Resumen

Elegibilidad

Detalles del diseño

Brazos e Intervenciones

Medidas de resultado

Sitios del ensayo

Fuente: NCT04546399

Reclutando

A Study to Compare Blinatumomab Alone to Blinatumomab With Nivolumab in Patients Diagnosed With First Relapse B-Cell Acute Lymphoblastic Leukemia (B-ALL)

Intervencionista

Fase 2

Newark Beth Israel Medical Center

Patrocinador: National Cancer Institute (NCI)

Última actualización: 10 de septiembre de 2025
Aviso: La información proviene de registros públicos y puede no reflejar cambios en tiempo real en el centro local.

This phase II trial studies the effect of nivolumab in combination with blinatumomab compared to blinatumomab alone in treating patients with B-cell acute lymphoblastic leukemia (B-ALL) that has come back (relapsed). Down syndrome patients with relapsed B-ALL are included in this study. Blinatumomab is an antibody, which is a protein that identifies and targets specific molecules in the body. Blinatumomab searches for and attaches itself to the cancer cell. Once attached, an immune response occurs which may kill the cancer cell. Nivolumab is a medicine that may boost a patient's immune system. Giving nivolumab in combination with blinatumomab may cause the cancer to stop growing for a period of time, and for some patients, it may lessen the symptoms, such as pain, that are caused by the cancer.

Mostrar descripción detallada

Categoría de tratamiento

Procedimiento, Otros medicamentos, Inhibidores de puestos de control, Quimioterapia, Anticuerpo monoclonal, Radioterapia

Erforderliche Mutationen

CD19

Ensayo iniciado

17 de diciembre de 2020

Última actualización por el patrocinador

10 de septiembre de 2025

Finalización estimada

30 de junio de 2028

Contacto del estudio

Elegibilidad

Criterios de inclusión

* Patients must be >= 1 and < 31 years at time of enrollment

* Patients must have first relapse of CD19+ B-ALL (relapse blasts must express CD19) in one of the following categories:

* Isolated bone marrow relapse

* Isolated central nervous system (CNS) (excluding known optic nerve/retinal and CNS chloromas) and/or testicular relapse

* Combined bone marrow with extramedullary relapse in the CNS (excluding known optic nerve/retinal and CNS chloromas) and/or testes

* Patients with Down syndrome (DS) are eligible in the following categories:

* Isolated bone marrow relapse

* Combined bone marrow with CNS (excluding known optic nerve/retinal and CNS chloromas) and/or testicular relapse

* Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1 or 2. Use Karnofsky for patients > 16 years of age and Lansky for patients =< 16 years of age

* Of note, for patients with developmental delay (e.g., Down syndrome) regardless of age, Lansky scale may be substituted for Karnofsky scale. However, the requirement for ECOG 0-2 remains, regardless of known history of developmental delay

* Patients must have fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study

* Patients with prior blinatumomab or CD19+ chimeric antigen receptor therapy in the upfront setting will be eligible, provided relapsed lymphoblasts retain CD19 expression

* Patients must not have had a prior hematopoietic stem cell transplant

* A single intrathecal chemotherapy at the time of relapse will be allowed. If < 7 days have elapsed between this intrathecal therapy (IT) and the start of protocol therapy, then the day 1 intrathecal chemotherapy (i.e. methotrexate, cytarabine, or triple intrathecal) may be omitted

* In the 28 days prior to enrollment, up to five days of post-relapse, pre-enrollment therapy (steroids and/or hydroxyurea only) is permissible

* Patients with Down syndrome who received pre-enrollment therapy and have a white blood count (WBC) >= 30,000/ul at the time of enrollment still must receive protocol specified cytoreductive therapy with vincristine and dexamethasone, and no "washout" is required

* Patients with Down syndrome who received pre-enrollment therapy and have a WBC < 30,000/ul at the time of enrollment must be given a 24 hour "washout" before starting immunotherapy

* Note: There is no waiting period or "washout" for patients who relapse while receiving upfront therapy

* Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 mL/min/1.73 m^2 OR a serum creatinine based on age/sex as follows (within 7 calendar days prior to enrollment):

* Age: Maximum serum creatinine (mg/dL)

* 1 to < 2 years: 0.6 (male), 0.6 (female)

* 2 to < 6 years: 0.8 (male), 0.8 (female)

* 6 to < 10 years: 1 (male), 1 (female)

* 10 to < 13 years: 1.2 (male), 1.2 (female)

* 13 to < 16 years: 1.5 (male), 1.4 (female)

* >= 16 years: 1.7 (male), 1.4 (female)

* The threshold creatinine values in this Table were derived from the Schwartz formula for estimating GFR utilizing child length and stature data published by the Center for Disease Control (CDC)

* Shortening fraction of >= 27% by echocardiogram, or ejection fraction of >= 50% by echocardiogram, cardiac magnetic resonance imaging (MRI) or radionuclide angiogram

* No evidence of dyspnea at rest, no exercise intolerance, and a pulse oximetry > 94% if there is clinical indication for determination

* 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

Criterios de exclusión

* Patients with B-lymphoblastic lymphoma (B-LLy)

* Patients with Burkitt leukemia/lymphoma or mature B-cell leukemia

* Patients with Philadelphia chromosome positive (Ph+) B-ALL

* Patients with mixed phenotype acute leukemia (MPAL)

* Patients with known Charcot-Marie-Tooth disease

* Patients with known MYC translocation associated with mature (Burkitt) B-cell ALL, regardless of blast immunophenotype

* Patients with active, uncontrolled infection defined as:

* Positive bacterial blood culture within 48 hours of study enrollment

* Receiving IV or PO antibiotics for an infection with continued signs or symptoms. Note: Patients may be receiving IV or oral antibiotics to complete a course of therapy for a prior documented infection if cultures have been negative for at least 48 hours and signs or symptoms of active infection have resolved. For patients with clostridium (C.) difficile diarrhea, at least 72 hours of antibacterial therapy must have elapsed and stools must have normalized to baseline.

* Fever above 38.2 degrees Celsius (C) within 48 hours of study enrollment with clinical signs of infection. Fever without clinical signs of infection that is attributed to tumor burden is allowed if blood cultures are negative for > 48 hours

* A positive fungal culture within 30 days of study enrollment or active therapy for presumed invasive fungal infection

* Active viral or protozoal infection requiring IV treatment

* Patients known to have one of the following concomitant genetic syndromes: Bloom syndrome, ataxia-telangiectasia, Fanconi anemia, Kostmann syndrome, Shwachman syndrome or any other known bone marrow failure syndrome are not eligible.

* Patients with uncontrolled HIV, hepatitis B, or hepatitis C infection. Of note, patients with known human immunodeficiency virus (HIV) infection on effective anti-retroviral therapy with undetectable viral load for at least the last 6 months prior to enrollment are eligible. Similarly, hepatitis B and hepatitis C positive patients who have been treated and have no viral detectable burden are also eligible

* Patients with significant central nervous system pathology that would preclude treatment with blinatumomab, including history of severe neurologic disorder or autoimmune disease with 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

* Patients with an active known/suspected autoimmune disease are not eligible. However, patients with type I diabetes mellitus, hypothyroidism only requiring hormone replacement, skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll

* Group 4 and patients with DS patients with known non-hematopoietic, non-CNS/testicular extramedullary disease (i.e., chloromatous disease) are not eligible

* Note: Group 3 patients with known non-hematopoietic, non-CNS/testicular extramedullary disease (i.e., chloromatous disease) are eligible if this is NOT the only site of relapsed disease

* Female patients of childbearing potential are not eligible unless a negative pregnancy test result has been obtained within 7 days prior to enrollment. Patients who are sexually active and of reproductive potential are not eligible unless they agree to use an effective contraceptive method for the duration of this study. Men with female partners of childbearing potential should use effective contraception during the duration of their treatment. The effect of blinatumomab on fertility has not been evaluated. Blinatumomab is not recommended for pregnant women or women of childbearing potential (WOCBP) not using contraception. Females of reproductive potential must use effective contraception during treatment and for at least 48 hours after the last dose of blinatumomab. Studies in animal models have shown that nivolumab can adversely impair pregnancy. Thus, nivolumab is expected to cause fetal harm during pregnancy. WOCBP receiving nivolumab must continue contraception for a period of at least 5 months after the last dose of nivolumab. It is unknown whether nivolumab is present in breast milk, thus breastfeeding should be discontinued while a patient is receiving nivolumab

* Lactating females are not eligible unless they agree to not breastfeed their infants. It is unknown whether blinatumomab or its metabolites are excreted in human breast milk. Women are not permitted to breastfeed while receiving blinatumomab and for the last 48 hours after the last blinatumomab dose. Due to the potential for serious adverse reactions in the breastfed infant, women are not permitted to breastfeed during treatment and for 5 months after the last nivolumab dose

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Detalles del diseño

AsignaciónRandomized

Modelo de intervenciónParallel Assignment

EnmascaramientoNone (Open Label)

Número a inscribir461

Brazos e Intervenciones

Brazos

Intervenciones

Tipo: Experimental

Descripción: See Outline section

Intervenciones:

Bone Marrow Aspiration
Bone Marrow Biopsy
Mercaptopurine
Lumbar Puncture
Calaspargase Pegol
Nivolumab
Cytarabine
Blinatumomab
Dexamethasone
3-Dimensional Conformal Radiation Therapy
Hydrocortisone Sodium Succinate
Pegaspargase
Biospecimen Collection
Methotrexate
Pegcrisantaspase
Vincristine Sulfate

Medidas de resultado

Medidas de resultado primarias

Minimal residual disease (MRD) negative second remission (Rem-2) rate with blinatumomab vs with blinatumomab + nivolumab (Group 1)Up to 2 cycles of therapy (each cycle = 36 days)

MRD negative Rem-2 be defined as Rem-2 (i.e., achievement of MRD < 1% blasts by flow cytometry and resolution of extramedullary disease (for CNS disease, requires CNS 1) ) and bone marrow with MRD < 0.01% by flow cytometry. MRD negative Rem-2 rate between Arm A vs Arm B will be compared using a one-sided Z test of proportions with Type I error of 0.10. Interim analysis will be conducted to monitor for futility. The futility boundaries are based on testing the alternative hypothesis at the 0.067 level.

Event-free survival post-reinduction (EFS PR) (Group 3)From date of randomization to date of treatment failure, relapse, disease progression, second malignancy (SMN) or death due to any cause, assessed up to 10 years after completion of enrollment.

Comparison of EFS post reinduction between Arm E versus Arm F will be based on a one-sided two-sample logrank test with Type I error of 0.10, to be conducted 3 years after completion of enrollment of Group 3. Interim analysis will be conducted to monitor for futility. The futility monitoring will be based on testing the alternative hypothesis at the 0.067 level. This alpha level corresponds to that which would cause futility stopping if the one-sided two-sample logrank test shows evidence of a hazard ratio > 1.0 when half of the expected events are observed.

EFS PR (Group 4)From date of randomization to date of treatment failure, relapse, disease progression, second malignancy (SMN) or death due to any cause, assessed up to 10 years after completion of enrollment.

Comparison of EFS post reinduction between Arm H versus Arm I will be based on a one-sided two-sample logrank test with Type I error of 0.10, to be conducted 3 years after completion of enrollment of Group 3. Interim analysis will be conducted to monitor for futility. The futility monitoring will be based on testing the alternative hypothesis at the 0.067 level. This alpha level corresponds to that which would cause futility stopping if the one-sided two-sample logrank test shows evidence of a hazard ratio > 1.0 when half of the expected events are observed.

Medidas de resultado secundarias

Dose-limiting toxicityUp to 1 cycle of therapy (each cycle = 36 days)

Will be assessed using the Common Terminology Criteria for Adverse Events version 5.0.

EFS PR (Group 4)From date of randomization to date of treatment failure, relapse, disease progression, SMN or death due to any cause, assessed up to 5 years after completion of enrollment

Comparison of EFS post-reinduction between Arm C versus Arm D will be based on a one-sided two-sample logrank test with type I error of 0.15, to be conducted 2 years after completion of enrollment of Group 2. The futility monitoring will be based on testing the alternative hypothesis at the 0.092 level.

Event-free survival (Group 1)From date of Group 1 randomization to date of treatment failure, relapse, disease progression, SMN or death due to any cause, assessed up to 5 years

EFS will be compared between Arm A and Arm B, and to similar patients treated on AALL1331. These analyses will be performed using logrank tests, semi-parametric or parametric survival analysis methods, as appropriate.

Event free survival (Group 4)From date of Group 4 randomization to date of treatment failure, relapse, disease progression, SMN or death due to any cause, assessed up to 5 years

EFS will be compared between Arm H and Arm I, and to similar patients treated on AALL1331. These analyses will be performed using logrank tests, semi-parametric or parametric survival analysis methods, as appropriate.

Incidence of adverse events in Arm A or Arm BUp to 1 cycle of therapy (each cycle = 36 days)

The toxicities as defined by grade 3 or greater reported adverse events during the first cycle of blinatumomab or blinatumomab/nivolumab will be compared to similar patients treated with Block 1 of cytotoxic chemotherapy on AALL1331 using two-sample test of proportions.

Incidence of adverse events in Arm H or Arm IUp to 1 cycle of therapy (each cycle = 36 days)

MRD negative Rem-2 rate (Group 2)Up to 2 cycles of therapy (each cycle = 36 days)

MRD negative Rem-2 rate will be estimated and be compared between Arm C and Arm D using two-sample test of proportions.

Dose-limiting toxicity (Down syndrome patients)Up to 1 cycle of therapy (each cycle = 36 days)

Analyses will be largely descriptive.

Incidence of adverse events (Down syndrome patients)Up to 1 cycle of therapy (each cycle = 36 days)

Analyses will be largely descriptive.

MRD negative Rem-2 rate (Down syndrome patients)Up to 2 cycles of therapy (each cycle = 36 days)

Analyses will be largely descriptive.

Subset analyses of EFSUp to 2 cycles of therapy (each cycle = 36 days)

Features at first relapse including degree of marrow disease at relapse, age, sex, body mass index, cytogenetics, site(s) of relapse, percent peripheral blasts at relapse and absolute lymphocyte count, will be conducted. These analyses will be exploratory.

Subset analyses of OSUp to 2 cycles of therapy (each cycle = 36 days)

EFS PR (Group 4)At 2 years from date of randomization

Corresponding 95% CIs by sex, by race, and by ethnicity separately for arm H and I.

EFS PR (Group 3)At 3 years from date of randomization

Corresponding 95% CIs by sex, by race, and by ethnicity separately for arm E and F.

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Sitios del ensayo

Este estudio tiene 146 sitios de ensayo

Newark Beth Israel Medical Center

Newark, New Jersey, US

Nombre:Site Public Contact

Correo electrónico:Christine.Kosmides@rwjbh.org

Teléfono:973-926-7230

Reclutando

Newark, New Jersey, 07112 US

Newark Beth Israel Medical Center

Reclutando

Dallas, Texas, 75230 US

Medical City Dallas Hospital

Reclutando

Providence, Rhode Island, 02903 US

Rhode Island Hospital

Reclutando

Loma Linda, California, 92354 US

Loma Linda University Medical Center

Reclutando

Maywood, Illinois, 60153 US

Loyola University Medical Center

Reclutando

Baltimore, Maryland, 21215 US

Sinai Hospital of Baltimore

Reclutando

Oklahoma City, Oklahoma, 73104 US

University of Oklahoma Health Sciences Center

Reclutando

Houston, Texas, 77030 US

M D Anderson Cancer Center

Reclutando

Tucson, Arizona, 85719 US

Banner University Medical Center - Tucson

Reclutando

Sacramento, California, 95817 US

University of California Davis Comprehensive Cancer Center

Reclutando

Orlando, Florida, 32803 US

AdventHealth Orlando

Reclutando

Savannah, Georgia, 31404 US

Memorial Health University Medical Center

Reclutando

Chicago, Illinois, 60612 US

University of Illinois

Reclutando

Chicago, Illinois, 60637 US

University of Chicago Comprehensive Cancer Center

Reclutando

Iowa City, Iowa, 52242 US

University of Iowa/Holden Comprehensive Cancer Center

Reclutando

Baltimore, Maryland, 21287 US

Johns Hopkins University/Sidney Kimmel Cancer Center

Reclutando

Minneapolis, Minnesota, 55455 US

University of Minnesota/Masonic Cancer Center

Reclutando

Jackson, Mississippi, 39216 US

University of Mississippi Medical Center

Reclutando

Omaha, Nebraska, 68198 US

University of Nebraska Medical Center

Reclutando

Hackensack, New Jersey, 07601 US

Hackensack University Medical Center

Reclutando

New Brunswick, New Jersey, 08903 US

Rutgers Cancer Institute of New Jersey

Reclutando

New York, New York, 10016 US

Laura and Isaac Perlmutter Cancer Center at NYU Langone

Reclutando

New York, New York, 10032 US

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

Reclutando

New York, New York, 10065 US

Memorial Sloan Kettering Cancer Center

Reclutando

Syracuse, New York, 13210 US

State University of New York Upstate Medical University

Reclutando

Chapel Hill, North Carolina, 27599 US

UNC Lineberger Comprehensive Cancer Center

Reclutando

Durham, North Carolina, 27710 US

Duke University Medical Center

Reclutando

Winston-Salem, North Carolina, 27157 US

Wake Forest University Health Sciences

Reclutando

Fargo, North Dakota, 58122 US

Sanford Broadway Medical Center

Reclutando

Danville, Pennsylvania, 17822 US

Geisinger Medical Center

Reclutando

Nashville, Tennessee, 37232 US

Vanderbilt University/Ingram Cancer Center

Reclutando

San Antonio, Texas, 78229 US

University of Texas Health Science Center at San Antonio

Reclutando

Burlington, Vermont, 05405 US

University of Vermont and State Agricultural College

Reclutando

Honolulu, Hawaii, 96826 US

Kapiolani Medical Center for Women and Children

Reclutando

Tacoma, Washington, 98431 US

Madigan Army Medical Center

Reclutando

Oakland, California, 94611 US

Kaiser Permanente-Oakland

Reclutando

Hollywood, Florida, 33021 US

Memorial Regional Hospital/Joe DiMaggio Children's Hospital

Reclutando

Reno, Nevada, 89502 US

Renown Regional Medical Center

Reclutando

Morristown, New Jersey, 07960 US

Morristown Medical Center

Reclutando

Allentown, Pennsylvania, 18103 US

Lehigh Valley Hospital-Cedar Crest

Reclutando

Sioux Falls, South Dakota, 57117-5134 US

Sanford USD Medical Center - Sioux Falls

Reclutando

Dallas, Texas, 75390 US

UT Southwestern/Simmons Cancer Center-Dallas

Reclutando

Houston, Texas, 77030 US

Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center

Reclutando

New Brunswick, New Jersey, 08903 US

Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital

Reclutando

Portland, Oregon, 97239 US

Oregon Health and Science University

Reclutando

New Haven, Connecticut, 06520 US

Yale University

Reclutando

Stony Brook, New York, 11794 US

Stony Brook University Medical Center

Reclutando

Los Angeles, California, 90048 US

Cedars Sinai Medical Center

Reclutando

Sacramento, California, 95816 US

Sutter Medical Center Sacramento

Reclutando

Gainesville, Florida, 32610 US

University of Florida Health Science Center - Gainesville

Reclutando

Lexington, Kentucky, 40536 US

University of Kentucky/Markey Cancer Center

Reclutando

Paterson, New Jersey, 07503 US

Saint Joseph's Regional Medical Center

Reclutando

Charlotte, North Carolina, 28203 US

Carolinas Medical Center/Levine Cancer Institute

Reclutando

Greenville, North Carolina, 27834 US

East Carolina University

Reclutando

Greenville, South Carolina, 29615 US

Prisma Health Cancer Institute - Eastside

Reclutando

Falls Church, Virginia, 22042 US

Inova Fairfax Hospital

Reclutando

Spokane, Washington, 99204 US

Providence Sacred Heart Medical Center and Children's Hospital

Reclutando

Anaheim, California, 92806 US

Kaiser Permanente-Anaheim

Reclutando

Fontana, California, 92335 US

Kaiser Permanente-Fontana

Reclutando

San Diego, California, 92120 US

Kaiser Permanente-San Diego Zion

Reclutando

Brooklyn, New York, 11219 US

Maimonides Medical Center

Reclutando

Sherbrooke, Quebec, J1H 5N4 CA

Centre Hospitalier Universitaire de Sherbrooke-Fleurimont

Reclutando

St Louis, Missouri, 63110 US

Washington University School of Medicine

Reclutando

Las Vegas, Nevada, 89135 US

Alliance for Childhood Diseases/Cure 4 the Kids Foundation

Reclutando

Las Vegas, Nevada, 89144 US

Summerlin Hospital Medical Center

Reclutando

Tacoma, Washington, 98405 US

Mary Bridge Children's Hospital and Health Center

Reclutando

San Francisco, California, 94158 US

UCSF Medical Center-Mission Bay

Reclutando

Tampa, Florida, 33607 US

Saint Joseph's Hospital/Children's Hospital-Tampa

Reclutando

Lubbock, Texas, 79415 US

UMC Cancer Center / UMC Health System

Reclutando

Pittsburgh, Pennsylvania, 15224 US

Children's Hospital of Pittsburgh of UPMC

Reclutando

Birmingham, Alabama, 35233 US

Children's Hospital of Alabama

Reclutando

Little Rock, Arkansas, 72202-3591 US

Arkansas Children's Hospital

Reclutando

Downey, California, 90242 US

Kaiser Permanente Downey Medical Center

Reclutando

Los Angeles, California, 90027 US

Children's Hospital Los Angeles

Reclutando

Orange, California, 92868 US

Children's Hospital of Orange County

Reclutando

San Diego, California, 92123 US

Rady Children's Hospital - San Diego

Reclutando

Aurora, Colorado, 80045 US

Children's Hospital Colorado

Reclutando

Wilmington, Delaware, 19803 US

Alfred I duPont Hospital for Children

Reclutando

Fort Myers, Florida, 33908 US

Golisano Children's Hospital of Southwest Florida

Reclutando

Chicago, Illinois, 60611 US

Lurie Children's Hospital-Chicago

Reclutando

Peoria, Illinois, 61637 US

Saint Jude Midwest Affiliate

Reclutando

Indianapolis, Indiana, 46202 US

Riley Hospital for Children

Reclutando

Scarborough, Maine, 04074 US

Maine Children's Cancer Program

Reclutando

Ann Arbor, Michigan, 48109 US

C S Mott Children's Hospital

Reclutando

Minneapolis, Minnesota, 55404 US

Children's Hospitals and Clinics of Minnesota - Minneapolis

Reclutando

Cincinnati, Ohio, 45229 US

Cincinnati Children's Hospital Medical Center

Reclutando

Cleveland, Ohio, 44106 US

Rainbow Babies and Childrens Hospital

Reclutando

Columbus, Ohio, 43205 US

Nationwide Children's Hospital

Reclutando

Philadelphia, Pennsylvania, 19104 US

Children's Hospital of Philadelphia

Reclutando

Columbia, South Carolina, 29203 US

Prisma Health Richland Hospital

Reclutando

Austin, Texas, 78723 US

Dell Children's Medical Center of Central Texas

Reclutando

Fort Worth, Texas, 76104 US

Cook Children's Medical Center

Reclutando

Salt Lake City, Utah, 84113 US

Primary Children's Hospital

Reclutando

Norfolk, Virginia, 23507 US

Children's Hospital of The King's Daughters

Reclutando

Seattle, Washington, 98105 US

Seattle Children's Hospital

Reclutando

Milwaukee, Wisconsin, 53226 US

Children's Hospital of Wisconsin

Reclutando

San Antonio, Texas, 78229 US

Methodist Children's Hospital of South Texas

Reclutando

Greenville, South Carolina, 29605 US

BI-LO Charities Children's Cancer Center

Reclutando

Tampa, Florida, 33606 US

Tampa General Hospital

Reclutando

Toledo, Ohio, 43606 US

ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital

Reclutando

Mobile, Alabama, 36604 US

USA Health Strada Patient Care Center

Reclutando

Phoenix, Arizona, 85016 US

Phoenix Childrens Hospital

Reclutando

Los Angeles, California, 90095 US

Mattel Children's Hospital UCLA

Reclutando

Madera, California, 93636 US

Valley Children's Hospital

Reclutando

Palo Alto, California, 94304 US

Lucile Packard Children's Hospital Stanford University

Reclutando

Denver, Colorado, 80218 US

Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center

Reclutando

Hartford, Connecticut, 06106 US

Connecticut Children's Medical Center

Reclutando

Jacksonville, Florida, 32207 US

Nemours Children's Clinic-Jacksonville

Reclutando

Orlando, Florida, 32806 US

Arnold Palmer Hospital for Children

Reclutando

Orlando, Florida, 32827 US

Nemours Children's Hospital

Reclutando

Pensacola, Florida, 32504 US

Nemours Children's Clinic - Pensacola

Reclutando

Des Moines, Iowa, 50309 US

Blank Children's Hospital

Reclutando

Louisville, Kentucky, 40202 US

Norton Children's Hospital

Reclutando

New Orleans, Louisiana, 70118 US

Children's Hospital New Orleans

Reclutando

Kansas City, Missouri, 64108 US

Children's Mercy Hospitals and Clinics

Reclutando

Omaha, Nebraska, 68114 US

Children's Hospital and Medical Center of Omaha

Reclutando

Albany, New York, 12208 US

Albany Medical Center

Reclutando

New Hyde Park, New York, 11040 US

The Steven and Alexandra Cohen Children's Medical Center of New York

Reclutando

Akron, Ohio, 44308 US

Children's Hospital Medical Center of Akron

Reclutando

Dayton, Ohio, 45404 US

Dayton Children's Hospital

Reclutando

Portland, Oregon, 97227 US

Legacy Emanuel Children's Hospital

Reclutando

Philadelphia, Pennsylvania, 19134 US

Saint Christopher's Hospital for Children

Reclutando

Knoxville, Tennessee, 37916 US

East Tennessee Childrens Hospital

Reclutando

Nashville, Tennessee, 37203 US

The Children's Hospital at TriStar Centennial

Reclutando

Corpus Christi, Texas, 78411 US

Driscoll Children's Hospital

Reclutando

El Paso, Texas, 79905 US

El Paso Children's Hospital

Reclutando

Lubbock, Texas, 79410 US

Covenant Children's Hospital

Reclutando

San Antonio, Texas, 78207 US

Children's Hospital of San Antonio

Reclutando

Montreal, Quebec, H3H 1P3 CA

The Montreal Children's Hospital of the MUHC

Reclutando

Montreal, Quebec, H3T 1C5 CA

Centre Hospitalier Universitaire Sainte-Justine

Reclutando

San Juan, 00926 PR

University Pediatric Hospital

Reclutando

Detroit, Michigan, 48201 US

Children's Hospital of Michigan

Reclutando

Mesa, Arizona, 85202 US

Banner Children's at Desert

Reclutando

Boise, Idaho, 83712 US

Saint Luke's Cancer Institute - Boise

Reclutando

Mineola, New York, 11501 US

NYU Langone Hospital - Long Island

Reclutando

Lebanon, New Hampshire, 03756 US

Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center

Reclutando

Grand Rapids, Michigan, 49503 US

Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital

Reclutando

Royal Oak, Michigan, 48073 US

Corewell Health Children's

Reclutando

Atlanta, Georgia, 30329 US

Children's Healthcare of Atlanta - Arthur M Blank Hospital

Reclutando

West Palm Beach, Florida, 33407 US

Saint Mary's Medical Center

Reclutando

St. Petersburg, Florida, 33701 US

Johns Hopkins All Children's Hospital

Reclutando

St Louis, Missouri, 63141 US

Mercy Hospital Saint Louis

Reclutando

The Bronx, New York, 10467 US

Montefiore Medical Center - Moses Campus

Reclutando

Washington D.C., District of Columbia, 20010 US

Children's National Medical Center

Reclutando

Québec, G1V 4G2 CA

CHU de Quebec-Centre Hospitalier de l'Universite Laval (CHUL)

Reclutando

St Louis, Missouri, 63104 US

Cardinal Glennon Children's Medical Center

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