Site Contact Information

15-MMUD: A Multi-Center, Phase II Trial of HLA-Mismatched Unrelated Donor Bone Marrow with Post-Transplantation Cyclophosphamide for Patients with Hematologic Malignancies

Site Name: CIBMTR Center # (CCN):

Principal Investigator:

Name/Title:
Address:
FedEx delivery address:
City, State, Zip:
Phone:
Pager (optional):
Fax:
E-mail:
Administrative Assistant:
Name:
Phone:
E-mail:

Sub-Investigators:

Name/Title:
Address:
FedEx delivery address:
City, State, Zip:
Phone:
Pager (optional):
Fax:
E-mail:
Name/Title:
Address:
FedEx delivery address:
City, State, Zip:
Phone:
Pager (optional):
Fax:
E-mail:

Primary Study Coordinator:

Name/Title:
Address
FedEx delivery address:
City, State, Zip:
Phone:
Pager (optional):
Fax:
E-mail:

CIBMTR Data Manager: (or Not applicable)

Name/Title :
Phone:
Fax:
E-mail:

IRB/Regulatory Contact:

Name/Title:
FedEx delivery address:
City, State, Zip:
Phone:
Fax:
E-mail:

Contracts Contact:

Name/Title:
FedEx delivery address:
City, State, Zip:
Phone:
Fax:
E-mail:
Study Tax ID:

Study Payments: (if different from Contracts information listed above)

Name/Title:
FedEx delivery address:
City, State, Zip:
N/A (same as Contracts information listed above)

Additional Study Staff: (if applicable)

Study Coordinator Pharmacy contact (if applicable) Other

Name/Title:
FedEx delivery address:
City, State, Zip:
Phone:
E-mail:

Additional Information:

How often does your local IRB meet? / Weekly Bi-weekly Monthly Other
Are there any other committees at your institution that are required to review the protocol? (e.g., Scientific Review committee, Pharmacy Committee) / No
Yes (Please list review committees)
What is the anticipated or average time at your site from protocol receipt to IRB approval and contract execution?
How often does your institution require a Principal Investigator to complete Human Research Subject Protection training? / Years Other, describe:
How many subjects do you estimate enrolling in this study during a 12 month accrual period
Do you have knowledge of any studies at your site competing with this study for the same patient population? / No Yes

Thank you for providing this important information. Please return by e-mail to Michael Tierney.