Randomized Phase III Trial Comparing Two Different Rituximab Dosing Regimens For Patients With Low Tumor Burden Indolent Non-Hodgkin's Lymphoma
Phase 3
18 Years
N/A
18 Years
N/A
Open (Enrolling)
Both
Lymphoma
Both
Lymphoma
Trial Information
Randomized Phase III Trial Comparing Two Different Rituximab Dosing Regimens For Patients With Low Tumor Burden Indolent Non-Hodgkin's Lymphoma
OBJECTIVES:
Primary
- Compare the time to rituximab failure in patients with low tumor burden indolent
non-Hodgkin's lymphoma treated with rituximab scheduled vs rituximab retreatment.
Secondary
- Compare the time to first cytotoxic therapy in patients treated with these regimens.
- Determine the rationale for beginning cytotoxic therapy, defined as chemotherapy,
radiotherapy, or radioimmunotherapy, in patients treated with these regimens.
- Compare the toxic effects associated with these regimens in these patients.
- Correlate response and duration of response in these patients with rituximab
pharmacokinetics.
- Compare the health-related quality of life, distress, psychological functioning,
physical well-being, and functional well-being of patients treated with these regimens.
- Compare the impact of differential treatment response (delayed time to rituximab
failure and/or time to first cytotoxic therapy) on quality of life, distress, and
psychological functioning in patients treated with these regimens.
- Determine, prospectively, the physical and functional well-being of patients during
treatment with these regimens.
OUTLINE: This is a randomized, multicenter study. Patients are stratified according to
histologic subtype (follicular vs other), age (under 60 vs 60 and over), and the time from
diagnosis (less than 1 year vs at least 1 year).
- Induction rituximab: Patients receive rituximab IV once a week for 4 weeks. Patients
are re-evaluated 9 weeks after the completion of induction rituximab. Patients with a
partial or complete response to induction rituximab are randomized to 1 of 2 treatment
arms.
- Arm I (retreatment rituximab): Patients receive rituximab IV once a week for 4 weeks
upon disease progression provided time to progression is more than 6 months.
- Arm II (scheduled rituximab): Patients receive a single dose of rituximab IV once every
13 weeks until disease progression and in the absence of unacceptable toxicity.
Quality of life is assessed after induction rituximab treatment and at 26, 39, 65, 117, 169,
and 221 weeks after randomization.
Patients are followed at least annually for 15 years from study entry.
PROJECTED ACCRUAL: A total of 389 patients will be accrued for this study within 45 months.
Inclusion Criteria
DISEASE CHARACTERISTICS:
- Histologically confirmed non-Hodgkin's lymphoma, including 1 of the following:
- Follicular grade 1 or 2
- Small lymphocytic
- Marginal zone (nodal)
- Marginal zone (splenic)
- Mucosa-associated lymphoid tissue (MALT)
- No evidence of transformation to a large cell histology
- Stage III or IV disease
- Must meet the following criteria for low tumor burden:
- No nodal or extranodal mass at least 7 cm
- Less than 3 nodal masses greater than 3 cm in diameter
- No systemic symptoms or B symptoms
- No splenomegaly greater than 16 cm by CT scan
- No evidence of risk of compression of a vital organ (i.e., ureteral or epidural)
- No leukemic phase with greater than 5,000/mm^3 circulating lymphocytes
- No cytopenias, defined as any of the following:
- Platelet count less than 100,000/mm^3
- Hemoglobin less than 10 g/dL
- Absolute neutrophil count less than 1,500/mm^3
- At least 1 objective measurable disease parameter
- Abnormal PET scans will not constitute evaluable disease unless verified by CT
scan or other appropriate imaging
PATIENT CHARACTERISTICS:
Age
- 18 and over
Performance status
- ECOG 0-1
Life expectancy
- Not specified
Hematopoietic
- See Disease Characteristics
- Absolute neutrophil count at least 1,500/mm^3*
- Hemoglobin at least 10 g/dL*
- Platelet count at least 100,000/mm^3* NOTE: *Without growth factor and/or transfusion
support
Hepatic
- Bilirubin no greater than 2 times upper limit of normal (ULN) OR direct bilirubin
normal for patients with Gilbert's Syndrome
- AST/ALT no greater than 5 times ULN
- Hepatitis B surface antigen negative
Renal
- Creatinine no greater than 2 times ULN
Other
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- HIV negative
- No uncontrolled active infection
- Afebrile for at least 48 hours off antibiotics
- No other malignancy within the past 2 years except adequately treated basal cell or
squamous cell skin cancer or carcinoma in situ of the cervix
PRIOR CONCURRENT THERAPY:
Biologic therapy
- See Radiotherapy
- No prior immunotherapy for lymphoma
Chemotherapy
- No prior chemotherapy for lymphoma
- No concurrent chemotherapy
Endocrine therapy
- Not specified
Radiotherapy
- No prior radiotherapy for lymphoma
- No concurrent radiotherapy
- No concurrent radioimmunotherapy
Surgery
- Not specified
Type of Study:
Interventional
Study Design:
Allocation: Randomized, Primary Purpose: Treatment
Outcome Measure:
Time to treatment failure
Safety Issue:
No
Principal Investigator
Brad S. Kahl, MD
Investigator Role:
Study Chair
Investigator Affiliation:
University of Wisconsin, Madison
Authority:
United States: Federal Government
Study ID:
CDR0000346359
NCT ID:
NCT00075946
Start Date:
November 2003
Completion Date:
Related Keywords:
- Lymphoma
- stage III grade 1 follicular lymphoma
- stage III grade 2 follicular lymphoma
- stage IV grade 1 follicular lymphoma
- stage IV grade 2 follicular lymphoma
- stage III small lymphocytic lymphoma
- stage III marginal zone lymphoma
- stage IV small lymphocytic lymphoma
- stage IV marginal zone lymphoma
- extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue
- nodal marginal zone B-cell lymphoma
- splenic marginal zone lymphoma
- Lymphoma
- Lymphoma, Non-Hodgkin
Name | Location |
|---|---|
| Mayo Clinic Scottsdale | Scottsdale, Arizona 85259 |
| Mayo Clinic - Jacksonville | Jacksonville, Florida 32224 |
| Mayo Clinic Cancer Center | Rochester, Minnesota 55905 |
| Walter Reed Army Medical Center | Washington, District of Columbia 20307-5000 |
| CCOP - Upstate Carolina | Spartanburg, South Carolina 29303 |
| CCOP - Wichita | Wichita, Kansas 67214-3882 |
| Hurley Medical Center | Flint, Michigan 48503 |
| CCOP - Kansas City | Kansas City, Missouri 64131 |
| CCOP - Missouri Valley Cancer Consortium | Omaha, Nebraska 68131 |
| CCOP - Christiana Care Health Services | Wilmington, Delaware 19899 |
| CCOP - Mount Sinai Medical Center | Miami Beach, Florida 33140 |
| CCOP - Illinois Oncology Research Association | Peoria, Illinois 61602 |
| CCOP - Carle Cancer Center | Urbana, Illinois 61801 |
| CCOP - Iowa Oncology Research Association | Des Moines, Iowa 50309-1016 |
| CCOP - Metro-Minnesota | Saint Louis Park, Minnesota 55416 |
| Veterans Affairs Medical Center - East Orange | East Orange, New Jersey 07018-1095 |
| Aurora Presbyterian Hospital | Aurora, Colorado 80012 |
| Boulder Community Hospital | Boulder, Colorado 80301-9019 |
| Penrose Cancer Center at Penrose Hospital | Colorado Springs, Colorado 80933 |
| CCOP - Colorado Cancer Research Program | Denver, Colorado 80224-2522 |
| Porter Adventist Hospital | Denver, Colorado 80210 |
| Presbyterian - St. Luke's Medical Center | Denver, Colorado 80218 |
| St. Joseph Hospital | Denver, Colorado 80218 |
| Rose Medical Center | Denver, Colorado 80220 |
| Swedish Medical Center | Englewood, Colorado 80110 |
| St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center | Grand Junction, Colorado 81502 |
| Sky Ridge Medical Center | Lone Tree, Colorado 80124 |
| Hope Cancer Care Center at Longmont United Hospital | Longmont, Colorado 80502 |
| St. Mary - Corwin Regional Medical Center | Pueblo, Colorado 81004 |
| North Suburban Medical Center | Thornton, Colorado 80229 |
| Rush-Copley Cancer Care Center | Aurora, Illinois 60507 |
| Evanston Northwestern Healthcare - Evanston Hospital | Evanston, Illinois 60201-1781 |
| Hinsdale Hematology Oncology Associates | Hinsdale, Illinois 60521 |
| Joliet Oncology-Hematology Associates, Limited - West | Joliet, Illinois 60435 |
| Carle Cancer Center at Carle Foundation Hospital | Urbana, Illinois 61801 |
| Saint Anthony Memorial Health Centers | Michigan City, Indiana 46360 |
| Cedar Rapids Oncology Associates | Cedar Rapids, Iowa 52403 |
| Mercy Medical Center - Sioux City | Sioux City, Iowa 51104 |
| Siouxland Hematology-Oncology Associates, LLP | Sioux City, Iowa 51101 |
| St. Luke's Regional Medical Center | Sioux City, Iowa 51104 |
| Tufts-NEMC Cancer Center | Boston, Massachusetts 02111 |
| CCOP - Michigan Cancer Research Consortium | Ann Arbor, Michigan 48106 |
| Saint Joseph Mercy Cancer Center | Ann Arbor, Michigan 48106-0995 |
| Oakwood Cancer Center at Oakwood Hospital and Medical Center | Dearborn, Michigan 48123-2500 |
| Genesys Hurley Cancer Institute | Flint, Michigan 48503 |
| Van Elslander Cancer Center at St. John Hospital and Medical Center | Grosse Pointe Woods, Michigan 48236 |
| Bronson Methodist Hospital | Kalamazoo, Michigan 49007 |
| West Michigan Cancer Center | Kalamazoo, Michigan 49007-3731 |
| Borgess Medical Center | Kalamazooaa, Michigan 49001 |
| Sparrow Regional Cancer Center | Lansing, Michigan 48912-1811 |
| St. John Macomb Hospital | Warren, Michigan 48093 |
| MeritCare Bemidji | Bemidji, Minnesota 56601 |
| Fairview Ridges Hospital | Burnsville, Minnesota 55337 |
| Mercy and Unity Cancer Center at Mercy Hospital | Coon Rapids, Minnesota 55433 |
| Duluth Clinic Cancer Center - Duluth | Duluth, Minnesota 55805-1983 |
| CCOP - Duluth | Duluth, Minnesota 55805 |
| Miller - Dwan Medical Center | Duluth, Minnesota 55805 |
| Fairview Southdale Hospital | Edina, Minnesota 55435 |
| Mercy and Unity Cancer Center at Unity Hospital | Fridley, Minnesota 55432 |
| Hutchinson Area Health Care | Hutchinson, Minnesota 55350 |
| Meeker County Memorial Hospital | Lichfield, Minnesota 55355 |
| Minnesota Oncology Hematology, PA - Maplewood | Maplewood, Minnesota 55109 |
| HealthEast Cancer Care at St. John's Hospital | Maplewood, Minnesota 55109 |
| Hennepin County Medical Center - Minneapolis | Minneapolis, Minnesota 55415 |
| Virginia Piper Cancer Institute at Abbott - Northwestern Hospital | Minneapolis, Minnesota 55407 |
| Hubert H. Humphrey Cancer Center at North Memorial Outpatient Center | Robbinsdale, Minnesota 55422-2900 |
| St. Francis Cancer Center at St. Francis Medical Center | Shakopee, Minnesota 55379 |
| HealthEast Cancer Care at St. Joseph's Hospital | St Paul, Minnesota 55102 |
| Park Nicollet Cancer Center | St. Louis Park, Minnesota 55416 |
| Regions Hospital Cancer Care Center | St. Paul, Minnesota 55101 |
| United Hospital | St. Paul, Minnesota 55102 |
| Ridgeview Medical Center | Waconia, Minnesota 55387 |
| Minnesota Oncology Hematology, PA - Woodbury | Woodbury, Minnesota 55125 |
| HealthEast Cancer Care at Woodwinds Health Campus | Woodbury, Minnesota 55125 |
| MeritCare Broadway | Fargo, North Dakota 58122 |
| CCOP - MeritCare Hospital | Fargo, North Dakota 58122 |
| Aultman Cancer Center at Aultman Hospital | Canton, Ohio 44710-1799 |
| Mercy Cancer Center at Mercy Medical Center | Canton, Ohio 44708 |
| Case Comprehensive Cancer Center | Cleveland, Ohio 44106-5065 |
| MetroHealth Cancer Care Center at MetroHealth Medical Center | Cleveland, Ohio 44109 |
| St. Rita's Medical Center | Lima, Ohio 45801 |
| Natalie Warren Bryant Cancer Center at St. Francis Hospital | Tulsa, Oklahoma 74136 |
| Penn State Cancer Institute at Milton S. Hershey Medical Center | Hershey, Pennsylvania 17033-0850 |
| Abramson Cancer Center of the University of Pennsylvania | Philadelphia, Pennsylvania 19104-4283 |
| Geisinger Medical Group - Scenery Park | State College, Pennsylvania 16801 |
| Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center | Wilkes-Barre, Pennsylvania 18711 |
| Sanford Cancer Center at Sanford USD Medical Center | Sioux Falls, South Dakota 57117-5039 |
| Medical X-Ray Center, PC | Sioux Falls, South Dakota 57105 |
| Avera Cancer Institute | Sioux Falls, South Dakota 57105 |
| Gundersen Lutheran Cancer Center at Gundersen Lutheran Medical Center | La Crosse, Wisconsin 54601 |
| Dean Medical Center - Madison | Madison, Wisconsin 53717 |
| University of Wisconsin Paul P. Carbone Comprehensive Cancer Center | Madison, Wisconsin 53792-6164 |
| Marshfield Clinic - Marshfield Center | Marshfield, Wisconsin 54449 |
| Medical College of Wisconsin Cancer Center | Milwaukee, Wisconsin 53226 |
| Froedtert Hospital and Medical College of Wisconsin | Milwaukee, Wisconsin 53226-3596 |
| Marshfield Clinic - Indianhead Center | Rice Lake, Wisconsin 54868 |
| CCOP - Ochsner | New Orleans, Louisiana 70121 |
| Rapid City Regional Hospital | Rapid City, South Dakota 57709 |
| Providence Saint Joseph Medical Center - Burbank | Burbank, California 91505 |
| Methodist Medical Center of Illinois | Peoria, Illinois 61636 |
| Memorial Hospital of South Bend | South Bend, Indiana 46601 |
| CCOP - Cancer Research for the Ozarks | Springfield, Missouri 65807 |
| CCOP - Montana Cancer Consortium | Billings, Montana 59101 |
| CCOP - Columbus | Columbus, Ohio 43206 |
| Veterans Affairs Medical Center - Dayton | Dayton, Ohio 45428 |
| CCOP - Dayton | Kettering, Ohio 45429 |
| Albert Einstein Cancer Center | Philadelphia, Pennsylvania 19141 |
| Mercy Hospital Cancer Center - Scranton | Scranton, Pennsylvania 18501 |
| Grand View Hospital | Sellersville, Pennsylvania 18960 |
| CCOP - Greenville | Greenville, South Carolina 29615 |
| Green Mountain Oncology Group | Rutland, Vermont 05701 |
| CCOP - Northern Indiana CR Consortium | South Bend, Indiana 46601 |
| Saint Joseph Regional Medical Center | South Bend, Indiana 46617 |
| Kimmel Cancer Center at Thomas Jefferson University - Philadelphia | Philadelphia, Pennsylvania 19107 |
| MultiCare Regional Cancer Center at Tacoma General Hospital | Tacoma, Washington 98405 |
| Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins | Baltimore, Maryland 21231-2410 |
| Cleveland Clinic Taussig Cancer Center | Cleveland, Ohio 44195 |
| MBCCOP - LSU Health Sciences Center | New Orleans, Louisiana 70112 |
| CCOP - St. Louis-Cape Girardeau | Saint Louis, Missouri 63141 |
| CCOP - Northwest | Tacoma, Washington 98405-0986 |
| Kaiser Permanente Medical Center - Vallejo | Vallejo, California 94589 |
| Veterans Affairs Medical Center - Richmond | Richmond, Virginia 23249 |
| St. Joseph's Hospital and Medical Center | Paterson, New Jersey 07503 |
| Veterans Affairs Medical Center - Palo Alto | Palo Alto, California 94304 |
| Louis A. Weiss Memorial Hospital | Chicago, Illinois 60640 |
| John Stoddard Cancer Center at Iowa Methodist Medical Center | Des Moines, Iowa 50309 |
| Kaiser Permanente Medical Center - San Francisco Geary Campus | San Francisco, California 94115 |
| Medical Center of Central Georgia | Macon, Georgia 31201 |
| St. Vincent Mercy Medical Center | Toledo, Ohio 43608 |
| Arkansas Cancer Research Center at University of Arkansas for Medical Sciences | Little Rock, Arkansas 72205 |
| Blumenthal Cancer Center at Carolinas Medical Center | Charlotte, North Carolina 28232-2861 |
| Hulston Cancer Center at Cox Medical Center South | Springfield, Missouri 65807 |
| St. John's Regional Health Center | Springfield, Missouri 65804 |
| McDowell Cancer Center at Akron General Medical Center | Akron, Ohio 44307 |
| CCOP - Toledo Community Hospital | Toledo, Ohio 43623-3456 |
| Mercy Fitzgerald Hospital | Darby, Pennsylvania 19023 |
| Kaiser Permanente Medical Center - Oakland | Sacramento, California 95825 |
| University of Florida Shands Cancer Center | Gainesville, Florida 32610-0232 |
| Via Christi Cancer Center at Via Christi Regional Medical Center | Wichita, Kansas 67214 |
| Ochsner Cancer Institute at Ochsner Clinic Foundation | New Orleans, Louisiana 70121 |
| Albert Einstein Cancer Center at Albert Einstein College of Medicine | Bronx, New York 10461 |
| SUNY Upstate Medical University Hospital | Syracuse, New York 13210 |
| Mission Hospitals - Memorial Campus | Asheville, North Carolina 28801 |
| Presbyterian Cancer Center at Presbyterian Hospital | Charlotte, North Carolina 28233-3549 |
| Medical University of Ohio Cancer Center | Toledo, Ohio 43614 |
| Toledo Hospital | Toledo, Ohio 43606 |
| Edwards Comprehensive Cancer Center at Cabell Huntington Hospital | Huntington, West Virginia 25701 |
| St. Vincent Hospital Regional Cancer Center | Green Bay, Wisconsin 54307-3508 |
| McCreery Cancer Center at Ottumwa Regional | Ottumwa, Iowa 52501 |
| Green Bay Oncology, Limited - Escanaba | Escanaba, Michigan 49431 |
| Dickinson County Healthcare System | Iron Mountain, Michigan 49801 |
| Our Lady of Mercy Medical Center Comprehensive Cancer Center | Bronx, New York 10466 |
| Lewistown Hospital | Lewistown, Pennsylvania 17044 |
| Mount Nittany Medical Center | State College, Pennsylvania 16803 |
| Chester County Hospital | West Chester, Pennsylvania 19380 |
| St. Mary's Hospital Medical Center - Green Bay | Green Bay, Wisconsin 54303 |
| Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center | Green Bay, Wisconsin 54301-3526 |
| Green Bay Oncology, Limited at St. Mary's Hospital | Green Bay, Wisconsin 54303 |
| Bay Area Cancer Care Center at Bay Area Medical Center | Marinette, Wisconsin 54143 |
| Green Bay Oncology, Limited - Oconto Falls | Oconto Falls, Wisconsin 54154 |
| Green Bay Oncology, Limited - Sturgeon Bay | Sturgeon Bay, Wisconsin 54235 |
| Hematology Oncology Associates of the Quad Cities | Bettendorf, Iowa 52722 |
| Somerset Medical Center | Somerville, New Jersey 08876 |
| Batte Cancer Center at Northeast Medical Center | Concord, North Carolina 28025 |
| North Colorado Medical Center | Greeley, Colorado 80631 |
| McKee Medical Center | Loveland, Colorado 80539 |
| Baptist Cancer Institute - Jacksonville | Jacksonville, Florida 32207 |
| Saint Anthony's Hospital at Saint Anthony's Health Center | Alton, Illinois 62002 |
| Good Samaritan Regional Health Center | Mt. Vernon, Illinois 62864 |
| Southwest Medical Center | Liberal, Kansas 67901 |
| Northern Michigan Hospital | Petoskey, Michigan 49770 |
| William Beaumont Hospital - Royal Oak Campus | Royal Oak, Michigan 48073 |
| Southeast Missouri Regional Cancer Center at Southeast Missouri Hospital | Gape Girardeau, Missouri 63701 |
| David C. Pratt Cancer Center at St. John's Mercy | St. Louis, Missouri 63141 |
| Northern Rockies Radiation Oncology Center | Billings, Montana 59101 |
| Hematology-Oncology Centers of the Northern Rockies - Billings | Billings, Montana 59101 |
| Big Sky Oncology | Great Falls, Montana 59405 |
| St. Peter's Hospital | Helena, Montana 59601 |
| Kalispell Regional Medical Center | Kalispell, Montana 59901 |
| Glacier Oncology, PLLC | Kalispell, Montana 59901 |
| Montana Cancer Center at St. Patrick Hospital and Health Sciences Center | Missoula, Montana 59802 |
| Montana Cancer Specialists at Montana Cancer Center | Missoula, Montana 59802 |
| Community Medical Center | Missoula, Montana 59801 |
| Wayne Memorial Hospital, Incorporated | Goldsboro, North Carolina 27534 |
| Adena Regional Medical Center | Chillicothe, Ohio 54601 |
| Doctors Hospital at Ohio Health | Columbus, Ohio 43228 |
| Riverside Methodist Hospital Cancer Care | Columbus, Ohio 43214 |
| Grady Memorial Hospital | Delaware, Ohio 43015 |
| Fairfield Medical Center | Lancaster, Ohio 43130 |
| Strecker Cancer Center at Marietta Memorial Hospital | Marietta, Ohio 45750 |
| Licking Memorial Cancer Care Program at Licking Memorial Hospital | Newark, Ohio 43055 |
| Community Hospital of Springfield and Clark County | Springfield, Ohio 45505 |
| Genesis - Good Samaritan Hospital | Zanesville, Ohio 43701 |
| Memorial Cancer Institute at Memorial Regional Hospital | Hollywood, Florida 33021 |
| Kaiser Permanente Medical Center - Santa Clara Kiely Campus | Santa Clara, California 95051-5386 |
| Mountain States Tumor Institute at St. Luke's Regional Medical Center | Boise, Idaho 83712-6297 |
| Swedish-American Regional Cancer Center | Rockford, Illinois 61104-2315 |
| Indiana University Melvin and Bren Simon Cancer Center | Indianapolis, Indiana 46202-5289 |
| CancerCare of Maine at Eastern Maine Medical Center | Bangor, Maine 04401 |
| CCOP - Nevada Cancer Research Foundation | Las Vegas, Nevada 89109-2306 |
| Geisinger Cancer Institute at Geisinger Health | Danville, Pennsylvania 17822-0001 |
| Virginia Commonwealth University Massey Cancer Center | Richmond, Virginia 23298-0037 |
| Kaiser Permanente Medical Center - Sacramento | Sacramento, California 95825 |
| Methodist Estabrook Cancer Center | Omaha, Nebraska 68114-4199 |
| University of Virginia Cancer Center | Charlottesville, Virginia 22908 |
| Robert H. Lurie Comprehensive Cancer Center at Northwestern University | Chicago, Illinois 60611 |
| Decatur Memorial Hospital Cancer Care Institute | Decatur, Illinois 62526 |
| Elkhart General Hospital | Elkhart, Indiana 46515 |
| Howard Community Hospital | Kokomo, Indiana 46904 |
| Lakeland Regional Cancer Care Center - St. Joseph | St. Joseph, Michigan 49085 |
| Cleveland Clinic Cancer Center at Fairview Hospital | Cleveland, Ohio 44111 |
| Mount Carmel Health - West Hospital | Columbus, Ohio 43222 |
| Rosenfeld Cancer Center at Abington Memorial Hospital | Abington, Pennsylvania 19001 |
| Morgan Cancer Center at Lehigh Valley Hospital - Cedar Crest | Allentown, Pennsylvania 18105 |
| Fox Chase Cancer Center - Philadelphia | Philadelphia, Pennsylvania 19111-2497 |
| Front Range Cancer Specialists | Fort Collins, Colorado 80528 |
| University Medical Center of Southern Nevada | Las Vegas, Nevada 89102 |
| Finger Lakes Hematology and Oncology | Clifton Springs, New York 14432 |
| Joan Karnell Cancer Center at Pennsylvania Hospital | Philadelphia, Pennsylvania 19107 |
| UPMC Cancer Centers | Pittsburgh, Pennsylvania 15232 |
| Fox Valley Hematology and Oncology - East Grant Street | Appleton, Wisconsin 54911-3496 |
| North Bay Cancer Center | Fairfield, California 94533 |
| Kaiser Permanente - Fremont | Fremont, California 94538 |
| Kaiser Permanente Medical Center - Hayward | Hayward, California 94545 |
| Kaiser Permanente Medical Center - Redwood City | Redwood City, California 94063 |
| Kaiser Permanente Medical Center - Richmond | Richmond, California 94801 |
| Kaiser Permanente Medical Center - Roseville | Roseville, California 95661 |
| South Sacramento Kaiser-Permanente Medical Center | Sacramento, California 95823 |
| Kaiser Permanente Medical Office -Vandever Medical Office | San Diego, California 92120 |
| Kaiser Permanente Medical Center - Santa Teresa | San Jose, California 95119 |
| Kaiser Foundation Hospital - San Rafael | San Rafael, California 94903 |
| Kaiser Permanente Medical Center - Santa Rosa | Santa Rosa, California 95403 |
| Kaiser Permanente Medical Center - South San Francisco | South San Francisco, California 94080 |
| Kaiser Permanente Medical Facility - Stockton | Stockton, California 95210 |
| Kaiser Permanente Medical Center - Walnut Creek | Walnut Creek, California 94596 |
| Poudre Valley Hospital | Fort Collins, Colorado 80524 |
| Ella Milbank Foshay Cancer Center at Jupiter Medical Center | Jupiter, Florida 33458 |
| St. Joseph Medical Center | Bloomington, Illinois 61701 |
| Graham Hospital | Canton, Illinois 61520 |
| Memorial Hospital | Carthage, Illinois 62321 |
| Eureka Community Hospital | Eureka, Illinois 61530 |
| Galesburg Cottage Hospital | Galesburg, Illinois 61401 |
| Ingalls Cancer Care Center at Ingalls Memorial Hospital | Harvey, Illinois 60426 |
| Mason District Hospital | Havana, Illinois 62644 |
| Hopedale Medical Complex | Hopedale, Illinois 61747 |
| McDonough District Hospital | Macomb, Illinois 61455 |
| Hematology Oncology Consultants - Naperville | Naperville, Illinois 60540 |
| BroMenn Regional Medical Center | Normal, Illinois 61761 |
| Community Cancer Center | Normal, Illinois 61761 |
| Community Hospital of Ottawa | Ottawa, Illinois 61350 |
| Oncology Hematology Associates of Central Illinois, PC - Ottawa | Ottawa, Illinois 61350 |
| Cancer Treatment Center at Pekin Hospital | Pekin, Illinois 61554 |
| Oncology Hematology Associates of Central Illinois, PC - Peoria | Peoria, Illinois 61615 |
| OSF St. Francis Medical Center | Peoria, Illinois 61637 |
| Proctor Hospital | Peoria, Illinois 61614 |
| Illinois Valley Community Hospital | Peru, Illinois 61354 |
| Perry Memorial Hospital | Princeton, Illinois 61356 |
| St. Margaret's Hospital | Spring Valley, Illinois 61362 |
| St. Francis Hospital and Health Centers - Beech Grove Campus | Beech Grove, Indiana 46107 |
| Fort Wayne Medical Oncology and Hematology | Fort Wayne, Indiana 46815 |
| Center for Cancer Therapy at LaPorte Hospital and Health Services | La Porte, Indiana 46350 |
| Genesis Medical Center - West Campus | Davenport, Iowa 52804 |
| Genesis Regional Cancer Center at Genesis Medical Center | Davenport, Iowa 52803 |
| John Stoddard Cancer Center at Iowa Lutheran Hospital | Des Moines, Iowa 50316-2301 |
| Mercy Capitol Hospital | Des Moines, Iowa 50307 |
| Medical Oncology and Hematology Associates at John Stoddard Cancer Center | Des Moines, Iowa 50309 |
| Medical Oncology and Hematology Associates at Mercy Cancer Center | Des Moines, Iowa 50314 |
| Mercy Cancer Center at Mercy Medical Center - Des Moines | Des Moines, Iowa 50314 |
| Cancer Center of Kansas, PA - Dodge City | Dodge City, Kansas 67801 |
| St. Francis Comprehensive Cancer Center | Topeka, Kansas 66606 |
| Pennington Cancer Center at Baton Rouge General | Baton Rouge, Louisiana 70806 |
| Mary Bird Perkins Cancer Center - Baton Rouge | Baton Rouge, Louisiana 70809 |
| Terrebonne General Medical Center | Houma, Louisiana 70360 |
| Medical Center of Louisiana - New Orleans | New Orleans, Louisiana 70112 |
| Hickman Cancer Center at Bixby Medical Center | Adrian, Michigan 49221 |
| Community Cancer Center of Monroe | Monroe, Michigan 48162 |
| Alexandria, Minnesota 56308 | |
| Coborn Cancer Center | Saint Cloud, Minnesota 56303 |
| CentraCare Clinic - River Campus | St. Cloud, Minnesota 56303 |
| Saint Francis Medical Center | Cape Girardeau, Missouri 63701 |
| Immanuel Medical Center | Omaha, Nebraska 68122 |
| Creighton University Medical Center | Omaha, Nebraska 68131-2197 |
| Cancer Institute of New Jersey at Cooper - Voorhees | Voorhees, New Jersey 08043 |
| Bismarck Cancer Center | Bismarck, North Dakota 58501 |
| Wood County Oncology Center | Bowling Green, Ohio 43402 |
| Samaritan North Cancer Care Center | Dayton, Ohio 45415 |
| Grandview Hospital | Dayton, Ohio 45405 |
| David L. Rike Cancer Center at Miami Valley Hospital | Dayton, Ohio 45409 |
| Good Samaritan Hospital | Dayton, Ohio 45406 |
| Blanchard Valley Medical Associates | Findlay, Ohio 45840 |
| Community Oncology Group at Cleveland Clinic Cancer Center | Independence, Ohio 44131 |
| Charles F. Kettering Memorial Hospital | Kettering, Ohio 45429 |
| Lima Memorial Hospital | Lima, Ohio 45804 |
| St. Luke's Hospital | Maumee, Ohio 43537 |
| Northwest Ohio Oncology Center | Maumee, Ohio 43537 |
| Middletown Regional Hospital | Middletown, Ohio 45044 |
| Toledo Clinic - Oregon | Oregon, Ohio 43616 |
| St. Charles Mercy Hospital | Oregon, Ohio 43616 |
| North Coast Cancer Care, Incorporated | Sandusky, Ohio 44870 |
| Firelands Regional Medical Center | Sandusky, Ohio 44870 |
| Mercy Medical Center | Springfield, Ohio 45504 |
| Mercy Hospital of Tiffin | Tiffin, Ohio 44883 |
| Toledo Clinic, Incorporated - Main Clinic | Toledo, Ohio 43623 |
| UVMC Cancer Care Center at Upper Valley Medical Center | Troy, Ohio 45373-1300 |
| Fulton County Health Center | Wauseon, Ohio 43567 |
| Cleveland Clinic - Wooster | Wooster, Ohio 44691 |
| Ruth G. McMillan Cancer Center at Greene Memorial Hospital | Xenia, Ohio 45385 |
| Bryn Mawr Hospital | Bryn Mawr, Pennsylvania 19010 |
| Delaware County Regional Cancer Center at Delaware County Memorial Hospital | Drexel Hill, Pennsylvania 19026 |
| Lankenau Cancer Center at Lankenau Hospital | Wynnewood, Pennsylvania 19096 |
| Oncology Services of Aberdeen | Aberdeen, South Dakota 57401 |
| Danville Regional Medical Center | Danville, Virginia 24541 |
| Holy Family Memorial Medical Center Cancer Care Center | Manitowoc, Wisconsin 54221-1450 |
| Welch Cancer Center at Sheridan Memorial Hospital | Sheridan, Wyoming 82801 |
| St. Anthony Central Hospital | Denver, Colorado 80204-1335 |
| Exempla Lutheran Medical Center | Wheat Ridge, Colorado 80033 |
| St. Francis Hospital | Federal Way, Washington 98003 |
| St. Clare Hospital | Lakewood, Washington 98499-0998 |
| Good Samaritan Cancer Center | Puyallup, Washington 98371 |
| Allenmore Hospital | Tacoma, Washington 98411-0414 |
| Morton Hospital & Medical Center | Taunton, Massachusetts 02780 |
| Lancaster General Hospital | Lancaster, Pennsylvania 17604-3555 |
| Pottstown Memorial Regional Cancer Center | Pottstown, Pennsylvania 19464 |
| Hembree Mercy Cancer Center at St. Edward Mercy Medical Center | Ft. Smith, Arkansas 72903 |
| Northeast Georgia Medical Center | Gainesville, Georgia 30501 |
| Creticos Cancer Center at Advocate Illinois Masonic Medical Center | Chicago, Illinois 60657 |
| Mercy Cancer Center at Mercy Medical Center - North Iowa | Mason City, Iowa 50401 |
| Missouri Baptist Cancer Center | St. Louis, Missouri 63131 |
| Cancer Resource Center - Lincoln | Lincoln, Nebraska 68510 |
| Altru Cancer Center at Altru Hospital | Grand Forks, North Dakota 58201 |
| Stanford Cancer Center | Stanford, California 94305-5824 |
| Eastern Connecticut Hematology and Oncology Associates | Norwich, Connecticut 06360 |
| Tunnell Cancer Center at Beebe Medical Center | Lewes, Delaware 19958 |
| Michael and Dianne Bienes Comprehensive Cancer Center at Holy Cross Hospital | Fort Lauderdale, Florida 33308 |
| Nancy N. and J. C. Lewis Cancer and Research Pavilion at St. Joseph's/Candler | Savannah, Georgia 31405 |
| William N. Wishard Memorial Hospital | Indianapolis, Indiana 46202 |
| Reid Hospital & Health Care Services | Richmond, Indiana 47374 |
| McFarland Clinic, PC | Ames, Iowa 50010 |
| Covenant Cancer Treatment Center | Waterloo, Iowa 50702 |
| Cancer Center of Kansas, PA - Chanute | Chanute, Kansas 66720 |
| Cancer Center of Kansas, PA - El Dorado | El Dorado, Kansas 67042 |
| Cancer Center of Kansas-Independence | Independence, Kansas 67301 |
| Cancer Center of Kansas, PA - Kingman | Kingman, Kansas 67068 |
| Lawrence Memorial Hospital | Lawrence, Kansas 66044 |
| Cancer Center of Kansas, PA - Newton | Newton, Kansas 67114 |
| Menorah Medical Center | Overland Park, Kansas 66209 |
| Cancer Center of Kansas, PA - Parsons | Parsons, Kansas 67357 |
| Cancer Center of Kansas, PA - Pratt | Pratt, Kansas 67124 |
| Cancer Center of Kansas, PA - Salina | Salina, Kansas 67401 |
| Shawnee Mission Medical Center | Shawnee Mission, Kansas 66204 |
| Cotton-O'Neil Cancer Center | Topeka, Kansas 66606 |
| Cancer Center of Kansas, PA - Wellington | Wellington, Kansas 67152 |
| Cancer Center of Kansas, PA - Wichita | Wichita, Kansas 67214 |
| Associates in Womens Health, PA - North Review | Wichita, Kansas 67208 |
| Cancer Center of Kansas, PA - Medical Arts Tower | Wichita, Kansas 67208 |
| Cancer Center of Kansas, PA - Winfield | Winfield, Kansas 67156 |
| Ochsner Health Center - Bluebonnet | Baton Rouge, Louisiana 70809 |
| Union Hospital Cancer Program at Union Hospital | Elkton MD, Maryland 21921 |
| Foote Memorial Hospital | Jackson, Michigan 49201 |
| Haematology-Oncology Associates of Ohio and Michigan, PC | Lambertville, Michigan 48144 |
| Mercy Memorial Hospital - Monroe | Monroe, Michigan 48162 |
| Seton Cancer Institute at Saint Mary's - Saginaw | Saginaw, Michigan 48601 |
| St. Luke's Hospital Cancer Care Center | Duluth, Minnesota 55805 |
| Willmar Cancer Center at Rice Memorial Hospital | Willmar, Minnesota 56201 |
| Truman Medical Center - Hospital Hill | Kansas City, Missouri 64108 |
| St. Joseph Medical Center | Kansas City, Missouri 64114 |
| North Kansas City Hospital | Kansas City, Missouri 64116 |
| Saint Luke's Cancer Institute at Saint Luke's Hospital | Kansas City, Missouri 64111 |
| Heartland Regional Medical Center | Saint Joseph, Missouri 64506 |
| Arch Medical Services, Incorporated at Center for Cancer Care and Research | Saint Louis, Missouri 63141 |
| Billings Clinic - Downtown | Billings, Montana 59107-7000 |
| Bozeman Deaconess Cancer Center | Bozeman, Montana 59715 |
| St. James Healthcare Cancer Care | Butte, Montana 59701 |
| Great Falls Clinic - Main Facility | Great Falls, Montana 59405 |
| Sletten Cancer Institute at Benefis Healthcare | Great Falls, Montana 59405 |
| Kalispell Medical Oncology at KRMC | Kalispell, Montana 59901 |
| Alegant Health Cancer Center at Bergan Mercy Medical Center | Omaha, Nebraska 68124 |
| Frederick R. and Betty M. Smith Cancer Treatment Center | Sparta, New Jersey 07871 |
| Leo W. Jenkins Cancer Center at ECU Medical School | Greenville, North Carolina 27834 |
| Mary Rutan Hospital | Bellefontaine, Ohio 43311 |
| Christ Hospital Cancer Center | Cincinnati, Ohio 45219 |
| Grant Medical Center Cancer Care | Columbus, Ohio 43215 |
| Flower Hospital Cancer Center | Sylvania, Ohio 43560 |
| Mount Carmel St. Ann's Cancer Center | Westerville, Ohio 43081 |
| Clinton Memorial Hospital | Wilmington, Ohio 45177 |
| St. Luke's Cancer Network at St. Luke's Hospital | Bethlehem, Pennsylvania 18015 |
| McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center | Reading, Pennsylvania 19612-6052 |
| Guthrie Cancer Center at Guthrie Clinic Sayre | Sayre, Pennsylvania 18840 |
| Hematology and Oncology Associates of Northeastern Pennsylvania | Scranton, Pennsylvania 18510 |
| Susquehanna Cancer Center at Divine Providence Hospital | Williamsport, Pennsylvania 17701 |
| York Cancer Center at Apple Hill Medical Center | York, Pennsylvania 17405 |
| Fredericksburg Oncology, Incorporated | Fredericksburg, Virginia 22401 |
| Franciscan Cancer Center at St. Joseph Medical Center | Tacoma, Washington 98405-3004 |
| Center for Cancer Treatment & Prevention at Sacred Heart Hospital | Eau Claire, Wisconsin 54701 |
| Marshfield Clinic Cancer Care at Regional Cancer Center | Eau Claire, Wisconsin 54701 |
| Vince Lombardi Cancer Center at Aurora Lakeland Medical Center - Elkhorn | Elkhorn, Wisconsin 53121 |
| Vince Lombardi Cancer Clinic - Green Bay at Aurora BayCare Medical Center | Green Bay, Wisconsin 54311 |
| Saint Joseph's Hospital | Marshfield, Wisconsin 54449 |
| Medical Consultants, Limited | Milwaukee, Wisconsin 53215 |
| Marshfield Clinic - Lakeland Center | Minocqua, Wisconsin 54548 |
| Ministry Medical Group at Saint Mary's Hospital | Rhinelander, Wisconsin 54501 |
| Saint Michael's Hospital Cancer Center | Stevens Point, Wisconsin 54481 |
| Marshfield Clinic - Wausau Center | Wausau, Wisconsin 54401 |
| Marshfield Clinic - Weston Center | Weston, Wisconsin 54476 |
| Marshfield Clinic - Wisconsin Rapids Center | Wisconsin Rapids, Wisconsin 54494 |
| Mid Dakota Clinic, PC | Bismarck, North Dakota 58501 |
| Regional Cancer Center at Memorial Medical Center | Springfield, Illinois 62781-0001 |
| John H. Stroger, Jr. Hospital of Cook County | Chicago, Illinois 60612-9985 |
| Aurora Sinai Medical Center | Milwaukee, Wisconsin 53201-0342 |
| Good Samaritan Cancer Center at Good Samaritan Hospital | Kearney, Nebraska 68848-1990 |
| Dizzy Gillespie Cancer Institute at Englewood Hospital and Medical Center | Englewood, New Jersey 07631 |
| Pardee Memorial Hospital | Hendersonville, North Carolina 28791 |
| Rutherford Hospital | Rutherfordton, North Carolina 28139 |
| Easton Regional Cancer Center at Easton Hospital | Easton, Pennsylvania 18042 |
| Gibbs Regional Cancer Center at Spartanburg Regional Medical Center | Spartanburg, South Carolina 29303 |
| Martha Jefferson Hospital Cancer Care Center | Charlottesville, Virginia 22901 |
| Kinston Medical Specialists | Kinston, North Carolina 28501 |
| Resurrection Medical Center | Chicago, Illinois 60631 |
| St. Francis Hospital | Evanston, Illinois 60202 |
| Frederick Memorial Hospital Regional Cancer Therapy Center | Frederick, Maryland 21701 |
| Underwood Memorial Hospital | Woodbury, New Jersey 08096 |
| McLeod Regional Medical Center | Florence, South Carolina 29501 |
| Central Pennsylvania Hematology and Medical Oncology Associates, PC | Lemoyne, Pennsylvania 17043 |
| La Grange Memorial Hospital | La Grange, Illinois 60525 |
| Cedar Valley Medical Specialists, PC - West Ridgeway Avenue | Waterloo, Iowa 50702 |
| Great Falls, Montana 59405 | |
| Guardian Oncology and Center for Wellness | Missoula, Montana 59804 |
| Rockwood Clinic Cancer Treatment Center | Spokane, Washington 99204-2967 |
| University of Wisconcin Cancer Center at Aspirus Wausau Hospital | Wausau, Wisconsin 54401 |
| Jacobi Medical Center | Bronx, New York 10461 |
| Franklin & Edith Scarpa Regional Cancer Center at South Jersey Healthcare | Vineland, New Jersey 08360 |
| Oncology Hematology Associates of Northern Pennsylvania, PC at Hahne Regional Cancer Center | Dubois, Pennsylvania 15801 |
| Galesburg Clinic, PC | Galesburg, Illinois 61401 |
| St. Vincent Healthcare Cancer Care Services | Billings, Montana 59101 |
| Desert Regional Medical Center Comprehensive Cancer Center | Palm Springs, California 92262 |
| Providence Medical Center | Kansas City, Kansas 66112 |
| Johnson County Radiation Therapy | Overland Park, Kansas 66210 |
| Berkshire Hematology Oncology, PC | Pittsfield, Massachusetts 01201 |
| Oncology Care Associates, PLLC | Saint Joseph, Michigan 49085 |
| Independence Regional Health Center | Independence, Missouri 64050 |
| Kansas City Cancer Center at St. Joseph's Medical Mall | Kansas City, Missouri 64114 |
| Parvin Radiation Oncology | Kansas City, Missouri 64116 |
| Radiation Oncology Associates of Kansas City at Northland Radiation Oncology Center | Kansas City, Missouri 64154 |
| Midwest Hematology Oncology Group, Incorporated | Saint Louis, Missouri 63109 |
| Memorial Medical Center | Modesto, California 95355 |
| Elmhurst Memorial Hospital | Elmhurst, Illinois 60126 |
| Veterans Affairs Medical Center - Indianapolis | Indianapolis, Indiana 46202 |
| Hattiesburg Clinic, PA at Forrest General | Hattiesburg, Mississippi 39401 |
| Valley Hospital - Ridgewood | Ridgewood, New Jersey 07450 |
| Trinity CancerCare Center | Minot, North Dakota 58701 |
| United States Air Force Medical Center - Wright-Patterson | Wright-Patterson AFB, Ohio 45433-5529 |
| Riddle Memorial Hospital Cancer Center | Media, Pennsylvania 19063 |
| Cancer Center of Paoli Memorial Hospital | Paoli, Pennsylvania 19301-1792 |
| CCOP - Main Line Health | Wynnewood, Pennsylvania 19096 |
| AnMed Cancer Center | Anderson, South Carolina 29621 |
| Dale and Frances Hughes Cancer Center at Pocono Medical Center | East Stroudsburg, Pennsylvania 18301 |
| Associates in Hematology-Oncology, PC at Crozer Regional Cancer Center | Upland, Pennsylvania 19013 |
| Saint James Hospital and Health Centers Comprehensive Cancer Institute - Olympia Fields | Olympia Fields, Illinois 60461 |
| Medcenter One Hospital Cancer Care Center | Bismarck, North Dakota 58501 |
| St. Alexius Medical Center Cancer Center | Bismarck, North Dakota 58502 |
| Center for Cancer Care at Goshen General Hospital | Goshen, Indiana 46526 |
| Augusta Oncology Associates - Walton Way | Augusta, Georgia 30901 |
| Provena St. Mary's Regional Cancer Center - Kankakee | Kankakee, Illinois 60901 |
| Hematology & Oncology Clinic | Hattiesburg, Mississippi 39402 |
| Frankford Hospital Cancer Center - Torresdale Campus | Philadelphia, Pennsylvania 19114 |
| Eugene M. and Christine E. Lynn Cancer Institute at Boca Raton Community Hospital - Main Campus | Boca Raton, Florida 33486 |
| Camino Medical Group - Treatment Center | Mountain View, California 94040 |
| Delnor Community Hospital - Geneva | Geneva, Illinois 60134 |
| Kaiser Permanente Capital Area Medical Group - Shady Grove Facility | Rockville, Maryland 20850 |
| Ephrata Cancer Center at Ephrata Community Hospital | Ephrata, Pennsylvania 17522 |
| Central Wisconsin Cancer Program at Agnesian HealthCare | Fond du Lac, Wisconsin 54935 |
| Richard G. Laube Cancer Center at ACMH | Kittanning, Pennsylvania 16201 |
| Clarian Arnett Cancer Care | Lafayette, Indiana 47904 |
| St. Agnes Hospital Cancer Center | Baltimore, Maryland 21229 |
| Kaiser Permanente Mid-Atlantic Medical Group-Largo Medical Facility | Largo, Maryland 20774 |
| Kaiser Permanente - Towson | Lutherville, Maryland 21093 |
| Kaiser Permanente Medical Center - Fair Oaks | Fairfax, Virginia 22033 |
| Langlade Memorial Hospital | Antigo, Wisconsin 54409 |
| MaineGeneral Medical Center - Waterville | Waterville, Maine 04901 |
| Upper Chesapeake Medical Center | Bel Air, Maryland 21014 |
| Carson Tahoe Cancer Center at Carson Tahoe Regional Medical Center | Carson City, Nevada 89703 |
| AtlantiCare Cancer Care Institute at AtlantiCare Regional Medical Center - Mainland Campus | Pomona, New Jersey 08240 |
