2
|
Cheung MC, Hay AE, Crump M, Imrie KR, Song Y, Hassan S, Risebrough N, Sussman J, Couban S, MacDonald D, Kukreti V, Kouroukis CT, Baetz T, Szwajcer D, Desjardins P, Shepherd L, Meyer RM, Le A, Chen BE, Mittmann N. Gemcitabine/dexamethasone/cisplatin vs cytarabine/dexamethasone/cisplatin for relapsed or refractory aggressive-histology lymphoma: cost-utility analysis of NCIC CTG LY.12. J Natl Cancer Inst 2015; 107:djv106. [PMID: 25868579 DOI: 10.1093/jnci/djv106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The NCIC CTG LY.12 study showed that gemcitabine, dexamethasone, and cisplatin (GDP) were noninferior to dexamethasone, cytarabine, and cisplatin (DHAP) in patients with relapsed or refractory aggressive histology lymphoma prior to autologous stem cell transplantation. We conducted an economic evaluation from the perspective of the Canadian public healthcare system based on trial data. METHODS The primary outcome was an incremental cost utility analysis comparing costs and benefits associated with GDP vs DHAP. Resource utilization data were collected from 519 Canadian patients in the trial. Costs were presented in 2012 Canadian dollars and disaggregated to highlight the major cost drivers of care. Benefit was measured as quality-adjusted life-years (QALYs) based on utilities translated from prospectively collected quality-of-life data. All statistical tests were two-sided. RESULTS The mean overall costs of treatment per patient in the GDP and DHAP arms were $19 961 (95% confidence interval (CI) = $17 286 to $24 565) and $34 425 (95% CI = $31 901 to $39 520), respectively, with an incremental difference in direct medical costs of $14 464 per patient in favor of GDP (P < .001). The predominant cost driver for both treatment arms was related to hospitalizations. The mean discounted quality-adjusted overall survival with GDP was 0.161 QALYs and 0.152 QALYs for DHAP (difference = 0.01 QALYs, P = .146). In probabilistic sensitivity analysis, GDP was associated with both cost savings and improved quality-adjusted outcomes compared with DHAP in 92.6% of cost-pair simulations. CONCLUSIONS GDP was associated with both lower costs and similar quality-adjusted outcomes compared with DHAP in patients with relapsed or refractory lymphoma. Considering both costs and outcomes, GDP was the dominant therapy.
Collapse
Affiliation(s)
- Matthew C Cheung
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD).
| | - Annette E Hay
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - Michael Crump
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - Kevin R Imrie
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - Yuyao Song
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - Shazia Hassan
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - Nancy Risebrough
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - Jonathan Sussman
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - Stephen Couban
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - David MacDonald
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - Vishal Kukreti
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - C Tom Kouroukis
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - Tara Baetz
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - David Szwajcer
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - Pierre Desjardins
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - Lois Shepherd
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - Ralph M Meyer
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - Al Le
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - Bingshu E Chen
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | - Nicole Mittmann
- Affiliations of authors: Odette Cancer Centre and University of Toronto, Toronto, Ontario, Canada (MCC, KRI, SH, NM); NCIC Clinical Trials Group, Kingston, Ontario, Canada (AEH, YS, NR, LS, AL, BEC, NM); Princess Margaret Cancer Centre, Toronto, Ontario, Canada (MC, VK); Juravinski Hospital and Cancer Centre and McMaster University, Hamilton, Ontario, Canada (JS, CTK, RMM); Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada (SC, DM); Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, Ontario, Canada (TB); Cancercare Manitoba, Winnipeg, Manitoba, Canada (DS); Hopital Charles Lemoyne, Montreal, Quebec, Canada (PD)
| | | |
Collapse
|
3
|
Crump M, Kuruvilla J, Couban S, MacDonald DA, Kukreti V, Kouroukis CT, Rubinger M, Buckstein R, Imrie KR, Federico M, Di Renzo N, Howson-Jan K, Baetz T, Kaizer L, Voralia M, Olney HJ, Turner AR, Sussman J, Hay AE, Djurfeldt MS, Meyer RM, Chen BE, Shepherd LE. Randomized Comparison of Gemcitabine, Dexamethasone, and Cisplatin Versus Dexamethasone, Cytarabine, and Cisplatin Chemotherapy Before Autologous Stem-Cell Transplantation for Relapsed and Refractory Aggressive Lymphomas: NCIC-CTG LY.12. J Clin Oncol 2014; 32:3490-6. [DOI: 10.1200/jco.2013.53.9593] [Citation(s) in RCA: 276] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose For patients with relapsed or refractory aggressive lymphoma, we hypothesized that gemcitabine-based therapy before autologous stem-cell transplantation (ASCT) is as effective as and less toxic than standard treatment. Patients and Methods We randomly assigned 619 patients with relapsed/refractory aggressive lymphoma to treatment with gemcitabine, dexamethasone, and cisplatin (GDP) or to dexamethasone, cytarabine, and cisplatin (DHAP). Patients with B-cell lymphoma also received rituximab. Responding patients proceeded to stem-cell collection and ASCT. Coprimary end points were response rate after two treatment cycles and transplantation rate. The noninferiority margin for the response rate to GDP relative to DHAP was set at 10%. Secondary end points included event-free and overall survival, treatment toxicity, and quality of life. Results For the intention-to-treat population, the response rate with GDP was 45.2%; with DHAP the response rate was 44.0% (95% CI for difference, −9.0% to 6.7%), meeting protocol-defined criteria for noninferiority of GDP (P = .005). Similar results were obtained in a per-protocol analysis. The transplantation rates were 52.1% with GDP and 49.3% with DHAP (P = .44). At a median follow-up of 53 months, no differences were detected in event-free survival (HR, 0.99; stratified log-rank P = .95) or overall survival (HR, 1.03; P = .78) between GDP and DHAP. Treatment with GDP was associated with less toxicity (P < .001) and need for hospitalization (P < .001), and preserved quality of life (P = .04). Conclusion For patients with relapsed or refractory aggressive lymphoma, in comparison with DHAP, treatment with GDP is associated with a noninferior response rate, similar transplantation rate, event-free survival, and overall survival, less toxicity and hospitalization, and superior quality of life.
Collapse
Affiliation(s)
- Michael Crump
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - John Kuruvilla
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Stephen Couban
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - David A. MacDonald
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Vishal Kukreti
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - C. Tom Kouroukis
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Morel Rubinger
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Rena Buckstein
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Kevin R. Imrie
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Massimo Federico
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Nicola Di Renzo
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Kang Howson-Jan
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Tara Baetz
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Leonard Kaizer
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Michael Voralia
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Harold J. Olney
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - A. Robert Turner
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Jonathan Sussman
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Annette E. Hay
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Marina S. Djurfeldt
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Ralph M. Meyer
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Bingshu E. Chen
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| | - Lois E. Shepherd
- Michael Crump, John Kuruvilla, and Vishal Kukreti, Princess Margaret Cancer Centre; Rena Buckstein and Kevin R. Imrie, Odette Cancer Centre and Sunnybrook Health Sciences Centre, Toronto; C. Tom Kouroukis, Jonathan Sussman, and Ralph M. Meyer, Margaret and Charles Juravinski Cancer Centre, Hamilton; Kang Howson-Jan, London Health Sciences Centre, London; Tara Baetz, Cancer Centre of Southeastern Ontario at Kingston General Hospital; Annette E. Hay, Marina S. Djurfeldt, Ralph M. Meyer, Bingshu E. Chen,
| |
Collapse
|