New combo therapy shows promise for older leukemia patients

NCT ID NCT02143414

Disease control Sponsor: National Cancer Institute (NCI) Source: ClinicalTrials.gov ↗

First seen Jun 27, 2026 · Last updated Aug 05, 2026 · Updated 4 times

Summary

This study tested a combination of the immunotherapy drug blinatumomab with either standard chemotherapy or dasatinib and prednisone in adults aged 65 and older with acute lymphoblastic leukemia (ALL). The goal was to see if the combination could improve survival and control the cancer. About 53 participants were enrolled, and the study focused on side effects and how well the treatment worked.

This is an AI summary of the original study and may miss details. Read our disclaimer.

Study facts

What this study's own registry entry says, in plain language.

Phase

Phase 2

Tests whether the treatment actually works, and watches for side effects, in a larger group.

Participants

53 people

The number who actually took part.

Started

Jun 2015

Expected to finish

Jun 2027

An estimate. End dates often move.

Lead sponsor

A government research agency

The lead sponsor is the US National Institutes of Health.

Who can take part

This study's own entry requirements. Only the study team can say for certain whether you qualify.

Ages

65 years and older

Sex

Anyone

Healthy volunteers

Not accepted

This study is not open to healthy volunteers. The entry requirements below say who it is open to.

Show the full entry requirements

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Registration Step 1 - Induction/Re-Induction: * Patients must have a new morphologic diagnosis of precursor B cell acute lymphoblastic leukemia (ALL) (non T cell) based on World Health Organization (WHO) criteria; patients with Burkitt's (L3) are excluded; patients with Ph-positive or Ph-like ALL with dasatinib-sensitive mutations or kinase fusions may have relapsed or refractory diagnoses * NOTE: Relapsed/refractory Ph-positive patients or Ph-like patients with dasatinib-sensitive mutations or kinase fusions who have previous exposure to either dasatinib or another 2nd or 3rd generation tyrosine kinase inhibitor (TKI) will begin protocol therapy with Cohort 2: re-induction cycle 1 * Patients must have a diagnosis of Philadelphia chromosome negative ALL or Ph chromosome positive ALL by cytogenetics, fluorescence in situ hybridization (FISH) or polymerase chain reaction (PCR); patients will be registered to receive treatment in either Cohort 1 (Ph-) or Cohort 2 (Ph+ or Ph-like DSMKF) based on these results; diagnostic specimens must be submitted to the site's local Clinical Laboratory Improvement Amendments (CLIA)-approved cytogenetics laboratory and results of tests (cytogenetics, FISH or PCR) must confirm Ph status prior to registration; if not already known, breakpoint cluster region- abelson murine leukemia viral oncogene homolog 1 (BCR-ABL) status (p190 or p210) must be evaluated in Ph-positive patients by PCR * For Cohort 2, Ph-like testing is not required specifically for this study; however, to be registered to Cohort 2 under the Ph-like DSMKF criterion, the patient must have a known or presumed activating Ph-like signature and dasatinib-sensitive mutation or kinase fusion, such as: ABL1, ABL2, colony stimulating factor 1 receptor (CSF1R), platelet derived growth factor receptor beta (PDGFRB), platelet derived growth factor receptor alpha (PDGFRA), or fibroblast growth factor receptor (FGFR)s that was otherwise identified as part of normal standard of care; prior to registering any patients with a known or presumed activating Ph-like signature and dasatinib-sensitive mutations or kinase fusions (DSMKF) treating physicians must confirm eligibility with the study chairs via email; the study chairs must respond via email with confirmation of patient eligibility prior to patient registration * All newly diagnosed patients must have evidence of ALL in their marrow or peripheral blood with at least 20% lymphoblasts present in blood or bone marrow collected within 28 days prior to registration; all relapsed/refractory patients (Cohort 2) must have at least 5% lymphoblasts present in blood or bone marrow collected within 28 days prior to registration; for relapsed/refractory patients, pathology and cytogenetics reports (both from time of original diagnosis) must be submitted at time of registration; if a bone marrow aspirate cannot be obtained despite an attempt (dry tap), appropriate immunohistochemistry (IHC) testing, including cluster of differentiation (CD)19, must be performed on the bone marrow biopsy to determine lineage; for ALL in marrow or peripheral blood, immunophenotyping of the blood or marrow lymphoblasts must be performed to determine lineage (B cell, T cell or mixed B/T cell); appropriate marker studies including CD19 (B cell), must be performed; co-expression of myeloid antigens (CD13 and CD33) will not exclude patients; if possible, the lineage specific markers (myeloid cells) should be determined; the blood/bone marrow sample for these assays must be obtained within 28 days prior to registration; patients with only extramedullary disease in the absence of bone marrow or blood involvement are not eligible * Patient must not have a history or presence of clinically relevant central nervous system (CNS) pathology such as epilepsy, seizure, paresis, aphasia, stroke, severe brain injuries, dementia, Parkinson's disease, cerebellar disease, organic brain syndrome, psychosis, active ALL in the CNS confirmed by cerebrospinal fluid (CSF) analysis, or other significant CNS abnormalities * Patients must have a lumbar puncture to determine CNS involvement of ALL within 14 days prior to registration; patients with CNS3 are excluded from the trial; patients with CNS1 or CNS2 will be eligible, but will be monitored for CNS involvement; note that intrathecal methotrexate administered during the pre-study lumbar puncture may count as the first dose of intrathecal therapy required as part of the study * Cohort I, Ph-negative Patients Only: Patients must not have received any prior chemotherapy, radiation therapy, or other therapy for the treatment of ALL (other than those noted below) and must not be receiving any immunosuppressive therapy; patients may not have received any prior investigational therapy within 28 days prior to registration; patients must not have received any monoclonal antibody therapy within 42 days of registration; patients may have received the following within any time prior to registration: low dose chemotherapy-including: cyclophosphamide 1 g/m\^2, oral 6-mercaptopurine, or oral methotrexate (other low dose chemotherapy may be allowable, however any other options not listed here should be confirmed with the study chairs), TKI therapy, steroids, hydroxyurea, leukapheresis, intrathecal chemotherapy or vincristine * Cohort I, Ph-negative Patients Only: In the event that the patient's bone marrow blast count is \>= 50% blasts, patients may be registered but should receive steroids for 3-5 days in order to reduce tumor burden prior to blinatumomab administration, as follows * Prephase treatment with dexamethasone (10-20 mg/m\^2) for 3-5 days is required for patients with bone marrow blasts \>= 50%, peripheral blood blasts 15,000/uL or higher, or elevated lactate dehydrogenase (LDH) suggesting rapidly progressive disease per investigator opinion * Pre-treatment should conclude at least 24 hours prior to the first dose of blinatumomab (although additional dexamethasone is automatically given as a pre-med prior to the first dose); at the time of first infusion of blinatumomab, the absolute peripheral blast count should be \< 25,000/uL * Note: For the purposes of the study, day 1 of the cycle will be the first day of blinatumomab administration * Cohort I, Ph-negative Patients Only: It is preferred, but not required, that corticosteroids and hydroxyurea should start only after all diagnostic samples have been obtained; however, if the patient was previously on corticosteroids and/or hydroxyurea, this is allowable provided that the patient still has measurable disease at time of the bone marrow aspirate * Corticosteroids and/or hydroxyurea, as well as any of the other therapies mentioned (with the exception of IV cyclophosphamide), may continue to be administered, at physician discretion, until 1 day prior to blinatumomab administration * IV cyclophosphamide must be discontinued at least 7 days prior to blinatumomab administration * Cohort 2, Ph-positive and Ph-like DSMKF Patients Only: Patients must NOT have received a prior autologous or allogeneic hematopoietic stem cell transplant at any time. Patients must NOT have received any chemotherapy, investigational agents, or undergone major surgery within 14 days prior to registration, with the following exceptions: * Monoclonal antibodies must not have been received for 1 week prior to registration * Chimeric antigen receptor (CAR) T-cells must not have been received for 28 days prior to registration * Steroids, hydroxyurea, vincristine, 6-mercaptopurine, methotrexate, thioguanine and intrathecal chemotherapy are permitted within any timeframe prior to registration; Food and Drug Administration (FDA)-approved TKIs may also be administered until 1 day prior to start of study therapy (C1, D1); IV cyclophosphamide may be administered at doses of 1 g/m\^2 or less until up to 7 days prior to registration * Patients must be \>= 65 years of age; for patients 65-69 years of age, patient must be deemed not suitable for standard intensive induction chemotherapy at the discretion of the local investigator, or must have refused standard intensive chemotherapy * Cohort I, Ph-negative Patients Only: Patients must not be candidates for allogeneic hematopoietic stem cell transplant; NOTE: Subjects up to age 70 years who are considered fit for allogeneic hematopoietic stem cell transplant, should be considered for enrollment on E1910, in order to avoid competing with that study; if a patient is considered unfit for intensive chemotherapy at the time of initial diagnosis, but subsequently achieves a complete remission (CR), then it will be left to the treating physician's discretion to consider hematopoietic stem cell transplant (HSCT) * Cohort I, Ph-negative Patients Only: Patients must have complete history and physical examination within 28 days prior to registration * Cohort I, Ph-negative Patients Only: Patients must have a Zubrod performance status of 0-2 * Cohort I, Ph-negative Patients Only: Patients must have serum creatinine =\< 1.5 mg/dl within 14 days prior to registration * Cohort I, Ph-negative Patients Only: Patients must have aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =\< 3.0 x institutional upper limit of normal (IULN) within 14 days prior to registration * Cohort I, Ph-negative Patients Only: Patients must have total bilirubin =\< 2.0 x IULN within 14 days prior to registration * Cohort I, Ph-negative Patients Only: Patients must have alkaline phosphatase =\< 2.5 x IULN within 14 days prior to registration * Cohort I, Ph-negative Patients Only: Patients must not have systemic fungal, bacterial, viral or other infection that is not controlled (defined as exhibiting ongoing signs/symptoms related to the infection and without improvement, despite appropriate antibiotics or other treatment) * Cohort I, Ph-negative Patients Only: Patients must not have Common Terminology Criteria for Adverse Events (CTCAE) \>= grade 2 neuropathy (cranial, motor or sensory) within 14 days prior to registration * Cohort I, Ph-negative Patients Only: Patients known to be positive for HIV (the human immunodeficiency virus) may be eligible, providing they meet the following additional criteria within 28 days prior to registration: * No history of acquired immune deficiency syndrome (AIDS)-defining conditions * CD4 cells \> 350 cells/mm\^3 * If on antiretroviral agents, must not include zidovudine or stavudine * Viral load =\< 50 copies HIV messenger ribonucleic acid (mRNA)/mm\^3 if on combination antiretroviral therapy (cART) or =\< 25,000 copies HIV mRNA/mm\^3 if not on cART * Highly active antiretroviral therapy (HAART) regimens are acceptable providing they have only weak P450A4 interactions * Cohort I, Ph-negative Patients Only: Patients must not have any known autoimmune disease * Cohort I, Ph-negative Patients Only: Patients must not have testicular involvement; if clinical or ultrasound findings are equivocal, biopsy must be performed; all tests for establishing testicular involvement must be completed within 14 days prior to registration * Cohort I, Ph-negative Patients Only: Patients with evidence of extramedullary disease at diagnosis will have computed tomography (CT) scan or magnetic resonance imaging (MRI) of the chest, abdomen and pelvis to obtain baseline values within 28 days prior to registration * Cohort I, Ph-negative Patients Only: No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease free for five years * Cohort I, Ph-negative Patients Only: Patients must have the following tests within 28 days prior to registration to obtain baseline measurements: * Prothrombin time (PT)/partial thromboplastin time (PTT)/international normalized ratio (INR)/fibrinogen (all patients) * Cohort 1, Ph- Patients Only: Neurologic assessment * Cohort 2, Ph+ and Ph-like DSMKF Patients Only: Patients must not have active pericardial effusion, ascites or pleural effusion of any grade based on chest x-ray and echocardiogram within 28 days prior to registration; exception: if the effusion is suspected to be related to the leukemia, the patient may have pericardial effusion =\< grade 2 or pleural effusion =\< grade 1 * Cohort 2, Ph+ and Ph-like DSMKF Patients Only: Patients must have ejection fraction \>= 45% based on echocardiogram performed within 28 days prior to registration * Cohort 2, Ph+ and Ph-like DSMKF Patients Only: Patients must have QTcF (by Fridericia calculation) \< 480/msec based on electrocardiogram (EKG) performed within 28 days prior to registration * Cohort 2, Ph+ and Ph-like DSMKF Patients Only: Patients must not be receiving any proton pump inhibitors at the time of registration * Pretreatment cytogenetics must be performed on all patients; collection of pretreatment specimens must be completed within 28 days prior to registration to S1318; specimens must be submitted to the site's preferred CLIA-approved cytogenetics laboratory; BCR-ABL status must be verified in Ph-positive patients by FISH, cytogenetics, and/or PCR prior to enrollment; if a patient is Ph-positive, PCR for both p190 and p210 must be sent * Patients must be offered participation in specimen submission for future research; with patient's consent, specimens must be submitted as outlined * Cohort 1, Ph-negative Patients Only: Patients must have specimens submitted for blinatumomab immunogenicity assessment; collection of pretreatment specimens must be completed within 28 days prior to registration to S1318; specimens must be submitted to LabConnect * Cohort 2, Ph-positive and Ph-like DSMKF Patients Only: Patients must agree to have specimens submitted for blinatumomab immunogenicity testing if subsequently moved to a blinatumomab containing treatment regimen on protocol * Patients or their legally authorized representative must be informed of the investigational nature of this study and must sign and give written informed consent in accordance with institutional and federal guidelines * As a part of the Oncology Patient Enrollment Network (OPEN) registration process the treating institution's identity is provided in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered in the system * Registration Step 2 - Post-Remission Therapy: * Cohort 1, Ph-negative Patients Only: Patients must have achieved CR or CRi within 2 cycles of induction/re-induction with blinatumomab * NOTE: day 1 of post-remission = day 43 of the preceding cycle (+/- 3 days) * Cohort 2, Ph-positive and Ph-like DSMKF Patients Only: Newly diagnosed Ph+, newly-diagnosed Ph-like DSMKF, and relapsed/refractory Ph+ patients without prior dasatinib or other 2nd or 3rd generation TKI therapy, must have achieved CR or CRi within 1 cycle of induction with dasatinib/prednisone, or within 2 cycles of re-induction with blinatumomab; relapsed/refractory Ph+ or Ph-like DSMKF patients with prior dasatinib or other 2nd or 3rd generation TKI therapy must have achieved CR or CRi within 2 cycles of re-induction therapy with blinatumomab * NOTE: day 1 of post-remission = day 85 of the preceding induction cycle (+/- 3 days), or day 43 of the preceding re-induction cycle (+/- 3 days) as applicable * Serum creatinine =\< 1.5 mg/dl within 14 days prior to registration * AST and ALT =\< 3.0 x institutional upper limit of normal (IULN) within 14 days prior to registration * Total bilirubin =\< 2.0 x IULN within 14 days prior to registration * Absolute neutrophil count (ANC) \>= 750/mcL within 28 days prior to registration * Platelets \>= 50,000/mcL within 28 days prior to registration * Patients must be registered to Step 2 within 28 days after count recovery; (Note: there is no maximum allotted time period for count recovery, providing patient remains in CR or CRi) * All non-hematologic treatment related toxicities that are deemed clinically significant by the treating investigator must have resolved to =\< grade 2 * Registration Step 3 - Maintenance: Patients must have documented CR or CRi within 28 days prior to registration; note that bone marrow examination is only required if there are clinical signs/symptoms of progression; if progression is a concern due to the length of the time for count recovery, a bone marrow examination is recommended * Registration Step 3 - Maintenance: Patients must have serum creatinine =\< 1.5 mg/dl within 14 days prior to registration * Registration Step 3 - Maintenance: Patients must have AST and ALT =\< 3.0 x institutional upper limit of normal (IULN) within 14 days prior to registration * Registration Step 3 - Maintenance: Patients must have total bilirubin \< 2.0 x institutional upper limit of normal (IULN) within 14 days prior to registration * Registration Step 3 - Maintenance: Patients must have adequate marrow function as evidenced by ANC \>= 750/mcL within 28 days prior to registration * Registration Step 3 - Maintenance: Patients must have adequate marrow function as evidenced by platelets \>= 75,000/mcL within 28 days prior to registration * Registration Step 3 - Maintenance: All non-hematologic treatment related toxicities that are deemed clinically significant by the treating investigator must have resolved to =\< grade 2

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Conditions

The condition(s) this trial relates to.

acute lymphoblastic leukemia B-cell acute lymphoblastic leukemia B-cell childhood acute lymphoblastic leukemia B-lymphoblastic leukemia/lymphoma with t(9;22)(q34.1;q11.2) B-lymphoblastic leukemia/lymphoma, BCR-ABL1–like Burkitt lymphoma leukemia, acute lymphocytic, susceptibility to, 1 Precursor Cell Lymphoblastic Leukemia-Lymphoma

As listed by the trial registrant

The condition terms exactly as the trial's registrant entered them.

Acute lymphoblastic leukemia B acute lymphoblastic leukemia B acute lymphoblastic leukemia with T(9;22)(Q34.1;Q11.2); BCR-ABL1 Recurrent acute lymphoblastic leukemia Refractory acute lymphoblastic leukemia

Contacts and locations

Locations

Ascension Via Christi Hospitals Wichita

Wichita, Kansas, 67214, United States
Associates In Womens Health

Wichita, Kansas, 67208, United States
Atrium Medical Center-Middletown Regional Hospital

Franklin, Ohio, 45005-1066, United States
Augusta University Medical Center

Augusta, Georgia, 30912, United States
Banner University Medical Center - Tucson

Tucson, Arizona, 85719, United States
Baylor University Medical Center

Dallas, Texas, 75246, United States
Beacon Kalamazoo

Kalamazoo, Michigan, 49048, United States
Blanchard Valley Hospital

Findlay, Ohio, 45840, United States
Bronson Battle Creek

Battle Creek, Michigan, 49017, United States
Bronson Methodist Hospital

Kalamazoo, Michigan, 49007, United States
Cancer Care Center of O'Fallon

O'Fallon, Illinois, 62269, United States
Cancer Care Specialists of Illinois - Decatur

Decatur, Illinois, 62526, United States
Cancer Center of Kansas - Chanute

Chanute, Kansas, 66720, United States
Cancer Center of Kansas - Dodge City

Dodge City, Kansas, 67801, United States
Cancer Center of Kansas - El Dorado

El Dorado, Kansas, 67042, United States
Cancer Center of Kansas - Fort Scott

Fort Scott, Kansas, 66701, United States
Cancer Center of Kansas - McPherson

McPherson, Kansas, 67460, United States
Cancer Center of Kansas - Newton

Newton, Kansas, 67114, United States
Cancer Center of Kansas - Parsons

Parsons, Kansas, 67357, United States
Cancer Center of Kansas - Pratt

Pratt, Kansas, 67124, United States
Cancer Center of Kansas - Salina

Salina, Kansas, 67401, United States
Cancer Center of Kansas - Wellington

Wellington, Kansas, 67152, United States
Cancer Center of Kansas - Wichita

Wichita, Kansas, 67214, United States
Cancer Center of Kansas - Winfield

Winfield, Kansas, 67156, United States
Cancer Center of Kansas-Independence

Independence, Kansas, 67301, United States
Cancer Center of Kansas-Kingman

Kingman, Kansas, 67068, United States
Cancer Center of Kansas-Liberal

Liberal, Kansas, 67905, United States
Cancer Center of Kansas-Wichita Medical Arts Tower

Wichita, Kansas, 67208, United States
Carle Cancer Center

Urbana, Illinois, 61801, United States
Carle Physician Group-Effingham

Effingham, Illinois, 62401, United States
Carle Physician Group-Mattoon/Charleston

Mattoon, Illinois, 61938, United States
Carle at The Riverfront

Danville, Illinois, 61832, United States
Case Western Reserve University

Cleveland, Ohio, 44106, United States
Central Care Cancer Center - Bolivar

Bolivar, Missouri, 65613, United States
Central Illinois Hematology Oncology Center

Springfield, Illinois, 62702, United States
Centralia Oncology Clinic

Centralia, Illinois, 62801, United States
City of Hope Comprehensive Cancer Center

Duarte, California, 91010, United States
Cleveland Clinic Foundation

Cleveland, Ohio, 44195, United States
Corewell Health Beaumont Troy Hospital

Troy, Michigan, 48085, United States
Corewell Health Farmington Hills Hospital

Farmington Hills, Michigan, 48336, United States
Corewell Health Grand Rapids Hospitals - Butterworth Hospital

Grand Rapids, Michigan, 49503, United States
Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center

Saint Joseph, Michigan, 49085, United States
Corewell Health Lakeland Hospitals - Niles Hospital

Niles, Michigan, 49120, United States
Corewell Health Lakeland Hospitals - Saint Joseph Hospital

Saint Joseph, Michigan, 49085, United States
Corewell Health Reed City Hospital

Reed City, Michigan, 49677, United States
Corewell Health William Beaumont University Hospital

Royal Oak, Michigan, 48073, United States
Cox Cancer Center Branson

Branson, Missouri, 65616, United States
CoxHealth South Hospital

Springfield, Missouri, 65807, United States
Crossroads Cancer Center

Effingham, Illinois, 62401, United States
Decatur Memorial Hospital

Decatur, Illinois, 62526, United States
Duke University Medical Center

Durham, North Carolina, 27710, United States
ECU Health Oncology Kenansville

Kenansville, North Carolina, 28349, United States
ECU Health Oncology Kinston

Kinston, North Carolina, 28501, United States
ECU Health Oncology Richlands

Richlands, North Carolina, 28574, United States
Franciscan Health Indianapolis

Indianapolis, Indiana, 46237, United States
Franciscan Saint Anthony Health-Michigan City

Michigan City, Indiana, 46360, United States
Freeman Health System

Joplin, Missouri, 64804, United States
Good Samaritan Hospital - Dayton

Dayton, Ohio, 45406, United States
Greenville Health System Cancer Institute-Andrews

Greenville, South Carolina, 29601, United States
Hickman Cancer Center

Adrian, Michigan, 49221, United States
Illinois CancerCare-Bloomington

Bloomington, Illinois, 61704, United States
Illinois CancerCare-Canton

Canton, Illinois, 61520, United States
Illinois CancerCare-Carthage

Carthage, Illinois, 62321, United States
Illinois CancerCare-Eureka

Eureka, Illinois, 61530, United States
Illinois CancerCare-Galesburg

Galesburg, Illinois, 61401, United States
Illinois CancerCare-Kewanee Clinic

Kewanee, Illinois, 61443, United States
Illinois CancerCare-Macomb

Macomb, Illinois, 61455, United States
Illinois CancerCare-Ottawa Clinic

Ottawa, Illinois, 61350, United States
Illinois CancerCare-Pekin

Pekin, Illinois, 61554, United States
Illinois CancerCare-Peoria

Peoria, Illinois, 61615, United States
Illinois CancerCare-Peru

Peru, Illinois, 61354, United States
Illinois CancerCare-Princeton

Princeton, Illinois, 61356, United States
John L McClellan Memorial Veterans Hospital

Little Rock, Arkansas, 72205, United States
Keck Medical Center of USC Pasadena

Pasadena, California, 91105, United States
Kettering Medical Center

Kettering, Ohio, 45429, United States
LSU Health Sciences Center at Shreveport

Shreveport, Louisiana, 71103, United States
Lawrence Memorial Hospital

Lawrence, Kansas, 66044, United States
Loma Linda University Medical Center

Loma Linda, California, 92354, United States
Long Island Jewish Medical Center

New Hyde Park, New York, 11040, United States
Los Angeles General Medical Center

Los Angeles, California, 90033, United States
MU Health Care Goldschmidt Cancer Center

Jefferson City, Missouri, 65109, United States
Mayo Clinic in Rochester

Rochester, Minnesota, 55905, United States
McFarland Clinic - Ames

Ames, Iowa, 50010, United States
McFarland Clinic - Boone

Boone, Iowa, 50036, United States
McFarland Clinic - Jefferson

Jefferson, Iowa, 50129, United States
McFarland Clinic - Marshalltown

Marshalltown, Iowa, 50158, United States
McFarland Clinic - Trinity Cancer Center

Fort Dodge, Iowa, 50501, United States
Medical College of Wisconsin

Milwaukee, Wisconsin, 53226, United States
Memorial Hospital of Carbondale

Carbondale, Illinois, 62902, United States
Mercy Cancer Center - Cape Girardeau

Cape Girardeau, Missouri, 63703, United States
Mercy Clinic-Rolla-Cancer and Hematology

Rolla, Missouri, 65401, United States
Mercy Health - Saint Anne Hospital

Toledo, Ohio, 43623, United States
Mercy Hospital Joplin

Joplin, Missouri, 64804, United States
Mercy Hospital Saint Louis

St Louis, Missouri, 63141, United States
Mercy Hospital Springfield

Springfield, Missouri, 65804, United States
Mercy Infusion Center - Chippewa

St Louis, Missouri, 63109, United States
Methodist Medical Center of Illinois

Peoria, Illinois, 61636, United States
Miami Valley Hospital

Dayton, Ohio, 45409, United States
Miami Valley Hospital North

Dayton, Ohio, 45415, United States
Miami Valley Hospital South

Centerville, Ohio, 45459, United States
Missouri Baptist Medical Center

St Louis, Missouri, 63131, United States
Missouri Baptist Sullivan Hospital

Sullivan, Missouri, 63080, United States
Munson Medical Center

Traverse City, Michigan, 49684, United States
Nebraska Medicine-Bellevue

Bellevue, Nebraska, 68123, United States
Nebraska Medicine-Village Pointe

Omaha, Nebraska, 68118, United States
North Shore University Hospital

Manhasset, New York, 11030, United States
Northside Hospital

Atlanta, Georgia, 30342, United States
Northwell Health/Center for Advanced Medicine

Lake Success, New York, 11042, United States
OSF Saint Francis Medical Center

Peoria, Illinois, 61637, United States
OSF Saint Francis Radiation Oncology at Pekin

Pekin, Illinois, 61554, United States
OSF Saint Francis Radiation Oncology at Peoria Cancer Center

Peoria, Illinois, 61615, United States
OSF Saint Joseph Medical Center

Bloomington, Illinois, 61701, United States
Ohio State University Comprehensive Cancer Center

Columbus, Ohio, 43210, United States
Oncology Hematology Care Inc-Anderson

Cincinnati, Ohio, 45230, United States
Oncology Hematology Care Inc-Blue Ash

Cincinnati, Ohio, 45242, United States
Oncology Hematology Care Inc-Crestview

Crestview Hills, Kentucky, 41017, United States
Oncology Hematology Care Inc-Eden Park

Cincinnati, Ohio, 45202, United States
Oncology Hematology Care Inc-Healthplex

Fairfield, Ohio, 45014, United States
Oncology Hematology Care Inc-Kenwood

Cincinnati, Ohio, 45236, United States
Oncology Hematology Care Inc-Mercy West

Cincinnati, Ohio, 45211, United States
Orlando Health Cancer Institute

Orlando, Florida, 32806, United States
Parkland Health Center-Bonne Terre

Bonne Terre, Missouri, 63628, United States
Phelps Health Delbert Day Cancer Institute

Rolla, Missouri, 65401, United States
Prisma Health Cancer Institute - Butternut

Greenville, South Carolina, 29605, United States
Prisma Health Cancer Institute - Easley

Easley, South Carolina, 29640, United States
Prisma Health Cancer Institute - Eastside

Greenville, South Carolina, 29615, United States
Prisma Health Cancer Institute - Faris

Greenville, South Carolina, 29605, United States
Prisma Health Cancer Institute - Greer

Greer, South Carolina, 29650, United States
Prisma Health Cancer Institute - Seneca

Seneca, South Carolina, 29672, United States
Prisma Health Cancer Institute - Spartanburg

Boiling Springs, South Carolina, 29316, United States
Prisma Health Greenville Memorial Hospital

Greenville, South Carolina, 29605, United States
Providence Portland Medical Center

Portland, Oregon, 97213, United States
Providence Saint Vincent Medical Center

Portland, Oregon, 97225, United States
Radiation Oncology of Northern Illinois

Ottawa, Illinois, 61350, United States
Reid Health

Richmond, Indiana, 47374, United States
Roswell Park Cancer Institute

Buffalo, New York, 14263, United States
Rush-Copley Healthcare Center

Yorkville, Illinois, 60560, United States
Rush-Copley Medical Center

Aurora, Illinois, 60504, United States
SSM Health Good Samaritan

Mount Vernon, Illinois, 62864, United States
Saint Charles Hospital

Oregon, Ohio, 43616, United States
Saint Francis Medical Center

Cape Girardeau, Missouri, 63703, United States
Saint Vincent Hospital Cancer Center Green Bay

Green Bay, Wisconsin, 54301, United States
Saint Vincent Hospital Cancer Center at Saint Mary's

Green Bay, Wisconsin, 54303, United States
Sainte Genevieve County Memorial Hospital

Sainte Genevieve, Missouri, 63670, United States
Sanford Bismarck Medical Center

Bismarck, North Dakota, 58501, United States
Sanford Broadway Medical Center

Fargo, North Dakota, 58122, United States
Sanford Joe Lueken Cancer Center

Bemidji, Minnesota, 56601, United States
Sanford Roger Maris Cancer Center

Fargo, North Dakota, 58122, United States
Siouxland Regional Cancer Center

Sioux City, Iowa, 51101, United States
Smilow Cancer Center/Yale-New Haven Hospital

New Haven, Connecticut, 06510, United States
Southern Illinois University School of Medicine

Springfield, Illinois, 62702, United States
Springfield Clinic

Springfield, Illinois, 62702, United States
Springfield Memorial Hospital

Springfield, Illinois, 62781, United States
Springfield Regional Cancer Center

Springfield, Ohio, 45504, United States
Springfield Regional Medical Center

Springfield, Ohio, 45504, United States
The Carle Foundation Hospital

Urbana, Illinois, 61801, United States
Thomas Jefferson University Hospital

Philadelphia, Pennsylvania, 19107, United States
Toledo Clinic Cancer Centers-Maumee

Maumee, Ohio, 43537, United States
Toledo Clinic Cancer Centers-Monroe

Monroe, Michigan, 48162, United States
Toledo Clinic Cancer Centers-Toledo

Toledo, Ohio, 43623, United States
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center

Maumee, Ohio, 43537, United States
Trinity Health Grand Rapids Hospital

Grand Rapids, Michigan, 49503, United States
Trinity Health Muskegon Hospital

Muskegon, Michigan, 49444, United States
UC Comprehensive Cancer Center at Silver Cross

New Lenox, Illinois, 60451, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center

Orange, California, 92868, United States
UC San Diego Moores Cancer Center

La Jolla, California, 92093, United States
USC / Norris Comprehensive Cancer Center

Los Angeles, California, 90033, United States
USC Norris Oncology/Hematology-Newport Beach

Newport Beach, California, 92663, United States
University of Alabama at Birmingham Cancer Center

Birmingham, Alabama, 35233, United States
University of Arizona Cancer Center-North Campus

Tucson, Arizona, 85719, United States
University of Chicago Comprehensive Cancer Center

Chicago, Illinois, 60637, United States
University of Illinois

Chicago, Illinois, 60612, United States
University of Kansas Cancer Center

Kansas City, Kansas, 66160, United States
University of Kansas Hospital-Westwood Cancer Center

Westwood, Kansas, 66205, United States
University of Maryland/Greenebaum Cancer Center

Baltimore, Maryland, 21201, United States
University of Michigan Rogel Cancer Center

Ann Arbor, Michigan, 48109, United States
University of Mississippi Medical Center

Jackson, Mississippi, 39216, United States
University of Nebraska Medical Center

Omaha, Nebraska, 68198, United States
University of New Mexico Cancer Center

Albuquerque, New Mexico, 87106, United States
University of Oklahoma Health Sciences Center

Oklahoma City, Oklahoma, 73104, United States
University of Pennsylvania/Abramson Cancer Center

Philadelphia, Pennsylvania, 19104, United States
University of Rochester

Rochester, New York, 14642, United States
Upper Valley Medical Center

Troy, Ohio, 45373, United States
Valley Radiation Oncology

Peru, Illinois, 61354, United States
Wake Forest University Health Sciences

Winston-Salem, North Carolina, 27157, United States
Wayne Hospital

Greenville, Ohio, 45331, United States
Wayne State University/Karmanos Cancer Institute

Detroit, Michigan, 48201, United States
Weisberg Cancer Treatment Center

Farmington Hills, Michigan, 48334, United States
Wesley Medical Center

Wichita, Kansas, 67214, United States
West Michigan Cancer Center

Kalamazoo, Michigan, 49007, United States
Western Illinois Cancer Treatment Center

Galesburg, Illinois, 61401, United States
William Beaumont Hospital-Grosse Pointe

Grosse Pointe, Michigan, 48230, United States
Woodland Cancer Care Center

Michigan City, Indiana, 46360, United States
Wright-Patterson Medical Center

Wright-Patterson Air Force Base, Ohio, 45433, United States
Yale University

New Haven, Connecticut, 06520, United States

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