ID
10095
Descrizione
E2905 Hematology Form Lenalidomide With or Without Epoetin Alfa in Treating Patients With Myelodysplastic Syndrome and Anemia NCT00843882 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=11427DB4-3795-240D-E044-0003BA3F9857
collegamento
Keywords
versioni (5)
- 19/09/12 19/09/12 -
- 08/01/15 08/01/15 - Martin Dugas
- 09/01/15 09/01/15 - Martin Dugas
- 09/01/15 09/01/15 - Martin Dugas
- 27/03/15 27/03/15 - Martin Dugas
Caricato su
27 marzo 2015
DOI
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Licenza
Creative Commons BY-NC 3.0 Legacy
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MDS Hematology Form NCT00843882
INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files
Descrizione
ON/Off TREATMENT
Descrizione
Cycle number
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C2045829
- NCI Thesaurus Property
- C25214
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ObjectClass
- C15368
Descrizione
Chemotherapy cycle
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C25214
- UMLS CUI-1
- C1302181
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ValueDomain
- C25685
- NCI Thesaurus ValueDomain-2
- C25472
- NCI Thesaurus ValueDomain-3
- C25275
Descrizione
PersonOff-TreatmentTimePeriodType
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- NCI Thesaurus Property
- C25616
- NCI Thesaurus Property-2
- C25601
- NCI Thesaurus Property-3
- C25207
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C0027361
- UMLS CUI-2
- C1948053
- UMLS CUI-3
- C1518544
- UMLS CUI-4
- C0040223
- UMLS CUI-5
- C0332307
Descrizione
Pre-registration Hematology/chemistry
Descrizione
HematologySpecimenCollectedDate
Tipo di dati
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ObjectClass
- C16673
- NCI Thesaurus ObjectClass-2
- C19157
- NCI Thesaurus Property
- C25452
- UMLS CUI-1
- C1317250
Descrizione
Test not done (Please mark "X" in Box only if test not done)
Tipo di dati
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus Property
- C25594
- NCI Thesaurus Property-2
- C38000
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0022885
- UMLS CUI-2
- C0445106
Descrizione
LaboratoryProcedureGranulocyteResultLowerLimitofNormalCount
Tipo di dati
float
Unità di misura
- /mm^3
Alias
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C12530
- NCI Thesaurus ValueDomain
- C25463
- NCI Thesaurus ValueDomain-2
- C25555
- UMLS CUI-1
- C0857490
- UMLS CUI-2
- C1518030
Descrizione
Peripheral Granulocytes Count (AGC/ANC/mm^3 - Do not report % granulocytes: report absolute count without decimal.)
Tipo di dati
float
Unità di misura
- /mm^3
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C12530
- NCI Thesaurus ValueDomain
- C25463
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0857490
Descrizione
Platelets LLN
Tipo di dati
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0005821
- NCI Thesaurus Property
- C20200
- UMLS CUI-2
- C1518030
- NCI Thesaurus Property-2
- C12520
- NCI Thesaurus ValueDomain
- C25712
- NCI Thesaurus ValueDomain-2
- C25555
Descrizione
Peripheral Platelet Count
Tipo di dati
float
Unità di misura
- 1000/uL
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C12520
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
- UMLS CUI-1
- C0005821
Descrizione
LaboratoryProcedureBlastCellOutcomePercentageValue
Tipo di dati
float
Unità di misura
- %
Alias
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C12918
- NCI Thesaurus ValueDomain
- C25613
- NCI Thesaurus ValueDomain-2
- C25712
- UMLS CUI-1
- C0523113
Descrizione
LaboratoryProcedureLeukocyteResultLowerLimitofNormalValue
Tipo di dati
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus Property
- C12529
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ValueDomain
- C25712
- NCI Thesaurus ValueDomain-2
- C25555
- UMLS CUI-1
- C0023508
- UMLS CUI-2
- C1518030
Descrizione
Leukocytes (WBC)
Tipo di dati
float
Unità di misura
- 1000/uL
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0023508
- NCI Thesaurus Property
- C12529
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ValueDomain
- C25712
- NCI Thesaurus ValueDomain-2
- C38024
Descrizione
LaboratoryProcedureCreatinineResultUpperLimitNormalValue
Tipo di dati
float
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C399
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
- NCI Thesaurus ValueDomain-2
- C25706
- UMLS CUI-1
- C0201976
- UMLS CUI-2
- C1519815
Descrizione
Creatinine, Serum
Tipo di dati
float
Unità di misura
- mg/dL
Alias
- NCI Thesaurus Property
- C20200
- UMLS CUI-1
- C0201976
- NCI Thesaurus Property-2
- C399
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
Descrizione
Hemoglobin (Hgb), LLN
Tipo di dati
float
Unità di misura
- g/dL
Alias
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus Property
- C16676
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ValueDomain
- C25712
- NCI Thesaurus ValueDomain-2
- C38024
- NCI Thesaurus ValueDomain-3
- C25555
- UMLS CUI-1
- C0019046
- UMLS CUI-2
- C1518030
Descrizione
Hemoglobin
Tipo di dati
float
Unità di misura
- g/dL
Alias
- NCI Thesaurus Property
- C16676
- UMLS CUI-1
- C0019046
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
Descrizione
CTC Adverse Event Attribution Code (Note: Use the standard CTC criteria, not the BMT-specific CTC criteria.)
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25358
- UMLS CUI-1
- C1706735
Descrizione
AdverseDrugExperienceReportText
Tipo di dati
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ObjectClass
- C25375
- NCI Metathesaurus ObjectClass
- C0085425
- NCI Thesaurus Property
- C25175
- UMLS CUI-1
- C2348483
Descrizione
AdverseEventCommonTerminologyforAdverseEventsVersion4TermName
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C41331
- NCI Thesaurus Property
- C49704
- NCI Thesaurus Property-2
- C45559
- NCI Thesaurus ValueDomain
- C45255
- NCI Thesaurus ValueDomain-2
- C49704
- NCI Thesaurus ValueDomain-3
- C42614
- NCI Thesaurus ValueDomain-4
- C45559
- NCI Thesaurus ValueDomain-5
- C25714
- UMLS CUI-1
- C1516728
- UMLS CUI-2
- C2826934
Descrizione
AdverseEventSeverityGrade CTC Adverse Event Grade (Note: Always provide CTC adverse event attribution code if an adverse event occurred. Also provide CTC AE v4 grade only if extenuating circumstances per the CTC AE v4 grading criteria would trigger a higher grade AE than the lab value would indicate.)
Tipo di dati
text
Alias
- NCI Thesaurus ObjectClass
- C41331
- NCI Thesaurus Property
- C48309
- NCI Thesaurus Property-2
- C49705
- NCI Thesaurus Property-3
- C25676
- NCI Thesaurus ValueDomain
- C41331
- NCI Thesaurus ValueDomain-2
- C48309
- NCI Thesaurus ValueDomain-3
- C25676
- UMLS CUI-1
- C2985911
Similar models
INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
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C25452 (NCI Thesaurus ObjectClass-2)
C1514821 (UMLS CUI-1)
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C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)
C2045829 (UMLS CUI-1)
C25214 (NCI Thesaurus Property)
C25616 (NCI Thesaurus Property-2)
C15368 (NCI Thesaurus ObjectClass)
C25214 (NCI Thesaurus Property)
C1302181 (UMLS CUI-1)
C25616 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
C25472 (NCI Thesaurus ValueDomain-2)
C25275 (NCI Thesaurus ValueDomain-3)
C25616 (NCI Thesaurus Property)
C25601 (NCI Thesaurus Property-2)
C25207 (NCI Thesaurus Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0027361 (UMLS CUI-1)
C1948053 (UMLS CUI-2)
C1518544 (UMLS CUI-3)
C0040223 (UMLS CUI-4)
C0332307 (UMLS CUI-5)
C16673 (NCI Thesaurus ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C25452 (NCI Thesaurus Property)
C1317250 (UMLS CUI-1)
C25594 (NCI Thesaurus Property)
C38000 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS CUI-1)
C0445106 (UMLS CUI-2)
C20200 (NCI Thesaurus Property)
C12530 (NCI Thesaurus Property-2)
C25463 (NCI Thesaurus ValueDomain)
C25555 (NCI Thesaurus ValueDomain-2)
C0857490 (UMLS CUI-1)
C1518030 (UMLS CUI-2)
C12530 (NCI Thesaurus Property-2)
C25463 (NCI Thesaurus ValueDomain)
C25294 (NCI Thesaurus ObjectClass)
C0857490 (UMLS CUI-1)
C0005821 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C1518030 (UMLS CUI-2)
C12520 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25555 (NCI Thesaurus ValueDomain-2)
C12520 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C0005821 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C12918 (NCI Thesaurus Property-2)
C25613 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0523113 (UMLS CUI-1)
C12529 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25555 (NCI Thesaurus ValueDomain-2)
C0023508 (UMLS CUI-1)
C1518030 (UMLS CUI-2)
C0023508 (UMLS CUI-1)
C12529 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C38024 (NCI Thesaurus ValueDomain-2)
C399 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C0201976 (UMLS CUI-1)
C1519815 (UMLS CUI-2)
C0201976 (UMLS CUI-1)
C399 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C16676 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C38024 (NCI Thesaurus ValueDomain-2)
C25555 (NCI Thesaurus ValueDomain-3)
C0019046 (UMLS CUI-1)
C1518030 (UMLS CUI-2)
C0019046 (UMLS CUI-1)
C20200 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C49704 (NCI Thesaurus ObjectClass)
C25358 (NCI Thesaurus Property)
C1706735 (UMLS CUI-1)
C1704787 (UMLS CUI-1)
C0332149 (UMLS CUI-1)
C1709683 (UMLS CUI-1)
C0445356 (UMLS CUI-1)
C25375 (NCI Thesaurus ObjectClass)
C0085425 (NCI Metathesaurus ObjectClass)
C25175 (NCI Thesaurus Property)
C2348483 (UMLS CUI-1)
C49704 (NCI Thesaurus Property)
C45559 (NCI Thesaurus Property-2)
C45255 (NCI Thesaurus ValueDomain)
C49704 (NCI Thesaurus ValueDomain-2)
C42614 (NCI Thesaurus ValueDomain-3)
C45559 (NCI Thesaurus ValueDomain-4)
C25714 (NCI Thesaurus ValueDomain-5)
C1516728 (UMLS CUI-1)
C2826934 (UMLS CUI-2)
C48309 (NCI Thesaurus Property)
C49705 (NCI Thesaurus Property-2)
C25676 (NCI Thesaurus Property-3)
C41331 (NCI Thesaurus ValueDomain)
C48309 (NCI Thesaurus ValueDomain-2)
C25676 (NCI Thesaurus ValueDomain-3)
C2985911 (UMLS CUI-1)
C2699517 (UMLS 2011AA)
C1513302 (UMLS 2011AA)
C1513374 (UMLS 2011AA)
C2919019 (UMLS 2011AA)
C1517874 (UMLS 2011AA)
C1705232 (UMLS 2011AA)