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Isotretinoin With or Without Dinutuximab, Aldesleukin, and Sargramostim Following Stem Cell Transplant in Treating Patients With Neuroblastoma
Study Purpose
This partially randomized phase III trial studies isotretinoin with dinutuximab, aldesleukin, and sargramostim to see how well it works compared to isotretinoin alone following stem cell transplant in treating patients with neuroblastoma. Drugs used in chemotherapy, such as isotretinoin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Monoclonal antibodies, such as dinutuximab, may block tumor growth in different ways by targeting certain cells. Aldesleukin and sargramostim may stimulate a person's white blood cells to kill cancer cells. It is not yet known if chemotherapy is more effective with or without dinutuximab, aldesleukin, and sargramostim following stem cell transplant in treating neuroblastoma.
Recruitment Criteria
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Accepts Healthy Volunteers
Healthy volunteers are participants who do not have a disease or condition, or related conditions or symptoms |
No |
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Study Type
An interventional clinical study is where participants are assigned to receive one or more interventions (or no intervention) so that researchers can evaluate the effects of the interventions on biomedical or health-related outcomes. An observational clinical study is where participants identified as belonging to study groups are assessed for biomedical or health outcomes. Searching Both is inclusive of interventional and observational studies. |
Interventional |
| Eligible Ages | N/A - 30 Years |
| Gender | All |
Inclusion Criteria:
- - All patients must be diagnosed with neuroblastoma, and categorized as high risk at the time of diagnosis; exception: patients who are initially diagnosed as non-high-risk neuroblastoma, but later converted (and/or relapsed) to high risk neuroblastoma are also eligible.
- - All patients must have completed therapy including intensive induction followed by ASCT and radiotherapy to be eligible for ANBL0032; radiotherapy may be waived for patients who either have small adrenal masses which are completely resected up front, or who never have an identifiable primary tumor; examples of such therapies include: - Following treatment per A3973 protocol.
- - Following treatment per Pediatric Oncology Group (POG)-9341/9342 protocol.
- - Following treatment per CCG3891.
- - Following treatment on New Approaches to Neuroblastoma Therapy (NANT) 2001-02.
- - Enrollment on or following treatment per ANBL02P1.
- - Enrollment on or following treatment per ANBL07P1.
- - Tandem transplant patients are eligible: - Following treatment on or per ANBL0532.
- - Following treatment per POG 9640.
- - Following treatment per COG ANBL00P1.
- - Following treatment per CHP 594/Dana-Farber Cancer Institute (DFCI) 34-DAT.
- - No more than 12 months from the date of starting the first induction chemotherapy after diagnosis to the date of ASCT except for the rare occasions as noted below; for tandem ASCT patients, this will be the date of the FIRST stem cell infusion; exception: for those who are initially diagnosed as non-high risk neuroblastoma, but later converted (and/or relapsed) to high risk neuroblastoma, the 12 months restriction should start from the date of induction therapy for high risk neuroblastoma (not from the initial induction therapy for non-high risk disease), to the date of ASCT.
- - At pre-ASCT evaluation patients must meet the International Neuroblastoma Response Criteria (INRC) for CR, VGPR, or PR for primary site, soft tissue metastases and bone metastases; patients who meet those criteria must also meet the protocol specified criteria for bone marrow response as outlined below: - =< 10% tumor (of total nucleated cellular content) seen on any specimen from a bilateral bone marrow aspirate/biopsy.
- - Patient who have no tumor seen on the prior bone marrow, and then have =< 10% tumor on any of the bilateral marrow aspirate/biopsy specimens done at pre-ASCT and/or pre-enrollment evaluation will also be eligible (note that per INRC this would have been defined as "overall" response of progressive disease [PD]) - Prior to enrollment on ANBL0032, a determination of mandatory disease staging must be performed (tumor imaging studies including computed tomography [CT] or magnetic resonance imaging [MRI], MIBG scan, and vanillylmandelic acid [VMA]/homovanillic acid [HVA]; bone marrow aspirates are required but biopsy may be omitted if negative prior to ASCT); this disease assessment is required for eligibility and should be done preferably within 2 weeks, but must be done within a maximum of 4 weeks before enrollment.
- - For those with residual disease before radiotherapy, re-evaluation of irradiated residual tumors is preferably performed at the earliest 5 days after completing radiotherapy; patients with residual disease are eligible; biopsy is not required; patients who have biopsy proven residual disease after ASCT will be enrolled on Stratum 07.
- - Patients must not have progressive disease at the time of study enrollment except for protocol specified bone marrow response and except for elevations of catecholamines as the only sign of disease in a patient who had normal catecholamines at pre-ASCT evaluation.
- - Patients must be enrolled before treatment begins; the date protocol therapy is projected to start must be no later than ten (10) calendar days after the date of study enrollment; patients should be enrolled preferably between day 56 and day 85 after peripheral blood stem cell (PBSC) infusion (day from 2nd stem cell infusion for tandem transplant); patients must be enrolled no later than day 200 after PBSC infusion; enrollment must occur after completion of radiotherapy, and after completion of tumor assessment post-ASCT and radiotherapy; informed consent should be obtained within 3 weeks pre-ASCT up to the time of registration.
- - Patients must not have received prior anti-disialoganglioside (GD2) antibody therapy.
- - Patients must have a Lansky or Karnofsky performance scale score of >= 50% and patients must have a life expectancy of >= 2 months.
- - Total absolute phagocyte count (APC = %neutrophils + %monocytes) X white blood cell (WBC) is at least 1000/uL.
- - Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 mL/min/1.73 m^2 or a serum creatinine based on age/gender as follows: - No greater than 0.4 mg/dL (1 month to < 6 months) - No greater than 0.5 mg/dL (6 months to < 1 year) - No greater than 0.6 mg/dL (1 to < 2 years) - No greater than 0.8 mg/dL (2 to < 6 years) - No greater than 1.0 mg/dL (6 to < 10 years) - No greater than 1.2 mg/dL (10 to < 13 years) - No greater than 1.4 mg/dL (>= 13 years [female]) - No greater than 1.5 mg/dL (13 to < 16 years [male]) - No greater than 1.7 mg/dL (>= 16 years [male]) - Total bilirubin =< 1.5 x normal.
- - Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 5 x normal.
- - Veno-occlusive disease, if present, should be stable or improving.
- - Shortening fraction of >= 27% by echocardiogram, or if shortening fraction abnormal, ejection fraction of >= 55% by gated radionuclide study or echocardiogram; note: the echocardiogram or gated radionuclide study must be performed within 4 weeks prior to enrollment.
- - Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) > 60% predicted by pulmonary function test; for children who are unable to do pulmonary function tests (PFTs), no evidence of dyspnea at rest and no exercise intolerance should be documented; note: the pulmonary function test must be performed within 4 weeks prior to enrollment.
- - Patients with seizure disorder may be enrolled if on anticonvulsants and well-controlled; central nervous system (CNS) toxicity < grade 2.
- - Written informed consent in accordance with institutional and Food and Drug Administration (FDA) guidelines must be obtained from parent or legal guardian.
Trial Details
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Trial ID:
This trial id was obtained from ClinicalTrials.gov, a service of the U.S. National Institutes of Health, providing information on publicly and privately supported clinical studies of human participants with locations in all 50 States and in 196 countries. |
NCT00026312 |
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Phase
Phase 1: Studies that emphasize safety and how the drug is metabolized and excreted in humans. Phase 2: Studies that gather preliminary data on effectiveness (whether the drug works in people who have a certain disease or condition) and additional safety data. Phase 3: Studies that gather more information about safety and effectiveness by studying different populations and different dosages and by using the drug in combination with other drugs. Phase 4: Studies occurring after FDA has approved a drug for marketing, efficacy, or optimal use. |
Phase 3 |
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Lead Sponsor
The sponsor is the organization or person who oversees the clinical study and is responsible for analyzing the study data. |
National Cancer Institute (NCI) |
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Principal Investigator
The person who is responsible for the scientific and technical direction of the entire clinical study. |
Alice L Yu |
| Principal Investigator Affiliation | Children's Oncology Group |
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Agency Class
Category of organization(s) involved as sponsor (and collaborator) supporting the trial. |
NIH |
| Overall Status | Active, not recruiting |
| Countries | Australia, Canada, New Zealand, Puerto Rico, United States |
|
Conditions
The disease, disorder, syndrome, illness, or injury that is being studied. |
Localized Resectable Neuroblastoma, Localized Unresectable Neuroblastoma, Recurrent Neuroblastoma, Regional Neuroblastoma, Stage 4 Neuroblastoma, Stage 4S Neuroblastoma |
PRIMARY OBJECTIVES:
- I. Determine if monoclonal antibody Ch14.18 (dinutuximab) + cytokines + isotretinoin (13-cis-retinoic acid, or RA) improves event free survival after myeloablative therapy and stem cell rescue as compared to RA alone, in high risk neuroblastoma patients who have achieved a pre-autologous stem cell transplant (ASCT) response of complete response (CR), very good partial response (VGPR), or partial response (PR).
- I. Determine if monoclonal antibody Ch14.18 + cytokines + isotretinoin (13-cis-retinoic acid, or RA) improves overall survival after myeloablative therapy and stem cell rescue as compared to RA alone, in high risk neuroblastoma patients who have achieved a pre-ASCT response of CR, VGPR, or PR.
- II. Determine if immunotherapy + RA improves event free survival and overall survival as compared to RA alone, in the subgroup of high risk International Neuroblastoma Staging System (INSS) stage 4 neuroblastoma patients who have achieved a pre-ASCT response of CR, VGPR, or PR.
- III. Determine the toxicities of the combination of monoclonal antibody Ch14.18 with cytokines.
- IV. To compare the outcome data of the patients with persistent disease documented by biopsy (Stratum 07) to the historical data for the analogous patients from Children's Cancer Group (CCG)-3981.
- V. To further describe and refine the event free survival (EFS) and overall survival (OS) estimates and baseline characteristics for subjects receiving Ch14.18 + cytokines + RA, following cessation of the randomized portion of the study.
- VI. To further describe the safety and toxicity of Ch14.18 + cytokines + RA under the new administration guidelines implemented following cessation of the randomized portion of the study with focus on: a) number of courses delivered per subject; b) number of dose reductions or stoppage (ch14.18 and/or interleukin [IL]-2); and c) number of toxic deaths.
- I. In the subgroup of neuroblastoma patients who have achieved a pre-ASCT response of CR, VGPR, or PR, determine if there is a difference between the two randomized regimens in reducing the minimal residual disease (MRD) burden as detected by the following parameters: meta-iodobenylguanidine (MIBG) scan, immunocytology (IC) of blood and bone marrow samples, reverse transcriptase-polymerase chain reaction (RT-PCR) for tyrosine hydroxylase, phosphoglycolate phosphatase (PGP) 9.5, and melanoma antigen family A, 1 (MAGE-1) in blood and bone marrow.
- II. Determine if change from baseline of MRD is associated with event free and overall survival.
- III. Determine whether tumor biology at diagnosis correlates with event-free and overall survival, for either of the randomized regimens.
- IV. To explore the relationship between antibody-dependent cellular cytoxicity (ADCC) and EFS.
- V. To determine a descriptive profile of human anti-chimeric antibody (HACA) during immunotherapy.
- VI. To determine the variability of 13-cis-retinoic-acid pharmacokinetics and relationship to pharmacogenomic parameters and determine if these levels and/or genetic variations correlate with EFS or systemic toxicity.
- VII. To determine the potential effect of ch14.18 on cardiac repolarization and to evaluate ch14.18 plasma levels.
- VIII. To determine if the presence of naturally occurring anti-glycan antibodies correlates with allergic reactions and blood levels of ch14.18.
- IX. To determine if the genotype of Fc receptor (FcR) and killer cell immunoglobulin-like receptor (Kir)/Kir-ligand correlate with EFS.
- X. To determine if natural killer cell p30-related protein (NKp30) isoform expression and single nucleotide polymorphism (SNP), and circulating ligand B7-H6 are prognostic of EFS or OS.
- II. Patients in the first set of strata are randomized to 1 of 2 treatment arms.
Arms
Active Comparator: Arm I (isotretinoin) (closed to accrual as of 4/16/2009)
Beginning preferably between day 56 and day 85 post-ASCT, but may be delayed up to day 200, patients receive isotretinoin PO BID for 14 days. Treatment repeats every 28 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients may cross over to Arm II provided they have not experienced disease progression and have not received any further anti-neuroblastoma therapy following completion of isotretinoin therapy.
Experimental: Arm II (sargramostim, dinutuximab, aldesleukin, isotretinoin)
Beginning preferably between day 56 and day 85 post-ASCT, but may be delayed up to day 200, patients receive immunotherapy comprising sargramostim SC or IV over 2 hours on days 0-13 during courses 1, 3, and 5 and dinutuximab IV over 10-20 hours on days 3-6 of courses 1-5. Patients also receive aldesleukin IV continuously on days 0-3 and 7-10 during courses 2 and 4. Immunotherapy repeats every 28 days for 5 courses in the absence of disease progression or unacceptable toxicity. Patients also receive isotretinoin as in Arm I beginning on day 11 of immunotherapy.
Interventions
Biological: - Aldesleukin
Given IV
Biological: - Dinutuximab
Given IV
Drug: - Isotretinoin
Given PO
Other: - Laboratory Biomarker Analysis
Correlative studies
Other: - Pharmacological Study
Correlative studies
Other: - Quality-of-Life Assessment
Ancillary studies
Biological: - Sargramostim
Given IV or SC
Contact a Trial Team
If you are interested in learning more about this trial, find the trial site nearest to your location and contact the site coordinator via email or phone. We also strongly recommend that you consult with your healthcare provider about the trials that may interest you and refer to our terms of service below.
Status
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Children's Hospital of Alabama
Birmingham, Alabama, 35233
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University of Alabama at Birmingham Cancer Center
Birmingham, Alabama, 35233
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Providence Alaska Medical Center
Anchorage, Alaska, 99508
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Phoenix Childrens Hospital
Phoenix, Arizona, 85016
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Banner University Medical Center - Tucson
Tucson, Arizona, 85719
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Arkansas Children's Hospital
Little Rock, Arkansas, 72202-3591
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University of Arkansas for Medical Sciences
Little Rock, Arkansas, 72205
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Kaiser Permanente Downey Medical Center
Downey, California, 90242
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City of Hope Comprehensive Cancer Center
Duarte, California, 91010
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Loma Linda University Medical Center
Loma Linda, California, 92354
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Miller Children's and Women's Hospital Long Beach
Long Beach, California, 90806
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Children's Hospital Los Angeles
Los Angeles, California, 90027
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Valley Children's Hospital
Madera, California, 93636
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UCSF Benioff Children's Hospital Oakland
Oakland, California, 94609
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Kaiser Permanente-Oakland
Oakland, California, 94611
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Children's Hospital of Orange County
Orange, California, 92868
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Lucile Packard Children's Hospital Stanford University
Palo Alto, California, 94304
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Sutter Medical Center Sacramento
Sacramento, California, 95816
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University of California Davis Comprehensive Cancer Center
Sacramento, California, 95817
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Rady Children's Hospital - San Diego
San Diego, California, 92123
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UCSF Medical Center-Parnassus
San Francisco, California, 94143
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UCSF Medical Center-Mission Bay
San Francisco, California, 94158
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Children's Hospital Colorado
Aurora, Colorado, 80045
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Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center
Denver, Colorado, 80218
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Connecticut Children's Medical Center
Hartford, Connecticut, 06106
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Yale University
New Haven, Connecticut, 06520
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Alfred I duPont Hospital for Children
Wilmington, Delaware, 19803
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MedStar Georgetown University Hospital
Washington, District of Columbia, 20007
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Children's National Medical Center
Washington, District of Columbia, 20010
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Address
Broward Health Medical Center
Fort Lauderdale, Florida, 33316
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Lee Memorial Health System
Fort Myers, Florida, 33901
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Golisano Children's Hospital of Southwest Florida
Fort Myers, Florida, 33908
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University of Florida Health Science Center - Gainesville
Gainesville, Florida, 32610
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Memorial Regional Hospital/Joe DiMaggio Children's Hospital
Hollywood, Florida, 33021
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Address
Nemours Children's Clinic-Jacksonville
Jacksonville, Florida, 32207
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University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami, Florida, 33136
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Address
Nicklaus Children's Hospital
Miami, Florida, 33155
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Miami Cancer Institute
Miami, Florida, 33176
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Address
AdventHealth Orlando
Orlando, Florida, 32803
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Arnold Palmer Hospital for Children
Orlando, Florida, 32806
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Nemours Children's Clinic - Orlando
Orlando, Florida, 32806
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Orlando Health Cancer Institute
Orlando, Florida, 32806
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Nemours Children's Hospital
Orlando, Florida, 32827
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Address
Nemours Children's Clinic - Pensacola
Pensacola, Florida, 32504
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Address
Johns Hopkins All Children's Hospital
Saint Petersburg, Florida, 33701
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Address
Saint Joseph's Hospital/Children's Hospital-Tampa
Tampa, Florida, 33607
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Saint Mary's Medical Center
West Palm Beach, Florida, 33407
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Children's Healthcare of Atlanta - Arthur M Blank Hospital
Atlanta, Georgia, 30329
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Address
Augusta University Medical Center
Augusta, Georgia, 30912
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Address
Memorial Health University Medical Center
Savannah, Georgia, 31404
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Address
University of Hawaii Cancer Center
Honolulu, Hawaii, 96813
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Address
Kapiolani Medical Center for Women and Children
Honolulu, Hawaii, 96826
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Address
Tripler Army Medical Center
Honolulu, Hawaii, 96859
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Address
Lurie Children's Hospital-Chicago
Chicago, Illinois, 60611
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Address
University of Illinois
Chicago, Illinois, 60612
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Address
University of Chicago Comprehensive Cancer Center
Chicago, Illinois, 60637
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Address
Advocate Children's Hospital-Oak Lawn
Oak Lawn, Illinois, 60453
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Address
Saint Jude Midwest Affiliate
Peoria, Illinois, 61637
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Address
Southern Illinois University School of Medicine
Springfield, Illinois, 62702
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Address
Riley Hospital for Children
Indianapolis, Indiana, 46202
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Address
Ascension Saint Vincent Indianapolis Hospital
Indianapolis, Indiana, 46260
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Address
Blank Children's Hospital
Des Moines, Iowa, 50309
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Address
University of Iowa/Holden Comprehensive Cancer Center
Iowa City, Iowa, 52242
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Address
University of Kentucky/Markey Cancer Center
Lexington, Kentucky, 40536
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Address
Norton Children's Hospital
Louisville, Kentucky, 40202
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Address
Children's Hospital New Orleans
New Orleans, Louisiana, 70118
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Address
Maine Children's Cancer Program
Scarborough, Maine, 04074
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Address
University of Maryland/Greenebaum Cancer Center
Baltimore, Maryland, 21201
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Address
Sinai Hospital of Baltimore
Baltimore, Maryland, 21215
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Address
Johns Hopkins University/Sidney Kimmel Cancer Center
Baltimore, Maryland, 21287
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Address
Walter Reed National Military Medical Center
Bethesda, Maryland, 20889-5600
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Address
Tufts Children's Hospital
Boston, Massachusetts, 02111
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Address
Massachusetts General Hospital Cancer Center
Boston, Massachusetts, 02114
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Address
Dana-Farber Cancer Institute
Boston, Massachusetts, 02215
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Address
Baystate Medical Center
Springfield, Massachusetts, 01199
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Address
C S Mott Children's Hospital
Ann Arbor, Michigan, 48109
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Address
Wayne State University/Karmanos Cancer Institute
Detroit, Michigan, 48201
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Address
Henry Ford Health Saint John Hospital
Detroit, Michigan, 48236
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Address
Michigan State University
East Lansing, Michigan, 48823
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Address
Hurley Medical Center
Flint, Michigan, 48503
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Address
Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
Grand Rapids, Michigan, 49503
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Address
Bronson Methodist Hospital
Kalamazoo, Michigan, 49007
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Address
Children's Hospitals and Clinics of Minnesota - Minneapolis
Minneapolis, Minnesota, 55404
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Address
University of Minnesota/Masonic Cancer Center
Minneapolis, Minnesota, 55455
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Mayo Clinic in Rochester
Rochester, Minnesota, 55905
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Address
University of Mississippi Medical Center
Jackson, Mississippi, 39216
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Address
University of Missouri Children's Hospital
Columbia, Missouri, 65212
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Address
Children's Mercy Hospitals and Clinics
Kansas City, Missouri, 64108
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Address
Cardinal Glennon Children's Medical Center
Saint Louis, Missouri, 63104
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Address
Washington University School of Medicine
Saint Louis, Missouri, 63110
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Address
Mercy Hospital Saint Louis
Saint Louis, Missouri, 63141
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Address
Children's Hospital and Medical Center of Omaha
Omaha, Nebraska, 68114
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Address
University of Nebraska Medical Center
Omaha, Nebraska, 68198
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Address
Nevada Cancer Research Foundation NCORP
Las Vegas, Nevada, 89120
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Address
Alliance for Childhood Diseases/Cure 4 the Kids Foundation
Las Vegas, Nevada, 89135
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Address
Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
Lebanon, New Hampshire, 03756
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Address
Hackensack University Medical Center
Hackensack, New Jersey, 07601
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Morristown Medical Center
Morristown, New Jersey, 07960
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Saint Peter's University Hospital
New Brunswick, New Jersey, 08901
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Address
Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
New Brunswick, New Jersey, 08903
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Address
Newark Beth Israel Medical Center
Newark, New Jersey, 07112
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Address
Overlook Hospital
Summit, New Jersey, 07902
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Address
University of New Mexico Cancer Center
Albuquerque, New Mexico, 87106
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Albany Medical Center
Albany, New York, 12208
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Montefiore Medical Center - Moses Campus
Bronx, New York, 10467
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Roswell Park Cancer Institute
Buffalo, New York, 14263
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Address
NYU Langone Hospital - Long Island
Mineola, New York, 11501
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Address
The Steven and Alexandra Cohen Children's Medical Center of New York
New Hyde Park, New York, 11040
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Laura and Isaac Perlmutter Cancer Center at NYU Langone
New York, New York, 10016
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Address
Mount Sinai Hospital
New York, New York, 10029
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Address
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
New York, New York, 10032
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Address
University of Rochester
Rochester, New York, 14642
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Address
State University of New York Upstate Medical University
Syracuse, New York, 13210
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New York Medical College
Valhalla, New York, 10595
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Mission Hospital
Asheville, North Carolina, 28801
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Address
UNC Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina, 27599
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Address
Carolinas Medical Center/Levine Cancer Institute
Charlotte, North Carolina, 28203
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Address
Novant Health Presbyterian Medical Center
Charlotte, North Carolina, 28204
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Address
Duke University Medical Center
Durham, North Carolina, 27710
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Address
Wake Forest University Health Sciences
Winston-Salem, North Carolina, 27157
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Address
Sanford Broadway Medical Center
Fargo, North Dakota, 58122
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Address
Children's Hospital Medical Center of Akron
Akron, Ohio, 44308
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Address
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, 45229
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Address
Rainbow Babies and Childrens Hospital
Cleveland, Ohio, 44106
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Address
Cleveland Clinic Foundation
Cleveland, Ohio, 44195
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Address
Nationwide Children's Hospital
Columbus, Ohio, 43205
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Address
Dayton Children's Hospital
Dayton, Ohio, 45404
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Address
ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital
Toledo, Ohio, 43606
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Address
Mercy Children's Hospital
Toledo, Ohio, 43608
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Address
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
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Address
Legacy Emanuel Children's Hospital
Portland, Oregon, 97227
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Address
Legacy Emanuel Hospital and Health Center
Portland, Oregon, 97227
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Address
Oregon Health and Science University
Portland, Oregon, 97239
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Address
Lehigh Valley Hospital - Muhlenberg
Bethlehem, Pennsylvania, 18017
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Address
Geisinger Medical Center
Danville, Pennsylvania, 17822
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Address
Penn State Children's Hospital
Hershey, Pennsylvania, 17033
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Address
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, 19104
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Address
Saint Christopher's Hospital for Children
Philadelphia, Pennsylvania, 19134
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Address
Children's Hospital of Pittsburgh of UPMC
Pittsburgh, Pennsylvania, 15224
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Address
Rhode Island Hospital
Providence, Rhode Island, 02903
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Address
Medical University of South Carolina
Charleston, South Carolina, 29425
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Address
Prisma Health Richland Hospital
Columbia, South Carolina, 29203
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Address
BI-LO Charities Children's Cancer Center
Greenville, South Carolina, 29605
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Address
Greenville Cancer Treatment Center
Greenville, South Carolina, 29605
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Address
Sanford USD Medical Center - Sioux Falls
Sioux Falls, South Dakota, 57117-5134
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Address
T C Thompson Children's Hospital
Chattanooga, Tennessee, 37403
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Address
East Tennessee Childrens Hospital
Knoxville, Tennessee, 37916
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Address
Saint Jude Children's Research Hospital
Memphis, Tennessee, 38105
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Address
Vanderbilt University/Ingram Cancer Center
Nashville, Tennessee, 37232
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Address
Dell Children's Medical Center of Central Texas
Austin, Texas, 78723
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Address
Driscoll Children's Hospital
Corpus Christi, Texas, 78411
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Address
Medical City Dallas Hospital
Dallas, Texas, 75230
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Address
UT Southwestern/Simmons Cancer Center-Dallas
Dallas, Texas, 75390
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Address
Cook Children's Medical Center
Fort Worth, Texas, 76104
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Address
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
Houston, Texas, 77030
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Address
Methodist Children's Hospital of South Texas
San Antonio, Texas, 78229
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Address
University of Texas Health Science Center at San Antonio
San Antonio, Texas, 78229
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Address
Primary Children's Hospital
Salt Lake City, Utah, 84113
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Address
University of Vermont and State Agricultural College
Burlington, Vermont, 05405
Status
Address
University of Virginia Cancer Center
Charlottesville, Virginia, 22908
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Address
Inova Fairfax Hospital
Falls Church, Virginia, 22042
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Address
Children's Hospital of The King's Daughters
Norfolk, Virginia, 23507
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Address
Naval Medical Center - Portsmouth
Portsmouth, Virginia, 23708-2197
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Address
VCU Massey Comprehensive Cancer Center
Richmond, Virginia, 23298
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Address
Carilion Children's
Roanoke, Virginia, 24014
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Address
Seattle Children's Hospital
Seattle, Washington, 98105
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Address
Providence Sacred Heart Medical Center and Children's Hospital
Spokane, Washington, 99204
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Address
West Virginia University Healthcare
Morgantown, West Virginia, 26506
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Address
Saint Vincent Hospital Cancer Center Green Bay
Green Bay, Wisconsin, 54301
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Address
University of Wisconsin Carbone Cancer Center - University Hospital
Madison, Wisconsin, 53792
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Address
Marshfield Medical Center-Marshfield
Marshfield, Wisconsin, 54449
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Address
Children's Hospital of Wisconsin
Milwaukee, Wisconsin, 53226
International Sites
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Address
John Hunter Children's Hospital
Hunter Regional Mail Centre, New South Wales, 2310
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Address
Sydney Children's Hospital
Randwick, New South Wales, 2031
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Address
The Children's Hospital at Westmead
Westmead, New South Wales, 2145
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Address
Royal Brisbane and Women's Hospital
Herston, Queensland, 4029
Status
Address
Royal Children's Hospital-Brisbane
Herston, Queensland, 4029
Status
Address
Queensland Children's Hospital
South Brisbane, Queensland, 4101
Status
Address
Women's and Children's Hospital-Adelaide
North Adelaide, South Australia, 5006
Status
Address
Royal Children's Hospital
Parkville, Victoria, 3052
Status
Address
Princess Margaret Hospital for Children
Perth, Western Australia, 6008
Status
Address
Alberta Children's Hospital
Calgary, Alberta, T3B 6A8
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Address
University of Alberta Hospital
Edmonton, Alberta, T6G 2B7
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Address
British Columbia Children's Hospital
Vancouver, British Columbia, V6H 3V4
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Address
CancerCare Manitoba
Winnipeg, Manitoba, R3E 0V9
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Address
Janeway Child Health Centre
Saint John's, Newfoundland and Labrador, A1B 3V6
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Address
IWK Health Centre
Halifax, Nova Scotia, B3K 6R8
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Address
McMaster Children's Hospital at Hamilton Health Sciences
Hamilton, Ontario, L8N 3Z5
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Address
Children's Hospital
London, Ontario, N6A 5W9
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Address
Children's Hospital of Eastern Ontario
Ottawa, Ontario, K1H 8L1
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Address
Hospital for Sick Children
Toronto, Ontario, M5G 1X8
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Address
The Montreal Children's Hospital of the MUHC
Montreal, Quebec, H3H 1P3
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Address
Centre Hospitalier Universitaire Sainte-Justine
Montreal, Quebec, H3T 1C5
Status
Address
CHU de Quebec-Centre Hospitalier de l'Universite Laval (CHUL)
Quebec, , G1V 4G2
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Address
Starship Children's Hospital
Grafton, Auckland, 1145
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Address
Christchurch Hospital
Christchurch, , 8011
Status
Address
San Jorge Children's Hospital
San Juan, , 00912
