, Brighton, Michigan, United States
Trinity Health Medical Center - Brighton, Brighton, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Canton, Canton, Michigan, United States
Trinity Health Medical Center - Canton, Canton, Michigan, United States
Caro Cancer Center, Caro, Michigan, United States
Saint Joseph Mercy Chelsea, Chelsea, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital, Chelsea, Michigan, United States
Hematology Oncology Consultants-Clarkston, Clarkston, Michigan, United States
Newland Medical Associates-Clarkston, Clarkston, Michigan, United States
Wayne State University/Karmanos Cancer Institute, Detroit, Michigan, United States
Ascension Saint John Hospital, Detroit, Michigan, United States
Great Lakes Cancer Management Specialists-Doctors Park, East China Township, Michigan, United States
Weisberg Cancer Treatment Center, Farmington Hills, Michigan, United States
Genesee Cancer and Blood Disease Treatment Center, Flint, Michigan, United States
Genesee Hematology Oncology PC, Flint, Michigan, United States
Genesys Hurley Cancer Institute, Flint, Michigan, United States
Hurley Medical Center, Flint, Michigan, United States
Corewell Health Grand Rapids Hospitals - Butterworth Hospital, Grand Rapids, Michigan, United States
Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital, Grand Rapids, Michigan, United States
Trinity Health Grand Rapids Hospital, Grand Rapids, Michigan, United States
Academic Hematology Oncology Specialists, Grosse Pointe Woods, Michigan, United States
Great Lakes Cancer Management Specialists-Van Elslander Cancer Center, Grosse Pointe Woods, Michigan, United States
Michigan Breast Specialists-Grosse Pointe Woods, Grosse Pointe Woods, Michigan, United States
Bronson Methodist Hospital, Kalamazoo, Michigan, United States
West Michigan Cancer Center, Kalamazoo, Michigan, United States
Ascension Borgess Cancer Center, Kalamazoo, Michigan, United States
Borgess Medical Center, Kalamazoo, Michigan, United States
University of Michigan Health - Sparrow Lansing, Lansing, Michigan, United States
Hope Cancer Clinic, Livonia, Michigan, United States
Trinity Health Saint Mary Mercy Livonia Hospital, Livonia, Michigan, United States
Great Lakes Cancer Management Specialists-Macomb Medical Campus, Macomb, Michigan, United States
Michigan Breast Specialists-Macomb Township, Macomb, Michigan, United States
Saint Mary's Oncology/Hematology Associates of Marlette, Marlette, Michigan, United States
Trinity Health Muskegon Hospital, Muskegon, Michigan, United States
Corewell Health Lakeland Hospitals - Niles Hospital, Niles, Michigan, United States
Cancer and Hematology Centers of Western Michigan - Norton Shores, Norton Shores, Michigan, United States
Hope Cancer Center, Pontiac, Michigan, United States
Michigan Healthcare Professionals Pontiac, Pontiac, Michigan, United States
Newland Medical Associates-Pontiac, Pontiac, Michigan, United States
Trinity Health Saint Joseph Mercy Oakland Hospital, Pontiac, Michigan, United States
Corewell Health Reed City Hospital, Reed City, Michigan, United States
Great Lakes Cancer Management Specialists-Rochester Hills, Rochester Hills, Michigan, United States
Ascension Saint Mary's Hospital, Saginaw, Michigan, United States
Oncology Hematology Associates of Saginaw Valley PC, Saginaw, Michigan, United States
Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center, Saint Joseph, Michigan, United States
Corewell Health Lakeland Hospitals - Saint Joseph Hospital, Saint Joseph, Michigan, United States
Bhadresh Nayak MD PC-Sterling Heights, Sterling Heights, Michigan, United States
Ascension Saint Joseph Hospital, Tawas City, Michigan, United States
Munson Medical Center, Traverse City, Michigan, United States
Advanced Breast Care Center PLLC, Warren, Michigan, United States
Great Lakes Cancer Management Specialists-Macomb Professional Building, Warren, Michigan, United States
Macomb Hematology Oncology PC, Warren, Michigan, United States
Michigan Breast Specialists-Warren, Warren, Michigan, United States
Saint John Macomb-Oakland Hospital, Warren, Michigan, United States
Saint Mary's Oncology/Hematology Associates of West Branch, West Branch, Michigan, United States
University of Michigan Health - West, Wyoming, Michigan, United States
Huron Gastroenterology PC, Ypsilanti, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus, Ypsilanti, Michigan, United States
Riverwood Healthcare Center, Aitkin, Minnesota, United States
Essentia Health Saint Joseph's Medical Center, Brainerd, Minnesota, United States
Fairview Ridges Hospital, Burnsville, Minnesota, United States
Minnesota Oncology - Burnsville, Burnsville, Minnesota, United States
Cambridge Medical Center, Cambridge, Minnesota, United States
Mercy Hospital, Coon Rapids, Minnesota, United States
Essentia Health - Deer River Clinic, Deer River, Minnesota, United States
Essentia Health Saint Mary's - Detroit Lakes Clinic, Detroit Lakes, Minnesota, United States
Essentia Health Cancer Center, Duluth, Minnesota, United States
Essentia Health Saint Mary's Medical Center, Duluth, Minnesota, United States
Miller-Dwan Hospital, Duluth, Minnesota, United States
Fairview Southdale Hospital, Edina, Minnesota, United States
Lake Region Healthcare Corporation-Cancer Care, Fergus Falls, Minnesota, United States
Essentia Health - Fosston, Fosston, Minnesota, United States
Unity Hospital, Fridley, Minnesota, United States
Essentia Health Hibbing Clinic, Hibbing, Minnesota, United States
Fairview Clinics and Surgery Center Maple Grove, Maple Grove, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood, Maplewood, Minnesota, United States
Saint John's Hospital - Healtheast, Maplewood, Minnesota, United States
Abbott-Northwestern Hospital, Minneapolis, Minnesota, United States
Hennepin County Medical Center, Minneapolis, Minnesota, United States
Health Partners Inc, Minneapolis, Minnesota, United States
Monticello Cancer Center, Monticello, Minnesota, United States
New Ulm Medical Center, New Ulm, Minnesota, United States
Essentia Health - Park Rapids, Park Rapids, Minnesota, United States
Fairview Northland Medical Center, Princeton, Minnesota, United States
North Memorial Medical Health Center, Robbinsdale, Minnesota, United States
Mayo Clinic in Rochester, Rochester, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park, Saint Louis Park, Minnesota, United States
Regions Hospital, Saint Paul, Minnesota, United States
United Hospital, Saint Paul, Minnesota, United States
Essentia Health Sandstone, Sandstone, Minnesota, United States
Saint Francis Regional Medical Center, Shakopee, Minnesota, United States
Lakeview Hospital, Stillwater, Minnesota, United States
Essentia Health Virginia Clinic, Virginia, Minnesota, United States
Ridgeview Medical Center, Waconia, Minnesota, United States
Rice Memorial Hospital, Willmar, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury, Woodbury, Minnesota, United States
Fairview Lakes Medical Center, Wyoming, Minnesota, United States
Saint Louis Cancer and Breast Institute-Ballwin, Ballwin, Missouri, United States
Central Care Cancer Center - Bolivar, Bolivar, Missouri, United States
Cox Cancer Center Branson, Branson, Missouri, United States
Siteman Cancer Center at West County Hospital, Creve Coeur, Missouri, United States
Freeman Health System, Joplin, Missouri, United States
Mercy Hospital Joplin, Joplin, Missouri, United States
Delbert Day Cancer Institute at PCRMC, Rolla, Missouri, United States
Mercy Clinic-Rolla-Cancer and Hematology, Rolla, Missouri, United States
Heartland Regional Medical Center, Saint Joseph, Missouri, United States
Saint Louis Cancer and Breast Institute-South City, Saint Louis, Missouri, United States
Washington University School of Medicine, Saint Louis, Missouri, United States
Mercy Hospital South, Saint Louis, Missouri, United States
Siteman Cancer Center-South County, Saint Louis, Missouri, United States
Mercy Hospital Saint Louis, Saint Louis, Missouri, United States
Siteman Cancer Center at Saint Peters Hospital, Saint Peters, Missouri, United States
Mercy Hospital Springfield, Springfield, Missouri, United States
CoxHealth South Hospital, Springfield, Missouri, United States
Mercy Hospital Washington, Washington, Missouri, United States
Community Hospital of Anaconda, Anaconda, Montana, United States
Billings Clinic Cancer Center, Billings, Montana, United States
Saint Vincent Healthcare, Billings, Montana, United States
Saint Vincent Frontier Cancer Center, Billings, Montana, United States
Bozeman Health Deaconess Hospital, Bozeman, Montana, United States
Saint James Community Hospital and Cancer Treatment Center, Butte, Montana, United States
Benefis Sletten Cancer Institute, Great Falls, Montana, United States
Great Falls Clinic, Great Falls, Montana, United States
Kalispell Regional Medical Center, Kalispell, Montana, United States
Saint Patrick Hospital - Community Hospital, Missoula, Montana, United States
Community Medical Center, Missoula, Montana, United States
Nebraska Medicine-Village Pointe, Omaha, Nebraska, United States
University of Nebraska Medical Center, Omaha, Nebraska, United States
Carson Tahoe Regional Medical Center, Carson City, Nevada, United States
Cancer and Blood Specialists-Henderson, Henderson, Nevada, United States
Comprehensive Cancer Centers of Nevada - Henderson, Henderson, Nevada, United States
Comprehensive Cancer Centers of Nevada-Horizon Ridge, Henderson, Nevada, United States
Las Vegas Cancer Center-Henderson, Henderson, Nevada, United States
OptumCare Cancer Care at Seven Hills, Henderson, Nevada, United States
Comprehensive Cancer Centers of Nevada-Southeast Henderson, Henderson, Nevada, United States
GenesisCare USA - Henderson, Henderson, Nevada, United States
Las Vegas Urology - Green Valley, Henderson, Nevada, United States
Las Vegas Urology - Pebble, Henderson, Nevada, United States
Urology Specialists of Nevada - Green Valley, Henderson, Nevada, United States
Las Vegas Urology - Pecos, Las Vegas, Nevada, United States
Desert West Surgery, Las Vegas, Nevada, United States
OptumCare Cancer Care at Charleston, Las Vegas, Nevada, United States
University Medical Center of Southern Nevada, Las Vegas, Nevada, United States
Hope Cancer Care of Nevada, Las Vegas, Nevada, United States
Radiation Oncology Centers of Nevada Central, Las Vegas, Nevada, United States
Urology Specialists of Nevada - Central, Las Vegas, Nevada, United States
GenesisCare USA - Las Vegas, Las Vegas, Nevada, United States
Sunrise Hospital and Medical Center, Las Vegas, Nevada, United States
Las Vegas Prostate Cancer Center, Las Vegas, Nevada, United States
Las Vegas Urology - Sunset, Las Vegas, Nevada, United States
Urology Specialists of Nevada - Southwest, Las Vegas, Nevada, United States
Radiation Oncology Centers of Nevada Southeast, Las Vegas, Nevada, United States
Ann M Wierman MD LTD, Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada - Northwest, Las Vegas, Nevada, United States
GenesisCare USA - Vegas Tenaya, Las Vegas, Nevada, United States
Las Vegas Urology - Cathedral Rock, Las Vegas, Nevada, United States
Las Vegas Urology - Smoke Ranch, Las Vegas, Nevada, United States
OptumCare Cancer Care at MountainView, Las Vegas, Nevada, United States
Urology Specialists of Nevada - Northwest, Las Vegas, Nevada, United States
Alliance for Childhood Diseases/Cure 4 the Kids Foundation, Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada - Town Center, Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada-Summerlin, Las Vegas, Nevada, United States
Summerlin Hospital Medical Center, Las Vegas, Nevada, United States
Las Vegas Cancer Center-Medical Center, Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada, Las Vegas, Nevada, United States
GenesisCare USA - Fort Apache, Las Vegas, Nevada, United States
OptumCare Cancer Care at Fort Apache, Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada - Central Valley, Las Vegas, Nevada, United States
University Cancer Center, Las Vegas, Nevada, United States
Hope Cancer Care of Nevada-Pahrump, Pahrump, Nevada, United States
Renown Regional Medical Center, Reno, Nevada, United States
Saint Mary's Regional Medical Center, Reno, Nevada, United States
Radiation Oncology Associates, Reno, Nevada, United States
University of New Mexico Cancer Center, Albuquerque, New Mexico, United States
Roswell Park Cancer Institute, Buffalo, New York, United States
Northwell Health/Center for Advanced Medicine, Lake Success, New York, United States
North Shore University Hospital, Manhasset, New York, United States
Long Island Jewish Medical Center, New Hyde Park, New York, United States
Mount Sinai Hospital, New York, New York, United States
NYP/Weill Cornell Medical Center, New York, New York, United States
University of Rochester, Rochester, New York, United States
Stony Brook University Medical Center, Stony Brook, New York, United States
State University of New York Upstate Medical University, Syracuse, New York, United States
Upstate Cancer Center at Verona, Verona, New York, United States
UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, United States
Duke University Medical Center, Durham, North Carolina, United States
East Carolina University, Greenville, North Carolina, United States
Wake Forest University Health Sciences, Winston-Salem, North Carolina, United States
Essentia Health Cancer Center-South University Clinic, Fargo, North Dakota, United States
Essentia Health - Jamestown Clinic, Jamestown, North Dakota, United States
University of Cincinnati Cancer Center-UC Medical Center, Cincinnati, Ohio, United States
Case Western Reserve University, Cleveland, Ohio, United States
Cleveland Clinic Foundation, Cleveland, Ohio, United States
Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
University of Cincinnati Cancer Center-West Chester, West Chester, Ohio, United States
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
Mercy Hospital Oklahoma City, Oklahoma City, Oklahoma, United States
Saint Alphonsus Medical Center-Baker City, Baker City, Oregon, United States
Saint Charles Health System, Bend, Oregon, United States
Clackamas Radiation Oncology Center, Clackamas, Oregon, United States
Providence Cancer Institute Clackamas Clinic, Clackamas, Oregon, United States
Bay Area Hospital, Coos Bay, Oregon, United States
Providence Newberg Medical Center, Newberg, Oregon, United States
Saint Alphonsus Medical Center-Ontario, Ontario, Oregon, United States
Providence Portland Medical Center, Portland, Oregon, United States
Providence Saint Vincent Medical Center, Portland, Oregon, United States
Oregon Health and Science University, Portland, Oregon, United States
Saint Charles Health System-Redmond, Redmond, Oregon, United States
Lehigh Valley Hospital-Cedar Crest, Allentown, Pennsylvania, United States
Lehigh Valley Hospital - Muhlenberg, Bethlehem, Pennsylvania, United States
Pocono Medical Center, East Stroudsburg, Pennsylvania, United States
Lehigh Valley Hospital-Hazleton, Hazleton, Pennsylvania, United States
University of Pennsylvania/Abramson Cancer Center, Philadelphia, Pennsylvania, United States
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
University of Pittsburgh Cancer Institute (UPCI), Pittsburgh, Pennsylvania, United States
Rhode Island Hospital, Providence, Rhode Island, United States
Miriam Hospital, Providence, Rhode Island, United States
Prisma Health Cancer Institute - Spartanburg, Boiling Springs, South Carolina, United States
Prisma Health Cancer Institute - Laurens, Clinton, South Carolina, United States
Prisma Health Richland Hospital, Columbia, South Carolina, United States
Prisma Health Cancer Institute - Easley, Easley, South Carolina, United States
Saint Francis Hospital, Greenville, South Carolina, United States
BI-LO Charities Children's Cancer Center, Greenville, South Carolina, United States
Prisma Health Cancer Institute - Butternut, Greenville, South Carolina, United States
Prisma Health Cancer Institute - Faris, Greenville, South Carolina, United States
Prisma Health Greenville Memorial Hospital, Greenville, South Carolina, United States
Saint Francis Cancer Center, Greenville, South Carolina, United States
Prisma Health Cancer Institute - Eastside, Greenville, South Carolina, United States
Prisma Health Cancer Institute - Greer, Greer, South Carolina, United States
Prisma Health Cancer Institute - Seneca, Seneca, South Carolina, United States
Houston Methodist Hospital, Houston, Texas, United States
Covenant Medical Center-Lakeside, Lubbock, Texas, United States
American Fork Hospital / Huntsman Intermountain Cancer Center, American Fork, Utah, United States
Sandra L Maxwell Cancer Center, Cedar City, Utah, United States
Logan Regional Hospital, Logan, Utah, United States
Intermountain Medical Center, Murray, Utah, United States
McKay-Dee Hospital Center, Ogden, Utah, United States
Utah Valley Regional Medical Center, Provo, Utah, United States
Riverton Hospital, Riverton, Utah, United States
Saint George Regional Medical Center, Saint George, Utah, United States
Utah Cancer Specialists-Salt Lake City, Salt Lake City, Utah, United States
Huntsman Cancer Institute/University of Utah, Salt Lake City, Utah, United States
LDS Hospital, Salt Lake City, Utah, United States
Inova Schar Cancer Institute, Fairfax, Virginia, United States
Inova Fairfax Hospital, Falls Church, Virginia, United States
Virginia Commonwealth University/Massey Cancer Center, Richmond, Virginia, United States
Providence Regional Cancer System-Aberdeen, Aberdeen, Washington, United States
Overlake Medical Center, Bellevue, Washington, United States
PeaceHealth Saint Joseph Medical Center, Bellingham, Washington, United States
Providence Regional Cancer System-Centralia, Centralia, Washington, United States
Swedish Cancer Institute-Edmonds, Edmonds, Washington, United States
Providence Regional Cancer Partnership, Everett, Washington, United States
Swedish Cancer Institute-Issaquah, Issaquah, Washington, United States
Kadlec Clinic Hematology and Oncology, Kennewick, Washington, United States
Providence Regional Cancer System-Lacey, Lacey, Washington, United States
PeaceHealth Saint John Medical Center, Longview, Washington, United States
Jefferson Healthcare, Port Townsend, Washington, United States
Valley Medical Center, Renton, Washington, United States
Pacific Gynecology Specialists, Seattle, Washington, United States
Swedish Medical Center-Ballard Campus, Seattle, Washington, United States
Kaiser Permanente Washington, Seattle, Washington, United States
Swedish Medical Center-Cherry Hill, Seattle, Washington, United States
Swedish Medical Center-First Hill, Seattle, Washington, United States
PeaceHealth United General Medical Center, Sedro-Woolley, Washington, United States
Providence Regional Cancer System-Shelton, Shelton, Washington, United States
PeaceHealth Southwest Medical Center, Vancouver, Washington, United States
Providence Saint Mary Regional Cancer Center, Walla Walla, Washington, United States
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital, Yakima, Washington, United States
Providence Regional Cancer System-Yelm, Yelm, Washington, United States
Duluth Clinic Ashland, Ashland, Wisconsin, United States
Northwest Wisconsin Cancer Center, Ashland, Wisconsin, United States
Essentia Health-Hayward Clinic, Hayward, Wisconsin, United States
University of Wisconsin Carbone Cancer Center - University Hospital, Madison, Wisconsin, United States
Marshfield Medical Center-Marshfield, Marshfield, Wisconsin, United States
Medical College of Wisconsin, Milwaukee, Wisconsin, United States
Cancer Center of Western Wisconsin, New Richmond, Wisconsin, United States
Essentia Health-Spooner Clinic, Spooner, Wisconsin, United States
Essentia Health Saint Mary's Hospital - Superior, Superior, Wisconsin, United States
Cheyenne Regional Medical Center-West, Cheyenne, Wyoming, United States
Billings Clinic-Cody, Cody, Wyoming, United States
Welch Cancer Center, Sheridan, Wyoming, United States
Tom Baker Cancer Centre, Calgary, Alberta, Canada
CancerCare Manitoba, Winnipeg, Manitoba, Canada
QEII Health Sciences Centre/Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
Ottawa Hospital and Cancer Center-General Campus, Ottawa, Ontario, Canada
Jewish General Hospital, Montreal, Quebec, Canada
Name: daniel_deangelo@dfci.harvard.edu J. DeAngelo, MD, PhD
Affiliation: Dana-Farber Cancer Institute
Role: STUDY_CHAIR