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A Study Testing the Combination of Dasatinib or Imatinib to Chemotherapy Treatment With Blinatumomab for Children, Adolescents, and Young Adults With Philadelphia Chromosome Positive (Ph+) or ABL-Class Philadelphia Chromosome-Like (Ph-Like) B-cell Acute Lymphoblastic Leukemia (B-ALL)
NCT06124157 · National Cancer Institute (NCI)
In plain English
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Official title
An International Phase 2 Study of Chemotherapy and Tyrosine Kinase Inhibitors With Blinatumomab in Patients With Newly-Diagnosed Philadelphia Chromosome-Positive or ABL-Class Philadelphia Chromosome-Like B-Cell Acute Lymphoblastic Leukemia
About this study
PRIMARY OBJECTIVES:
I. To estimate the 3-year event free survival (EFS) of children, adolescents, and young adults \<25 years old with newly-diagnosed Ph+ (BCR::ABL1-rearranged) B- ALL who are treated with a modified Berlin-Frankfurt-Münster (mBFM) chemotherapy backbone that incorporates three cycles of blinatumomab without traditional consolidation chemotherapy in combination with continuous dasatinib.
II. To estimate the 3-year EFS of children, adolescents, and young adults \<25 years old with newly-diagnosed ABL-class Ph-like B-ALL who are treated with a modified BFM chemotherapy backbone that incorporates three cycles of blinatumomab without traditional consolidation chemotherapy in combination with continuous imatinib for those with PDGFRB gene fusions or dasatinib for those without PDGFRB gene fusions.
III. To describe the safety and toxicity profile (infections, mucositis, neurotoxicity, cytokine release syndrome, hypogammaglobulinemia, therapy delays \> 14 days, and treatment-related mortality) for patients with Ph+ or ABL-class Ph-like B-ALL treated on this novel chemo-immunotherapy backbone with continuous tyrosine kinase inhibitor (TKI).
SECONDARY OBJECTIVES:
I. To estimate the 3-year overall survival (OS) of patients with Ph+ and ABL-class Ph-like B-ALL, respectively.
II. To estimate the 3-year EFS, disease-free survival (DFS), cumulative incidence rates (CIR) of relapse, and treatment related mortality (TRM), and OS of patients with ABL-class Ph-like B-ALL stratified by their underlying ABL-class fusion subtypes.
III. To describe rates of end of consolidation (EOC)/timepoint 2 (TP2) minimal residual disease (MRD) negativity defined as \<1x10-4 or \<0.01% for patients with Ph+ B-ALL.
IV. To describe rates of EOC/TP2 MRD negativity defined as \<1x10-4 or \<0.01% for patients with ABL-class Ph-like B-ALL collectively and based on their ABL-class fusion subtypes.
EXPLORATORY OBJECTIVES:
I. To describe rates of end of induction (EOI)/timepoint 1 (TP1) bone marrow MRD negativity defined as \<1x10-4 or \<0.01% with the introduction of the relevant TKI during Induction for patients with Ph+ and ABL-class Ph-like B-ALL, respectively.
II. To describe the outcomes of patients with Ph+ and ABL-class Ph-like B-ALL who are removed from protocol therapy due to Consolidation Failure.
III. To describe the percentage of patients with Ph+ and ABL-class Ph-like B-ALL who continue TKI beyond protocol-prescribed therapy and their outcomes.
IV. To describe the impact of MRD by next-generation sequencing (NGS) at End of Consolidation on outcomes for patients with Ph+ and ABL-class Ph-like B-ALL.
V. To describe the clinical characteristics and outcomes of patients with chronic myeloid leukemia-like biology.
VI. To describe the immune function of patients with Ph+ and ABL-class Ph-like B-ALL pre- and post-blinatumomab plus TKI and correlate with treatment response.
VII. To describe the TKI levels in the plasma and cerebrospinal fluid of children with Ph+ and ABL-class Ph-like B-ALL over the treatment course and correlate with outcome VIII. To describe the impact of TKIs and high-dose methotrexate interaction and identify clinical and biologic factors influencing methotrexate clearance.
OUTLINE:
STRATUM I (PH+ B-ALL PATIENTS):
INDUCTION PART I: Patients receive induction chemotherapy on days 1-14 as per standard of care (SOC).
INDUCTION PART II: Patients receive dasatinib PO once daily (QD) on days 15-29, daunorubicin intravenously (IV) over 15 minutes on days 15 and 22, prednisolone or prednisone PO twice daily (BID) on days 15-28, vincristine IV on days 15 and 22, methotrexate intrathecally (IT) on days 15, 22, and 29, and cytarabine IT on days 18 and 25 if central nervous system (CNS)-3 at study entry.
BLINATUMOMAB BLOCK I: Patients receive dexamethasone PO or intravenously (IV) on day 1, blinatumomab IV on days 1-28, dasatinib PO on days 1-35, and methotrexate IT on days 1 and 15 over 5 weeks on study. Patients may undergo radiation therapy in 12 QD fractions.
BLINATUMOMAB BLOCK II: Patients receive dexamethasone PO or IV on day 1, blinatumomab IV on days 1-28, dasatinib PO on days 1-35, and methotrexate IT on days 1 and 15 over 5 weeks on study.
INTERIM MAINTENANCE I: Patients receive dasatinib PO QD until the end of interim maintenance I, mercaptopurine PO QD on days 1-56, vincristine IV on days 8, 22, 36, and 50, methotrexate IT on days 8 and 36, high-dose methotrexate IV over 24 hours on days 8, 22, 36 and 50, and leucovorin PO or IV on days 10, 11, 24, 25, 38, 39, 52 and 53 over 9 weeks on study.
BLINATUMOMAB BLOCK III: Patients receive blinatumomab IV on days 1-28, dasatinib PO QD on days 1-35, and methotrexate IT on day 1 over 5 weeks on study.
DELAYED INTENSIFICATION PART I: Patients receive dasatinib PO QD on days 1-28, methotrexate IT on day 1, dexamethasone PO or IV on days 1-7 and 15-21, doxorubicin IV over 15 minutes on days 1, 8, and 15, vincristine IV on days 1, 8, and 15, and pegaspargase IV or calaspargase pegol IV over 1-2 hours on day 4 over 4 weeks on study.
DELAYED INTENSIFICATION PART II: Patients receive dasatinib PO QD on day 29 until the end of delayed intensification part II, cyclophosphamide IV over 60 minutes on day 29, cytarabine IV over 30 minutes on days 29-32 and 36-39, methotrexate IT on days 29 and 36, thioguanine PO on days 29-42, pegaspargase IV or calaspargase pegol on day 43 and vincristine IV on days 43 and 50 over 5 weeks on study.
INTERIM MAINTENANCE PART II: Patients receive dasatinib PO QD on day 1 until the end of interim maintenance part II, methotrexate IV on days 1, 11, 21, 31, and 41, vincristine IV on 1, 11, 21, 31, and 41, methotrexate IT on days 1 and 31, and pegaspargase IV or calaspargase pegol IV over 1-2 hours on days 2, 22 or 23 over 8 weeks on study.
MAINTENANCE CYCLES I-II: Patients receive dasatinib PO QD on days 1-84, methotrexate IT on days 1 and 29, dexamethasone PO BID or IV on days 1-5, 29-33, and 57-61, mercaptopurine PO on days 1-84, vincristine IV on days 1, 29 and 57, and methotrexate PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78 on study.
MAINTENANCE CYCLES III AND SUBSEQUENT CYCLES: Patients receive dasatinib PO QD on days 1-84, methotrexate IT on day 1, dexamethasone PO BID or IV on days 1-5, 29-33, and 57-61, mercaptopurine PO on days 1-84, vincristine IV on days 1, 29 and 57, and methotrexate PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78 on study. Cycles repeat every 12 weeks for 2 years from the start of Induction therapy in the absence of disease progression or unacceptable toxicity.
STRATUM II (PDGFRB ABL-CLASS FUSIONS):
BLINATUMOMAB BLOCK I: Patients receive dexamethasone PO or IV on day 1, blinatumomab IV on days 1-28, imatinib PO on days 1-35, and methotrexate IT on days 1 and 15 over 5 weeks on study. Patients may undergo radiation therapy in 12 QD fractions.
BLINATUMOMAB BLOCK II: Patients receive dexamethasone PO or IV on day 1, blinatumomab IV on days 1-28, imatinib PO on days 1-35, and methotrexate IT on days 1 and 15 over 5 weeks on study.
INTERIM MAINTENANCE I: Patients receive imatinib PO QD until the end of interim maintenance I, mercaptopurine PO QD on days 1-56, vincristine IV on days 8, 22, 36, and 50, methotrexate IT on days 8 and 36, high-dose methotrexate IV over 24 hours on days 8, 22, 36 and 50, and leucovorin PO or IV on days 10, 11, 24, 25, 38, 39, 52 and 53 over 9 weeks on study.
BLINATUMOMAB BLOCK III: Patients receive blinatumomab IV on days 1-28, imatinib PO QD on days 1-35, and methotrexate IT on day 1 over 5 weeks on study.
DELAYED INTENSIFICATION PART I: Patients receive imatinib PO QD on days 1-28, methotrexate IT on day 1, dexamethasone PO or IV on days 1-7 and 15-21, doxorubicin IV over 15 minutes on days 1, 8, and 15, vincristine IV on days 1, 8, and 15, and pegaspargase IV or calaspargase pegol IV over 1-2 hours on day 4 over 9 weeks on study.
DELAYED INTENSIFICATION PART II: Patients receive imatinib PO QD on day 29 until the end of Delayed Intensification part II, cyclophosphamide IV over 30-60 minutes on day 29, cytarabine IV over 30 minutes on days 29-32 and 36-39, methotrexate IT on days 29 and 36, thioguanine PO on days 29-42, and pegaspargase IV or calaspargase pegol IV on day 43, and vincristine IV on days 43 and 50 over 5 weeks on study.
INTERIM MAINTENANCE II: Patients receive imatinib PO QD until the end of interim maintenance II, methotrexate IV and vincristine IV on days 1, 11, 21, 31 and 41, methotrexate IT on days 1 and 31, and pegaspargase IV or calaspargase pegol IV over 1-2 hours on days 2, 22 or 23 over 8 weeks on study.
MAINTENANCE CYCLES I-II: Patients receive imatinib PO QD on days 1-84, methotrexate IT on days 1 and 29, dexamethasone PO BID or IV on days 1-5, 29-33, and 57-61, mercaptopurine PO on days 1-84, vincristine IV on days 1, 29 and 57, and methotrexate PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78 on study.
MAINTENANCE CYCLES III AND SUBSEQUENT CYCLES: Patients receive imatinib PO QD on days 1-84, methotrexate IT on day 1, dexamethasone PO BID or IV on days 1-5, 29-33, and 57-61, mercaptopurine PO on days 1-84, vincristine IV on days 1, 29 and 57, and methotrexate PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78 on study. Cycles repeat every 12 weeks for 2 years from the start of Induction therapy in the absence of disease progression or unacceptable toxicity.
STRATUM III (NON-PDGFRB ABL-CLASS FUSIONS):
BLINATUMOMAB BLOCK I: Patients receive dexamethasone PO or IV on day 1, blinatumomab IV on days 1-28, dasatinib PO on days 1-35, and methotrexate IT on days 1 and 15 over 5 weeks on study. Patients may undergo radiation therapy in 12 QD fractions.
BLINATUMOMAB BLOCK II: Patients receive dexamethasone PO or IV on day 1, blinatumomab IV on days 1-28, dasatinib PO on days 1-35, and methotrexate IT on days 1 and 15 over 5 weeks on study.
INTERIM MAINTENANCE I: Patients receive dasatinib PO QD until the end of interim maintenance I, mercaptopurine PO QD on days 1-56, vincristine IV on days 8, 22, 36, and 50, methotrexate IT on days 8 and 36, high-dose methotrexate IV over 24 hours on days 8, 22, 36 and 50, and leucovorin PO or IV on days 10, 11, 24, 25, 38, 39, 52 and 53 over 9 weeks on study.
BLINATUMOMAB BLOCK III: Patients receive blinatumomab IV on days 1-28, dasatinib PO on days 1-35, and methotrexate IT on day 1 over 5 weeks on study.
DELAYED INTENSIFICATION PART I: Patients receive dasatinib PO QD on days 1-28, methotrexate IT on day 1, dexamethasone PO or IV on days 1-7 and 15-21, doxorubicin IV over 15 minutes on days 1, 8, and 15, vincristine IV on days 1, 8, and 15, and pegaspargase IV or calaspargase pegol IV over 1-2 hours on day 4 over 4 weeks on study.
DELAYED INTENSIFICATION PART II: Patients receive dasatinib PO QD and methotrexate IT on day 29 until the end of Delayed Intensification part II, cyclophosphamide IV over 30-60 minutes on day 29, cytarabine IV over 30 minutes on days 29-32 and 36-39, methotrexate IT on days 29 and 36, thioguanine PO on days 29-42, pegaspargase IV or calaspargase pegol on day 43 and vincristine IV on days 43 and 50 over 5 weeks on study.
INTERIM MAINTENANCE II: Patients receive dasatinib PO QD until the end of interim maintenance II, methotrexate IV and vincristine IV on days 1, 11, 21, 31 and 41, methotrexate IT on days 1 and 31, and pegaspargase IV or calaspargase pegol IV over 1-2 hours on days 2, 22 or 23 over 8 weeks on study.
MAINTENANCE CYCLES I-II: Patients receive dasatinib PO QD on days 1-84, methotrexate IT on days 1 and 29, dexamethasone PO BID or IV on days 1-5, 29-33, and 57-61, mercaptopurine PO on days 1-84, vincristine IV on days 1, 29 and 57, and methotrexate PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78 on study.
MAINTENANCE CYCLES III AND SUBSEQUENT CYCLES: Patients receive dasatinib PO QD on days 1-84, methotrexate IT on day 1, dexamethasone PO BID or IV on days 1-5, 29-33, and 57-61, mercaptopurine PO on days 1-84, vincristine IV on days 1, 29 and 57, and methotrexate PO on days 8, 15, 22, 29, 36, 43, 50, 57, 64, 71, and 78 on study. Cycles repeat every 12 weeks for 2 years from the start of Induction therapy in the absence of disease progression or unacceptable toxicity.
All patients undergo echocardiography (ECHO) or multigated acquisition scan (MUGA) during screening. Patients also undergo blood and cerebrospinal fluid (CSF) sample collection and bone marrow biopsy throughout the study and as clinically indicated on study.
Eligibility criteria
Inclusion Criteria:
* Patients must be \> 365 days and \< 18 years (for AIEOP-BFM), \> 365 days and \< 22 years (for Children's Oncology Group \[COG\]) and \> 365 days and \< 46 years (for ALLTogether sites) at the time of enrollment
* Newly-diagnosed Ph+ or ABL-class Ph-like B-ALL. Leukemic blasts must express CD19. ABL-class fusions are defined as rearrangements involving the following genes predicted to be sensitive to imatinib and/or dasatinib: ABL1, ABL2, CSF1R, and PDGFRB
* Evidence of BCR::ABL1 should be documented by a clinically-validated assay prior to study entry on day 15 from the first dose of vinCRIStine during Induction therapy. ABL-class Ph-like B-ALL gene rearrangements should be documented by a clinically-validated assay and enrolled on study by day 1 of Blinatumomab Block 1. Accepted methods of detection include fluorescence in situ hybridization (FISH) using break-apart of colocalization signal probes, singleplex or multiplex reverse-transcription polymerase chain reaction (RT-PCR), whole-transcriptome or panel-based ribonucleic acid (RNA) sequencing (e.g., Hematologic Cancer Fusion Analysis, TruSight RNA Pan-Cancer Panel or equivalent). Confirmation of 5' fusion partner genes is not required for study enrollment
* Patients with Ph+ B-ALL must have previously started Induction therapy, which includes vinCRIStine, a corticosteroid, pegaspargase or calaspargase pegol, with or without anthracycline, and/or other standard cytotoxic chemotherapy
* Patients with Ph+ B-ALL have not received more than 14 days of systemic Induction therapy beginning with the first Induction dose of vinCRIStine
* Patients with ABL-class Ph-like B-ALL must have previously completed 4 or 5 weeks of multiagent Induction chemotherapy (Induction 1A)
* Patients may have started either imatinib or dasatinib prior to study entry but should have received no more than 14 days of TKI for Ph+ B-ALL or no more than 35 days of TKI for ABL-class Ph-like B-ALL
* Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of ≤ 2 or Karnofsky and Lansky performance scores ≥ 50%. Use Karnofsky for patients \> 16 years of age and Lansky for patients ≤ 16 years of age
* For pediatric patients (age 1-17 years): a glomerular filtration rate (GFR) ≥ 50 mL/min/1.73 m\^2, as determined by one of the following methods (must be performed within 7 days prior to enrollment unless otherwise indicated):
* Estimated GFR (eGFR) ≥ 50 mL/min/1.73 m2
* Measured GFR ≥ 50 mL/min/1.73 m\^2 (any age). If measured GFR is used, it must be performed using direct measurement with a nuclear blood sampling method or small molecule clearance method (iothalamate or other molecule per institutional standard
* For adult patients (age 18 years or older): Creatinine clearance ≥ 30 mL/min, as estimated by the Cockcroft and Gault formula. The creatinine value used in the calculation must have been obtained within 28 days prior to registration. Estimated creatinine clearance is based on body weight
* Direct bilirubin \< 2.0 mg/dL (34.2 micromoles/L) (must be performed within 7 days prior to enrollment unless otherwise indicated)
* Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 10 x upper limit of normal (ULN) (must be performed within 7 days prior to enrollment unless otherwise indicated)
* \* Shortening fraction of ≥ 27% by echocardiogram (must be obtained within 21 days prior to enrollment and start of protocol therapy \[repeat if necessary\]) OR
* Left Ventricular Ejection fraction of ≥ 50% by radionuclide angiogram or echocardiogram (must be obtained within 21 days prior to enrollment and start of protocol therapy \[repeat if necessary\]) AND
* Corrected QT Interval, QTc \< 480mSec (must be obtained within 21 days prior to enrollment and start of protocol therapy \[repeat if necessary\])
* Note: Repeat echocardiogram and electrocardiogram are not required if they were performed at or after initial ALL diagnosis before study enrollment
Exclusion Criteria:
* Known history of chronic myeloid leukemia (CML)
* ABL-class Ph-like B-ALL who are CNS2 or CNS3 at end of Induction phase
* ALL developing after a previous cancer treated with cytotoxic chemotherapy
* Active, uncontrolled infection or active systemic illness that requires ongoing vasopressor support or mechanical ventilation
* Down syndrome (trisomy 21)
* Pregnancy and breast feeding
* Female patients who are pregnant since fetal toxicities and teratogenic effects have been noted for several of the study drugs. A negative pregnancy test is required for female patients of childbearing potential within 7 days prior to enrollment
* Lactating females who plan to breastfeed their infants
* Sexually active male and female patients of reproductive potential who have not agreed to use an effective contraception method for the duration of treatment according to protocol
* NOTE: Patients who could become pregnant or could father a child must use effective contraception during protocol treatment and for 30 days after the last dose of dasatinib or 14 days after the last dose of imatinib dose or per institutional standard of care for multiagent chemotherapy, whichever is longer
* Prior treatment with TKIs before study entry with the exception of imatinib or dasatinib
* Patients with congenital long QT syndrome, history of ventricular arrhythmias, or heart block
* Patients with known Charcot-Marie-Tooth disease
* Patients with significant central nervous system pathology that would preclude treatment with blinatumomab, including history of severe neurologic disorder or autoimmune disease with central nervous system (CNS) involvement
* Note: Patients with a history of seizures that are well controlled on stable doses of anti-epileptic drugs are eligible. Patients with a history of cerebrovascular ischemia/hemorrhage with residual deficits are not eligible. Patients with a history of cerebrovascular ischemia/hemorrhage remain eligible provided all neurologic deficits have resolved
* HIV-infected patients are eligible if on effective anti-retroviral therapy that does not interact with planned study agents and with undetectable viral load within 6 months of treatment
* All patients and/or their parents or legal guardians must sign a written informed consent
* All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met
Study design
Enrollment target: 222 participants
Allocation: non_randomized
Masking: none
Age groups: child, adult
Timeline
Starts: 2025-05-30
Estimated completion: 2030-12-01
Last updated: 2026-04-14
Interventions
Procedure: Biospecimen CollectionBiological: BlinatumomabProcedure: Bone Marrow BiopsyDrug: Calaspargase PegolDrug: CyclophosphamideDrug: CytarabineDrug: DasatinibDrug: DaunorubicinDrug: DoxorubicinProcedure: Echocardiography TestDrug: ImatinibDrug: LeucovorinDrug: MercaptopurineDrug: MethotrexateProcedure: Multigated Acquisition ScanDrug: PegaspargaseDrug: PrednisoloneDrug: PrednisoneRadiation: Radiation TherapyDrug: ThioguanineDrug: Vincristine
Primary outcomes
- • Philadelphia chromosome-positive (Ph+) (BCR::ABL1-rearranged) 3-year event free survival (EFS) (Time from enrollment to first event, relapse, second malignancy, or death in complete remission, or last contact for those who are event-free, assessed up to 3 years)
- • ABL-class Ph-like B-ALL 3-year event free survival (EFS) (Time from enrollment to first event, relapse, second malignancy, or death in complete remission, or last contact for those who are event-free, assessed up to 3 years)
- • Incidence of adverse events (Up to 3 years)
Sponsor
National Cancer Institute (NCI) · nih
Contacts & investigators
InvestigatorThai Hoa Tran · principal_investigator, Children's Oncology Group
All locations (142)
Children's Hospital of AlabamaRecruiting
Birmingham, Alabama, United States
Phoenix Childrens HospitalRecruiting
Phoenix, Arizona, United States
Banner University Medical Center - TucsonRecruiting
Tucson, Arizona, United States
Arkansas Children's HospitalRecruiting
Little Rock, Arkansas, United States
Loma Linda University Medical CenterRecruiting
Loma Linda, California, United States
Miller Children's and Women's Hospital Long BeachRecruiting
Long Beach, California, United States
Children's Hospital Los AngelesRecruiting
Los Angeles, California, United States
Valley Children's HospitalRecruiting
Madera, California, United States
UCSF Benioff Children's Hospital OaklandRecruiting
Oakland, California, United States
Kaiser Permanente-OaklandRecruiting
Oakland, California, United States
Children's Hospital of Orange CountyRecruiting
Orange, California, United States
Lucile Packard Children's Hospital Stanford UniversityRecruiting
Palo Alto, California, United States
Rady Children's Hospital - San DiegoRecruiting
San Diego, California, United States
UCSF Medical Center-Mission BayRecruiting
San Francisco, California, United States
Children's Hospital ColoradoRecruiting
Aurora, Colorado, United States
Connecticut Children's Medical CenterRecruiting
Hartford, Connecticut, United States
Yale UniversityRecruiting
New Haven, Connecticut, United States
Alfred I duPont Hospital for ChildrenRecruiting
Wilmington, Delaware, United States
MedStar Georgetown University HospitalRecruiting
Washington D.C., District of Columbia, United States
Children's National Medical CenterRecruiting
Washington D.C., District of Columbia, United States
Golisano Children's Hospital of Southwest FloridaRecruiting
Fort Myers, Florida, United States
UF Health Cancer Institute - GainesvilleRecruiting
Gainesville, Florida, United States
Memorial Regional Hospital/Joe DiMaggio Children's HospitalRecruiting
Hollywood, Florida, United States
Nemours Children's Clinic-JacksonvilleRecruiting
Jacksonville, Florida, United States
University of Miami Miller School of Medicine-Sylvester Cancer CenterRecruiting
Miami, Florida, United States
Arnold Palmer Hospital for ChildrenRecruiting
Orlando, Florida, United States
Nemours Children's HospitalRecruiting
Orlando, Florida, United States
Nemours Children's Clinic - PensacolaRecruiting
Pensacola, Florida, United States
Johns Hopkins All Children's HospitalRecruiting
St. Petersburg, Florida, United States
Saint Joseph's Hospital/Children's Hospital-TampaRecruiting
Tampa, Florida, United States
Saint Mary's Medical CenterRecruiting
West Palm Beach, Florida, United States
Children's Healthcare of Atlanta - Arthur M Blank HospitalRecruiting
Atlanta, Georgia, United States
Augusta University Medical CenterRecruiting
Augusta, Georgia, United States
Atrium Health NavicentRecruiting
Macon, Georgia, United States
Memorial Health University Medical CenterRecruiting
Savannah, Georgia, United States
Kapiolani Medical Center for Women and ChildrenRecruiting
Honolulu, Hawaii, United States
Saint Luke's Cancer Institute - BoiseRecruiting
Boise, Idaho, United States
Lurie Children's Hospital-ChicagoRecruiting
Chicago, Illinois, United States
University of IllinoisRecruiting
Chicago, Illinois, United States
University of Chicago Comprehensive Cancer CenterRecruiting
Chicago, Illinois, United States
Advocate Children's Hospital-Oak LawnRecruiting
Oak Lawn, Illinois, United States
Advocate Children's Hospital-Park RidgeRecruiting
Park Ridge, Illinois, United States
Southern Illinois University School of MedicineRecruiting
Springfield, Illinois, United States
Riley Hospital for ChildrenRecruiting
Indianapolis, Indiana, United States
Blank Children's HospitalRecruiting
Des Moines, Iowa, United States
University of Iowa/Holden Comprehensive Cancer CenterRecruiting
Iowa City, Iowa, United States
University of Kentucky/Markey Cancer CenterRecruiting
Lexington, Kentucky, United States
Ochsner Medical Center JeffersonRecruiting
New Orleans, Louisiana, United States
Maine Children's Cancer ProgramRecruiting
Scarborough, Maine, United States
Sinai Hospital of BaltimoreRecruiting
Baltimore, Maryland, United States
Johns Hopkins University/Sidney Kimmel Cancer CenterRecruiting
Baltimore, Maryland, United States
Walter Reed National Military Medical CenterRecruiting
Bethesda, Maryland, United States
Dana-Farber Cancer InstituteRecruiting
Boston, Massachusetts, United States
UMass Memorial Medical Center - University CampusRecruiting
Worcester, Massachusetts, United States
C S Mott Children's HospitalRecruiting
Ann Arbor, Michigan, United States
Children's Hospital of MichiganRecruiting
Detroit, Michigan, United States
Corewell Health Grand Rapids Hospitals - Helen DeVos Children's HospitalRecruiting
Grand Rapids, Michigan, United States
Bronson Methodist HospitalRecruiting
Kalamazoo, Michigan, United States
University of Minnesota/Masonic Cancer CenterRecruiting
Minneapolis, Minnesota, United States
Mayo Clinic in RochesterRecruiting
Rochester, Minnesota, United States
University of Mississippi Medical CenterRecruiting
Jackson, Mississippi, United States
Children's Mercy Hospitals and ClinicsRecruiting
Kansas City, Missouri, United States
Washington University School of MedicineRecruiting
St Louis, Missouri, United States
Children's Hospital and Medical Center of OmahaRecruiting
Omaha, Nebraska, United States
Alliance for Childhood Diseases/Cure 4 the Kids FoundationRecruiting
Las Vegas, Nevada, United States
Dartmouth Hitchcock Medical Center/Dartmouth Cancer CenterRecruiting
Lebanon, New Hampshire, United States
Hackensack University Medical CenterRecruiting
Hackensack, New Jersey, United States
Morristown Medical CenterRecruiting
Morristown, New Jersey, United States
Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University HospitalRecruiting
New Brunswick, New Jersey, United States
Saint Joseph's Regional Medical CenterRecruiting
Paterson, New Jersey, United States
University of New Mexico Cancer CenterRecruiting
Albuquerque, New Mexico, United States
Albany Medical CenterRecruiting
Albany, New York, United States
Roswell Park Cancer InstituteRecruiting
Buffalo, New York, United States
NYU Langone Hospital - Long IslandRecruiting
Mineola, New York, United States
The Steven and Alexandra Cohen Children's Medical Center of New YorkRecruiting
New Hyde Park, New York, United States
Laura and Isaac Perlmutter Cancer Center at NYU LangoneRecruiting
New York, New York, United States
Memorial Sloan Kettering Cancer CenterRecruiting
New York, New York, United States
NYP/Weill Cornell Medical CenterRecruiting
New York, New York, United States
Stony Brook University Medical CenterRecruiting
Stony Brook, New York, United States
State University of New York Upstate Medical UniversityRecruiting
Syracuse, New York, United States
Montefiore Medical Center - Moses CampusRecruiting
The Bronx, New York, United States
New York Medical CollegeRecruiting
Valhalla, New York, United States
Mission HospitalRecruiting
Asheville, North Carolina, United States
Carolinas Medical Center/Levine Cancer InstituteRecruiting
Charlotte, North Carolina, United States
Duke University Medical CenterRecruiting
Durham, North Carolina, United States
Wake Forest University Health SciencesRecruiting
Winston-Salem, North Carolina, United States
Children's Hospital Medical Center of AkronRecruiting
Akron, Ohio, United States
Cincinnati Children's Hospital Medical CenterRecruiting
Cincinnati, Ohio, United States
Rainbow Babies and Childrens HospitalRecruiting
Cleveland, Ohio, United States
Nationwide Children's HospitalRecruiting
Columbus, Ohio, United States
Dayton Children's HospitalRecruiting
Dayton, Ohio, United States
ProMedica Toledo Hospital/Russell J Ebeid Children's HospitalRecruiting
Toledo, Ohio, United States
University of Oklahoma Health Sciences CenterRecruiting
Oklahoma City, Oklahoma, United States
Lehigh Valley Hospital-Cedar CrestRecruiting
Allentown, Pennsylvania, United States
Penn State Children's HospitalRecruiting
Hershey, Pennsylvania, United States
Children's Hospital of PhiladelphiaRecruiting
Philadelphia, Pennsylvania, United States
Saint Christopher's Hospital for ChildrenRecruiting
Philadelphia, Pennsylvania, United States
Children's Hospital of Pittsburgh of UPMCRecruiting
Pittsburgh, Pennsylvania, United States
Rhode Island HospitalRecruiting
Providence, Rhode Island, United States
Prisma Health Richland HospitalRecruiting
Columbia, South Carolina, United States
BI-LO Charities Children's Cancer CenterRecruiting
Greenville, South Carolina, United States
Sanford USD Medical Center - Sioux FallsRecruiting
Sioux Falls, South Dakota, United States
East Tennessee Childrens HospitalRecruiting
Knoxville, Tennessee, United States
The Children's Hospital at TriStar CentennialRecruiting
Nashville, Tennessee, United States
Vanderbilt University/Ingram Cancer CenterRecruiting
Nashville, Tennessee, United States
Dell Children's Medical Center of Central TexasRecruiting
Austin, Texas, United States
Driscoll Children's HospitalRecruiting
Corpus Christi, Texas, United States
Medical City Dallas HospitalRecruiting
Dallas, Texas, United States
UT Southwestern/Simmons Cancer Center-DallasRecruiting
Dallas, Texas, United States
El Paso Children's HospitalRecruiting
El Paso, Texas, United States
Cook Children's Medical CenterRecruiting
Fort Worth, Texas, United States
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer CenterRecruiting
Houston, Texas, United States
Covenant Children's HospitalRecruiting
Lubbock, Texas, United States
UMC Cancer Center / UMC Health SystemRecruiting
Lubbock, Texas, United States
Children's Hospital of San AntonioRecruiting
San Antonio, Texas, United States
Methodist Children's Hospital of South TexasRecruiting
San Antonio, Texas, United States
University of Texas Health Science Center at San AntonioRecruiting
San Antonio, Texas, United States
Primary Children's HospitalRecruiting
Salt Lake City, Utah, United States
University of Vermont and State Agricultural CollegeRecruiting
Burlington, Vermont, United States
University of Virginia Cancer CenterRecruiting
Charlottesville, Virginia, United States
Inova Fairfax HospitalRecruiting
Falls Church, Virginia, United States
Children's Hospital of The King's DaughtersRecruiting
Norfolk, Virginia, United States
VCU Massey Comprehensive Cancer CenterRecruiting
Richmond, Virginia, United States
Carilion Children'sRecruiting
Roanoke, Virginia, United States
Seattle Children's HospitalRecruiting
Seattle, Washington, United States
Providence Sacred Heart Medical Center and Children's HospitalRecruiting
Spokane, Washington, United States
Mary Bridge Children's Hospital and Health CenterRecruiting
Tacoma, Washington, United States
Saint Vincent Hospital Cancer Center Green BayRecruiting
Green Bay, Wisconsin, United States
University of Wisconsin Carbone Cancer Center - University HospitalRecruiting
Madison, Wisconsin, United States
Children's Hospital of WisconsinRecruiting
Milwaukee, Wisconsin, United States
Queensland Children's HospitalRecruiting
South Brisbane, Queensland, Australia
Perth Children's HospitalRecruiting
Perth, Western Australia, Australia
Alberta Children's HospitalRecruiting
Calgary, Alberta, Canada
British Columbia Children's HospitalSuspended
Vancouver, British Columbia, Canada
IWK Health CentreRecruiting
Halifax, Nova Scotia, Canada
McMaster Children's Hospital at Hamilton Health SciencesRecruiting
Hamilton, Ontario, Canada
Hospital for Sick ChildrenRecruiting
Toronto, Ontario, Canada
The Montreal Children's Hospital of the MUHCSuspended
Montreal, Quebec, Canada
Centre Hospitalier Universitaire Sainte-JustineSuspended
Montreal, Quebec, Canada
Centre Hospitalier Universitaire de Sherbrooke-FleurimontSuspended
Sherbrooke, Quebec, Canada
CHU de Quebec-Centre Hospitalier de l'Universite Laval (CHUL)Suspended
Québec, Canada
University Pediatric HospitalRecruiting
San Juan, Puerto Rico