ID
10095
Beschrijving
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
Link
Trefwoorden
Versies (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
Geüploaded op
27 maart 2015
DOI
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Licentie
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
Beschrijving
ON/Off TREATMENT
Beschrijving
Cycle number
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C2045829
- NCI Thesaurus Property
- C25214
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ObjectClass
- C15368
Beschrijving
Chemotherapy cycle
Datatype
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
Beschrijving
PersonOff-TreatmentTimePeriodType
Datatype
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
Beschrijving
Pre-registration Hematology/chemistry
Beschrijving
HematologySpecimenCollectedDate
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ObjectClass
- C16673
- NCI Thesaurus ObjectClass-2
- C19157
- NCI Thesaurus Property
- C25452
- UMLS CUI-1
- C1317250
Beschrijving
Test not done (Please mark "X" in Box only if test not done)
Datatype
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
Beschrijving
LaboratoryProcedureGranulocyteResultLowerLimitofNormalCount
Datatype
float
Maateenheden
- /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
Beschrijving
Peripheral Granulocytes Count (AGC/ANC/mm^3 - Do not report % granulocytes: report absolute count without decimal.)
Datatype
float
Maateenheden
- /mm^3
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C12530
- NCI Thesaurus ValueDomain
- C25463
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0857490
Beschrijving
Platelets LLN
Datatype
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
Beschrijving
Peripheral Platelet Count
Datatype
float
Maateenheden
- 1000/uL
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C12520
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
- UMLS CUI-1
- C0005821
Beschrijving
LaboratoryProcedureBlastCellOutcomePercentageValue
Datatype
float
Maateenheden
- %
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
Beschrijving
LaboratoryProcedureLeukocyteResultLowerLimitofNormalValue
Datatype
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
Beschrijving
Leukocytes (WBC)
Datatype
float
Maateenheden
- 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
Beschrijving
LaboratoryProcedureCreatinineResultUpperLimitNormalValue
Datatype
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
Beschrijving
Creatinine, Serum
Datatype
float
Maateenheden
- mg/dL
Alias
- NCI Thesaurus Property
- C20200
- UMLS CUI-1
- C0201976
- NCI Thesaurus Property-2
- C399
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
Beschrijving
Hemoglobin (Hgb), LLN
Datatype
float
Maateenheden
- 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
Beschrijving
Hemoglobin
Datatype
float
Maateenheden
- g/dL
Alias
- NCI Thesaurus Property
- C16676
- UMLS CUI-1
- C0019046
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
Beschrijving
CTC Adverse Event Attribution Code (Note: Use the standard CTC criteria, not the BMT-specific CTC criteria.)
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25358
- UMLS CUI-1
- C1706735
Beschrijving
AdverseDrugExperienceReportText
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ObjectClass
- C25375
- NCI Metathesaurus ObjectClass
- C0085425
- NCI Thesaurus Property
- C25175
- UMLS CUI-1
- C2348483
Beschrijving
AdverseEventCommonTerminologyforAdverseEventsVersion4TermName
Datatype
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
Beschrijving
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.)
Datatype
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
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INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files
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C25712 (NCI Thesaurus ValueDomain)
C0005821 (UMLS CUI-1)
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C25712 (NCI Thesaurus ValueDomain-2)
C0523113 (UMLS CUI-1)
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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)
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