S1803, Lenalidomide +/- Daratumumab/rHuPh20 as Post-ASCT Maintenance for MM w/MRD to Direct Therapy Duration (DRAMMATIC) DRAMMATIC

What's the purpose of this trial?

Patients are randomized between Lenalidomide for 2 years and Lenalidomide + Daratumumab/rHuPH20.

This trial has suspended patient recruitment.


What will happen during the trial?

Patients are randomized between Lenalidomide for 2 years and Lenalidomide + Daratumumab/rHuPH20. After 2 years of Maintenance, MRD is assessed to guide further therapy. MRD-positive patients will continue with the assigned treatment. MRD-negative patients will be further randomized (Reg Step 3) to either continue or discontinue the assigned treatment. 

You may be able to join this trial if you:

The following criteria is a partial list of reasons why patients may be eligible to participate in this clinical trial. Further evaluation with a medical professional is required.

Registration Step 1 Except where otherwise indicated below that test is required in a shorter timeframe, all tests for establishing baseline disease status must be completed within 60 days prior to registration. All test results must be documented on the Baseline Tumor Assessment Form for Multiple Myeloma and the Onstudy Form.

Inclusion Criteria

  • Patients must have had a confirmed diagnosis of symptomatic multiple myeloma (See Section 4.1) that required systemic induction therapy prior to autologous stem cell transplantation (ASCT).
  • Patients with disease measurable by serum light chain assay alone are eligible (defined as >/= 100 mg/L on involved light chain).
  • Patients must be registered to Step 1 prior to registration to Step 2. Registration to Step 1 may take place prior to or after autologous stem cell transplant (ASCT), but after completion of induction therapy.
  • Patients must have initiated induction therapy within 12 months prior to registration Step 1 and have received at least two cycles of induction therapy.
  • Patients must be willing and able to take DVT prophylaxis (aspirin, low molecular weight heparin, warfarin, or equivalent oral anticoagulation).
  • Patients must be >/= 18 and </= 75 years of age at time of registration to Step 1.
  • Patients must have history and physical exam within 28 days prior to registration.
  • Patients must have Zubrod Performance Status </= 2.
  • Patients must have evidence of adequate renal function, as defined by (1) creatinine clearance (CrCl) >/= 30 mL/min., as measured by a 24-hour urine collection, or estimated by the Cockcroft and Gault formula, or (2) serum creatinine < 2.5 mg/dL. Values must be obtained within 28 days prior to registration.
  • Patients must have adequate hepatic function defined by the following within 42 days prior to registration:
    • Total bilirubin </=1.5 x IULN (institutional upper limit of the norm) AND
    • AST and ALT </=3.0 x IULN
  • Patients must meet one of the following criteria:
    • Be acceptable for transplant per institutional guidelines and the criteria evidencing this must be documented on the S1803 Onstudy Form. (See Appendix 18.3 for standard transplant eligibility guidelines. Note that these are guidelines and not required criteria.) OR
    • Have completed autologous stem cell transplant within 180 days prior to registration (see also Section 5.2a).
  • Patient's with human immunodeficiency virus (HIV) are eligible providing they are on effective antiretroviral therapy and have undetectable viral load at their most previous viral load test and within 6 months prior to registration.
  • Patients must be able to take and swallow oral medication (capsules) whole. Patients may not have any known impairment of gastrointestinal function or gastrointestinal disease that may significantly alter the absorption of study drug (e.g. ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, or small bowel resection).
  • For patients who have not yet received transplant: Patients must be willing and able to return to the transplant center for their assigned treatment after randomization. Note that patients need not have a direct relationship with the transplant center in order to register.
  • Patients must submit specimens for MRD as outlined in Section 15.1. See Section 15.1 for further information, including specimen submission timepoints. Note that patients are not ineligible based solely on archival specimens being unavailable.
  • Patients must be offered participation in specimen banking for future research. With patient's consent, specimens must be submitted as outlined in Section 15.2.
  • Patients must be informed of the investigational nature of this study and must sign and give written informed consent in accordance with institutional and federal guidelines.
  • As a part of the OPEN registration process (see Section 13.3 for OPEN access instructions) the treating institution's identity is provided in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered in the system.

Exclusion Criteria

  • Patients with smoldering myeloma are not eligible. Patients with purely non-secretory MM as measured by electrophoresis and immunofixation and the absence of Bence Jones proteins in the urine are not eligible. Patients must have measurable M protein in the serum (defined as >/= 0.5g/dL) or urine (defined as >/= 200 mg/24h). Patients with plasma cell leukemia are not eligible.
  • Patients must not have any organ involvement by amyloidosis or evidence of amyloidosis related organ dysfunction.
  • Patients must not have progressive disease at any time prior to registration.
  • Patients must not be refractory to either lenalidomide or daratumumab/rHuPH20.
  • Patients must not be intolerant to either lenalidomide or daratumumab/rHuPH20.
  • Patients must not have received any investigational agents within 14 days prior to registration.
  • Patients must not have chronic obstructive pulmonary disease with a forced expiratory volume in 1 second (FEV1) < 50% of predicted normal. FEV1 is required for patients suspected of having chronic obstructive pulmonary disease and are not eligible if FEV1 is < 50% of predicted normal.
  • Patients must not have moderate or severe persistent asthma within the past 2 years and must not have currently uncontrolled asthma of any classification.
  • Patients must not have had prior autograft or allograft, or prior organ transplant requiring immunosuppressive therapy.
  • Patients must not have known allergy to any of the study drugs.
  • Patients with uncontrolled bacterial, viral or fungal infections (currently taking medication and with progression or no clinical improvement) at time of enrollment are not eligible.
  • Patients must not have known central nervous system (CNS) involvement with multiple myeloma, defined as CSF positivity for plasma cells at any time or a parenchymal CNS plasmacytoma at time of enrollment. Lumbar puncture is not required.
  • Patients must not be seropositive for hepatitis C (except in the setting of sustained virologic response, defined as undetectable viral load at least 12 weeks after completion of antiviral therapy). HCV testing is only required if clinically indicated or if the patient has a history of HCV.
  • No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated Stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease free for three years.
  • Patients must not have any uncontrolled intercurrent illness including (not limited to): Symptomatic CHF (NYHA III/IV), unstable angina pectoris or coronary angioplasty, or stenting within 6 months prior to registration, Unstable cardiac arrhythmia (ongoing cardiac dysrhythmias of NCI CTCAE v5.0 Grade >/= 2), intra-cardiac defibrillators, known cardiac metastases, or abnormal cardiac valve morphology (>/= Grade 3), or known psychiatric illness that would limit study compliance.

Registration Step 2 - First Randomization (Post-ASCT, Pre-Maintenance)

Inclusion Criteria:

  • Patients must have completed ASCT within 180 days prior to registering to Step 2.
  • Patients must have one of the following performed within 60 days prior to registration for disease assessment: diagnostic quality skeletal survey, whole body CT scan, MRI, or PET.
  • Patients must have Zubrod Performance Status </= 2
  • Patients must have adequate bone marrow function as evidenced by platelets >/= 75,000/mm3 and ANC >/= 1,000/mm3 within 28 days prior to first randomization:
  • Patients must have adequate hepatic function defined by the following within 28 days prior to first randomization:
  • Total bilirubin </=1.5 x IULN (institutional upper limit of the norm) AND AST and ALT </=3.0 x IULN
  • Patients must have evidence of adequate renal function, as defined by creatinine clearance (CrCl) >/= 30 mL/min., as measured by a 24-hour urine collection, or estimated by the Cockcroft and Gault formula, or have a serum creatinine < 2.5 mg/dL within 28 days prior to first randomization.
  • All ASCT-related toxicities must have recovered to </=Grade 1 (except for alopecia, fatigue and amenorrhea) prior to first randomization.
  • Mucositis and gastrointestinal symptoms must have resolved to </=Grade 1.
  • Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL within 10-14 days prior to registration.
  • FCBP must agree to have a second pregnancy test within 24 hours prior to starting Cycle 1. Further, FCBP must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control: one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before starting lenalidomide. FCBP must also agree to ongoing pregnancy testing and must agree to not become pregnant for at least 3 months after the last dose of study treatment.
  • Men must agree to use a latex condom during sexual contact with a FCBP, even if they have had a successful vasectomy, during the study treatment and for 3 months after the last dose of study treatment.
  • Patients must be informed of the investigational nature of this study and must sign and give written informed consent in accordance with institutional and federal guidelines.

Exclusion Criteria:

  • Patients must not have received any other maintenance therapy post-ASCT and prior to Step 2 registration.
  • Patients must not have had progressive disease between induction and registration to Registration Step 2. (See Section 10.1b).

Registration Step 3 - Second Randomization (Post 24 Months Maintenance)

Inclusion Criteria:

  • Patients must have completed 24 cycles of protocol maintenance with either lenalidomide or lenalidomide + daratumumab/rHuPH20.
  • Patients must have 24-month MRD by NGS test results available and must be MRD negative. Patients whose PCR results are indeterminable will be considered to have positive results.
  • Patients must be in very good partial remission (VGPR) or better by IMWG response criteria (see Section 10.1b).

Additional Trial Information

Phase 3

Enrollment: 1,100 patients (estimated)

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Trial Locations

All Trial Locations

View all clinical trial locations sorted by state.

Alaska

Alaska Women's Cancer Care

Anchorage, AK

Temporarily Suspended

Anchorage Oncology Centre

Anchorage, AK

Temporarily Suspended

Katmai Oncology Group

Anchorage, AK

Temporarily Suspended

Providence Alaska Medical Center

Anchorage, AK

Temporarily Suspended

Arizona

Mayo Clinic (Arizona)

Phoenix, AZ

Temporarily Suspended

University of Arizona Cancer Center

Tucson, AZ

Temporarily Suspended

Banner Health University Medical Center

Tucson, AZ

Temporarily Suspended

Arkansas

Mercy Hospital Fort Smith

Fort Smith, AR

Temporarily Suspended

California

Kaiser Permanente (Antioch Medical Center)

Antioch, CA

Temporarily Suspended

Alta Bates Summit Medical Center - Alta Bates Campus

Berkeley, CA

Temporarily Suspended

City of Hope Comprehensive Cancer Center Beckman Research Institute

Duarte, CA

Temporarily Suspended

Kaiser Permanente (Dublin)

Dublin, CA

Temporarily Suspended

Kaiser Permanente (Fremont Medical Center)

Fremont, CA

Temporarily Suspended

Kaiser Permanente (Fresno Medical Center)

Fresno, CA

Temporarily Suspended

Rideout Cancer Center (Fremont)

Linda, CA

Temporarily Suspended

Kaiser Permanente (Modesto Medical Center)

Modesto, CA

Temporarily Suspended

Kaiser Permanente - Oakland Medical Center

Oakland, CA

Temporarily Suspended

Chao Family Comprehensive Cancer Center University of California, Irvine

Orange, CA

Temporarily Suspended

Kaiser Permanente (Redwood City Medical Center)

Redwood City, CA

Temporarily Suspended

Kaiser Permanente (Richmond Medical Center)

Richmond, CA

Temporarily Suspended

Kaiser Permanente - Roseville Medical Center

Roseville, CA

Temporarily Suspended

Kaiser Permanente - Sacramento Medical Center

Sacramento, CA

Temporarily Suspended

University of California Davis Comprehensive Cancer Center

Sacramento, CA

Temporarily Suspended

Kaiser Permanente (South Sacramento Medical Center)

Sacramento, CA

Temporarily Suspended

Kaiser Permanente - San Francisco Medical Center

San Francisco, CA

Temporarily Suspended

Kaiser Permanente - San Jose Medical Center

San Jose, CA

Temporarily Suspended

Kaiser Permanente - San Leandro Medical Center

San Leandro, CA

Temporarily Suspended

Kaiser Permanente (San Rafael Medical Center)

San Rafael, CA

Temporarily Suspended

Kaiser Permanente - Santa Clara Medical Center

Santa Clara, CA

Temporarily Suspended

Mission Hope Cancer Center (Santa Maria) Central Coast Medical Oncology

Santa Maria, CA

Temporarily Suspended

Kaiser Permanente (Santa Rosa Medical Center)

Santa Rosa, CA

Temporarily Suspended

Kaiser Permanente (South San Francisco Medical Center)

South San Francisco, CA

Temporarily Suspended

Kaiser Permanente (Stockton Medical Center)

Stockton, CA

Temporarily Suspended

Tahoe Forest Cancer Center

Truckee, CA

Temporarily Suspended

Kaiser Permanente (Vacaville Medical Center)

Vacaville, CA

Temporarily Suspended

Kaiser Permanente - Vallejo Medical Center

Vallejo, CA

Temporarily Suspended

Kaiser Permanente (Walnut Creek Medical Center)

Walnut Creek, CA

Temporarily Suspended

Colorado

Littleton Adventist Hospital

Centennial, CO

Temporarily Suspended

Centura Penrose Hospital

Colorado Springs, CO

Temporarily Suspended

Rocky Mountain Cancer Center - Penrose Hospital Colorado Springs

Colorado Springs, CO

Temporarily Suspended

St. Francis Medical Center Catholic Health Initiatives

Colorado Springs, CO

Temporarily Suspended

Kaiser Permanente (Franklin)

Denver, CO

Temporarily Suspended

Porter Adventist Hospital

Denver, CO

Temporarily Suspended

Centura Mercy Hospital

Durango, CO

Temporarily Suspended

Centura Southwest Oncology

Durango, CO

Temporarily Suspended

Kaiser Permanente - Rock Creek

Lafayette, CO

Temporarily Suspended

Centura St. Anthony Hospital

Lakewood, CO

Temporarily Suspended

Kaiser Permanente (Lone Tree) Lone Tree Medical Offices

Lone Tree, CO

Temporarily Suspended

Centura Longmont United Hospital

Longmont, CO

Temporarily Suspended

Rocky Mountain Cancer Centers (Longmont) Longmont

Longmont, CO

Temporarily Suspended

Centura Parker Adventist Hospital

Parker, CO

Temporarily Suspended

Saint Mary Corwin Medical Center

Pueblo, CO

Temporarily Suspended

Delaware

Beebe Medical Center

Lewes, DE

Temporarily Suspended

ChristianaCare Hematology

Newark, DE

Temporarily Suspended

ChristianaCare Helen F. Graham Cancer Center Christiana Hospital

Newark, DE

Temporarily Suspended

Christiana Care Health System (Christiana Hospital)

Newark, DE

Temporarily Suspended

Beebe Health Campus

Rehoboth Beach, DE

Temporarily Suspended

Nanticoke Memorial Hospital

Seaford, DE

Temporarily Suspended

Christiana Care Health System (Wilmington Hospital)

Wilmington, DE

Temporarily Suspended

Florida

Shands Hospital University of Florida Health

Gainesville, FL

Temporarily Suspended

Advent Health Cancer Institute (Orlando)

Orlando, FL

Temporarily Suspended

Moffitt Cancer Center Magnolia Campus

Tampa, FL

Temporarily Suspended

Georgia

Northside Hospital (Atlanta)

Atlanta, GA

Temporarily Suspended

Grady Memorial Hospital

Atlanta, GA

Temporarily Suspended

Hawaii

Pali Momi Medical Center

Aiea, HI

Temporarily Suspended

Kaiser Permanente (Moanalua Medical Center)

Honolulu, HI

Temporarily Suspended

Kapiolani Medical Center for Women and Children

Honolulu, HI

Temporarily Suspended

Idaho

St. Luke's Cancer Institute - Boise

Boise, ID

Temporarily Suspended

Saint Alphonsus Cancer Care Center (Boise)

Boise City, ID

Temporarily Suspended

Kootenai Clinic Cancer Services - Coeur d'Alene

Coeur d'Alene, ID

Temporarily Suspended

Saint Luke's Mountain States Tumor Institute (Fruitland)

Fruitland, ID

Temporarily Suspended

St. Luke's Cancer Institute (Meridian)

Meridian, ID

Temporarily Suspended

Saint Luke's Mountain States Tumor Institute (Nampa)

Nampa, ID

Temporarily Suspended

Kootenai Cancer Center

Post Falls, ID

Temporarily Suspended

Kootenai Clinic

Sandpoint, ID

Temporarily Suspended

Saint Luke's Mountain States Tumor Institute (Twin Falls)

Twin Falls, ID

Temporarily Suspended

Illinois

Illinois CancerCare (Bloomington)

Bloomington, IL

Temporarily Suspended

Loyola Center for Health at Burr Ridge

Burr Ridge, IL

Temporarily Suspended

Illinois CancerCare (Canton)

Canton, IL

Temporarily Suspended

Memorial Hospital of Carbondale

Carbondale, IL

Temporarily Suspended

SIH Cancer Institute

Carterville, IL

Temporarily Suspended

Illinois CancerCare (Carthage)

Carthage, IL

Temporarily Suspended

Centralia Oncology Clinic

Centralia, IL

Temporarily Suspended

Advocate Illinois Masonic Medical Center

Chicago, IL

Temporarily Suspended

Cancer Care Specialists of IL - Cancer Care Center of Decatur

Decatur, IL

Temporarily Suspended

Memorial Health - Decatur Memorial Hospital Memorial Health

Decatur, IL

Temporarily Suspended

Illinois CancerCare-Dixon

Dixon, IL

Temporarily Suspended

Cancer Care Specialists (Crossroads Cancer Center)

Effingham, IL

Temporarily Suspended

Illinois CancerCare (Eureka)

Eureka, IL

Temporarily Suspended

Illinois CancerCare (Galesburg)

Galesburg, IL

Temporarily Suspended

Western Illinois Cancer Treatment Center

Galesburg, IL

Temporarily Suspended

Illinois CancerCare (Kewanee)

Kewanee, IL

Temporarily Suspended

Illinois CancerCare (Macomb)

Macomb, IL

Temporarily Suspended

Loyola University Medical Center Cardinal Bernardin Cancer Center

Maywood, IL

Temporarily Suspended

Marjorie Weinberg Cancer Center at Loyola-Gottlieb

Melrose Park, IL

Temporarily Suspended

Good Samaritan Regional Health Center

Mount Vernon, IL

Temporarily Suspended

Illinois CancerCare - Fox River Cancer Center

Ottawa, IL

Temporarily Suspended

Advocate Lutheran General Hospital

Park Ridge, IL

Temporarily Suspended

Illinois CancerCare - Pekin

Pekin, IL

Temporarily Suspended

Illinois CancerCare - Peoria

Peoria, IL

Temporarily Suspended

Methodist Medical Center of Illinois

Peoria, IL

Temporarily Suspended

Illinois CancerCare - Peru In Valley Regional Cancer Center

Peru, IL

Temporarily Suspended

US Oncology - Valley Regional Cancer Center

Peru, IL

Temporarily Suspended

Illinois CancerCare - Princeton

Princeton, IL

Temporarily Suspended

Southern Illinois University School of Medicine - Simmons Cancer Institute

Springfield, IL

Temporarily Suspended

Springfield Clinic

Springfield, IL

Temporarily Suspended

Memorial Medical Center

Springfield, IL

Temporarily Suspended

Cancer Care Specialists of Illinois (Swansea)

Swansea, IL

Temporarily Suspended

Indiana

Simon Cancer Center Indiana University

Indianapolis, IN

Temporarily Suspended

Springmill Medical Center

Indianapolis, IN

Temporarily Suspended

Iowa

Mary Greeley Medical Center

Ames, IA

Temporarily Suspended

McFarland Clinic PC

Ames, IA

Temporarily Suspended

McFarland Clinic PC (Boone)

Boone, IA

Temporarily Suspended

Broadlawns Medical Center

Des Moines, IA

Temporarily Suspended

Mission Cancer MercyOne Cancer Center (Laurel)

Des Moines, IA

Temporarily Suspended

MercyOne Des Moines Medical Center

Des Moines, IA

Temporarily Suspended

Iowa Lutheran Hospital

Des Moines, IA

Temporarily Suspended

McFarland Clinic Trinity Cancer Center

Fort Dodge, IA

Temporarily Suspended

UnityPoint Health - Trinity Regional Medical Center

Fort Dodge, IA

Temporarily Suspended

McFarland Clinic PC (Jefferson)

Jefferson, IA

Temporarily Suspended

McFarland Clinic PC (Marshalltown)

Marshalltown, IA

Temporarily Suspended

MercyOne West Des Moines Medical Center

West Des Moines, IA

Temporarily Suspended

UnityPoint Health - Methodist West Hospital

West Des Moines, IA

Temporarily Suspended

Kansas

Central Care Cancer Center (Heartland)

Garden City, KS

Temporarily Suspended

Central Care Cancer Center - Great Bend

Great Bend, KS

Temporarily Suspended

University of Kansas Cancer Center

Kansas City, KS

Temporarily Suspended

Kentucky

Flaget Memorial Hospital

Bardstown, KY

Temporarily Suspended

Commonwealth Cancer Center (Corbin)

Corbin, KY

Temporarily Suspended

Saint Joseph Hospital

Lexington, KY

Temporarily Suspended

Saint Joseph Hospital East

Lexington, KY

Temporarily Suspended

UK Markey Cancer Center University of Kentucky

Lexington, KY

Temporarily Suspended

U of L - Brown Cancer Center University of Louisville Jewish Hospital

Louisville, KY

Temporarily Suspended

Saints Mary and Elizabeth Hospital

Louisville, KY

Temporarily Suspended

Jewish Hospital Medical Center Northeast

Louisville, KY

Temporarily Suspended

Jewish Hospital Medical Center South

Shepherdsville, KY

Temporarily Suspended

Louisiana

Hematology Oncology Clinic

Baton Rouge, LA

Temporarily Suspended

Tulane Cancer Center Tulane University School of Medicine

New Orleans, LA

Temporarily Suspended

Ochsner LSU Health Shreveport Ochsner Louisiana State University

Shreveport, LA

Temporarily Suspended

Maine

Eastern Maine Medical Center

Bangor, ME

Temporarily Suspended

Lafayette Family Cancer Institute Northern Light Health

Brewer, ME

Temporarily Suspended

Maryland

Walter Reed National Military Medical Center

Bethesda, MD

Temporarily Suspended

Massachusetts

Boston Medical Center

Boston, MA

Temporarily Suspended

Beth Israel Lahey Hospital and Medical Center

Burlington, MA

Temporarily Suspended

University of Massachusetts Medical School

Worcester, MA

Temporarily Suspended

Michigan

University of Michigan Comprehensive Cancer Center Rogel Cancer Center

Ann Arbor, MI

Temporarily Suspended

Bronson Battle Creek Cancer Care Center

Battle Creek, MI

Temporarily Suspended

St. Joseph Mercy Brighton Health Center

Brighton, MI

Temporarily Suspended

IHA Hematology Oncology at St. Joe's Brighton

Brighton, MI

Temporarily Suspended

St. Joseph Mercy Canton Health Center

Canton, MI

Temporarily Suspended

IHA Hematology Oncology at St. Joe's Canton

Canton, MI

Temporarily Suspended

Caro Cancer Center

Caro, MI

Temporarily Suspended

Chelsea Hospital Michigan Cancer Research Consortium

Chelsea, MI

Temporarily Suspended

IHA Hematology Oncology at St. Joe's Chelsea

Chelsea, MI

Temporarily Suspended

Hematology Oncology Consultants (Clarkston)

Clarkston, MI

Temporarily Suspended

Karmanos Cancer Institute at McLaren Clarkston

Clarkston, MI

Temporarily Suspended

Newland Medical Associates of Clarkston

Clarkston, MI

Temporarily Suspended

Barbara Ann Karmanos Cancer Institute Wayne State University

Detroit, MI

Temporarily Suspended

Great Lakes Cancer Management Specialists (Doctors Park)

East China, MI

Temporarily Suspended

Karmanos-Weisberg Cancer Treatment Center

Farmington Hills, MI

Temporarily Suspended

Beaumont Hospital

Farmington Hills, MI

Temporarily Suspended

McLaren Regional Medical Center (Flint)

Flint, MI

Temporarily Suspended

The Cancer & Hematology Centers

Flint, MI

Temporarily Suspended

Genesys Hurley Cancer Institute

Flint, MI

Temporarily Suspended

Hurley Medical Center

Flint, MI

Temporarily Suspended

Karmanos Cancer Institute at McLaren Flint

Flint, MI

Temporarily Suspended

Mercy Health Saint Mary's

Grand Rapids, MI

Temporarily Suspended

Spectrum Health

Grand Rapids, MI

Temporarily Suspended

Academic Hematology Oncology Specialists Ascension St. John Hospital

Grosse Pointe Woods, MI

Temporarily Suspended

Bronson Methodist Hospital

Kalamazoo, MI

Temporarily Suspended

West Michigan Cancer Center

Kalamazoo, MI

Temporarily Suspended

Sparrow Hospital

Lansing, MI

Temporarily Suspended

St. Mary Mercy Hospital St. Joe's Health

Livonia, MI

Temporarily Suspended

Great Lakes Cancer Management Specialists (Macomb Medical Campus)

Macomb, MI

Temporarily Suspended

Trinity Health Muskegon Hospital

Muskegon, MI

Temporarily Suspended

Lakeland Community Hospital

Niles, MI

Temporarily Suspended

Newland Medical Associates (Pontiac) The Alice Gustafson Center

Pontiac, MI

Temporarily Suspended

St. Joseph Mercy (Oakland)

Pontiac, MI

Temporarily Suspended

Spectrum Health Reed City Hospital

Reed City, MI

Temporarily Suspended

Spectrum Health Lakeland Medical Center

St. Joseph, MI

Temporarily Suspended

Spectrum Health Marie Yeager Cancer Center

St. Joseph, MI

Temporarily Suspended

Munson Medical Center

Traverse City, MI

Temporarily Suspended

Minnesota

Essentia Health Saint Joseph's Medical Center

Brainerd, MN

Temporarily Suspended

M Health Fairview Ridges Hospital

Burnsville, MN

Temporarily Suspended

Cambridge Medical Center

Cambridge, MN

Temporarily Suspended

Mercy Hospital

Coon Rapids, MN

Temporarily Suspended

Essentia Health

Deer River, MN

Temporarily Suspended

Essentia Health (Duluth Clinic)

Duluth, MN

Temporarily Suspended

Essentia Health Saint Mary's Medical Center

Duluth, MN

Temporarily Suspended

Essentia Health (Miller-Dwan Building)

Duluth, MN

Temporarily Suspended

Fairview Southdale Hospital

Edina, MN

Temporarily Suspended

Lake Region Healthcare Corporation-Cancer Care

Fergus Falls, MN

Temporarily Suspended

Unity Hospital

Fridley, MN

Temporarily Suspended

Essentia Health Hibbing Clinic

Hibbing, MN

Temporarily Suspended

Fairview Maple Grove Medical Center

Maple Grove, MN

Temporarily Suspended

Minnesota Oncology Maplewood Cancer Center

Maplewood, MN

Temporarily Suspended

M Health Fairview St. John's Hospital

Maplewood, MN

Temporarily Suspended

Abbott-Northwestern Hospital Allina Health Cancer Institute

Minneapolis, MN

Temporarily Suspended

Hennepin County Medical Center

Minneapolis, MN

Temporarily Suspended

Health Partners Inc.

Minneapolis, MN

Temporarily Suspended

University of Minnesota - Masonic Cancer Center

Minneapolis, MN

Temporarily Suspended

Monticello Cancer Center

Monticello, MN

Temporarily Suspended

New Ulm Medical Center

New Ulm, MN

Temporarily Suspended

Fairview Northland Medical Center

Princeton, MN

Temporarily Suspended

North Memorial Medical Health Center

Robbinsdale, MN

Temporarily Suspended

Mayo Clinic (Rochester)

Rochester, MN

Temporarily Suspended

Saint Francis Regional Medical Center

Shakopee, MN

Temporarily Suspended

Coborn Cancer Center at Saint Cloud Hospital

St. Cloud, MN

Temporarily Suspended

Park Nicollet Specialty Center at Methodist Hospital

St. Louis Park, MN

Temporarily Suspended

Regions Hospital

St. Paul, MN

Temporarily Suspended

United Hospital

St. Paul, MN

Temporarily Suspended

Lakeview Hospital

Stillwater, MN

Temporarily Suspended

Essentia Health Virginia Clinic

Virginia, MN

Temporarily Suspended

Ridgeview Medical Center

Waconia, MN

Temporarily Suspended

Rice Memorial Hospital

Willmar, MN

Temporarily Suspended

Minnesota Oncology and Hematology PA (Woodbury)

Woodbury, MN

Temporarily Suspended

Fairview Lakes Medical Center

Wyoming, MN

Temporarily Suspended

Missouri

Alvin J. Siteman Cancer Center Washington University Medical Campus

St. Louis, MO

Temporarily Suspended

Saint Louis Cancer and Breast Institute

Ballwin, MO

Temporarily Suspended

Central Care Cancer Center

Bolivar, MO

Temporarily Suspended

Parkland Health Center (Bonne Terre)

Bonne Terre, MO

Temporarily Suspended

CoxHealth Cancer Center

Branson, MO

Temporarily Suspended

Saint Francis Medical Center (Cape Girardeau)

Cape Girardeau, MO

Temporarily Suspended

Southeast Cancer Center Southeast Health

Cape Girardeau, MO

Temporarily Suspended

Siteman Cancer Center at Barnes-Jewish West County Hospital

Creve Coeur, MO

Temporarily Suspended

Capital Region Medical Center (Goldschmidt Cancer Center)

Jefferson City, MO

Temporarily Suspended

Freeman Cornell-Beshore Cancer Institute

Joplin, MO

Temporarily Suspended

Phelps Health Hospital Delbert Day Cancer Institute

Rolla, MO

Temporarily Suspended

Mercy Clinic Cancer and Hematology (Rolla)

Rolla, MO

Temporarily Suspended

Siteman Cancer Center at Saint Peters Hospital

Saint Peters, MO

Temporarily Suspended

Sainte Genevieve County Memorial Hospital

Sainte Genevieve, MO

Temporarily Suspended

Mercy Hospital Springfield

Springfield, MO

Temporarily Suspended

CoxHealth South Hospital Cox Medical Center South

Springfield, MO

Temporarily Suspended

St. Joseph Oncology

St. Joseph, MO

Temporarily Suspended

Heartland Regional Medical Center

St. Joseph, MO

Temporarily Suspended

Saint Louis Cancer and Breast Institute (South City)

St. Louis, MO

Temporarily Suspended

Mercy Hospital South

St. Louis, MO

Temporarily Suspended

Siteman Cancer Center (South St. Louis County)

St. Louis, MO

Temporarily Suspended

Missouri Baptist Medical Cancer Center

St. Louis, MO

Temporarily Suspended