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ID

11920

Beskrivning

AMC-075 Study Drug Administration Form (DA3) Vorinostat and Combination Chemotherapy With Rituximab in Treating Patients With Previously Untreated HIV-Related Diffuse Large B-Cell Non-Hodgkin Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9F024D4D-B085-7931-E040-BB89AD4333FF

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9F024D4D-B085-7931-E040-BB89AD4333FF

Nyckelord

  1. 2012-09-19 2012-09-19 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
  3. 2015-08-22 2015-08-22 - Martin Dugas
Uppladdad den

22 augusti 2015

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy

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    Drug Administration Form DA3 Lymphoma AMC-075 NCT01193842

    No Instruction available.

    1. StudyEvent: AMC-075 Study Drug Administration Form (DA3)
      1. No Instruction available.
    Header Module
    Beskrivning

    Header Module

    Visit number
    Beskrivning

    Visit number

    Datatyp

    integer

    Alias
    NCI Thesaurus ValueDomain
    C25337
    NCI Thesaurus ObjectClass
    C16696
    NCI Thesaurus Property
    C25385
    UMLS CUI [1]
    C1549755
    Comments
    Beskrivning

    Research Comments

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0947611
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393
    Enter Total Dose Of Study Drug Received This Cycle And Dose Modification Codes
    Beskrivning

    Enter Total Dose Of Study Drug Received This Cycle And Dose Modification Codes

    Cycle Start Date
    Beskrivning

    Cycle Start Date

    Datatyp

    date

    Måttenheter
    • DD.MM.YYYY
    Alias
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ValueDomain-2
    C25431
    NCI Thesaurus Property
    C25379
    UMLS CUI [1,1]
    C1302181
    UMLS CUI [1,2]
    C3173309
    DD.MM.YYYY
    Body surface area
    Beskrivning

    Body surface area BSA is to be calculated at the start of each cycle. Doses of R-CHOP and R-DA-EPOCH will be based upon the subject's BSA. With any change of weight within 10% of baseline, drug dosing will be maintained at the baseline level. Doses of chemotherapy are to be adjusted only if the subject's weight has changed more than 10% from baseline or the prior dose.

    Datatyp

    float

    Måttenheter
    Alias
    NCI Thesaurus ObjectClass
    C25190
    NCI Thesaurus ValueDomain
    C25712
    NCI Thesaurus Property
    C25157
    UMLS CUI [1]
    C0005902
    Agent Name
    Beskrivning

    Agent

    Datatyp

    text

    Alias
    NCI Thesaurus Property
    C25364
    UMLS CUI-1
    C1521826
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus ValueDomain
    C1708
    NCI Thesaurus ValueDomain-2
    C42614
    Dose Modification
    Beskrivning

    Dose Modification Status

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C25488
    UMLS CUI-1
    C1707811
    NCI Thesaurus ValueDomain
    C25688
    NCI Thesaurus Property
    C25572
    Total Dose of Agents/Drugs for this Cycle
    Beskrivning

    Total Dose of Agents/Drugs for this Cycle

    Datatyp

    float

    Måttenheter
    • mg/cycle
    Alias
    NCI Thesaurus ValueDomain
    C25304
    NCI Thesaurus Property
    C25379
    NCI Thesaurus ValueDomain-2
    C25488
    NCI Thesaurus ObjectClass
    C1708
    UMLS CUI [1]
    C2986497
    mg/cycle
    Number of Doses Missed
    Beskrivning

    Missed doses should be reported for any dose that was missed regardless of the reason. If the subject missed a dose due to an adverse event, please ensure the corresponding adverse event has been reported per the adverse event reporting requirements of this protocol

    Datatyp

    integer

    Alias
    NCI Thesaurus Property
    C54031
    NCI Thesaurus ObjectClass
    C25488
    NCI Metathesaurus ValueDomain
    CL052797
    UMLS CUI [1,1]
    C1705492
    UMLS CUI [1,2]
    C0178602
    Agent Start Date
    Beskrivning

    Agent Start Date

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25431
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus Property
    C25275
    UMLS CUI [1,1]
    C1521826
    UMLS CUI [1,2]
    C0808070
    Agent End Date
    Beskrivning

    Agent End Date

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus Property
    C25275
    UMLS CUI [1,1]
    C1521826
    UMLS CUI [1,2]
    C0806020
    Duration Delay
    Beskrivning

    Duration Delay

    Datatyp

    durationDatetime

    Måttenheter
    • days
    Alias
    NCI Thesaurus Property
    C25477
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus Property-2
    C25409
    NCI Thesaurus ValueDomain
    C25330
    UMLS CUI [1]
    C1299700
    days

    Similar models

    No Instruction available.

    1. StudyEvent: AMC-075 Study Drug Administration Form (DA3)
      1. No Instruction available.
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    Alias
    Item Group
    Header Module
    Visit number
    Item
    Visit number
    integer
    C25337 (NCI Thesaurus ValueDomain)
    C16696 (NCI Thesaurus ObjectClass)
    C25385 (NCI Thesaurus Property)
    C1549755 (UMLS CUI [1])
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    Item Group
    Enter Total Dose Of Study Drug Received This Cycle And Dose Modification Codes
    Chemotherapy Cycle Start Date
    Item
    Cycle Start Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C15368 (NCI Thesaurus ObjectClass)
    C25431 (NCI Thesaurus ValueDomain-2)
    C25379 (NCI Thesaurus Property)
    C1302181 (UMLS CUI [1,1])
    C3173309 (UMLS CUI [1,2])
    BSA
    Item
    Body surface area
    float
    C25190 (NCI Thesaurus ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    C25157 (NCI Thesaurus Property)
    C0005902 (UMLS CUI [1])
    Agent
    Item
    Agent Name
    text
    C25364 (NCI Thesaurus Property)
    C1521826 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass)
    C1708 (NCI Thesaurus ValueDomain)
    C42614 (NCI Thesaurus ValueDomain-2)
    Item
    Dose Modification
    text
    C25488 (NCI Thesaurus ObjectClass)
    C1707811 (UMLS CUI-1)
    C25688 (NCI Thesaurus ValueDomain)
    C25572 (NCI Thesaurus Property)
    Code List
    Dose Modification
    CL Item
    No Dose Modification (No dose modification)
    CL Item
    Dose Delayed (Dose delayed)
    CL Item
    Dose Escalated (Dose escalated)
    CL Item
    Dose Reduced (Dose reduced)
    C49505 (NCI Thesaurus)
    C1707814 (UMLS 2011AA)
    C49505 (NCI Thesaurus-3)
    C1707814 (UMLS 2011AA-4)
    CL Item
    Dose Delayed And Reduced (Dose delayed and reduced)
    CL Item
    Drug Discontinued (Drug discontinued)
    Agent Total Dose
    Item
    Total Dose of Agents/Drugs for this Cycle
    float
    C25304 (NCI Thesaurus ValueDomain)
    C25379 (NCI Thesaurus Property)
    C25488 (NCI Thesaurus ValueDomain-2)
    C1708 (NCI Thesaurus ObjectClass)
    C2986497 (UMLS CUI [1])
    Missed Dose Count
    Item
    Number of Doses Missed
    integer
    C54031 (NCI Thesaurus Property)
    C25488 (NCI Thesaurus ObjectClass)
    CL052797 (NCI Metathesaurus ValueDomain)
    C1705492 (UMLS CUI [1,1])
    C0178602 (UMLS CUI [1,2])
    Medication Start Date
    Item
    Agent Start Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    C1708 (NCI Thesaurus ObjectClass)
    C25275 (NCI Thesaurus Property)
    C1521826 (UMLS CUI [1,1])
    C0808070 (UMLS CUI [1,2])
    Medication End Date
    Item
    Agent End Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C1708 (NCI Thesaurus ObjectClass)
    C25275 (NCI Thesaurus Property)
    C1521826 (UMLS CUI [1,1])
    C0806020 (UMLS CUI [1,2])
    Delay of drug therapy
    Item
    Duration Delay
    durationDatetime
    C25477 (NCI Thesaurus Property)
    C1708 (NCI Thesaurus ObjectClass)
    C25409 (NCI Thesaurus Property-2)
    C25330 (NCI Thesaurus ValueDomain)
    C1299700 (UMLS CUI [1])

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