Ignite Creation Date:
2025-12-25 @ 5:04 AM
Ignite Modification Date:
2025-12-26 @ 4:07 AM
Study NCT ID:
NCT00499018
Status:
UNKNOWN
Last Update Posted:
2011-02-15
First Post:
2007-07-10
Is NOT Gene Therapy:
False
Has Adverse Events:
False
Brief Title:
Dose Dense Chemotherapy + Rituximab +/-Intensified High Dose Chemoimmunotherapy With Support of Peripheral Autologous Stem Cell in Diffuse Large B-Cell Lymphoma
Sponsor:
Organization:
Raw JSON
{'hasResults': False, 'derivedSection': {'miscInfoModule': {'versionHolder': '2025-12-24'}, 'conditionBrowseModule': {'meshes': [{'id': 'D016403', 'term': 'Lymphoma, Large B-Cell, Diffuse'}], 'ancestors': [{'id': 'D016393', 'term': 'Lymphoma, B-Cell'}, {'id': 'D008228', 'term': 'Lymphoma, Non-Hodgkin'}, {'id': 'D008223', 'term': 'Lymphoma'}, {'id': 'D009370', 'term': 'Neoplasms by Histologic Type'}, {'id': 'D009369', 'term': 'Neoplasms'}, {'id': 'D008232', 'term': 'Lymphoproliferative Disorders'}, {'id': 'D008206', 'term': 'Lymphatic Diseases'}, {'id': 'D006425', 'term': 'Hemic and Lymphatic Diseases'}, {'id': 'D007160', 'term': 'Immunoproliferative Disorders'}, {'id': 'D007154', 'term': 'Immune System Diseases'}]}, 'interventionBrowseModule': {'meshes': [{'id': 'D000069283', 'term': 'Rituximab'}, {'id': 'D003520', 'term': 'Cyclophosphamide'}, {'id': 'D004317', 'term': 'Doxorubicin'}, {'id': 'D014750', 'term': 'Vincristine'}, {'id': 'D011241', 'term': 'Prednisone'}, {'id': 'C455861', 'term': 'pegfilgrastim'}, {'id': 'D008942', 'term': 'Mitoxantrone'}, {'id': 'D003561', 'term': 'Cytarabine'}, {'id': 'D000078224', 'term': 'Lenograstim'}, {'id': 'D002330', 'term': 'Carmustine'}, {'id': 'D005047', 'term': 'Etoposide'}], 'ancestors': [{'id': 'D058846', 'term': 'Antibodies, Monoclonal, Murine-Derived'}, {'id': 'D000911', 'term': 'Antibodies, Monoclonal'}, {'id': 'D000906', 'term': 'Antibodies'}, {'id': 'D007136', 'term': 'Immunoglobulins'}, {'id': 'D007162', 'term': 'Immunoproteins'}, {'id': 'D001798', 'term': 'Blood Proteins'}, {'id': 'D011506', 'term': 'Proteins'}, {'id': 'D000602', 'term': 'Amino Acids, Peptides, and Proteins'}, {'id': 'D012712', 'term': 'Serum Globulins'}, {'id': 'D005916', 'term': 'Globulins'}, {'id': 'D010752', 'term': 'Phosphoramide Mustards'}, {'id': 'D009588', 'term': 'Nitrogen Mustard Compounds'}, {'id': 'D009150', 'term': 'Mustard Compounds'}, {'id': 'D006846', 'term': 'Hydrocarbons, Halogenated'}, {'id': 'D006838', 'term': 'Hydrocarbons'}, {'id': 'D009930', 'term': 'Organic Chemicals'}, {'id': 'D063088', 'term': 'Phosphoramides'}, {'id': 'D009943', 'term': 'Organophosphorus Compounds'}, {'id': 'D003630', 'term': 'Daunorubicin'}, {'id': 'D018943', 'term': 'Anthracyclines'}, {'id': 'D009279', 'term': 'Naphthacenes'}, {'id': 'D011084', 'term': 'Polycyclic Aromatic Hydrocarbons'}, {'id': 'D006841', 'term': 'Hydrocarbons, Aromatic'}, {'id': 'D006844', 'term': 'Hydrocarbons, Cyclic'}, {'id': 'D011083', 'term': 'Polycyclic Compounds'}, {'id': 'D000617', 'term': 'Aminoglycosides'}, {'id': 'D006027', 'term': 'Glycosides'}, {'id': 'D002241', 'term': 'Carbohydrates'}, {'id': 'D014748', 'term': 'Vinca Alkaloids'}, {'id': 'D046948', 'term': 'Secologanin Tryptamine Alkaloids'}, {'id': 'D026121', 'term': 'Indole Alkaloids'}, {'id': 'D000470', 'term': 'Alkaloids'}, {'id': 'D006571', 'term': 'Heterocyclic Compounds'}, {'id': 'D007211', 'term': 'Indoles'}, {'id': 'D006574', 'term': 'Heterocyclic Compounds, 2-Ring'}, {'id': 'D000072471', 'term': 'Heterocyclic Compounds, Fused-Ring'}, {'id': 'D054836', 'term': 'Indolizidines'}, {'id': 'D007212', 'term': 'Indolizines'}, {'id': 'D011244', 'term': 'Pregnadienediols'}, {'id': 'D011245', 'term': 'Pregnadienes'}, {'id': 'D011278', 'term': 'Pregnanes'}, {'id': 'D013256', 'term': 'Steroids'}, {'id': 'D000072473', 'term': 'Fused-Ring Compounds'}, {'id': 'D000880', 'term': 'Anthraquinones'}, {'id': 'D000095322', 'term': 'Anthrones'}, {'id': 'D000873', 'term': 'Anthracenes'}, {'id': 'D011809', 'term': 'Quinones'}, {'id': 'D003562', 'term': 'Cytidine'}, {'id': 'D011741', 'term': 'Pyrimidine Nucleosides'}, {'id': 'D011743', 'term': 'Pyrimidines'}, {'id': 'D006573', 'term': 'Heterocyclic Compounds, 1-Ring'}, {'id': 'D001087', 'term': 'Arabinonucleosides'}, {'id': 'D009705', 'term': 'Nucleosides'}, {'id': 'D009706', 'term': 'Nucleic Acids, Nucleotides, and Nucleosides'}, {'id': 'D016179', 'term': 'Granulocyte Colony-Stimulating Factor'}, {'id': 'D003115', 'term': 'Colony-Stimulating Factors'}, {'id': 'D006023', 'term': 'Glycoproteins'}, {'id': 'D006001', 'term': 'Glycoconjugates'}, {'id': 'D016298', 'term': 'Hematopoietic Cell Growth Factors'}, {'id': 'D016207', 'term': 'Cytokines'}, {'id': 'D036341', 'term': 'Intercellular Signaling Peptides and Proteins'}, {'id': 'D010455', 'term': 'Peptides'}, {'id': 'D001685', 'term': 'Biological Factors'}, {'id': 'D009607', 'term': 'Nitrosourea Compounds'}, {'id': 'D014508', 'term': 'Urea'}, {'id': 'D000577', 'term': 'Amides'}, {'id': 'D009603', 'term': 'Nitroso Compounds'}, {'id': 'D011034', 'term': 'Podophyllotoxin'}, {'id': 'D013764', 'term': 'Tetrahydronaphthalenes'}, {'id': 'D009281', 'term': 'Naphthalenes'}, {'id': 'D005960', 'term': 'Glucosides'}]}}, 'protocolSection': {'designModule': {'phases': ['PHASE3'], 'studyType': 'INTERVENTIONAL', 'designInfo': {'allocation': 'RANDOMIZED', 'maskingInfo': {'masking': 'NONE'}, 'primaryPurpose': 'TREATMENT', 'interventionModel': 'PARALLEL'}, 'enrollmentInfo': {'type': 'ESTIMATED', 'count': 399}}, 'statusModule': {'overallStatus': 'UNKNOWN', 'lastKnownStatus': 'ACTIVE_NOT_RECRUITING', 'startDateStruct': {'date': '2006-01'}, 'expandedAccessInfo': {'hasExpandedAccess': False}, 'statusVerifiedDate': '2011-02', 'completionDateStruct': {'date': '2013-09', 'type': 'ESTIMATED'}, 'lastUpdateSubmitDate': '2011-02-14', 'studyFirstSubmitDate': '2007-07-10', 'studyFirstSubmitQcDate': '2007-07-10', 'lastUpdatePostDateStruct': {'date': '2011-02-15', 'type': 'ESTIMATED'}, 'studyFirstPostDateStruct': {'date': '2007-07-11', 'type': 'ESTIMATED'}, 'primaryCompletionDateStruct': {'date': '2011-06', 'type': 'ESTIMATED'}}, 'outcomesModule': {'primaryOutcomes': [{'measure': 'To evaluate the activity of arms "R-MegaCHOP14/R-CHOP14 + R-MAD+BEAM and ASCT" and "R-MegaCHOP14/R-CHOP14" in terms of 2-years Failure Free Survival (FFS).', 'timeFrame': '2 years'}], 'secondaryOutcomes': [{'measure': 'To evaluate the activity of arms "R-MegaCHOP14/R-CHOP14 + R-MAD+BEAM and ASCT" and "R-MegaCHOP14/R-CHOP14" in terms of 3-years Overall Survival (OS).', 'timeFrame': '3 years'}, {'measure': 'To evaluate the efficacy of two different dose-dense + Rituximab chemotherapy regimens in term of 2-years Failure Free Survival (FFS).', 'timeFrame': '2 years'}, {'measure': 'To evaluate the activity of the first four courses of two different dose dense + Rituximab chemotherapy regimens (standard dose R-CHOP14 or intensified dose R-MegaCHOP14) in terms of Overall Response Rate (ORR) and Complete Remission (RC).', 'timeFrame': '2 years'}, {'measure': 'To evaluate the efficacy of the four different induction arms in terms of 2-years FFS (exploratory analysis).', 'timeFrame': '2 years'}]}, 'oversightModule': {'oversightHasDmc': False}, 'conditionsModule': {'keywords': ['Large B-Cell Lymphoma', 'Rituximab', 'Autologous Stem Cell Transplantation'], 'conditions': ['Diffuse Large B-Cell Lymphoma', 'IPI≥2']}, 'referencesModule': {'references': [{'pmid': '32817282', 'type': 'DERIVED', 'citation': 'Derenzini E, Mazzara S, Melle F, Motta G, Fabbri M, Bruna R, Agostinelli C, Cesano A, Corsini CA, Chen N, Righi S, Sabattini E, Chiappella A, Calleri A, Fiori S, Tabanelli V, Cabras A, Pruneri G, Vitolo U, Gianni AM, Rambaldi A, Corradini P, Zinzani PL, Tarella C, Pileri S. A three-gene signature based on MYC, BCL-2 and NFKBIA improves risk stratification in diffuse large B-cell lymphoma. Haematologica. 2021 Sep 1;106(9):2405-2416. doi: 10.3324/haematol.2019.236455.'}, {'pmid': '28668386', 'type': 'DERIVED', 'citation': "Chiappella A, Martelli M, Angelucci E, Brusamolino E, Evangelista A, Carella AM, Stelitano C, Rossi G, Balzarotti M, Merli F, Gaidano G, Pavone V, Rigacci L, Zaja F, D'Arco A, Cascavilla N, Russo E, Castellino A, Gotti M, Congiu AG, Cabras MG, Tucci A, Agostinelli C, Ciccone G, Pileri SA, Vitolo U. Rituximab-dose-dense chemotherapy with or without high-dose chemotherapy plus autologous stem-cell transplantation in high-risk diffuse large B-cell lymphoma (DLCL04): final results of a multicentre, open-label, randomised, controlled, phase 3 study. Lancet Oncol. 2017 Aug;18(8):1076-1088. doi: 10.1016/S1470-2045(17)30444-8. Epub 2017 Jun 28."}]}, 'descriptionModule': {'briefSummary': 'The purpose of this study is to define an improvement in patients randomized in four different arms:\n\nArm 1: R-MegaCHOP14x4 + R-MAD + MAD + BEAM + ASCT; Arm 1BIS: R-CHOP14x4 + R-MAD + MAD + BEAM + ASCT; Arm 2: R-MegaCHOP14x4 + R-MegaCHOP14x2; Arm 2BIS: R-CHOP14x4 + R-CHOP14x4; Which are different in dose dense chemotherapy + Rituximab with or without intensified high dose chemoimmunotherapy and support of peripheral autologous stem cells.'}, 'eligibilityModule': {'sex': 'ALL', 'stdAges': ['ADULT'], 'maximumAge': '60 Years', 'minimumAge': '18 Years', 'healthyVolunteers': False, 'eligibilityCriteria': "Inclusion Criteria:\n\n1. Age 18-60;\n2. Histological confirmed diagnosis of Diffuse Large B-Cell Lymphoma CD20+ (newly diagnosis or shifted from low grade NHL and not previously treated) or of Follicular Lymphoma grade III according to REAL/WHO Classification.\n3. Advanced stage II, stage III and stage IV with at least two aa-IPI risk factors.\n4. Age-adjusted IPI 2-3.\n5. ECOG performance status 0-2.\n6. LVEF\\>45%, measured with echocardiography.\n7. Normal hepatic, renal and pulmonary functions.\n8. HIV, HCV and HBV negativity.\n9. HCV+ admitted only in histologically confirmed absence of replication marks.\n10. Positive serology for HBV (occult carriers: AntiHBcAg+, HbsAg-, AntiHBsAg+/-) admitted only upon negativity of weakly positive HBV-DNA test.\n11. Life expectancy \\> 3 months.\n12. Negative pregnancy test.\n13. Written Informed Consent.\n\nExclusion Criteria:\n\n1. Histological diagnosis of:\n\n * Lymphoblastic NHL\n * Burkitt's Lymphoma\n * CD 20 negative B-cell Lymphoma\n * grade I-IIIa Follicular Lymphoma\n * Mantle Cell Lymphoma\n * Primary mediastinal NHL with exclusively intrathoracic localization.\n2. Age \\> 60\n3. Stage I disease\n4. Age-adjusted IPI 0-1\n5. ECOG-PS\\>3, if not related to Lymphoma\n6. Renal impairment (creatinine\\>1,2 mg/dl or creatinine clearance \\< 60ml/min)\n7. Hepatic impairment (AST/ALT or bilirubin \\> 2,5 times normal limit, unless due to Lymphoma)\n8. HIV positive patients and/or with HBV or HCV active infection(documented by HBV-DNA and HCV-RNA positive tests)\n9. Clinically significant secondary cardiovascular disease e.g. uncontrolled hypertension (resting diastolic blood pressure \\> 115 mmHG), uncontrolled multifocal cardiac arrhythmias, symptomatic angina pectoris or congestive cardiac failure NYHA class III-IV\n10. LFEV\\<45%\n11. Severe diabetes mellitus difficult to control with adequate insulin therapy\n12. Severe chronic obstructive pulmonary disease with hypoxemia\n13. Active bacterial, viral of fungal infection requiring systemic therapy\n14. Concurrent thrombohemolytic disease\n15. HIV positivity\n16. HBV positivity\n17. Positive serology for HBV (occult carriers: AntiHBc+, HbsAg-, AntiHbs+/-) with positive HBV-DNA test\n18. HCV positivity in presence of replication marks (HCV+, CRP+, AST 1,5-2 times normal ranges)\n19. CNS localization of disease\n20. Prior (during last 3 years) or concurrent malignancy except adequately treated basal cell carcinoma of the skin or carcinoma in situ of the cervix or early stage prostate cancer not requiring systemic therapy, or early breast cancer treated with surgery alone. Any other co.existing medical condition that would preclude study therapy administration\n21. Pregnancy or breast-feeding women\n22. Inability of the patient to give her/his informed consent\n23. Known hypersensitivity or anaphylactic reaction to murine antibodies or proteins"}, 'identificationModule': {'nctId': 'NCT00499018', 'acronym': 'DLCL04', 'briefTitle': 'Dose Dense Chemotherapy + Rituximab +/-Intensified High Dose Chemoimmunotherapy With Support of Peripheral Autologous Stem Cell in Diffuse Large B-Cell Lymphoma', 'organization': {'class': 'OTHER', 'fullName': 'Fondazione Italiana Linfomi - ETS'}, 'officialTitle': 'A Randomised Multicentric Phase III Study for the Treatment of Young Patients With High Risk (IPI 2-3) Diffuse Large B-Cell Lymphoma. Dose Dense Chemotherapy + Rituximab +/- Intensified High Dose Chemoimmunotherapy With Support of Peripheral Autologous Stem Cells.', 'orgStudyIdInfo': {'id': 'IIL-DLCL04'}, 'secondaryIdInfos': [{'id': 'EudraCT number 2007-000275-42'}]}, 'armsInterventionsModule': {'armGroups': [{'type': 'EXPERIMENTAL', 'label': '1', 'description': 'R-MegaCHOP14 x 4 Restaging + R-MAD + MAD + BEAM + ASCT', 'interventionNames': ['Drug: Rituximab', 'Drug: Ciclofosfamide', 'Drug: Doxorubicina', 'Drug: Vincristina', 'Drug: Prednisone', 'Drug: Pegfilgrastim', 'Drug: Mitoxantrone', 'Drug: ARA-C', 'Drug: Lenograstim', 'Drug: BCNU', 'Drug: VP-16', 'Procedure: ASCT']}, {'type': 'EXPERIMENTAL', 'label': '1 BIS', 'description': 'R-CHOP14 x 4 Restaging + R-MAD + MAD + BEAM + ASCT', 'interventionNames': ['Drug: Rituximab', 'Drug: Vincristina', 'Drug: Prednisone', 'Drug: Pegfilgrastim', 'Drug: Lenograstim', 'Drug: BCNU', 'Drug: ARA-C', 'Drug: VP-16', 'Procedure: ASCT', 'Drug: Ciclofosfamide', 'Drug: Doxorubicina']}, {'type': 'EXPERIMENTAL', 'label': '2', 'description': 'R-MegaCHOP14 x 4 Restaging + R-MegaCHOP x 2', 'interventionNames': ['Drug: Rituximab', 'Drug: Ciclofosfamide', 'Drug: Doxorubicina', 'Drug: Vincristina', 'Drug: Prednisone', 'Drug: Pegfilgrastim', 'Drug: Mitoxantrone', 'Drug: ARA-C']}, {'type': 'EXPERIMENTAL', 'label': '2 BIS', 'description': 'R-CHOP14 x 4 Restaging + R-CHOP14 x 4', 'interventionNames': ['Drug: Rituximab', 'Drug: Vincristina', 'Drug: Prednisone', 'Drug: Ciclofosfamide', 'Drug: Doxorubicina']}], 'interventions': [{'name': 'Rituximab', 'type': 'DRUG', 'description': '375 mg/m2 day 1', 'armGroupLabels': ['1', '1 BIS', '2', '2 BIS']}, {'name': 'Ciclofosfamide', 'type': 'DRUG', 'description': '1200 mg/m2 day 1', 'armGroupLabels': ['1', '2']}, {'name': 'Doxorubicina', 'type': 'DRUG', 'description': '70 mg/m2 day 1', 'armGroupLabels': ['1', '2']}, {'name': 'Vincristina', 'type': 'DRUG', 'description': '1,4 mg/m2 (max 2 mg) day 1', 'armGroupLabels': ['1', '1 BIS', '2', '2 BIS']}, {'name': 'Prednisone', 'type': 'DRUG', 'description': '100 mg day g 1-5', 'armGroupLabels': ['1', '1 BIS', '2', '2 BIS']}, {'name': 'Pegfilgrastim', 'type': 'DRUG', 'description': '6 mg day +1', 'armGroupLabels': ['1', '1 BIS', '2']}, {'name': 'Mitoxantrone', 'type': 'DRUG', 'description': '8 mg/m2/days 1-3', 'armGroupLabels': ['1', '2']}, {'name': 'ARA-C', 'type': 'DRUG', 'description': '2000 mg/m2/12h day 1 - 3', 'armGroupLabels': ['1', '2']}, {'name': 'Lenograstim', 'type': 'DRUG', 'description': '5 μg/Kg/days +2', 'armGroupLabels': ['1', '1 BIS']}, {'name': 'BCNU', 'type': 'DRUG', 'description': '300 mg/m2 day -7', 'armGroupLabels': ['1', '1 BIS']}, {'name': 'ARA-C', 'type': 'DRUG', 'description': '200 mg/m2/12 days -6,-5,-4,-3', 'armGroupLabels': ['1', '1 BIS']}, {'name': 'VP-16', 'type': 'DRUG', 'description': '100 mg/m2/12h days -6,-5,-4,-3', 'armGroupLabels': ['1', '1 BIS']}, {'name': 'ASCT', 'type': 'PROCEDURE', 'description': 'PBSC Reinfusion', 'armGroupLabels': ['1', '1 BIS']}, {'name': 'Ciclofosfamide', 'type': 'DRUG', 'description': '750 mg/m2 day 1', 'armGroupLabels': ['1 BIS', '2 BIS']}, {'name': 'Doxorubicina', 'type': 'DRUG', 'description': '50 mg/m2 day 1', 'armGroupLabels': ['1 BIS', '2 BIS']}, {'name': 'Vincristina', 'type': 'DRUG', 'description': '1,4 mg/m2 (max 2 mg) day 1', 'armGroupLabels': ['1 BIS', '2 BIS']}]}, 'contactsLocationsModule': {'locations': [{'city': 'Nocera Inferiore', 'state': 'Salerno', 'country': 'Italy', 'facility': 'Ospedale Umberto I - DH Oncoematologico', 'geoPoint': {'lat': 40.7454, 'lon': 14.64542}}, {'city': 'Mestre', 'state': 'Venezia', 'country': 'Italy', 'facility': 'Ospedale Civile Umberto I', 'geoPoint': {'lat': 45.49167, 'lon': 12.24538}}, {'city': 'Mirano', 'state': 'Venezia', 'country': 'Italy', 'facility': 'Osp. Calvi, Noale', 'geoPoint': {'lat': 45.49458, 'lon': 12.10775}}, {'city': 'Alessandria', 'country': 'Italy', 'facility': 'Az. Osp. SS. Antonio e Biagio e Cesare Arrigo', 'geoPoint': {'lat': 44.90924, 'lon': 8.61007}}, {'city': 'Asti', 'country': 'Italy', 'facility': 'Ospedale Cardinal Massaia', 'geoPoint': {'lat': 44.90162, 'lon': 8.20751}}, {'city': 'Aviano - PN', 'country': 'Italy', 'facility': 'Centro di Riferimento Oncologico'}, {'city': 'Bari', 'country': 'Italy', 'facility': 'Azienda Ospedale Policlinico Consorziale', 'geoPoint': {'lat': 41.12066, 'lon': 16.86982}}, {'city': 'Bari', 'country': 'Italy', 'facility': 'IRCC Istituto tumori Ematologia', 'geoPoint': {'lat': 41.12066, 'lon': 16.86982}}, {'city': 'Biella', 'country': 'Italy', 'facility': 'Osp. Degli Infermi', 'geoPoint': {'lat': 45.56304, 'lon': 8.05796}}, {'city': 'Bologna', 'country': 'Italy', 'facility': 'Ospedale Policlinico S. Orsola Malpighi', 'geoPoint': {'lat': 44.49381, 'lon': 11.33875}}, {'city': 'Brescia', 'country': 'Italy', 'facility': 'Spedali Civili', 'geoPoint': {'lat': 45.53558, 'lon': 10.21472}}, {'city': 'Brescia', 'country': 'Italy', 'facility': 'UTMO Ematologia Università Spedali Civili', 'geoPoint': {'lat': 45.53558, 'lon': 10.21472}}, {'city': 'Brindisi', 'country': 'Italy', 'facility': 'Stabilimento "Perrino"', 'geoPoint': {'lat': 40.63215, 'lon': 17.93607}}, {'city': 'Busto Arsizio - VA', 'country': 'Italy', 'facility': 'Ospedale di Circolo'}, {'city': 'Cagliari', 'country': 'Italy', 'facility': 'Ospedale Armando Businco', 'geoPoint': {'lat': 39.23054, 'lon': 9.11917}}, {'city': 'Campobasso', 'country': 'Italy', 'facility': 'Università Cattolica del Sacro Cuore', 'geoPoint': {'lat': 41.55947, 'lon': 14.66737}}, {'city': 'Candiolo (TO)', 'country': 'Italy', 'facility': 'IRCC', 'geoPoint': {'lat': 44.95858, 'lon': 7.59812}}, {'city': 'Catanzaro', 'country': 'Italy', 'facility': 'Ospedale Pugliese', 'geoPoint': {'lat': 38.88247, 'lon': 16.60086}}, {'city': 'Cesena - FC', 'country': 'Italy', 'facility': 'Ospedale Bufalini'}, {'city': 'Ciriè - to', 'country': 'Italy', 'facility': 'Stabilimento Ospedaliero'}, {'city': 'Civitanova Marche (MC)', 'country': 'Italy', 'facility': 'Ospedale Generale di Zona', 'geoPoint': {'lat': 43.30491, 'lon': 13.72068}}, {'city': 'Cosenza', 'country': 'Italy', 'facility': 'Presidio Ospedaliero Annunziata', 'geoPoint': {'lat': 39.2989, 'lon': 16.25307}}, {'city': 'Cremona', 'country': 'Italy', 'facility': 'Istituti Ospitalieri', 'geoPoint': {'lat': 45.13325, 'lon': 10.02129}}, {'city': 'Florence', 'country': 'Italy', 'facility': 'Az. Ospedaliero Universitaria Careggi', 'geoPoint': {'lat': 43.77925, 'lon': 11.24626}}, {'city': 'Forlì', 'country': 'Italy', 'facility': 'Stabilimento Forlì', 'geoPoint': {'lat': 44.22177, 'lon': 12.04144}}, {'city': 'Genova', 'country': 'Italy', 'facility': 'Azienda Universitaria San Martino', 'geoPoint': {'lat': 45.21604, 'lon': 11.87211}}, {'city': 'Ivrea', 'country': 'Italy', 'facility': 'A.S.L. 9', 'geoPoint': {'lat': 45.46723, 'lon': 7.87617}}, {'city': 'La Spezia', 'country': 'Italy', 'facility': 'Ospedale Felettino', 'geoPoint': {'lat': 44.103, 'lon': 9.82375}}, {'city': 'Lecce', 'country': 'Italy', 'facility': 'Istituto Vito Fazzi', 'geoPoint': {'lat': 40.35481, 'lon': 18.17244}}, {'city': 'Messina', 'country': 'Italy', 'facility': 'Azienda Ospedaliera Papardo', 'geoPoint': {'lat': 38.19394, 'lon': 15.55256}}, {'city': 'Messina', 'country': 'Italy', 'facility': 'Azienda Ospedaliero Universitaria Policlinico Gaetano Martino', 'geoPoint': {'lat': 38.19394, 'lon': 15.55256}}, {'city': 'Milan', 'country': 'Italy', 'facility': 'Istituto Europeo di Oncologia', 'geoPoint': {'lat': 42.78235, 'lon': 12.59836}}, {'city': 'Milan', 'country': 'Italy', 'facility': 'Osp. 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