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Brief Title: Fludarabine and Rituximab With or Without Lenalidomide or Cyclophosphamide in Treating Patients With Symptomatic Chronic Lymphocytic Leukemia
Official Title: A Genetic Risk-Stratified, Randomized Phase II Study of Four Fludarabine/Antibody Combinations for Patients With Symptomatic, Previously Untreated Chronic Lymphocytic Leukemia
Study ID: NCT00602459
Brief Summary: This randomized phase II trial studies how well fludarabine (fludarabine phosphate) and rituximab with or without lenalidomide or cyclophosphamide work in treating patients with symptomatic chronic lymphocytic leukemia. Drugs used in chemotherapy, such as fludarabine phosphate and cyclophosphamide, 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. Monoclonal antibodies, such as rituximab, may block cancer growth in different ways by targeting certain cells. Lenalidomide may stimulate the immune system in different ways and stop cancer cells from growing. Giving fludarabine phosphate and rituximab together with lenalidomide or cyclophosphamide may be an effective treatment for chronic lymphocytic leukemia.
Detailed Description: PRIMARY OBJECTIVES: I. To determine the two-year progression-free survival (PFS) after remission induction with four different chemo-immunotherapy combinations for patients with untreated, symptomatic, lower-risk and high-risk chronic lymphocytic leukemia (CLL) to decide which of the four arms, if any, to take forward into a randomized phase III trial. II. To determine the induction response to fludarabine phosphate and rituximab (FR) and fludarabine phosphate, cyclophosphamide, and rituximab (FCR) in each of these arms, along with the consolidation response to lenalidomide in patients with CLL. III. To determine the toxicity from these four chemoimmunotherapy combinations and that of consolidation therapy with lenalidomide. IV. To determine the induction response and toxicity of FCR in patients with deletion (del) (11q22.3) along with consolidation response, 2-year PFS and toxicity of lenalidomide in this specific genetic group. V. To determine the effect of pretreatment biologic characteristics on clinical outcomes, such as attaining a complete response to induction therapy and progression-free survival. VI. To collect relapse samples to determine the frequency of clonal evolution among patients with immunoglobulin heavy chain variable region (IgVH) mutated and unmutated disease and to study mechanisms of resistance to chemoimmunotherapy. VII. To determine if flow cytometry-negative status immediately post-therapy and at 24 months after study entry is an effective surrogate marker for prolonged progression-free survival and overall survival. OUTLINE: Patients are randomized to 1 of 3 treatment arms (Arms A, B, or C). Patients on Arm A or B who are found to be del (11q22.3) positive are assigned to Arm D beginning with course 2 of induction therapy. ARM A (remission-induction \[RI\] therapy with fludarabine phosphate and rituximab): Participants receive induction therapy (every 28 days for up to 6 cycles) of: rituximab intravenously (IV) over 1-4 hours on days 1 (50 mg/m\^2), 3 (325 mg/m\^2), and 5 (375 mg/m\^2) of course 1 and on day 1 (375 mg/m\^2) of all subsequent courses. Patients also receive fludarabine phosphate 25 mg/m\^2/day IV over 30 minutes or orally (PO) on days 1-5. ARM B (RI therapy with fludarabine phosphate and rituximab followed by remission-consolidation \[RC\] therapy with lenalidomide): Participants receive induction therapy (every 28 days for up to 6 cycles) of: rituximab IV over 1-4 hours on days 1 (50 mg/m\^2), 3 (325 mg/m\^2), and 5 (375 mg/m\^2) of course 1 and on day 1 (375 mg/m\^2) of all subsequent courses. Patients also receive fludarabine phosphate 25 mg/m\^2/day IV over 30 minutes or PO on days 1-5. Participants without progression receive consolidation therapy: lenalidomide 5mg/day cycle 1, 10 mg/day cycles 2-6 PO once daily (QD) on days 1-21 of 28 day cycle. ARM C (RI therapy with fludarabine phosphate, rituximab, and cyclophosphamide): Participants receive induction therapy (every 28 days for up to 6 cycles) of: rituximab IV over 4 hours on days 1 (50mg/m\^2) and 3 (325 mg/m\^2) of course 1 and on day 1 (500 mg/m\^2) of all subsequent courses. Patients then receive fludarabine phosphate (age \< 70: 25 mg/m\^2/day; age \>= 70: 20 mg/m\^2/day) IV piggyback over 30 minutes or PO (32 mg/m\^2/day) followed by cyclophosphamide (age \< 70: 250 mg/m\^2/day; age \>= 70: 150 mg/m\^2/day) IV piggyback over 30 minutes on days 1-3. ARM D (RI therapy with fludarabine phosphate, rituximab, and cyclophosphamide followed by RC therapy with lenalidomide): Patients receive the first course of induction therapy as in Arm A or B before being re-assigned to Arm D. Beginning in course 2, patients receive rituximab IV (500 mg/m\^2) on day 1 and fludarabine phosphate (age \< 70: 25 mg/m\^2/day; age \>= 70: 20 mg/m\^2/day) IV piggyback over 30 minutes or PO (32 mg/m\^2/day) and cyclophosphamide IV (age \< 70: 250 mg/m\^2/day; age \>= 70: 150 mg/m\^2/day) piggyback over 30 minutes on days 1-3. Participants without progression receive consolidation therapy: lenalidomide 5mg/day cycle 1, 10 mg/day cycles 2-6 PO QD on days 1-21 of 28 day cycle. After completion of study therapy, patients are followed up every 3 months for 1 year and then every 6 months for up to 15 years.
Minimum Age: 18 Years
Eligible Ages: ADULT, OLDER_ADULT
Sex: ALL
Healthy Volunteers: No
Mayo Clinic in Arizona, Scottsdale, Arizona, United States
PCR Oncology, Arroyo Grande, California, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center, Burbank, California, United States
Palo Alto Medical Foundation-Camino Division, Mountain View, California, United States
Palo Alto Medical Foundation Health Care, Palo Alto, California, United States
UCSF Medical Center-Mount Zion, San Francisco, California, United States
Hartford Hospital, Hartford, Connecticut, United States
Smilow Cancer Hospital Care Center at Saint Francis, Hartford, Connecticut, United States
Norwalk Hospital, Norwalk, Connecticut, United States
Smilow Cancer Hospital-Torrington Care Center, Torrington, Connecticut, United States
Beebe Medical Center, Lewes, Delaware, United States
Christiana Care Health System-Christiana Hospital, Newark, Delaware, United States
MedStar Georgetown University Hospital, Washington, District of Columbia, United States
Sibley Memorial Hospital, Washington, District of Columbia, United States
Jupiter Medical Center, Jupiter, Florida, United States
Mount Sinai Medical Center, Miami Beach, Florida, United States
Orlando Health Cancer Institute, Orlando, Florida, United States
Saint Anthony's Health, Alton, Illinois, United States
Rush - Copley Medical Center, Aurora, Illinois, United States
MacNeal Hospital and Cancer Center, Berwyn, Illinois, United States
Saint Joseph Medical Center, Bloomington, Illinois, United States
Illinois CancerCare-Bloomington, Bloomington, Illinois, United States
Graham Hospital Association, Canton, Illinois, United States
Illinois CancerCare-Canton, Canton, Illinois, United States
Illinois CancerCare-Carthage, Carthage, Illinois, United States
Memorial Hospital, Carthage, Illinois, United States
Hematology and Oncology Associates, Chicago, Illinois, United States
Northwestern University, Chicago, Illinois, United States
University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States
Weiss Memorial Hospital, Chicago, Illinois, United States
Decatur Memorial Hospital, Decatur, Illinois, United States
Heartland Cancer Research NCORP, Decatur, Illinois, United States
Ascension Alexian Brothers - Elk Grove Village, Elk Grove Village, Illinois, United States
Eureka Hospital, Eureka, Illinois, United States
Illinois CancerCare-Eureka, Eureka, Illinois, United States
NorthShore University HealthSystem-Evanston Hospital, Evanston, Illinois, United States
Galesburg Cottage Hospital, Galesburg, Illinois, United States
Illinois CancerCare-Galesburg, Galesburg, Illinois, United States
Illinois CancerCare-Havana, Havana, Illinois, United States
Mason District Hospital, Havana, Illinois, United States
Hematology Oncology Associates of Illinois-Highland Park, Highland Park, Illinois, United States
Hopedale Medical Complex - Hospital, Hopedale, Illinois, United States
Midwest Center for Hematology Oncology, Joliet, Illinois, United States
Duly Health and Care Joliet, Joliet, Illinois, United States
Presence Saint Mary's Hospital, Kankakee, Illinois, United States
Illinois CancerCare-Kewanee Clinic, Kewanee, Illinois, United States
AMG Libertyville - Oncology, Libertyville, Illinois, United States
Illinois CancerCare-Macomb, Macomb, Illinois, United States
Mcdonough District Hospital, Macomb, Illinois, United States
Loyola University Medical Center, Maywood, Illinois, United States
Holy Family Medical Center, Monmouth, Illinois, United States
Illinois CancerCare-Monmouth, Monmouth, Illinois, United States
Good Samaritan Regional Health Center, Mount Vernon, Illinois, United States
DuPage Medical Group-Ogden, Naperville, Illinois, United States
Illinois Cancer Specialists-Niles, Niles, Illinois, United States
Bromenn Regional Medical Center, Normal, Illinois, United States
Carle Cancer Institute Normal, Normal, Illinois, United States
Illinois CancerCare-Community Cancer Center, Normal, Illinois, United States
Illinois CancerCare-Ottawa Clinic, Ottawa, Illinois, United States
Ottawa Regional Hospital and Healthcare Center, Ottawa, Illinois, United States
Illinois CancerCare-Pekin, Pekin, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center, Pekin, Illinois, United States
Pekin Hospital, Pekin, Illinois, United States
Proctor Hospital, Peoria, Illinois, United States
Illinois CancerCare-Peoria, Peoria, Illinois, United States
Methodist Medical Center of Illinois, Peoria, Illinois, United States
OSF Saint Francis Medical Center, Peoria, Illinois, United States
Illinois CancerCare-Peru, Peru, Illinois, United States
Illinois Valley Hospital, Peru, Illinois, United States
Illinois CancerCare-Princeton, Princeton, Illinois, United States
Perry Memorial Hospital, Princeton, Illinois, United States
Swedish American Hospital, Rockford, Illinois, United States
OSF Saint Anthony Medical Center, Rockford, Illinois, United States
Hematology Oncology Associates of Illinois - Skokie, Skokie, Illinois, United States
Illinois CancerCare-Spring Valley, Spring Valley, Illinois, United States
Saint Margaret's Hospital, Spring Valley, Illinois, United States
Memorial Medical Center, Springfield, Illinois, United States
Carle Cancer Center, Urbana, Illinois, United States
Northwestern Medicine Cancer Center Warrenville, Warrenville, Illinois, United States
Franciscan Saint Francis Health-Beech Grove, Beech Grove, Indiana, United States
Elkhart Clinic, Elkhart, Indiana, United States
Michiana Hematology Oncology PC-Elkhart, Elkhart, Indiana, United States
Elkhart General Hospital, Elkhart, Indiana, United States
Fort Wayne Medical Oncology and Hematology Inc-Parkview, Fort Wayne, Indiana, United States
Community Howard Regional Health, Kokomo, Indiana, United States
IU Health La Porte Hospital, La Porte, Indiana, United States
Franciscan Saint Anthony Health-Michigan City, Michigan City, Indiana, United States
Michiana Hematology Oncology PC-Mishawaka, Mishawaka, Indiana, United States
Saint Joseph Regional Medical Center-Mishawaka, Mishawaka, Indiana, United States
Michiana Hematology Oncology PC-Plymouth, Plymouth, Indiana, United States
Reid Health, Richmond, Indiana, United States
Memorial Hospital of South Bend, South Bend, Indiana, United States
Michiana Hematology Oncology PC-South Bend, South Bend, Indiana, United States
South Bend Clinic, South Bend, Indiana, United States
Northern Indiana Cancer Research Consortium, South Bend, Indiana, United States
Michiana Hematology Oncology PC-Westville, Westville, Indiana, United States
McFarland Clinic PC - Ames, Ames, Iowa, United States
Medical Oncology and Hematology Associates-West Des Moines, Clive, Iowa, United States
Mercy Capitol, Des Moines, Iowa, United States
Iowa Methodist Medical Center, Des Moines, Iowa, United States
Iowa-Wide Oncology Research Coalition NCORP, Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines, Des Moines, Iowa, United States
Mercy Medical Center - Des Moines, Des Moines, Iowa, United States
Mission Cancer and Blood - Laurel, Des Moines, Iowa, United States
Iowa Lutheran Hospital, Des Moines, Iowa, United States
University of Iowa/Holden Comprehensive Cancer Center, Iowa City, Iowa, United States
Iowa City VA Healthcare System, Iowa City, Iowa, United States
Ottumwa Regional Health Center, Ottumwa, Iowa, United States
Siouxland Regional Cancer Center, Sioux City, Iowa, United States
Mercy Medical Center-Sioux City, Sioux City, Iowa, United States
Saint Luke's Regional Medical Center, Sioux City, Iowa, United States
HaysMed University of Kansas Health System, Hays, Kansas, United States
Hutchinson Regional Medical Center, Hutchinson, Kansas, United States
Providence Medical Center, Kansas City, Kansas, United States
University of Kansas Cancer Center, Kansas City, Kansas, United States
Lawrence Memorial Hospital, Lawrence, Kansas, United States
Olathe Cancer Center, Olathe, Kansas, United States
Menorah Medical Center, Overland Park, Kansas, United States
Radiation Oncology Practice Corporation Southwest, Overland Park, Kansas, United States
Saint Luke's South Hospital, Overland Park, Kansas, United States
Ascension Via Christi - Pittsburg, Pittsburg, Kansas, United States
Kansas City NCI Community Oncology Research Program, Prairie Village, Kansas, United States
Salina Regional Health Center, Salina, Kansas, United States
Advent Health - Shawnee Mission Medical Center, Shawnee Mission, Kansas, United States
Cotton O'Neil Cancer Center / Stormont Vail Health, Topeka, Kansas, United States
University of Kansas Health System Saint Francis Campus, Topeka, Kansas, United States
Wesley Medical Center, Wichita, Kansas, United States
Doctors Carrol, Sheth, Raghavan, Louisville, Kentucky, United States
Harold Alfond Center for Cancer Care, Augusta, Maine, United States
Eastern Maine Medical Center, Bangor, Maine, United States
University of Maryland/Greenebaum Cancer Center, Baltimore, Maryland, United States
Walter Reed National Military Medical Center, Bethesda, Maryland, United States
Christiana Care - Union Hospital, Elkton, Maryland, United States
Unspecified Site, Rockville, Maryland, United States
Lahey Hospital and Medical Center, Burlington, Massachusetts, United States
Henry Ford Hospital, Detroit, Michigan, United States
Green Bay Oncology - Escanaba, Escanaba, Michigan, United States
Cancer Research Consortium of West Michigan NCORP, Grand Rapids, Michigan, United States
Green Bay Oncology - Iron Mountain, Iron Mountain, Michigan, United States
Bronson Methodist Hospital, Kalamazoo, Michigan, United States
West Michigan Cancer Center, Kalamazoo, Michigan, United States
Borgess Medical Center, Kalamazoo, Michigan, United States
Lakeland Hospital Niles, Niles, Michigan, United States
Lakeland Medical Center Saint Joseph, Saint Joseph, Michigan, United States
Marie Yeager Cancer Center, Saint Joseph, Michigan, United States
Munson Medical Center, Traverse City, Michigan, United States
Fairview Ridges Hospital, Burnsville, Minnesota, United States
Mercy Hospital, Coon Rapids, Minnesota, United States
Fairview Southdale Hospital, Edina, Minnesota, United States
Unity Hospital, Fridley, Minnesota, United States
Hutchinson Area Health Care, Hutchinson, 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
Virginia Piper Cancer Institute, Minneapolis, Minnesota, United States
Hennepin County Medical Center, Minneapolis, Minnesota, United States
Minneapolis VA Medical Center, Minneapolis, Minnesota, United States
North Memorial Medical Health Center, Robbinsdale, Minnesota, United States
Mayo Clinic in Rochester, Rochester, Minnesota, United States
Metro Minnesota Community Oncology Research Consortium, Saint Louis Park, 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
Saint Francis Regional Medical Center, Shakopee, Minnesota, United States
Lakeview Hospital, Stillwater, 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
Saint Francis Medical Center, Cape Girardeau, Missouri, United States
Southeast Cancer Center, Cape Girardeau, Missouri, United States
University of Missouri - Ellis Fischel, Columbia, Missouri, United States
Centerpoint Medical Center LLC, Independence, Missouri, United States
Capital Region Southwest Campus, Jefferson City, Missouri, United States
Truman Medical Centers, Kansas City, Missouri, United States
Saint Luke's Hospital of Kansas City, Kansas City, Missouri, United States
Radiation Oncology Practice Corporation South, Kansas City, Missouri, United States
Saint Joseph Health Center, Kansas City, Missouri, United States
North Kansas City Hospital, Kansas City, Missouri, United States
Heartland Hematology and Oncology Associates Incorporated, Kansas City, Missouri, United States
Research Medical Center, Kansas City, Missouri, United States
Radiation Oncology Practice Corporation - North, Kansas City, Missouri, United States
Saint Luke's East - Lee's Summit, Lee's Summit, Missouri, United States
Liberty Radiation Oncology Center, Liberty, Missouri, United States
Heartland Regional Medical Center, Saint Joseph, Missouri, United States
Saint Joseph Oncology Inc, Saint Joseph, Missouri, United States
SSM Health Saint Louis University Hospital, Saint Louis, 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
Missouri Baptist Medical Center, Saint Louis, Missouri, United States
Center for Cancer Care and Research, Saint Louis, Missouri, United States
Comprehensive Cancer Care PC, Saint Louis, Missouri, United States
Mercy Hospital Saint Louis, Saint Louis, Missouri, United States
Saint Louis-Cape Girardeau CCOP, Saint Louis, Missouri, United States
Mercy Hospital Springfield, Springfield, Missouri, United States
CoxHealth South Hospital, Springfield, Missouri, United States
Billings Clinic Cancer Center, Billings, Montana, United States
Saint Vincent Healthcare, Billings, Montana, United States
Montana Cancer Consortium NCORP, Billings, Montana, United States
Saint Vincent Frontier Cancer Center, Billings, Montana, United States
Bozeman Deaconess Hospital, Bozeman, Montana, United States
Saint James Community Hospital and Cancer Treatment Center, Butte, Montana, United States
Benefis Healthcare- Sletten Cancer Institute, Great Falls, Montana, United States
Great Falls Clinic, Great Falls, Montana, United States
Northern Montana Hospital, Havre, Montana, United States
Saint Peter's Community Hospital, Helena, Montana, United States
Glacier Oncology PLLC, Kalispell, Montana, United States
Kalispell Medical Oncology, Kalispell, Montana, United States
Kalispell Regional Medical Center, Kalispell, Montana, United States
Montana Cancer Specialists, Missoula, Montana, United States
Saint Patrick Hospital - Community Hospital, Missoula, Montana, United States
CHI Health Saint Francis, Grand Island, Nebraska, United States
Nebraska Methodist Hospital, Omaha, Nebraska, United States
University of Nebraska Medical Center, Omaha, Nebraska, United States
University Medical Center of Southern Nevada, Las Vegas, Nevada, United States
Nevada Cancer Research Foundation NCORP, Las Vegas, Nevada, United States
New Hampshire Oncology Hematology PA-Concord, Concord, New Hampshire, United States
LRGHealthcare-Lakes Region General Hospital, Laconia, New Hampshire, United States
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center, Lebanon, New Hampshire, United States
Norris Cotton Cancer Center-Manchester, Manchester, New Hampshire, United States
Solinsky Center for Cancer Care, Manchester, New Hampshire, United States
Cooper Hospital University Medical Center, Camden, New Jersey, United States
Veterans Adminstration New Jersey Health Care System, East Orange, New Jersey, United States
Virtua Memorial, Mount Holly, New Jersey, United States
Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, United States
Saint Joseph's Regional Medical Center, Paterson, New Jersey, United States
Virtua Voorhees, Voorhees, New Jersey, United States
Lovelace Medical Center-Saint Joseph Square, Albuquerque, New Mexico, United States
University of New Mexico Cancer Center, Albuquerque, New Mexico, United States
Memorial Medical Center - Las Cruces, Las Cruces, New Mexico, United States
Montefiore Medical Center-Weiler Hospital, Bronx, New York, United States
Montefiore Medical Center - Moses Campus, Bronx, New York, United States
Hematology Oncology Associates of Central New York-East Syracuse, East Syracuse, New York, United States
Northwell Health NCORP, Lake Success, 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
Laura and Isaac Perlmutter Cancer Center at NYU Langone, New York, 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
Randolph Hospital, Asheboro, North Carolina, United States
Mission Hospital, Asheville, North Carolina, United States
UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, United States
Carolinas Medical Center/Levine Cancer Institute, Charlotte, North Carolina, United States
Wayne Memorial Hospital, Goldsboro, North Carolina, United States
Cone Health Cancer Center, Greensboro, North Carolina, United States
East Carolina University, Greenville, North Carolina, United States
Margaret R Pardee Memorial Hospital, Hendersonville, North Carolina, United States
Vidant Oncology-Kinston, Kinston, North Carolina, United States
Annie Penn Memorial Hospital, Reidsville, North Carolina, United States
Iredell Memorial Hospital, Statesville, North Carolina, United States
Wake Forest University Health Sciences, Winston-Salem, North Carolina, United States
Mary Rutan Hospital, Bellefontaine, Ohio, United States
Aultman Health Foundation, Canton, Ohio, United States
Adena Regional Medical Center, Chillicothe, Ohio, United States
Case Western Reserve University, Cleveland, Ohio, United States
MetroHealth Medical Center, Cleveland, Ohio, United States
Cleveland Clinic Foundation, Cleveland, Ohio, United States
Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States
Riverside Methodist Hospital, Columbus, Ohio, United States
Columbus NCI Community Oncology Research Program, Columbus, Ohio, United States
Grant Medical Center, Columbus, Ohio, United States
Mount Carmel Health Center West, Columbus, Ohio, United States
Doctors Hospital, Columbus, Ohio, United States
Grandview Hospital, Dayton, Ohio, United States
Good Samaritan Hospital - Dayton, Dayton, Ohio, United States
Miami Valley Hospital, Dayton, Ohio, United States
Miami Valley Hospital North, Dayton, Ohio, United States
Dayton NCI Community Oncology Research Program, Dayton, Ohio, United States
Grady Memorial Hospital, Delaware, Ohio, United States
Blanchard Valley Hospital, Findlay, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital, Franklin, Ohio, United States
Wayne Hospital, Greenville, Ohio, United States
Kettering Medical Center, Kettering, Ohio, United States
Fairfield Medical Center, Lancaster, Ohio, United States
Marietta Memorial Hospital, Marietta, Ohio, United States
Knox Community Hospital, Mount Vernon, Ohio, United States
Licking Memorial Hospital, Newark, Ohio, United States
Springfield Regional Medical Center, Springfield, Ohio, United States
Upper Valley Medical Center, Troy, Ohio, United States
Saint Ann's Hospital, Westerville, Ohio, United States
Clinton Memorial Hospital, Wilmington, Ohio, United States
Greene Memorial Hospital, Xenia, Ohio, United States
Genesis Healthcare System Cancer Care Center, Zanesville, Ohio, United States
Bryn Mawr Hospital, Bryn Mawr, Pennsylvania, United States
Geisinger Medical Center, Danville, Pennsylvania, United States
Easton Hospital, Easton, Pennsylvania, United States
Geisinger Medical Center-Cancer Center Hazleton, Hazleton, Pennsylvania, United States
Penn State Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
Lewistown Hospital, Lewistown, Pennsylvania, United States
Paoli Memorial Hospital, Paoli, Pennsylvania, United States
University of Pennsylvania/Abramson Cancer Center, Philadelphia, Pennsylvania, United States
Fox Chase Cancer Center, Philadelphia, Pennsylvania, United States
Pottstown Hospital, Pottstown, Pennsylvania, United States
Geisinger Medical Group, State College, Pennsylvania, United States
Mount Nittany Medical Center, State College, Pennsylvania, United States
Geisinger Wyoming Valley/Henry Cancer Center, Wilkes-Barre, Pennsylvania, United States
Geisinger South Wilkes-Barre, Wilkes-Barre, Pennsylvania, United States
Lankenau Medical Center, Wynnewood, Pennsylvania, United States
Main Line Health NCORP, Wynnewood, Pennsylvania, United States
Prisma Health Cancer Institute - Spartanburg, Boiling Springs, South Carolina, United States
Medical University of South Carolina, Charleston, South Carolina, United States
Prisma Health Cancer Institute - Easley, Easley, South Carolina, United States
McLeod Regional Medical Center, Florence, South Carolina, United States
Greenville Health System Cancer Institute-Andrews, Greenville, South Carolina, United States
Saint Francis Hospital, 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
Prisma Health Cancer Institute - Eastside, Greenville, South Carolina, United States
Self Regional Healthcare, Greenwood, South Carolina, United States
Prisma Health Cancer Institute - Greer, Greer, South Carolina, United States
Prisma Health Cancer Institute - Seneca, Seneca, South Carolina, United States
Thompson Cancer Survival Center, Knoxville, Tennessee, United States
Vanderbilt University/Ingram Cancer Center, Nashville, Tennessee, United States
Baylor University Medical Center, Dallas, Texas, United States
Central Vermont Medical Center/National Life Cancer Treatment, Berlin, Vermont, United States
University of Vermont and State Agricultural College, Burlington, Vermont, United States
Norris Cotton Cancer Center-North, Saint Johnsbury, Vermont, United States
Danville Regional Medical Center, Danville, Virginia, United States
Sovah Health Martinsville, Martinsville, Virginia, United States
Virginia Commonwealth University/Massey Cancer Center, Richmond, Virginia, United States
West Virginia University Healthcare, Morgantown, West Virginia, United States
Wheeling Hospital/Schiffler Cancer Center, Wheeling, West Virginia, United States
Marshfield Clinic-Chippewa Center, Chippewa Falls, Wisconsin, United States
HSHS Sacred Heart Hospital, Eau Claire, Wisconsin, United States
Marshfield Clinic Cancer Center at Sacred Heart, Eau Claire, Wisconsin, United States
Green Bay Oncology at Saint Vincent Hospital, Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center Green Bay, Green Bay, Wisconsin, United States
Green Bay Oncology Limited at Saint Mary's Hospital, Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Saint Mary's, Green Bay, Wisconsin, United States
UW Cancer Center Johnson Creek, Johnson Creek, Wisconsin, United States
Gundersen Lutheran Medical Center, La Crosse, Wisconsin, United States
University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, United States
Holy Family Memorial Hospital, Manitowoc, Wisconsin, United States
Bay Area Medical Center, Marinette, Wisconsin, United States
Marshfield Medical Center-Marshfield, Marshfield, Wisconsin, United States
Marshfield Medical Center, Marshfield, Wisconsin, United States
Marshfield Clinic-Minocqua Center, Minocqua, Wisconsin, United States
ProHealth Oconomowoc Memorial Hospital, Oconomowoc, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Oconto Falls, Oconto Falls, Wisconsin, United States
Ascension Saint Mary's Hospital, Rhinelander, Wisconsin, United States
Saint Mary's Hospital, Rhinelander, Wisconsin, United States
Marshfield Medical Center-Rice Lake, Rice Lake, Wisconsin, United States
HSHS Saint Nicholas Hospital, Sheboygan, Wisconsin, United States
Ascension Saint Michael's Hospital, Stevens Point, Wisconsin, United States
Green Bay Oncology - Sturgeon Bay, Sturgeon Bay, Wisconsin, United States
ProHealth Waukesha Memorial Hospital, Waukesha, Wisconsin, United States
Diagnostic and Treatment Center, Weston, Wisconsin, United States
Marshfield Medical Center - Weston, Weston, Wisconsin, United States
Marshfield Clinic - Wisconsin Rapids Center, Wisconsin Rapids, Wisconsin, United States
Rocky Mountain Oncology, Casper, Wyoming, United States
Welch Cancer Center, Sheridan, Wyoming, United States
Tom Baker Cancer Centre, Calgary, Alberta, Canada
Cross Cancer Institute, Edmonton, Alberta, Canada
CancerCare Manitoba, Winnipeg, Manitoba, Canada
QEII Health Sciences Centre/Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
Juravinski Cancer Centre at Hamilton Health Sciences, Hamilton, Ontario, Canada
University Health Network-Princess Margaret Hospital, Toronto, Ontario, Canada
CSSS Champlain-Charles Le Moyne, Greenfield Park, Quebec, Canada
McGill University Health Centre at Royal Victoria Hospital, Montreal, Quebec, Canada
CHU de Quebec-Hopital du Saint-Sacrement (HSS), Quebec City, Quebec, Canada
Name: John C Byrd
Affiliation: Alliance for Clinical Trials in Oncology
Role: PRINCIPAL_INVESTIGATOR