ID

10553

Beskrivning

Acute Leukemia Disease Assessment Form NCT00049517 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

Länk

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

Nyckelord

Versioner (3)
  1. 2012-09-19 2012-09-19 -
  2. 2015-05-28 2015-05-28 -
  3. 2015-06-03 2015-06-03 -
Uppladdad den

3 juni 2015

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy
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Acute Leukemia Disease Assessment Form NCT00049517

Engelsk

No Instruction available.

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

ECOG clinical trial administrative data

Registration Step
Beskrivning

RegistrationStep

Datatyp

text

Cycle Number
Beskrivning

CycleNumber

Datatyp

text

Patient?s Name
Beskrivning

Patient'sName

Datatyp

text

ECOG Protocol No.
Beskrivning

ECOGProtocolNo.

Datatyp

text

ECOG Protocol No.
Beskrivning

ECOGProtocolNo.

Datatyp

text

ECOG Patient ID
Beskrivning

ECOGPatientID

Datatyp

text

ECOG Patient ID
Beskrivning

ECOGPatientID

Datatyp

text

Participating Group Protocol No.
Beskrivning

ParticipatingGroupProtocolNo.

Datatyp

text

Participating Group Patient ID
Beskrivning

ParticipatingGroupPatientID

Datatyp

text

Institution/Affiliate
Beskrivning

MainMemberInstitution/Affiliate

Datatyp

text

Acute Leukemia Disease assessment
Beskrivning

Acute Leukemia Disease assessment

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

AmendedDataInd

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Date of bone marrow biopsy
Beskrivning

BoneMarrowBiopsyDate

Datatyp

date

Marrow blasts (%)
Beskrivning

BoneMarrow,Blasts,CellPercentage

Datatyp

double

Marrow cellularity (%)
Beskrivning

BoneMarrow,CellularityPercentage

Datatyp

double

Are all cell lines maturing?
Beskrivning

Areallcelllinesmaturing?

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
Are auer rods present?
Beskrivning

BoneMarrowAuerrods

Datatyp

text

Is there extramedullary disease
Beskrivning

Isthereextramedullarydisease

Datatyp

text

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

ExtramedullaryDisease,OtherSite

Datatyp

text

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

CompleteResponseInd,Hematologic

Datatyp

text

Date of complete response
Beskrivning

CRFirstObservedDate

Datatyp

date

Alias
NCI Thesaurus ObjectClass
C25755
UMLS 2011AA ObjectClass
C0871261
NCI Thesaurus Property
C15722
UMLS 2011AA Property
C0700325
Comments
Beskrivning

Comments

Datatyp

text

Investigator Signature
Beskrivning

InvestigatorSignature

Datatyp

text

Alias
NCI Thesaurus Property
C25678
UMLS 2011AA Property
C1519316
NCI Thesaurus ObjectClass
C17089
UMLS 2011AA ObjectClass
C0035173
Date
Beskrivning

InvestigatorSignatureDate

Datatyp

date

Ccrr Module For Acute Leukemia Disease Assessment Form
Beskrivning

Ccrr Module For Acute Leukemia Disease Assessment Form

specify sites of extramedullary disease
Beskrivning

specifysitesofextramedullarydisease

Datatyp

text

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Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: Acute Leukemia Disease Assessment Form
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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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