ID

11344

Description

GRF Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF19E559-5522-2E71-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF19E559-5522-2E71-E034-0003BA3F9857

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 7/3/15 7/3/15 -
Uploaded on

July 3, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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GRF

English

No Instruction available.

1 forms  
Header module
Description

Header module

Visit number
Description

Visit number

Data type

float

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

Segment

Data type

text

Record number of columns used for the selection
Description

Recordnumberofcolumnsusedfortheselection

Data type

text

Record Date Of Each Cd34 Cell Selection Procedure
Description

Record Date Of Each Cd34 Cell Selection Procedure

Selection #3
Description

LaboratoryProcedureLymphocyteOutcomeDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C12535
UMLS 2011AA Property
C0024264
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
Selection #3
Description

LaboratoryProcedureLymphocyteOutcomeDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C12535
UMLS 2011AA Property
C0024264
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
Selection #3
Description

LaboratoryProcedureLymphocyteOutcomeDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C12535
UMLS 2011AA Property
C0024264
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
For Each Column Used For Cell Selection, Record The Following Information
Description

For Each Column Used For Cell Selection, Record The Following Information

Final Product #1
Description

Final Product #1

Total nucleated cell count
Description

CerebrospinalFluidTotalCellValue

Data type

float

Alias
NCI Thesaurus Property
C25304
UMLS 2011AA Property
C0439810
NCI Thesaurus ObjectClass
C12692
UMLS 2011AA ObjectClass
C0007806
NCI Thesaurus Property-2
C12508
UMLS 2011AA Property-2
C0007634
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
CD34+ cell count
Description

PeripheralBloodStemCellCD34+CellHarvestPerformedValue

Data type

float

Alias
NCI Thesaurus ObjectClass
C12946
UMLS 2011AA ObjectClass
C1518999
NCI Thesaurus ObjectClass-2
C37963
UMLS 2011AA ObjectClass-2
C1512335
NCI Metathesaurus ObjectClass
C0882849
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
CD3+ T cell count
Description

TransplantCD3+CellInfusionDose

Data type

float

Alias
NCI Thesaurus Property
C15388
UMLS 2011AA Property
C0574032
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
NCI Metathesaurus Property
C0882828
CD3+ CD4+ T cells
Description

CD3+CD4+Tcells

Data type

text

CD3+ CD8+ T cells
Description

CD3+CD8+Tcells

Data type

text

CD3-CD56+ CD16+ NK cells
Description

CD3-CD56+CD16+NKcells

Data type

text

CD19+ or CD20+ B cells
Description

CD19+orCD20+Bcells

Data type

text

CD14+ monocytes
Description

CD14+monocytes

Data type

text

CD34+ cell purity
Description

CD34+cellpurity

Data type

text

CD34+ cell yield
Description

CD34+cellyield

Data type

text

Log10 T cell depletion
Description

Log10Tcelldepletion

Data type

text

Sterility results - gram stain
Description

Sterilityresults-gramstain

Data type

text

Sterility results - 14 day cultures
Description

Sterilityresults-14daycultures

Data type

text

Endotoxin concentration
Description

Endotoxinconcentration

Data type

text

Was the entire final product infused
Description

Wastheentirefinalproductinfused

Data type

boolean

Final Product #2
Description

Final Product #2

Total nucleated cell count
Description

CerebrospinalFluidTotalCellValue

Data type

float

Alias
NCI Thesaurus Property
C25304
UMLS 2011AA Property
C0439810
NCI Thesaurus ObjectClass
C12692
UMLS 2011AA ObjectClass
C0007806
NCI Thesaurus Property-2
C12508
UMLS 2011AA Property-2
C0007634
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
CD34+ cell count
Description

TransplantCD34+CellInfusionDose

Data type

float

Alias
NCI Thesaurus Property
C15388
UMLS 2011AA Property
C0574032
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
NCI Metathesaurus Property
C0882849
CD3+ T cell count
Description

TransplantCD3+CellInfusionDose

Data type

float

Alias
NCI Thesaurus Property
C15388
UMLS 2011AA Property
C0574032
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
NCI Metathesaurus Property
C0882828
CD3+ CD4+ T cells
Description

CD3+CD4+Tcells

Data type

text

CD3+ CD8+ T cells
Description

CD3+CD8+Tcells

Data type

text

CD3-CD56+ CD16+ NK cells
Description

CD3-CD56+CD16+NKcells

Data type

text

CD19+ or CD20+ B cells
Description

CD19+orCD20+Bcells

Data type

text

CD14+ monocytes
Description

CD14+monocytes

Data type

text

CD34+ cell purity
Description

CD34+cellpurity

Data type

text

CD34+ cell yield
Description

CD34+cellyield

Data type

text

Log10 T cell depletion
Description

Log10Tcelldepletion

Data type

text

Sterility results - gram stain
Description

Sterilityresults-gramstain

Data type

text

Sterility results - 14 day cultures
Description

Sterilityresults-14daycultures

Data type

text

Endotoxin concentration
Description

Endotoxinconcentration

Data type

text

Was the entire final product infused
Description

Wastheentirefinalproductinfused

Data type

boolean

Final Product #3
Description

Final Product #3

Total nucleated cell count
Description

CerebrospinalFluidTotalCellValue

Data type

float

Alias
NCI Thesaurus Property
C25304
UMLS 2011AA Property
C0439810
NCI Thesaurus ObjectClass
C12692
UMLS 2011AA ObjectClass
C0007806
NCI Thesaurus Property-2
C12508
UMLS 2011AA Property-2
C0007634
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
CD34+ cell count
Description

Totalno.ofCD34+cellsinfused

Data type

text

CD3+ T cell count
Description

TransplantCD3+CellInfusionDose

Data type

float

Alias
NCI Thesaurus Property
C15388
UMLS 2011AA Property
C0574032
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
NCI Metathesaurus Property
C0882828
Record patient's weight at time of infusion
Description

Patient Weight

Data type

float

Measurement units
  • Kg
Alias
NCI Thesaurus ValueDomain
C25209
UMLS CUI-1
C0005910
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25208
Kg
Comments
Description

Research Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
CD3+ CD4+ T cells
Description

CD3+CD4+Tcells

Data type

text

CD3+ CD8+ T cells
Description

CD3+CD8+Tcells

Data type

text

CD3-CD56+ CD16+ NK cells
Description

CD3-CD56+CD16+NKcells

Data type

text

CD19+ or CD20+ B cells
Description

CD19+orCD20+Bcells

Data type

text

CD14+ monocytes
Description

CD14+monocytes

Data type

text

CD34+ cell purity
Description

CD34+cellpurity

Data type

text

CD34+ cell yield
Description

CD34+cellyield

Data type

text

Log10 T cell depletion
Description

Log10Tcelldepletion

Data type

text

Sterility results - gram stain
Description

Sterilityresults-gramstain

Data type

text

Sterility results - 14 day cultures
Description

Sterilityresults-14daycultures

Data type

text

Endotoxin concentration
Description

Endotoxinconcentration

Data type

text

Was the entire final product infused
Description

Wastheentirefinalproductinfused

Data type

boolean

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1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
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
Item
Record number of columns used for the selection
text
CL.1
Code List
Record number of columns used for the selection
CL Item
One column (One column)
CL Item
Two columns (Two columns)
CL Item
Three columns (Three columns)
Item Group
Record Date Of Each Cd34 Cell Selection Procedure
LaboratoryProcedureLymphocyteOutcomeDate
Item
Selection #3
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C12535 (NCI Thesaurus Property)
C0024264 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
LaboratoryProcedureLymphocyteOutcomeDate
Item
Selection #3
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C12535 (NCI Thesaurus Property)
C0024264 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
LaboratoryProcedureLymphocyteOutcomeDate
Item
Selection #3
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C12535 (NCI Thesaurus Property)
C0024264 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
Item Group
For Each Column Used For Cell Selection, Record The Following Information
Item Group
Final Product #1
CerebrospinalFluidTotalCellValue
Item
Total nucleated cell count
float
C25304 (NCI Thesaurus Property)
C0439810 (UMLS 2011AA Property)
C12692 (NCI Thesaurus ObjectClass)
C0007806 (UMLS 2011AA ObjectClass)
C12508 (NCI Thesaurus Property-2)
C0007634 (UMLS 2011AA Property-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
PeripheralBloodStemCellCD34+CellHarvestPerformedValue
Item
CD34+ cell count
float
C12946 (NCI Thesaurus ObjectClass)
C1518999 (UMLS 2011AA ObjectClass)
C37963 (NCI Thesaurus ObjectClass-2)
C1512335 (UMLS 2011AA ObjectClass-2)
C0882849 (NCI Metathesaurus ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
TransplantCD3+CellInfusionDose
Item
CD3+ T cell count
float
C15388 (NCI Thesaurus Property)
C0574032 (UMLS 2011AA Property)
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
C0882828 (NCI Metathesaurus Property)
CD3+CD4+Tcells
Item
CD3+ CD4+ T cells
text
CD3+CD8+Tcells
Item
CD3+ CD8+ T cells
text
CD3-CD56+CD16+NKcells
Item
CD3-CD56+ CD16+ NK cells
text
CD19+orCD20+Bcells
Item
CD19+ or CD20+ B cells
text
CD14+monocytes
Item
CD14+ monocytes
text
CD34+cellpurity
Item
CD34+ cell purity
text
CD34+cellyield
Item
CD34+ cell yield
text
Log10Tcelldepletion
Item
Log10 T cell depletion
text
Item
Sterility results - gram stain
text
CL.2
Code List
Sterility results - gram stain
CL Item
Positive (Positive)
CL Item
Negative (Negative)
Item
Sterility results - 14 day cultures
text
CL.3
Code List
Sterility results - 14 day cultures
CL Item
Positive (Positive)
CL Item
Negative (Negative)
Endotoxinconcentration
Item
Endotoxin concentration
text
Wastheentirefinalproductinfused
Item
Was the entire final product infused
boolean
Item Group
Final Product #2
CerebrospinalFluidTotalCellValue
Item
Total nucleated cell count
float
C25304 (NCI Thesaurus Property)
C0439810 (UMLS 2011AA Property)
C12692 (NCI Thesaurus ObjectClass)
C0007806 (UMLS 2011AA ObjectClass)
C12508 (NCI Thesaurus Property-2)
C0007634 (UMLS 2011AA Property-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
TransplantCD34+CellInfusionDose
Item
CD34+ cell count
float
C15388 (NCI Thesaurus Property)
C0574032 (UMLS 2011AA Property)
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
C0882849 (NCI Metathesaurus Property)
TransplantCD3+CellInfusionDose
Item
CD3+ T cell count
float
C15388 (NCI Thesaurus Property)
C0574032 (UMLS 2011AA Property)
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
C0882828 (NCI Metathesaurus Property)
CD3+CD4+Tcells
Item
CD3+ CD4+ T cells
text
CD3+CD8+Tcells
Item
CD3+ CD8+ T cells
text
CD3-CD56+CD16+NKcells
Item
CD3-CD56+ CD16+ NK cells
text
CD19+orCD20+Bcells
Item
CD19+ or CD20+ B cells
text
CD14+monocytes
Item
CD14+ monocytes
text
CD34+cellpurity
Item
CD34+ cell purity
text
CD34+cellyield
Item
CD34+ cell yield
text
Log10Tcelldepletion
Item
Log10 T cell depletion
text
Item
Sterility results - gram stain
text
CL.5
Code List
Sterility results - gram stain
CL Item
Positive (Positive)
CL Item
Negative (Negative)
Item
Sterility results - 14 day cultures
text
CL.6
Code List
Sterility results - 14 day cultures
CL Item
Positive (Positive)
CL Item
Negative (Negative)
Endotoxinconcentration
Item
Endotoxin concentration
text
Wastheentirefinalproductinfused
Item
Was the entire final product infused
boolean
Item Group
Final Product #3
CerebrospinalFluidTotalCellValue
Item
Total nucleated cell count
float
C25304 (NCI Thesaurus Property)
C0439810 (UMLS 2011AA Property)
C12692 (NCI Thesaurus ObjectClass)
C0007806 (UMLS 2011AA ObjectClass)
C12508 (NCI Thesaurus Property-2)
C0007634 (UMLS 2011AA Property-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
Totalno.ofCD34+cellsinfused
Item
CD34+ cell count
text
TransplantCD3+CellInfusionDose
Item
CD3+ T cell count
float
C15388 (NCI Thesaurus Property)
C0574032 (UMLS 2011AA Property)
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
C0882828 (NCI Metathesaurus Property)
Patient Weight
Item
Record patient's weight at time of infusion
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)
CD3+CD4+Tcells
Item
CD3+ CD4+ T cells
text
CD3+CD8+Tcells
Item
CD3+ CD8+ T cells
text
CD3-CD56+CD16+NKcells
Item
CD3-CD56+ CD16+ NK cells
text
CD19+orCD20+Bcells
Item
CD19+ or CD20+ B cells
text
CD14+monocytes
Item
CD14+ monocytes
text
CD34+cellpurity
Item
CD34+ cell purity
text
CD34+cellyield
Item
CD34+ cell yield
text
Log10Tcelldepletion
Item
Log10 T cell depletion
text
Item
Sterility results - gram stain
text
CL.8
Code List
Sterility results - gram stain
CL Item
Positive (Positive)
CL Item
Negative (Negative)
Item
Sterility results - 14 day cultures
text
CL.9
Code List
Sterility results - 14 day cultures
CL Item
Positive (Positive)
CL Item
Negative (Negative)
Endotoxinconcentration
Item
Endotoxin concentration
text
Wastheentirefinalproductinfused
Item
Was the entire final product infused
boolean
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