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ID

10371

Descripción

Acute Leukemia Disease Assessment Form Combination Chemotherapy With or Without Monoclonal Antibody Therapy Followed by Stem Cell Transplant in Treating Patients With Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A727ECDC-BAED-2F88-E034-0003BA0B1A09

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A727ECDC-BAED-2F88-E034-0003BA0B1A09

Palabras clave

Versiones (3)
  1. 19/9/12 19/9/12 -
  2. 28/5/15 28/5/15 -
  3. 3/6/15 3/6/15 -
Subido en

28 de mayo de 2015

DOI

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Licencia

Creative Commons BY-NC 3.0 Legacy
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    Acute Leukemia Disease Assessment Form

    Inglés

    No Instruction available.

    1 formularios  
    1. StudyEvent: Acute Leukemia Disease Assessment Form
      1. No Instruction available.
    ECOG clinical trial administrative data
    Descripción

    ECOG clinical trial administrative data

    Registration Step
    Descripción

    RegistrationStep

    Tipo de datos

    text

    Cycle Number
    Descripción

    CycleNumber

    Tipo de datos

    text

    Patient?s Name
    Descripción

    Patient'sName

    Tipo de datos

    text

    ECOG Protocol No.
    Descripción

    ECOGProtocolNo.

    Tipo de datos

    text

    ECOG Protocol No.
    Descripción

    ECOGProtocolNo.

    Tipo de datos

    text

    ECOG Patient ID
    Descripción

    ECOGPatientID

    Tipo de datos

    text

    ECOG Patient ID
    Descripción

    ECOGPatientID

    Tipo de datos

    text

    Participating Group Protocol No.
    Descripción

    ParticipatingGroupProtocolNo.

    Tipo de datos

    text

    Participating Group Patient ID
    Descripción

    ParticipatingGroupPatientID

    Tipo de datos

    text

    Institution/Affiliate
    Descripción

    MainMemberInstitution/Affiliate

    Tipo de datos

    text

    Acute Leukemia Disease assessment
    Descripción

    Acute Leukemia Disease assessment

    Are data amended? (If yes, please circle amended items in red)
    Descripción

    AmendedDataInd

    Tipo de datos

    text

    Alias
    NCI Thesaurus ObjectClass
    C25474 (undefined)
    UMLS 2011AA ObjectClass
    C1511726 (Data)
    NCI Thesaurus Property
    C25416 (undefined)
    UMLS 2011AA Property
    C1691222 (Amended)
    Date of bone marrow biopsy
    Descripción

    BoneMarrowBiopsyDate

    Tipo de datos

    date

    Marrow blasts (%)
    Descripción

    BoneMarrow,Blasts,CellPercentage

    Tipo de datos

    double

    Marrow cellularity (%)
    Descripción

    BoneMarrow,CellularityPercentage

    Tipo de datos

    double

    Are all cell lines maturing?
    Descripción

    Areallcelllinesmaturing?

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    Are auer rods present?
    Descripción

    BoneMarrowAuerrods

    Tipo de datos

    text

    Is there extramedullary disease
    Descripción

    Isthereextramedullarydisease

    Tipo de datos

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180 (undefined)
    UMLS 2011AA ValueDomain
    C1522602 (Indicator)
    yes, specify sites (extramedullary disease)
    Descripción

    ExtramedullaryDisease,OtherSite

    Tipo de datos

    text

    Did the patient achieve a complete response according to clinical/hematologic criteria during this reporting period?
    Descripción

    CompleteResponseInd,Hematologic

    Tipo de datos

    text

    Date of complete response
    Descripción

    CRFirstObservedDate

    Tipo de datos

    date

    Alias
    NCI Thesaurus ObjectClass
    C25755 (undefined)
    UMLS 2011AA ObjectClass
    C0871261 (Response process)
    NCI Thesaurus Property
    C15722 (undefined)
    UMLS 2011AA Property
    C0700325 (Patient observation)
    SNOMED
    103705002
    Comments
    Descripción

    Comments

    Tipo de datos

    text

    Investigator Signature
    Descripción

    InvestigatorSignature

    Tipo de datos

    text

    Alias
    NCI Thesaurus Property
    C25678 (undefined)
    UMLS 2011AA Property
    C1519316 (Signature)
    LOINC
    LP248948-4
    NCI Thesaurus ObjectClass
    C17089 (undefined)
    UMLS 2011AA ObjectClass
    C0035173 (Research Personnel)
    SNOMED
    769038007
    LOINC
    LA23773-7
    Date
    Descripción

    InvestigatorSignatureDate

    Tipo de datos

    date

    Ccrr Module For Acute Leukemia Disease Assessment Form
    Descripción

    Ccrr Module For Acute Leukemia Disease Assessment Form

    specify sites of extramedullary disease
    Descripción

    specifysitesofextramedullarydisease

    Tipo de datos

    text

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    Similar models

    No Instruction available.

    1 formularios
    1. StudyEvent: Acute Leukemia Disease Assessment Form
      1. No Instruction available.
    Name
    Tipo
    Description | Question | Decode (Coded Value)
    Tipo de datos
    Alias
    Item Group
    ECOG clinical trial administrative data
    RegistrationStep
    Item
    Registration Step
    text
    CycleNumber
    Item
    Cycle Number
    text
    Patient'sName
    Item
    Patient?s Name
    text
    ECOGProtocolNo.
    Item
    ECOG Protocol No.
    text
    ECOGProtocolNo.
    Item
    ECOG Protocol No.
    text
    ECOGPatientID
    Item
    ECOG Patient ID
    text
    ECOGPatientID
    Item
    ECOG Patient ID
    text
    ParticipatingGroupProtocolNo.
    Item
    Participating Group Protocol No.
    text
    ParticipatingGroupPatientID
    Item
    Participating Group Patient ID
    text
    MainMemberInstitution/Affiliate
    Item
    Institution/Affiliate
    text
    Item Group
    Acute Leukemia Disease assessment
    Item
    Are data amended? (If yes, please circle amended items in red)
    text
    C25474 (NCI Thesaurus ObjectClass)
    C1511726 (UMLS 2011AA ObjectClass)
    C25416 (NCI Thesaurus Property)
    C1691222 (UMLS 2011AA Property)
    CL.1
    Code List
    Are data amended? (If yes, please circle amended items in red)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    BoneMarrowBiopsyDate
    Item
    Date of bone marrow biopsy
    date
    BoneMarrow,Blasts,CellPercentage
    Item
    Marrow blasts (%)
    double
    BoneMarrow,CellularityPercentage
    Item
    Marrow cellularity (%)
    double
    Item
    Are all cell lines maturing?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.2
    Code List
    Are all cell lines maturing?
    CL Item
    No (no)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Are auer rods present?
    text
    CL.3
    Code List
    Are auer rods present?
    CL Item
    Auer Rods Absent From Bone Marrow (absent)
    CL Item
    Auer Rods Present In Bone Marrow (present)
    Item
    Is there extramedullary disease
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.4
    Code List
    Is there extramedullary disease
    CL Item
    No (no)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    ExtramedullaryDisease,OtherSite
    Item
    yes, specify sites (extramedullary disease)
    text
    Item
    Did the patient achieve a complete response according to clinical/hematologic criteria during this reporting period?
    text
    CL.5
    Code List
    Did the patient achieve a complete response according to clinical/hematologic criteria during this reporting period?
    CL Item
    Null (no)
    CL Item
    Null (yes)
    CL Item
    Null (unknown)
    CRFirstObservedDate
    Item
    Date of complete response
    date
    C25755 (NCI Thesaurus ObjectClass)
    C0871261 (UMLS 2011AA ObjectClass)
    C15722 (NCI Thesaurus Property)
    C0700325 (UMLS 2011AA Property)
    Comments
    Item
    Comments
    text
    InvestigatorSignature
    Item
    Investigator Signature
    text
    C25678 (NCI Thesaurus Property)
    C1519316 (UMLS 2011AA Property)
    C17089 (NCI Thesaurus ObjectClass)
    C0035173 (UMLS 2011AA ObjectClass)
    InvestigatorSignatureDate
    Item
    Date
    date
    Item Group
    Ccrr Module For Acute Leukemia Disease Assessment Form
    specifysitesofextramedullarydisease
    Item
    specify sites of extramedullary disease
    text
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