VITAL SIGNS
Were vital signs taken?
boolean
Date
date
Position
text
Blood pressure systolic
float
Blood pressure diastolic
float
Heart rate
integer
PHYSICAL MEASUREMENTS
Were any physical measurements taken?
boolean
Date of measurement
date
Weight
float
Performance status (ECOG)
text
EXTRAMEDULLARY INVOLVEMENT
Date of assessment
date
Is extramedullary disease present?
boolean
f yes, please provide the side code(s) from below: 1=Skin/ Soft tissue, 2=Bone, 3=Visceral (lung), 4=Visceral (liver), 5=Visceral (other), 6=Lymph node, 8=Bone marrow, 9=CNS, 10=Mediastinum, 14=Effusion, 16=Spleen, 18= Intestine, 19= Ascites, 25= Pelvis, 26=Peritoneum, 34= Ovary, 36= Pleura, 37= Gastric, 98= Other
text
PROGRESSION
Did the subject progress?
boolean
Date of progression
date
Reason for progression
text
BEST OVERALL HEMATOLOGIC RESPONSE
Was the hematologic response confirmed?
boolean
Complete hematologic response
boolean
If yes, date of CHR
date
No evidence of leukemia (NEL)
boolean
If yes, date of NEL
date
Return to chronic phase (RTC)
boolean
If yes, date of RTC
date
Minor hematologic response
boolean
No hematologic response
boolean
Unable to determine
text
Please specify "The reason other than toxicity or progression":
text
BEST OVERALL CYTOGENETIC RESPONSE
Date of best cytogenetic response
date
Best cytogenetic response
text
No cytogenetic response
boolean
Unable to determine
text
Please specify "The reason other than toxicity or progression"
text
EXTERNAL DATA TRACKING
Were any of the following protocol specified activities performed?
boolean
If yes, provide date and time
datetime
Mutation analysis
boolean
END OF TREATMENT STATUS
Date of subject off treatment
date
Reason for discontinuing
text
For the reasons with "Specify", please mention the details:
text
SUBJECT STATUS
Will the subject continue to be followed?
boolean
If no, please indicate the primary reason
text
In case of "Lost to follow-up", please mention the date of last contact
date
For the reasons with "Specify", please mention the details
text