Back to Trials
NCT05561387PHASE3Recruiting

Comparing Combinations of Drugs to Treat Newly Diagnosed Multiple Myeloma (NDMM) When a Stem Cell Transplant is Not a Medically Suitable Treatment

SWOG Cancer Research Network

Start Date

10/12/2023

Completion Date

5/30/2031

Summary

This phase III trial compares three-drug induction regimens followed by double-or single-drug maintenance therapy for the treatment of newly diagnosed multiple myeloma in patients who are not receiving a stem cell transplant and are considered frail or intermediate-fit based on age, comorbidities, and functional status. Treatment for multiple myeloma includes initial treatment (induction) which is the first treatment a patient receives for cancer followed by ongoing treatment (maintenance) which is given after initial treatment to help keep the cancer from coming back. There are three combinations of four different drugs being studied. Bortezomib is one of the drugs that may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Lenalidomide works by helping bone marrow to produce normal blood cells and killing cancer cells. Anti-inflammatory drugs, such as dexamethasone, lower the body's immune response and are used with other drugs in the treatment of some types of cancer. Daratumumab and hyaluronidase-fihj is a monoclonal antibody that may interfere with the ability of cancer cells to grow and spread. Patients receive 1 of 3 combinations of these drugs for treatment to determine which combination of study drugs works better to shrink and control multiple myeloma.

Detailed Description

PRIMARY OBJECTIVES: I. To compare progression-free survival (PFS) in frail or selected intermediate fit newly diagnosed multiple myeloma (NDMM) participants treated with bortezomib with lenalidomide and dexamethasone at reduced dosing (VRd-Lite) induction followed by lenalidomide maintenance (Arm 1) versus daratumumab and hyaluronidase-fihj with lenalidomide and dexamethasone (DRd) induction followed by lenalidomide maintenance (Arm 2). II. To compare overall survival (OS) in frail or selected intermediate fit NDMM participants treated with VRd-Lite induction followed by lenalidomide maintenance (Arm 1) versus DRd induction followed by lenalidomide and daratumumab and hyaluronidase-fihj maintenance (Arm 3). SECONDARY OBJECTIVES: I. To compare PFS in Arm 1 versus Arm 3 II. To compare OS in Arm 1 versus Arm 2. III. To compare PFS in Arm 2 versus 3. IV. To compare the overall response rate (ORR) of Arm 1 against the ORR of Arm 2 and Arm 3. V. To compare the safety of Arm 1 with the safety of Arm 2 and Arm 3. VI. To explore veinous thrombo-embolism (VTE) incidence in participants receiving lenalidomide during induction across the three study arms. VII. To describe median time to response (complete response \[CR\] or better per International Myeloma Working Group \[IMWG\] criteria, very good partial response \[VGPR\] or better per IMWG criteria, partial response \[PR\] or better per IMWG criteria) on the three study arms. PRIMARY QUALITY OF LIFE (QOL) OBJECTIVE: I. To compare patient-reported global health status between treatment arms (Arm 1 versus the combination of Arms 2 and 3) at 9 months after randomization (end of induction therapy) using the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30). SECONDARY QOL OBJECTIVE: II. To compare longitudinal changes in global health status between treatment arms (Arm 1 versus the combination of Arms 2 and 3) from baseline to 9 months after randomization (end of induction therapy). PATIENT REPORTED OUTCOMES-COMMON TERMINOLOGY CRITERIA FOR ADVERSE EVENTS (PRO-CTCAE) OBJECTIVE: I. To compare selected patient-reported outcome symptoms using PRO-CTCAE items among the 3 study arms. ADDITIONAL OBJECTIVES: I. To compare the rate of minimal residual disease (MRD) by clonoSEQ after 9 cycles of induction in Arm 1 versus Arm 2 and Arm 3, respectively. II. To compare the rate of MRD conversion after 1 year of maintenance in participants who were MRD positive after induction in Arm 1 versus Arm 2 and Arm 3, respectively. III. To compare the rate of sustained MRD negativity at time points of post-induction, post-1 year maintenance in Arm 1 versus Arm 2 and Arm 3, respectively. BANKING OBJECTIVES: I. To bank specimens for future correlative studies. OUTLINE: Patients are randomized to 1 of 3 arms. ARM I (VRd-Lite): INDUCTION CYCLES 1-9: Patients receive bortezomib subcutaneously (SC) on days 1, 8, 15, and 22 of each cycle, lenalidomide orally (PO) on days 1-21 of each cycle, and dexamethasone PO on days 1, 8, 15, and 22 of each cycle. Treatment repeats every 28 days for up to 9 cycles in the absence of disease progression or unacceptable toxicity. MAINTENANCE CYCLES 10+: Patients receive lenalidomide PO on days 1-21 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. ARM II (DRd-R): INDUCTION CYCLES 1-9: Patients receive daratumumab and hyaluronidase-fihj SC on days 1, 8, 15, and 22 of cycles 1-2, days 1 and 15 of cycles 3-6, and day 1 of cycles 7-9, lenalidomide PO on days 1-21 of each cycle, and dexamethasone PO on days 1, 8, 15, and 22 of each cycle. Treatment repeats every 28 days for up to 9 cycles in the absence of disease progression or unacceptable toxicity. MAINTENANCE CYCLES 10+: Patients receive lenalidomide PO on days 1-21 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. ARM III (DRd-DR): INDUCTION CYCLES 1-9: Patients receive daratumumab and hyaluronidase-fihj SC on days 1, 8, 15, and 22 of cycles 1-2, days 1 and 15 of cycles 3-6, and day 1 of cycles 7-9, lenalidomide PO on days 1-21 of each cycle, and dexamethasone PO on days 1, 8, 15, and 22 of each cycle. Treatment repeats every 28 days for up to 9 cycles in the absence of disease progression or unacceptable toxicity. MAINTENANCE CYCLES 10+: Patients receive daratumumab and hyaluronidase-fihj SC on day 1 of each cycle and lenalidomide PO on days 1-21 of each cycle. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 3 months for 1 year, every 6 months for 2 years, and then annually for up to 10 years.

Eligibility Criteria

Age Range: No minimum to No maximum

Inclusion Criteria: * Participants must have documented multiple myeloma satisfying standard International Myeloma Working Group (IMWG) diagnostic criteria within 28 days prior to registration * Participants must have measurable disease within 28 days prior to registration as defined by any of the following: * Immunoglobulin (Ig) G myeloma (serum monoclonal paraprotein \[M-protein\] level \>= 0.5 gram/deciliter \[g/dL\] or urine M-protein level \>= 200 milligram\[mg\]/24 hours\[hrs\]); OR * IgA, IgM, IgD, or IgE multiple myeloma (serum M-protein level \>= 0.2 g/dL or urine M-protein level \>= 200 mg/24 hrs); OR * Light chain multiple myeloma (serum immunoglobulin free light chain \>= 10 mg/dL and abnormal serum immunoglobulin kappa lambda free light chain ratio) * All disease must be assessed and documented on the baseline/pre-registration tumor assessment form * Participants must have a calculated myeloma frailty index (Myeloma Frailty Score Calculator; http://www.myelomafrailtyscorecalculator.net/) categorized as frail or intermediate fit (regardless of age) within 28 days prior to registration * For Participants Meeting "Frail" Status: * Participants with any degree of kidney dysfunction are allowed; however, participants on dialysis are not eligible * For Participants Meeting "Frail" Status: * Hemoglobin \>= 7 g/dL (must be performed within 28 days prior to registration) * Note: growth factor and transfusion utilization are allowed if cytopenias are considered secondary to bone marrow involvement from MM) * For Participants Meeting "Frail" Status: * Platelets \>= 50 x 10\^9/L (must be performed within 28 days prior to registration) * Note: growth factor and transfusion utilization are allowed if cytopenias are considered secondary to bone marrow involvement from MM) * For Participants Meeting "Frail" Status: * Absolute neutrophil count (ANC) \>= 0.75 x10\^9/L (must be performed within 28 days prior to registration) * Note: growth factor and transfusion utilization are allowed if cytopenias are considered secondary to bone marrow involvement from MM) * For Participants Meeting "Intermediate Fit" Status, one or more of the following criteria must be present: * Kidney dysfunction showing calculated creatinine clearance (CrCl) \<30 ml/min. * Actual lab serum creatinine value with a minimum of 0.7 mg/dL. * Participants must have bone marrow function assessed and meet the below criteria ranges: * Hemoglobin between 7-8 g/dL, OR * Platelets between 50-75 x10\^9/L, OR * ANC between 0.75-1 x10\^9/L * Note: growth factor and transfusion utilization are allowed as long as cytopenias are considered secondary to bone marrow involvement from MM) * Revised International Staging System (R-ISS) stage III disease * Note: All labs must be performed within 28 days prior to registration * Participants must have a complete medical history and physical exam within 28 days prior to registration * Participants must have whole body imaging within 60 days prior to registration. The recommended method of imaging is a positron emission tomography/computed tomography (PET/CT); a low-dose whole body CT scan or whole-body magnetic resonance imaging (MRI) or skeletal survey should be done only if a PET/CT scan cannot be done or is non-feasible. This must be documented in the comments section of the Onstudy form. * Total bilirubin =\< 2 times institutional upper limit of normal (ULN) unless history of Gilbert's disease. Participants with history of Gilbert's disease must have total bilirubin =\< 5 x institutional ULN (within 28 days prior to registration) * Aspartate aminotransferase (AST)/alanine aminotransferase (ALT) =\< 3 × institutional ULN (within 28 days prior to registration) * Participants must have adequate cardiac function, as assessed by the treating physician within 14 days prior to registration. Participants with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, must have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification and must not be assessed as class 3 or 4 * Participants with known diabetes must show evidence of controlled disease within 14 days prior to registration. Uncontrolled diabetes is defined as: A glycosylated hemoglobin (Hg)A1C \> 7 * Participants with known human immunodeficiency virus (HIV)-infection must be receiving anti-retroviral therapy and have an undetectable viral load test on the most recent test result obtained, within 6 months prior to registration * All participants with evidence of chronic hepatitis B virus (HBV) infection must have undetectable HBV viral load on suppressive therapy within 28 days prior to registration * Participants with a history of hepatitis C virus (HCV) infection must have been treated and cured. For participants with HCV infection who are currently on treatment, participant must have an undetectable HCV viral load within 28 days prior to registration * Participants must have an Eastern Cooperative Oncology Group (ECOG)/Zubrod performance status score of 0-2 (Note: Participants with ECOG/Zubrod performance score \[PS\] 3, especially where the deterioration of PS is considered secondary to the MM diagnosis, will be allowed) * Participants must be offered the opportunity to participate in specimen banking. With participant consent, specimens must be collected and submitted via the Southwest Oncology Group (SWOG) specimen tracking system * Participants who are able to complete the patient-reported outcomes measures in English or Spanish must agree to participate in the PRO portion of the study * Participants must be informed of the investigational nature of this study and must sign and give informed consent in accordance with institutional and federal guidelines. For participants with impaired decision-making capabilities, legally authorized representatives may sign and give informed consent on behalf of study participants in accordance with applicable federal, local, and Central Institutional Review Board (CIRB) regulations Exclusion Criteria: * Participants must not have received any prior systemic therapy for multiple myeloma with the exception of any one or more of the following: * An emergency use of a short course of corticosteroids (equivalent of dexamethasone 160 mg) any time before registration, or * Up to one complete cycle of a non-daratumumab and hyaluronidase-fihj containing anti-myeloma regimen (1 cycle = 21 or 28 days depending on the regimen being used), or * Localized palliative radiation therapy for multiple myeloma, as long as the radiation therapy is completed at least 3 days prior to starting the systemic treatment as per the study protocol. * Participants must not have evidence of grade 4 peripheral neuropathy prior to study registration * Participants must not have uncontrolled blood pressure within 14 days prior to registration. Uncontrolled blood pressure: systolic blood pressure (SBP) \> 140 mmHg or diastolic blood pressure (DBP) \> 90 mmHg. Participants are permitted to be receiving multiple anti-hypertensive medications (unless otherwise indicated in the study). All blood pressure measurements within the 14 days prior to registration must be SBP =\< 140 and DBP =\< 90. A participant with a single blood pressure elevation who upon rechecking has a normal blood pressure will remain eligible at the discretion of the registering investigator. * Participants must not have a prior or concurrent malignancy whose natural history or treatment (in the opinion of the treating physician) has the potential to interfere with the safety or efficacy assessment of the investigational regimen. * Participants must not be pregnant or nursing. Individuals who are of reproductive potential must have agreed to use an effective contraceptive method with details provided as a part of the consent process. A person who has had menses at any time in the preceding 24 consecutive months or who has semen likely to contain sperm is considered to be of "reproductive potential." In addition to routine contraceptive methods, "effective contraception" also includes refraining from sexual activity that might result in pregnancy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) including hysterectomy, bilateral oophorectomy, bilateral tubal ligation/occlusion, and vasectomy with testing showing no sperm in the semen.

Interventions

DRUG

Bortezomib

DRUG

Daratumumab and Hyaluronidase-fihj

DRUG

Dexamethasone

DRUG

Lenalidomide

OTHER

Quality-of-Life Assessment

OTHER

Questionnaire Administration

Interested in This Trial?

Contact the trial locations directly using the information below to learn more about enrollment.

Expressing interest lets you review the study and consent before we connect you with the research site.

Conditions

Plasma Cell Myeloma

Locations

Anchorage Associates in Radiation Medicine

Anchorage, Alaska 98508

United States

Anchorage Radiation Therapy Center

Anchorage, Alaska 99504

United States

Alaska Breast Care and Surgery LLC

Anchorage, Alaska 99508

United States

Alaska Oncology and Hematology LLC

Anchorage, Alaska 99508

United States

Alaska Women's Cancer Care

Anchorage, Alaska 99508

United States

Anchorage Oncology Centre

Anchorage, Alaska 99508

United States

Katmai Oncology Group

Anchorage, Alaska 99508

United States

Providence Alaska Medical Center

Anchorage, Alaska 99508

United States

Cancer Center at Saint Joseph's

Phoenix, Arizona 85004

United States

Mercy Hospital Fort Smith

Fort Smith, Arkansas 72903

United States

CARTI Cancer Center

Little Rock, Arkansas 72205

United States

John L McClellan Memorial Veterans Hospital

Little Rock, Arkansas 72205

United States

University of Arkansas for Medical Sciences

Little Rock, Arkansas 72205

United States

Mission Hope Medical Oncology - Arroyo Grande

Arroyo Grande, California 93420

United States

Providence Saint Joseph Medical Center/Disney Family Cancer Center

Burbank, California 91505

United States

Marshall Cancer Center

Cameron Park, California 95682

United States

Mercy Cancer Center - Carmichael

Carmichael, California 95608

United States

Mercy San Juan Medical Center

Carmichael, California 95608

United States

Mercy Cancer Center - Elk Grove

Elk Grove, California 95758

United States

Fremont - Rideout Cancer Center

Marysville, California 95901

United States

Mercy UC Davis Cancer Center

Merced, California 95340

United States

Providence Queen of The Valley

Napa, California 94558

United States

Mercy Cancer Center - Rocklin

Rocklin, California 95765

United States

Mercy Cancer Center - Sacramento

Sacramento, California 95816

United States

University of California Davis Comprehensive Cancer Center

Sacramento, California 95817

United States

Pacific Central Coast Health Center-San Luis Obispo

San Luis Obispo, California 93401

United States

Mission Hope Medical Oncology - Santa Maria

Santa Maria, California 93444

United States

Providence Medical Foundation - Santa Rosa

Santa Rosa, California 95403

United States

Providence Santa Rosa Memorial Hospital

Santa Rosa, California 95405

United States

Gene Upshaw Memorial Tahoe Forest Cancer Center

Truckee, California 96161

United States

Woodland Memorial Hospital

Woodland, California 95695

United States

Rocky Mountain Regional VA Medical Center

Aurora, Colorado 80045

United States

Penrose-Saint Francis Healthcare

Colorado Springs, Colorado 80907

United States

Rocky Mountain Cancer Centers-Penrose

Colorado Springs, Colorado 80907

United States

Saint Francis Cancer Center

Colorado Springs, Colorado 80923

United States

Porter Adventist Hospital

Denver, Colorado 80210

United States

Mercy Medical Center

Durango, Colorado 81301

United States

Southwest Oncology PC

Durango, Colorado 81301

United States

Saint Anthony Hospital

Lakewood, Colorado 80228

United States

Littleton Adventist Hospital

Littleton, Colorado 80122

United States

Longmont United Hospital

Longmont, Colorado 80501

United States

Parker Adventist Hospital

Parker, Colorado 80138

United States

Saint Mary Corwin Medical Center

Pueblo, Colorado 81004

United States

Smilow Cancer Hospital-Derby Care Center

Derby, Connecticut 06418

United States

Smilow Cancer Hospital Care Center-Fairfield

Fairfield, Connecticut 06824

United States

Smilow Cancer Hospital Care Center at Glastonbury

Glastonbury, Connecticut 06033

United States

Smilow Cancer Hospital Care Center at Greenwich

Greenwich, Connecticut 06830

United States

Smilow Cancer Hospital Care Center - Guilford

Guilford, Connecticut 06437

United States

Smilow Cancer Hospital Care Center at Saint Francis

Hartford, Connecticut 06105

United States

Smilow Cancer Center/Yale-New Haven Hospital

New Haven, Connecticut 06510

United States

Yale University

New Haven, Connecticut 06520

United States

Yale-New Haven Hospital North Haven Medical Center

North Haven, Connecticut 06473

United States

Smilow Cancer Hospital Care Center at Long Ridge

Stamford, Connecticut 06902

United States

Smilow Cancer Hospital-Torrington Care Center

Torrington, Connecticut 06790

United States

Smilow Cancer Hospital Care Center-Trumbull

Trumbull, Connecticut 06611

United States

Smilow Cancer Hospital-Waterbury Care Center

Waterbury, Connecticut 06708

United States

Smilow Cancer Hospital Care Center - Waterford

Waterford, Connecticut 06385

United States

Holy Cross Hospital

Fort Lauderdale, Florida 33308

United States

Mayo Clinic in Florida

Jacksonville, Florida 32224-9980

United States

Jupiter Medical Center

Jupiter, Florida 33458

United States

Saint Luke's Cancer Institute - Boise

Boise, Idaho 83712

United States

Saint Luke's Cancer Institute - Fruitland

Fruitland, Idaho 83619

United States

Saint Luke's Cancer Institute - Meridian

Meridian, Idaho 83642

United States

Saint Luke's Cancer Institute - Nampa

Nampa, Idaho 83686

United States

Saint Luke's Cancer Institute - Twin Falls

Twin Falls, Idaho 83301

United States

Saint Anthony's Health

Alton, Illinois 62002

United States

Rush - Copley Medical Center

Aurora, Illinois 60504

United States

Saint Joseph Medical Center

Bloomington, Illinois 61701

United States

Illinois CancerCare-Bloomington

Bloomington, Illinois 61704

United States

Loyola Center for Health at Burr Ridge

Burr Ridge, Illinois 60527

United States

Illinois CancerCare-Canton

Canton, Illinois 61520

United States

Memorial Hospital of Carbondale

Carbondale, Illinois 62902

United States

SIH Cancer Institute

Carterville, Illinois 62918

United States

Illinois CancerCare-Carthage

Carthage, Illinois 62321

United States

Centralia Oncology Clinic

Centralia, Illinois 62801

United States

Saint Mary's Hospital

Centralia, Illinois 62801

United States

Carle at The Riverfront

Danville, Illinois 61832

United States

Cancer Care Specialists of Illinois - Decatur

Decatur, Illinois 62526

United States

Decatur Memorial Hospital

Decatur, Illinois 62526

United States

Illinois CancerCare-Dixon

Dixon, Illinois 61021

United States

Carle Physician Group-Effingham

Effingham, Illinois 62401

United States

Crossroads Cancer Center

Effingham, Illinois 62401

United States

Illinois CancerCare-Eureka

Eureka, Illinois 61530

United States

Illinois CancerCare-Galesburg

Galesburg, Illinois 61401

United States

Western Illinois Cancer Treatment Center

Galesburg, Illinois 61401

United States

Edward Hines Jr VA Hospital

Hines, Illinois 60141

United States

Loyola Medicine Homer Glen

Homer Glen, Illinois 60491

United States

Illinois CancerCare-Kewanee Clinic

Kewanee, Illinois 61443

United States

Illinois CancerCare-Macomb

Macomb, Illinois 61455

United States

Carle Physician Group-Mattoon/Charleston

Mattoon, Illinois 61938

United States

Loyola University Medical Center

Maywood, Illinois 60153

United States

Marjorie Weinberg Cancer Center at Loyola-Gottlieb

Melrose Park, Illinois 60160

United States

Good Samaritan Regional Health Center

Mount Vernon, Illinois 62864

United States

Cancer Care Center of O'Fallon

O'Fallon, Illinois 62269

United States

HSHS Saint Elizabeth's Hospital

O'Fallon, Illinois 62269

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

Methodist Medical Center of Illinois

Peoria, Illinois 61636

United States

Illinois CancerCare-Peru

Peru, Illinois 61354

United States

Valley Radiation Oncology

Peru, Illinois 61354

United States

Illinois CancerCare-Princeton

Princeton, Illinois 61356

United States

Southern Illinois University School of Medicine

Springfield, Illinois 62702

United States

Springfield Clinic

Springfield, Illinois 62702

United States

Memorial Medical Center

Springfield, Illinois 62781

United States

Carle Cancer Center

Urbana, Illinois 61801

United States

The Carle Foundation Hospital

Urbana, Illinois 61801

United States

Illinois CancerCare - Washington

Washington, Illinois 61571

United States

Rush-Copley Healthcare Center

Yorkville, Illinois 60560

United States

IU Health North Hospital

Carmel, Indiana 46032

United States

Northwest Cancer Center - Main Campus

Crown Point, Indiana 46307

United States

Northwest Oncology LLC

Dyer, Indiana 46311

United States

Northwest Cancer Center - Hobart

Hobart, Indiana 46342

United States

Saint Mary Medical Center

Hobart, Indiana 46342

United States

Indiana University/Melvin and Bren Simon Cancer Center

Indianapolis, Indiana 46202

United States

Saint Catherine Hospital

Indianapolis, Indiana 46312

United States

The Community Hospital

Munster, Indiana 46321

United States

Women's Diagnostic Center - Munster

Munster, Indiana 46321

United States

Reid Health

Richmond, Indiana 47374

United States

Northwest Cancer Center - Valparaiso

Valparaiso, Indiana 46383

United States

Mission Cancer and Blood - Ankeny

Ankeny, Iowa 50023

United States

University of Iowa Healthcare Cancer Services Quad Cities

Bettendorf, Iowa 52722

United States

Physicians' Clinic of Iowa PC

Cedar Rapids, Iowa 52402

United States

Medical Oncology and Hematology Associates-West Des Moines

Clive, Iowa 50325

United States

Mercy Cancer Center-West Lakes

Clive, Iowa 50325

United States

Alegent Health Mercy Hospital

Council Bluffs, Iowa 51503

United States

Greater Regional Medical Center

Creston, Iowa 50801

United States

Mercy Medical Center - Des Moines

Des Moines, Iowa 50314

United States

Mission Cancer and Blood - Laurel

Des Moines, Iowa 50314

United States

University of Iowa/Holden Comprehensive Cancer Center

Iowa City, Iowa 52242

United States

Mercy Medical Center-West Lakes

West Des Moines, Iowa 50266

United States

Central Care Cancer Center - Garden City

Garden City, Kansas 67846

United States

Central Care Cancer Center - Great Bend

Great Bend, Kansas 67530

United States

Flaget Memorial Hospital

Bardstown, Kentucky 40004

United States

Commonwealth Cancer Center-Corbin

Corbin, Kentucky 40701

United States

Saint Joseph Hospital

Lexington, Kentucky 40504

United States

Saint Joseph Radiation Oncology Resource Center

Lexington, Kentucky 40504

United States

Saint Joseph Hospital East

Lexington, Kentucky 40509

United States

Saint Joseph London

London, Kentucky 40741

United States

Saint Joseph Mount Sterling

Mount Sterling, Kentucky 40353

United States

Greater Baltimore Medical Center

Baltimore, Maryland 21204

United States

Saint Joseph Mercy Hospital

Ann Arbor, Michigan 48106

United States

Bronson Battle Creek

Battle Creek, Michigan 49017

United States

Saint Joseph Mercy Brighton

Brighton, Michigan 48114

United States

Trinity Health IHA Medical Group Hematology Oncology - Brighton

Brighton, Michigan 48114

United States

Saint Joseph Mercy Canton

Canton, Michigan 48188

United States

Trinity Health IHA Medical Group Hematology Oncology - Canton

Canton, Michigan 48188

United States

Caro Cancer Center

Caro, Michigan 48723

United States

Saint Joseph Mercy Chelsea

Chelsea, Michigan 48118

United States

Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital

Chelsea, Michigan 48118

United States

Hematology Oncology Consultants-Clarkston

Clarkston, Michigan 48346

United States

Newland Medical Associates-Clarkston

Clarkston, Michigan 48346

United States

Ascension Saint John Hospital

Detroit, Michigan 48236

United States

Great Lakes Cancer Management Specialists-Doctors Park

East China, Michigan 48054

United States

Genesee Cancer and Blood Disease Treatment Center

Flint, Michigan 48503

United States

Genesee Hematology Oncology PC

Flint, Michigan 48503

United States

Genesys Hurley Cancer Institute

Flint, Michigan 48503

United States

Hurley Medical Center

Flint, Michigan 48503

United States

Helen DeVos Children's Hospital at Spectrum Health

Grand Rapids, Michigan 49503

United States

Spectrum Health at Butterworth Campus

Grand Rapids, Michigan 49503

United States

Trinity Health Grand Rapids Hospital

Grand Rapids, Michigan 49503

United States

Academic Hematology Oncology Specialists

Grosse Pointe Woods, Michigan 48236

United States

Great Lakes Cancer Management Specialists-Van Elslander Cancer Center

Grosse Pointe Woods, Michigan 48236

United States

Bronson Methodist Hospital

Kalamazoo, Michigan 49007

United States

West Michigan Cancer Center

Kalamazoo, Michigan 49007

United States

Ascension Borgess Cancer Center

Kalamazoo, Michigan 49009

United States

Borgess Medical Center

Kalamazoo, Michigan 49048

United States

University of Michigan Health - Sparrow Lansing

Lansing, Michigan 48912

United States

Trinity Health Saint Mary Mercy Livonia Hospital

Livonia, Michigan 48154

United States

Great Lakes Cancer Management Specialists-Macomb Medical Campus

Macomb, Michigan 48044

United States

Saint Mary's Oncology/Hematology Associates of Marlette

Marlette, Michigan 48453

United States

Trinity Health Muskegon Hospital

Muskegon, Michigan 49444

United States

Corewell Health Lakeland Hospitals - Niles Hospital

Niles, Michigan 49120

United States

Cancer and Hematology Centers of Western Michigan - Norton Shores

Norton Shores, Michigan 49444

United States

21st Century Oncology-Pontiac

Pontiac, Michigan 48341

United States

Hope Cancer Center

Pontiac, Michigan 48341

United States

Newland Medical Associates-Pontiac

Pontiac, Michigan 48341

United States

Saint Joseph Mercy Oakland

Pontiac, Michigan 48341

United States

Corewell Health Reed City Hospital

Reed City, Michigan 49677

United States

Ascension Saint Mary's Hospital

Saginaw, Michigan 48601

United States

Oncology Hematology Associates of Saginaw Valley PC

Saginaw, Michigan 48604

United States

Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center

Saint Joseph, Michigan 49085

United States

Lakeland Medical Center Saint Joseph

Saint Joseph, Michigan 49085

United States

Bhadresh Nayak MD PC-Sterling Heights

Sterling Heights, Michigan 48312

United States

Ascension Saint Joseph Hospital

Tawas City, Michigan 48764

United States

Munson Medical Center

Traverse City, Michigan 49684

United States

Advanced Breast Care Center PLLC

Warren, Michigan 48088

United States

Great Lakes Cancer Management Specialists-Macomb Professional Building

Warren, Michigan 48093

United States

Macomb Hematology Oncology PC

Warren, Michigan 48093

United States

Michigan Breast Specialists-Warren

Warren, Michigan 48093

United States

Saint John Macomb-Oakland Hospital

Warren, Michigan 48093

United States

Saint Mary's Oncology/Hematology Associates of West Branch

West Branch, Michigan 48661

United States

University of Michigan Health - West

Wyoming, Michigan 49519

United States

Huron Gastroenterology PC

Ypsilanti, Michigan 48106

United States

Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus

Ypsilanti, Michigan 48197

United States

Riverwood Healthcare Center

Aitkin, Minnesota 56431

United States

Essentia Health - Baxter Clinic

Baxter, Minnesota 56425

United States

Sanford Joe Lueken Cancer Center

Bemidji, Minnesota 56601

United States

Essentia Health Saint Joseph's Medical Center

Brainerd, Minnesota 56401

United States

Minnesota Oncology - Burnsville

Burnsville, Minnesota 55337

United States

Cambridge Medical Center

Cambridge, Minnesota 55008

United States

Mercy Hospital

Coon Rapids, Minnesota 55433

United States

Essentia Health - Deer River Clinic

Deer River, Minnesota 56636

United States

Essentia Health Saint Mary's - Detroit Lakes Clinic

Detroit Lakes, Minnesota 56501

United States

Essentia Health Cancer Center

Duluth, Minnesota 55805

United States

Essentia Health Saint Mary's Medical Center

Duluth, Minnesota 55805

United States

Miller-Dwan Hospital

Duluth, Minnesota 55805

United States

Fairview Southdale Hospital

Edina, Minnesota 55435

United States

Essentia Health - Ely Clinic

Ely, Minnesota 55731

United States

Essentia Health - Fosston

Fosston, Minnesota 56542

United States

Unity Hospital

Fridley, Minnesota 55432

United States

Essentia Health Hibbing Clinic

Hibbing, Minnesota 55746

United States

Essentia Health - International Falls Clinic

International Falls, Minnesota 56649

United States

Fairview Clinics and Surgery Center Maple Grove

Maple Grove, Minnesota 55369

United States

Minnesota Oncology Hematology PA-Maplewood

Maplewood, Minnesota 55109

United States

Saint John's Hospital - Healtheast

Maplewood, Minnesota 55109

United States

Abbott-Northwestern Hospital

Minneapolis, Minnesota 55407

United States

Hennepin County Medical Center

Minneapolis, Minnesota 55415

United States

Health Partners Inc

Minneapolis, Minnesota 55454

United States

Monticello Cancer Center

Monticello, Minnesota 55362

United States

Essentia Health - Moose Lake Clinic

Moose Lake, Minnesota 55767

United States

New Ulm Medical Center

New Ulm, Minnesota 56073

United States

Essentia Health - Park Rapids

Park Rapids, Minnesota 56470

United States

Fairview Northland Medical Center

Princeton, Minnesota 55371

United States

North Memorial Medical Health Center

Robbinsdale, Minnesota 55422

United States

Mayo Clinic in Rochester

Rochester, Minnesota 55905

United States

Park Nicollet Clinic - Saint Louis Park

Saint Louis Park, Minnesota 55416

United States

Regions Hospital

Saint Paul, Minnesota 55101

United States

United Hospital

Saint Paul, Minnesota 55102

United States

Essentia Health Sandstone

Sandstone, Minnesota 55072

United States

Saint Francis Regional Medical Center

Shakopee, Minnesota 55379

United States

Lakeview Hospital

Stillwater, Minnesota 55082

United States

Sanford Thief River Falls Medical Center

Thief River Falls, Minnesota 56701

United States

Essentia Health Virginia Clinic

Virginia, Minnesota 55792

United States

Ridgeview Medical Center

Waconia, Minnesota 55387

United States

Rice Memorial Hospital

Willmar, Minnesota 56201

United States

Minnesota Oncology Hematology PA-Woodbury

Woodbury, Minnesota 55125

United States

Sanford Cancer Center Worthington

Worthington, Minnesota 56187

United States

Fairview Lakes Medical Center

Wyoming, Minnesota 55092

United States

Saint Louis Cancer and Breast Institute-Ballwin

Ballwin, Missouri 63011

United States

Central Care Cancer Center - Bolivar

Bolivar, Missouri 65613

United States

Cox Cancer Center Branson

Branson, Missouri 65616

United States

Saint Francis Medical Center

Cape Girardeau, Missouri 63703

United States

Southeast Cancer Center

Cape Girardeau, Missouri 63703

United States

Parkland Health Center - Farmington

Farmington, Missouri 63640

United States

Capital Region Southwest Campus

Jefferson City, Missouri 65109

United States

Freeman Health System

Joplin, Missouri 64804

United States

Mercy Hospital Joplin

Joplin, Missouri 64804

United States

Research Medical Center

Kansas City, Missouri 64132

United States

Lake Regional Hospital

Osage Beach, Missouri 65065

United States

Delbert Day Cancer Institute at PCRMC

Rolla, Missouri 65401

United States

Mercy Clinic-Rolla-Cancer and Hematology

Rolla, Missouri 65401

United States

Heartland Regional Medical Center

Saint Joseph, Missouri 64506

United States

Sainte Genevieve County Memorial Hospital

Sainte Genevieve, Missouri 63670

United States

Mercy Hospital Springfield

Springfield, Missouri 65804

United States

CoxHealth South Hospital

Springfield, Missouri 65807

United States

Saint Louis Cancer and Breast Institute-South City

St Louis, Missouri 63109

United States

Mercy Hospital South

St Louis, Missouri 63128

United States

Missouri Baptist Medical Center

St Louis, Missouri 63131

United States

Mercy Hospital Saint Louis

St Louis, Missouri 63141

United States

Missouri Baptist Sullivan Hospital

Sullivan, Missouri 63080

United States

BJC Outpatient Center at Sunset Hills

Sunset Hills, Missouri 63127

United States

Mercy Hospital Washington

Washington, Missouri 63090

United States

Saint Patrick Hospital - Community Hospital

Missoula, Montana 59802

United States

CHI Health Good Samaritan

Kearney, Nebraska 68847

United States

Saint Elizabeth Regional Medical Center

Lincoln, Nebraska 68510

United States

Alegent Health Immanuel Medical Center

Omaha, Nebraska 68122

United States

Alegent Health Bergan Mercy Medical Center

Omaha, Nebraska 68124

United States

Alegent Health Lakeside Hospital

Omaha, Nebraska 68130

United States

Creighton University Medical Center

Omaha, Nebraska 68131

United States

Midlands Community Hospital

Papillion, Nebraska 68046

United States

Exeter Hospital

Exeter, New Hampshire 03833

United States

Lovelace Medical Center-Saint Joseph Square

Albuquerque, New Mexico 87102

United States

University of New Mexico Cancer Center

Albuquerque, New Mexico 87102

United States

Presbyterian Kaseman Hospital

Albuquerque, New Mexico 87110

United States

Presbyterian Rust Medical Center/Jorgensen Cancer Center

Rio Rancho, New Mexico 87124

United States

NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center

New York, New York 10032

United States

University of Rochester

Rochester, New York 14642

United States

Sanford Bismarck Medical Center

Bismarck, North Dakota 58501

United States

Essentia Health Cancer Center-South University Clinic

Fargo, North Dakota 58103

United States

Sanford South University Medical Center

Fargo, North Dakota 58103

United States

Southpointe-Sanford Medical Center Fargo

Fargo, North Dakota 58103

United States

Sanford Medical Center Fargo

Fargo, North Dakota 58104

United States

Sanford Broadway Medical Center

Fargo, North Dakota 58122

United States

Sanford Roger Maris Cancer Center

Fargo, North Dakota 58122

United States

Essentia Health - Jamestown Clinic

Jamestown, North Dakota 58401

United States

Indu and Raj Soin Medical Center

Beavercreek, Ohio 45431

United States

Saint Elizabeth Boardman Hospital

Boardman, Ohio 44512

United States

Dayton Physicians LLC-Miami Valley South

Centerville, Ohio 45459

United States

Good Samaritan Hospital - Cincinnati

Cincinnati, Ohio 45220

United States

Oncology Hematology Care Inc-Kenwood

Cincinnati, Ohio 45236

United States

Bethesda North Hospital

Cincinnati, Ohio 45242

United States

TriHealth Cancer Institute-Westside

Cincinnati, Ohio 45247

United States

TriHealth Cancer Institute-Anderson

Cincinnati, Ohio 45255

United States

Dayton Physician LLC-Miami Valley Hospital North

Dayton, Ohio 45415

United States

Armes Family Cancer Center

Findlay, Ohio 45840

United States

Blanchard Valley Hospital

Findlay, Ohio 45840

United States

Orion Cancer Care

Findlay, Ohio 45840

United States

Dayton Physicians LLC-Atrium

Franklin, Ohio 45005

United States

Dayton Physicians LLC-Wayne

Greenville, Ohio 45331

United States

Wayne Hospital

Greenville, Ohio 45331

United States

Greater Dayton Cancer Center

Kettering, Ohio 45409

United States

Kettering Medical Center

Kettering, Ohio 45429

United States

Dayton Physicians LLC - Troy

Troy, Ohio 45373

United States

Saint Joseph Warren Hospital

Warren, Ohio 44484

United States

Saint Elizabeth Youngstown Hospital

Youngstown, Ohio 44501

United States

University of Oklahoma Health Sciences Center

Oklahoma City, Oklahoma 73104

United States

Mercy Hospital Oklahoma City

Oklahoma City, Oklahoma 73120

United States

Saint Charles Health System

Bend, Oregon 97701

United States

Clackamas Radiation Oncology Center

Clackamas, Oregon 97015

United States

Providence Cancer Institute Clackamas Clinic

Clackamas, Oregon 97015

United States

Bay Area Hospital

Coos Bay, Oregon 97420

United States

Rogue Valley Medical Center

Medford, Oregon 97504

United States

Providence Newberg Medical Center

Newberg, Oregon 97132

United States

Providence Willamette Falls Medical Center

Oregon City, Oregon 97045

United States

Providence Portland Medical Center

Portland, Oregon 97213

United States

Providence Saint Vincent Medical Center

Portland, Oregon 97225

United States

Saint Charles Health System-Redmond

Redmond, Oregon 97756

United States

Lehigh Valley Hospital-Cedar Crest

Allentown, Pennsylvania 18103

United States

Lehigh Valley Hospital - Muhlenberg

Bethlehem, Pennsylvania 18017

United States

Geisinger Medical Center

Danville, Pennsylvania 17822

United States

Pocono Medical Center

East Stroudsburg, Pennsylvania 18301

United States

Lehigh Valley Hospital-Hazleton

Hazleton, Pennsylvania 18201

United States

Geisinger Medical Oncology-Lewisburg

Lewisburg, Pennsylvania 17837

United States

Community Medical Center

Scranton, Pennsylvania 18510

United States

Geisinger Wyoming Valley/Henry Cancer Center

Wilkes-Barre, Pennsylvania 18711

United States

Smilow Cancer Hospital Care Center - Westerly

Westerly, Rhode Island 02891

United States

Prisma Health Cancer Institute - Spartanburg

Boiling Springs, South Carolina 29316

United States

Prisma Health Cancer Institute - Easley

Easley, South Carolina 29640

United States

Prisma Health Cancer Institute - Butternut

Greenville, South Carolina 29605

United States

Prisma Health Cancer Institute - Faris

Greenville, South Carolina 29605

United States

Prisma Health Cancer Institute - Eastside

Greenville, South Carolina 29615

United States

Prisma Health Cancer Institute - Greer

Greer, South Carolina 29650

United States

Prisma Health Cancer Institute - Seneca

Seneca, South Carolina 29672

United States

Avera Cancer Institute-Aberdeen

Aberdeen, South Dakota 57401

United States

Sanford Cancer Center Oncology Clinic

Sioux Falls, South Dakota 57104

United States

Avera Cancer Institute

Sioux Falls, South Dakota 57105

United States

Sanford USD Medical Center - Sioux Falls

Sioux Falls, South Dakota 57117-5134

United States

Avera Cancer Institute at Yankton

Yankton, South Dakota 57078

United States

MD Anderson in The Woodlands

Conroe, Texas 77384

United States

Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center

Houston, Texas 77030

United States

Ben Taub General Hospital

Houston, Texas 77030

United States

M D Anderson Cancer Center

Houston, Texas 77030

United States

Michael E DeBakey VA Medical Center

Houston, Texas 77030

United States

MD Anderson West Houston

Houston, Texas 77079

United States

MD Anderson League City

League City, Texas 77573

United States

University of Texas Health Science Center at San Antonio

San Antonio, Texas 78229

United States

MD Anderson in Sugar Land

Sugar Land, Texas 77478

United States

Sovah Health Martinsville

Martinsville, Virginia 24115

United States

Virginia Cancer Institute

Richmond, Virginia 23229

United States

VCU Massey Cancer Center at Stony Point

Richmond, Virginia 23235

United States

Virginia Commonwealth University/Massey Cancer Center

Richmond, Virginia 23298

United States

VCU Community Memorial Health Center

South Hill, Virginia 23970

United States

Providence Regional Cancer System-Aberdeen

Aberdeen, Washington 98520

United States

PeaceHealth Saint Joseph Medical Center

Bellingham, Washington 98225

United States

Harrison Medical Center

Bremerton, Washington 98310

United States

Providence Regional Cancer System-Centralia

Centralia, Washington 98531

United States

Swedish Cancer Institute-Edmonds

Edmonds, Washington 98026

United States

Providence Regional Cancer Partnership

Everett, Washington 98201

United States

Swedish Cancer Institute-Issaquah

Issaquah, Washington 98029

United States

Kadlec Clinic Hematology and Oncology

Kennewick, Washington 99336

United States

Providence Regional Cancer System-Lacey

Lacey, Washington 98503

United States

PeaceHealth Saint John Medical Center

Longview, Washington 98632

United States

Swedish Medical Center-Ballard Campus

Seattle, Washington 98107

United States

Swedish Medical Center-Cherry Hill

Seattle, Washington 98122-5711

United States

Swedish Medical Center-First Hill

Seattle, Washington 98122

United States

PeaceHealth United General Medical Center

Sedro-Woolley, Washington 98284

United States

Providence Regional Cancer System-Shelton

Shelton, Washington 98584

United States

PeaceHealth Southwest Medical Center

Vancouver, Washington 98664

United States

Providence Saint Mary Regional Cancer Center

Walla Walla, Washington 99362

United States

Providence Regional Cancer System-Yelm

Yelm, Washington 98597

United States

West Virginia University Charleston Division

Charleston, West Virginia 25304

United States

Langlade Hospital and Cancer Center

Antigo, Wisconsin 54409

United States

ThedaCare Regional Cancer Center

Appleton, Wisconsin 54911

United States

Duluth Clinic Ashland

Ashland, Wisconsin 54806

United States

Northwest Wisconsin Cancer Center

Ashland, Wisconsin 54806

United States

Marshfield Clinic-Chippewa Center

Chippewa Falls, Wisconsin 54729

United States

Marshfield Medical Center-EC Cancer Center

Eau Claire, Wisconsin 54701

United States

Essentia Health-Hayward Clinic

Hayward, Wisconsin 54843

United States

Gundersen Lutheran Medical Center

La Crosse, Wisconsin 54601

United States

Marshfield Clinic - Ladysmith Center

Ladysmith, Wisconsin 54848

United States

Marshfield Medical Center-Marshfield

Marshfield, Wisconsin 54449

United States

Aspirus Medford Hospital

Medford, Wisconsin 54451

United States

Marshfield Clinic-Minocqua Center

Minocqua, Wisconsin 54548

United States

Marshfield Medical Center - Neillsville

Neillsville, Wisconsin 54456

United States

Cancer Center of Western Wisconsin

New Richmond, Wisconsin 54017

United States

Ascension Saint Mary's Hospital

Rhinelander, Wisconsin 54501

United States

Marshfield Medical Center-Rice Lake

Rice Lake, Wisconsin 54868

United States

Essentia Health-Spooner Clinic

Spooner, Wisconsin 54801

United States

Ascension Saint Michael's Hospital

Stevens Point, Wisconsin 54481

United States

Marshfield Medical Center-River Region at Stevens Point

Stevens Point, Wisconsin 54482

United States

Essentia Health Saint Mary's Hospital - Superior

Superior, Wisconsin 54880

United States

Aspirus Regional Cancer Center

Wausau, Wisconsin 54401

United States

Marshfield Clinic-Wausau Center

Wausau, Wisconsin 54401

United States

Marshfield Medical Center - Weston

Weston, Wisconsin 54476

United States

Aspirus Cancer Care - Wisconsin Rapids

Wisconsin Rapids, Wisconsin 54494

United States

Marshfield Clinic - Wisconsin Rapids Center

Wisconsin Rapids, Wisconsin 54494

United States