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Response and Biology-Based Risk Factor-Guided Therapy in Treating Younger Patients With Non-high Risk Neuroblastoma
Study Purpose
This phase III trial studies how well response and biology-based risk factor-guided therapy works in treating younger patients with non-high risk neuroblastoma. Sometimes a tumor may not need treatment until it progresses. In this case, observation may be sufficient. Measuring biomarkers in tumor cells may help plan when effective treatment is necessary and what the best treatment is. Response and biology-based risk factor-guided therapy may be effective in treating patients with non-high risk neuroblastoma and may help to avoid some of the risks and side effects related to standard treatment.
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 - 18 Months |
| Gender | All |
Inclusion Criteria:
- - Patients must be: - < 12 months (< 365 days) of age at diagnosis with INRG stage L1; or.
- - < 18 months (< 547 days) of age at diagnosis with INRG stage L2 or stage Ms neuroblastoma/ganglioneuroblastoma.
- - Enrollment on ANBL00B1 or APEC14B1 is required for all newly diagnosed patients.
- - Patients must have newly diagnosed v-myc avian myelocytomatosis viral oncogene neuroblastoma derived homolog (MYCN) non-amplified neuroblastoma (International Classification of Diseases for Oncology [ICD-O] morphology 9500/3) or MYCN non-amplified ganglioneuroblastoma verified by histology.
- - Patients must meet the specified criteria for one of the treatment groups defined below; genomic features include MYCN gene amplification, segmental chromosome aberrations (somatic copy number loss at 1p, 3p, 4p, or 11q or somatic copy number gain at 1q, 2p, or 17q) and deoxyribonucleic acid (DNA) index.
- - "Favorable" genomic features are defined by one or more whole-chromosome gains or hyperdiploid tumor (DNA index > 1) in the absence of segmental chromosome aberrations as defined above.
- - "Unfavorable" genomic features are defined by the presence of any segmental chromosome aberration (somatic copy number loss at 1p, 3p, 4p, or 11q or somatic copy number gain at 1q, 2p, or 17q) or diploid tumor (DNA index = 1); this includes copy neutral loss of heterozygosity (LOH) - Only patients with MYCN non-amplified tumors are eligible for this study.
- - Group A: patients < 12 months (< 365 days) of age with newly diagnosed INRG stage L1 neuroblastoma/ganglioneuroblastoma who meet the following criteria: - Greatest tumor diameter < 5 cm of adrenal or non-adrenal origin.
- - Patients with non-adrenal primaries are eligible, but must have positive uptake on metaiodobenzylguanidine (MIBG) scan or elevated catecholamine metabolites (urine or serum) to support the diagnosis of neuroblastoma.
- - No prior tumor resection or biopsy.
- - Group A will be further split into two subsets, which are mutually exclusive, for statistical purposes.
- - Group A1: - > 6 months and < 12 months of age with an adrenal primary tumor < 5 cm in greatest diameter OR.
- - Patients less than 6 months of age with an adrenal primary tumor > 3.1 and < 5 cm in greatest diameter OR.
- - < 12 months of age with a non-adrenal primary site < 5 cm in greatest diameter.
- - Group A2: =< 6 months of age with an adrenal primary site and tumor =< 3.1 cm in greatest diameter.
- - Group B: patients < 18 months (< 547 days) of age with newly diagnosed INRG stage L2 neuroblastoma/ganglioneuroblastoma who meet the following criteria: - No life threatening symptoms or no impending neurologic or other organ function compromise (e.g. epidural or intraspinal tumors with existing or impending neurologic impairment, periorbital or calvarial-based lesions with existing or impending cranial nerve impairment, anatomic or mechanical compromise of critical organ function by tumor [abdominal compartment syndrome, urinary obstruction, etc.]); horner syndrome is not considered neurologic compromise.
- - No prior tumor resection, tumor biopsy ONLY.
- - Only patients with both favorable histology and favorable genomic features will remain on study as part of Group B; the institution will be notified of histologic and genomic results within 3 weeks of specimen submission on ANBL00B1 or APEC14B1.
- - Group C: patients < 18 months (< 547 days) of age with newly diagnosed INRG stage Ms neuroblastoma/ganglioneuroblastoma.
- - No prior radiotherapy or chemotherapy, with the exception of dexamethasone, which is allowed.
- - 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.
Exclusion Criteria:
- - Patients with MYCN amplified tumors are not eligible.
- - Group B and C patients who do not enroll on ANBL1232 within 4 weeks of definitive diagnostic procedure.
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. |
NCT02176967 |
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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. |
Children's Oncology Group |
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Principal Investigator
The person who is responsible for the scientific and technical direction of the entire clinical study. |
Holly J Meany |
| 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. |
Other, NIH |
| Overall Status | Active, not recruiting |
| Countries | Australia, Canada, New Zealand, Puerto Rico, Saudi Arabia, United States |
|
Conditions
The disease, disorder, syndrome, illness, or injury that is being studied. |
Ganglioneuroblastoma, Localized Resectable Neuroblastoma, Localized Unresectable Neuroblastoma, Neuroblastoma |
PRIMARY OBJECTIVES:
- I. To eliminate therapy as the initial approach for infants < 12 months of age with small International Neuroblastoma Risk Group (INRG) stage L1 neuroblastoma while maintaining an overall survival (OS) of 99%.
- II. To eliminate therapy as the initial approach for non-high-risk patients < 18 months of age with localized neuroblastoma and favorable biology (histologic and genomic features) while maintaining an OS of 99%.
- III. To achieve a 3-year OS of > 81% for infants < 18 months of age with INRG stage Ms neuroblastoma using objective criteria for early initiation of a response-based treatment algorithm.
- I. To describe the time to intervention or tumor progression, type of intervention and site of progression for patients with localized neuroblastoma who experience progression after an initial period of observation.
- II. To characterize the pharmacokinetic profile of the chemotherapeutic agents carboplatin and etoposide in patients with stage Ms disease.
- III. To define the genomic profile of tumors from patients with non-high-risk neuroblastoma both at initial biopsy and at the time of subsequent biopsy or surgical resection.
- IV. To describe the histology of tumor specimens obtained at the time of subsequent biopsy or surgical resection.
- V. To determine the salvage rate (OS) of patients with tumor relapse or disease progression.
- VI. To determine the procedural complication rate (initial biopsy, resection [intraoperative and postoperative], subsequent biopsy) and correlate with the degree of surgical resection.
- VII. To determine the rate of reduction in image defined risk factors (IDRF) in L2 tumors following observation or chemotherapy.
Arms
Experimental: Group A (clinical observation)
Patients undergo clinical observation for 96 weeks in the absence of disease progression. Patients also undergo CT, MRI, and/or ultrasound throughout the trial.
Experimental: Group B (clinical observation, first-line chemotherapy)
Patients undergo clinical observation for 3 years in the absence of disease progression. Upon disease progression, patients undergo surgery or receive first-line chemotherapy comprising carboplatin IV over 1 hour on day 1 (courses 1, 2, 4, 6, and 7), etoposide IV over 1 hour on days 1-3 (courses 1, 3, 4, 5, and 7), cyclophosphamide IV over 1 hour on day 1 (courses 2, 3, 5, 6, and 8), and doxorubicin hydrochloride IV over 15 minutes on day 1 (courses 2, 4, 6 and 8). Treatment with chemotherapy repeats every 21 days for 2-8 courses in the absence of disease progression or unacceptable toxicity. Once a PR or better is achieved, patients undergo clinical observation for 3 years. Patients also undergo CT, MRI, and/or ultrasound throughout the trial and undergo bone marrow aspiration, bone marrow biopsy, and tumor biopsy at screening and time of progression.
Experimental: Group C (clinical observation, first-line chemotherapy)
Patients at high risk for deterioration and a poor outcome immediately receive first-line chemotherapy as in Group B. All other patients undergo clinical observation for 3 years in the absence of disease progression. Upon disease progression, patients receive first-line chemotherapy as in Group B. Once a PR or better is achieved, patients undergo clinical observation for 3 years. Patients also undergo CT, MRI, and/or ultrasound throughout the trial and undergo bone marrow aspiration, bone marrow biopsy, and tumor biopsy at screening and time of progression.
Interventions
Procedure: - Biopsy
Undergo biopsy
Procedure: - Bone Marrow Aspiration
Undergo bone marrow aspiration
Procedure: - Bone Marrow Biopsy
Undergo bone marrow biopsy
Drug: - Carboplatin
Given IV
Other: - Clinical Observation
Undergo clinical observation
Procedure: - Computed Tomography
Undergo CT
Drug: - Cyclophosphamide
Given IV
Drug: - Doxorubicin Hydrochloride
Given IV
Drug: - Etoposide
Given IV
Procedure: - Magnetic Resonance Imaging
Undergo MRI
Procedure: - Ultrasound
Undergo ultrasound
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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USA Health Strada Patient Care Center
Mobile, Alabama, 36604
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Providence Alaska Medical Center
Anchorage, Alaska, 99508
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Banner Children's at Desert
Mesa, Arizona, 85202
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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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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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Cedars Sinai Medical Center
Los Angeles, California, 90048
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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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Naval Medical Center -San Diego
San Diego, California, 92134
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UCSF Medical Center-Mission Bay
San Francisco, California, 94158
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Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center
Torrance, California, 90502
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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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Broward Health Medical Center
Fort Lauderdale, Florida, 33316
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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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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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Nicklaus Children's Hospital
Miami, Florida, 33155
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Miami Cancer Institute
Miami, Florida, 33176
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AdventHealth Orlando
Orlando, Florida, 32803
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Arnold Palmer Hospital for Children
Orlando, Florida, 32806
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Nemours Children's Hospital
Orlando, Florida, 32827
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Nemours Children's Clinic - Pensacola
Pensacola, Florida, 32504
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Sacred Heart Hospital
Pensacola, Florida, 32504
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Johns Hopkins All Children's Hospital
Saint Petersburg, Florida, 33701
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Tampa General Hospital
Tampa, Florida, 33606
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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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Augusta University Medical Center
Augusta, Georgia, 30912
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Memorial Health University Medical Center
Savannah, Georgia, 31404
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Kapiolani Medical Center for Women and Children
Honolulu, Hawaii, 96826
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Tripler Army Medical Center
Honolulu, Hawaii, 96859
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Saint Luke's Cancer Institute - Boise
Boise, Idaho, 83712
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Lurie Children's Hospital-Chicago
Chicago, Illinois, 60611
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University of Illinois
Chicago, Illinois, 60612
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University of Chicago Comprehensive Cancer Center
Chicago, Illinois, 60637
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Loyola University Medical Center
Maywood, Illinois, 60153
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Advocate Children's Hospital-Oak Lawn
Oak Lawn, Illinois, 60453
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Advocate Children's Hospital-Park Ridge
Park Ridge, Illinois, 60068
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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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IU Health North Hospital
Carmel, Indiana, 46032
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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
Ochsner Medical Center Jefferson
New Orleans, Louisiana, 70121
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Address
Eastern Maine Medical Center
Bangor, Maine, 04401
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Address
Maine Children's Cancer Program
Scarborough, Maine, 04074
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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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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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UMass Memorial Medical Center - University Campus
Worcester, Massachusetts, 01655
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C S Mott Children's Hospital
Ann Arbor, Michigan, 48109
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Children's Hospital of Michigan
Detroit, Michigan, 48201
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Address
Wayne State University/Karmanos Cancer Institute
Detroit, Michigan, 48201
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Henry Ford Health Saint John Hospital
Detroit, Michigan, 48236
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Michigan State University Clinical Center
East Lansing, Michigan, 48824
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Hurley Medical Center
Flint, Michigan, 48503
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Corewell Health Grand Rapids Hospitals - Butterworth Hospital
Grand Rapids, Michigan, 49503
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Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
Grand Rapids, Michigan, 49503
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Bronson Methodist Hospital
Kalamazoo, Michigan, 49007
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West Michigan Cancer Center
Kalamazoo, Michigan, 49007
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Address
Corewell Health Children's
Royal Oak, Michigan, 48073
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Address
Children's Hospitals and Clinics of Minnesota - Minneapolis
Minneapolis, Minnesota, 55404
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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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Washington University School of Medicine
Saint Louis, Missouri, 63110
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Mercy Hospital Saint Louis
Saint Louis, Missouri, 63141
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Children's Hospital and Medical Center of Omaha
Omaha, Nebraska, 68114
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University of Nebraska Medical Center
Omaha, Nebraska, 68198
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University Medical Center of Southern Nevada
Las Vegas, Nevada, 89102
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Sunrise Hospital and Medical Center
Las Vegas, Nevada, 89109
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Alliance for Childhood Diseases/Cure 4 the Kids Foundation
Las Vegas, Nevada, 89135
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Summerlin Hospital Medical Center
Las Vegas, Nevada, 89144
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Renown Regional Medical Center
Reno, Nevada, 89502
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Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center
Lebanon, New Hampshire, 03756
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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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Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
New Brunswick, New Jersey, 08903
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Newark Beth Israel Medical Center
Newark, New Jersey, 07112
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Saint Joseph's Regional Medical Center
Paterson, New Jersey, 07503
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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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Maimonides Medical Center
Brooklyn, New York, 11219
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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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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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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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Address
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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Novant Health Presbyterian Medical Center
Charlotte, North Carolina, 28204
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Duke University Medical Center
Durham, North Carolina, 27710
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Address
East Carolina University
Greenville, North Carolina, 27834
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Address
Wake Forest University Health Sciences
Winston-Salem, North Carolina, 27157
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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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Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, 45229
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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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University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma, 73104
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Legacy Emanuel Children's Hospital
Portland, Oregon, 97227
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Oregon Health and Science University
Portland, Oregon, 97239
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Address
Lehigh Valley Hospital-Cedar Crest
Allentown, Pennsylvania, 18103
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Lehigh Valley Hospital - Muhlenberg
Bethlehem, Pennsylvania, 18017
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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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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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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
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
The Children's Hospital at TriStar Centennial
Nashville, Tennessee, 37203
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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
El Paso Children's Hospital
El Paso, Texas, 79905
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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
Covenant Children's Hospital
Lubbock, Texas, 79410
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UMC Cancer Center / UMC Health System
Lubbock, Texas, 79415
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Address
Children's Hospital of San Antonio
San Antonio, Texas, 78207
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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
Scott and White Memorial Hospital
Temple, Texas, 76508
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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
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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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Virginia Commonwealth University/Massey 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
Mary Bridge Children's Hospital and Health Center
Tacoma, Washington, 98405
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Address
Madigan Army Medical Center
Tacoma, Washington, 98431
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Address
West Virginia University Charleston Division
Charleston, West Virginia, 25304
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Address
Edwards Comprehensive Cancer Center
Huntington, West Virginia, 25701
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Address
West Virginia University Healthcare
Morgantown, West Virginia, 26506
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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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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
Queensland Children's Hospital
South Brisbane, Queensland, 4101
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Address
Women's and Children's Hospital-Adelaide
North Adelaide, South Australia, 5006
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Address
Princess Margaret Hospital for Children
Perth, Western Australia, 6008
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Address
Perth Children's Hospital
Perth, Western Australia, 6009
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Address
Alberta Children's Hospital
Calgary, Alberta, T3B 6A8
Status
Address
University of Alberta Hospital
Edmonton, Alberta, T6G 2B7
Status
Address
British Columbia Children's Hospital
Vancouver, British Columbia, V6H 3V4
Status
Address
CancerCare Manitoba
Winnipeg, Manitoba, R3E 0V9
Status
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
Kingston Health Sciences Centre
Kingston, Ontario, K7L 2V7
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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
Status
Address
The Montreal Children's Hospital of the MUHC
Montreal, Quebec, H3H 1P3
Status
Address
Centre Hospitalier Universitaire Sainte-Justine
Montreal, Quebec, H3T 1C5
Status
Address
Centre Hospitalier Universitaire de Sherbrooke-Fleurimont
Sherbrooke, Quebec, J1H 5N4
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Address
Jim Pattison Children's Hospital
Saskatoon, Saskatchewan, S7N 0W8
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Address
Saskatoon Cancer Centre
Saskatoon, Saskatchewan, S7N 4H4
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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
Status
Address
Christchurch Hospital
Christchurch, , 8011
Status
Address
San Jorge Children's Hospital
San Juan, , 00912
Status
Address
University Pediatric Hospital
San Juan, , 00926
Status
Address
King Faisal Specialist Hospital and Research Centre
Riyadh, , 11211
