ID
10095
Beskrivning
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
Länk
Nyckelord
Versioner (5)
- 2012-09-19 2012-09-19 -
- 2015-01-08 2015-01-08 - Martin Dugas
- 2015-01-09 2015-01-09 - Martin Dugas
- 2015-01-09 2015-01-09 - Martin Dugas
- 2015-03-27 2015-03-27 - Martin Dugas
Uppladdad den
27 mars 2015
DOI
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Licens
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
Beskrivning
ON/Off TREATMENT
Beskrivning
Cycle number
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C2045829
- NCI Thesaurus Property
- C25214
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ObjectClass
- C15368
Beskrivning
Chemotherapy cycle
Datatyp
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
Beskrivning
PersonOff-TreatmentTimePeriodType
Datatyp
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
Beskrivning
Pre-registration Hematology/chemistry
Beskrivning
HematologySpecimenCollectedDate
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ObjectClass
- C16673
- NCI Thesaurus ObjectClass-2
- C19157
- NCI Thesaurus Property
- C25452
- UMLS CUI-1
- C1317250
Beskrivning
Test not done (Please mark "X" in Box only if test not done)
Datatyp
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
Beskrivning
LaboratoryProcedureGranulocyteResultLowerLimitofNormalCount
Datatyp
float
Måttenheter
- /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
Beskrivning
Peripheral Granulocytes Count (AGC/ANC/mm^3 - Do not report % granulocytes: report absolute count without decimal.)
Datatyp
float
Måttenheter
- /mm^3
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C12530
- NCI Thesaurus ValueDomain
- C25463
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0857490
Beskrivning
Platelets LLN
Datatyp
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
Beskrivning
Peripheral Platelet Count
Datatyp
float
Måttenheter
- 1000/uL
Alias
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C12520
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
- UMLS CUI-1
- C0005821
Beskrivning
LaboratoryProcedureBlastCellOutcomePercentageValue
Datatyp
float
Måttenheter
- %
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
Beskrivning
LaboratoryProcedureLeukocyteResultLowerLimitofNormalValue
Datatyp
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
Beskrivning
Leukocytes (WBC)
Datatyp
float
Måttenheter
- 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
Beskrivning
LaboratoryProcedureCreatinineResultUpperLimitNormalValue
Datatyp
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
Beskrivning
Creatinine, Serum
Datatyp
float
Måttenheter
- mg/dL
Alias
- NCI Thesaurus Property
- C20200
- UMLS CUI-1
- C0201976
- NCI Thesaurus Property-2
- C399
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
Beskrivning
Hemoglobin (Hgb), LLN
Datatyp
float
Måttenheter
- 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
Beskrivning
Hemoglobin
Datatyp
float
Måttenheter
- g/dL
Alias
- NCI Thesaurus Property
- C16676
- UMLS CUI-1
- C0019046
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
Beskrivning
CTC Adverse Event Attribution Code (Note: Use the standard CTC criteria, not the BMT-specific CTC criteria.)
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25358
- UMLS CUI-1
- C1706735
Beskrivning
AdverseDrugExperienceReportText
Datatyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25704
- NCI Thesaurus ObjectClass
- C25375
- NCI Metathesaurus ObjectClass
- C0085425
- NCI Thesaurus Property
- C25175
- UMLS CUI-1
- C2348483
Beskrivning
AdverseEventCommonTerminologyforAdverseEventsVersion4TermName
Datatyp
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
Beskrivning
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.)
Datatyp
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
C3274381 (UMLS CUI-1)
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C25364 (NCI Thesaurus Property)
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C25214 (NCI Thesaurus Property)
C25616 (NCI Thesaurus Property-2)
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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)
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C0445356 (UMLS CUI-1)
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C49704 (NCI Thesaurus Property)
C45559 (NCI Thesaurus Property-2)
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