ID
17562
Description
ODM form derived from 100days past HSCT EBMT. please refer to: http://www.ebmt.org/Contents/Data-Management/Registrystructure/MED-ABdatacollectionforms/Pages/MED-AB-data-collection-forms.aspx HLA typing results of patient and donor should be attached and sent: - to your NATIONAL REGISTRY if - you normally report to your National Registry and - you are based in the Netherlands, Switzerland, Turkey or the UK - to the EBMT REGISTRY OFFICE in London for any other centre Contact: Shelley Hewerdine EBMT Registry Office 4th Floor, Tabard House Guy's Hospital Great Maze Pond London SE1 9RT United Kingdom Phone: 00 44-207-188-8409 Fax: 00 44-207-188-8411 Email: shelley.hewerdine@ebmt.org
Link
Keywords
Versions (4)
- 8/9/16 8/9/16 -
- 9/23/16 9/23/16 -
- 9/24/16 9/24/16 -
- 9/20/21 9/20/21 -
Uploaded on
September 23, 2016
DOI
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License
Creative Commons BY-NC 3.0
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100 days past HSCT EBMT
100 days past HSCT EBMT
- StudyEvent: ODM
Description
PATIENT DATA
Description
Date of this report
Data type
date
Alias
- UMLS CUI [1]
- C1302584
Description
Patient following national / international study / trial
Data type
integer
Alias
- UMLS CUI [1]
- C1997894
Description
Name of study / trial
Data type
integer
Alias
- UMLS CUI [1]
- C0008976
Description
Hospital Unique Patient Number
Data type
integer
Alias
- UMLS CUI [1]
- C2348585
Description
Initials
Data type
integer
Alias
- UMLS CUI [1]
- C2986440
Description
Date of Birth
Data type
date
Alias
- UMLS CUI [1]
- C0421451
Description
Sex
Data type
text
Alias
- UMLS CUI [1]
- C0079399
Description
DISEASE
Description
HSCT
Description
Performance score
Data type
integer
Alias
- UMLS CUI [1]
- C1518965
Description
Score
Data type
text
Alias
- UMLS CUI [1]
- C1518965
Description
Type of HSCT
Data type
integer
Alias
- UMLS CUI [1]
- C0472699
Description
Patient CMV status
Data type
integer
Alias
- UMLS CUI [1]
- C0582172
Description
Multiple donors
Data type
boolean
Alias
- UMLS CUI [1]
- C0013018
Description
if yes, Number (including multiple CB units or different stem cell products from same donor)
Data type
integer
Alias
- UMLS CUI [1]
- C0013018
Description
STEM CELLS (autograft or allograft)
Description
(check all that apply)
Data type
integer
Alias
- UMLS CUI [1]
- C0018956
Description
Source of Stem Cells
Data type
integer
Alias
- UMLS CUI [1]
- C0018956
Description
Donor ID
Data type
text
Alias
- UMLS CUI [1]
- C1718162
Description
if autograft, go to Graft manipulation below
Data type
integer
Alias
- UMLS CUI [1]
- C1718162
Description
HLA match type
Data type
integer
Alias
- UMLS CUI [1]
- C0242318
Description
Degree of mismatch
Data type
integer
Alias
- UMLS CUI [1]
- C1881865
Description
donor registry
Data type
integer
Alias
- UMLS CUI [1]
- C0034975
Description
BMDW/WMDA code
Data type
integer
Alias
- UMLS CUI [1]
- C2987198
Description
Number of mismatches A
Data type
integer
Alias
- UMLS CUI [1,1]
- C1881865
- UMLS CUI [1,2]
- C0449788
Description
Number of mismatches B
Data type
integer
Alias
- UMLS CUI [1,1]
- C1881865
- UMLS CUI [1,2]
- C0449788
Description
Number of mismatches C
Data type
integer
Alias
- UMLS CUI [1,1]
- C1881865
- UMLS CUI [1,2]
- C0449788
Description
Number of mismatches DRB1
Data type
integer
Alias
- UMLS CUI [1,1]
- C1881865
- UMLS CUI [1,2]
- C0449788
Description
Number of mismatches DQB1
Data type
integer
Alias
- UMLS CUI [1,1]
- C1881865
- UMLS CUI [1,2]
- C0449788
Description
Number of mismatches DPB1
Data type
integer
Alias
- UMLS CUI [1,1]
- C1881865
- UMLS CUI [1,2]
- C0449788
Description
Donor Sex
Data type
integer
Alias
- UMLS CUI [1]
- C0079399
Description
Donor age
Data type
integer
Alias
- UMLS CUI [1,1]
- C0013018
- UMLS CUI [1,2]
- C0421451
Description
Graft manipulation ex-vivo (including T-cell depletion) other than for RBC removal or volume reduction
Data type
boolean
Alias
- UMLS CUI [1]
- C0677960
Description
HSCT
Description
Chronological number of HSCT
Data type
integer
Alias
- UMLS CUI [1,1]
- C1318453
- UMLS CUI [1,2]
- C0449788
Description
If >1, date of last HSCT before this one
Data type
date
Alias
- UMLS CUI [1,1]
- C0018956
- UMLS CUI [1,2]
- C0029216
- UMLS CUI [1,3]
- C2745955
- UMLS CUI [1,4]
- C0011008
Description
HSCT part of a planned multiple graft protocol?
Data type
boolean
Description
Preparative (conditioning) regimen given?
Data type
boolean
Alias
- UMLS CUI [1]
- C1882454
Description
Was this intended to be myeloablative?
Data type
boolean
Alias
- UMLS CUI [1]
- C1831742
Description
Reason HSCT
Data type
integer
Alias
- UMLS CUI [1]
- C0392360
Description
Ara-C
Data type
float
Measurement units
- mg
Alias
- UMLS CUI [1]
- C0733521
Description
Ara-C (cytarabine)
Data type
integer
Alias
- UMLS CUI [1,1]
- C0733521
- UMLS CUI [1,2]
- C1321095
Description
ALS
Data type
float
Alias
- UMLS CUI [1]
- C0002736
Description
AST: Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C1321095
- UMLS CUI [1,2]
- C0004002
Description
Animal origin
Data type
integer
Alias
- UMLS CUI [1]
- C3494749
Description
Bleomycin
Data type
float
Alias
- UMLS CUI [1]
- C0005740
Description
Unit of doseing
Data type
integer
Alias
- UMLS CUI [1]
- C1321095
Description
Busulfan
Data type
float
Alias
- UMLS CUI [1]
- C0006463
Description
Busulfan Unit of dosing:
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0006463
Description
Busulfan
Data type
integer
Description
BCNU
Data type
float
Alias
- UMLS CUI [1]
- C0007257
Description
BCNU Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0007257
Description
Bexar (radiolabelled MoAB)
Data type
float
Alias
- UMLS CUI [1]
- C3831356
Description
Bexar Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C3831356
Description
CCNU
Data type
float
Alias
- UMLS CUI [1]
- C0687700
Description
CCNU Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0687700
Description
Campath
Data type
float
Alias
- UMLS CUI [1]
- C0939276
Description
Campath Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0939276
Description
Carboplatin
Data type
float
Alias
- UMLS CUI [1]
- C0079083
Description
Carboplatin Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0079083
Description
Cisplatin
Data type
float
Alias
- UMLS CUI [1]
- C0008838
Description
Cisplatin Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0008838
Description
Corticosteroids
Data type
float
Alias
- UMLS CUI [1]
- C0001617
Description
Corticosteroids Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0001617
Description
Cyclophosphamide
Data type
float
Alias
- UMLS CUI [1]
- C0010583
Description
Cyclophosphamide Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0010583
Description
Daunorubicin
Data type
float
Alias
- UMLS CUI [1]
- C0011015
Description
Unit of dosing Daunorubicin
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0011015
Description
Doxorubicin
Data type
float
Alias
- UMLS CUI [1]
- C0013089
Description
Doxorubicin Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0013089
Description
Etoposide
Data type
float
Alias
- UMLS CUI [1]
- C0015133
Description
Etoposide Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0015133
Description
Fludarabine
Data type
float
Alias
- UMLS CUI [1]
- C0059985
Description
Fludarabine Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0059985
Description
Gemtuzumab
Data type
float
Alias
- UMLS CUI [1]
- C0872968
Description
Gemtuzumab Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0872968
Description
Idarubicin
Data type
float
Alias
- UMLS CUI [1]
- C0020789
Description
Idarubicin Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0020789
Description
Ifosfamide
Data type
float
Alias
- UMLS CUI [1]
- C0020823
Description
Ifosfamide Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0020823
Description
Imatinib mesylate
Data type
float
Alias
- UMLS CUI [1]
- C0939537
Description
Imatinib mesylate Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0939537
Description
Melphalan
Data type
float
Alias
- UMLS CUI [1]
- C0025241
Description
Melphalan Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0025241
Description
Mitoxantrone
Data type
float
Alias
- UMLS CUI [1]
- C0026259
Description
Mitoxantrone Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0026259
Description
Paclitaxel
Data type
float
Alias
- UMLS CUI [1]
- C0144576
Description
Paclitaxel Unit of dosing
Data type
integer
Alias
- UMLS CUI [1]
- C0869039
Description
Rituximab
Data type
float
Alias
- UMLS CUI [1]
- C0393022
Description
Rituximab Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0393022
Description
Teniposide
Data type
float
Alias
- UMLS CUI [1]
- C0039512
Description
Teniposide Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0039512
Description
Thiotepa
Data type
float
Alias
- UMLS CUI [1]
- C0039871
Description
Thiotepa Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0039871
Description
Zevalin
Data type
float
Alias
- UMLS CUI [1]
- C0919274
Description
Zevalin Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0919274
Description
other radiolabelled MoAB
Data type
float
Alias
- UMLS CUI [1,1]
- C0003250
- UMLS CUI [1,2]
- C0454110
Description
other radiolabelled MoAB Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0003250
- UMLS CUI [1,3]
- C0454110
Description
Other radiolabelled MoAB: if other, please specify
Data type
integer
Alias
- UMLS CUI [1,1]
- C0205394
- UMLS CUI [1,2]
- C0003250
- UMLS CUI [1,3]
- C0454110
Description
Other MoAB
Data type
float
Alias
- UMLS CUI [1]
- C0003250
Description
MoAB Unit of dosing
Data type
integer
Alias
- UMLS CUI [1,1]
- C0869039
- UMLS CUI [1,2]
- C0003250
Description
Total body irradiation
Data type
boolean
Alias
- UMLS CUI [1]
- C0043162
Description
Total Body Irradiation: if yes, please specify value
Data type
integer
Alias
- UMLS CUI [1,1]
- C4035158
- UMLS CUI [1,2]
- C0043162
Description
TLI, TNI, TAI
Data type
boolean
Alias
- UMLS CUI [1]
- C4035158
- UMLS CUI [2]
- C0043162
Description
AFTER HSCT
Description
GvHD prophylaxis
Data type
boolean
Alias
- UMLS CUI [1]
- C0278845
Description
GvHD prophylaxis or preventive treatment: if yes, please specify
Data type
integer
Alias
- UMLS CUI [1,1]
- C0278845
- UMLS CUI [1,2]
- C4035158
Description
GvHD prophylaxis or preventive treatment: if other, please specify
Data type
integer
Alias
- UMLS CUI [1,1]
- C4035158
- UMLS CUI [1,2]
- C4035158
Description
GvHD prophylaxis or preventive treatment: if Other monoclonal antibody, please specify
Data type
integer
Alias
- UMLS CUI [1,1]
- C4035158
- UMLS CUI [1,2]
- C4035158
- UMLS CUI [1,3]
- C0003250
Description
Absolute neutrophil count
Data type
integer
Alias
- UMLS CUI [1]
- C0948762
Description
Date of last assessment
Data type
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C1516048
Description
Date of ANC recovery
Data type
date
Alias
- UMLS CUI [1,1]
- C0948762
- UMLS CUI [1,2]
- C2004454
- UMLS CUI [1,3]
- C0011008
Description
Date of last assessment
Data type
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C1516048
Description
Maximum grade
Data type
integer
Alias
- UMLS CUI [1,1]
- C0856825
- UMLS CUI [1,2]
- C0441800
Description
ADDITIONAL TREATMENT INCLUDING CELL THERAPY
Description
Cell infusion
Data type
boolean
Alias
- UMLS CUI [1]
- C2145394
Description
(can be the same as HSCT date)
Data type
date
Alias
- UMLS CUI [1,1]
- C0574032
- UMLS CUI [1,2]
- C0011008
Description
Type of cell(s): (check all that apply)
Data type
integer
Description
Type of cell(s): (check all that apply)
Data type
text
Description
Chronological no. of CI for this patient
Data type
text
Description
Indication
Data type
text
Alias
- UMLS CUI [1,1]
- C3146298
- UMLS CUI [1,2]
- C0302189
Description
Indication:
Data type
text
Description
Infusion count
Data type
float
Alias
- UMLS CUI [1,1]
- C0574032
- UMLS CUI [1,2]
- C0750480
Description
Disease treatment
Data type
integer
Alias
- UMLS CUI [1]
- C0087111
Description
DISEASE STATUS
Description
Best disease status (response) after HSCT
Data type
integer
Description
CR achieved: Date achieved
Data type
date
Description
Never in CR: Date assessed
Data type
date
Description
Date of last follow up or death
Data type
date
Alias
- UMLS CUI [1,1]
- C3694716
- UMLS CUI [1,2]
- C0011065
Description
Date of last follow up or death
Description
First Relapse or Progression after HSCT
Data type
text
Description
Date assessed
Data type
date
Description
Date first seen
Data type
date
Description
Relapse/progression detected by clinical/haematological method
Data type
text
Description
Date assessed
Data type
date
Description
Date first seen
Data type
date
Description
Relapse/progression detected by cytogenetic method
Data type
integer
Description
Date assessed
Data type
date
Description
Date first seen
Data type
date
Description
Relapse/progression detected by molecular method
Data type
integer
Description
Date assessed
Data type
date
Description
Date first seen
Data type
date
Description
DISEASE PRESENCE/DETECTION AT LAST CONTACT
Description
Was disease detected by clinical/haematological method?:
Data type
date
Description
Last date assessed
Data type
date
Description
Was disease detected by cytogenetic/FISH method?:
Data type
integer
Description
Considered disease relapse/progression
Data type
boolean
Description
Last date assessed
Data type
date
Description
PATIENT STATUS AT LAST CONTACT
Description
Survival Status
Data type
text
Description
Check here if patient lost to follow up
Data type
boolean
Description
Cause of Death
Data type
integer
Alias
- UMLS CUI [1]
- C0007465
Description
HSCT related cause
Data type
integer
Description
DATE OF NEXT HSCT
Data type
date
Description
COVER PAGE FOR HISTOCOMPATIBILITY REPORTS
Description
EBMT Code (CIC):
Data type
text
Description
Hospital
Data type
text
Alias
- UMLS CUI [1]
- C0019994
Description
Unit:
Data type
text
Description
Contact person
Data type
text
Description
Data type
text
Description
Has the HSCT been registered in the EBMT database ?
Data type
boolean
Alias
- UMLS CUI [1]
- C0421512
Description
Has the HSCT been registered in the EBMT database ?
Data type
text
Description
Hospital Unique Patient Number/ Code
Data type
text
Description
Initials
Data type
text
Description
Gender
Data type
text
Description
Date of Birth
Data type
date
Description
Date of HSCT
Data type
date
Description
Donor ID
Data type
text
Description
PATIENT ETHNIC OR RACIAL ORIGIN
Description
DISEASE OF SECONDARY ORIGIN
Description
THERAPY GIVEN PRIOR TO THIS HSCT
Description
THERAPY GIVEN PRIOR TO THIS HSCT
Data type
boolean
Description
THERAPY GIVEN PRIOR TO THIS HSCT
Data type
date
Description
Tyrosine kinase receptor antagonist given
Data type
boolean
Description
Tyrosine kinase receptor antagonist given
Data type
integer
Description
Other agent
Data type
text
Description
Were there any clinically significant co-existing disease or organ impairment at time of patient assessment prior to preparative (conditioning) regimen?
Data type
boolean
Description
Comorbidity
Description
Treated at any time point in the patient's past history, excluding nonmelanoma skin cancer
Data type
integer
Description
Crohn's disease or ulcerative colitis
Data type
integer
Alias
- UMLS CUI [1]
- C0021390
Description
SLE, RA, polymyositis, mixed CTD, or polymyalgia rheumatica
Data type
integer
Description
Requiring continuation of antimicrobial treatment after day 0
Data type
integer
Description
Requiring treatment with insulin or oral hypoglycaemics but not diet alone
Data type
integer
Description
Serum creatinine > 2 mg/dL or >177 μmol/L, on dialysis, or prior renal transplantation
Data type
integer
Description
Chronic hepatitis, bilirubin between Upper Limit Normal (ULN) and 1.5 x the ULN, or AST/ALT between ULN and 2.5 × ULN
Data type
integer
Description
Liver cirrhosis, bilirubin greater than 1.5 × ULN, or AST/ALT greater than 2.5 × ULN
Data type
integer
Description
Atrial fibrillation or flutter, sick sinus syndrome, or ventricular arrhythmias
Data type
integer
Description
Coronary artery disease, congestive heart failure, myocardial infarction, or EF ≤ 50%
Data type
integer
Description
Transient ischemic attack or cerebrovascular accident
Data type
integer
Description
Except mitral valve prolapse
Data type
integer
Description
DLco and/or FEV1 66-80% or dyspnoea on slight activity
Data type
integer
Description
DLco and/or FEV1 ≤ 65% or dyspnoea at rest or requiring oxygen
Data type
integer
Description
Patients with a body mass index > 35 kg/m2
Data type
integer
Description
Peptic ulcer
Data type
integer
Description
Depression or anxiety requiring psychiatric consult or treatment
Data type
integer
Description
Other Comorbidity
Data type
text
Description
GRAFT PERFORMANCE Compulsory for CIBMTR Research centres
Description
GRAFT PERFORMANCE
Description
Platelet reconstitution
Data type
text
Description
Date Platelets > 20 x 10 9 /l
Data type
date
Description
Compulsory for CIBMTR Research centres. Fill in only if you answered Yes: Planned to the question on Disease treatment under Additional treatment
Data type
date
Description
Chemo/drug
Data type
boolean
Description
Chemo/drug
Data type
integer
Description
Radiotherapy
Data type
boolean
Description
HSCT - Minimum Essential Data - A First report - 100 days after HSCT DISEASE CLASSIFICATION SHEET 1
Description
EBMT Centre Identification Code (CIC)
Data type
text
Alias
- UMLS CUI [1]
- C2348585
Description
Hospital Unique Patient Number/Code (UPN)
Data type
text
Description
Date of Initial Diagnosis
Data type
date
Similar models
100 days past HSCT EBMT
- StudyEvent: ODM
C0600091 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
C0029216 (UMLS CUI [1,2])
C2745955 (UMLS CUI [1,3])
C0011008 (UMLS CUI [1,4])
C1321095 (UMLS CUI [1,2])
C0004002 (UMLS CUI [1,2])
C0006463 (UMLS CUI [1,2])
C0007257 (UMLS CUI [1,2])
C3831356 (UMLS CUI [1,2])
C0687700 (UMLS CUI [1,2])
C0939276 (UMLS CUI [1,2])
C0079083 (UMLS CUI [1,2])
C0008838 (UMLS CUI [1,2])
C0001617 (UMLS CUI [1,2])
C0010583 (UMLS CUI [1,2])
C0011015 (UMLS CUI [1,2])
C0013089 (UMLS CUI [1,2])
C0015133 (UMLS CUI [1,2])
C0059985 (UMLS CUI [1,2])
C0872968 (UMLS CUI [1,2])
C0020789 (UMLS CUI [1,2])
C0020823 (UMLS CUI [1,2])
C0939537 (UMLS CUI [1,2])
C0025241 (UMLS CUI [1,2])
C0026259 (UMLS CUI [1,2])
C0393022 (UMLS CUI [1,2])
C0039512 (UMLS CUI [1,2])
C0039871 (UMLS CUI [1,2])
C0919274 (UMLS CUI [1,2])
C0454110 (UMLS CUI [1,2])
C0003250 (UMLS CUI [1,2])
C0454110 (UMLS CUI [1,3])
C0003250 (UMLS CUI [1,2])
C0454110 (UMLS CUI [1,3])
C0003250 (UMLS CUI [1,2])
C0043162 (UMLS CUI [1,2])
C0043162 (UMLS CUI [2])
C4035158 (UMLS CUI [1,2])
C4035158 (UMLS CUI [1,2])
C4035158 (UMLS CUI [1,2])
C0003250 (UMLS CUI [1,3])
C1516048 (UMLS CUI [1,2])
C2004454 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
C1516048 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
C0302189 (UMLS CUI [1,2])
C0750480 (UMLS CUI [1,2])
C0011065 (UMLS CUI [1,2])