CALGB: 10603 Treatment Form NCT00651261 Daunorubicin, Cytarabine, and Midostaurin in Treating Patients With Newly Diagnosed Acute Myeloid Leukemia Source Form: NCI FormBuilder:

  1. 9/19/12 9/19/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
  3. 6/8/15 6/8/15 -
Uploaded on:

June 8, 2015

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License :
Creative Commons BY-NC 3.0 Legacy
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CALGB: 10603 Treatment Form DRKS00003845 NCT00651261

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice

Are data amended
Patient demographics
Treatment Phase
Treatment Phase
Patient status assessment
Did the patient receive any protocol treatment?
First Treatment (cycles 1 ¿ 6)
Medication calendar completed by
Reason for missed/reduced Midostaurin/Placebo dose
Midostaurin/Placebo Dosing
Time point
Daunorubicin Dosing
Time point
Cytarabine Dosing
Time point
Cytarabine Dosing
Time point
Reason Treatment Ended
Reason Treatment Ended (Mark one with an X.)
Overall Response

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