Blood and Marrow Transplant
Clinical Trials Network (BMT CTN):
Past, Present and Future
Hillard M. Lazarus, MD
The George & Edith Richman Professor and
Distinguished Scientist in Cancer Research
Director of Novel Cell Therapy
University Hospitals Case Medical Center
Case Western Reserve University
E Donnall Thomas, MD
1920-2012
Nobel Prize in Physiology or Medicine, 1990
BONE MARROW TRANSPLANTATION
Initial Report: Mary Imogene Bassett Hospital
ED Thomas, et al. N Engl J Med 257: 491-496, 1957
• N=6 pts: variety of diseases, malignant & non-malignant
• differing marrow products infused
• demonstrated safety (no marrow emboli)
• demonstrated some donor engraftment
F Appelbaum. N Engl J Med 357: 1472-1475, 2007
Genesis
I can’t cover
everything
BLOOD AND MARROW TRANSPLANT
CLINICAL TRIALS NETWORK
 Established November 2001
 Mission: Conduct scientifically meritorious
multicenter trials in an efficient manner to improve
transplant outcomes
 Provide infrastructure to allow promising
therapies to be developed/evaluated in high
quality, multicenter studies that give definitive
answers as rapidly as possible
BMT CTN Organizational Structure
NHLBI & NCI
Data and Safety
Monitoring Board
Protocol Review
Committee
NCI Coop Group
Chairs (ex officio)
STEERING COMMITTEE
Administrative
Committees
Technical
Committees
Data and Coordinating Center
20 Clinical Cores;
High-performing
Affiliate Centers
Protocol
Teams
Affiliate
Clinical
Centers
BMT CTN
Data and Coordinating Center
CIBMTR
Electronic
Communications
Statistical
Overall
Design/
Coordination
Data
Analysis Management
Scientific
Protocol
Leadership
Trial Oversight/
Development/
Monitoring
Implementation
Lab/
Medical
Repository
Monitoring
Management
Patient Advocacy
* EMMES
NMDP
Contracting
* professional partner to clinicians, scientists, program leaders
BLOOD & MARROW TRANSPLANTATION
1st State of Science Symposium: 4/01/2000
• Stem cell source & donor selection – Horowitz, Champlin,
Anasetti, Hansen, Wagner, Confer
• Regimen-related toxicity – Armitage, Blume, McDonald,
Jones
• Graft-versus-host disease – Blazar, Martin, Guinan,
Parkman, Storb, Ferrara
• Recurrence after autograft – Nadler, Vose, Press, Gribben,
Antman
BLOOD & MARROW TRANSPLANTATION
1st State of Science Symposium: 4/01/2000
• Recurrence after allograft – O’Reilly, Scheinberg, Barrett,
Levitsky, Riddell
• Infectious complications – Wingard, Forman, Zaia, Heslop
• Late complications & immune recovery – Sullivan,
Weinberg, Gress, Vogelsang
BLOOD & MARROW TRANSPLANTATION
1st State of Science Symposium
Conclusions:
1. Necessity of multi-institutional studies
2. Studies can be adapted to multi-institutional setting
3. Studies could be completed in a responsible time
BLOOD & MARROW TRANSPLANTATION
1st State of Science Symposium
Conclusions for studies needed:
1. Blood vs marrow in matched sibling donors – (NA)
2. Blood vs marrow in matched unrelated donors – (0201)
3. Techniques to improve cord blood engraftment – (0501)
4. T-cell depletion studies – (0303)
5. Methods to improve autologous cell collection – (NA)
6. Comparisons of related and unrelated HCT vs
standard chemotherapy for high risk patients – (S1203)
BMT CTN FOUNDATION
Creation and Organization/Administration
 RFA from NHLBI in 2001
 Competition for Data Coordinating Center (DCC)
 Emmes Corp, NMDP and CIBMTR awarded
 Competition for Centers
 Established 16 Core Centers
 Case Consortium original Core Center
 ( Re-competition: expanded to 20 in July 2011 )
BMT CTN
Case Consortium (Original & Current)
 Case Western Reserve University (CWRU);
 Oregon Health Sciences University (OHSU);
 University of Illinois Chicago
 Transition to add Washington University (St. Louis)
and Ohio State University (through 2011)
 Present configuration
 CWRU, OHSU
 Cleveland Clinic, West Virginia University
BMT CTN FOUNDATION
Creation and Organization/Administration
Formation of committees and teams:
 Manual of Policies/Procedures (MOP)
 Disease-specific teams
 Protocol-specific teams
 Liaison relation with cooperative oncology groups
 Electronic data capture system
 Per patient reimbursement model
 Websites for members & public
 Metrics for center performance: “Report Card”
Protocol Development & Prioritization
Clinical
Population
Scientific
Rationale
Feasibility
Issues
Logistical/
budgetary
Constraints
Collaboration with cooperative groups to avoid duplication
C
No. pts 440 1,058
2001
2002
2003
2004
2005
2006
1,615 2,133
2007
2008
2625
3048
4,200
2009
2010
2011
5,200
2012
2013
1101 Haplo vs. 2 UCB
0903 Allo Tx for HIV+
0901 Full vs RIC - MDS/AML
0804 High Risk CLL
0902 Post Tx Stress Mgmt
0803 HIV+ Lymphoma
0702 PIII Myeloma Follow-on
0801 P II/III CGVHD Treatment
0802 PIII AGVHD Treatment
0701 PII NST for NHL
0604 PII DCB in Adult
0603 PII Haplo in Adult
0601 PII Sickle Cell NST
0703 PII HD
0403 PIII Etanercept for IPS
0704 PIII MM maintenance
0502 PII NST for AML >60y
0402 PIII GVHD prophylaxis
= Enrollment complete
0501 III Single vs Double CBT
= Enrollment on-going
= Cumulative actual
[projected] accrual
0301 PII Unrelated Tx for aplastic anemia
0401 PIII BEAM vs BEAM-Bexxar for Lymphoma
0302 PII AGVHD therapy
0303 PII T-depleted HCT for AML
= Coop group collaboration
0202 PIII follicular NHL (closed early)
(see color key above)
0201 PIII Unrelated PBSC vs. Marrow
0101 PIII Vori vs. Fluconazole
0102 PIII Myeloma Tandem HCT
(closed early)
BMT CTN Centers, 2013
>115 centers enrolled >5000 pts since 2003
= Core Centers
= PBMTC Centers
= Affiliate Centers
Mmh11_9.ppt
8
BMT CTN: Numbers of Protocols Opened
0702 0803
0801 0804*
0802 0805*
7
6
5
0302
0303
0401
4
3
2
1
0301 0403
0402 0502*
0501 0704*
0601
0603
0604
0703*
0101 0201
0102 0202
1102
1202
1203
1204
1205
0901 0903
0902 1101
0701
0
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
(proj)
BMT CTN Yearly & Cumulative Accrual
All Protocols, 2004-2012
1200
6000
1000
5000
800
4000
600
3000
400
2000
200
1000
0
0
2004
2005
2006
2007
2008
2009
2010
2011
2012
BMT CTN TRIALS
Protocol Categories
All Trials Phase II
Donor/Graft Source
Phase III
12
6
6
GVHD
5
3
2
Infection
3
2
1
Disease Control
12
6
6
Regimen Toxicity
4
2
2
QOL
7
2
5
28
14
14
TOTAL
BMT CTN
Publications Summary
 2012:
 7 peer-reviewed papers (+1 in press)
 28 total:
 10 primary results papers: 0101, 0102,
0202, 0301, 0302, 0303, 0401, 0601,
0603/0604, 0704 (100104)
 8 other protocol-related papers
 3 methodology papers
 7 other Network publications
BLOOD & MARROW TRANSPLANTATION
2nd State of Science Symposium
-
BMT CTN organized and led
June 7-8, 2007 @ Ann Arbor, MI
Goal: identify key transplant-related issues
Propose critical trials to address these issues
- may be sequential phase II  III
- may require cooperative oncology group or
other participants
- trials should be ready to start quickly
BLOOD & MARROW TRANSPLANTATION
2nd State of Science Symposium
1. Optimal donor and graft source – C. Anasetti
2. Regimen-related toxicity – E. Stadtmauer
3. Graft-versus-host disease – J. Antin
4. Infection & immune reconstitution – J. Wingard
5. Late effects/quality of life – S. Lee
6. Pediatrics – K. Schultze, J. Levine
BLOOD & MARROW TRANSPLANTATION
2nd State of Science Symposium (con’t)
7. Leukemia – F. Appelbaum
8. Lymphoma – R. Negrin
9. Plasma cell myeloma – S. Giralt
10. Non-malignant disorders – C. Bredson
11. Gene and cell therapy – H. Heslop, D. Kohn
12. Cinical trial design – M. Horowitz
BLOOD & MARROW TRANSPLANTATION
Timeline: 2nd State of Science Symposium
April 2006
June-Dec 2006
Dec 2006
Feb 2007
May 2007
June 2007
Committees named and charged
Committee conference calls
Committee in-person mtgs @ ASH
Committee in-person mtg @ Tandem
Document due
SOSS
JL Ferrara, BMT CTN. Biol Blood Marrow Transplant 13: 1268-1285, 2007
BLOOD & MARROW TRANSPLANTATION
2nd State of Science Symposium: Conclusions
1. GVHD: Phase II trial calcineurin-free regimen – 0402
2. QOL: Phase III study stress management – 0902
3. Myeloma: Phase III comparison tandem HCT vs.
consolidation and maintenance – 0702
4. AML: Phase III chemotherapy vs. URD HCT – SWOG 1203
5. AML: Phase III full intensity vs. RIC HCT - 0901
6. Ph+ ALL: Phase III chemotherapy vs. Allo HCT – S0805
BLOOD & MARROW TRANSPLANTATION
2nd State of Science Symposium: Conclusions
7. CLL: Phase II RIC Allo HCT for high risk CLL – 0804
8. Lymphoma: Phase II RIC Allo HCT in T cell lymphoma – NA
9. HLH: Phase II RIC for children with HLH – planning
10. Non-malignant: Phase II auto HCT in Crohn disease – NA
11. Cell Therapy: Phase II viral-specific CTL adenovirus - NA
MAJOR SCIENTIFIC PUBLICATIONS
Potentially Practice-Changing
BMT CTN
Donor Graft Source Questions
Blood versus Marrow
Extremely complex undertaking;
Dual consent: donor and recipient
BLOOD vs MARROW GRAFT SOURCE
Matched Unrelated Donors (MUD): Engraftment
C Anasetti, BMT CTN. N Engl J Med 367: 1487-96, 2012.
BLOOD vs MARROW GRAFT SOURCE
Matched Unrelated Donors (MUD): GVHD
C Anasetti, BMT CTN. N Engl J Med 367: 1487-96, 2012.
BLOOD vs MARROW GRAFT SOURCE
Matched Unrelated Donors (MUD): Relapse & TRM
C Anasetti, BMT CTN. N Engl J Med 367: 1487-96, 2012.
BLOOD vs MARROW GRAFT SOURCE
Matched Unrelated Donors (MUD): Survival
C Anasetti, BMT CTN. N Engl J Med 367: 1487-96, 2012.
BMT CTN 0401
Reduce Relapse After Autograft: NHL
DLBCL: BEXXAR-BEAM vs Rituximab-BEAM
No differences in patient outcome except increased mucositis
Randomized to Bexxar/BEAM or Rituxan/BEAM
Within 3 mo of
mobilization
Day -19
Bexxar 5 mCi
dosimetry
Rituxan 375 mg/m2
Day -12
Bexxar 75 cGy TBD
Rituxan 375 mg/m2
Day -6
Days -5 to -2
Days -5 to -2
Day -1
Day 0
Day +5
BCNU 300 mg/m2
Etoposide [VP-16] 100 mg/m2 BID (8 doses)
Ara-C [Cytarabine] 100 mg/m2 BID (8 doses)
Melphalan 140 mg/m2
Infusion of mobilized hematopoietic cells
G-CSF 5 µg/kg daily until ANC >500/mm3 x 3 days
BMT CTN 0401
Autograft BEXXAR-BEAM vs Rituximab-BEAM
Probability Progression-free survival (PFS)
Probability, %
100
100
90
90
80
80
70
70
Rituxan/BEAM (N=113)
60
60
50
50
Bexxar/BEAM (N=111)
40
40
30
30
20
Bexxar/BEAM @ 2 yr: 48.6%
Rituxan/BEAM @ 2 yr: 49.0%
10
20
p=0.65
10
0
0
0
6
12
18
24
30
36
42
Months
JM Vose, BMT CTN. J Clin Oncol 31: 1662-1668, 2013.
48
BMT CTN 0401
Autograft BEXXAR-BEAM vs Rituximab-BEAM
Probability Survival
Probability, %
100
100
90
90
80
80
70
70
Rituxan/BEAM (N=113)
60
60
50
50
Bexxar/BEAM (N=111)
40
40
30
30
20
Bexxar/BEAM @ 2 yrs: 60.1%
Rituxan/BEAM @ 2 yrs: 66.3%
10
20
p=0.29
10
0
0
0
6
12
18
24
30
36
42
Months
JM Vose, BMT CTN. J Clin Oncol 31: 1662-1668, 2013.
48
BMT CTN
Relapse Prevention Questions: Myeloma
Tandem Autograft vs
Autograft-Allograft
TRANSPLANTATION IN MYELOMA
Tandem Autograft vs Autograft-RIC Allograft
Autografts:
Melphalan 200 mg/m2
Allograft: TBI 200 cGy
A Krishnan, BMT CTN. Lancet Oncol 12: 1195-203, 2011.
TRANSPLANTATION IN MYELOMA
Tandem Autograft vs Autograft-RIC Allograft
Standard-risk
A Krishnan, BMT CTN. Lancet Oncol 12: 1195-203, 2011.
TRANSPLANTATION IN MYELOMA
Tandem Autograft vs Autograft-RIC Allograft
High-risk
A Krishnan, BMT CTN. Lancet Oncol 12: 1195-203, 2011.
BMT CTN
Relapse Prevention Questions: Myeloma
Post-Autograft Maintenance Therapy
AUTOGRAFT IN MYELOMA
Post-Transplant Lenalidomide vs Placebo
Joint BMT CTN and CALGB study
88% @ 3 yr
Median TTP 46 mo
80% @ 3 yr
Median TTP 27 mo
PL McCarthy, BMT CTN. N Engl J Med 366: 1770-81, 2012.
AUTOGRAFT IN MYELOMA
Post-Transplant Lenalidomide vs Placebo
Risk 2nd maligancy
PL McCarthy, BMT CTN. N Engl J Med 366: 1770-81, 2012.
BMT CTN
Novel GVHD Prevention Strategies
T Cell Depletion and
Other Strategies
HEMATOPOIETIC CELL TRANSPLANT
Allograft & High-dose Rituximab in FCC NHL
Survival
Graft-vs-Host Disease
IF Khouri, MD Anderson. Blood 111: 5530-5536, 2008
BMT CTN 0701
Allograft & High-dose Rituximab in FCC NHL
Rituximab 375 mg/m2
Rituximab 1,000 mg/m2
(day –13)
(day – 6)
Fludarabine + Cyclophosphamide conditioning
Tacrolimus+ Methotrexate (GVHD prophylaxis)
Rituximab 1,000 mg/m2 day +1 and +8
Blood allograft infusion (matched-related or MUD)
PK studies for rituximab blood concentration
Accrual completed: awaiting DSMB recommendations
GRAFT-VS-HOST DISEASE
Prophylaxis: T Cell Depletion
• Decades of failure
• Engraftment failure
• Prolonged immune incompetence
• viral, opportunistic infections
• High relapse rates
VT Ho, RJ Soiffer. Blood 98: 3192-204, 2001.
GRAFT-VS-HOST DISEASE
Prophylaxis: AML CR1 & T Cell Depletion
• Multi-center BMT CTN trial: CD34 selection, Miltenyi device
• Few AML CR2; early follow-up
Grade 3-4 Acute GVHD
Chronic GVHD
S Devine, BMT CTN. Biol Blood Marrow Transplant 17: 1343-51, 2010
GRAFT-VS-HOST DISEASE
Prophylaxis: AML CR1 & T Cell Depletion
Relapse
Survival
No engraftment failures
S Devine, BMT CTN. Biol Blood Marrow Transplant 17: 1343-51, 2010
AML CR1 ALLOGRAFTS: BMT CTN
T Cell Depletion vs Immune Suppression
N=44 T Cell Depletion; N=88 Immune Suppression
Relapse
Survival
GVHD-Free Survival
MC Pasquini, BMT CTN. J Clin Oncol 30: 3194-3201, 2012
GRAFT-VS-HOST DISEASE
Prophylaxis: Combination
Myeloablative conditioning: Cy or VP-16 plus TBI > 1200 cGy
Mobilized blood graft
Median (range) age 44 (13-59) yr
C Cutler, BMT CTN. Blood 120: 2012 (abstract #739).
BMT CTN GVHD PROPHYLAXIS
Sirolimus/Tacrolimus vs Tacrolimus/Methotrexate
Sirolimus/tacrolimus:
No advantage in 114-day acute GVHD-free survival
• 2 and 3 days faster neutrophil and platelet engraftment
• Reduction in acute GVHD
 8% absolute  II-IV, p = 0.17
 7% absolute  III-IV, p = 0.05
• More chronic GVHD
 9% absolute , p = 0.05
• Less mucositis but more endothelial injury (all p  0.05)
Acceptable alternative to tacrolimus/methotrexate
BMT CTN
Regimen-Intensity Questions
Acute Leukemia and MDS
ACUTE MYELOID LEUKEMIA CR1
Reduced-Intensity Conditioning in Elderly
ACUTE MYELOID LEUKEMIA CR1
Reduced-Intensity Conditioning in Elderly
•
•
•
•
•
CALGB & BMT CTN: N=123 @ 21 centers
Median age 65 (60-74) yr
N= 58 matched-related donor; N=65 MUD
82 intermediate cytogenetics; 25 adverse cytogenetics
Fludarabine + busulfan ± ATG
Event
Treatment-related mortality
Acute GVHD gr 3-4
Chronic GVHD
Relapse
Overall survival
Incidence @ 2 Yr
14%
3.4% @ 100 days
26%
47%
46%
SM Devine, CALGB, BMT CTN. Blood 120: 2012 (abstract #230).
ACUTE MYELOID LEUKEMIA CR1
Prospective Randomized: RIC vs Myeloablative
German AML Study Group: small series
M Bornhäuser, German AML. Lancet Oncol 13: 1035-1044, 2012.
ACUTE MYELOID LEUKEMIA & ALLOGRAFT
Myeloablative vs Reduced-Intensity Conditioning
BMT CTN 0901
BMT CTN
Alternative Donor Graft Source Questions
No Matched-Related or MUD Available
GRAFT-VS-HOST DISEASE
Post-Transplant Cyclophosphamide
Acute GVHD
Chronic GVHD
N=117; Bu/CY
T-replete marrow
CY 50 mg/kg/d T+3, T+4
L Luznik, Hopkins. Blood 115: 3224-30, 2010.
BMT CTN Protocol 1101
Multi-center, Phase III, Randomized Trial of
Reduced Intensity Conditioning and Transplantation
Of Double Unrelated Umbilical Cord Blood versus
HLA-Haploidentical Related Bone Marrow for
Patients with Hematologic Malignancies
Followup to 2 independent BMT CTN phase II studies
BMT CTN 0603 and 0604
31%
54%
CG Brunstein, BMT CTN. Blood 118:282-288, 2011
45%
BMT CTN
Study Design Protocol 1101
Patient ≥ 18 and ≤70 yr
Acute leukemia or lymphoma
Adequate organ function
Performance score ≥70
No sibling or matched unrelated donor available, BUT:
• Double umbilical cord blood (UCB) graft
• Haploidentical related donor marrow (Haplo-BM)
• No donor specific anti-HLA-Ab
Randomization
Stratified by Transplant Center
Double
UCB
Haplo-BM
BMT CTN Protocol 1101
Minnesota Protocol (0604)
Haploidentical
Hopkins Protocol (0603)
Eliminate alloreactive T cells
BMT CTN
Manuscripts in Preparation
 0402 – Sirolimus vs methotrexate (in combo with tacrolimus)
to prevent acute GVHD : NO BENEFIT
 0403 – Etanercept for Idiopathic Pneumonia Syndrome:
NO BENEFIT
 0501 – Single vs double UCB transplant in children:
MORE GVHD with double; NO ADVANTAGE engraftment or
survival
 0502 – RIC HCT for older AML adults: GOOD RESULTS
 0802 – MMF as initial therapy for AGVHD: NO BENEFIT
BMT CTN
Future
• Continued accrual enhancement
• Continued publications in high-impact journals
• Repository trials: GVHD blood biomarkers
BMT CTN Protocol 1202
Prospective Multi-Center Cohort for the Evaluation of
Biomarkers Predicting Risk of Complications and Mortality
Following Allogeneic HCT
1,500 allogeneic patients over 4 yr: HCT only @ US centers
Samples collected for DNA, RNA, and proteins: R24
Building upon University of Michigan data and other sources
Data collection for post-transplant complications
BMT CTN Protocol 1202
Recipient Samples
Biomarker
Approach
Genetic
Proteomic
Gene
Expression
Sample
DNA
17mL
blood
Serum
(10 mL
blood)
PAXgene
Lysates(20 mL
blood)
No.
Pts
1500
1500
240
Days post-HCT
Pre-HCT
PreDay -1 or 7 14 ± 21 28 42
Conditioning
0
±2
2
±2 ±2 ±3
56 90
± 3 ±10
X
X
X
X
X
X
X
X
X
X
X
BMT CTN
Future (con’t)
• Partnering with other groups:
• IFM
• Canadians
• Germans
• Increased companion translational trials: obesity
• 3rd State of the Science Symposium
IFM/DFCI 2009
Phase III: Untreated Myeloma
•
Symptomatic myeloma with measurable disease
 <65 yrs and transplant-eligible; ECOG <2 (KPS ≥60%)
Initial
Therapy
RVD
Cycle 1
R
A
N
D
O
M
I
Z
E
Arm A
 RVD Cycles 2-3
 HD Cytoxan; collect cells
 RVD Cycles 4-8
 Maintenance lenalidomide
(Melphalan + HCT @ relapse)
Arm B
 RVD Cycles 2-3
 HD Cytoxan; collect cells
 HD Melphalan + HCT
RVD=lenalidomide;  RVD for 2 more cycles
bortezomib;
 Maintenance Lenalidomide
dexamethasone
1° Endpoint:
PFS
2° Endpoints:
relapse, TTP,
survival, QOL,
economics,
genetic
prognostic
BMT CTN
Future (con’t)
• Partnering with other groups:
• IFM
• Canadians
• Germans
• Increased companion translational trials: obesity
• 3rd State of the Science Symposium
COOPERATIVE ONCOLOGY GROUPS
Obesity and Myeloma: BMT CTN 0702
 Myeloma patients within 9 months of diagnosis
 Single autograft +/- consolidation versus tandem
autograft and maintenance
 N=750 patients (250 each arm)
 Uniformity of treatment:
 Melphalan 200 mg/m2 IV plus autograft
 Accrual nearly reached
COOPERATIVE ONCOLOGY GROUPS
Companion Investigation: Example
Myeloma is an obesity-driven disease
Critical questions
- What is impact of obesity on treatment and disease?
- If obesity has detrimental effects, what are the
mechanisms & how can these be addressed & improved?
- If obesity has beneficial effects, how can these be
identified and used to enhance therapeutic outcomes?
OBESITY AND MYELOMA
 Limitations of BMI (body mass index)
 Anthropomorphic measures of abdominal adiposity
 correlate with cardiovascular and cancer mortality:
 independent of BMI
 Which anthropomorphic measurements are better?
 Waist:Hip measure better indicator of visceral fat
 better correlation with incidence colon & ovarian cancer
C Zhang, et al. Circulation 117: 1658-1667, 2008
YC Wang, et al. Obesity 15: 2855-2865, 2007
OBESITY AND MYELOMA
 Opportunity to study prospectively other biologic
measurements
 Identify mechanisms by which obesity impacts therapy
 Identify mechanisms by which obesity affects disease
progression
 Identification of potential markers and mediators to impact
disease progression
COOPERATIVE ONCOLOGY GROUPS
Clinical Investigation: Example
Companion translational obesity study to transplant trial
Investigators:
HM Lazarus
E Campagnaro
NA Berger
Anthropomorphic measures at frequent intervals
Analysis of prospectively collected/archived blood samples
Measure Hip & Waist Circumference
OBESITY AND TRANSPLANT
Myeloma: BMT CTN 0702
Waist:Hip measurement
Plasma biomarkers
Adipokines/cytokines:
• adiponectin, leptin, IL-6, TNF-α
Hormones:
• insulin, C-peptide, pancreatic peptide (PP), peptide YY (PYY)
Growth factors:
• IGF-1, IGFBP-3
BMT CTN
Future (con’t)
• 3rd State of the Science Symposium
• February 24-25, 2014 @ Grapevine, TX