ID

15798

Description

reference: http://www.ebmt.org/Contents/Data-Management/Registrystructure/MED-ABdatacollectionforms/Pages/MED-AB-data-collection-forms.aspx DOCUMENTED PATHOGENS (Use this table for guidance on the pathogens of interest) 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

Link

http://www.ebmt.org/Contents/Data-Management/Registrystructure/MED-ABdatacollectionforms/Pages/MED-AB-data-collection-forms.aspx

Keywords

Versions (1)
  1. 6/13/16 6/13/16 -
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June 13, 2016

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License

Creative Commons BY-NC 3.0
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FOLLOW UP EBMT Lymphoma

English

FOLLOW UP EBMT Lymphoma

1 forms  
LYMPHOMA FOLLOW UP
Description

LYMPHOMA FOLLOW UP

Unique Identification Code (UIC) (if known)
Description

Unique Identification Code (UIC)

Data type

integer

Alias
UMLS CUI [1]
C1827636
Date of this report
Description

Date of this report

Data type

date

Alias
UMLS CUI [1]
C1302584
Patient following national / international study / trial
Description

Patient in Trial

Data type

integer

Alias
UMLS CUI [1]
C1997894
Name of study / trial
Description

Name of study / trial

Data type

integer

Alias
UMLS CUI [1]
C2348560
Hospital Unique Patient Number
Description

Hospital Unique Patient Number

Data type

integer

Alias
UMLS CUI [1]
C2348585
First name(s)_surname(s)
Description

Initials

Data type

text

Alias
UMLS CUI [1]
C2986440
Date of birth
Description

Date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Date of last HSCT for this patient
Description

Date of last HSCT for this patient

Data type

date

Alias
UMLS CUI [1,1]
C0472699
UMLS CUI [1,2]
C0011008
DATE OF LAST CONTACT OR DEATH
Description

DATE OF LAST CONTACT OR DEATH

Data type

date

Alias
UMLS CUI [1]
C0805839
GRAFT VERSUS HOST DISEASE (GvHD) SINCE LAST REPORT
Description

GRAFT VERSUS HOST DISEASE (GvHD) SINCE LAST REPORT

ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)
Description

Maximum Grade of Acute GVHD

Data type

integer

Alias
UMLS CUI [1]
C0441799
AGVHD present? Pleae indicate
Description

ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)

Data type

integer

Reason for aGvHD
Description

Reason for aGvHD

Data type

text

Alias
UMLS CUI [1,1]
C0392360
UMLS CUI [1,2]
C0856825
Date onset of this episode (if new or recurrent)
Description

Date onset of this episode

Data type

date

Measurement units
  • yyyy/mm/dd
Alias
UMLS CUI [1]
C0574845
yyyy/mm/dd
Acute graft versus host disease in skin
Description

Acute graft versus host disease in skin

Data type

integer

Alias
UMLS CUI [1]
C1739372
Acute graft versus host disease in liver
Description

Acute graft versus host disease in liver

Data type

integer

Alias
UMLS CUI [1]
C1739104
Acute graft versus host disease in intestine
Description

Acute graft versus host disease in intestine

Data type

integer

Alias
UMLS CUI [1]
C1737219
Resolution
Description

aGvHD Resolution

Data type

integer

Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C1514893
Date of resolution
Description

aGvHD Date of resolution

Data type

date

Measurement units
  • yyyy/mm/dd
Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C1514893
UMLS CUI [1,3]
C0011008
yyyy/mm/dd
Chronic Graft versus Host Disease
Description

Presence of cGvHD

Data type

integer

Alias
UMLS CUI [1]
C0867389
Presence of cGVHD
Description

Presence of cGVHD

Data type

integer

Alias
UMLS CUI [1]
C0867389
Date of onset Date of onset
Description

Date of onset

Data type

date

Alias
UMLS CUI [1]
C0574845
cGvHD grade
Description

cGvHD grade

Data type

integer

Alias
UMLS CUI [1,1]
C0867389
UMLS CUI [1,2]
C0441800
Organs affected
Description

Organs affected

Data type

integer

Alias
UMLS CUI [1]
C0449642
If resolved, specify the date of resolution:
Description

Date of Resolution

Data type

date

Alias
UMLS CUI [1,1]
C1514893
UMLS CUI [1,2]
C0011008
OTHER COMPLICATIONS SINCE LAST REPORT
Description

OTHER COMPLICATIONS SINCE LAST REPORT

Infection related complications
Description

Infection related complications

Data type

boolean

Alias
UMLS CUI [1,1]
C0009450
UMLS CUI [1,2]
C0009566
Bacteremia / fungemia / viremia / parasites
Description

Use the list of pathogens listed after this table for guidance.

Data type

integer

Alias
UMLS CUI [1]
C0004610
UMLS CUI [2]
C0085082
UMLS CUI [3]
C0042749
UMLS CUI [4]
C0030498
Septic shock
Description

Use the list of pathogens listed after this table for guidance.

Data type

integer

Alias
UMLS CUI [1]
C0036983
ARDS
Description

Use the list of pathogens listed after this table for guidance.

Data type

integer

Alias
UMLS CUI [1]
C0035222
Multiorgan failure due to infection
Description

Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.

Data type

integer

Alias
UMLS CUI [1]
C0026766
Pneumonia
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.

Data type

integer

Alias
UMLS CUI [1]
C0032285
Hepatitis
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.

Data type

integer

Alias
UMLS CUI [1]
C0019158
CNS infection
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.

Data type

integer

Alias
UMLS CUI [1]
C0007684
Gut infection
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.

Data type

integer

Alias
UMLS CUI [1]
C0178238
Skin infection
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.

Data type

integer

Alias
UMLS CUI [1]
C0037278
Cystitis
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.

Data type

integer

Alias
UMLS CUI [1]
C0010692
Other
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.

Data type

integer

Alias
UMLS CUI [1]
C0205394
Non infection related complications
Description

Non infection related complications

Data type

boolean

Alias
UMLS CUI [1]
C0009566
Idiopathic pneumonia syndrome
Description

NON INFECTION RELATED COMPLICATIONS

Data type

integer

Alias
UMLS CUI [1]
C1504431
VOD
Description

VOD

Data type

integer

Alias
UMLS CUI [1]
C0948441
Cataract Cataract
Description

Cataract

Data type

integer

Alias
UMLS CUI [1]
C0086543
Haemorrhagic cystitis, non infectious Haemorrhagic cystitis, non infectious
Description

Haemorrhagic cystitis, non infectious

Data type

integer

Alias
UMLS CUI [1]
C0085692
ARDS, non infectious ARDS, non infectious
Description

ARDS, non infectious

Data type

integer

Alias
UMLS CUI [1]
C1963227
Multiorgan failure, non infectious
Description

Multiorgan failure, non infectious

Data type

integer

Alias
UMLS CUI [1]
C0026766
HSCT-associated microangiopathy HSCT-associated microangiopathy
Description

HSCT-associated microangiopathy

Data type

integer

Alias
UMLS CUI [1]
C0155765
Renal failure requiring dialysis Renal failure requiring dialysis
Description

Renal failure requiring dialysis

Data type

integer

Alias
UMLS CUI [1]
C0035078
Haemolytic anaemia due to blood group Haemolytic anaemia due to blood group
Description

Haemolytic anaemia due to blood group

Data type

integer

Alias
UMLS CUI [1]
C0002878
Aseptic bone necrosis Aseptic bone necrosis
Description

Aseptic bone necrosis

Data type

integer

Alias
UMLS CUI [1]
C0158452
Graft loss
Description

Graft loss

Data type

integer

Alias
UMLS CUI [1]
C0877042
Overall chimaerism
Description

Overall chimaerism

Data type

integer

Alias
UMLS CUI [1]
C0333678
DATE(S) AND RESULTS OF ALL TESTS DONE FOR ALL DONORS
Description

DATE(S) AND RESULTS OF ALL TESTS DONE FOR ALL DONORS

Date of Test
Description

Date of Test

Data type

date

Alias
UMLS CUI [1]
C2826247
Identification of donor or Cord Blood Unit given by the centre
Description

Identification

Data type

text

Alias
UMLS CUI [1]
C1718162
Number in the infusion order (if applicable)
Description

Number in the infusion order (if applicable)

Data type

integer

Alias
UMLS CUI [1]
C2348184
Cell type on which test was performed (% Donor Cells): BM
Description

Test used FISH  Molecular  Cytogenetic  ABO group  Other: ……………………  unknown

Data type

integer

Measurement units
  • %
Alias
UMLS CUI [1,1]
C0449475
UMLS CUI [1,2]
C0022885
Test used
Description

Laboratory tests

Data type

integer

Alias
UMLS CUI [1]
C0022885
Test used: If other, specify:
Description

Specification other labaratory tests

Data type

text

Alias
UMLS CUI [1,1]
C0022885
UMLS CUI [1,2]
C2348235
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFERATIVE Disease DIAGNOSED
Description

SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFERATIVE DISORDER DIAGNOSED

Data type

integer

Alias
UMLS CUI [1]
C3266877
UMLS CUI [2]
C0024314
UMLS CUI [3]
C0027022
Diagnosis
Description

Diagnosis

Data type

integer

Alias
UMLS CUI [1]
C0011900
ADDITIONAL THERAPIES SINCE LAST FOLLOW UP
Description

ADDITIONAL THERAPIES SINCE LAST FOLLOW UP

Treatment given since last report
Description

Additional treatment

Data type

boolean

Alias
UMLS CUI [1]
C1706712
ADDITIONAL TREATMENT start date
Description

if yes, date started

Data type

date

Alias
UMLS CUI [1,1]
C1706712
UMLS CUI [1,2]
C0808070
Cellular therapy
Description

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.

Data type

integer

Alias
UMLS CUI [1]
C0302189
Disease status before this cellular therapy
Description

Disease status before this cellular therapy

Data type

integer

Alias
UMLS CUI [1]
C3899365
Type of cells
Description

If CELLULAR THERAPY was administered, please indicate:

Data type

integer

Alias
UMLS CUI [1]
C0302189
Number of cells infused by type DLI only
Description

Number of cells infused by type DLI only

Data type

integer

Alias
UMLS CUI [1]
C1512034
Chronological number of this cell therapy for this patient
Description

Chronological number

Data type

float

Alias
UMLS CUI [1]
C2348184
Indication (check all that apply)
Description

Indication

Data type

text

Alias
UMLS CUI [1,1]
C3146298
UMLS CUI [1,2]
C0302189
Number of Infusions (count only infusions that are part of same regimen and given for the same indication)
Description

(within 10 weeks)

Data type

float

Alias
UMLS CUI [1,1]
C2348184
UMLS CUI [1,2]
C0574032
Acute Graft versus Host Disease (after this infusion but before any further infusion/ transplant) Maximum grade:
Description

after this infusion but before any further infusion / HSCT): AGVHGRMX

Data type

integer

Alias
UMLS CUI [1]
C0856825
Disease treatment
Description

(apart from donor cell infusion or other type of cell therapy)

Data type

integer

Alias
UMLS CUI [1]
C0087111
Chemo/drug/agent
Description

Pharmacotherapy

Data type

boolean

Alias
UMLS CUI [1]
C0013216
Radiotherapy
Description

Radiotherapy

Data type

text

Alias
UMLS CUI [1]
C1522449
Other treatment
Description

Other treatment

Data type

text

Alias
UMLS CUI [1]
C0087111
FIRST EVIDENCE OF RELAPSE OR PROGRESSION SINCE LAST HSCT
Description

FIRST EVIDENCE OF RELAPSE OR PROGRESSION SINCE LAST HSCT

Relapse or Progression
Description

Relapse or Progression

Data type

integer

Alias
UMLS CUI [1]
C0035020
UMLS CUI [2]
C0242656
last disease status
Description

Last Disease Status

Data type

integer

Alias
UMLS CUI [1]
C0456079
Has patient or partner become pregnant after this HSCT?
Description

Conception

Data type

integer

Alias
UMLS CUI [1]
C0032961
Survival Status
Description

Survival Status

Data type

integer

Alias
UMLS CUI [1]
C1148433
If alive: Type of performance score used:
Description

Performance Score

Data type

integer

Alias
UMLS CUI [1]
C1518965
Score used
Description

performance status

Data type

integer

Alias
UMLS CUI [1]
C1518965
If dead, specify cause of death:
Description

Cause of Death

Data type

text

Alias
UMLS CUI [1]
C0007465
GvHD
Description

If dead and HSCT related cause of death, specify (check as many as apppropriate):

Data type

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0018133
Interstitial Pneumonitis
Description

If dead and HSCT related cause of death, specify (check as many as apppropriate):

Data type

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0206061
Pulmonary toxicity
Description

If dead and HSCT related cause of death, specify (check as many as apppropriate):

Data type

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0919924
Infection
Description

If dead and HSCT related cause of death, specify (check as many as apppropriate):

Data type

integer

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0009450
Infection
Description

Infection HSCT

Data type

integer

Rejection / poor graft function
Description

(check as many as appropriate)

Data type

integer

Alias
UMLS CUI [1]
C0018129
Veno-Occlusive disease (VOD)
Description

If dead and HSCT related cause of death, specify (check as many as apppropriate):

Data type

integer

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0948441
Haemorrhage
Description

If dead and HSCT related cause of death, specify (check as many as apppropriate):

Data type

integer

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0019080
Cardiac toxicity
Description

If dead and HSCT related cause of death, specify (check as many as apppropriate):

Data type

integer

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0876994
Central nervous system toxicity
Description

If dead and HSCT related cause of death, specify (check as many as apppropriate):

Data type

integer

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C3160947
Gastro intestinal toxicity
Description

If dead and HSCT related cause of death, specify (check as many as apppropriate):

Data type

integer

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C1142499
Skin toxicity
Description

If dead and HSCT related cause of death, specify (check as many as apppropriate):

Data type

integer

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C1167791
Renal failure
Description

If dead and HSCT related cause of death, specify (check as many as apppropriate):

Data type

integer

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0035078
Multiple organ failure
Description

If dead and HSCT related cause of death, specify (check as many as apppropriate):

Data type

integer

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0026766
Other
Description

If dead and HSCT related cause of death, specify (check as many as apppropriate):

Data type

boolean

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0007465
ADDITIONAL NOTES IF APPLICABLE
Description

ADDITIONAL NOTES IF APPLICABLE

Comments
Description

Comments

Data type

text

Alias
UMLS CUI [1]
C0947611
IDENTIFICATION & SIGNATURE
Description

IDENTIFICATION & SIGNATURE

Data type

text

Alias
UMLS CUI [1]
C1519316
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Similar models

FOLLOW UP EBMT Lymphoma

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
LYMPHOMA FOLLOW UP
Unique Identification Code (UIC)
Item
Unique Identification Code (UIC) (if known)
integer
C1827636 (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])
Patient in Trial
Code List
Patient following national / international study / trial
CL Item
No (1)
C1298908 (UMLS CUI-1)
CL Item
Yes (2)
C1705108 (UMLS CUI-1)
CL Item
Not evaluated (3)
C3846720 (UMLS CUI-1)
CL Item
Unknown (4)
C0439673 (UMLS CUI-1)
Name of study / trial
Item
Name of study / trial
integer
C2348560 (UMLS CUI [1])
Hospital Unique Patient Number
Item
Hospital Unique Patient Number
integer
C2348585 (UMLS CUI [1])
Initials
Item
First name(s)_surname(s)
text
C2986440 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
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 OF LAST CONTACT OR DEATH
Item
DATE OF LAST CONTACT OR DEATH
date
C0805839 (UMLS CUI [1])
Item Group
GRAFT VERSUS HOST DISEASE (GvHD) SINCE LAST REPORT
Item
ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)
integer
C0441799 (UMLS CUI [1])
AcuteGraftVersusHostDiseaseMaximumOverallGrade
Code List
ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)
CL Item
Agvhd Grade 0 (0)
C0856825 (UMLS CUI-1)
C0687695 (UMLS CUI-2)
CL Item
Agvhd Grade I (I)
C0856825 (UMLS CUI-1)
C0441802 (UMLS CUI-2)
CL Item
Agvhd Grade Ii (II)
C0856825 (UMLS CUI-1)
C0687695 (UMLS CUI-2)
CL Item
Agvhd Grade Iii (III)
C0856825 (UMLS CUI-1)
CL Item
Agvhd Grade Iv (IV)
C0856825 (UMLS CUI-1)
C0687695 (UMLS CUI-2)
CL Item
Agvhd Present, Grade Unknown (Present, grade unknown)
C3846524 (UMLS CUI-1)
C0856825 (UMLS CUI-2)
Item
AGVHD present? Pleae indicate
integer
Maximum grade
Code List
AGVHD present? Pleae indicate
CL Item
New onset  (1)
C0746890 (UMLS CUI-1)
CL Item
Recurrent  (2)
C2945760 (UMLS CUI-1)
CL Item
Persistent (3)
C0205322 (UMLS CUI-1)
Item
Reason for aGvHD
text
C0392360 (UMLS CUI [1,1])
C0856825 (UMLS CUI [1,2])
Reason
Code List
Reason for aGvHD
CL Item
DLI (DLI)
C1512034 (UMLS CUI-1)
CL Item
Tapering (Tapering)
C0441640 (UMLS CUI-1)
CL Item
Unexplained (Unexplained)
C0439673 (UMLS CUI-1)
Date onset of this episode
Item
Date onset of this episode (if new or recurrent)
date
C0574845 (UMLS CUI [1])
Item
Acute graft versus host disease in skin
integer
C1739372 (UMLS CUI [1])
aGvHD Stage Skin
Code List
Acute graft versus host disease in skin
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)
Item
Acute graft versus host disease in liver
integer
C1739104 (UMLS CUI [1])
aGvHD Stage liver
Code List
Acute graft versus host disease in liver
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)
Item
Acute graft versus host disease in intestine
integer
C1737219 (UMLS CUI [1])
aGvHD stage gut
Code List
Acute graft versus host disease in intestine
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)
Item
Resolution
integer
C0856825 (UMLS CUI [1,1])
C1514893 (UMLS CUI [1,2])
aGvHD Resolution
Code List
Resolution
CL Item
No  (1)
CL Item
Yes (2)
CL Item
Date (3)
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
Chronic Graft versus Host Disease
integer
C0867389 (UMLS CUI [1])
Chronic Graft versus Host Disease
Code List
Chronic Graft versus Host Disease
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Present continously since last reported episode (Present continously since last reported episode)
CL Item
Resolved (Resolved)
Item
Presence of cGVHD
integer
C0867389 (UMLS CUI [1])
Presence of cGVHD
Code List
Presence of cGVHD
CL Item
No (1)
C1298908 (UMLS CUI-1)
CL Item
Yes, First Episode (2)
C0439615 (UMLS CUI-1)
CL Item
Yes, Recurrence (3)
C0035020 (UMLS CUI-1)
Date of onset
Item
Date of onset Date of onset
date
C0574845 (UMLS CUI [1])
Item
cGvHD grade
integer
C0867389 (UMLS CUI [1,1])
C0441800 (UMLS CUI [1,2])
cGvHD grade
Code List
cGvHD grade
CL Item
Limited (1)
C0439801 (UMLS CUI-1)
CL Item
Extensive (2)
C0205231 (UMLS CUI-1)
Item
Organs affected
integer
C0449642 (UMLS CUI [1])
Organs affected
Code List
Organs affected
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])
Item Group
OTHER COMPLICATIONS SINCE LAST REPORT
Infection related complications
Item
Infection related complications
boolean
C0009450 (UMLS CUI [1,1])
C0009566 (UMLS CUI [1,2])
Item
Bacteremia / fungemia / viremia / parasites
integer
C0004610 (UMLS CUI [1])
C0085082 (UMLS CUI [2])
C0042749 (UMLS CUI [3])
C0030498 (UMLS CUI [4])
Bacteremia / fungemia / viremia / parasites
Code List
Bacteremia / fungemia / viremia / parasites
CL Item
Pathogen (Pathogen)
C0450254 (UMLS CUI-1)
CL Item
Use “unknown” if necessary (Use “unknown” if necessary)
C0439673 (UMLS CUI-1)
CL Item
Date (Date)
C0011008 (UMLS CUI-1)
Item
Septic shock
integer
C0036983 (UMLS CUI [1])
Septic shock
Code List
Septic shock
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
Use “unknown” if necessary (2)
C0439673 (UMLS CUI-1)
CL Item
Date (3)
C0011008 (UMLS CUI-1)
Item
ARDS
integer
C0035222 (UMLS CUI [1])
ARDS
Code List
ARDS
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
unknown (2)
C0439673 (UMLS CUI-1)
CL Item
Date (3)
C0011008 (UMLS CUI-1)
Item
Multiorgan failure due to infection
integer
C0026766 (UMLS CUI [1])
Multiorgan failure due to infection
Code List
Multiorgan failure due to infection
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
Unknown (2)
C0439673 (UMLS CUI-1)
CL Item
Date (3)
C0011008 (UMLS CUI-1)
Item
Pneumonia
integer
C0032285 (UMLS CUI [1])
Pneumonia
Code List
Pneumonia
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
unknown (2)
C0439673 (UMLS CUI-1)
CL Item
Date (3)
C0011008 (UMLS CUI-1)
Item
Hepatitis
integer
C0019158 (UMLS CUI [1])
Hepatitis
Code List
Hepatitis
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
unknown (2)
C0439673 (UMLS CUI-1)
CL Item
Date (3)
C0011008 (UMLS CUI-1)
Item
integer
C0007684 (UMLS CUI [1])
CNS infection
Code List
CNS infection
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
unknown (2)
C0439673 (UMLS CUI-1)
CL Item
date (3)
C0011008 (UMLS CUI-1)
Item
Gut infection
integer
C0178238 (UMLS CUI [1])
Gut infection
Code List
Gut infection
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
unknown (2)
C0439673 (UMLS CUI-1)
CL Item
date (3)
C0011008 (UMLS CUI-1)
Item
Skin infection
integer
C0037278 (UMLS CUI [1])
Skin infection
Code List
Skin infection
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
unknown (2)
C0439673 (UMLS CUI-1)
CL Item
date (3)
C0011008 (UMLS CUI-1)
Item
Cystitis
integer
C0010692 (UMLS CUI [1])
Cystitis
Code List
Cystitis
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
unknown (2)
C0439673 (UMLS CUI-1)
CL Item
date (3)
C0011008 (UMLS CUI-1)
Item
Other
integer
C0205394 (UMLS CUI [1])
Other
Code List
Other
CL Item
Pathogen (1)
CL Item
unknown (2)
CL Item
date (3)
Non infection related complications
Item
Non infection related complications
boolean
C0009566 (UMLS CUI [1])
Item
Idiopathic pneumonia syndrome
integer
C1504431 (UMLS CUI [1])
Idiopathic pneumonia syndrome
Code List
Idiopathic pneumonia syndrome
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Date (Date)
Item
VOD
integer
C0948441 (UMLS CUI [1])
VOD
Code List
VOD
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Cataract Cataract
integer
C0086543 (UMLS CUI [1])
Cataract
Code List
Cataract Cataract
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Haemorrhagic cystitis, non infectious Haemorrhagic cystitis, non infectious
integer
C0085692 (UMLS CUI [1])
Haemorrhagic cystitis, non infectious
Code List
Haemorrhagic cystitis, non infectious Haemorrhagic cystitis, non infectious
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
ARDS, non infectious ARDS, non infectious
integer
C1963227 (UMLS CUI [1])
ARDS, non infectious
Code List
ARDS, non infectious ARDS, non infectious
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Multiorgan failure, non infectious
integer
C0026766 (UMLS CUI [1])
Multiorgan failure, non infectious
Code List
Multiorgan failure, non infectious
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
HSCT-associated microangiopathy HSCT-associated microangiopathy
integer
C0155765 (UMLS CUI [1])
HSCT-associated microangiopathy
Code List
HSCT-associated microangiopathy HSCT-associated microangiopathy
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Renal failure requiring dialysis Renal failure requiring dialysis
integer
C0035078 (UMLS CUI [1])
Renal failure requiring dialysis
Code List
Renal failure requiring dialysis Renal failure requiring dialysis
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Haemolytic anaemia due to blood group Haemolytic anaemia due to blood group
integer
C0002878 (UMLS CUI [1])
Haemolytic anaemia due to blood group
Code List
Haemolytic anaemia due to blood group Haemolytic anaemia due to blood group
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Aseptic bone necrosis Aseptic bone necrosis
integer
C0158452 (UMLS CUI [1])
Aseptic bone necrosis
Code List
Aseptic bone necrosis Aseptic bone necrosis
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Graft loss
integer
C0877042 (UMLS CUI [1])
Graft loss
Code List
Graft loss
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
Overall chimaerism
integer
C0333678 (UMLS CUI [1])
Overall chimaerism
Code List
Overall chimaerism
CL Item
Full (donor >95 %) (Full (donor >)
C0443225 (UMLS CUI-1)
CL Item
Mixed (partial) (Mixed (partial))
C0205430 (UMLS CUI-1)
CL Item
Autologous reconstitution (recipient >95 %) (Autologuos reconstitution (recipient >)
C0439859 (UMLS CUI-1)
C0301944 (UMLS CUI-2)
CL Item
Aplasia (Aplasia)
C0243065 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated)
C3846720 (UMLS CUI-1)
Item Group
DATE(S) AND RESULTS OF ALL TESTS DONE FOR ALL DONORS
Date of Test
Item
Date of Test
date
C2826247 (UMLS CUI [1])
Identification
Item
Identification of donor or Cord Blood Unit given by the centre
text
C1718162 (UMLS CUI [1])
Item
Number in the infusion order (if applicable)
integer
C2348184 (UMLS CUI [1])
Number in the infusion order (if applicable)
Code List
Number in the infusion order (if applicable)
CL Item
......... (1)
CL Item
N/A (2)
Item
Cell type on which test was performed (% Donor Cells): BM
integer
C0449475 (UMLS CUI [1,1])
C0022885 (UMLS CUI [1,2])
Cell type on which test was performed (% Donor Cells):
Code List
Cell type on which test was performed (% Donor Cells): BM
CL Item
BM (1)
C0005953 (UMLS CUI-1)
CL Item
PB mononuclear cells (PBMC) (2)
C1321301 (UMLS CUI-1)
CL Item
T-cell (3)
C0039194 (UMLS CUI-1)
CL Item
B-cells (4)
C0004561 (UMLS CUI-1)
CL Item
Red blood cells (5)
C0014772 (UMLS CUI-1)
CL Item
Monocytes (6)
C0026473 (UMLS CUI-1)
CL Item
PMNs (neutrophils) (7)
C0200633 (UMLS CUI-1)
CL Item
Lymphocytes, NOS (8)
C0024264 (UMLS CUI-1)
CL Item
Myeloid cells, NOS (9)
C0887899 (UMLS CUI-1)
CL Item
Other, specify (10)
C1299220 (UMLS CUI-1)
Item
Test used
integer
C0022885 (UMLS CUI [1])
Laboratory tests
Code List
Test used
CL Item
FISH (FISH)
C0162789 (UMLS CUI-1)
CL Item
Molecular (Molecular)
C0026376 (UMLS CUI-1)
CL Item
Cytogenetic (Cytogenetic)
C0010802 (UMLS CUI-1)
CL Item
ABO group (ABO group)
C0000778 (UMLS CUI-1)
CL Item
Other (Other)
C0205394 (UMLS CUI-1)
CL Item
unknown (unknown)
C0439673 (UMLS CUI-1)
Specification other labaratory tests
Item
Test used: If other, specify:
text
C0022885 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Item
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFERATIVE Disease DIAGNOSED
integer
C3266877 (UMLS CUI [1])
C0024314 (UMLS CUI [2])
C0027022 (UMLS CUI [3])
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
Code List
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFERATIVE Disease DIAGNOSED
CL Item
Previously reported (Previously reported)
C1115086 (UMLS CUI-1)
CL Item
Yes, date of diagnosis (Yes, date of diagnosis)
C2316983 (UMLS CUI-1)
CL Item
No at date of this follow-up (No at date of this follow-up)
C1298908 (UMLS CUI-1)
Item
Diagnosis
integer
C0011900 (UMLS CUI [1])
Diagnosis
Code List
Diagnosis
CL Item
AML (AML)
C0023467 (UMLS CUI-1)
CL Item
MDS (MDS)
C3463824 (UMLS CUI-1)
CL Item
Lymphoproliferative disorder (Lymphoproliferative disorder)
C0024314 (UMLS CUI-1)
CL Item
Other (Other)
C0205394 (UMLS CUI-1)
CL Item
No at date of this follow-up (5)
Item Group
ADDITIONAL THERAPIES SINCE LAST FOLLOW UP
Additional treatment
Item
Treatment given since last report
boolean
C1706712 (UMLS CUI [1])
ADDITIONAL TREATMENT start date
Item
ADDITIONAL TREATMENT start date
date
C1706712 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Item
Cellular therapy
integer
C0302189 (UMLS CUI [1])
Cellular therapy
Code List
Cellular therapy
CL Item
No  (1)
CL Item
Yes (Mark disease status before this cellular therapy) (2)
CL Item
Unknown (3)
Item
Disease status before this cellular therapy
integer
C3899365 (UMLS CUI [1])
Disease status before this cellular therapy
Code List
Disease status before this cellular therapy
CL Item
CR  (1)
C0677874 (UMLS CUI-1)
CL Item
Not in CR  (2)
C0544452 (UMLS CUI-1)
CL Item
Not evaluated (3)
C3846720 (UMLS CUI-1)
Item
Type of cells
integer
C0302189 (UMLS CUI [1])
Type of cells
Code List
Type of cells
CL Item
Donor lymphocyte infusion (DLI) (1)
C1512034 (UMLS CUI-1)
CL Item
Mesenchymal cells (2)
C1257975 (UMLS CUI-1)
CL Item
Other (3)
C0205394 (UMLS CUI-1)
CL Item
Unknown (4)
C0439673 (UMLS CUI-1)
Item
Number of cells infused by type DLI only
integer
C1512034 (UMLS CUI [1])
Nucleated cells
Code List
Number of cells infused by type DLI only
CL Item
CD 3+ (1)
C3542405 (UMLS CUI-1)
CL Item
Nucleated cells (2)
C1180059 (UMLS CUI-1)
CL Item
CD 34+ (3)
C3538723 (UMLS CUI-1)
CL Item
Total number of cells infused any non DLI infusion (4)
C0302189 (UMLS CUI-1)
C0007584 (UMLS CUI-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])
Indication
Code List
Indication (check all that apply)
CL Item
Planned/ protocol (Planned/ protocol)
C1320712 (UMLS CUI-1)
CL Item
Treatment for disease (Treatment for disease)
C1511988 (UMLS CUI-1)
CL Item
Prophylactic (Prophylactic)
C0199176 (UMLS CUI-1)
CL Item
Mixed chimaerism (Mixed chimaerism)
C0333678 (UMLS CUI-1)
CL Item
Treatment of GvHD (Treatment of GvHD)
C0278845 (UMLS CUI-1)
CL Item
Treatment viral infection (Treatment viral infection)
C0280274 (UMLS CUI-1)
CL Item
Loss/decreased chimaerism (Loss/decreased chimaerism)
C0333678 (UMLS CUI-1)
CL Item
Treatment PTLD, EBV, lymphoma (Treatment PTLD, EBV, lymphoma)
C0432487 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
CL Item
Other (Other)
Number of Infusions
Item
Number of Infusions (count only infusions that are part of same regimen and given for the same indication)
float
C2348184 (UMLS CUI [1,1])
C0574032 (UMLS CUI [1,2])
Item
Acute Graft versus Host Disease (after this infusion but before any further infusion/ transplant) Maximum grade:
integer
C0856825 (UMLS CUI [1])
Acute Graft versus Host Disease
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
integer
C0087111 (UMLS CUI [1])
Disease treatment
Code List
Disease treatment
CL Item
No (1)
C1298908 (UMLS CUI-1)
CL Item
Yes: Planned (planned before HSCT took place) (2)
C0087111 (UMLS CUI-1)
CL Item
Yes: Not planned (for relapse/progression or persistent disease) (3)
C1518546 (UMLS CUI-1)
CL Item
Unknown (4)
C0439673 (UMLS CUI-1)
Pharmacotherapy
Item
Chemo/drug/agent
boolean
C0013216 (UMLS CUI [1])
Item
Radiotherapy
text
C1522449 (UMLS CUI [1])
Radiotherapy
Code List
Radiotherapy
CL Item
yes no=no not known=not known (yes)
Item
Other treatment
text
C0087111 (UMLS CUI [1])
Other treatment
Code List
Other treatment
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Item Group
FIRST EVIDENCE OF RELAPSE OR PROGRESSION SINCE LAST HSCT
Item
Relapse or Progression
integer
C0035020 (UMLS CUI [1])
C0242656 (UMLS CUI [2])
Relapse or Progression
Code List
Relapse or Progression
CL Item
Previously reported (Previously reported)
C0205309 (UMLS CUI-1)
CL Item
No (No)
C1298908 (UMLS CUI-1)
CL Item
Yes, date (Yes)
C1705108 (UMLS CUI-1)
CL Item
Continous progression since transplant (Continous progression since transplant)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
last disease status
integer
C0456079 (UMLS CUI [1])
Last Disease Status
Code List
last disease status
CL Item
Complete Remission (Complete Remission)
C0677874 (UMLS CUI-1)
CL Item
Relapse (Relapse)
C0277556 (UMLS CUI-1)
Item
Has patient or partner become pregnant after this HSCT?
integer
C0032961 (UMLS CUI [1])
Conception
Code List
Has patient or partner become pregnant after this HSCT?
CL Item
No (No)
C0232973 (UMLS CUI-1)
CL Item
Yes (Yes)
C0549206 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Survival Status
integer
C1148433 (UMLS CUI [1])
Survival Status
Code List
Survival Status
CL Item
alive (0)
C2584946 (UMLS CUI-1)
CL Item
dead (1)
C0011065 (UMLS CUI-1)
Item
If alive: Type of performance score used:
integer
C1518965 (UMLS CUI [1])
Performance Score
Code List
If alive: Type of performance score used:
CL Item
Karnofsky (Karnofsky)
C0206065 (UMLS CUI-1)
CL Item
Lansky (Lansky)
C1522275 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated)
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Score used
integer
C1518965 (UMLS CUI [1])
Performance score
Code List
Score used
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)
Item
If dead, specify cause of death:
text
C0007465 (UMLS CUI [1])
Cause of Death
Code List
If dead, specify cause of death:
CL Item
Relapse or progression (Relapse or progression)
C0277556 (UMLS CUI-1)
C0242656 (UMLS CUI-3)
CL Item
Secondary malignancy (including lymphoproliferative disease) (Secondary malignancy (including lymphoproliferative disease))
C3266877 (UMLS CUI-1)
CL Item
HSCT related cause  (HSCT related cause )
C0472699 (UMLS CUI-1)
CL Item
Unknown  (Unknown )
C0439673 (UMLS CUI-1)
CL Item
Other (Other)
C0205394 (UMLS CUI-1)
Item
GvHD
text
C0007465 (UMLS CUI [1,1])
C0018133 (UMLS CUI [1,2])
GvHD
Code List
GvHD
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Interstitial Pneumonitis
text
C0007465 (UMLS CUI [1,1])
C0206061 (UMLS CUI [1,2])
Interstitial Pneumonitis
Code List
Interstitial Pneumonitis
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Pulmonary toxicity
text
C0007465 (UMLS CUI [1,1])
C0919924 (UMLS CUI [1,2])
Pulmonary toxicity
Code List
Pulmonary toxicity
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Infection
integer
C0007465 (UMLS CUI [1,1])
C0009450 (UMLS CUI [1,2])
Infection
Code List
Infection
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Infection
integer
Infection HSCT
Code List
Infection
CL Item
bacterial (1)
CL Item
viral (2)
CL Item
fungal (3)
CL Item
parasitic (4)
CL Item
unknown (5)
Item
Rejection / poor graft function
integer
C0018129 (UMLS CUI [1])
Rejection / poor graft function
Code List
Rejection / poor graft function
CL Item
Yes  (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Veno-Occlusive disease (VOD)
integer
C0007465 (UMLS CUI [1,1])
C0948441 (UMLS CUI [1,2])
Veno-Occlusive disease (VOD)
Code List
Veno-Occlusive disease (VOD)
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Haemorrhage
integer
C0007465 (UMLS CUI [1,1])
C0019080 (UMLS CUI [1,2])
Haemorrhage
Code List
Haemorrhage
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Cardiac toxicity
integer
C0007465 (UMLS CUI [1,1])
C0876994 (UMLS CUI [1,2])
Cardiac toxicity
Code List
Cardiac toxicity
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Central nervous system toxicity
integer
C0007465 (UMLS CUI [1,1])
C3160947 (UMLS CUI [1,2])
Central nervous system toxicity
Code List
Central nervous system toxicity
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Gastro intestinal toxicity
integer
C0007465 (UMLS CUI [1,1])
C1142499 (UMLS CUI [1,2])
Gastro intestinal toxicity
Code List
Gastro intestinal toxicity
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Skin toxicity
integer
C0007465 (UMLS CUI [1,1])
C1167791 (UMLS CUI [1,2])
Skin toxicity
Code List
Skin toxicity
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Renal failure
integer
C0007465 (UMLS CUI [1,1])
C0035078 (UMLS CUI [1,2])
Renal failure
Code List
Renal failure
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Multiple organ failure
integer
C0007465 (UMLS CUI [1,1])
C0026766 (UMLS CUI [1,2])
Multiple organ failure
Code List
Multiple organ failure
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Other
Item
Other
boolean
C0205394 (UMLS CUI [1,1])
C0007465 (UMLS CUI [1,2])
Item Group
ADDITIONAL NOTES IF APPLICABLE
Comments
Item
Comments
text
C0947611 (UMLS CUI [1])
IDENTIFICATION & SIGNATURE
Item
IDENTIFICATION & SIGNATURE
text
C1519316 (UMLS CUI [1])
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