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Informatie:
Fout:
ID
14976
Beschrijving
Bacteria:S. pneumoniae, Other gram positive (i.e.: other streptococci, staphylococci, listeria …), Haemophilus influenzae, Other gram negative (i.e.: E. coli klebsiella, proteus, serratia, pseudomonas …), Legionella sp, Mycobacteria sp, Other Fungi: Candida sp, Aspergillus sp, Pneumocystis carinii, Other Parasites: Toxoplasma gondii, Other Viruses: HSV, VZV, EBV,CMV, HHV-6,RSV, Other respiratory virus (influenza, parainfluenza, rhinovirus), Adenovirus, HBV, HCV, HIV, Papovavirus, Parvovirus,Other
Trefwoorden
Versies (2)
- 27-09-17 27-09-17 -
- 10-04-21 10-04-21 - Ahmed Rafee, MD
Geüploaded op
27 september 2017
DOI
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Licentie
Creative Commons BY-NC 3.0
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EBMT Multiple Myeloma
16pp EBMT Multiple Myeloma 10PCD
- StudyEvent: ODM
Similar models
16pp EBMT Multiple Myeloma 10PCD
- StudyEvent: ODM
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
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])
Unit
Item
Unit
text
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])
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])
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])
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
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])
C0030705 (UMLS CUI [1,2])
C0079399 (UMLS CUI [1,3])
CL Item
Male (Male)
CL Item
Female (Female)
ABO Group
Item
ABO Group
text
CL Item
Absent (Absent )
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])
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
MDS (MDS)
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 Group
PLASMA CELL DISORDERS (INCLUDING MULTIPLE MYELOMA)
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)
CL Item
Multiple myeloma (1)
CL Item
Plasma Cell Leukaemia (2)
CL Item
Solitary plasmacytoma of bone (3)
CL Item
POEMS (4)
CL Item
Monoclonal light and heavy chain deposition disease (LCDD/HCDD) (5)
CL Item
Other (6)
CL Item
IgG (IgG)
CL Item
IgA (IgA)
CL Item
IgD (IgD)
CL Item
IgE (IgE)
CL Item
IgM (IgM)
CL Item
Kappa (Kappa)
CL Item
Lambda (Lambda)
CL Item
Kappa (1)
CL Item
Lambda (2)
CL Item
I (I)
CL Item
II (II)
CL Item
III (III)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
Normal (1)
CL Item
Abnormal (2)
CL Item
Not done or failed (3)
CL Item
Unknown (4)
Number of abnormal metaphases
Item
Number of metaphases with anomalies:
float
C1621812 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
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])
C0237753 (UMLS CUI [1,2])
C0260877 (UMLS CUI [1,3])
CL Item
Absent (1)
CL Item
Present (2)
CL Item
Not evaluated (3)
CL Item
Absent (1)
CL Item
Present (2)
CL Item
Not evaluated (3)
CL Item
Absent (1)
CL Item
Present (2)
CL Item
Not evaluated (3)
CL Item
Absent (1)
CL Item
Present (2)
CL Item
Not evaluated (3)
CL Item
Absent (1)
CL Item
Present (2)
CL Item
Not evaluated (3)
CL Item
Absent (1)
CL Item
Present (2)
CL Item
Not evaluated (3)
CL Item
Absent (1)
CL Item
Present (2)
CL Item
Not evaluated (3)
CL Item
Absent (1)
CL Item
Present (2)
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
CL Item
Done but failed (1)
CL Item
Done, successful (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
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)
CL Item
Not evaluated (1)
CL Item
Not evaluated (1)
CL Item
Not evaluated (1)
CL Item
Not evaluated (1)
CL Item
Not evaluated (1)
CL Item
Not evaluated (1)
CL Item
Not evaluated (1)
CL Item
Not evaluated (1)
CL Item
Normal (1)
CL Item
Minor (2)
CL Item
Major (3)
CL Item
Not evaluated (4)
Item
Extramedullary involvement
integer
C1517060 (UMLS CUI [1,1])
C1314939 (UMLS CUI [1,2])
C1314939 (UMLS CUI [1,2])
CL Item
No (1)
CL Item
Yes (2)
CL Item
Unknown (3)
Extramedullary involvement
Item
if yes, please specify location
text
Item
Was the patient treated before the HSCT procedure?
text
C0087111 (UMLS CUI [1])
CL Item
No (proceed to `Date of HSCT`) (No (proceed to `Date of HSCT`))
CL Item
Yes (Yes)
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
CL Item
sCR (0)
CL Item
CR (1)
CL Item
vgPR (2)
CL Item
PR (3)
CL Item
Stable disease (5)
CL Item
Progression (6)
CL Item
Not evaluated (7)
CL Item
Unknown (8)
Date of HSCT
Item
Date of HSCT
date
C2584899 (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
CL Item
Stringent complete remission (sCR) (1)
CL Item
Complete remission (CR) (2)
CL Item
Very good PR (VGPR) (3)
CL Item
PR (4)
CL Item
Relapse from CR (5)
CL Item
Stable disease (no change, includes old MR) (6)
CL Item
Progression (7)
CL Item
Unknown (8)
CL Item
1st (1st )
CL Item
2nd (2nd)
CL Item
3rd or higher (3rd or higher)
CL Item
1st (1st )
CL Item
2nd (2nd)
CL Item
3rd or higher (3rd or higher)
CL Item
1st (1st )
CL Item
2nd (2nd)
CL Item
3rd or higher (3rd or higher)
CL Item
no (1)
CL Item
yes (2)
CL Item
unknown (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
CL Item
Negative (1)
CL Item
Positive (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
CLINICAL AND LABORATORY DATA
Item
Monoclonal Ig in urine (g/24 h)
float
CL Item
Negative (1)
CL Item
Positive (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
CLINICAL AND LABORATORY DAT
Item
Serum 2 microglobulin (mg/L)
float
CL Item
Not evaluated (1)
CL Item
Not evaluated (1)
CL Item
Not evaluated (1)
CL Item
Not evaluated (1)
CL Item
Not evaluated (1)
CL Item
Not evaluated (1)
CL Item
Not evaluated (1)
CL Item
Not evaluated (1)
CL Item
Not evaluated (1)
CL Item
Normal (1)
CL Item
Minor (2)
CL Item
Major (3)
CL Item
Not evaluated (4)
CL Item
No (No)
CL Item
Yes (Yes)
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)
CL Item
Thalidomide (Thalidomide)
CL Item
Other (Other)
CL Item
Unknown (Unknown)
Chemo/drug/agent
Item
text
CL Item
No (1)
CL Item
Yes (2)
CL Item
Unknown (3)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
CL Item
Stringent complete remission (sCR) (1)
CL Item
Complete remission (CR) (2)
CL Item
Very good PR (VGPR) (3)
CL Item
PR (4)
CL Item
Stable disease (no change, includes old MR) (5)
CL Item
Progression (6)
CL Item
Unknown (7)
CL Item
1st (1st )
CL Item
2nd (2nd)
CL Item
3rd or higher (3rd or higher)
CL Item
1st (1st )
CL Item
2nd (2nd)
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])
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)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Unknown (3)
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))
Item Group
PLASMA CELL DISORDERS (INCLUDING MULTIPLE MYELOMA)
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])
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
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])
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])
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)
CL Item
Yes, date (2)
CL Item
No (3)
CL Item
Unknown (4)
Item Group
GRAFT VERSUS HOST DISEASE (GvHD) SINCE LAST REPORT
Item
Acute Graft versus Host Disease (aGvHD) - Grade
integer
C0856825 (UMLS CUI [1,1])
C0441800 (UMLS CUI [1,2])
C0441800 (UMLS CUI [1,2])
CL Item
grade 0 (Absent) (1)
CL Item
grade I (2)
CL Item
grade II (3)
CL Item
grade III (4)
CL Item
grade IV (5)
CL Item
Not evaluated (6)
CL Item
New onset (New onset)
CL Item
Recurrent (Recurrent)
CL Item
Persistent (Persistent)
CL Item
Tapering (1)
CL Item
DLI (2)
CL Item
Unexplained (3)
Date onset of this episode
Item
Date onset of this episode (if new or recurrent)
date
C0574845 (UMLS CUI [1])
CL Item
None (0)
CL Item
Stage 1 (1)
CL Item
Stage 2 (2)
CL Item
Stage 3 (3)
CL Item
Stage 4 (4)
Item
Stage liver
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C0023884 (UMLS CUI [1,3])
C1306673 (UMLS CUI [1,2])
C0023884 (UMLS CUI [1,3])
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
Not evaluated (6)
CL Item
unknown (7)
CL Item
No (1)
CL Item
Yes (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])
C1514893 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Present continuously since last reported episode (Present continuously since last reported episode)
CL Item
Resolved (Resolved)
CL Item
First episode (1)
CL Item
Recurrence (2)
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])
C0441799 (UMLS CUI [1,2])
CL Item
Limited (Limited)
CL Item
Extensive (Extensive)
CL Item
Skin (1)
CL Item
Gut (2)
CL Item
Liver (3)
CL Item
Mouth (4)
CL Item
Eyes (5)
CL Item
Lung (6)
CL Item
Other, specify (7)
CL Item
Unknown (8)
Date of Resolution
Item
If resolved, specify the date of resolution:
date
C1514893 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
Infection related complications
Item
Infection related complications
boolean
C0009450 (UMLS CUI [1,1])
C0009566 (UMLS CUI [1,2])
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])
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Specify: Haemorrhagic cystitis, non infectious
text
C0085692 (UMLS CUI [1])
CL Item
Yes (Yes )
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Specify: HSCT-associated microangiopathy
text
C0155765 (UMLS CUI [1])
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Specify: Renal failure requiring dialysis
text
C0035078 (UMLS CUI [1])
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Specify: Haemolytic anaemia due to blood group
text
C0002878 (UMLS CUI [1])
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Other INFECTION RELATED COMPLICATIONS
Item
if other, please specify
text
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
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])
C0011008 (UMLS CUI [1,2])
Item
Number in the infusion order (if applicable)
integer
C2348184 (UMLS CUI [1])
CL Item
......... (1)
CL Item
N/A (2)
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
Yes (Yes)
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
AML (AML)
CL Item
MDS (MDS)
CL Item
Lymphoproliferative disorder (Lymphoproliferative disorder)
CL Item
Other (Other)
Diagnosis
Item
if other, please specify
text
CL Item
No (No)
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
No (1)
CL Item
Yes (Mark disease status before this cellular therapy) (2)
CL Item
Unknown (3)
CL Item
CR (CR)
CL Item
Not in CR (Not in CR)
CL Item
Not evaluated (Not evaluated)
CL Item
Donor lymphocyte infusion (DLI) (1)
CL Item
Mesenchymal cells (2)
CL Item
Other (3)
CL Item
Unknown (4)
CL Item
Number (1)
CL Item
Not evaluated (2)
CL Item
Unknown (3)
Item
If DLI, specify the number of cells infused by type: CD 34+
text
C3538723 (UMLS CUI [1])
CL Item
Evaluated (Evaluated)
CL Item
Not Evaluated (Not Evaluated)
CL Item
Unknown (Unknown)
CL Item
Evaluated (Evaluated )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Number (1)
CL Item
Not evaluated (2)
CL Item
Unknown (3)
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])
C0302189 (UMLS CUI [1,2])
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)
CL Item
Other (Other)
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])
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
No (1)
CL Item
Yes: Planned (planned before HSCT took place) (2)
CL Item
Yes: Not planned (for relapse/progression or persistent disease) (3)
Item Group
FIRST EVIDENCE OF RELAPSE OR PROGRESSION SINCE LAST HSCT
Item
Relapse or Progression
text
C0277556 (UMLS CUI [1,1])
C0242656 (UMLS CUI [1,2])
C0242656 (UMLS CUI [1,2])
CL Item
Previously reported (Previously reported)
CL Item
No (No)
CL Item
Yes (Yes)
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])
C0012634 (UMLS CUI [1,2])
C0678257 (UMLS CUI [1,3])
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])
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
CL Item
alive (0)
CL Item
dead (1)
CL Item
Karnofsky (Karnofsky)
CL Item
Lansky (Lansky)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
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
Unknown (12)
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)
CL Item
Other (Other)
CL Item
GvHD (1)
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
Haemorrhage (11)
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)
CL Item
Other (18)
Comments
Item
Comments
text
IDENTIFICATION & SIGNATURE
Item
IDENTIFICATION & SIGNATURE
text