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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
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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
Similar models
100 days past HSCT EBMT
- StudyEvent: ODM
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
EBMT Code (CIC)
Item
EBMT Code (CIC)
integer
C3826859 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
C0600091 (UMLS CUI [1,2])
Klinik
Item
Hospital
text
C0019994 (UMLS CUI [1])
Unit
Item
Unit
integer
C1519795 (UMLS CUI [1])
Contact person
Item
Contact person
integer
C0337611 (UMLS CUI [1])
Phone
Item
Phone
integer
C1550483 (UMLS CUI [1])
Fax
Item
Fax
integer
C1549619 (UMLS CUI [1])
e-mail
Item
e-mail
integer
C1705961 (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
no (1)
CL Item
yes (2)
CL Item
unknown (3)
Name of study / trial
Item
Name of study / trial
integer
C0008976 (UMLS CUI [1])
Hospital Unique Patient Number
Item
Hospital Unique Patient Number/Code
integer
C2348585 (UMLS CUI [1])
Initials
Item
Initials (first name(s) _family name(s))
integer
C2986440 (UMLS CUI [1])
Date of Birth
Item
Date of Birth
date
C0421451 (UMLS CUI [1])
CL Item
Male (1)
CL Item
Female (2)
Date of initial diagnosis
Item
Date of initial diagnosis
date
C2316983 (UMLS CUI [1])
PRIMARY DISEASE DIAGNOSIS
Item
PRIMARY DISEASE DIAGNOSIS
integer
C0277554 (UMLS CUI [1])
CL Item
Karnofsky (1)
CL Item
Lansky (2)
CL Item
10 (1)
CL Item
100 (10)
CL Item
20 (2)
CL Item
30 (3)
CL Item
40 (4)
CL Item
50 (5)
CL Item
60 (6)
CL Item
70 (7)
CL Item
80 (8)
CL Item
90 (9)
CL Item
Autologous (1)
CL Item
Allogeneic (2)
CL Item
Negative (Negative )
CL Item
Positive (Positive)
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Multiple donors
Item
Multiple donors/products
boolean
C0013018 (UMLS CUI [1])
Multiple donors
Item
Multiple donors: if yes:
integer
C0013018 (UMLS CUI [1])
CL Item
Bone Marrow VBMSC (Bone Marrow VBMSC )
CL Item
Peripheral Blood VPBSC (Peripheral Blood VPBSC)
CL Item
Cord Blood VCBSC (Cord Blood VCBSC )
CL Item
Other (Other)
Source of Stem Cells
Item
Source of Stem Cells: if other, please specify
integer
C0018956 (UMLS CUI [1])
Donor ID
Item
Donor ID
text
C1718162 (UMLS CUI [1])
CL Item
N/A (1)
CL Item
Syngeneic (monozygotic twin) (Syngeneic (monozygotic twin))
CL Item
HLA-identical sibling (may include non-monozygotic twin) (HLA-identical sibling (may include non-monozygotic twin) )
CL Item
HLA-matched other relative (HLA-matched other relative)
CL Item
HLA-mismatched relative (HLA-mismatched relative)
CL Item
Unrelated donor (Unrelated donor)
CL Item
1 HLA antigen mismatch (1)
CL Item
> 2 HLA antigen mismatch (2)
donor registry
Item
Name of donor registry/CB Bank
integer
C0034975 (UMLS CUI [1])
BMDW/WMDA code
Item
BMDW/WMDA code (up to 4 characters)
integer
C2987198 (UMLS CUI [1])
Item
Number of mismatches A
integer
C1881865 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
CL Item
match (0)
CL Item
one mismatch (1)
CL Item
2 mismatches (2)
CL Item
not done (ND)
Item
Number of mismatches B
integer
C1881865 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
CL Item
match (0)
CL Item
one mismatch (1)
CL Item
2 mismatches (2)
CL Item
not done (ND)
Item
Number of mismatches C
integer
C1881865 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
CL Item
match (0)
CL Item
one mismatch (1)
CL Item
2 mismatches (2)
CL Item
not done (ND)
Item
Number of mismatches DRB1
integer
C1881865 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
CL Item
match (0)
CL Item
one mismatch (1)
CL Item
2 mismatches (2)
CL Item
not done (ND)
Item
Number of mismatches DQB1
integer
C1881865 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
CL Item
match (0)
CL Item
one mismatch (1)
CL Item
2 mismatches (2)
CL Item
not done (ND)
Item
Number of mismatches DPB1
integer
C1881865 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
CL Item
match (0)
CL Item
one mismatch (1)
CL Item
2 mismatches (2)
CL Item
not done (ND)
CL Item
Male (Male )
CL Item
Female (Female)
CL Item
Negative (1)
CL Item
Positive (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Graft manipulation ex-vivo (including T-cell depletion) other than for RBC removal or volume reduction
Item
Graft manipulation ex-vivo (including T-cell depletion) other than for RBC removal or volume reduction
boolean
C0677960 (UMLS CUI [1])
Chronological number of HSCT
Item
Chronological number of HSCT for this patient?
integer
C1318453 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,2])
If >1, date of last HSCT before this one
Item
If >1, date of last HSCT before this one
date
C0018956 (UMLS CUI [1,1])
C0029216 (UMLS CUI [1,2])
C2745955 (UMLS CUI [1,3])
C0011008 (UMLS CUI [1,4])
C0029216 (UMLS CUI [1,2])
C2745955 (UMLS CUI [1,3])
C0011008 (UMLS CUI [1,4])
HSCT part of a planned multiple graft protocol?
Item
HSCT part of a planned multiple graft protocol?
boolean
Preparative (conditioning) regimen given?
Item
Preparative (conditioning) regimen given?
boolean
C1882454 (UMLS CUI [1])
Was this intended to be myeloablative?
Item
Was this intended to be myeloablative?
boolean
C1831742 (UMLS CUI [1])
CL Item
Age of recipient (Age of recipient)
CL Item
Comorbid conditions (Comorbid conditions)
CL Item
Prior HSCT (Prior HSCT)
CL Item
Protocol driven REASRIOT (Protocol driven REASRIOT)
CL Item
Other (Other)
Ara-C
Item
Ara-C (cytarabine)
float
C0733521 (UMLS CUI [1])
Item
Ara-C (cytarabine): Unit of dosing
integer
C0733521 (UMLS CUI [1,1])
C1321095 (UMLS CUI [1,2])
C1321095 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
ALS
Item
ALG, ATG (ALS, ATS)
float
C0002736 (UMLS CUI [1])
Item
AST: Unit of dosing
integer
C1321095 (UMLS CUI [1,1])
C0004002 (UMLS CUI [1,2])
C0004002 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
CL Item
Horse (1)
CL Item
Rabbit (2)
CL Item
Other (3)
Bleomycin
Item
Bleomycin
float
C0005740 (UMLS CUI [1])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Busulfan
Item
Busulfan
float
C0006463 (UMLS CUI [1])
Item
Busulfan Unit of dosing:
integer
C0869039 (UMLS CUI [1,1])
C0006463 (UMLS CUI [1,2])
C0006463 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
CL Item
Oral (1)
CL Item
IV (2)
CL Item
Both (3)
BCNU
Item
BCNU
float
C0007257 (UMLS CUI [1])
Item
BCNU Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0007257 (UMLS CUI [1,2])
C0007257 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Bexar (radiolabelled MoAB)
Item
Bexar (radiolabelled MoAB)
float
C3831356 (UMLS CUI [1])
Item
Bexar Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C3831356 (UMLS CUI [1,2])
C3831356 (UMLS CUI [1,2])
CL Item
mCi (1)
CL Item
MBq (2)
CCNU
Item
CCNU
float
C0687700 (UMLS CUI [1])
Item
CCNU Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0687700 (UMLS CUI [1,2])
C0687700 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Campath
Item
Campath (antiCD52)
float
C0939276 (UMLS CUI [1])
Item
Campath Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0939276 (UMLS CUI [1,2])
C0939276 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Carboplatin
Item
Carboplatin
float
C0079083 (UMLS CUI [1])
Item
Carboplatin Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0079083 (UMLS CUI [1,2])
C0079083 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Cisplatin
Item
Cisplatin
float
C0008838 (UMLS CUI [1])
Item
Cisplatin Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0008838 (UMLS CUI [1,2])
C0008838 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Corticosteroids
Item
Corticosteroids
float
C0001617 (UMLS CUI [1])
Item
Corticosteroids Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0001617 (UMLS CUI [1,2])
C0001617 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Cyclophosphamide
Item
Cyclophosphamide
float
C0010583 (UMLS CUI [1])
Item
Cyclophosphamide Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0010583 (UMLS CUI [1,2])
C0010583 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Daunorubicin
Item
Daunorubicin
float
C0011015 (UMLS CUI [1])
Item
Unit of dosing Daunorubicin
integer
C0869039 (UMLS CUI [1,1])
C0011015 (UMLS CUI [1,2])
C0011015 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Doxorubicin
Item
Doxorubicin (adriamycine)
float
C0013089 (UMLS CUI [1])
Item
Doxorubicin Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0013089 (UMLS CUI [1,2])
C0013089 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Etoposide
Item
Etoposide (VP16)
float
C0015133 (UMLS CUI [1])
Item
Etoposide Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0015133 (UMLS CUI [1,2])
C0015133 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Fludarabine
Item
Fludarabine
float
C0059985 (UMLS CUI [1])
Item
Fludarabine Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0059985 (UMLS CUI [1,2])
C0059985 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Gemtuzumab
Item
Gemtuzumab
float
C0872968 (UMLS CUI [1])
Item
Gemtuzumab Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0872968 (UMLS CUI [1,2])
C0872968 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Idarubicin
Item
Idarubicin
float
C0020789 (UMLS CUI [1])
Item
Idarubicin Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0020789 (UMLS CUI [1,2])
C0020789 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Ifosfamide
Item
Ifosfamide
float
C0020823 (UMLS CUI [1])
Item
Ifosfamide Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0020823 (UMLS CUI [1,2])
C0020823 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Imatinib mesylate
Item
Imatinib mesylate
float
C0939537 (UMLS CUI [1])
Item
Imatinib mesylate Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0939537 (UMLS CUI [1,2])
C0939537 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Melphalan
Item
Melphalan
float
C0025241 (UMLS CUI [1])
Item
Melphalan Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0025241 (UMLS CUI [1,2])
C0025241 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Mitoxantrone
Item
Mitoxantrone
float
C0026259 (UMLS CUI [1])
Item
Mitoxantrone Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0026259 (UMLS CUI [1,2])
C0026259 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Paclitaxel
Item
Paclitaxel
float
C0144576 (UMLS CUI [1])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Rituximab
Item
Rituximab (mabthera, antiCD20)
float
C0393022 (UMLS CUI [1])
Item
Rituximab Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0393022 (UMLS CUI [1,2])
C0393022 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Teniposide
Item
Teniposide
float
C0039512 (UMLS CUI [1])
Item
Teniposide Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0039512 (UMLS CUI [1,2])
C0039512 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Thiotepa
Item
Thiotepa
float
C0039871 (UMLS CUI [1])
Item
Thiotepa Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0039871 (UMLS CUI [1,2])
C0039871 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Zevalin
Item
Zevalin (radiolabelled MoAB)
float
C0919274 (UMLS CUI [1])
Item
Zevalin Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0919274 (UMLS CUI [1,2])
C0919274 (UMLS CUI [1,2])
CL Item
mCi (1)
CL Item
MBq (2)
other radiolabelled MoAB
Item
Other radiolabelled MoAB
float
C0003250 (UMLS CUI [1,1])
C0454110 (UMLS CUI [1,2])
C0454110 (UMLS CUI [1,2])
Item
other radiolabelled MoAB Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0003250 (UMLS CUI [1,2])
C0454110 (UMLS CUI [1,3])
C0003250 (UMLS CUI [1,2])
C0454110 (UMLS CUI [1,3])
CL Item
mCi (1)
CL Item
MBq (2)
Other radiolabelled MoAB: if other, please specify
Item
Other radiolabelled MoAB: if other, please specify
integer
C0205394 (UMLS CUI [1,1])
C0003250 (UMLS CUI [1,2])
C0454110 (UMLS CUI [1,3])
C0003250 (UMLS CUI [1,2])
C0454110 (UMLS CUI [1,3])
Other MoAB
Item
Other MoAB
float
C0003250 (UMLS CUI [1])
Item
MoAB Unit of dosing
integer
C0869039 (UMLS CUI [1,1])
C0003250 (UMLS CUI [1,2])
C0003250 (UMLS CUI [1,2])
CL Item
mg/m2 (1)
CL Item
mg/Kg (2)
Total body irradiation
Item
Total body irradiation
boolean
C0043162 (UMLS CUI [1])
Total Body Irradiation: if yes, please specify value
Item
Total Body Irradiation: if yes, please specify value
integer
C4035158 (UMLS CUI [1,1])
C0043162 (UMLS CUI [1,2])
C0043162 (UMLS CUI [1,2])
TLI, TNI, TAI
Item
TLI, TNI, TAI
boolean
C4035158 (UMLS CUI [1])
C0043162 (UMLS CUI [2])
C0043162 (UMLS CUI [2])
GvHD prophylaxis
Item
GvHD prophylaxis or preventive treatment (Allografts only)
boolean
C0278845 (UMLS CUI [1])
Item
GvHD prophylaxis or preventive treatment: if yes, please specify
integer
C0278845 (UMLS CUI [1,1])
C4035158 (UMLS CUI [1,2])
C4035158 (UMLS CUI [1,2])
Code List
GvHD prophylaxis or preventive treatment: if yes, please specify
CL Item
Drugs (Immunosuppressive chemo) VAGVHDP5 (1)
CL Item
ALG, ALS, ATG, ATS (given after day 0) (2)
CL Item
Anti CD25 (MoAB in vivo) (3)
CL Item
Campath (MoAB in vivo; can be "in the bag") (4)
CL Item
Corticosteroids (5)
CL Item
Cyclosporine (6)
CL Item
Cyclophosphamide (given after day 0) (7)
CL Item
Etanercept (MoAB in vivo) (8)
CL Item
FK 506 (Tacrolimus, Prograf) (9)
CL Item
Infliximab (MoAB in vivo) (10)
CL Item
Methotrexate (11)
CL Item
Mycophenolate (MMF) (12)
CL Item
Sirolimus (13)
CL Item
Other monoclonal antibody (in vivo), (14)
CL Item
specify (15)
CL Item
Other agent (in vivo), specify (16)
CL Item
Extracorporeal photopheresis (ECP) (17)
CL Item
Other, specify (18)
GvHD prophylaxis or preventive treatment: if other, please specify
Item
GvHD prophylaxis or preventive treatment: if other, please specify
integer
C4035158 (UMLS CUI [1,1])
C4035158 (UMLS CUI [1,2])
C4035158 (UMLS CUI [1,2])
GvHD prophylaxis or preventive treatment: if Other monoclonal antibody, please specify
Item
GvHD prophylaxis or preventive treatment: if Other monoclonal antibody, please specify
integer
C4035158 (UMLS CUI [1,1])
C4035158 (UMLS CUI [1,2])
C0003250 (UMLS CUI [1,3])
C4035158 (UMLS CUI [1,2])
C0003250 (UMLS CUI [1,3])
Item
Absolute neutrophil count (ANC) recovery (engraftment) (Neutrophils >0.5X109 /L)
integer
C0948762 (UMLS CUI [1])
Code List
Absolute neutrophil count (ANC) recovery (engraftment) (Neutrophils >0.5X109 /L)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Lost fraft (3)
CL Item
Never below (4)
CL Item
Unknown (5)
Date of last assessment
Item
Date of last assessment
date
C0011008 (UMLS CUI [1,1])
C1516048 (UMLS CUI [1,2])
C1516048 (UMLS CUI [1,2])
Date of ANC recovery
Item
Date of ANC recovery
date
C0948762 (UMLS CUI [1,1])
C2004454 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
C2004454 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Date of last assessment
Item
Date of last assessment
date
C0011008 (UMLS CUI [1,1])
C1516048 (UMLS CUI [1,2])
C1516048 (UMLS CUI [1,2])
CL Item
0 (none) (1)
CL Item
I (2)
CL Item
II (3)
CL Item
III (4)
CL Item
IV (5)
CL Item
Present but grade unknown (6)
CL Item
Not evaluated (7)
Cell infusion
Item
Cell infusion (CI)
boolean
C2145394 (UMLS CUI [1])
Date of first infusion
Item
Date of first infusion
date
C0574032 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
CL Item
Lymphocyte (DLI) (1)
CL Item
Mesenchymal (2)
CL Item
Fibroblasts (3)
CL Item
Dendritic cells (4)
CL Item
Other (5)
Type of cell(s): (check all that apply)
Item
if other, please specify
text
Chronological no. of CI for this patient
Item
Chronological no. of CI for this patient
text
Item
Indication (check all that apply)
text
C3146298 (UMLS CUI [1,1])
C0302189 (UMLS CUI [1,2])
C0302189 (UMLS CUI [1,2])
CL Item
Loss/decreased chimaerism (Loss/decreased chimaerism)
CL Item
Mixed chimaerism (Mixed chimaerism)
CL Item
Other (Other)
CL Item
Planned/ protocol (Planned/ protocol)
CL Item
Prophylactic (Prophylactic)
CL Item
Treatment for disease (Treatment for disease)
CL Item
Treatment of GvHD (Treatment of GvHD)
CL Item
Treatment PTLD, EBV, lymphoma (Treatment PTLD, EBV, lymphoma)
CL Item
Treatment viral infection (Treatment viral infection)
Indication:
Item
if other, please specify
text
Infusion count
Item
Number of infusions within 10 weeks (count only infusions that are part of same regimen and given for the same indication)
float
C0574032 (UMLS CUI [1,1])
C0750480 (UMLS CUI [1,2])
C0750480 (UMLS CUI [1,2])
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)
CL Item
Unknown (4)
Item
Best disease status (response) after HSCT (prior to treatment modification in response to a post HSCT disease assessment)
integer
Code List
Best disease status (response) after HSCT (prior to treatment modification in response to a post HSCT disease assessment)
CL Item
Continued complete remission (CCR) (1)
CL Item
CR achieved: Date achieved (2)
CL Item
Never in CR: Date assessed (3)
CL Item
Not evaluated (4)
CR achieved: Date achieved
Item
CR achieved: Date achieved
date
Never in CR: Date assessed
Item
Never in CR: Date assessed
date
Date of last follow up or death
Item
Date of last follow up or death
date
C3694716 (UMLS CUI [1,1])
C0011065 (UMLS CUI [1,2])
C0011065 (UMLS CUI [1,2])
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Continuous progression since HSCT (Continuous progression since HSCT)
Date assessed
Item
Date assessed
date
Date first seen
Item
Date first seen
date
Item
Relapse/progression detected by clinical/haematological method
text
Code List
Relapse/progression detected by clinical/haematological method
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Mot evaluated (Mot evaluated)
Date assessed
Item
Date assessed
date
Date first seen
Item
Date first seen
date
Item
Relapse/progression detected by cytogenetic method
integer
Code List
Relapse/progression detected by cytogenetic method
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
Date assessed
Item
Date assessed
date
Date first seen
Item
Date first seen
date
Item
Relapse/progression detected by molecular method
integer
Code List
Relapse/progression detected by molecular method
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
Date assessed
Item
Date assessed
date
Date first seen
Item
Date first seen
date
Was disease detected by clinical/haematological method?:
Item
Was disease detected by clinical/haematological method?:
date
Last date assessed
Item
Last date assessed
date
Item
Was disease detected by cytogenetic/FISH method?:
integer
Code List
Was disease detected by cytogenetic/FISH method?:
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
Considered disease relapse/progression
Item
Considered disease relapse/progression
boolean
Last date assessed
Item
Last date assessed
date
CL Item
Alive (Alive )
CL Item
Dead (Dead )
CL Item
Died before HSCT (Died before HSCT)
Check here if patient lost to follow up
Item
Check here if patient lost to follow up
boolean
CL Item
Relapse or Progression (if indication: primary disease) (1)
CL Item
HSCT related (if applicable) (2)
CL Item
Cell Therapy (3)
CL Item
Other (4)
CL Item
Unknown (5)
CL Item
GVHD GVH (1)
CL Item
Cardiac Toxicity CTX (2)
CL Item
Rejection/Poor graft function REJ (3)
CL Item
Infection INF (4)
CL Item
Pulmonary toxicity PTX (5)
CL Item
Veno occlusive disorder (6)
CL Item
Other (7)
DATE OF NEXT HSCT
Item
Date of this HSCT
date
EBMT Code (CIC):
Item
EBMT Code (CIC):
text
Hospital
Item
Name of the hospital
text
C0019994 (UMLS CUI [1])
Unit:
Item
Unit:
text
Contact person
Item
Contact person
text
e-mail
Item
e-mail
text
Has the HSCT been registered in the EBMT database ?
Item
Has the HSCT been registered in the EBMT database ?
boolean
C0421512 (UMLS CUI [1])
Has the HSCT been registered in the EBMT database ?
Item
If Yes: UIC number
text
Hospital Unique Patient Number/ Code
Item
Hospital Unique Patient Number/ Code
text
Initials
Item
Initials
text
Gender
Item
Gender
text
Date of Birth
Item
Date of Birth
date
Date of HSCT
Item
Date of HSCT
date
Donor ID
Item
Donor ID
text
Item Group
PATIENT ETHNIC OR RACIAL ORIGIN
CL Item
Hispanic or Latino (Hispanic or Latino )
CL Item
Not Hispanic or Latino (Not Hispanic or Latino)
CL Item
White (White)
CL Item
Black (Black)
CL Item
Asian ETHNIC12 (Asian ETHNIC12 )
CL Item
American Indian/Alaska Native (American Indian/Alaska Native )
CL Item
Native Hawaiian/Other Pacific Islander (Native Hawaiian/Other Pacific Islander)
CL Item
Alkylating agent/radiation-related (Alkylating agent/radiation-related)
CL Item
Topoisomerase II inhibitor-related (Topoisomerase II inhibitor-related)
CL Item
Unknown (Unknown)
Item
MOLECULAR BIOLOGYCompulsory for CIBMTR Research centres. Fill only for MPS. Janus kinase 2 (jak2)
integer
Code List
MOLECULAR BIOLOGYCompulsory for CIBMTR Research centres. Fill only for MPS. Janus kinase 2 (jak2)
CL Item
Absent (1)
CL Item
Present (2)
CL Item
Unknown (3)
THERAPY GIVEN PRIOR TO THIS HSCT
Item
THERAPY GIVEN PRIOR TO THIS HSCT
boolean
THERAPY GIVEN PRIOR TO THIS HSCT
Item
Date started
date
Tyrosine kinase receptor antagonist given
Item
Tyrosine kinase receptor antagonist given
boolean
CL Item
Imatinib mesylate (Gleevec, Glivec) (1)
CL Item
Dasatinib (Sprycel) (2)
CL Item
Nilotinib (Tasigna) (3)
CL Item
Other (4)
CL Item
Combination chemotherapy (Combination chemotherapy )
CL Item
Hydroxyurea (Hydroxyurea)
CL Item
Interferon (Interferon)
CL Item
Other (Other)
Were there any clinically significant co-existing disease or organ impairment at time of patient assessment prior to preparative (conditioning) regimen?
Item
Were there any clinically significant co-existing disease or organ impairment at time of patient assessment prior to preparative (conditioning) regimen?
boolean
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
Item
limited food choices due to celiac sprue or inflammatory bowel disease
integer
C0021390 (UMLS CUI [1])
CL Item
Combination chemotherapy (Combination chemotherapy )
CL Item
Hydroxyurea (Hydroxyurea)
CL Item
Interferon (Interferon)
CL Item
Other (Other)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
Other Comorbidity
Item
if other Comorbidity, please specify
text
Item Group
GRAFT PERFORMANCE Compulsory for CIBMTR Research centres
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Never below this lever (Never below this lever)
CL Item
Unknown (Unknown)
Date Platelets > 20 x 10 9 /l
Item
Date Platelets > 20 x 10 9 /l
date
Item Group
GRAFT PERFORMANCE
Item
Platelet reconstitution (Platelets >20X109 /L; first of 3 consecutive days)
text
Code List
Platelet reconstitution (Platelets >20X109 /L; first of 3 consecutive days)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Never below this lever (Never below this lever)
CL Item
Unknown (Unknown)
Date Platelets > 20 x 10 9 /l
Item
Date Platelets > 20 x 10 9 /l
date
PLANNED THERAPY GIVEN AFTER THIS HSCT
Item
PLANNED THERAPY GIVEN AFTER THIS HSCT, Date started
date
Chemo/drug
Item
Chemo/drug
boolean
CL Item
Imatinib mesylate (Gleevec, Glivec) (Imatinib mesylate (Gleevec, Glivec))
CL Item
Dasatinib (Sprycel) (Dasatinib (Sprycel))
CL Item
Nilotinib (Tasigna) (Nilotinib (Tasigna))
CL Item
Bortezomib (Velcade) (Bortezomib (Velcade))
CL Item
Intrathecal chemotherapy (Intrathecal chemotherapy)
CL Item
Lenalidomide (Revlimid) (Lenalidomide (Revlimid))
CL Item
Rituximab (Rituxan, mabthera) (Rituximab (Rituxan, mabthera))
CL Item
Velafermin (FGF) (Velafermin (FGF))
CL Item
Lepivance (KGF, palifermin) (Lepivance (KGF, palifermin))
CL Item
Thalidomide (Thalidomide)
CL Item
Other (Other)
Radiotherapy
Item
Radiotherapy
boolean
Item Group
HSCT - Minimum Essential Data - A First report - 100 days after HSCT DISEASE CLASSIFICATION SHEET 1
EBMT Centre Identification Code (CIC)
Item
EBMT Centre Identification Code (CIC)
text
C2348585 (UMLS CUI [1])
Hospital Unique Patient Number/Code (UPN)
Item
Hospital Unique Patient Number/Code (UPN)
text
Date of Initial Diagnosis
Item
Date of Initial Diagnosis
date