Description:

AMC-061 Baseline Evaluation Form (B61) Sunitinib Malate in Treating HIV-Positive Patients With Cancer Undergoing Highly Active Antiretroviral Therapy NCT00890747 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=715BD918-9168-2975-E040-BB89AD434610

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=715BD918-9168-2975-E040-BB89AD434610

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Versions (2) ▾
  1. 8/26/12
  2. 5/20/15
Uploaded on:

May 20, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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HIV with Cancer Baseline AMC-061 NCT00890747

Complete this form at baseline only

  1. StudyEvent: AMC-061 Baseline Evaluation Form (B61)
    1. Complete this form at baseline only
Visit Number
SOLID TUMOR/LYMPHOMA ASSESSMENT
Disease status
Hematopoietic Diagnosis
If diffuse large B-cell lymphoma, specify morphologic type
If Burkitt lymphoma/leukemia, specify morphologic type
Kaposi's Sarcoma Assessment
Does the patient have >=50 cutaneous lesions
Are there any oral cavity lesions present
Is there visceral disease
Hematologic Malignancy Assessment
Hematologic diagnosis
Acute Lymphoblastic Leukemia
Acute Myeloid Leukemia
Chronic Lymphoid Leukemia
Chronic Myeloproliferative Disease
Leukemia Miscellaneous