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A Phase IIb Study of Molecular Responses to Imatinib, at Standard or Increased Doses, or Dasatinib (NSC-732517) for Previously Untreated Patients With Chronic Myelogenous Leukemia (CML) in Chronic Phase


Phase 2
18 Years
N/A
Open (Enrolling)
Both
Chronic Myelogenous Leukemia, BCR-ABL1 Positive, Chronic Phase Chronic Myelogenous Leukemia

Thank you

Trial Information

A Phase IIb Study of Molecular Responses to Imatinib, at Standard or Increased Doses, or Dasatinib (NSC-732517) for Previously Untreated Patients With Chronic Myelogenous Leukemia (CML) in Chronic Phase


PRIMARY OBJECTIVES:

I. Compare the rate of molecular response, as measured by the decrease in bcr-abl
transcripts after 12 months of treatment, in patients with previously untreated chronic
phase chronic myelogenous leukemia treated with imatinib mesylate at standard vs increased
dose or dasatinib.

II. Test whether increasing dose of imatinib mesylate from 400 mg/day to 800 mg/day
increases molecular response rate (as measured by decrease in bcr-abl transcript after 12
months of treatment) in these patients.

III. Compare rates of cytogenetic and hematologic response in patients treated with these
regimens.

IV. Compare, preliminarily, the prognostic effects of der(9) and der(22) chromosomal
deletions for response in patients treated with these regimens.

V. Compare, preliminarily, changes in gene expression at pre-treatment vs at relapse or
progression in patients treated with these regimens.

VI. Compare the frequency and severity of the toxic effects of these regimens in these
patients.

VII. Compare, preliminarily, the overall survival and relapse-free survival of patients
treated with these regimens.

OUTLINE:

This is a randomized, multicenter study. Patients are stratified according to Hasford risk
category (low vs intermediate vs high). Patients are randomized to 1 of 3 treatment arms.

ARM I: Patients receive oral imatinib mesylate once daily.

ARM II: Patients receive oral imatinib mesylate twice daily.

ARM III: Patients receive oral dasatinib twice daily.

In all arms, treatment continues for 5 years in the absence of disease progression or
unacceptable toxicity.

After completion of study treatment, patients are followed for up to 5 years.

Inclusion Criteria


Criteria:

- Diagnosis of chronic phase chronic myelogenous leukemia (CML) by bone marrow
aspiration, biopsy, and peripheral blood counts, meeting criteria for 1 of the
following:

- Philadelphia chromosome-positive* or presence of the variants of the (9;22)
translocation by cytogenetics or fluorescent in situ hybridization

- Secondary chromosomal abnormalities (in addition to the Philadelphia chromosome)
allowed; bcr-abl positive* by reverse transcription polymerase chain reaction
[Note: *First cytogenetic or molecular analysis performed within the past 180
days to confirm status]

- No other malignancy within the past 5 years except adequately treated basal cell or
squamous cell skin cancer, carcinoma in situ of the cervix, or adequately treated
stage I or II cancer currently in complete remission

- Must be enrolled on SWOG-9007 (SWOG institutions only) and SWOG-S9910

- No significant bleeding disorder unrelated to cancer including:

- Congenital bleeding disorders (e.g., von Willebrand's disease)

- Acquired bleeding disorder within the past year (e.g., acquired anti-factor VIII
antibodies)

- Bilirubin no greater than 2.0 times upper limit of normal (ULN)

- AST or ALT no greater than 2.0 times ULN

- No cardiac symptoms including any of the following:

- Uncontrolled angina

- Congestive heart failure or myocardial infarction within the past 6 months

- Diagnosed or suspected congenital long QT syndrome

- History of clinically significant ventricular arrhythmias (e.g., ventricular
tachycardia, ventricular fibrillation, or Torsades de pointes)

- Prolonged QTc interval on electrocardiogram (> 450 msec)

- Uncontrolled hypertension

- Zubrod 0-2

- Not pregnant or nursing

- Fertile patients must use effective contraception

- No other concurrent anticancer biologic agents

- No prior chemotherapy for peripheral blood stem cell mobilization

- Prior collection of unmobilized peripheral blood stem cells allowed

- No other concurrent anticancer chemotherapy

- Concurrent hydroxyurea and/or anagrelide to control blood counts allowed provided it
is only administered during the first 28 days of study therapy and for no more than
28 additional days after study therapy

- No concurrent anticancer radiotherapy

- More than 28 days since prior major surgery and recovered

- No prior treatment for CML (except hydroxyurea and/or anagrelide)

- No concurrent therapeutic anticoagulation with warfarin

- Concurrent therapeutic anticoagulation with low-molecular weight heparin allowed

- Concurrent low-dose warfarin for prophylaxis to prevent catheter thrombosis allowed
(arm III only)

- No concurrent drugs* that have a risk of causing Torsades de Pointe including (arm
III patients only):

- Quinidine

- Procainamide

- Disopyramide

- Amiodarone

- Sotalol

- Ibutilide

- Dofetilide

- Erythromycin

- Clarithromycin

- Chlorpromazine

- Haloperidol

- Mesoridazine

- Thioridazine

- Pimozide

- Cisapride

- Pepridil

- Droperidol

- Methadone

- Arsenic

- Chloroquine

- Domperidone

- Halofantrine

- Levomethadyl

- Pentamidine

- Sparfloxacin

- Lidoflazine [Note: *Patients who have discontinued any of these medications must
have a wash-out period of at least 5 days or at least 5 half-lives of the drug
prior to first dose of dasatinib]

- No concurrent drugs that irreversibly inhibit platelet function, including any of the
following (arm III only):

- Aspirin

- Patients who have discontinued aspirin must have a wash-out period of at
least 7 days for low-dose aspirin (< 325 mg/day) or 14 days for high-dose
aspirin (> 325 mg/day) prior to first dose of dasatinib

- Dipyridamole

- Epoprostenol

- Eptifibatide

- Clopidogrel

- Cilostazol

- Abciximab

- Ticlopidine

- No other concurrent anticancer agents

Type of Study:

Interventional

Study Design:

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

Outcome Measure:

Molecular Response Rate at 12 Months

Outcome Description:

Median value of baseline bcr-abl/bcr ratio from pretreatment was used as the baseline value for assessing each patient's molecular response. Molecular response criteria were: 1) not failed treatment on or before 12-month evaluation; 2) met criteria for hemalotogic response; 3) bcr-abl/bcr ration at 12-months must be 10,000 times smaller than the pretreatment ratio.

Outcome Time Frame:

pretreatment and after 12 months of treatment

Safety Issue:

No

Principal Investigator

Brian Druker

Investigator Role:

Principal Investigator

Investigator Affiliation:

Southwest Oncology Group

Authority:

United States: Food and Drug Administration

Study ID:

NCI-2009-00764

NCT ID:

NCT00070499

Start Date:

August 2004

Completion Date:

Related Keywords:

  • Chronic Myelogenous Leukemia, BCR-ABL1 Positive
  • Chronic Phase Chronic Myelogenous Leukemia
  • Leukemia
  • Leukemia, Myeloid
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive
  • Leukemia, Myeloid, Chronic-Phase

Name

Location

Mayo ClinicRochester, Minnesota  55905
H. Lee Moffitt Cancer Center and Research InstituteTampa, Florida  33612
University of Washington Medical CenterSeattle, Washington  98195-6043
Hurley Medical CenterFlint, Michigan  48503
University of Texas Health Science Center at San AntonioSan Antonio, Texas  78284-7811
Bronson Methodist HospitalKalamazoo, Michigan  49007
West Michigan Cancer CenterKalamazoo, Michigan  49007-3731
Borgess Medical CenterKalamazooaa, Michigan  49001
Fairview Ridges HospitalBurnsville, Minnesota  55337
Hutchinson Area Health CareHutchinson, Minnesota  55350
Meeker County Memorial HospitalLichfield, Minnesota  55355
United HospitalSt. Paul, Minnesota  55102
Ridgeview Medical CenterWaconia, Minnesota  55387
Geisinger Medical CenterDanville, Pennsylvania  17822-0001
Loyola University Medical CenterMaywood, Illinois  60153
Massachusetts General Hospital Cancer CenterBoston, Massachusetts  02114
Henry Ford HospitalDetroit, Michigan  48202
Marshfield ClinicMarshfield, Wisconsin  54449
Methodist Medical Center of IllinoisPeoria, Illinois  61636
Western Pennsylvania HospitalPittsburgh, Pennsylvania  15224
Dana-Farber Cancer InstituteBoston, Massachusetts  02115
Virginia Piper Cancer InstituteMinneapolis, Minnesota  55407
Brooke Army Medical CenterFort Sam Houston, Texas  78234-6200
Puget Sound Oncology ConsortiumSeattle, Washington  98109
Eastern Maine Medical CenterBangor, Maine  04401
Via Christi Regional Medical CenterWichita, Kansas  67214
Carolinas Medical CenterCharlotte, North Carolina  28232-2861
Group Health CooperativeSeattle, Washington  98112
Great Falls ClinicGreat Falls, Montana  59405
Wilford Hall Medical CenterLackland Air Force Base, Texas  78236-5300
Tod Children's Hospital - Forum HealthYoungstown, Ohio  44501
Fred Hutchinson Cancer Research Center/University of Washington Cancer ConsortiumSeattle, Washington  98109
Lewistown HospitalLewistown, Pennsylvania  17044
Mount Nittany Medical CenterState College, Pennsylvania  16803
Cancer Center of Kansas - ChanuteChanute, Kansas  66720
Cancer Center of Kansas - Dodge CityDodge City, Kansas  67801
Cancer Center of Kansas - NewtonNewton, Kansas  67114
Cancer Center of Kansas - SalinaSalina, Kansas  67042
Cancer Center of Kansas - WellingtonWellington, Kansas  67152
Associates in Womens HealthWichita, Kansas  67203
Cancer Center of Kansas - WinfieldWinfield, Kansas  67156
Holland Community HospitalHolland, Michigan  49423
Munson Medical CenterTraverse City, Michigan  49684
Northern Rockies Radiation Oncology CenterBillings, Montana  59101
Bozeman Deaconess HospitalBozeman, Montana  59715
Big Sky OncologyGreat Falls, Montana  59405
Kalispell Medical OncologyKalispell, Montana  59901
Kalispell Regional Medical CenterKalispell, Montana  59901
Eastern Montana Cancer CenterMiles City, Montana  59301
Adena Regional Medical CenterChillicothe, Ohio  54601
Grady Memorial HospitalDelaware, Ohio  43015
Fairfield Medical CenterLancaster, Ohio  43130
Medical X-Ray CenterSioux Falls, South Dakota  57105
Harborview Medical CenterSeattle, Washington  98104
Cancer Care Northwest - Spokane SouthSpokane, Washington  99202
Central Washington HospitalWenatchee, Washington  98801
Welch Cancer CenterSheridan, Wyoming  82801
University of New Mexico Cancer CenterAlbuquerque, New Mexico  87131-5636
Brigham and Women's HospitalBoston, Massachusetts  02115
City of Hope Medical CenterDuarte, California  91010
Arthur G. James Cancer Hospital and Solove Research Institute at Ohio State University Medical CenterColumbus, Ohio  43210-1240
Beebe Medical CenterLewes, Delaware  19958
Memorial HospitalCarthage, Illinois  62321
Swedish Covenant HospitalChicago, Illinois  60625
Mercy Hospital and Medical CenterChicago, Illinois  60616
Hematology and Oncology AssociatesChicago, Illinois  60611
Galesburg Cottage HospitalGalesburg, Illinois  61401
Galesburg ClinicGalesburg, Illinois  61401
Mason District HospitalHavana, Illinois  62644
Kewanee HospitalKewanee, Illinois  61443
McDonough District HospitalMacomb, Illinois  61455
BroMenn Regional Medical CenterNormal, Illinois  61761
Proctor HospitalPeoria, Illinois  61614
Perry Memorial HospitalPrinceton, Illinois  61356
Valley Cancer CenterSpring Valley, Illinois  61362
Mecosta County Medical CenterBig Rapids, Michigan  49307
Saint Francis Medical CenterCape Girardeau, Missouri  63701
Wayne Radiation OncologyGoldsboro, North Carolina  27534
Iredell Memorial HospitalStatesville, North Carolina  28677
Wilson Medical CenterWilson, North Carolina  27893-3428
Grandview HospitalDayton, Ohio  45405
Exempla Lutheran Medical CenterWheat Ridge, Colorado  80033
Eureka HospitalEureka, Illinois  61530
Cancer Center of Kansas - OttawaOttawa, Kansas  66067
Mercy HospitalCoon Rapids, Minnesota  55433
Graham Hospital AssociationCanton, Illinois  61520
Saint Joseph Medical CenterJoliet, Illinois  60435
Deerpath Medical AssociatesLake Forest, Illinois  60045
Pekin HospitalPekin, Illinois  61554
Saint Joseph Mercy HospitalAnn Arbor, Michigan  48106
Fairview-Southdale HospitalEdina, Minnesota  55435
Abbott-Northwestern HospitalMinneapolis, Minnesota  55407
Regions HospitalSaint Paul, Minnesota  55101
Saint Francis Regional Medical CenterShakopee, Minnesota  55379
Mary Imogene Bassett HospitalCooperstown, New York  13326
Geisinger Medical GroupState College, Pennsylvania  16801
Swedish American HospitalRockford, Illinois  61104
Missouri Cancer AssociatesColumbia, Missouri  65201
Miami Valley HospitalDayton, Ohio  45409
Spartanburg Regional Medical CenterSpartanburg, South Carolina  29303
Cancer Center of Kansas-IndependenceIndependence, Kansas  67301
Lawrence Memorial HospitalLawrence, Kansas  66044
Menorah Medical CenterOverland Park, Kansas  66209
Shawnee Mission Medical CenterShawnee Mission, Kansas  66204
North Kansas City HospitalKansas City, Missouri  64116
Research Medical CenterKansas City, Missouri  64132
Heartland Regional Medical CenterSaint Joseph, Missouri  64506
Bozeman Deaconess Cancer CenterBozeman, Montana  59715
Mary Rutan HospitalBellefontaine, Ohio  43311
Wenatchee Valley Medical CenterWenatchee, Washington  98801-2028
Marshfield Clinic Cancer Care at Regional Cancer CenterEau Claire, Wisconsin  54701
Saint Joseph's HospitalMarshfield, Wisconsin  54449
Marshfield Clinic - Weston CenterWeston, Wisconsin  54476
Marshfield Clinic - Wisconsin Rapids CenterWisconsin Rapids, Wisconsin  54494
Singing River HospitalPascagoula, Mississippi  39581
Greene Memorial HospitalXenia, Ohio  45385
Union Hospital of Cecil CountyElkton MD, Maryland  21921
Mayo Clinic in FloridaJacksonville, Florida  32224
Memorial Medical CenterSpringfield, Illinois  62781
McLeod Regional Medical CenterFlorence, South Carolina  29501
Metro Health HospitalGrand Rapids, Michigan  49506
Guardian Oncology and Center for WellnessMissoula, Montana  59804
Woodwinds Health CampusWoodbury, Minnesota  55125
Providence Medical CenterKansas City, Kansas  66112
Independence Regional Health CenterIndependence, Missouri  64050
Northwestern UniversityChicago, Illinois  60611
Hennepin County Medical CenterMinneapolis, Minnesota  
Saint Louis University HospitalSt. Louis, Missouri  63110-0250
University of RochesterRochester, New York  14642
Riverside Methodist HospitalColumbus, Ohio  43214
Licking Memorial HospitalNewark, Ohio  43055-2899
Columbus CCOPColumbus, Ohio  43206
Wichita CCOPWichita, Kansas  67214-3882
Montana Cancer Consortium CCOPBillings, Montana  59101
Huntsman Cancer Institute/University of UtahSalt Lake City, Utah  84112
Metro-Minnesota CCOPSt. Louis Park, Minnesota  
Providence HospitalSouthfield, Michigan  48075
Oregon Health and Science UniversityPortland, Oregon  97201
Decatur Memorial HospitalDecatur, Illinois  62526
Kaiser PermanentePortland, Oregon  97227
Montana Cancer SpecialistsMissoula, Montana  59807-7877
University of Chicago Comprehensive Cancer CenterChicago, Illinois  60637-1470
University of Southern CaliforniaLos Angeles, California  90033
University of CincinnatiCincinnati, Ohio  45267-0502
Penn State Milton S Hershey Medical CenterHershey, Pennsylvania  17033
Wake Forest University Health SciencesWinston-Salem, North Carolina  27157
OSF Saint Francis Medical CenterPeoria, Illinois  61637
Kaiser Permanente-Santa Teresa-San JoseSan Jose, California  95119
Edna Williams Cancer Center at the Baptist Cancer InstituteJacksonville, Florida  32207
M D Anderson Cancer Center- OrlandoOrlando, Florida  32806
Saint Anthony's HealthAlton, Illinois  62002
Rush - Copley Medical CenterAurora, Illinois  60504
Intercommunity Cancer CenterGalesburg, Illinois  61401
Hopedale Medical Complex - HospitalHopedale, Illinois  61747
Joliet Oncology-Hematology Associates LimitedJoliet, Illinois  60435
Midwest Center for Hematology OncologyJoliet, Illinois  60432
North Shore Hematology OncologyLibertyville, Illinois  60048
Good Samaritan Regional Medical CenterMt. Vernon, Illinois  62864
Community Cancer Center FoundationNormal, Illinois  61761
Illinois CancerCare-Ottawa ClinicOttawa, Illinois  61350
Ottawa Regional Hospital and Healthcare CenterOttawa, Illinois  61350
Pekin Cancer Treatment CenterPekin, Illinois  61554
Illinois Oncology Research Association CCOPPeoria, Illinois  61615
Illinois CancerCare-PeoriaPeoria, Illinois  61615
Illinois Valley HospitalPeru, Illinois  61354
Hematology Oncology Associates of Illinois - SkokieSkokie, Illinois  60076
Midwest Cancer Research Group IncorporatedSkokie, Illinois  60077
Edward H Kaplan MD and AssociatesSkokie, Illinois  60076
Saint Margaret's HospitalSpring Valley, Illinois  61362
Carle Clinic-Urbana MainUrbana, Illinois  61801
Saint Francis Hospital and Health CentersBeech Grove, Indiana  46107
Fort Wayne Medical Oncology and Hematology Inc - State BoulevardFort Wayne, Indiana  46845
Saint Anthony Memorial Health CenterMichigan City, Indiana  46360
Reid Hospital and Health Care ServicesRichmond, Indiana  47374
McFarland ClinicAmes, Iowa  50010
Memorial Hospital of Arkansas CityArkansas City, Kansas  67005
Cancer Center of Kansas - El DoradoEl Dorado, Kansas  67042
Cancer Center of Kansas-KingmanKingman, Kansas  67068
Radiation Oncology Practice Corporation SouthwestOverland Park, Kansas  66210
Cancer Center of Kansas - ParsonsParsons, Kansas  67357
Cancer Center of Kansas - PrattPratt, Kansas  67124
Stormont-Vail Regional Health CenterTopeka, Kansas  66604
Saint Francis Hospital and Medical Center - TopekaTopeka, Kansas  66606
Cancer Center of Kansas-Wichita Medical Arts TowerWichita, Kansas  67208
Cancer Center of Kansas - Main OfficeWichita, Kansas  67214
Michigan Cancer Research Consortium Community Clinical Oncology ProgramAnn Arbor, Michigan  48106
Oakwood HospitalDearborn, Michigan  48123
Saint John Hospital and Medical CenterDetroit, Michigan  48236
Grand Rapids Clinical Oncology ProgramGrand Rapids, Michigan  49503
Saint Mary's Health CareGrand Rapids, Michigan  49503
Spectrum Health at Butterworth CampusGrand Rapids, Michigan  49503
Allegiance HealthJackson, Michigan  49201
Sparrow HospitalLansing, Michigan  48912
Saint Mary Mercy HospitalLivonia, Michigan  48154
Mercy Health Partners-Hackley CampusMuskegon, Michigan  49442
Saint Joseph Mercy OaklandPontiac, Michigan  48341-2985
Saint Joseph Mercy Port HuronPort Huron, Michigan  48060
Saint Mary's of MichiganSaginaw, Michigan  48601
Saint John Macomb-Oakland HospitalWarren, Michigan  48093
Unity HospitalFridley, Minnesota  55432
Saint John's Hospital - HealtheastMaplewood, Minnesota  55109
Minnesota Oncology Hematology PA-MaplewoodMaplewood, Minnesota  55109
North Memorial Medical Health CenterRobbinsdale, Minnesota  55422
Park Nicollet Clinic - Saint Louis ParkSaint Louis Park, Minnesota  55416
Saint Joseph's Hospital - HealtheastSaint Paul, Minnesota  55102
Minnesota Oncology and Hematology PA-WoodburyWoodbury, Minnesota  55125
Southeast Missouri HospitalCape Girardeau, Missouri  63701
Radiation Oncology Practice Corporation - NorthKansas City, Missouri  64154
Saint Luke's Cancer InstituteKansas City, Missouri  64111
Radiation Oncology Practice Corporation SouthKansas City, Missouri  64114
Saint Luke's Hospital of Kansas CityKansas City, Missouri  64111
Saint Joseph Health CenterKansas City, Missouri  64114
Liberty Radiation Oncology ClinicKansas City, Missouri  64116
Truman Medical CenterKansas City, Missouri  64108
Saint Louis-Cape Girardeau CCOPSaint Louis, Missouri  63141
Saint John's Mercy Medical CenterSaint Louis, Missouri  63141
Saint Louis Cancer and Breast InstituteSaint Louis, Missouri  63109
Hematology-Oncology Centers of the Northern Rockies PCBillings, Montana  59101
Saint Vincent HealthcareBillings, Montana  59101
Deaconess Medical CenterBillings, Montana  59107
Billings ClinicBillings, Montana  59107-7000
Internal Medicine of BozemanBozeman, Montana  59715
Saint James Community Hospital and Cancer Treatment CenterButte, Montana  59701
Benefis Healthcare- Sletten Cancer InstituteGreat Falls, Montana  59405
Berdeaux, Donald MD (UIA Investigator)Great Falls, Montana  59405
Saint Peter's Community HospitalHelena, Montana  59601
Glacier Oncology PLLCKalispell, Montana  59901
Community Medical HospitalMissoula, Montana  59801
Saint Patrick Hospital - Community HospitalMissoula, Montana  59802
Cooper Hospital University Medical CenterCamden, New Jersey  08103
The North Division of Montefiore Medical CenterBronx, New York  10466
Adirondack Cancer CenterGlens Falls, New York  12801
Interlakes Foundation Inc-RochesterRochester, New York  14623
State University of New York Upstate Medical UniversitySyracuse, New York  13210
Wayne Memorial HospitalGoldsboro, North Carolina  27534
Kinston Medical Specialists PAKinston, North Carolina  28501
Aultman Health FoundationCanton, Ohio  44710
Doctors HospitalColumbus, Ohio  43228
Grant Medical CenterColumbus, Ohio  43215
Mount Carmel Health Center WestColumbus, Ohio  43222
Good Samaritan Hospital - DaytonDayton, Ohio  45406
Dayton CCOPDayton, Ohio  45429
Samaritan North Health CenterDayton, Ohio  45415
Veteran Affairs Medical CenterDayton, Ohio  45428
Blanchard Valley HospitalFindlay, Ohio  45840
Atrium Medical Center-Middletown Regional HospitalFranklin, Ohio  45005-1066
Kettering Medical CenterKettering, Ohio  45429
Saint Rita's Medical CenterLima, Ohio  45801
Mansfield General Hospital-MedCentral Health SystemMansfield, Ohio  44903
Marietta Memorial HospitalMarietta, Ohio  45750
Upper Valley Medical CenterTroy, Ohio  45373
Saint Ann's HospitalWesterville, Ohio  43081
Genesis HealthCare SystemZanesville, Ohio  43701
Natalie W Bryant Cancer CenterTulsa, Oklahoma  74136
Saint Luke's HospitalBethlehem, Pennsylvania  18015
Aria Health-Torresdale CampusPhiladelphia, Pennsylvania  19114
Geisinger Wyoming ValleyWilkes-Barre, Pennsylvania  18711
Upstate Carolina CCOPSpartanburg, South Carolina  29303
Sanford Cancer Center-Oncology ClinicSioux Falls, South Dakota  57104
Sanford University of South Dakota Medical CenterSioux Falls, South Dakota  57117-5134
Audie L Murphy Veterans Affairs HospitalSan Antonio, Texas  78209
University HospitalSan Antonio, Texas  78229
Saint Joseph HospitalBellingham, Washington  98225
Harrison Bremerton Hematology and OncologyBremerton, Washington  98310
Columbia Basin Hematology and Oncology PLLCKennewick, Washington  99336
Minor and James Medical PLLCSeattle, Washington  98104
The PolyclinicSeattle, Washington  98122
Swedish Medical Center-First HillSeattle, Washington  98122-4307
West Virginia UniversityMorgantown, West Virginia  26506
Sacred Heart HospitalEau Claire, Wisconsin  54701
Marshfield Clinic-Minocqua CenterMinocqua, Wisconsin  54548
Marshfield Clinic at James Beck Cancer CenterRhinelander, Wisconsin  54501
Marshfield Clinic-Rice Lake CenterRice Lake, Wisconsin  54868
Saint Michael's HospitalStevens Point, Wisconsin  54481
Marshfield Clinic-Wausau CenterWausau, Wisconsin  54401
University of IllinoisChicago, Illinois  60612
Stony Brook University Medical CenterStony Brook, New York  11794
York HospitalYork, Maine  03909
Denver Veterans Administration Medical CenterDenver, Colorado  80220
Montrose Memorial HospitalMontrose, Colorado  81401
Jesse Brown Veterans Affairs Medical CenterChicago, Illinois  60612
DuPage Medical Group-OgdenNaperville, Illinois  60563
University of Michigan University HospitalAnn Arbor, Michigan  48109
Syracuse Veterans Administration Medical CenterSyracuse, New York  13210
Skagit Valley HospitalMt. Vernon, Washington  98273
University of Miami Miller School of Medicine-Sylvester Cancer CenterMiami, Florida  33136
Salina Regional Health Center.Salina, Kansas  67401
United General HospitalSedro-Woolley, Washington  98284
Gundersen LutheranLa Crosse, Wisconsin  54601
Hematology Oncology Associates of Central New York PCEast Syracuse, New York  13057
Southwest Oncology GroupSan Antonio, Texas  78245
Genesys Regional Medical Center-West Flint CampusFlint, Michigan  48532
Christiana Care Health System-Christiana HospitalNewark, Delaware  19718
Saint Francis Hospital - WilmingtonWilmington, Delaware  19805
Illinois Cancer Specialists-NilesNiles, Illinois  60714
Bronson Battle CreekBattle Creek, Michigan  49017
Riverview Medical Center/Booker Cancer CenterRed Bank, New Jersey  07701
Springfield Regional Medical CenterSpringfield, Ohio  45505