Hybrid Immunotherapy for Hemophagocytic LymphoHistiocytosis
Study Details
Study Description
Brief Summary
Despite good progress during the last decade, hemophagocytic lymphohistiocytosis (HLH) remains difficult to treat. Two different treatment regimens have been used successfully. The first one, a treatment regimen based on two drugs called etoposide and dexamethasone, has been used worldwide. The second regimen, based on two drugs called Anti-thymocyte globulin (ATG) and prednisone, has been used mostly at one hospital in Paris, for over 15 years. With either regimen, about three quarters of treated children survive the most difficult time, the first two months after diagnosis. These two different regimens appear to work somewhat differently, and we suspect that combining them may give better results than either regimen alone. We are conducting this clinical trial to test the combination of ATG, dexamethasone, and etoposide for the treatment of HLH.
The purpose of this research study is to find out what effects (good and bad) this drug combination has on you and your HLH.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 2 |
Detailed Description
Hemophagocytic lymphohistiocytosis (HLH) is a rare immunological disorder first recognized almost 70 years ago.(1) Genetic and animal studies have indicated that the familial form of HLH is clearly due to a deficiency of cytotoxic killing. Patients with HLH present with a potentially fatal syndrome of 'hyperimmunity.' These patients have severe inflammation, associated with cytopenias and variably severe bone marrow, liver, or CNS damage. Tissue damage and mortality appear to be due to hypercytokinemia related to persistent immune hyperactivation. An animal model of HLH and correlative human studies all suggest that excessive and abnormal activation of T cells drives the pathophysiology of this disorder, and that suppressing this excessive activation is critical for successful therapy of HLH. It is believed a combination of the two proven induction regimens for hemophagocytic lymphohistiocytosis (HLH) (anti-thymocyte globulin (ATG)- and etoposide-based) will result in response rates and overall survival rates at eight weeks which are comparable or better than the current standard of care (induction therapy per the HLH-94 protocol).
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Induction Therapy ATG, rabbit: intravenous, 5 mg/kg/dose, 5 consecutive days Dexamethasone: intravenous, 20mg/m2/day x7days, 10mg/m2/day x7days, 5mg/m2/day x14days, 2.5mg/m2/day x14days, 1.25mg/m2/day x14days Etoposide: intravenous, 150 mg/m2 weekly, starting 7 days after first dose of Thymoglobulin Methotrexate and hydrocortisone: intrathecal to patients with central nervous system involvement, age< 1 yr: 6/8mg (MTX/HC), 1-2 yrs: 8/10mg, 2-3 yrs: 10/12mg, >3 yrs: 12/15 mg, on day 7, 14, 21 and 42 |
Drug: ATG, rabbit
ATG, rabbit (Thymoglobulin, Genzyme) will be dosed at 5 mg/kg/dose, given IV on 5 consecutive days (titrated over 4 to 8 hours).
Other Names:
Drug: Etoposide
Etoposide will be dosed at 150mg/m2, given IV. The first dose will be given 7 days (+/- 2 days) after the first dose of ATG, and be given weekly for a total of 7 doses.
Other Names:
Drug: Methotrexate
Intrathecal Methotrexate and hydrocortisone will be administered to CNS+ patients (CNS+ patients are those patients which have any of the following: elevated CSF (cerebral spinal fluid) protein or white count, seizures, focal or global neurologic deficit, MRI abnormalities consistent with CNS involvement by HLH.) in the following doses: age< 1 yr: 6/8mg (MTX/HC), 1-2 yrs: 8/10mg, 2-3 yrs: 10/12mg, >3 yrs: 12/15 mg. It will be administered (+/- 3 days) on day 7, 14, 21 and 42.
Drug: hydrocortisone
Intrathecal Methotrexate and hydrocortisone will be administered to CNS+ patients (CNS+ patients are those patients which have any of the following: elevated CSF (cerebral spinal fluid) protein or white count, seizures, focal or global neurologic deficit, MRI abnormalities consistent with CNS involvement by HLH.) in the following doses: age< 1 yr: 6/8mg (MTX/HC), 1-2 yrs: 8/10mg, 2-3 yrs: 10/12mg, >3 yrs: 12/15 mg. It will be administered (+/- 3 days) on day 7, 14, 21 and 42.
Drug: Dexamethasone
will be started with the ATG. It will be divided BID, given IV for at least 1 week before switching to PO. Dosing: 20mg/m2/day x7days, 10mg/m2/day x7days, 5mg/m2/day x14days, 2.5mg/m2/day x14days, 1.25mg/m2/day x14days.
|
Outcome Measures
Primary Outcome Measures
- Overall Survival [8 Weeks]
To determine the overall survival of patients with hemophagocytic lymphohistiocytosis at 8 weeks after an ATG/etoposide-based induction regimen and to determine the feasibility of this approach in the context of a multicenter clinical trial.
Secondary Outcome Measures
- Time to Response [8 Weeks]
To determine the median time to complete response during 8 weeks of therapy
- Overall Survival [up to day 180]
To determine overall survival prior to the initiation of BMT (bone marrow transplant) preparative regimen (or day 180, if BMT preparative regimen not yet begun)
- Number of Participants Who Experienced Reactivation [up to 180 days]
To determine the frequency of disease reactivation prior to initiation of BMT preparative regimen (or day 180, if BMT preparative regimen not yet begun)
- Overall Survival to Day +100 [up to day 280]
To determine overall survival to day +100 after BMT, for patients who have undergone BMT within 6 months of study entry
- Disease Status at BMT [up to day 180]
To determine the rate of complete response at the time of BMT preparative regimen initiation
Eligibility Criteria
Criteria
Inclusion Criteria:
-
diagnosis of hemophagocytic lymphohistiocytosis
-
Patients <18 years of age
-
The patient must have active disease at the time of enrollment
-
Patient's legal guardians must sign an Institutional Review Board approved consent form indicating their awareness of the investigational nature and the risks of this study.
-
Eligible subjects must be enrolled with the protocol coordinating center
Exclusion Criteria:
-
Recent treatment, within 3 months, with another therapeutic regimen for HLH
-
Known active malignancy
-
Known rheumatologic diagnosis which may be the underlying cause of HLH
-
Pregnancy (as determined by serum or urine test) or active breast feeding
-
Failure to provide signed informed consent
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Phoenix Children's Hospital | Phoenix | Arizona | United States | 85254 |
| 2 | University of California, San Francisco Department of Pediatrics | San Francisco | California | United States | 94143 |
| 3 | Stanford University | Stanford | California | United States | 94305 |
| 4 | University of Colorado | Aurora | Colorado | United States | 80045 |
| 5 | Nemours | Wilmington | Delaware | United States | 19803 |
| 6 | Children's National Medical Center | Washington | District of Columbia | United States | 20010 |
| 7 | Nemours | Jacksonville | Florida | United States | 32827 |
| 8 | Florida All Children's Hospital | Saint Petersburg | Florida | United States | 33701 |
| 9 | Tulane University Medical Center | New Orleans | Louisiana | United States | 70118 |
| 10 | Children's Hospital Boston | Boston | Massachusetts | United States | 02115 |
| 11 | Cincinnati Children's Hospital Medical Center | Cincinnati | Ohio | United States | 45229 |
| 12 | Oregon Health and Science University | Portland | Oregon | United States | 21703 |
| 13 | Children's Hospital of Philadelphia | Philadelphia | Pennsylvania | United States | 19145 |
| 14 | Texas Children's Cancer Center/Baylor College of Medicine | Houston | Texas | United States | 77030 |
| 15 | The Hospital for Sick Children | Toronto | Ontario | Canada |
Sponsors and Collaborators
- Children's Hospital Medical Center, Cincinnati
Investigators
- Principal Investigator: Michael Jordan, MD, Children's Hospital Medical Center, Cincinnati
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- HIT-HLH
Study Results
Participant Flow
| Recruitment Details | |
|---|---|
| Pre-assignment Detail |
| Arm/Group Title | Induction Therapy |
|---|---|
| Arm/Group Description | ATG, rabbit: intravenous, 5 mg/kg/dose, 5 consecutive days Dexamethasone: intravenous, 20mg/m2/day x7days, 10mg/m2/day x7days, 5mg/m2/day x14days, 2.5mg/m2/day x14days, 1.25mg/m2/day x14days Etoposide: intravenous, 150 mg/m2 weekly, starting 7 days after first dose of Thymoglobulin Methotrexate and hydrocortisone: intrathecal to patients with central nervous system involvement, age< 1 yr: 6/8mg (MTX/HC), 1-2 yrs: 8/10mg, 2-3 yrs: 10/12mg, >3 yrs: 12/15 mg, on day 7, 14, 21 and 42 ATG, rabbit: ATG, rabbit (Thymoglobulin, Genzyme) will be dosed at 5 mg/kg/dose, given IV on 5 consecutive days (titrated over 4 to 8 hours). Etoposide: Etoposide will be dosed at 150mg/m2, given IV. The first dose will be given 7 days (+/- 2 days) after the first dose of ATG, and be given weekly for a total of 7 doses. Methotrexate: Intrathecal Methotrexate and hydrocortisone will be administered to CNS+ patients. |
| Period Title: Treatment Period | |
| STARTED | 31 |
| COMPLETED | 25 |
| NOT COMPLETED | 6 |
| Period Title: Treatment Period | |
| STARTED | 25 |
| COMPLETED | 22 |
| NOT COMPLETED | 3 |
| Period Title: Treatment Period | |
| STARTED | 11 |
| COMPLETED | 9 |
| NOT COMPLETED | 2 |
Baseline Characteristics
| Arm/Group Title | Induction Therapy |
|---|---|
| Arm/Group Description | ATG, rabbit: intravenous, 5 mg/kg/dose, 5 consecutive days Dexamethasone: intravenous, 20mg/m2/day x7days, 10mg/m2/day x7days, 5mg/m2/day x14days, 2.5mg/m2/day x14days, 1.25mg/m2/day x14days Etoposide: intravenous, 150 mg/m2 weekly, starting 7 days after first dose of Thymoglobulin Methotrexate and hydrocortisone: intrathecal to patients with central nervous system involvement, age< 1 yr: 6/8mg (MTX/HC), 1-2 yrs: 8/10mg, 2-3 yrs: 10/12mg, >3 yrs: 12/15 mg, on day 7, 14, 21 and 42 ATG, rabbit: ATG, rabbit (Thymoglobulin, Genzyme) will be dosed at 5 mg/kg/dose, given IV on 5 consecutive days (titrated over 4 to 8 hours). Etoposide: Etoposide will be dosed at 150mg/m2, given IV. The first dose will be given 7 days (+/- 2 days) after the first dose of ATG, and be given weekly for a total of 7 doses. Methotrexate: Intrathecal Methotrexate and hydrocortisone will be administered to CNS+ patients |
| Overall Participants | 31 |
| Age (Count of Participants) | |
| <=18 years |
31
100%
|
| Between 18 and 65 years |
0
0%
|
| >=65 years |
0
0%
|
| Sex: Female, Male (Count of Participants) | |
| Female |
13
41.9%
|
| Male |
18
58.1%
|
| Race (NIH/OMB) (Count of Participants) | |
| American Indian or Alaska Native |
2
6.5%
|
| Asian |
3
9.7%
|
| Native Hawaiian or Other Pacific Islander |
0
0%
|
| Black or African American |
1
3.2%
|
| White |
25
80.6%
|
| More than one race |
0
0%
|
| Unknown or Not Reported |
0
0%
|
| Region of Enrollment (participants) [Number] | |
| Canada |
1
3.2%
|
| United States |
30
96.8%
|
Outcome Measures
| Title | Overall Survival |
|---|---|
| Description | To determine the overall survival of patients with hemophagocytic lymphohistiocytosis at 8 weeks after an ATG/etoposide-based induction regimen and to determine the feasibility of this approach in the context of a multicenter clinical trial. |
| Time Frame | 8 Weeks |
Outcome Measure Data
| Analysis Population Description |
|---|
| [Not Specified] |
| Arm/Group Title | Induction Therapy |
|---|---|
| Arm/Group Description | ATG, rabbit: intravenous, 5 mg/kg/dose, 5 consecutive days Dexamethasone: intravenous, 20mg/m2/day x7days, 10mg/m2/day x7days, 5mg/m2/day x14days, 2.5mg/m2/day x14days, 1.25mg/m2/day x14days Etoposide: intravenous, 150 mg/m2 weekly, starting 7 days after first dose of Thymoglobulin Methotrexate and hydrocortisone: intrathecal to patients with central nervous system involvement, age< 1 yr: 6/8mg (MTX/HC), 1-2 yrs: 8/10mg, 2-3 yrs: 10/12mg, >3 yrs: 12/15 mg, on day 7, 14, 21 and 42 ATG, rabbit: ATG, rabbit (Thymoglobulin, Genzyme) will be dosed at 5 mg/kg/dose, given IV on 5 consecutive days (titrated over 4 to 8 hours). Etoposide: Etoposide will be dosed at 150mg/m2, given IV. The first dose will be given 7 days (+/- 2 days) after the first dose of ATG, and be given weekly for a total of 7 doses. Methotrexate: Intrathecal Methotrexate and hydrocortisone will be administered to CNS+ patients |
| Measure Participants | 31 |
| Count of Participants [Participants] |
25
80.6%
|
| Title | Time to Response |
|---|---|
| Description | To determine the median time to complete response during 8 weeks of therapy |
| Time Frame | 8 Weeks |
Outcome Measure Data
| Analysis Population Description |
|---|
| Patients assessed for disease features and classified each week per definition of complete response in order to determine the time at which they achieved complete response. |
| Arm/Group Title | Induction Therapy |
|---|---|
| Arm/Group Description | ATG, rabbit: intravenous, 5 mg/kg/dose, 5 consecutive days Dexamethasone: intravenous, 20mg/m2/day x7days, 10mg/m2/day x7days, 5mg/m2/day x14days, 2.5mg/m2/day x14days, 1.25mg/m2/day x14days Etoposide: intravenous, 150 mg/m2 weekly, starting 7 days after first dose of Thymoglobulin Methotrexate and hydrocortisone: intrathecal to patients with central nervous system involvement, age< 1 yr: 6/8mg (MTX/HC), 1-2 yrs: 8/10mg, 2-3 yrs: 10/12mg, >3 yrs: 12/15 mg, on day 7, 14, 21 and 42 ATG, rabbit: ATG, rabbit (Thymoglobulin, Genzyme) will be dosed at 5 mg/kg/dose, given IV on 5 consecutive days (titrated over 4 to 8 hours). Etoposide: Etoposide will be dosed at 150mg/m2, given IV. The first dose will be given 7 days (+/- 2 days) after the first dose of ATG, and be given weekly for a total of 7 doses. Methotrexate: Intrathecal Methotrexate and hydrocortisone will be administered to CNS+ patients |
| Measure Participants | 11 |
| Median (Full Range) [weeks] |
4
|
| Title | Overall Survival |
|---|---|
| Description | To determine overall survival prior to the initiation of BMT (bone marrow transplant) preparative regimen (or day 180, if BMT preparative regimen not yet begun) |
| Time Frame | up to day 180 |
Outcome Measure Data
| Analysis Population Description |
|---|
| [Not Specified] |
| Arm/Group Title | Induction Therapy |
|---|---|
| Arm/Group Description | ATG, rabbit: intravenous, 5 mg/kg/dose, 5 consecutive days Dexamethasone: intravenous, 20mg/m2/day x7days, 10mg/m2/day x7days, 5mg/m2/day x14days, 2.5mg/m2/day x14days, 1.25mg/m2/day x14days Etoposide: intravenous, 150 mg/m2 weekly, starting 7 days after first dose of Thymoglobulin Methotrexate and hydrocortisone: intrathecal to patients with central nervous system involvement, age< 1 yr: 6/8mg (MTX/HC), 1-2 yrs: 8/10mg, 2-3 yrs: 10/12mg, >3 yrs: 12/15 mg, on day 7, 14, 21 and 42 ATG, rabbit: ATG, rabbit (Thymoglobulin, Genzyme) will be dosed at 5 mg/kg/dose, given IV on 5 consecutive days (titrated over 4 to 8 hours). Etoposide: Etoposide will be dosed at 150mg/m2, given IV. The first dose will be given 7 days (+/- 2 days) after the first dose of ATG, and be given weekly for a total of 7 doses. Methotrexate: Intrathecal Methotrexate and hydrocortisone will be administered to CNS+ patients |
| Measure Participants | 31 |
| Count of Participants [Participants] |
22
71%
|
| Title | Number of Participants Who Experienced Reactivation |
|---|---|
| Description | To determine the frequency of disease reactivation prior to initiation of BMT preparative regimen (or day 180, if BMT preparative regimen not yet begun) |
| Time Frame | up to 180 days |
Outcome Measure Data
| Analysis Population Description |
|---|
| all patients surviving to BMT or day 180 and achieving complete or partial response |
| Arm/Group Title | Induction Therapy |
|---|---|
| Arm/Group Description | ATG, rabbit: intravenous, 5 mg/kg/dose, 5 consecutive days Dexamethasone: intravenous, 20mg/m2/day x7days, 10mg/m2/day x7days, 5mg/m2/day x14days, 2.5mg/m2/day x14days, 1.25mg/m2/day x14days Etoposide: intravenous, 150 mg/m2 weekly, starting 7 days after first dose of Thymoglobulin Methotrexate and hydrocortisone: intrathecal to patients with central nervous system involvement, age< 1 yr: 6/8mg (MTX/HC), 1-2 yrs: 8/10mg, 2-3 yrs: 10/12mg, >3 yrs: 12/15 mg, on day 7, 14, 21 and 42 ATG, rabbit: ATG, rabbit (Thymoglobulin, Genzyme) will be dosed at 5 mg/kg/dose, given IV on 5 consecutive days (titrated over 4 to 8 hours). Etoposide: Etoposide will be dosed at 150mg/m2, given IV. The first dose will be given 7 days (+/- 2 days) after the first dose of ATG, and be given weekly for a total of 7 doses. Methotrexate: Intrathecal Methotrexate and hydrocortisone will be administered to CNS+ patients |
| Measure Participants | 21 |
| Count of Participants [Participants] |
4
12.9%
|
| Title | Overall Survival to Day +100 |
|---|---|
| Description | To determine overall survival to day +100 after BMT, for patients who have undergone BMT within 6 months of study entry |
| Time Frame | up to day 280 |
Outcome Measure Data
| Analysis Population Description |
|---|
| [Not Specified] |
| Arm/Group Title | Induction Therapy |
|---|---|
| Arm/Group Description | ATG, rabbit: intravenous, 5 mg/kg/dose, 5 consecutive days Dexamethasone: intravenous, 20mg/m2/day x7days, 10mg/m2/day x7days, 5mg/m2/day x14days, 2.5mg/m2/day x14days, 1.25mg/m2/day x14days Etoposide: intravenous, 150 mg/m2 weekly, starting 7 days after first dose of Thymoglobulin Methotrexate and hydrocortisone: intrathecal to patients with central nervous system involvement, age< 1 yr: 6/8mg (MTX/HC), 1-2 yrs: 8/10mg, 2-3 yrs: 10/12mg, >3 yrs: 12/15 mg, on day 7, 14, 21 and 42 ATG, rabbit: ATG, rabbit (Thymoglobulin, Genzyme) will be dosed at 5 mg/kg/dose, given IV on 5 consecutive days (titrated over 4 to 8 hours). Etoposide: Etoposide will be dosed at 150mg/m2, given IV. The first dose will be given 7 days (+/- 2 days) after the first dose of ATG, and be given weekly for a total of 7 doses. Methotrexate: Intrathecal Methotrexate and hydrocortisone will be administered to CNS+ patients |
| Measure Participants | 11 |
| Count of Participants [Participants] |
9
29%
|
| Title | Disease Status at BMT |
|---|---|
| Description | To determine the rate of complete response at the time of BMT preparative regimen initiation |
| Time Frame | up to day 180 |
Outcome Measure Data
| Analysis Population Description |
|---|
| [Not Specified] |
| Arm/Group Title | Induction Therapy |
|---|---|
| Arm/Group Description | ATG, rabbit: intravenous, 5 mg/kg/dose, 5 consecutive days Dexamethasone: intravenous, 20mg/m2/day x7days, 10mg/m2/day x7days, 5mg/m2/day x14days, 2.5mg/m2/day x14days, 1.25mg/m2/day x14days Etoposide: intravenous, 150 mg/m2 weekly, starting 7 days after first dose of Thymoglobulin Methotrexate and hydrocortisone: intrathecal to patients with central nervous system involvement, age< 1 yr: 6/8mg (MTX/HC), 1-2 yrs: 8/10mg, 2-3 yrs: 10/12mg, >3 yrs: 12/15 mg, on day 7, 14, 21 and 42 ATG, rabbit: ATG, rabbit (Thymoglobulin, Genzyme) will be dosed at 5 mg/kg/dose, given IV on 5 consecutive days (titrated over 4 to 8 hours). Etoposide: Etoposide will be dosed at 150mg/m2, given IV. The first dose will be given 7 days (+/- 2 days) after the first dose of ATG, and be given weekly for a total of 7 doses. Methotrexate: Intrathecal Methotrexate and hydrocortisone will be administered to CNS+ patients |
| Measure Participants | 11 |
| Count of Participants [Participants] |
8
25.8%
|
Adverse Events
| Time Frame | Adverse event data were collected over the 8 weeks of the treatment period. All cause mortality was assessed up to day +100 after BMT, if participant proceeded to BMT by day 180. If participant did not proceed to BMT by day 180, all cause mortality was only assessed until day 180. | |
|---|---|---|
| Adverse Event Reporting Description | ||
| Arm/Group Title | Induction Therapy | |
| Arm/Group Description | ATG, rabbit: intravenous, 5 mg/kg/dose, 5 consecutive days Dexamethasone: intravenous, 20mg/m2/day x7days, 10mg/m2/day x7days, 5mg/m2/day x14days, 2.5mg/m2/day x14days, 1.25mg/m2/day x14days Etoposide: intravenous, 150 mg/m2 weekly, starting 7 days after first dose of Thymoglobulin Methotrexate and hydrocortisone: intrathecal to patients with central nervous system involvement, age< 1 yr: 6/8mg (MTX/HC), 1-2 yrs: 8/10mg, 2-3 yrs: 10/12mg, >3 yrs: 12/15 mg, on day 7, 14, 21 and 42 ATG, rabbit: ATG, rabbit (Thymoglobulin, Genzyme) will be dosed at 5 mg/kg/dose, given IV on 5 consecutive days (titrated over 4 to 8 hours). Etoposide: Etoposide will be dosed at 150mg/m2, given IV. The first dose will be given 7 days (+/- 2 days) after the first dose of ATG, and be given weekly for a total of 7 doses. Methotrexate: Intrathecal Methotrexate and hydrocortisone will be administered to CNS+ patients | |
All Cause Mortality |
||
| Induction Therapy | ||
| Affected / at Risk (%) | # Events | |
| Total | 11/31 (35.5%) | |
Serious Adverse Events |
||
| Induction Therapy | ||
| Affected / at Risk (%) | # Events | |
| Total | 22/31 (71%) | |
| Blood and lymphatic system disorders | ||
| hospitalization | 7/31 (22.6%) | 8 |
| Eye disorders | ||
| herpetic keratitis | 1/31 (3.2%) | 1 |
| Nervous system disorders | ||
| status epilepticus | 1/31 (3.2%) | 1 |
| Renal and urinary disorders | ||
| acute kidney injury | 3/31 (9.7%) | 3 |
| Respiratory, thoracic and mediastinal disorders | ||
| respiratory failure | 4/31 (12.9%) | 4 |
| Vascular disorders | ||
| multiple organ failure | 4/31 (12.9%) | 4 |
| hypotension | 3/31 (9.7%) | 3 |
Other (Not Including Serious) Adverse Events |
||
| Induction Therapy | ||
| Affected / at Risk (%) | # Events | |
| Total | 31/31 (100%) | |
| Blood and lymphatic system disorders | ||
| anemia | 31/31 (100%) | 31 |
| hemorrhage | 5/31 (16.1%) | 5 |
| thrombosis | 2/31 (6.5%) | 2 |
| Immune system disorders | ||
| fever | 30/31 (96.8%) | 40 |
| Vascular disorders | ||
| hypertension | 3/31 (9.7%) | 3 |
Limitations/Caveats
More Information
Certain Agreements
All Principal Investigators ARE employed by the organization sponsoring the study.
There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.
Results Point of Contact
| Name/Title | Michael Jordan, MD |
|---|---|
| Organization | Cincinnati Children's Hospital Medical Center |
| Phone | 513-803-9063 |
| Michael.Jordan@cchmc.org |
- HIT-HLH