EXCALIBER-RRMM: Open-label Study Comparing Iberdomide, Daratumumab and Dexamethasone (IberDd) Versus Daratumumab, Bortezomib, and Dexamethasone (DVd) in Participants With Relapsed or Refractory Multiple Myeloma (RRMM)

Sponsor

Celgene (Industry)

Overall Status

Recruiting

CT.gov ID

NCT04975997

Collaborator

(none)

864

Enrollment

241

Locations

Arms

81.9

Anticipated Duration (Months)

3.6

Patients Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

Condition or Disease	Intervention/Treatment	Phase
Multiple Myeloma	Drug: Dexamethasone Drug: Daratumumab Drug: Bortezomib Drug: Iberdomide Drug: Iberdomide Drug: Iberdomide	Phase 3

Detailed Description

This is a multicenter, two-stage, randomized, controlled, open-label, Phase 3 study comparing the efficacy and safety of iberdomide in combination with dexamethasone and daratumumab (IberDd) versus daratumumab, bortezomib, and dexamethasone (DVd) in participants with relapsed or refractory multiple myeloma (RRMM). Approximately 200 patients randomized in stage 1 to one of three iberdomide dose levels of 1, 1.3, or 1.6 mg in combination with daratumumab and dexamethasone (Treatment Arms A1, A2, or A3), or to the DVd comparator arm (Treatment Arm B).

In Stage 2 of the study, approximately 664 additional subjects will be randomized 1:1 between 2 treatment arms:

Approximately 332 subjects will be randomized to receive Treatment Arm A (IberDd)
Approximately 332 subjects will be randomized to receive Treatment Arm B (DVd)

Participants in both treatment arms will continue to receive treatment until confirmed progressive disease (PD), unacceptable toxicity or withdrawal of consent. To ensure accuracy and completeness of the primary endpoint assessment of progression-free survival (PFS), participants who permanently discontinue study treatment for any reason, other than confirmed PD or withdrawal of consent, will continue to be followed for disease assessment.

The study will be conducted in compliance with International Council for Harmonisation (ICH) and Good Clinical Practices (GCPs).

Study Design

Study Type:

Interventional

Anticipated Enrollment :

864 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A Phase 3, Two-Stage, Randomized, Multicenter, Open-label Study Comparing Iberdomide, Daratumumab and Dexamethasone (IberDd) Versus Daratumumab, Bortezomib, and Dexamethasone (DVd) in Subjects With Relapsed or Refractory Multiple Myeloma (RRMM)

Actual Study Start Date :

Jul 27, 2022

Anticipated Primary Completion Date :

Jun 11, 2026

Anticipated Study Completion Date :

May 25, 2029

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Daratumumab in combination with Iberdomide and dexamethasone - Dose 1 Participants will receive oral iberdomide, subcutaneous daratumumab and oral dexamethasone.	Drug: Dexamethasone Oral dexamethasone 40mg on days 1, 8, 15, 22 of a 28-day cycle Drug: Daratumumab Subcutaneous Daratumumab 1800mg on Days 1, 8, 15 and 22 for Cycles 1 to 2, on Days 1 and 15 for Cycles 3 to 6, and then on Day 1 for Cycle 7 of a 28-day cycle Other Names: DARZALEX FASPRO Drug: Iberdomide Oral Iberdomide 1.0mg on Days 1 to 21 of a 28-day cycle Other Names: CC-220
Experimental: Daratumumab in combination with Iberdomide and dexamethasone - Dose 2	Drug: Dexamethasone Oral dexamethasone 40mg on days 1, 8, 15, 22 of a 28-day cycle Drug: Daratumumab Subcutaneous Daratumumab 1800mg on Days 1, 8, 15 and 22 for Cycles 1 to 2, on Days 1 and 15 for Cycles 3 to 6, and then on Day 1 for Cycle 7 of a 28-day cycle Other Names: DARZALEX FASPRO Drug: Iberdomide Oral Iberdomide 1.3mg on Days 1 to 21 of a 28-day cycle Other Names: CC-220
Experimental: Daratumumab in combination with Iberdomide and dexamethasone - Dose 3	Drug: Dexamethasone Oral dexamethasone 40mg on days 1, 8, 15, 22 of a 28-day cycle Drug: Daratumumab Subcutaneous Daratumumab 1800mg on Days 1, 8, 15 and 22 for Cycles 1 to 2, on Days 1 and 15 for Cycles 3 to 6, and then on Day 1 for Cycle 7 of a 28-day cycle Other Names: DARZALEX FASPRO Drug: Iberdomide Oral Iberdomide 1.6mg on Days 1 to 21 of a 28-day cycle Other Names: CC-220
Active Comparator: Daratumumab in combination with dexamethasone and bortezomib Participants will receive subcutaneous daratumumab, bortezomib and oral dexamethasone	Drug: Dexamethasone Oral dexamethasone 40mg on days 1, 8, 15, 22 of a 28-day cycle Drug: Daratumumab Subcutaneous Daratumumab 1800mg on Days 1, 8, 15 and 22 for Cycles 1 to 2, on Days 1 and 15 for Cycles 3 to 6, and then on Day 1 for Cycle 7 of a 28-day cycle Other Names: DARZALEX FASPRO Drug: Bortezomib Subcutaneous Bortezomib 1.3 mg/m2 on Days 1, 4, 8 and 11 of each 21-day cycle for a total of 8 cycles.

Outcome Measures

Primary Outcome Measures

Progression-free Survival (PFS) [Up to approximately 5 years]
To compare the efficacy of iberdomide, daratumumab, and dexamethasone (IberDd) to that of daratumumab, bortezomib, and dexamethasone (DVd) in terms of progression-free survival (PFS) in participants with relapsed or refractory multiple myeloma (RRMM).

Secondary Outcome Measures

Overall Survival (OS) [Up to approximately 5 years]
To evaluate clinical efficacy in terms of overall survival (OS) in participants with relapsed or refractory multiple myeloma (RRMM) treated with iberdomide, daratumumab, and dexamethasone (IberDd) compared to daratumumab, bortezomib, and dexamethasone (DVd).
Minimal Residual Disease (MRD) negativity rate [Up to approximately 5 years]
Proportion of participants who achieve complete response (CR) or better and are MRD negative (defined at a sensitivity of a minimum of 1 in 105 nucleated cells by next generation flow cytometry).
Overall Response Rate (ORR) [Up to approximately 5 years]
Calculated as percentage of participants who achieve best response of partial response (PR) or better according to the IMWG Uniform Response Criteria for multiple myeloma.
Time to response (TTR) [Up to approximately 5 years]
Time from randomization to the first documentation of response (PR or better).
Duration of Response (DoR) [Up to approximately 5 years]
Time from the first documentation of response (PR or better) to the first documentation of progressive disease (PD) or death due to any cause, whichever occurs first.
Time to Progression (TTP) [Up to approximately 5 years]
The time from randomization to the first documented disease progression.
Time to Next Treatment (TTNT) [Up to approximately 5 years]
Time from randomization to the start of the next antimyeloma treatment.
Progression-free Survival 2 (PFS2) [Up to approximately 5 years]
Time from randomization to progression on the next anti-myeloma treatment or death due to any cause, whichever occurs first.
Safety [Up to approximately 5 years]
Type, frequency, seriousness and severity of adverse events (AEs), and relationship of AEs to study treatment.
European Organization for Research and Treatment of Cancer - Quality of Life C30 Questionnaire (EORTC QLQ-C30) [Up to approximately 5 years]
Mean changes from baseline in subscale scores in subject-reported health related quality of life outcomes and multiple myeloma-related symptoms as measured by the EORTC QLQ-C30.
European Quality of Life Multiple Myeloma Module (EORTC QLQ-MY20) [Up to approximately 5 years]
EORTC QLQ-MY20 is a 20-item myeloma module intended for use among participants varying in disease stage and treatment modality. Mean changes from baseline in subscale scores in subject-reported health related quality of life outcomes and multiple myeloma-related symptoms as measured by the EORTC QLQ- MY20.
Recommended iberdomide dose for Stage 2 [Up to approximately 1 year]
Area under the plasma concentration-time curve from time zero to tau (AUC(TAU)) [Up to approximately 1 year]
Maximum plasma concentration (Cmax) [Up to approximately 1 year]
Time to maximum plasma concentration (Tmax) [Up to approximately 1 year]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Documented diagnosis of multiple myeloma (MM) and measurable disease
Received 1 to 2 prior lines of anti-myeloma therapy
Must have documented disease progression during or after their last anti-myeloma regimen
Eastern Cooperative Oncology Group (ECOG) performance status score of 0, 1 or 2

Exclusion Criteria:

Any condition that confounds the ability to interpret data from the study
Has plasma cell leukemia, Waldenstrom's macroglobulinemia or POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes), or clinically significant amyloidosis
Known central nervous system involvement with MM
Prior therapy with iberdomide

Other protocol-defined inclusion/exclusion criteria apply

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Advent Health	Orlando	Florida	United States	32804
2	Advent Health	Orlando	Florida	United States	32804
3	Florida Cancer Specialists North Region Sarah Cannon Research	Saint Petersburg	Florida	United States	33705
4	Emory University	Atlanta	Georgia	United States	30322
5	Hematology-Oncology Clinic	Baton Rouge	Louisiana	United States	70809
6	Center for Cancer And Blood Disorders	Bethesda	Maryland	United States	20817
7	Dana Farber Cancer Institute	Boston	Massachusetts	United States	02215
8	UMASS Memorial Hospital	Worcester	Massachusetts	United States	01655
9	HCA Midwest Health	Kansas City	Missouri	United States	64132
10	Summit Medical Group Overlook Oncology Center	Summit	New Jersey	United States	07901
11	NYU Winthrop Hospital	Mineola	New York	United States	11501
12	NYU Winthrop Hospital	Mineola	New York	United States	11501
13	New York University School of Medicine	New York	New York	United States	10016
14	New York University School Of Medicine	New York	New York	United States	10016
15	New York - Presbyterian/Weill Cornell Medical Center	New York	New York	United States	10021
16	New York - Presbyterian/Weill Cornell Medical Center	New York	New York	United States	10021
17	Cleveland Clinic - Taussig Cancer Institute	Cleveland	Ohio	United States	44195
18	Ohio Health Corporation	Columbus	Ohio	United States	43214
19	West Penn Allegheny Lupus Center of Excellence	Pittsburgh	Pennsylvania	United States	15212
20	Avera Cancer Institute	Sioux Falls	South Dakota	United States	57105
21	Tennessee Oncology	Chattanooga	Tennessee	United States	37404
22	Sarah Cannon Research Institute	Nashville	Tennessee	United States	37203
23	UT Southwestern Simmons Cancer Center	Dallas	Texas	United States	75390
24	UT Southwestern Simmons Cancer Center	Dallas	Texas	United States	75390
25	University Of Wisconsin	Madison	Wisconsin	United States	53705
26	Local Institution - 032	Milwaukee	Wisconsin	United States	53226-3548
27	Princess Alexandra Hospital	Woolloongabba	Queensland	Australia	4102
28	Royal Adelaide Hospital	Adelaide	South Australia	Australia	5000
29	Flinders Medical Centre, Dept Of Oncology	Bedford Park	South Australia	Australia	5042
30	Monash Medical Centre	Clayton	Victoria	Australia	3168
31	Epworth Hospital	East Melbourne	Victoria	Australia	3001
32	The Alfred Hospital	Melbourne	Victoria	Australia	3004
33	Fiona Stanley Hospital	Murdoch	Western Australia	Australia	6150
34	Perth Blood Institute	West Perth	Western Australia	Australia	6005
35	Royal Prince Alfred Hospital	Camperdown		Australia	2050
36	Local Institution - 800	Fitzroy		Australia	3065
37	St Vincent's Hospital Melbourne	Fitzroy		Australia	3065
38	The Canberra Hospital	Garran		Australia	ACT 2605
39	Medical University of Graz	Graz		Austria	A-8036
40	Innsbruck Medical University	Innsbruck		Austria	6020
41	Local Institution - 152	Innsbruck		Austria	6020
42	Krankenhaus der Barmherzigen Schwestern Linz	Linz		Austria	4010
43	Universitatsklinik der PMU	Salzburg		Austria	5020
44	University Hospital St. Poelten	St Polten		Austria	3100
45	Medizinische Universitaet Wien	Vienna		Austria	1090
46	Wilhelminenspital der Stadt Wien	Wien		Austria	1160
47	AZ Sint-Jan AV Brugge	Brugge		Belgium	8000
48	Institut Jules Bordet	Brussel		Belgium	1000
49	Cliniques Universitaires Saint-Luc	Bruxelles		Belgium	1200
50	Centre Hospitalier Universitaire de Liege	Liege		Belgium	4000
51	Tom Baker Cancer Centre	Calgary	Alberta	Canada	T2N 4N2
52	Cross Cancer Institute	Edmonton	Alberta	Canada	T6G 1Z2
53	BC Cancer Agency, Fraser Valley Center	Surrey	British Columbia	Canada	V3V 1Z2
54	Saint John Regional Hospital	Saint John	New Brunswick	Canada	E2L 3L6
55	Memorial University of NewfoundlandDr. H Bliss Murphy Cancer Center	St John's	Newfoundland and Labrador	Canada	A1B3V6
56	Queen Elizabeth II Health Sciences Centre	Halifax	Nova Scotia	Canada	B3H 1V7
57	Hamilton Health Sciences Corporation	Hamilton	Ontario	Canada	L8V5C2
58	Princess Margaret Cancer Centre	Toronto	Ontario	Canada	M5G 2M9
59	Hopital Maisonneuve Rosemont dba CIUSSS de lEst de lIle de Montreal	Montreal	Quebec	Canada	H1T 2M4
60	The Ottawa Hospital - General Campus	Ottawa	Quebec	Canada	K1H 8L6
61	University of Saskatchewan	Saskatoon	Saskatchewan	Canada	S7N-0W8
62	CHUQ	Quebec		Canada	G1R 2J6
63	Beijing Boren Hospital	Beijing		China	100071
64	Peking University Third Hospital	Beijing		China	100191
65	Peking Union Medical College Hospital	Beijing		China	100730
66	First Hospital of Jilin University	Changchun		China	130021
67	Beijing Chaoyang Hospital Capital Medical University	Chaoyang District		China	100020
68	Guangdong General Hospital	Guangzhou		China	510030
69	Sun Yat-sen University Cancer Center	Guangzhou		China	510060
70	The First Affiliated Hospital of Medical School of Zhejiang University	Hangzhou City		China	310006
71	The First Affiliated Hospital of Medical School of Zhejiang University	Hangzhou, Zhejiang		China	310006
72	The First Affiliated Hospital of Harbin Medical University	Harbin		China	150081
73	Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University	Nanjing		China	210029
74	Ruijin Hospital Shanghai Jiaotong University	Shanghai		China	200025
75	Shengjing Hospital Of China Medical University	Shenyang		China	110004
76	The First Affiliated Hospital of Soochow University	Suzhu		China	215006
77	Institution of Hematology & Hospital of Blood Disease, Chinese Academy of Medical Sciences	Tianjin		China	300020
78	Local Institution - 133	Tianjin		China	300020
79	Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology	Wuhan		China	430030
80	Xijing Hospital	Xian		China	710000
81	Henan Cancer Hospital	Zhengzhou		China
82	Fakultni Nemocnice Brno	Brno		Czechia	625 00
83	Fakultni Nemocnice Ostrava	Ostrava-Poruba		Czechia	708 52
84	Vseobecna Fakultni Nemocnice v Praze	Prague 2		Czechia	128 08
85	Aalborg Universitetshospital	Aalborg		Denmark	9000
86	Aarhus University Hospital	Aarhus		Denmark	8000
87	Odense University Hospital	Odense		Denmark	DK-5000
88	Sealand University Hospital	Roskilde		Denmark	4000
89	Helsinki University Central Hospital	Helsinki		Finland	290
90	Oulu University Hospital	Oulu		Finland	90220
91	Turku University Hospital	Turku		Finland	FI-20520
92	CH Argenteuil Victor Dupouy	Argenteuil		France	95100
93	Hopital Henri Mondor	Creteil		France	94010
94	Centre Hospitalier Departemental de Vendee	La Roche -Sur-Yon - Cedex 9		France	85925
95	CHRU de Lille France	Lille Cedex		France	59037
96	CHU Montpellier- Hopital Lapeyronie	Montpellier Cedex 5		France	34295
97	Local Institution - 455	Montpellier Cedex 5		France	34295
98	CHU de Nancy - Hopital Brabois- Service d'Hematologie et DE medecine Interne, 7eme etage	Nancy Cedex		France	54511
99	CHRU Nantes	Nantes		France	44093
100	Hopital Saint-Louis	Paris Cedex		France	75475
101	Hopital Saint Antoine	Paris		France	75012
102	CHU Bordeaux	Pessac		France	33604
103	Centre Hospitalier Lyon-Sud	Pierre-Benite CEDEX		France	69495
104	CHU La Miletrie	Poitiers Cedex		France	86021
105	CHRU Rennes	Rennes		France	35033
106	CLCC H BecquerelHematology	Rouen		France	76038
107	Institut Universitaire du Cancer de Toulouse - Oncopole	Toulouse Cedex 9		France	31059
108	Local Institution - 0978	Kiel	Schleswig-Holstein	Germany	24105
109	Universitätsklinikum der RWTH Aachen	Aachen		Germany	52074
110	Local Institution - 307	Erlangen		Germany	91054
111	Universitatsklinikum Erlangen	Erlangen		Germany	91054
112	Klinikum der Johann Wolfgang Goethe Universitat	Frankfurt am Main		Germany	60590
113	Universitaetsklinik Hamburg - Eppendorf	Hamburg		Germany	20246
114	Asklepios Klinik St. Georg	Hamburg		Germany	D-20099
115	Universitaetsklinikum Heidelberg	Heidelberg		Germany	69120
116	Local Institution - 304	Munster		Germany	48149
117	Universitaetsklinikum Muenster	Munster		Germany	48149
118	Local Institution - 303	Wuerzburg		Germany	97080
119	Universitaetsklinikum Wuerzburg	Wuerzburg		Germany	97080
120	Alexandra General Hospital of Athens	Athens		Greece	115 28
121	Local Institution - 571	Athens		Greece	115 28
122	Georgios Papanikolaou General Hospital of Thessaloniki	Thessaloniki		Greece	57010
123	Cork University Hospital	Cork		Ireland
124	Beaumont Hospital	Dublin 9		Ireland	D09 V2N0
125	St James Hospital	Dublin		Ireland	Dublin 8
126	University Hospital Galway	Galway		Ireland	ST46QG
127	Rambam Medical Center	Haifa		Israel	35254
128	Hadassah Medical Center	Jerusalem		Israel	91120
129	Tel Aviv Sourasky Medical Center	Tel Aviv		Israel	64239
130	A.O.U. di Bologna Policlinico S.Orsola-Malpighi	Bologna		Italy	40138
131	Università di Catania- Presidio Ospedaliero Ferrarotto	Catania		Italy	95124
132	Fondazione IRCCS CA Granda Ospedale Maggiore Policlinico	Milano		Italy	20122
133	ASST Grande Ospedale Metropolitano Niguarda, Milano	Milano		Italy	20162
134	A.O.U. Maggiore della Carità	Novara		Italy	28100
135	Azienda Ospedaliera di Padova	Padova		Italy	35128
136	Fondazione IRCCS Policlinico San Matteo	Pavia		Italy	27100
137	Azienda Ospedaliera Universitaria Pisana	Pisa		Italy	56100
138	Azienda Ospedaliera Bianchi-Melacrino-Morelli	Reggio Calabria		Italy	89100
139	Arcispedale Santa Maria Nuova - AUSL Reggio Emilia	Reggio Emilia		Italy	42122
140	Azienda Ospedaliera S. Andrea - Università La Sapienza	Roma		Italy	00189
141	IRCCS Ospedale Casa Sollievo della Sofferenza	San Giovanni Rotondo FG		Italy	71013
142	Azienda Ospedaliera S Maria di Terni	Terni		Italy	05100
143	Azienda Ospedaliero-Universitaria Santa Maria della Misericordia die Udine	Udine		Italy	33100
144	Aomori Prefectural Central Hospital	Aomori		Japan	030-8553
145	National Hospital Organization Kyushu Medical Center	Fukuoka		Japan	810-8563
146	Kameda Medical Center	Kamogawa		Japan	296-8602
147	University Hospital Kyoto Prefectural University of Medicine	Kyoto-City		Japan	602-8566
148	Matsuyama Red Cross Hospital	Matsuyama		Japan	790-8524
149	Aichi Cancer Center	Nagoya		Japan	464-8681
150	Nagoya City University Hospital	Nagoya		Japan	467-8602
151	Okayama Medical Center	Okayama		Japan	701-1192
152	Kindai University Hospital	Osaka-Sayama		Japan	589-8511
153	Osaka City University Hospital	Osaka		Japan	545-8585
154	Sapporo Hokuyu Hospital	Sapporo		Japan	003-0006
155	Tohoku University Hospital	Sendai		Japan	980-8574
156	Japan Red Cross Medical Center	Shibuya-ku		Japan	150-8935
157	NTT Medical Center Tokyo	Shinagawa-ku, Tokyo		Japan	141-8625
158	Toyohashi Municipal Hospital	Toyohashi		Japan	441-8570
159	Kyungpook National University Hospital	Daegu		Korea, Republic of	700-721
160	National Cancer Center	Gyeonggi-do		Korea, Republic of	410-769
161	Hwasun Chonnam National University Hospital	Hwasun-gun		Korea, Republic of	519-809
162	Severance Hospital, Yonsei University Health System	Seoul		Korea, Republic of	120-752
163	Samsung Medical Center	Seoul		Korea, Republic of	135-710
164	The Catholic University of Korea Seoul - Saint Mary's Hospital	Seoul		Korea, Republic of	137-701
165	Seoul National University Hospital	Seoul		Korea, Republic of	3080
166	Asan Medical Center	Seoul		Korea, Republic of	5505
167	Vrije Universiteit Medisch Centrum (VUMC)	Amsterdam		Netherlands	1081 HV
168	HagaZiekenhuis	Den Haag		Netherlands	2545 CH
169	Albert Schweitzer Ziekenhuis	Dordrecht		Netherlands	3318 AT
170	Haukeland University Hospital	Bergen		Norway	N-5053
171	Oslo Universitetssykehus HF Ulleval	Oslo		Norway	0424
172	Trondheim university hospital	Trondheim		Norway	7030
173	Uniwersytecki Szpital Kliniczny w Bialymstoku	Bialystok		Poland	15-276
174	Uniwersytet Jagiellonski Collegium Medicum	Krakow		Poland	31-501
175	Szpital Specjalistyczny im. Jedrzeja Sniadeckiego w Nowym Saczu	Nowy Sacz		Poland	33-300
176	Szpital Kliniczny im. H.Swiecickiego Uniwersytetu Medycznego im. Karola Marcinkowskiego w Poznaniu	Poznan		Poland	60-569
177	Specjalistyczny Szpital im. dra Alfreda Sokolowskiego	Walbrzych		Poland	58-309
178	Centrum Onkologii-Instytut im.Marii Sklodowskiej-Curie	Warszawa		Poland	02-781
179	Uniwersytecki Szpital Kliniczny	Wroclaw		Poland	50-367
180	Centro Hospital e Universitario de Coimbra	Coimbra		Portugal	4200-072
181	Instituto Portugues de Oncologia de Lisboa, Francisco Gentil	Lisboa		Portugal	1099-023
182	Champalimaud Cancer Center	Lisboa		Portugal	1400-038
183	Hospital Center of Lisbon North E.P.E - Hospital Pulido Valente	Lisboa		Portugal	1649-035
184	Ipo Instituto Portugues De Oncologia Porto	Porto		Portugal	4200-072
185	Centro Hospitalar de Sao Joao, EPE	Porto		Portugal	4200-319
186	City Clinical Hospital 52	Moscow		Russian Federation	123182
187	State Institution Hematological Research, Centre of Russian Academy of Medical Science	Moscow		Russian Federation	125167
188	Moscow State Healthcare Institution City clinical hospital n.a. S.P.Botkin	Moscow		Russian Federation	125284
189	Novosibirsk State Medical University	Novosibirsk		Russian Federation	630091
190	Pavlov First Saint Petersburg State Medical University	Saint-Petersburg		Russian Federation	197022
191	Hospital de la Santa Creu i Sant Pau	Barcelona		Spain	08025
192	Hospital Universitario Vall D hebron - PPDS	Barcelona		Spain	08035
193	Hospital Universitari Germans Trias i Pujol	Barcelona		Spain	08916
194	Hospital San Pedro de Alcantara	Caceres		Spain	10005
195	Hospital Universitario Reina Sofia	Cordoba		Spain	14001
196	Hospital de La Princesa	Madrid		Spain	28006
197	Local Institution - 0979	Madrid		Spain	28027
198	Hospital Universitario Ramon y Cajal	Madrid		Spain	28034
199	Hospital Universitario Fundacion Jimenez Diaz	Madrid		Spain	28040
200	Hospital Universitario Virgen de la Victoria	Malaga		Spain	29010
201	Hospital Universitario Virgen de La Arrixaca	Murcia		Spain	30120
202	Hospital Universitario Central de Asturias	Oviedo		Spain	33011
203	Clinica Universidad de Navarra	Pamplona		Spain	31008
204	Universitario de Salamanca - Hospital Clinico	Salamanca		Spain	37007
205	Hospital Clinico Universitario de Santiago	Santiago de Compostela		Spain	15706
206	Hospital Universitari i Politecnic La Fe de Valencia	Valencia		Spain	46026
207	Hospital Universitario Miguel Servet	Zaragoza		Spain	50009
208	Medicinkliniken	Boras		Sweden	501 82
209	Sahlgrenska University Hospital Department of Hematology and Coagulation	Goteborg		Sweden	S-413 45
210	Helsingborg hospital	Helsingborg		Sweden	254 37
211	Local Institution - 270	Lund		Sweden	222 41
212	Lund University Hosptial	Lund		Sweden	222 41
213	Kantonsspital Graubunden	Chur		Switzerland	7000
214	Kantonsspital St. GallenBereich OnkologieHamatologie	St. Gallen		Switzerland	CH-9007
215	Chang Gung Medical Foundation, Kaohsiung Memorial Hospital	Niao-Sung Hsiang Kaohsiung County		Taiwan	83301
216	China Medical University Hospital	Taichung City		Taiwan	40447
217	Taichung Veterans General Hospital	Taichung		Taiwan	40705
218	National Cheng Kung University Hospital	Tainan, Taiana		Taiwan	704
219	National Taiwan University Hospital	Taipei, Zhongzheng Dist.		Taiwan	10002
220	Taipei Veterans General Hospital	Taipei		Taiwan	11217
221	Chang Gung Medical Foundation, Linkou Memorial Hospital	Taoyuan City		Taiwan	33305
222	Ankara University Medical Faculty	Ankara		Turkey	06100
223	Dokuz Eylul University Medical Faculty	Balçova		Turkey	35330
224	Gazi Universitesi	Besevler Ankara		Turkey	06500
225	Ege University Medical Faculty	Izmir		Turkey	35100
226	Erciyes University Medical Faculty	Kayseri		Turkey	38039
227	Ondokuz Mayis University Medical Faculty	Samsun		Turkey	55139
228	Belfast City Hospital	Belfast Northern Ireland		United Kingdom	BT9 7AD
229	University Hospitals Birmingham NHS Foundation Trust - Queen Elizabeth Hospital	Birmingham		United Kingdom	B15 2TH
230	Kent and Canterbury Hospital	Canterbury Kent		United Kingdom	CT1 3NG
231	Victoria Hospital Blackpool	Lancashire Blackpool		United Kingdom	FY3 8NR
232	Leicester Royal Infirmary	Leicester		United Kingdom	LE1 5WW
233	University College London Hospitals NHS Foundation Trust - University College Hospital	London		United Kingdom	NW1 2BU
234	Guy's and St Thomas' Hospital - London	London		United Kingdom	SE1 9RT
235	Freeman Hospital	Newcastle upon Tyne		United Kingdom	NE7 7DN
236	Nottingham City Hospital	Nottingham		United Kingdom	NG5 1PB
237	Oxford University Hospitals NHS Foundation Trust-Churchill Hospital-Cancer and Haematology Centre	Oxford		United Kingdom	OX3 7LE
238	Queen Alexandra Hospital - Portsmouth	Portsmouth		United Kingdom	PO6 3LY
239	The Royal Marsden NHS Foundation Trust	Sutton		United Kingdom	SM2 5PT
240	Royal Cornwall Hospitals Trust	Truro		United Kingdom	TR1 3LJ
241	New Cross Hospital	Wolverhampton		United Kingdom	WV10 0QP