EBMT Centre Identification Code (CIC)
Item
EBMT Centre Identification Code (CIC)
text
C2348585 (UMLS CUI [1])
Hospital
Item
Name of the hospital
text
C0019994 (UMLS CUI [1])
Contact person
Item
Name of contact person
text
C0337611 (UMLS CUI [1])
Telephone
Item
Telephone number of contact person
text
C1515258 (UMLS CUI [1])
ContactPersonFaxNumber
Item
Fax
text
C0237753 (UMLS CUI [1,1])
C0027361 (UMLS CUI [1,2])
C0337611 (UMLS CUI [1,3])
C0085205 (UMLS CUI [1,4])
ContactPersonE-mailText
Item
E-mail
text
C1527021 (UMLS CUI [1,1])
C0027361 (UMLS CUI [1,2])
C0013849 (UMLS CUI [1,3])
C0337611 (UMLS CUI [1,4])
Date of this report
Item
Date of this report
date
C1302584 (UMLS CUI [1])
Item
Patient following national / international study / trial
integer
C1997894 (UMLS CUI [1])
Code List
Patient following national / international study / trial
CL Item
Not evaluated (3)
Name of study trial
Item
Name of study trial
text
C2348560 (UMLS CUI [1])
Unique Identification Code (UIC)
Item
To be entered only if patient previously reported
text
C2348585 (UMLS CUI [1])
Hospital Unique Patient Number or Code
Item
Hospital Unique Patient Number or Code
text
C1827636 (UMLS CUI [1])
Initials
Item
First name(s) - surname(s) (Registration will not be accepted if this item is left blank)
text
C2986440 (UMLS CUI [1])
Patient Birth Date
Item
Date of Birth
date
C0421451 (UMLS CUI [1])
Item
Sex:
text
C0683312 (UMLS CUI [1,1])
C0030705 (UMLS CUI [1,2])
C0079399 (UMLS CUI [1,3])
ABO Group
Item
ABO Group
text
CL Item
Present (Present)
CL Item
Not evaluated (Not evaluated)
Date of Diagnosis
Item
Date of Diagnosis
date
C2316983 (UMLS CUI [1])
Item
Check the disease for which this transplant was performed
text
C0277554 (UMLS CUI [1])
Code List
Check the disease for which this transplant was performed
CL Item
Acute Leukaemia (Acute Leukaemia)
CL Item
Acute Myelogenous Leukaemia (AML) (Acute Myelogenous Leukaemia (AML))
CL Item
Acute Lymphoblastic Leukaemia (ALL) (Acute Lymphoblastic Leukaemia (ALL))
CL Item
Secondary Acute Leukaemia (do not use if transformed from MDS/MPN) (Secondary Acute Leukaemia (do not use if transformed from MDS/MPN))
CL Item
Chronic Leukaemia (Chronic Leukaemia)
CL Item
Chronic Myeloid Leukaemia (CML) (Chronic Myeloid Leukaemia (CML))
CL Item
Chronic Lymphocytic Leukaemia (Chronic Lymphocytic Leukaemia)
CL Item
Lymphoma (Lymphoma)
CL Item
Non Hodgkin (Non Hodgkin)
CL Item
Hodgkin´s Disease (Hodgkin´s Disease)
CL Item
Myeloma/ Plasma cell disorder (Myeloma/ Plasma cell disorder)
CL Item
Solid Tumour (Solid Tumour)
CL Item
Myelodysplastic syndromes (Myelodysplastic syndromes)
CL Item
MD/ MPN (MD/ MPN)
CL Item
Myeloproliferative neoplasm (Myeloproliferative neoplasm)
CL Item
Bone marrow failure including Aplastic anaemia (Bone marrow failure including Aplastic anaemia)
CL Item
Inherited disorders (Inherited disorders)
CL Item
Primary immune deficiencies (Primary immune deficiencies)
CL Item
Metabolic disorders (Metabolic disorders)
CL Item
Histiocytic disorders (Histiocytic disorders)
CL Item
Autoimmune disease (Autoimmune disease)
CL Item
Juvenile Idiopathic Arthritis (Juvenile Idiopathic Arthritis)
CL Item
Multiple Sclerosis (Multiple Sclerosis)
CL Item
Systemic Lupus (Systemic Lupus)
CL Item
Systemic Sclerosis (Systemic Sclerosis)
CL Item
Haemoglobinopathiy (Haemoglobinopathiy)
CL Item
Other diagnosis (Other diagnosis)
Non infection related complications
Item
Non infection related complications
boolean
C0009566 (UMLS CUI [1])
Item
Has the information requested in this section been submitted with a previous HSCT registration for this patient?
integer
Code List
Has the information requested in this section been submitted with a previous HSCT registration for this patient?
CL Item
Yes: go to page 2, Pre HSCT Treatment (1)
CL Item
No: proceed with this section (2)
Item
SUBCLASSIFICATION, Select one
integer
Code List
SUBCLASSIFICATION, Select one
CL Item
Multiple myeloma (1)
CL Item
Plasma Cell Leukaemia (2)
CL Item
Solitary plasmacytoma of bone (3)
CL Item
Monoclonal light and heavy chain deposition disease (LCDD/HCDD) (5)
Item
Heavy chain and light chain (check light and heavy chain types)
text
Code List
Heavy chain and light chain (check light and heavy chain types)
Item
Light chain only (check light chain type only)
integer
Code List
Light chain only (check light chain type only)
Item
STAGE AT DIAGNOSIS
text
Code List
STAGE AT DIAGNOSIS
Item
ISS Stage
integer
C2346508 (UMLS CUI [1])
Item
Chromosome analysis
integer
Code List
Chromosome analysis
CL Item
Not done or failed (3)
Number of abnormal metaphases
Item
Number of metaphases with anomalies:
float
C1621812 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Number of examined metaphases
Item
Number of metaphases examined
float
C1621812 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
C0260877 (UMLS CUI [1,3])
Item
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
integer
Code List
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
CL Item
Not evaluated (3)
Item
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
integer
Code List
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
CL Item
Not evaluated (3)
Item
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
integer
Code List
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
CL Item
Not evaluated (3)
Item
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
integer
Code List
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
CL Item
Not evaluated (3)
Item
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
integer
Code List
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
CL Item
Not evaluated (3)
Item
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
integer
Code List
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
CL Item
Not evaluated (3)
Item
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
integer
Code List
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
CL Item
Not evaluated (3)
Item
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
integer
Code List
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
CL Item
Not evaluated (3)
other
Item
IF ABNORMAL, INDICATE ABNORMALITIES FOUND, please specify
text
Other or associated abnormalities
Item
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
text
Item
Molecular analysis
integer
C1513380 (UMLS CUI [1])
Code List
Molecular analysis
CL Item
Done but failed (1)
CL Item
Done, successful (2)
CL Item
Not evaluated (3)
CLINICAL AND LABORATORY DATA
Item
Hb (g/dl)
float
CLINICAL AND LABORATORY DATA
Item
Serum creatinine (mol/L)
float
CLINICAL AND LABORATORY DATA
Item
Serum calcium (mmol/L)
float
CLINICAL AND LABORATORY DATA
Item
Serum albumin (g/L)
float
CLINICAL AND LABORATORY DATA
Item
BM aspirate: % plasmacytosis
float
CLINICAL AND LABORATORY DATA
Item
BM trephine: % plasmacytosis
float
CLINICAL AND LABORATORY DATA
Item
Monoclonal Ig in serum (g/L)
float
CLINICAL AND LABORATORY DATA
Item
Monoclonal Ig in urine (g/24 h)
float
CLINICAL AND LABORATORY DATA
Item
Serum 2 microglobulin (mg/L)
float
CL Item
Not evaluated (1)
Item
Serum creatinine (mol/L)
integer
Code List
Serum creatinine (mol/L)
CL Item
Not evaluated (1)
Item
Serum calcium (mmol/L)
integer
Code List
Serum calcium (mmol/L)
CL Item
Not evaluated (1)
Item
Serum albumin (g/L)
integer
Code List
Serum albumin (g/L)
CL Item
Not evaluated (1)
Item
BM aspirate: % plasmacytosis
integer
Code List
BM aspirate: % plasmacytosis
CL Item
Not evaluated (1)
Item
BM trephine: % plasmacytosis
integer
Code List
BM trephine: % plasmacytosis
CL Item
Not evaluated (1)
Item
Monoclonal Ig in serum (g/L)
integer
Code List
Monoclonal Ig in serum (g/L)
CL Item
Not evaluated (1)
Item
Monoclonal Ig in urine (g/24 h)
integer
Code List
Monoclonal Ig in urine (g/24 h)
CL Item
Not evaluated (1)
Item
Serum 2 microglobulin (mg/L)
integer
Code List
Serum 2 microglobulin (mg/L)
CL Item
Not evaluated (1)
Item
INVOLVEMENT AT DIAGNOSIS Bone structure
integer
Code List
INVOLVEMENT AT DIAGNOSIS Bone structure
CL Item
Not evaluated (4)
Item
Extramedullary involvement
integer
C1517060 (UMLS CUI [1,1])
C1314939 (UMLS CUI [1,2])
Code List
Extramedullary involvement
Extramedullary involvement
Item
if yes, please specify location
text
Item
Was the patient treated before the HSCT procedure?
text
C0087111 (UMLS CUI [1])
Code List
Was the patient treated before the HSCT procedure?
CL Item
No (proceed to `Date of HSCT`) (No (proceed to `Date of HSCT`))
CL Item
Unknown (Unknown)
Sequential number of this treatment
Item
counted from diagnosis, or last HSCT if applicable
text
Modality Chemo/Drugs
Item
Modality Chemo/Drugs
boolean
Modality Chemo/Drugs regimen
Item
Modality Chemo/Drugs regimen
text
Modality Radiotherapy
Item
Modality Radiotherapy
boolean
Item
Response see manual for full definition of each response
integer
Code List
Response see manual for full definition of each response
CL Item
Stable disease (5)
CL Item
Not evaluated (7)
Date of HSCT
Item
Date of HSCT
date
C2584899 (UMLS CUI [1])
Item
HSCT Type
text
C0472699 (UMLS CUI [1])
CL Item
Allogenic (Allogenic)
CL Item
Autologuos (Autologuos)
Autologous Date of 1st collection or pheresis
Item
Autologous Date of 1st collection or pheresis
date
Item
SEE MANUAL FOR FULL DEFINITION OF EACH DISEASE STATUS
integer
Code List
SEE MANUAL FOR FULL DEFINITION OF EACH DISEASE STATUS
CL Item
Stringent complete remission (sCR) (1)
CL Item
Complete remission (CR) (2)
CL Item
Very good PR (VGPR) (3)
CL Item
Relapse from CR (5)
CL Item
Stable disease (no change, includes old MR) (6)
Item
If sCR or CR: NUMBER OF THIS COMPLETE REMISSION
text
Code List
If sCR or CR: NUMBER OF THIS COMPLETE REMISSION
CL Item
3rd or higher (3rd or higher)
Item
If VGPR or PR: NUMBER OF THIS PARTIAL REMISSION
integer
Code List
If VGPR or PR: NUMBER OF THIS PARTIAL REMISSION
CL Item
3rd or higher (3rd or higher)
Item
NUMBER OF THIS RELAPSE
integer
Code List
NUMBER OF THIS RELAPSE
CL Item
3rd or higher (3rd or higher)
Item
COMPLETE ONLY IF STATUS IS STABLE DIEASE OR PR
integer
Code List
COMPLETE ONLY IF STATUS IS STABLE DIEASE OR PR
CLINICAL AND LABORATORY DATA
Item
Hb (g/dL)
float
CLINICAL AND LABORATORY DATA
Item
Serum creatinine (mol/L)
float
CLINICAL AND LABORATORY DATA
Item
Serum calcium (mmol/L)
float
CLINICAL AND LABORATORY DATA
Item
Serum albumin (g/L)
float
CLINICAL AND LABORATORY DATA
Item
BM aspirate: % plasmacytosis
float
CLINICAL AND LABORATORY DATA
Item
BM trephine: % plasmacytosis
float
CLINICAL AND LABORATORY DATA
Item
Monoclonal Ig in serum (g/L)
float
Item
Immunofixation of serum
integer
Code List
Immunofixation of serum
CL Item
Not evaluated (3)
CLINICAL AND LABORATORY DATA
Item
Monoclonal Ig in urine (g/24 h)
float
Item
Immunofixation of urine
integer
Code List
Immunofixation of urine
CL Item
Not evaluated (3)
CLINICAL AND LABORATORY DAT
Item
Serum 2 microglobulin (mg/L)
float
CL Item
Not evaluated (1)
Item
Serum creatinine (mol/L)
integer
Code List
Serum creatinine (mol/L)
CL Item
Not evaluated (1)
Item
Serum calcium (mmol/L)
integer
Code List
Serum calcium (mmol/L)
CL Item
Not evaluated (1)
Item
Serum albumin (g/L)
integer
Code List
Serum albumin (g/L)
CL Item
Not evaluated (1)
Item
BM aspirate: % plasmacytosis
integer
Code List
BM aspirate: % plasmacytosis
CL Item
Not evaluated (1)
Item
BM trephine: % plasmacytosis
integer
Code List
BM trephine: % plasmacytosis
CL Item
Not evaluated (1)
Item
Monoclonal Ig in serum (g/L)
integer
Code List
Monoclonal Ig in serum (g/L)
CL Item
Not evaluated (1)
Item
Monoclonal Ig in urine (g/24 h)
integer
Code List
Monoclonal Ig in urine (g/24 h)
CL Item
Not evaluated (1)
Item
Serum 2 microglobulin (mg/L)
integer
Code List
Serum 2 microglobulin (mg/L)
CL Item
Not evaluated (1)
Item
Lytic lesions
integer
CL Item
Not evaluated (4)
Item
Additional Disease Treatment
text
C1706712 (UMLS CUI [1])
Code List
Additional Disease Treatment
CL Item
Unknown (Unknown)
CL Item
Planned (planned before HSCT took place) (1)
CL Item
Not planned (for relapse/progression or persistent disease), Date started (2)
Item
(including MoAB, etc.)
text
Code List
(including MoAB, etc.)
CL Item
Thalidomide (Thalidomide)
CL Item
Unknown (Unknown)
Chemo/drug/agent
Item
text
Item
Radiotherapy
integer
Item
If additional treatment: Other treatment
text
C1706712 (UMLS CUI [1])
Code List
If additional treatment: Other treatment
CL Item
Unknown (Unknown)
Item
(see manual for full definition of each response)
integer
Code List
(see manual for full definition of each response)
CL Item
Stringent complete remission (sCR) (1)
CL Item
Complete remission (CR) (2)
CL Item
Very good PR (VGPR) (3)
CL Item
Stable disease (no change, includes old MR) (5)
Item
If sCR or CR: NUMBER OF THIS COMPLETE REMISSION
integer
Code List
If sCR or CR: NUMBER OF THIS COMPLETE REMISSION
CL Item
3rd or higher (3rd or higher)
Item
If VGPR or PR: NUMBER OF THIS PARTIAL REMISSION
integer
Code List
If VGPR or PR: NUMBER OF THIS PARTIAL REMISSION
CL Item
3rd or higher (3rd or higher)
CR Date
Item
If complete response: date of CR
date
C0677874 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Otherwise
Item
Otherwise: date of evaluation
date
C1708335 (UMLS CUI [1])
Item
Plateau (COMPLETE ONLY IF STATUS IS STABLE DISEASE OR PR) (not applicable for non secretory myelona)
integer
Code List
Plateau (COMPLETE ONLY IF STATUS IS STABLE DISEASE OR PR) (not applicable for non secretory myelona)
Item
Type of Transplant
text
C0559189 (UMLS CUI [1,1])
C0040739 (UMLS CUI [1,2])
Code List
Type of Transplant
CL Item
AUTOgraft (proceed to Autograft form) (AUTOgraft (proceed to Autograft form))
CL Item
ALLOgraft or Syngeneic graft (proceed to Allograft form) (ALLOgraft or Syngeneic graft (proceed to Allograft form))
CL Item
Other (contact the EBMT Central Registry for instructions) (Other (contact the EBMT Central Registry for instructions))
Unique Identification Code (UIC)
Item
Unique Identification Code (UIC) (if known)
text
C2348585 (UMLS CUI [1])
Hospital Unique Patient Number
Item
Hospital Unique Patient Number
text
C2348585 (UMLS CUI [1])
Date of this report
Item
Date of this report
date
C1302584 (UMLS CUI [1])
Item
Patient following national / international study / trial
integer
C1997894 (UMLS CUI [1])
Code List
Patient following national / international study / trial
CL Item
Not evaluated (3)
Name of study / trial
Item
Name of study / trial
text
C0008976 (UMLS CUI [1])
Initials
Item
First name(s)_surname(s)
text
C2986440 (UMLS CUI [1])
PersonBirthDate
Item
Date of Birth
date
C0011008 (UMLS CUI [1,1])
C0027361 (UMLS CUI [1,2])
C0005615 (UMLS CUI [1,3])
Date of last HSCT for this patient
Item
Date of last HSCT for this patient
date
C0472699 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date last contact
Item
Date of Last Contact or Death
date
C0805839 (UMLS CUI [1])
Item
Complete haematological remission obtained after the HSCT in the absence of additional disease treatment
integer
Code List
Complete haematological remission obtained after the HSCT in the absence of additional disease treatment
CL Item
Previously reported (1)
Item
Acute Graft versus Host Disease (aGvHD) - Grade
integer
C0856825 (UMLS CUI [1,1])
C0441800 (UMLS CUI [1,2])
Code List
Acute Graft versus Host Disease (aGvHD) - Grade
CL Item
grade 0 (Absent) (1)
CL Item
Not evaluated (6)
CL Item
New onset (New onset)
CL Item
Recurrent (Recurrent)
CL Item
Persistent (Persistent)
Item
aGvHD Reason
integer
C0856825 (UMLS CUI [1,1])
M (UMLS CUI [1,2])
Date onset of this episode
Item
Date onset of this episode (if new or recurrent)
date
C0574845 (UMLS CUI [1])
Item
Stage liver
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C0023884 (UMLS CUI [1,3])
CL Item
Not evaluated (6)
Item
Resolution
integer
C0856825 (UMLS CUI [1,1])
C1514893 (UMLS CUI [1,2])
aGvHD Date of resolution
Item
Date of resolution
date
C0856825 (UMLS CUI [1,1])
C1514893 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item
Presence of cGvHD
text
C0867389 (UMLS CUI [1])
Code List
Presence of cGvHD
CL Item
Present continuously since last reported episode (Present continuously since last reported episode)
CL Item
Resolved (Resolved)
CL Item
First episode (1)
Date of onset
Item
Date of onset
date
C0574845 (UMLS CUI [1])
Item
If present continously since last report, specify cGvHD gade:
text
C0867389 (UMLS CUI [1,1])
C0441799 (UMLS CUI [1,2])
Code List
If present continously since last report, specify cGvHD gade:
CL Item
Limited (Limited)
CL Item
Extensive (Extensive)
Item
Organs affected
integer
C0449642 (UMLS CUI [1])
Code List
Organs affected
CL Item
Other, specify (7)
Date of Resolution
Item
If resolved, specify the date of resolution:
date
C1514893 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Infection related complications
Item
Infection related complications
boolean
C0009450 (UMLS CUI [1,1])
C0009566 (UMLS CUI [1,2])
Bacteremia / fungemia / viremia / parasites
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Bacteremia / fungemia / viremia / parasites
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Septic shock
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Septic shock
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
ARDS
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
ARDS
Item
Date Provide different dates for different episodes of the same complication if applicable
date
Multiorgan failure due to infection
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Multiorgan failure due to infection
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Pneumonia
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Pneumonia
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Hepatitis
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Hepatitis
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
CNS infection
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
CNS infection
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Gut infection
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Gut infection
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Skin infection
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Skin infection
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Cystitis
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Cystitis
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Retinitis
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Retinitis
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Other
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Other
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Non infection related complications
Item
Non infection related complications
boolean
C0009566 (UMLS CUI [1])
Item
Specify: Idiopathic pneumonia syndrome
text
C1504431 (UMLS CUI [1])
Code List
Specify: Idiopathic pneumonia syndrome
CL Item
Unknown (Unknown)
Item
Specify: VOD
text
C0948441 (UMLS CUI [1])
CL Item
Unknown (Unknown)
Item
Specify: Cataract
text
C0086543 (UMLS CUI [1])
Code List
Specify: Cataract
CL Item
Unknown (Unknown)
Item
Specify: Haemorrhagic cystitis, non infectious
text
C0085692 (UMLS CUI [1])
Code List
Specify: Haemorrhagic cystitis, non infectious
CL Item
Unknown (Unknown)
Item
Specify: ARDS, non infectious
text
C0035222 (UMLS CUI [1])
Code List
Specify: ARDS, non infectious
CL Item
Unknown (Unknown)
Item
Multiorgan failure, non infectious
integer
Code List
Multiorgan failure, non infectious
Item
Specify: HSCT-associated microangiopathy
text
C0155765 (UMLS CUI [1])
Code List
Specify: HSCT-associated microangiopathy
CL Item
Unknown (Unknown)
Item
Specify: Renal failure requiring dialysis
text
C0035078 (UMLS CUI [1])
Code List
Specify: Renal failure requiring dialysis
CL Item
Unknown (Unknown)
Item
Specify: Haemolytic anaemia due to blood group
text
C0002878 (UMLS CUI [1])
Code List
Specify: Haemolytic anaemia due to blood group
CL Item
Unknown (Unknown)
Item
Specify: Aseptic bone necrosis
text
C0158452 (UMLS CUI [1])
Code List
Specify: Aseptic bone necrosis
CL Item
Unknown (Unknown)
Other INFECTION RELATED COMPLICATIONS
Item
if other, please specify
text
CL Item
Not evaluated (3)
Item
Overall chimaerism
text
C0333678 (UMLS CUI [1])
Code List
Overall chimaerism
CL Item
95%) (Full (donor >)
CL Item
Mixed (partial) (Mixed (partial))
CL Item
95%) (Autologuos reconstitution (recipient >)
CL Item
Aplasia (Aplasia)
CL Item
Not evaluated (Not evaluated)
Identification
Item
Identification of donor or Cord Blood Unit given by the centre
text
C1718162 (UMLS CUI [1])
Date of Test
Item
Date of Test
date
C0024671 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Number in the infusion order (if applicable)
integer
C2348184 (UMLS CUI [1])
Code List
Number in the infusion order (if applicable)
Bone marrow
Item
Cell type on which test was performed (% Donor Cells): BM
float
C0005953 (UMLS CUI [1])
PB mononuclear cells (PBMC)
Item
Cell type on which test was performed (% Donor cells): PB mononuclear cells (PBMC)
float
C1321301 (UMLS CUI [1])
T-Cells
Item
Cell type on which test was performed (% Donor cells): T-Cells (Indicate the date(s) and results of all tests done for all donors. Split the results by donor and by the cell type on which the test was performed if applicable. Copy this table as many times as necessary.)
float
C0039194 (UMLS CUI [1])
B-Cells
Item
Cell type on which test was performed (% Donor cells): B-Cells
float
C0004561 (UMLS CUI [1])
Red blood cells
Item
Cell type on which test was performed (% Donor cells): Red blood cells
float
C0014772 (UMLS CUI [1])
Monocytes
Item
Cell type on which test was performed (% Donor cells): Monocytes
float
C0026473 (UMLS CUI [1])
PMNs (neutrophils)
Item
Cell type on which test was performed (% Donor cells): PMNs (neutrophils)
float
C0200633 (UMLS CUI [1])
Lymphocytes, NOS
Item
Cell type on which test was performed (% Donor cells): Lymphocytes, NOS
float
C0024264 (UMLS CUI [1])
Myeloid cells, NOS
Item
Cell type on which test was performed (% Donor cells): Myeloid cells, NOS
float
C0887899 (UMLS CUI [1])
Other
Item
Cell type on which test was performed
text
Item
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
integer
Code List
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
CL Item
Previously reported (Previously reported)
CL Item
No at date of this follow-up (No at date of this follow-up)
Date of diagnosis
Item
If yes, specify date of diagnosis
date
C2316983 (UMLS CUI [1])
Item
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
text
Code List
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
CL Item
Lymphoproliferative disorder (Lymphoproliferative disorder)
Diagnosis
Item
if other, please specify
text
Item
Treatment given since last report
text
Code List
Treatment given since last report
CL Item
Yes, date started (Yes, date started)
CL Item
Unknown (Unknown)
Date started
Item
ADDITIONAL THERAPIES SINCE LAST FOLLOW UP
date
Item
If yes: Cellular therapy (One cell therapy regimen is defined as any number of infusions given within 10 weeks for the same indication. If more than one regimen of cell therapy has been given since last report, copy this section and complete it as many times as necessary.)
integer
C0302189 (UMLS CUI [1])
Code List
If yes: Cellular therapy (One cell therapy regimen is defined as any number of infusions given within 10 weeks for the same indication. If more than one regimen of cell therapy has been given since last report, copy this section and complete it as many times as necessary.)
CL Item
Yes (Mark disease status before this cellular therapy) (2)
Item
if yes, Disease status before this cellular therapy
text
Code List
if yes, Disease status before this cellular therapy
CL Item
Not in CR (Not in CR)
CL Item
Not evaluated (Not evaluated)
Item
If yes: Type of cells
integer
C0302189 (UMLS CUI [1])
Code List
If yes: Type of cells
CL Item
Donor lymphocyte infusion (DLI) (1)
CL Item
Mesenchymal cells (2)
Item
Number of Nucleated cells infused (DLI only)
integer
C1180059 (UMLS CUI [1])
Code List
Number of Nucleated cells infused (DLI only)
CL Item
Not evaluated (2)
Item
If DLI, specify the number of cells infused by type: CD 34+
text
C3538723 (UMLS CUI [1])
Code List
If DLI, specify the number of cells infused by type: CD 34+
CL Item
Evaluated (Evaluated)
CL Item
Not Evaluated (Not Evaluated)
CL Item
Unknown (Unknown)
Item
If DLI, specify the number of cells infused by type: CD 3+
text
C3542405 (UMLS CUI [1])
Code List
If DLI, specify the number of cells infused by type: CD 3+
CL Item
Evaluated (Evaluated )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item
Total number of cells infused (non DLI only)
integer
C0007584 (UMLS CUI [1])
Code List
Total number of cells infused (non DLI only)
CL Item
Not evaluated (2)
Chronological number
Item
Chronological number of this cell therapy for this patient
float
C2348184 (UMLS CUI [1])
Item
Indication (check all that apply)
text
C3146298 (UMLS CUI [1,1])
C0302189 (UMLS CUI [1,2])
Code List
Indication (check all that apply)
CL Item
Planned/ protocol (Planned/ protocol)
CL Item
Treatment for disease (Treatment for disease)
CL Item
Prophylactic (Prophylactic)
CL Item
Mixed chimaerism (Mixed chimaerism)
CL Item
Treatment of GvHD (Treatment of GvHD)
CL Item
Treatment viral infection (Treatment viral infection)
CL Item
Loss/decreased chimaerism (Loss/decreased chimaerism)
CL Item
Treatment PTLD, EBV, lymphoma (Treatment PTLD, EBV, lymphoma)
Number of Infusions
Item
Number of Infusions (within 10 weeks) (count only infusions that are part of same regimen and given for the same indication)
float
C2348184 (UMLS CUI [1,1])
C1289919 (UMLS CUI [1,2])
Item
Acute Graft versus Host Disease (after this infusion but before any further infusion/ transplant) Maximum grade:
text
C0856825 (UMLS CUI [1])
Code List
Acute Graft versus Host Disease (after this infusion but before any further infusion/ transplant) Maximum grade:
CL Item
grade 0 (absent) (grade 0 (absent))
CL Item
grade 1 (grade 1)
CL Item
grade 2 (grade 2)
CL Item
grade 3 (grade 3)
CL Item
grade 4 (grade 4)
CL Item
present, grade unknown (present, grade unknown)
Item
Disease treatment (apart from donor cell infusion or other type of cell therapy)
integer
C0087111 (UMLS CUI [1])
Code List
Disease treatment (apart from donor cell infusion or other type of cell therapy)
CL Item
Yes: Planned (planned before HSCT took place) (2)
CL Item
Yes: Not planned (for relapse/progression or persistent disease) (3)
Item
Relapse or Progression
text
C0277556 (UMLS CUI [1,1])
C0242656 (UMLS CUI [1,2])
Code List
Relapse or Progression
CL Item
Previously reported (Previously reported)
CL Item
Continous progression since transplant (Continous progression since transplant)
CL Item
Unknown (Unknown)
If yes, date diagnosed
Item
RELAPSE OR PROGRESSION
date
Item
last disease status
text
C0332307 (UMLS CUI [1,1])
C0012634 (UMLS CUI [1,2])
C0678257 (UMLS CUI [1,3])
Code List
last disease status
CL Item
Complete Remission (Complete Remission)
CL Item
Stable disease (Stable disease)
CL Item
Relapse (Relapse)
CL Item
Treatment failure/ progression (Treatment failure/ progression)
Item
Has patient or partner become pregnant after this HSCT?
text
C0032961 (UMLS CUI [1])
Code List
Has patient or partner become pregnant after this HSCT?
CL Item
Unknown (Unknown)
Item
Survival Status
integer
C1148433 (UMLS CUI [1])
Code List
Survival Status
Item
If alive: Type of score used:
text
C1518965 (UMLS CUI [1])
Code List
If alive: Type of score used:
CL Item
Karnofsky (Karnofsky)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item
Score
integer
C1518965 (UMLS CUI [1])
CL Item
100 (Normal, NED) (1)
CL Item
90 (Normal activity) (2)
CL Item
80 (Normal with effort) (3)
CL Item
70 (Cares for self) (4)
CL Item
60 (Requires occasional assistance) (5)
CL Item
50 (Requires assistance) (6)
CL Item
40 (Disabled) (7)
CL Item
30 (Severely disabled) (8)
CL Item
20 (Very sick) (9)
CL Item
10 (Moribund) (10)
CL Item
Not evaluated (11)
CL Item
Relapse or progression (Relapse or progression)
CL Item
Secondary malignancy (Secondary malignancy)
CL Item
HSCT related cause (HSCT related cause)
CL Item
Unknown (Unknown)
Item
HSCT related cause
integer
Code List
HSCT related cause
CL Item
Interstitial pneumonitis (2)
CL Item
Pulmonary toxicity (3)
CL Item
Infection bacterial (4)
CL Item
Infection viral (5)
CL Item
Infection fungal (6)
CL Item
Infection parasitic (7)
CL Item
Infection unknown (8)
CL Item
Rejection / poor graft function (9)
CL Item
Veno-occlusive disease (VOD) (10)
CL Item
Cardiac toxicity (12)
CL Item
Central nervous system toxicity (13)
CL Item
Gastro intestinal toxicity (14)
CL Item
Skin toxicity (15)
CL Item
Renal failure (16)
CL Item
Multiple organ failure (17)
Comments
Item
Comments
text
IDENTIFICATION & SIGNATURE
Item
IDENTIFICATION & SIGNATURE
text