| ID | Type | Description | Link |
|---|---|---|---|
| 04-C-0288 | |||
| NCI-7025 | |||
| NCI-PRMC-P6273 | |||
| CDR0000393480 |
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| Name | Class |
|---|---|
| National Cancer Institute (NCI) | NIH |
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RATIONALE: Drugs used in chemotherapy, such as cyclophosphamide and fludarabine, work in different ways to stop tumor cells from dividing so they stop growing or die. Radiation therapy uses high-energy x-rays to damage tumor cells. Biological therapies, such as cellular adoptive immunotherapy, work in different ways to stimulate the immune system and stop tumor cells from growing. Autologous stem cell transplant may be able to replace immune cells that were destroyed by chemotherapy and radiation therapy. Interleukin-2 may stimulate a person's lymphocytes to kill tumor cells. Combining chemotherapy, radiation therapy, and biological therapy may kill more tumor cells.
PURPOSE: This phase II trial is studying how well giving cyclophosphamide and fludarabine together with radiation therapy followed by cellular adoptive immunotherapy, autologous stem cell transplant, and interleukin-2 works in treating patients with metastatic melanoma.
OBJECTIVES:
Primary
Secondary
OUTLINE:
Autologous stem cell collection: Patients receive filgrastim (G-CSF) subcutaneously (SC) twice daily for 8 days. Beginning on day 5 of G-CSF, patients undergo apheresis daily for up to 3 days. Patients may receive 1 additional course of G-CSF and apheresis or use stem cells stored from a prior stem cell harvest in order to obtain an adequate number of cells.
Lymphocyte-depleting myeloablative preparative regimen: Patients receive cyclophosphamide intravenous (IV) over 1 hour on days -5 and -6 and fludarabine IV over 15-30 minutes on days -6 to -2. Patients also undergo total body irradiation on day -1.
Autologous lymphocyte infusion: Patients receive autologous tumor-reactive tumor-infiltrating lymphocytes IV over 20-30 minutes on day 0* followed by G-CSF SC once daily until blood counts recover.
Autologous stem cell transplantation: Patients receive autologous CD34+ stem cells IV on day 2.
Interleukin therapy: Patients are assigned to 1 of 2 cohorts, depending on whether they have received prior high-dose interleukin-2 (IL-2).
NOTE: *Day 0 is 1-4 days after the last dose of fludarabine.
Patients are evaluated at 4-6 weeks.
PROJECTED ACCRUAL: A total of 116 patients will be accrued for this study.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| TBI 200cGy + TIL +HD IL-2, prior IL-2 | Other | Patients will receive 2Gy of total body irradiation (TBI) at a rate of 0.07 Gy/minute using a linear accelerator. Lymphocytes that that are isolated from the tumor, grown in the laboratory to high amounts and then infused into the patient. |
|
| TBI 200cGy + TIL +HD IL-2, No prior IL-2 | Other | Patients will receive 2Gy of total body irradiation (TBI) at a rate of 0.07 Gy/minute using a linear accelerator. Lymphocytes that that are isolated from the tumor, grown in the laboratory to high amounts and then infused into the patient. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| aldesleukin | Biological | high dose: 720,000 IU/kg intravenously over 15 minutes every 8 hours for up to 5 days (maximum 5 doses) or low dose: 250,000 IU/kg subcutaneously daily for 5 days, after a two day rest, 125,000 IU/kg subcutaneously daily for 5 days for five weeks (2 days rest per week) |
| Measure | Description | Time Frame |
|---|---|---|
| Clinical Tumor Regression | Tumor regression is defined as a complete response (CR) or partial response (PR) and was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST). Complete response is the disappearance of all target lesions. Partial response is at least a 30% decrease in the sum of the longest diameter (LD) of target lesions taking as reference the baseline sum LD. | Every 4-6 weeks for up to 1 year, and then every 6 months for up to 5 years. |
| Safety | Here is the number of participants with adverse events. For a detailed list of adverse events see the adverse event module. | 4 years |
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DISEASE CHARACTERISTICS:
PATIENT CHARACTERISTICS:
Age
Performance status
Life expectancy
Hematopoietic
Hepatic
Renal
Cardiovascular
Pulmonary
Immunologic
No active major immunologic illness
No active systemic infections
No primary or secondary immunodeficiency
Fully recovered immune competence after prior chemotherapy or radiotherapy as evidenced by both of the following:
Human Immunodeficiency virus (HIV) negative
Epstein-Barr virus positive
Other
PRIOR CONCURRENT THERAPY:
Biologic therapy
Chemotherapy
Endocrine therapy
Radiotherapy
Surgery
Other
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| Name | Affiliation | Role |
|---|---|---|
| Steven A. Rosenberg, MD, PhD | NCI - Surgery Branch | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Warren Grant Magnuson Clinical Center - NCI Clinical Trials Referral Office | Bethesda | Maryland | 20892-1182 | United States | ||
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 22555974 | Derived | Yao X, Ahmadzadeh M, Lu YC, Liewehr DJ, Dudley ME, Liu F, Schrump DS, Steinberg SM, Rosenberg SA, Robbins PF. Levels of peripheral CD4(+)FoxP3(+) regulatory T cells are negatively associated with clinical response to adoptive immunotherapy of human cancer. Blood. 2012 Jun 14;119(24):5688-96. doi: 10.1182/blood-2011-10-386482. Epub 2012 May 3. |
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Of the 34 participants who were enrolled, 8 patients were not assigned to treatment since their TIL did not grow. Of the 26 assigned to treatment, 1 patient was not actually treated therefore only 25 patients were evaluable.
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| ID | Title | Description |
|---|---|---|
| FG000 | TBI 200cGy + TIL +HD IL-2, Prior IL-2 | Patients will receive 2Gy of total body irradiation (TBI) at a rate of 0.07 Gy/minute using a linear accelerator. Lymphocytes that that are isolated from the tumor, grown in the laboratory to high amounts and then infused into the patient. |
| FG001 |
| Title | Milestones | Reasons Not Completed | |||||
|---|---|---|---|---|---|---|---|
| Overall Study |
|
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| filgrastim | Biological | 10 mcg/kg/day daily subcutaneously until neutrophil count >1x10^9/1. |
|
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| therapeutic tumor infiltrating lymphocytes | Biological | Lymphocytes that are isolated from the tumor, grown in the laboratory to high amounts and then infused into the patient. |
|
| cyclophosphamide | Drug | 60 mg/kg/day x 2 days intravenously over 1 hour |
|
|
| fludarabine phosphate | Drug | 25 mg/m^2/day intravenous piggyback daily over 15-20 minutes for 5 days |
|
|
| radiation therapy | Radiation | Patients will receive 2Gy of total body irradiation (TBI) at a rate of 0.07 Gy/minute using a linear accelerator. |
|
|
| NCI - Surgery Branch |
| Bethesda |
| Maryland |
| 20892-1201 |
| United States |
| TBI 200cGy + TIL +HD IL-2, No Prior IL-2 |
Patients will receive 2Gy of total body irradiation (TBI) at a rate of 0.07 Gy/minute using a linear accelerator. Lymphocytes that that are isolated from the tumor, grown in the laboratory to high amounts and then infused into the patient. |
| COMPLETED |
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| NOT COMPLETED |
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| ID | Title | Description |
|---|---|---|
| BG000 | TBI 200cGy + TIL +HD IL-2, Prior IL-2 | Patients will receive 2Gy of total body irradiation (TBI) at a rate of 0.07 Gy/minute using a linear accelerator. Lymphocytes that that are isolated from the tumor, grown in the laboratory to high amounts and then infused into the patient. |
| BG001 | TBI 200cGy + TIL +HD IL-2, No Prior IL-2 | Patients will receive 2Gy of total body irradiation (TBI) at a rate of 0.07 Gy/minute using a linear accelerator. Lymphocytes that that are isolated from the tumor, grown in the laboratory to high amounts and then infused into the patient. |
| BG002 | Total | Total of all reporting groups |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants | Participants |
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| Age, Continuous | Mean | Standard Deviation | years |
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| Sex: Female, Male | Count of Participants | Participants |
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| Ethnicity (NIH/OMB) | Count of Participants | Participants |
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| Race (NIH/OMB) | Count of Participants | Participants |
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| Region of Enrollment | Number | participants |
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| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | ||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Clinical Tumor Regression | Tumor regression is defined as a complete response (CR) or partial response (PR) and was assessed by the Response Evaluation Criteria in Solid Tumors (RECIST). Complete response is the disappearance of all target lesions. Partial response is at least a 30% decrease in the sum of the longest diameter (LD) of target lesions taking as reference the baseline sum LD. | Posted | Number | Participants | Every 4-6 weeks for up to 1 year, and then every 6 months for up to 5 years. |
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| Primary | Safety | Here is the number of participants with adverse events. For a detailed list of adverse events see the adverse event module. | Posted | Number | Participants | 4 years |
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | TBI 200cGy + TIL +HD IL-2, Prior IL-2 | Patients will receive 2Gy of total body irradiation (TBI) at a rate of 0.07 Gy/minute using a linear accelerator. Lymphocytes that that are isolated from the tumor, grown in the laboratory to high amounts and then infused into the patient. | 3 | 22 | 22 | 22 | ||
| EG001 | TBI 200cGy + TIL +HD IL-2, No Prior IL-2 | Patients will receive 2Gy of total body irradiation (TBI) at a rate of 0.07 Gy/minute using a linear accelerator. Lymphocytes that that are isolated from the tumor, grown in the laboratory to high amounts and then infused into the patient. | 1 | 3 | 3 | 3 |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Fatigue | General disorders | CTCv3.0 | Systematic Assessment |
| |
| Dehydration | Gastrointestinal disorders | CTCv3.0 | Systematic Assessment |
| |
| Infection | Infections and infestations | CTCv3.0 | Systematic Assessment |
| |
| Somnolence/depressed level of consciousness | Nervous system disorders | CTCv3.0 | Systematic Assessment |
| |
| Dyspnea | Respiratory, thoracic and mediastinal disorders | CTCv3.0 | Systematic Assessment |
| |
| Hypoxia | Respiratory, thoracic and mediastinal disorders | CTCv3.0 | Systematic Assessment |
| |
| Pneumonitis | Respiratory, thoracic and mediastinal disorders | CTCv3.0 | Systematic Assessment |
| |
| Thrombosis | Vascular disorders | CTCv3.0 | Systematic Assessment |
|
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hemoglobin | Blood and lymphatic system disorders | CTCv3.0 | Systematic Assessment |
| |
| Leukocytes (total WBC) | Blood and lymphatic system disorders | CTCv3.0 | Systematic Assessment |
| |
| Neutrophils/granulocytes (ANC/AGC) | Blood and lymphatic system disorders | CTCv3.0 | Systematic Assessment |
| |
| Platelet | Blood and lymphatic system disorders | CTCv3.0 | Systematic Assessment |
| |
| Ventricular arrhythmia | Cardiac disorders | CTCv3.0 | Systematic Assessment |
| |
| Supraventricular & nodal arrhythmia | Cardiac disorders | CTCv3.0 | Systematic Assessment |
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| Vasovagal episode | Cardiac disorders | CTCv3.0 | Systematic Assessment |
| |
| Hypertension | Cardiac disorders | CTCv3.0 | Systematic Assessment |
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| Hypotension | Cardiac disorders | CTCv3.0 | Systematic Assessment |
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| Rigors/Chills | General disorders | CTCv3.0 | Systematic Assessment |
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| Fatigue (asthenia, lethargy, malaise) | General disorders | CTCv3.0 | Systematic Assessment |
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| Fever (in the absence of neutropenia, where neutropenia is defined as ANC <1.0 x 10e9/L) | General disorders | CTCv3.0 | Systematic Assessment |
| |
| Insomnia | General disorders | CTCv3.0 | Systematic Assessment |
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| Weight loss | General disorders | CTCv3.0 | Systematic Assessment |
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| Hypopigmentation | Skin and subcutaneous tissue disorders | CTCv3.0 | Systematic Assessment |
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| Rash/Desquamation | Skin and subcutaneous tissue disorders | CTCv3.0 | Systematic Assessment |
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| Diarrhea | Gastrointestinal disorders | CTCv3.0 | Systematic Assessment |
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| Distention, bloating, abdominal | Gastrointestinal disorders | CTCv3.0 | Systematic Assessment |
| |
| Heartburn/Dyspepsia | Gastrointestinal disorders | CTCv3.0 | Systematic Assessment |
| |
| Nausea | Gastrointestinal disorders | CTCv3.0 | Systematic Assessment |
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| Vomiting | Gastrointestinal disorders | CTCv3.0 | Systematic Assessment |
| |
| Hemorrhage, GI | Gastrointestinal disorders | CTCv3.0 | Systematic Assessment |
| |
| Petechiae/purpura (hemorrhage/bleeding into skin or mucosa) | Skin and subcutaneous tissue disorders | CTCv3.0 | Systematic Assessment |
| |
| Hemorrhage, pulmonary/upper respiratory | Respiratory, thoracic and mediastinal disorders | CTCv3.0 | Systematic Assessment |
| |
| Febrile Neutropenia | Infections and infestations | CTCv3.0 | Systematic Assessment | fever of unknown origin without clinically or microbiologically documented infection) (ANC <1.0 x 10e9/L, fever > =38.5 degrees C) |
|
| Infection | Infections and infestations | CTCv3.0 | Systematic Assessment |
| |
| Edema: head and neck | Blood and lymphatic system disorders | CTCv3.0 | Systematic Assessment |
| |
| Albumin, serum-low (hypoalbuminemia) | Metabolism and nutrition disorders | CTCv3.0 | Systematic Assessment |
| |
| ALT/SGPT (serum glutamic pyruvic transaminase) | Metabolism and nutrition disorders | CTCv3.0 | Systematic Assessment |
| |
| AST/SGOT (serum glutamic oxaloacetic transaminase) | Metabolism and nutrition disorders | CTCv3.0 | Systematic Assessment |
| |
| Bilirubin (hyperbilirubinemia) | Metabolism and nutrition disorders | CTCv3.0 | Systematic Assessment |
| |
| Calcium, serum-low (hypocalcemia) | Metabolism and nutrition disorders | CTCv3.0 | Systematic Assessment |
| |
| Creatinine | Metabolism and nutrition disorders | CTCv3.0 | Systematic Assessment |
| |
| Magnesium, serum-high (hypermagnesemia) | Metabolism and nutrition disorders | CTCv3.0 | Systematic Assessment |
| |
| Magnesium, serum-low (hypomagnesemia) | Metabolism and nutrition disorders | CTCv3.0 | Systematic Assessment |
| |
| Phosphate, serum-low (hypophosphatemia) | Metabolism and nutrition disorders | CTCv3.0 | Systematic Assessment |
| |
| Potassium, serum-high (hyperkalemia) increased | Metabolism and nutrition disorders | CTCv3.0 | Systematic Assessment |
| |
| Potassium, serum-low (hypokalemia) | Metabolism and nutrition disorders | CTCv3.0 | Systematic Assessment |
| |
| Sodium, serum-low (hyponatremia) | Metabolism and nutrition disorders | CTCv3.0 | Systematic Assessment |
| |
| Uric acid | Metabolism and nutrition disorders | CTCv3.0 | Systematic Assessment |
| |
| Apnea | Nervous system disorders | CTCv3.0 | Systematic Assessment |
| |
| Leak, Cerebrospinal fluid (CSF) | Nervous system disorders | CTCv3.0 | Systematic Assessment |
| |
| Confusion | Nervous system disorders | CTCv3.0 | Systematic Assessment |
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| Dizziness | Nervous system disorders | CTCv3.0 | Systematic Assessment |
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| Somnolence/depressed level of consciousness | Nervous system disorders | CTCv3.0 | Systematic Assessment |
| |
| Syncope (fainting) | Nervous system disorders | CTCv3.0 | Systematic Assessment |
| |
| Tremor | Nervous system disorders | CTCv3.0 | Systematic Assessment |
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| Atelectasis | Respiratory, thoracic and mediastinal disorders | CTCv3.0 | Systematic Assessment |
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| Cough | Respiratory, thoracic and mediastinal disorders | CTCv3.0 | Systematic Assessment |
| |
| Dyspnea (shortness of breath) | Respiratory, thoracic and mediastinal disorders | CTCv3.0 | Systematic Assessment |
| |
| Hypoxia | Respiratory, thoracic and mediastinal disorders | CTCv3.0 | Systematic Assessment |
| |
| Pneumonitis/pulmonary infiltrates | Respiratory, thoracic and mediastinal disorders | CTCv3.0 | Systematic Assessment |
| |
| Incontinence, urinary | Renal and urinary disorders | CTCv3.0 | Systematic Assessment |
| |
| Renal failure | Renal and urinary disorders | CTCv3.0 | Systematic Assessment |
| |
| Retinopathy | Eye disorders | CTCv3.0 | Systematic Assessment |
| |
| Mood alteration | Nervous system disorders | CTCv3.0 | Systematic Assessment |
| |
| Pain | General disorders | CTCv3.0 | Systematic Assessment |
| |
| Acute vascular leak syndrome | Vascular disorders | CTCv3.0 | Systematic Assessment |
| |
| Lymphopenia | Blood and lymphatic system disorders | CTCv3.0 | Systematic Assessment |
| |
| PTT (partial thromboplastin time) | Blood and lymphatic system disorders | CTCv3.0 | Systematic Assessment |
|
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Steven A. Rosenberg, M.D. | National Cancer Institute, National Institutes of Health | 301-496-4164 | sar@mail.nih.gov |
| ID | Term |
|---|---|
| D008545 | Melanoma |
| ID | Term |
|---|---|
| D018358 | Neuroendocrine Tumors |
| D017599 | Neuroectodermal Tumors |
| D009373 | Neoplasms, Germ Cell and Embryonal |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D009380 | Neoplasms, Nerve Tissue |
| D018326 | Nevi and Melanomas |
| D012878 | Skin Neoplasms |
| D009371 | Neoplasms by Site |
| D012871 | Skin Diseases |
| D017437 | Skin and Connective Tissue Diseases |
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| ID | Term |
|---|---|
| C082598 | aldesleukin |
| D007376 | Interleukin-2 |
| D000069585 | Filgrastim |
| D003520 | Cyclophosphamide |
| C042382 | fludarabine phosphate |
| D011878 | Radiotherapy |
| D014916 | Whole-Body Irradiation |
| ID | Term |
|---|---|
| D007378 | Interleukins |
| D016207 | Cytokines |
| D036341 | Intercellular Signaling Peptides and Proteins |
| D010455 | Peptides |
| D000602 | Amino Acids, Peptides, and Proteins |
| D008222 | Lymphokines |
| D011506 | Proteins |
| D001685 | Biological Factors |
| D016179 | Granulocyte Colony-Stimulating Factor |
| D003115 | Colony-Stimulating Factors |
| D006023 | Glycoproteins |
| D006001 | Glycoconjugates |
| D002241 | Carbohydrates |
| D016298 | Hematopoietic Cell Growth Factors |
| D010752 | Phosphoramide Mustards |
| D009588 | Nitrogen Mustard Compounds |
| D009150 | Mustard Compounds |
| D006846 | Hydrocarbons, Halogenated |
| D006838 | Hydrocarbons |
| D009930 | Organic Chemicals |
| D063088 | Phosphoramides |
| D009943 | Organophosphorus Compounds |
| D013812 | Therapeutics |
| D008919 | Investigative Techniques |
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| >=65 years |
|
| Male |
|
| Not Hispanic or Latino |
|
| Unknown or Not Reported |
|
| Asian |
|
| Native Hawaiian or Other Pacific Islander |
|
| Black or African American |
|
| White |
|
| More than one race |
|
| Unknown or Not Reported |
|
|