Description:

ADVL0212: Eligibility Worksheet (Leukemia) NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C0F2D219-E599-53B9-E034-0003BA12F5E7

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https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C0F2D219-E599-53B9-E034-0003BA12F5E7

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Versions (3) ▾
  1. 8/26/12
  2. 1/9/15
  3. 6/16/15
Uploaded on:

June 16, 2015

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Creative Commons BY-NC 3.0 Legacy
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ADVL0212: Eligibility Worksheet (Leukemia) NCT00053963

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  1. StudyEvent: ADVL0212: Eligibility Worksheet (Leukemia)
    1. No Instruction available.
Header
Eligibility Assessment
Is the planned start of treatment within five working days of fulfilling all eligibility criteria?
Is patient less than 22 years of age at the time of study entry?
Does patient have histologic verification of the malignancy at original diagnosis
Is patient's disease considered refractory to conventional therapy, or is there no existing effective conventional therapy
If patient has a CNS tumor, were neurologic deficits relatively stable for a minimum of two weeks prior to study entry?
Karnofsky Performance Score
Lansky Play Score
Does patient have a life expectancy of greater than or equal to 8 weeks?
Has patient fully recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy prior to entering this study?
Did patient receive growth factors within 1 week of entry onto this study?
If patient has a CNS tumor and is receiving dexamethasone, is patient on a stable dose for at least two weeks prior to study entry?
Is patient receiving enzyme-inducing anticonvulsant drugs?
Does patient have adequate bone marrow function?
Does patient have adequate renal function?
Does patient have adequate liver function?
Does patient have adequate cardiac function?
Does patient have adequate pulmonary function?
Does patient have adequate central nervous system function?
If female and post-menarchal, was a pregnancy test obtained?
is the patient pregnant?
has he or she agreed to use an effective contraceptive method?
Does patient have an uncontrolled infection?
Has patient previously received Depsipeptide?
Does patient have the following: Symptoms of congestive heart failure, Uncontrolled cardiac rhythm disturbance, or QTC that is greater than or equal to 480 msec
Comments
Treatment Assignment
Ccrr Module For Advl0212: Eligibility Worksheet (leukemia)