ID

10850

Beschreibung

CGV Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF18B4D3-D937-1066-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF18B4D3-D937-1066-E034-0003BA3F9857

Stichworte

Versionen (3)
  1. 19.09.12 19.09.12 -
  2. 09.01.15 09.01.15 - Martin Dugas
  3. 09.06.15 09.06.15 -
Hochgeladen am

9. Juni 2015

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy
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CGV

Englisch

No Instruction available.

1 Formulare  
Header module
Beschreibung

Header module

Visit Number
Beschreibung

Visit number

Datentyp

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1549755
NCI Thesaurus ObjectClass
C16696
NCI Thesaurus Property
C25385
Segment
Beschreibung

Segment

Datentyp

text

Start of assessment period
Beschreibung

Startofassessmentperiod

Datentyp

text

End of assessment period
Beschreibung

Endofassessmentperiod

Datentyp

text

Answer Questions 3-8 Relating To Acute Gvhd
Beschreibung

Answer Questions 3-8 Relating To Acute Gvhd

Maximum overall grade of acute GVHD during this assessment period
Beschreibung

AcuteGraftVersusHostDiseaseTransplantAssessedGrade

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C4980
UMLS 2011AA ObjectClass
C0856825
NCI Thesaurus ObjectClass-2
C14140
UMLS 2011AA ObjectClass-2
C0205178
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property-2
C12981
UMLS 2011AA Property-2
C0332835
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
Did clinical signs and/or symptoms of acute GVHD develop during this assessment
Beschreibung

DidthepatientdevelopacuteGVHD?

Datentyp

boolean

Date of diagnosis of acute GVHD
Beschreibung

TransplantAcuteGVHDBeginDate

Datentyp

date

Alias
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Thesaurus Property
C14140
UMLS 2011AA Property
C0205178
NCI Metathesaurus Property
C0018133
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25431
UMLS 2011AA ValueDomain-2
C0439659
Record method used to diagnose acute GVHD
Beschreibung

RecordmethodusedtodiagnoseacuteGVHD

Datentyp

text

Was prophylaxis for GVHD given during this assessment period
Beschreibung

WasprophylaxisforGVHDgivenduringthisassessmentperiod

Datentyp

boolean

If Yes, Specify All Immuno Suppressants Used For Gvhd Prophylaxis
Beschreibung

If Yes, Specify All Immuno Suppressants Used For Gvhd Prophylaxis

Cyclosporine
Beschreibung

MedicationGraftVersusHostDiseaseAdministeredType

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C459
UMLS 2011AA ObjectClass
C0013227
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Metathesaurus ObjectClass
C0018133
Specify other agent used
Beschreibung

PriorChemotherapyOtherName

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C15632
UMLS 2011AA ObjectClass
C0392920
NCI Thesaurus ObjectClass-2
C25629
UMLS 2011AA ObjectClass-2
C0332152
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property-2
C25364
UMLS 2011AA Property-2
C0600091
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ValueDomain-2
C17649
UMLS 2011AA ValueDomain-2
C0205394
Tacrolimus
Beschreibung

Tacrolimus

Datentyp

boolean

Sirolumis
Beschreibung

Sirolumis

Datentyp

boolean

MMF
Beschreibung

MMF

Datentyp

boolean

Prednisone
Beschreibung

Prednisone

Datentyp

boolean

Other
Beschreibung

Other

Datentyp

boolean

If no, specify the date GVHD prophylaxis was discontinued
Beschreibung

Ifno,specifythedateGVHDprophylaxiswasdiscontinued

Datentyp

text

Answer Questions 9-19 Relating To Chronic Gvhd
Beschreibung

Answer Questions 9-19 Relating To Chronic Gvhd

Maximum overall severity of chronic GVHD during this assessment period
Beschreibung

SeverityName

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C25499
UMLS 2011AA ObjectClass
C0441471
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
NCI Thesaurus Property
C25676
UMLS 2011AA Property
C0439793
Maximum overall grade of chronic GVHD during this assessment period
Beschreibung

ChronicGraftVersusHostDiseaseTransplantOutcomeGrade

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C14141
UMLS 2011AA ObjectClass
C0205191
NCI Metathesaurus ObjectClass
C0018133
NCI Thesaurus Property
C12981
UMLS 2011AA Property
C0332835
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus ValueDomain
C48309
UMLS 2011AA ValueDomain
C0441800
Current Karnofsky/Lansky score
Beschreibung

KarnofskyPerformanceStatusScore

Datentyp

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C20641
UMLS 2011AA ObjectClass
C1518965
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
Record method used to diagnose chronic GVHD
Beschreibung

DiagnosisMethodType

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus ObjectClass
C15220
UMLS 2011AA ObjectClass
C0011900
Current platelet count
Beschreibung

Platelets

Datentyp

float

Maßeinheiten
  • 1000/uL
Alias
NCI Thesaurus Property
C20200
UMLS CUI-1
C0005821
NCI Thesaurus Property-2
C12520
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus ValueDomain
C25712
1000/uL
Date of diagnosis of chronic GVHD
Beschreibung

RelevantDiagnosticTestResultDate

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
Current weight
Beschreibung

Patient Weight

Datentyp

float

Maßeinheiten
  • Kg
Alias
NCI Thesaurus ValueDomain
C25209
UMLS CUI-1
C0005910
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25208
Kg
Alkaline phosphatase at time of diagnosis
Beschreibung

HepaticAlkalinePhosphataseLabValue

Datentyp

float

Alias
NCI Thesaurus ObjectClass
C13308
UMLS 2011AA ObjectClass
C0205054
NCI Thesaurus Property
C37984
UMLS 2011AA Property
C0022877
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus Property-2
C16276
UMLS 2011AA Property-2
C0002059
Total bilirubin at time of diagnosis
Beschreibung

HepaticBilirubinLabValue

Datentyp

float

Maßeinheiten
  • mg/dL
Alias
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property-2
C305
UMLS 2011AA Property-2
C0005437
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
mg/dL
Body surface area involved with rash at time of diagnosis
Beschreibung

Body Surface Area

Datentyp

float

Alias
NCI Thesaurus ValueDomain
C25209
UMLS CUI-1
C0005902
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25157
Indicate The Maximum Severity Of Involvement For The Following Organ Systems During This Assessment Period
Beschreibung

Indicate The Maximum Severity Of Involvement For The Following Organ Systems During This Assessment Period

Dyspnea
Beschreibung

CommonToxicityCriteriaAdverseEventDyspneaGrade

Datentyp

float

Alias
NCI Thesaurus Property
C2998
UMLS 2011AA Property
C0013404
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
Pulmonary fibrosis
Beschreibung

CommonToxicityCriteriaAdverseEventPulmonaryFibrosisGrade

Datentyp

float

Alias
NCI Thesaurus Property
C26869
UMLS 2011AA Property
C0034069
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
FEV1
Beschreibung

CommonToxicityCriteriaAdverseEventForcedExpiratoryVolumein1SecondGrade

Datentyp

float

Alias
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
NCI Thesaurus Property
C38084
UMLS 2011AA Property
C0849974
Oxygen saturation
Beschreibung

OxygenSaturation

Datentyp

float

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Metathesaurus ObjectClass
C0150411
NCI Metathesaurus Property
CL105480
Nausea and vomiting
Beschreibung

CommonToxicityCriteriaAdverseEventNauseaGrade

Datentyp

float

Alias
NCI Thesaurus Property
C3258
UMLS 2011AA Property
C0027497
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
Diarrhea
Beschreibung

CommonToxicityCriteriaAdverseEventDiarrheaGrade

Datentyp

float

Alias
NCI Thesaurus Property
C2987
UMLS 2011AA Property
C0011991
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
Malabsorption
Beschreibung

CommonToxicityCriteriaAdverseEventGastrointestinalMalabsorptionSyndromeGrade

Datentyp

float

Alias
NCI Thesaurus Property
C13359
UMLS 2011AA Property
C0521362
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
NCI Metathesaurus Property
C0024523
Bilirubin level
Beschreibung

CTCAdverseEventBilirubinGrade

Datentyp

float

Alias
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus Property
C305
UMLS 2011AA Property
C0005437
NCI Thesaurus Property-2
C25365
UMLS 2011AA Property-2
C0678257
NCI Thesaurus ValueDomain
C305
UMLS 2011AA ValueDomain
C0005437
NCI Thesaurus ValueDomain-2
C18000
UMLS 2011AA ValueDomain-2
C0919553
Vaginitis
Beschreibung

CommonToxicityCriteriaAdverseEventVaginitisGrade

Datentyp

float

Alias
NCI Thesaurus Property
C26911
UMLS 2011AA Property
C0042267
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
Myositis
Beschreibung

CommonToxicityCriteriaAdverseEventMyositisGrade

Datentyp

boolean

Alias
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
NCI Metathesaurus Property
C0027121
Specify other organ
Beschreibung

DiseaseInvolvedSiteSpecify

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property-2
C25547
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
Extent of skin involvement
Beschreibung

Extentofskininvolvement

Datentyp

text

If there is skin involvement, indicate the type of rash
Beschreibung

Ifthereisskininvolvement,indicatethetypeofrash

Datentyp

text

Lichenoid
Beschreibung

Lichenoid

Datentyp

boolean

Maculpapular
Beschreibung

Maculpapular

Datentyp

boolean

Sclerodermatous
Beschreibung

Sclerodermatous

Datentyp

boolean

Xerophthalmia
Beschreibung

Xerophthalmia

Datentyp

text

Bronchiolitis obliterans
Beschreibung

Bronchiolitisobliterans

Datentyp

text

Esophagus
Beschreibung

Esophagus

Datentyp

text

Answer one of the next two questions
Beschreibung

Answeroneofthenexttwoquestions

Datentyp

text

Diarrhea (number of stools)
Beschreibung

Diarrhea(numberofstools)

Datentyp

text

Diarrhea (volume of stools)
Beschreibung

Diarrhea(volumeofstools)

Datentyp

text

Contractures
Beschreibung

Contractures

Datentyp

text

Eosinophilia
Beschreibung

Eosinophilia

Datentyp

boolean

Serositis
Beschreibung

Serositis

Datentyp

boolean

Fascitis
Beschreibung

Fascitis

Datentyp

boolean

Was there other organ involvement
Beschreibung

Wasthereotherorganinvolvement

Datentyp

text

Answer Questions 42-48 Related To Biopsies Performed During This Assessment Period
Beschreibung

Answer Questions 42-48 Related To Biopsies Performed During This Assessment Period

Were any biopsies performed during this assessment period for suspected GVHD
Beschreibung

BiopsyPerformedInd-3

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C15189
UMLS 2011AA ObjectClass
C0005558
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
Date of biopsy
Beschreibung

Biopsy Date

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C0005558
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus ObjectClass
C15189
UMLS CUI-2
C0011008
NCI Thesaurus Property
C25275
Result of biopsy
Beschreibung

BiopsyResultType

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C15189
UMLS 2011AA ObjectClass
C0005558
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
Type of biopsy
Beschreibung

Typeofbiopsy

Datentyp

text

Answer Questions 49-52 Relating To Gvhd
Beschreibung

Answer Questions 49-52 Relating To Gvhd

Was a specific therapy used to treat GVHD during this assessment period
Beschreibung

WasaspecifictherapyusedtotreatGVHDduringthisassessmentperiod

Datentyp

text

If Yes, Indicate Whether Or Not The Agents Listed Below Were Used To Treat Gvhd During This Assessment Period
Beschreibung

If Yes, Indicate Whether Or Not The Agents Listed Below Were Used To Treat Gvhd During This Assessment Period

Other
Beschreibung

OtherMedicationAdministrationInd-3

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C17649
UMLS 2011AA ObjectClass
C0205394
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass-2
C459
UMLS 2011AA ObjectClass-2
C0013227
NCI Thesaurus Property
C25409
UMLS 2011AA Property
C1533734
Specify other agent used
Beschreibung

other,specify

Datentyp

text

Alias
NCI Thesaurus ObjectClass
C25179
UMLS 2011AA ObjectClass
C0019993
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Has treatment been discontinued
Beschreibung

PatientOff-TreatmentInd

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25601
UMLS 2011AA Property
C1518544
If yes, enter date of discontinuation
Beschreibung

OffTreatmentDate

Datentyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25601
UMLS 2011AA ObjectClass
C1518544
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
ALS, ALG, ATS, ATG
Beschreibung

ALS,ALG,ATS,ATG

Datentyp

text

Azathioprine
Beschreibung

Azathioprine

Datentyp

text

Cyclosporine
Beschreibung

Cyclosporine

Datentyp

text

Systemic corticosteriods
Beschreibung

Systemiccorticosteriods

Datentyp

text

Topical corticosteroids
Beschreibung

Topicalcorticosteroids

Datentyp

text

Thalidomide
Beschreibung

Thalidomide

Datentyp

text

Tacrolimus
Beschreibung

Tacrolimus

Datentyp

text

Mycophenolate Mofetil
Beschreibung

MycophenolateMofetil

Datentyp

text

PUVA (Psoralen and UVA)
Beschreibung

PUVA(PsoralenandUVA)

Datentyp

text

ECP (Extra-corporeal photopheresis)
Beschreibung

ECP(Extra-corporealphotopheresis)

Datentyp

text

Sirolumis
Beschreibung

Sirolumis

Datentyp

text

Etretinate
Beschreibung

Etretinate

Datentyp

text

Lamprene
Beschreibung

Lamprene

Datentyp

text

Etanercept
Beschreibung

Etanercept

Datentyp

text

Zenapax
Beschreibung

Zenapax

Datentyp

text

Chloroquine phosphate
Beschreibung

Chloroquinephosphate

Datentyp

text

In vivo anti T-lymphocyte monoclonal antibody
Beschreibung

InvivoantiT-lymphocytemonoclonalantibody

Datentyp

text

Specify in vivo anti T-lymphocyte monoclonal antibody used
Beschreibung

SpecifyinvivoantiT-lymphocytemonoclonalantibodyused

Datentyp

text

Specify in vivo immunotoxin
Beschreibung

Specifyinvivoimmunotoxin

Datentyp

text

Indicate the best response to GVHD therapy during this assessment period
Beschreibung

IndicatethebestresponsetoGVHDtherapyduringthisassessmentperiod

Datentyp

text

Answer Questions 53-56 Relating To Current Patient Status
Beschreibung

Answer Questions 53-56 Relating To Current Patient Status

Are symptoms of GVHD still present
Beschreibung

DiseaseSymptomInd-3

Datentyp

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C4876
UMLS 2011AA Property
C1457887
Current Karnofsky/Lansky score
Beschreibung

KarnofskyPerformanceStatusScore

Datentyp

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C20641
UMLS 2011AA ObjectClass
C1518965
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
Current platelet count
Beschreibung

Platelets

Datentyp

float

Maßeinheiten
  • 1000/uL
Alias
NCI Thesaurus Property
C20200
UMLS CUI-1
C0005821
NCI Thesaurus Property-2
C12520
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus ValueDomain
C25712
1000/uL
Current weight
Beschreibung

Patient Weight

Datentyp

float

Maßeinheiten
  • Kg
Alias
NCI Thesaurus ValueDomain
C25209
UMLS CUI-1
C0005910
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25208
Kg
Comments
Beschreibung

Research Comments

Datentyp

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
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1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Header module
Visit number
Item
Visit Number
float
C25337 (NCI Thesaurus ValueDomain)
C1549755 (UMLS CUI-1)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
Segment
Item
Segment
text
Startofassessmentperiod
Item
Start of assessment period
text
Endofassessmentperiod
Item
End of assessment period
text
Item Group
Answer Questions 3-8 Relating To Acute Gvhd
Item
Maximum overall grade of acute GVHD during this assessment period
text
C4980 (NCI Thesaurus ObjectClass)
C0856825 (UMLS 2011AA ObjectClass)
C14140 (NCI Thesaurus ObjectClass-2)
C0205178 (UMLS 2011AA ObjectClass-2)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C12981 (NCI Thesaurus Property-2)
C0332835 (UMLS 2011AA Property-2)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
CL.1
Code List
Maximum overall grade of acute GVHD during this assessment period
CL Item
0 (No symptoms of acute GVHD)
C0919414 (NCI Metathesaurus)
CL Item
1 (I)
CL Item
2 (II)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (III)
CL Item
4 (IV)
DidthepatientdevelopacuteGVHD?
Item
Did clinical signs and/or symptoms of acute GVHD develop during this assessment
boolean
TransplantAcuteGVHDBeginDate
Item
Date of diagnosis of acute GVHD
date
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C14140 (NCI Thesaurus Property)
C0205178 (UMLS 2011AA Property)
C0018133 (NCI Metathesaurus Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C0439659 (UMLS 2011AA ValueDomain-2)
Item
Record method used to diagnose acute GVHD
text
CL.3
Code List
Record method used to diagnose acute GVHD
CL Item
Histologic Evidence (Histologic Evidence)
CL Item
Clinical Evidence (Clinical Evidence)
CL Item
Both (Both)
WasprophylaxisforGVHDgivenduringthisassessmentperiod
Item
Was prophylaxis for GVHD given during this assessment period
boolean
Item Group
If Yes, Specify All Immuno Suppressants Used For Gvhd Prophylaxis
MedicationGraftVersusHostDiseaseAdministeredType
Item
Cyclosporine
boolean
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C459 (NCI Thesaurus ObjectClass)
C0013227 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C0018133 (NCI Metathesaurus ObjectClass)
PriorChemotherapyOtherName
Item
Specify other agent used
text
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property-2)
C0600091 (UMLS 2011AA Property-2)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain-2)
C0205394 (UMLS 2011AA ValueDomain-2)
Tacrolimus
Item
Tacrolimus
boolean
Sirolumis
Item
Sirolumis
boolean
MMF
Item
MMF
boolean
Prednisone
Item
Prednisone
boolean
Other
Item
Other
boolean
Ifno,specifythedateGVHDprophylaxiswasdiscontinued
Item
If no, specify the date GVHD prophylaxis was discontinued
text
Item Group
Answer Questions 9-19 Relating To Chronic Gvhd
Item
Maximum overall severity of chronic GVHD during this assessment period
text
C25499 (NCI Thesaurus ObjectClass)
C0441471 (UMLS 2011AA ObjectClass)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C25676 (NCI Thesaurus Property)
C0439793 (UMLS 2011AA Property)
CL.11
Code List
Maximum overall severity of chronic GVHD during this assessment period
CL Item
No symptoms of chronic GVHD (No symptoms of chronic GVHD)
CL Item
Mild (Mild)
C70666 (NCI Thesaurus)
C2945599 (UMLS 2011AA)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
Item
Maximum overall grade of chronic GVHD during this assessment period
text
C14141 (NCI Thesaurus ObjectClass)
C0205191 (UMLS 2011AA ObjectClass)
C0018133 (NCI Metathesaurus ObjectClass)
C12981 (NCI Thesaurus Property)
C0332835 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C48309 (NCI Thesaurus ValueDomain)
C0441800 (UMLS 2011AA ValueDomain)
CL.12
Code List
Maximum overall grade of chronic GVHD during this assessment period
CL Item
Limited (Limited)
CL110648 (NCI Metathesaurus)
CL Item
Extensive (Extensive)
C47863 (NCI Thesaurus)
C0205231 (UMLS 2011AA)
CL Item
Did clinical signs and/or symptoms of chronic GVHD develop during this assessment (Did clinical signs and/or symptoms of chronic GVHD develop during this assessment)
CL Item
Yes (Yes)
CL Item
No (No)
Item
Current Karnofsky/Lansky score
text
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C1518965 (UMLS 2011AA ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
CL.63
Code List
Current Karnofsky/Lansky score
CL Item
Normal, No Complaints, No Evidence Of Disease (100 (Normal; No Complaints/Fully Active))
CL Item
Able To Carry On Normal Activity; Minor Signs Or Symptoms Of Disease (90 (Normal activity/minor restriction in strenuous play))
CL Item
Normal Activity With Effort; Some Signs Or Symptoms Of Disease (80 (Normal acitvity with efforts/restricted in strenuous play))
CL Item
Cares For Self, Unable To Carry On Normal Activity Or To Do Active Work (70 (Unable to carry on normal activity/less time spent in play))
CL Item
Requires Occasional Assistance, But Is Able To Care For Most Of His/her Needs (60 (Requires occasional assistance/minimal active play))
CL Item
Requires Considerable Assistance And Frequent Medical Care (50 (Requires considerable assistance/no active play))
CL Item
Disabled, Requires Special Care And Assistance (40 (Disabled/Able to initiate quiet activities))
CL Item
Severely Disabled, Hospitalization Indicated. Death Not Imminent (30 (Severely disabled/needs assistance for quiet play))
CL Item
Very Sick, Hospitalization Indicated. Death Not Imminent (20 (Very sick/limited to very passive activity))
CL Item
Moribund, Fatal Processes Progressing Rapidly (10 (Moribund; Completely disabled))
Item
Record method used to diagnose chronic GVHD
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C15220 (NCI Thesaurus ObjectClass)
C0011900 (UMLS 2011AA ObjectClass)
CL.13
Code List
Record method used to diagnose chronic GVHD
CL Item
Histology (Histologic Evidence)
C16681 (NCI Thesaurus)
C0019638 (UMLS 2011AA)
C16681 (NCI Thesaurus-3)
C0019638 (UMLS 2011AA-4)
CL Item
Clinical (Clinical Evidence)
C25398 (NCI Thesaurus)
C0205210 (UMLS 2011AA)
CL Item
Both (Both)
Platelets
Item
Current platelet count
float
C20200 (NCI Thesaurus Property)
C0005821 (UMLS CUI-1)
C12520 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
RelevantDiagnosticTestResultDate
Item
Date of diagnosis of chronic GVHD
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
Patient Weight
Item
Current weight
float
C25209 (NCI Thesaurus ValueDomain)
C0005910 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25208 (NCI Thesaurus Property)
HepaticAlkalinePhosphataseLabValue
Item
Alkaline phosphatase at time of diagnosis
float
C13308 (NCI Thesaurus ObjectClass)
C0205054 (UMLS 2011AA ObjectClass)
C37984 (NCI Thesaurus Property)
C0022877 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C16276 (NCI Thesaurus Property-2)
C0002059 (UMLS 2011AA Property-2)
HepaticBilirubinLabValue
Item
Total bilirubin at time of diagnosis
float
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C305 (NCI Thesaurus Property-2)
C0005437 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
Body Surface Area
Item
Body surface area involved with rash at time of diagnosis
float
C25209 (NCI Thesaurus ValueDomain)
C0005902 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25157 (NCI Thesaurus Property)
Item Group
Indicate The Maximum Severity Of Involvement For The Following Organ Systems During This Assessment Period
CommonToxicityCriteriaAdverseEventDyspneaGrade
Item
Dyspnea
float
C2998 (NCI Thesaurus Property)
C0013404 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
CommonToxicityCriteriaAdverseEventPulmonaryFibrosisGrade
Item
Pulmonary fibrosis
float
C26869 (NCI Thesaurus Property)
C0034069 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
CommonToxicityCriteriaAdverseEventForcedExpiratoryVolumein1SecondGrade
Item
FEV1
float
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
C38084 (NCI Thesaurus Property)
C0849974 (UMLS 2011AA Property)
OxygenSaturation
Item
Oxygen saturation
float
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0150411 (NCI Metathesaurus ObjectClass)
CL105480 (NCI Metathesaurus Property)
CommonToxicityCriteriaAdverseEventNauseaGrade
Item
Nausea and vomiting
float
C3258 (NCI Thesaurus Property)
C0027497 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
CommonToxicityCriteriaAdverseEventDiarrheaGrade
Item
Diarrhea
float
C2987 (NCI Thesaurus Property)
C0011991 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
CommonToxicityCriteriaAdverseEventGastrointestinalMalabsorptionSyndromeGrade
Item
Malabsorption
float
C13359 (NCI Thesaurus Property)
C0521362 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
C0024523 (NCI Metathesaurus Property)
CTCAdverseEventBilirubinGrade
Item
Bilirubin level
float
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C305 (NCI Thesaurus Property)
C0005437 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)
C305 (NCI Thesaurus ValueDomain)
C0005437 (UMLS 2011AA ValueDomain)
C18000 (NCI Thesaurus ValueDomain-2)
C0919553 (UMLS 2011AA ValueDomain-2)
CommonToxicityCriteriaAdverseEventVaginitisGrade
Item
Vaginitis
float
C26911 (NCI Thesaurus Property)
C0042267 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
CommonToxicityCriteriaAdverseEventMyositisGrade
Item
Myositis
boolean
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
C0027121 (NCI Metathesaurus Property)
DiseaseInvolvedSiteSpecify
Item
Specify other organ
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25547 (NCI Thesaurus Property-2)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
Item
Extent of skin involvement
text
CL.15
Code List
Extent of skin involvement
CL Item
No Rash (No Rash)
CL Item
<25% of BSA involvement (<25% of BSA involvement)
CL Item
25-50% of BSA involvement (25-50% of BSA involvement)
CL Item
>50% of BSA involvement (>50% of BSA involvement)
CL Item
Generalized involvement (Generalized involvement)
Ifthereisskininvolvement,indicatethetypeofrash
Item
If there is skin involvement, indicate the type of rash
text
Lichenoid
Item
Lichenoid
boolean
Maculpapular
Item
Maculpapular
boolean
Sclerodermatous
Item
Sclerodermatous
boolean
Item
Xerophthalmia
text
CL.19
Code List
Xerophthalmia
CL Item
No symptoms (No symptoms)
CL Item
Minimal symptoms, normal diet (Minimal symptoms, normal diet)
CL Item
Symptomatic but can eat and swallow modified diet (Symptomatic but can eat and swallow modified diet)
CL Item
Symptomatic and unable to adequately aliment or hydrate orally (Symptomatic and unable to adequately aliment or hydrate orally)
Item
Bronchiolitis obliterans
text
CL.22
Code List
Bronchiolitis obliterans
CL Item
Yes, histologic diagnosis (Yes, histologic diagnosis)
CL Item
Yes, clinical diagnosis (Yes, clinical diagnosis)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Esophagus
text
CL.25
Code List
Esophagus
CL Item
No changes (No changes)
CL Item
Symptomatic but can ear regular diet (Symptomatic but can ear regular diet)
CL Item
Dysphagia or odynophagia requiring dietary changes (Dysphagia or odynophagia requiring dietary changes)
CL Item
Need for parenteral nutrition (Need for parenteral nutrition)
Answeroneofthenexttwoquestions
Item
Answer one of the next two questions
text
Item
Diarrhea (number of stools)
text
CL.28
Code List
Diarrhea (number of stools)
CL Item
Increase of <4 stools/day over baseline; mild increase in ostomy output compared to baseline (Increase of <4 stools/day over baseline; mild increase in ostomy output compared to baseline)
CL Item
Increase of 4-6 stools;IV fluids indicated <24 hrs;moderate increase in ostomy output (Increase of 4-6 stools;IV fluids indicated <24 hrs;moderate increase in ostomy output)
CL Item
Increase of 7 or more stools/day, IV fluids indicated <24 hrs;moderate increase in ostomy output (Increase of 7 or more stools/day, IV fluids indicated <24 hrs;moderate increase in ostomy output)
CL Item
Life-threatening consequences (e.g., hemodynamic collapse) (Life-threatening consequences (e.g., hemodynamic collapse))
CL Item
Death (Death)
Item
Diarrhea (volume of stools)
text
CL.29
Code List
Diarrhea (volume of stools)
CL Item
Diarrhea less than or equal to 500 mL/day or <280 mL/m^s (Diarrhea less than or equal to 500 mL/day or <280 mL/m^s)
CL Item
Diarrhea >500 but less than or equal to 1000 mL/day or 280-555 mL/m^2 (Diarrhea >500 but less than or equal to 1000 mL/day or 280-555 mL/m^2)
CL Item
Diarrhea >1000 but less than or equal to 1500 mL/day or 556-833 mL/m^2 (Diarrhea >1000 but less than or equal to 1500 mL/day or 556-833 mL/m^2)
CL Item
Diarrhea >1500 mL/day or >833 mL/m^2 (Diarrhea >1500 mL/day or >833 mL/m^2)
CL Item
Severe abdominal pain with or without ileus, stool with frank blood or melena (Severe abdominal pain with or without ileus, stool with frank blood or melena)
Item
Contractures
text
CL.33
Code List
Contractures
CL Item
No symptoms (No symptoms)
CL Item
Mild joint contractures (does not affect ADL) (Mild joint contractures (does not affect ADL))
CL Item
Severe joint contractures (intereferes with ADL) (Severe joint contractures (intereferes with ADL))
Eosinophilia
Item
Eosinophilia
boolean
Serositis
Item
Serositis
boolean
Fascitis
Item
Fascitis
boolean
Wasthereotherorganinvolvement
Item
Was there other organ involvement
text
Item Group
Answer Questions 42-48 Related To Biopsies Performed During This Assessment Period
BiopsyPerformedInd-3
Item
Were any biopsies performed during this assessment period for suspected GVHD
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
Biopsy Date
Item
Date of biopsy
date
C25164 (NCI Thesaurus ValueDomain)
C0005558 (UMLS CUI-1)
C25367 (NCI Thesaurus ValueDomain-2)
C15189 (NCI Thesaurus ObjectClass)
C0011008 (UMLS CUI-2)
C25275 (NCI Thesaurus Property)
Item
Result of biopsy
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
CL.40
Code List
Result of biopsy
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Equivocal (Equivocal)
C86071 (NCI Thesaurus)
C0332241 (UMLS 2011AA)
Item
Type of biopsy
text
CL.39
Code List
Type of biopsy
CL Item
Skin biopsy (Skin biopsy)
CL Item
Oral biopsy (Oral biopsy)
CL Item
Upper GI biopsy (Upper GI biopsy)
CL Item
Lower GI biopsy (Lower GI biopsy)
CL Item
Liver biopsy (Liver biopsy)
CL Item
Lung biopse (Lung biopse)
Item Group
Answer Questions 49-52 Relating To Gvhd
Item
Was a specific therapy used to treat GVHD during this assessment period
text
CL.41
Code List
Was a specific therapy used to treat GVHD during this assessment period
CL Item
Yes, initiated this assessment period (Yes, initiated this assessment period)
CL Item
Yes, continuing from previous assessment period (Yes, continuing from previous assessment period)
CL Item
No (No)
Item Group
If Yes, Indicate Whether Or Not The Agents Listed Below Were Used To Treat Gvhd During This Assessment Period
Item
Other
text
C17649 (NCI Thesaurus ObjectClass)
C0205394 (UMLS 2011AA ObjectClass)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C459 (NCI Thesaurus ObjectClass-2)
C0013227 (UMLS 2011AA ObjectClass-2)
C25409 (NCI Thesaurus Property)
C1533734 (UMLS 2011AA Property)
CL.60
Code List
Other
CL Item
Yes (Yes, still taking drug)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No (No, drug not given)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
other,specify
Item
Specify other agent used
text
C25179 (NCI Thesaurus ObjectClass)
C0019993 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
PatientOff-TreatmentInd
Item
Has treatment been discontinued
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25601 (NCI Thesaurus Property)
C1518544 (UMLS 2011AA Property)
OffTreatmentDate
Item
If yes, enter date of discontinuation
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25601 (NCI Thesaurus ObjectClass)
C1518544 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
Item
ALS, ALG, ATS, ATG
text
CL.42
Code List
ALS, ALG, ATS, ATG
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Azathioprine
text
CL.43
Code List
Azathioprine
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Cyclosporine
text
CL.44
Code List
Cyclosporine
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Systemic corticosteriods
text
CL.45
Code List
Systemic corticosteriods
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Topical corticosteroids
text
CL.46
Code List
Topical corticosteroids
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Thalidomide
text
CL.47
Code List
Thalidomide
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Tacrolimus
text
CL.48
Code List
Tacrolimus
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Mycophenolate Mofetil
text
CL.49
Code List
Mycophenolate Mofetil
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
PUVA (Psoralen and UVA)
text
CL.50
Code List
PUVA (Psoralen and UVA)
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
ECP (Extra-corporeal photopheresis)
text
CL.51
Code List
ECP (Extra-corporeal photopheresis)
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Sirolumis
text
CL.52
Code List
Sirolumis
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Etretinate
text
CL.53
Code List
Etretinate
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Lamprene
text
CL.54
Code List
Lamprene
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Etanercept
text
CL.55
Code List
Etanercept
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Zenapax
text
CL.56
Code List
Zenapax
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Chloroquine phosphate
text
CL.57
Code List
Chloroquine phosphate
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
In vivo anti T-lymphocyte monoclonal antibody
text
CL.58
Code List
In vivo anti T-lymphocyte monoclonal antibody
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Specify in vivo anti T-lymphocyte monoclonal antibody used
text
CL.59
Code List
Specify in vivo anti T-lymphocyte monoclonal antibody used
CL Item
In vivo immunotoxin (In vivo immunotoxin)
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Specifyinvivoimmunotoxin
Item
Specify in vivo immunotoxin
text
IndicatethebestresponsetoGVHDtherapyduringthisassessmentperiod
Item
Indicate the best response to GVHD therapy during this assessment period
text
Item Group
Answer Questions 53-56 Relating To Current Patient Status
DiseaseSymptomInd-3
Item
Are symptoms of GVHD still present
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
Item
Current Karnofsky/Lansky score
text
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C1518965 (UMLS 2011AA ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
CL.63
Code List
Current Karnofsky/Lansky score
CL Item
Normal, No Complaints, No Evidence Of Disease (100 (Normal; No Complaints/Fully Active))
CL Item
Able To Carry On Normal Activity; Minor Signs Or Symptoms Of Disease (90 (Normal activity/minor restriction in strenuous play))
CL Item
Normal Activity With Effort; Some Signs Or Symptoms Of Disease (80 (Normal acitvity with efforts/restricted in strenuous play))
CL Item
Cares For Self, Unable To Carry On Normal Activity Or To Do Active Work (70 (Unable to carry on normal activity/less time spent in play))
CL Item
Requires Occasional Assistance, But Is Able To Care For Most Of His/her Needs (60 (Requires occasional assistance/minimal active play))
CL Item
Requires Considerable Assistance And Frequent Medical Care (50 (Requires considerable assistance/no active play))
CL Item
Disabled, Requires Special Care And Assistance (40 (Disabled/Able to initiate quiet activities))
CL Item
Severely Disabled, Hospitalization Indicated. Death Not Imminent (30 (Severely disabled/needs assistance for quiet play))
CL Item
Very Sick, Hospitalization Indicated. Death Not Imminent (20 (Very sick/limited to very passive activity))
CL Item
Moribund, Fatal Processes Progressing Rapidly (10 (Moribund; Completely disabled))
Platelets
Item
Current platelet count
float
C20200 (NCI Thesaurus Property)
C0005821 (UMLS CUI-1)
C12520 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
Patient Weight
Item
Current weight
float
C25209 (NCI Thesaurus ValueDomain)
C0005910 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25208 (NCI Thesaurus Property)
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
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