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Irinotecan Hydrochloride, Temozolomide, and Dinutuximab With or Without Eflornithine in Treating Patients With Relapsed or Refractory Neuroblastoma
Study Purpose
This phase II trial studies how well irinotecan hydrochloride, temozolomide, and dinutuximab work with or without eflornithine in treating patients with neuroblastoma that has come back (relapsed) or that isn't responding to treatment (refractory). Drugs used in chemotherapy, such as irinotecan hydrochloride and temozolomide, 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. Immunotherapy with monoclonal antibodies, such as dinutuximab, may induce changes in the body's immune system and may interfere with the ability of tumor cells to grow and spread. Eflornithine blocks the production of chemicals called polyamines that are important in the growth of cancer cells. Giving eflornithine with irinotecan hydrochloride, temozolomide, and dinutuximab, may work better in treating patients with relapsed or refractory 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 | 1 Year and Over |
| Gender | All |
Inclusion Criteria:
- - Patients must have had histologic verification of neuroblastoma or ganglioneuroblastoma or demonstration of neuroblastoma cells in the bone marrow with elevated urinary catecholamines (i.e. > 2 x upper limit of normal [ULN]), at the time of initial diagnosis.
- - For the purposes of this study, aggressive multidrug chemotherapy is defined as chemotherapy including 2 or more agents that must include an alkylating agent and a platinum-containing compound as intended to treat high-risk disease.
- - First episode of recurrent high-risk disease following completion of aggressive multi-drug frontline high-risk therapy.
- - First episode of progressive high-risk disease during aggressive multi-drug frontline therapy.
- - Primary resistant/refractory disease (less than partial response by International Neuroblastoma Response Criteria [INRC]) detected at the conclusion of at least 4 cycles of aggressive multidrug induction chemotherapy on or according to a high-risk neuroblastoma protocol (examples include A3973, ANBL0532, ANBL09P1, ANBL12P1, ANBL1531, etc.).
- - Patients must have at least ONE of the following at the time of enrollment: - Measurable tumor on magnetic resonance imaging (MRI) or computed tomography (CT) scan.
- - MIBG-avid lesion detected on MIBG scan with positive uptake at a minimum of one site.
- - Patients with resistant/refractory soft tissue disease that is not MIBG avid or does not demonstrate increased FDG uptake on PET scan must undergo biopsy to document the presence of viable neuroblastoma.
- - Patients with bone marrow disease only will be eligible if they have more than 5% disease involvement (documented neuroblastoma cells) in at least one sample from bilateral bone marrow biopsies.
- - Note: Patients with elevated catecholamines (i.e. > 2 x ULN) only are NOT eligible for this study.
- - Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1 or 2.
- - Primary refractory/resistant patients must have received at least 4 cycles of frontline high-risk chemotherapy.
- - At least 14 days must have elapsed since completion of myelosuppressive therapy.
- - Anti-cancer agents not known to be myelosuppressive (e.g. not associated with reduced platelet or absolute neutrophil count [ANC] counts): >= 7 days after the last dose of agent.
- - Antibodies: >= 21 days must have elapsed from infusion of last dose of antibody, and toxicity related to prior antibody therapy must be recovered to grade =< 1.
- - No interim time prior to study entry is required following prior radiation therapy (RT) for non-target lesions.
- - Patients are eligible >= 6 weeks after autologous stem cell transplants or stem cell infusions (including stem cell infusions given as supportive care following 131 I-MIBG therapy) as long as hematologic and other eligibility criteria have been met.
- - Patients are eligible >= 6 weeks after therapeutic 131 I-MIBG provided that all other eligibility criteria are met.
- - Subjects who have previously received anti-GD2 monoclonal antibodies with or without retinoids for biologic therapy are eligible unless they have had progressive disease while receiving prior anti-GD2 therapy or progressed/relapsed within 3 months of receiving anti-GD2 therapy.
- - Subjects who have received autologous marrow infusions or autologous stem cell infusions that were purged using monoclonal antibody linked to beads are eligible.
- - Subjects who have previously received DFMO are eligible for this study provided they have not had progressive disease while receiving DFMO or progressed/relapsed within 3 months of completing DFMO.
- - Patients must not have received long-acting myeloid growth factors (e.g. pegfilgrastim) within 14 days of entry on this study.
- - For patients with solid tumors (without marrow involvement) including status post SCT: peripheral absolute neutrophil count (ANC) >= 750/uL (within 7 days prior to enrollment).
- - For patients with solid tumors (without marrow involvement) including status post SCT: platelet count >= 75,000/uL (transfusion independent) (within 7 days prior to enrollment).
- - Patients known to have bone marrow involvement with neuroblastoma are eligible provided that minimum ANC and transfusion independent platelet count criteria are met (as above).
- - Creatinine clearance or radioisotope GFR >= 70 mL/min/1.73 m^2 or a serum creatinine based on age/gender as follows: - 1 to < 2 years (male 0.6 mg/dL, female 0.6 mg/dL) - 2 to < 6 years (male 0.8 mg/dL, female 0.8 mg/dL) - 6 to < 10 years (male 1 mg/dL, female 1 mg/dL) - 10 to < 13 years (male 1.2 mg/dL, female 1.2 mg/dL) - 13 to < 16 years (male 1.5 mg/dL, female 1.4 mg/dL) - >= 16 years (male 1.7 mg/dL, female 1.4 mg/dL) (within 7 days prior to enrollment).
- - Total bilirubin =< 1.5 x ULN for age (within 7 days prior to enrollment).
- - Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 5.0 x ULN for age (=< 225 U/L).
- - Shortening fraction of >= 27% by echocardiography (ECHO) (within 7 days prior to enrollment).
- - Ejection fraction of >= 50% by ECHO or gated radionuclide study (within 7 days prior to enrollment).
- - No evidence of dyspnea at rest, no exercise intolerance, no chronic oxygen requirement, and room air pulse oximetry > 94% if there is a clinical indication for pulse oximetry.
- - Patients with a history of central nervous system (CNS) disease must have no clinical or radiological evidence of active CNS disease at the time of study enrollment.
- - Patients with seizure disorders may be enrolled if seizures are well controlled on anti-convulsants.
- - CNS toxicity =< grade 2.
Exclusion Criteria:
- - Men and women of childbearing potential and their partners must agree to use adequate contraception while enrolled on this study.
- - Patients with only elevated catecholamines (i.e. > 2 x ULN) are NOT eligible for this study.
- - Patients must have been off pharmacologic doses of systemic steroids for at least 7 days prior to enrollment.
- - Patients must not have received prior treatment with irinotecan and temozolomide.
- - Patients must not have received enzyme-inducing anticonvulsants including phenytoin, phenobarbital, or carbamazepine for at least 7 days prior to study enrollment.
- - Patients who have received drugs that are strong inducers or inhibitors of CYP3A4 within 7 days prior to study enrollment are not eligible.
- - Patients must not have been diagnosed with myelodysplastic syndrome or with any malignancy other than neuroblastoma.
- - Patients with symptoms of congestive heart failure are not eligible.
- - Patients must not have >= grade 2 diarrhea.
- - Patients who are unable to tolerate oral/nasogastric/gastrostomy medications will not be eligible for this trial.
- - Patients must not have uncontrolled infection.
- - Patients with a history of grade 4 allergic reactions to anti-GD2 antibodies or reactions that required permanent discontinuation of the anti-GD2 therapy are not eligible.
- - Patients with a significant intercurrent illness (any ongoing serious medical problem unrelated to cancer or its treatment) that is not covered by the detailed exclusion criteria and that is expected to interfere with the action of study agents or to significantly increase the severity of the toxicities experienced from study treatment are not eligible.
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. |
NCT03794349 |
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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 2 |
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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. |
Margaret E Macy |
| Principal Investigator Affiliation | Children's Oncology Group |
|
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, United States |
|
Conditions
The disease, disorder, syndrome, illness, or injury that is being studied. |
High Risk Neuroblastoma, Recurrent Neuroblastoma, Refractory Neuroblastoma |
PRIMARY OBJECTIVE:
- I. To determine whether administration of eflornithine hydrochloride (eflornithine [DFMO]) in combination with dinutuximab, irinotecan hydrochloride (irinotecan) and temozolomide results in an improved response rate compared to dinutuximab, irinotecan and temozolomide in patients with relapsed or refractory neuroblastoma and therefore is a therapeutic regimen worthy of further testing in patients with newly-diagnosed high-risk neuroblastoma.
- I. To compare progression-free survival and overall survival between patients receiving dinutuximab, irinotecan and temozolomide with and without the addition of DFMO.
- II. To define the toxicity profile of DFMO administered with dinutuximab, irinotecan and temozolomide.
- I. To characterize the immune and cytokine profiles of patients treated with DFMO/chemotherapy/dinutuximab combination and correlate with response to therapy.
- II. To evaluate GD2 levels in tumor cells from patient bone marrow samples and correlate with response to therapy.
- III. To explore whether the addition of DFMO to the dinutuximab and chemotherapy backbone affects pain as determined by patient report and opiate usage.
Arms
Active Comparator: Regimen A (chemotherapy, dinutuximab, sargramostim)
Patients receive temozolomide PO, via NG, or G tube on days 1-5, irinotecan hydrochloride IV over 90 minutes on days 1-5, dinutuximab IV over 10-20 hours on days 2-5, and sargramostim SC or IV over 2 hours on days 6-12 of a 21-day cycle. Treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity.
Experimental: Regimen B (eflornithine, chemotherapy, dinutuximab)
Patients receive eflornithine PO, via NG, or G tube on days -6 to 7 and days 15-21 of cycle 1 and days 1-7 and 15-21 of subsequent cycles, temozolomide PO, via NG, or G tube on days 1-5, irinotecan hydrochloride IV over 90 minutes on days 1-5, dinutuximab IV over 10-20 hours on days 2-5, and sargramostim SC or IV over 2 hours on days 6-12. Treatment duration is 28 days for cycle 1 and then every 21 days in subsequent cycles for up to 6 cycles in the absence of disease progression or unacceptable toxicity.
Interventions
Biological: - Dinutuximab
Given IV
Drug: - Eflornithine Hydrochloride
Given PO or via NG or G tube
Drug: - Irinotecan Hydrochloride
Given IV
Biological: - Sargramostim
Given SC or IV
Drug: - Temozolomide
Given PO or via NG or G tube
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
Address
Children's Hospital of Alabama
Birmingham 4049979, Alabama 4829764, 35233
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Address
Arkansas Children's Hospital
Little Rock 4119403, Arkansas 4099753, 72202-3591
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Address
Kaiser Permanente Downey Medical Center
Downey 5343858, California 5332921, 90242
Status
Address
Miller Children's and Women's Hospital Long Beach
Long Beach 5367929, California 5332921, 90806
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Address
Children's Hospital Los Angeles
Los Angeles 5368361, California 5332921, 90027
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Address
Cedars Sinai Medical Center
Los Angeles 5368361, California 5332921, 90048
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Address
Valley Children's Hospital
Madera 5369568, California 5332921, 93636
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Address
Kaiser Permanente-Oakland
Oakland 5378538, California 5332921, 94611
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Address
Children's Hospital of Orange County
Orange 5379513, California 5332921, 92868
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Address
Lucile Packard Children's Hospital Stanford University
Palo Alto 5380748, California 5332921, 94304
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Address
University of California Davis Comprehensive Cancer Center
Sacramento 5389489, California 5332921, 95817
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Address
Rady Children's Hospital - San Diego
San Diego 5391811, California 5332921, 92123
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Address
UCSF Medical Center-Mission Bay
San Francisco 5391959, California 5332921, 94158
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Address
Children's Hospital Colorado
Aurora 5412347, Colorado 5417618, 80045
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Address
Rocky Mountain Hospital for Children-Presbyterian Saint Luke's Medical Center
Denver 5419384, Colorado 5417618, 80218
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Address
Connecticut Children's Medical Center
Hartford 4835797, Connecticut 4831725, 06106
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Address
Yale University
New Haven 4839366, Connecticut 4831725, 06520
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Address
Alfred I duPont Hospital for Children
Wilmington 4145381, Delaware 4142224, 19803
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Address
MedStar Georgetown University Hospital
Washington D.C. 4140963, District of Columbia 4138106, 20007
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Address
Children's National Medical Center
Washington D.C. 4140963, District of Columbia 4138106, 20010
Status
Address
Golisano Children's Hospital of Southwest Florida
Fort Myers 4155995, Florida 4155751, 33908
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Address
University of Florida Health Science Center - Gainesville
Gainesville 4156404, Florida 4155751, 32610
Status
Address
Memorial Regional Hospital/Joe DiMaggio Children's Hospital
Hollywood 4158928, Florida 4155751, 33021
Status
Address
Nemours Children's Clinic-Jacksonville
Jacksonville 4160021, Florida 4155751, 32207
Status
Address
University of Miami Miller School of Medicine-Sylvester Cancer Center
Miami 4164138, Florida 4155751, 33136
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Address
Nicklaus Children's Hospital
Miami 4164138, Florida 4155751, 33155
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Address
Arnold Palmer Hospital for Children
Orlando 4167147, Florida 4155751, 32806
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Address
Nemours Children's Hospital
Orlando 4167147, Florida 4155751, 32827
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Address
Johns Hopkins All Children's Hospital
St. Petersburg 4171563, Florida 4155751, 33701
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Address
Saint Mary's Medical Center
West Palm Beach 4177887, Florida 4155751, 33407
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Address
Children's Healthcare of Atlanta - Arthur M Blank Hospital
Atlanta 4180439, Georgia 4197000, 30329
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Address
Memorial Health University Medical Center
Savannah 4221552, Georgia 4197000, 31404
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Address
Kapiolani Medical Center for Women and Children
Honolulu 5856195, Hawaii 5855797, 96826
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Address
Saint Luke's Cancer Institute - Boise
Boise 5586437, Idaho 5596512, 83712
Status
Address
Lurie Children's Hospital-Chicago
Chicago 4887398, Illinois 4896861, 60611
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Address
University of Illinois
Chicago 4887398, Illinois 4896861, 60612
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Address
University of Chicago Comprehensive Cancer Center
Chicago 4887398, Illinois 4896861, 60637
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Address
Loyola University Medical Center
Maywood 4901514, Illinois 4896861, 60153
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Address
Saint Jude Midwest Affiliate
Peoria 4905687, Illinois 4896861, 61637
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Address
Riley Hospital for Children
Indianapolis 4259418, Indiana 4921868, 46202
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Address
Ascension Saint Vincent Indianapolis Hospital
Indianapolis 4259418, Indiana 4921868, 46260
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Address
Blank Children's Hospital
Des Moines 4853828, Iowa 4862182, 50309
Status
Address
University of Iowa/Holden Comprehensive Cancer Center
Iowa City 4862034, Iowa 4862182, 52242
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Address
University of Kentucky/Markey Cancer Center
Lexington 4297983, Kentucky 6254925, 40536
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Address
Norton Children's Hospital
Louisville 4299276, Kentucky 6254925, 40202
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Address
Children's Hospital New Orleans
New Orleans 4335045, Louisiana 4331987, 70118
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Address
Ochsner Medical Center Jefferson
New Orleans 4335045, Louisiana 4331987, 70121
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Address
Eastern Maine Medical Center
Bangor 4957280, Maine 4971068, 04401
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Address
Maine Children's Cancer Program
Scarborough 4977882, Maine 4971068, 04074
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Address
University of Maryland/Greenebaum Cancer Center
Baltimore 4347778, Maryland 4361885, 21201
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Address
Sinai Hospital of Baltimore
Baltimore 4347778, Maryland 4361885, 21215
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Address
Johns Hopkins University/Sidney Kimmel Cancer Center
Baltimore 4347778, Maryland 4361885, 21287
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Address
Dana-Farber Cancer Institute
Boston 4930956, Massachusetts 6254926, 02215
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Address
C S Mott Children's Hospital
Ann Arbor 4984247, Michigan 5001836, 48109
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Address
Children's Hospital of Michigan
Detroit 4990729, Michigan 5001836, 48201
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Address
Wayne State University/Karmanos Cancer Institute
Detroit 4990729, Michigan 5001836, 48201
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Address
Michigan State University Clinical Center
East Lansing 4991640, Michigan 5001836, 48824
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Address
Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
Grand Rapids 4994358, Michigan 5001836, 49503
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Address
Bronson Methodist Hospital
Kalamazoo 4997787, Michigan 5001836, 49007
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Address
Children's Hospitals and Clinics of Minnesota - Minneapolis
Minneapolis 5037649, Minnesota 5037779, 55404
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Address
University of Minnesota/Masonic Cancer Center
Minneapolis 5037649, Minnesota 5037779, 55455
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Address
University of Mississippi Medical Center
Jackson 4431410, Mississippi 4436296, 39216
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Address
Children's Mercy Hospitals and Clinics
Kansas City 4393217, Missouri 4398678, 64108
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Address
Washington University School of Medicine
St Louis 4407066, Missouri 4398678, 63110
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Address
Mercy Hospital Saint Louis
St Louis 4407066, Missouri 4398678, 63141
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Address
Children's Hospital and Medical Center of Omaha
Omaha 5074472, Nebraska 5073708, 68114
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Address
University of Nebraska Medical Center
Omaha 5074472, Nebraska 5073708, 68198
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Address
University Medical Center of Southern Nevada
Las Vegas 5506956, Nevada 5509151, 89102
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Address
Sunrise Hospital and Medical Center
Las Vegas 5506956, Nevada 5509151, 89109
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Address
Alliance for Childhood Diseases/Cure 4 the Kids Foundation
Las Vegas 5506956, Nevada 5509151, 89135
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Address
Summerlin Hospital Medical Center
Las Vegas 5506956, Nevada 5509151, 89144
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Address
Renown Regional Medical Center
Reno 5511077, Nevada 5509151, 89502
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Address
Hackensack University Medical Center
Hackensack 5098706, New Jersey 5101760, 07601
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Address
Morristown Medical Center
Morristown 5101427, New Jersey 5101760, 07960
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Address
Albany Medical Center
Albany 5106834, New York 5128638, 12208
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Address
Roswell Park Cancer Institute
Buffalo 5110629, New York 5128638, 14263
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Address
NYU Langone Hospital - Long Island
Mineola 5127134, New York 5128638, 11501
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Address
The Steven and Alexandra Cohen Children's Medical Center of New York
New Hyde Park 5128514, New York 5128638, 11040
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Address
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
New York 5128581, New York 5128638, 10032
Status
Address
University of Rochester
Rochester 5134086, New York 5128638, 14642
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Address
State University of New York Upstate Medical University
Syracuse 5140405, New York 5128638, 13210
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Address
Montefiore Medical Center - Moses Campus
The Bronx 5110266, New York 5128638, 10467
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Address
Carolinas Medical Center/Levine Cancer Institute
Charlotte 4460243, North Carolina 4482348, 28203
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Address
Duke University Medical Center
Durham 4464368, North Carolina 4482348, 27710
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Address
Wake Forest University Health Sciences
Winston-Salem 4499612, North Carolina 4482348, 27157
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Address
Children's Hospital Medical Center of Akron
Akron 5145476, Ohio 5165418, 44308
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Address
Cincinnati Children's Hospital Medical Center
Cincinnati 4508722, Ohio 5165418, 45229
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Address
Rainbow Babies and Childrens Hospital
Cleveland 5150529, Ohio 5165418, 44106
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Address
Cleveland Clinic Foundation
Cleveland 5150529, Ohio 5165418, 44195
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Address
Nationwide Children's Hospital
Columbus 4509177, Ohio 5165418, 43205
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Address
Dayton Children's Hospital
Dayton 4509884, Ohio 5165418, 45404
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Address
ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital
Toledo 5174035, Ohio 5165418, 43606
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Address
University of Oklahoma Health Sciences Center
Oklahoma City 4544349, Oklahoma 4544379, 73104
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Address
Oregon Health and Science University
Portland 5746545, Oregon 5744337, 97239
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Address
Lehigh Valley Hospital-Cedar Crest
Allentown 5178127, Pennsylvania 6254927, 18103
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Address
Penn State Children's Hospital
Hershey 5193342, Pennsylvania 6254927, 17033
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Address
Children's Hospital of Philadelphia
Philadelphia 4560349, Pennsylvania 6254927, 19104
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Address
Children's Hospital of Pittsburgh of UPMC
Pittsburgh 5206379, Pennsylvania 6254927, 15224
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Address
Rhode Island Hospital
Providence 5224151, Rhode Island 5224323, 02903
Status
Address
Prisma Health Richland Hospital
Columbia 4575352, South Carolina 4597040, 29203
Status
Address
BI-LO Charities Children's Cancer Center
Greenville 4580543, South Carolina 4597040, 29605
Status
Address
Sanford USD Medical Center - Sioux Falls
Sioux Falls 5231851, South Dakota 5769223, 57117-5134
Status
Address
East Tennessee Childrens Hospital
Knoxville 4634946, Tennessee 4662168, 37916
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Address
Saint Jude Children's Research Hospital
Memphis 4641239, Tennessee 4662168, 38105
Status
Address
The Children's Hospital at TriStar Centennial
Nashville 4644585, Tennessee 4662168, 37203
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Address
Vanderbilt University/Ingram Cancer Center
Nashville 4644585, Tennessee 4662168, 37232
Status
Address
Dell Children's Medical Center of Central Texas
Austin 4671654, Texas 4736286, 78723
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Address
Driscoll Children's Hospital
Corpus Christi 4683416, Texas 4736286, 78411
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Address
Medical City Dallas Hospital
Dallas 4684888, Texas 4736286, 75230
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Address
UT Southwestern/Simmons Cancer Center-Dallas
Dallas 4684888, Texas 4736286, 75390
Status
Address
Cook Children's Medical Center
Fort Worth 4691930, Texas 4736286, 76104
Status
Address
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
Houston 4699066, Texas 4736286, 77030
Status
Address
Children's Hospital of San Antonio
San Antonio 4726206, Texas 4736286, 78207
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Address
University of Texas Health Science Center at San Antonio
San Antonio 4726206, Texas 4736286, 78229
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Address
Primary Children's Hospital
Salt Lake City 5780993, Utah 5549030, 84113
Status
Address
University of Vermont and State Agricultural College
Burlington 5234372, Vermont 5242283, 05405
Status
Address
University of Virginia Cancer Center
Charlottesville 4752031, Virginia 6254928, 22908
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Address
Children's Hospital of The King's Daughters
Norfolk 4776222, Virginia 6254928, 23507
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Address
Seattle Children's Hospital
Seattle 5809844, Washington 5815135, 98105
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Address
Providence Sacred Heart Medical Center and Children's Hospital
Spokane 5811696, Washington 5815135, 99204
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Address
Mary Bridge Children's Hospital and Health Center
Tacoma 5812944, Washington 5815135, 98405
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Address
Madigan Army Medical Center
Tacoma 5812944, Washington 5815135, 98431
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Address
West Virginia University Healthcare
Morgantown 4815352, West Virginia 4826850, 26506
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Address
University of Wisconsin Carbone Cancer Center - University Hospital
Madison 5261457, Wisconsin 5279468, 53792
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Address
Children's Hospital of Wisconsin
Milwaukee 5263045, Wisconsin 5279468, 53226
International Sites
Status
Address
John Hunter Children's Hospital
Hunter Regional Mail Centre, New South Wales 2155400, 2310
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Address
Sydney Children's Hospital
Randwick 2208285, New South Wales 2155400, 2031
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Address
The Children's Hospital at Westmead
Westmead 2143973, New South Wales 2155400, 2145
Status
Address
Queensland Children's Hospital
South Brisbane 2207259, Queensland 2152274, 4101
Status
Address
Women's and Children's Hospital-Adelaide
North Adelaide 8469169, South Australia 2061327, 5006
Status
Address
Royal Children's Hospital
Parkville 2153770, Victoria 2145234, 3052
Status
Address
Perth Children's Hospital
Perth 2063523, Western Australia 2058645, 6009
Status
Address
CancerCare Manitoba
Winnipeg 6183235, Manitoba 6065171, R3E 0V9
Status
Address
Janeway Child Health Centre
St. John's 6324733, Newfoundland and Labrador 6354959, A1B 3V6
Status
Address
IWK Health Centre
Halifax 6324729, Nova Scotia 6091530, B3K 6R8
Status
Address
McMaster Children's Hospital at Hamilton Health Sciences
Hamilton 5969782, Ontario 6093943, L8N 3Z5
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Address
Kingston Health Sciences Centre
Kingston 5992500, Ontario 6093943, K7L 2V7
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Address
Children's Hospital
London 6058560, Ontario 6093943, N6A 5W9
Status
Address
Hospital for Sick Children
Toronto 6167865, Ontario 6093943, M5G 1X8
Status
Address
The Montreal Children's Hospital of the MUHC
Montreal 6077243, Quebec 6115047, H3H 1P3
Status
Address
Centre Hospitalier Universitaire Sainte-Justine
Montreal 6077243, Quebec 6115047, H3T 1C5
Status
Address
Centre Hospitalier Universitaire de Sherbrooke-Fleurimont
Sherbrooke 6146143, Quebec 6115047, J1H 5N4
Status
Address
CHU de Quebec-Centre Hospitalier de l'Universite Laval (CHUL)
Québec 6325494, , G1V 4G2
Status
Address
Starship Children's Hospital
Grafton 6232401, Auckland 2193734, 1145
Status
Address
Christchurch Hospital
Christchurch 2192362, , 8011
Status
Address
HIMA San Pablo Oncologic Hospital
Caguas 4563008, , 00726
