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AML- Register_Therapy form_SAL_University hospital dresden

1 forms  
Patient information
Description

Patient information

Patient name:
Description

Patient name

Data type

text

Patient ID:
Description

Patient ID

Data type

integer

Clinic code:
Description

Clinic code

Data type

integer

Date of birth:
Description

Date of birth

Data type

date

Gender:
Description

Gender

Data type

text

Cancer remission by therapy beginning (to be completed from 2nd therapy)
Description

Cancer remission by therapy beginning (to be completed from 2nd therapy)

Date of cancer remission:
Description

date

Data type

date

Through bone marrow puncture secured?
Description

bone marrow puncture

Data type

boolean

Remission status:
Description

Remission status

Data type

text

CR by acute promyelocytic leukemia:
Description

Complete remission

Data type

text

Recurrence by acute promyelocytic leukemia:
Description

recurrence

Data type

text

CRi/ CRp:
Description

CRi/ CRp

Data type

boolean

Partial remission:
Description

Partial remission

Data type

boolean

Progression / refractory:
Description

Progression; refractory

Data type

boolean

Can not be assessed:
Description

assessment

Data type

boolean

Chemotherapy
Description

Chemotherapy

Date of chemotherapy:
Description

Date

Data type

date

Chemotherapy:
Description

Chemotherapy

Data type

text

Therapy schema:
Description

Schema

Data type

text

Medication (chemotherapy)
Description

Medication (chemotherapy)

Medication:
Description

medication

Data type

text

Chemotherapy start date:
Description

start date

Data type

date

Days:
Description

days

Data type

text

Total dose:
Description

dose

Data type

integer

Measurement units
  • mg
mg
Transplantation
Description

Transplantation

Date of transplantation:
Description

date

Data type

date

Stem cell transplantation centre:
Description

stem Cell transplantation

Data type

text

Stem cell transplantation type:
Description

Stem cell transplantation type

Data type

text

Donor:
Description

donor

Data type

text

Conditioning regimens:
Description

Conditioning regimens

Data type

text

Toxicity grade III-IV
Description

Toxicity grade III-IV

Creatinine:
Description

creatinine

Data type

boolean

Hemorrhage:
Description

hemorrhage

Data type

boolean

Bilirubin:
Description

Bilirubin

Data type

boolean

Infection:
Description

Infection

Data type

boolean

Heart:
Description

heart

Data type

boolean

GvHD:
Description

GvHD

Data type

boolean

ALAT/ASAT:
Description

ALAT/ASAT

Data type

boolean

Other:
Description

Other

Data type

text

Therapy outcome
Description

Therapy outcome

Date of therapy response:
Description

date

Data type

date

Through bone marrow puncture secured?
Description

bone marrow puncture

Data type

boolean

Therapy outcome:
Description

therapy outcome

Data type

text

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Similar models

AML- Register_Therapy form_SAL_University hospital dresden

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Patient information
Patient name
Item
Patient name:
text
Patient ID
Item
Patient ID:
integer
Clinic code
Item
Clinic code:
integer
Date of birth
Item
Date of birth:
date
Item
Gender:
text
Gender
Code List
Gender:
CL Item
male  (1)
CL Item
female (2)
Item Group
Cancer remission by therapy beginning (to be completed from 2nd therapy)
date
Item
Date of cancer remission:
date
bone marrow puncture
Item
Through bone marrow puncture secured?
boolean
Item
Remission status:
text
Remission status
Code List
Remission status:
CL Item
good response (blasts under 10%) (1)
CL Item
moderate response (min. halving the number of Blast auf >=10%) (2)
CL Item
no response (no decrease in the blasts, decrease of <50%) (3)
Item
CR by acute promyelocytic leukemia:
text
Complete remission
Code List
CR by acute promyelocytic leukemia:
CL Item
hematological (1)
CL Item
molecular (2)
Item
Recurrence by acute promyelocytic leukemia:
text
recurrence
Code List
Recurrence by acute promyelocytic leukemia:
CL Item
hematological (1)
CL Item
molecular (2)
CRi/ CRp
Item
CRi/ CRp:
boolean
Partial remission
Item
Partial remission:
boolean
Progression; refractory
Item
Progression / refractory:
boolean
assessment
Item
Can not be assessed:
boolean
Item Group
Chemotherapy
Date
Item
Date of chemotherapy:
date
Item
Chemotherapy:
text
Chemotherapy
Code List
Chemotherapy:
CL Item
during a study; curative  (1)
CL Item
during a study; palliative (2)
CL Item
outside of a study; curative  (3)
CL Item
outside of a study; palliative (4)
Schema
Item
Therapy schema:
text
Item Group
Medication (chemotherapy)
medication
Item
Medication:
text
start date
Item
Chemotherapy start date:
date
days
Item
Days:
text
dose
Item
Total dose:
integer
Item Group
Transplantation
date
Item
Date of transplantation:
date
stem Cell transplantation
Item
Stem cell transplantation centre:
text
Item
Stem cell transplantation type:
text
Stem cell transplantation type
Code List
Stem cell transplantation type:
CL Item
Autologous (1)
CL Item
Allogeneic (related) (2)
CL Item
Allogeneic (unrelated) (3)
Item
Donor:
text
donor
Code List
Donor:
CL Item
identical (1)
CL Item
haploidentical  (2)
CL Item
Mismatch (3)
Conditioning regimens
Item
Conditioning regimens:
text
Item Group
Toxicity grade III-IV
creatinine
Item
Creatinine:
boolean
hemorrhage
Item
Hemorrhage:
boolean
Bilirubin
Item
Bilirubin:
boolean
Infection
Item
Infection:
boolean
heart
Item
Heart:
boolean
GvHD
Item
GvHD:
boolean
ALAT/ASAT
Item
ALAT/ASAT:
boolean
Other
Item
Other:
text
Item Group
Therapy outcome
date
Item
Date of therapy response:
date
bone marrow puncture
Item
Through bone marrow puncture secured?
boolean
Item
Therapy outcome:
text
therapy outcome
Code List
Therapy outcome:
CL Item
good response (blasts under 10%) (1)
CL Item
moderate response (min. halving the number of Blast auf >=10%) (2)
CL Item
no response (no decrease in the blasts, decrease of <50%) (3)
CL Item
CR by acute promyelocytic leukemia, hematological (4)
CL Item
CR by acute promyelocytic leukemia, molecular (5)
CL Item
Recurrence by acute promyelocytic leukemia, hematological (6)
CL Item
Recurrence by acute promyelocytic leukemia, molecular (7)
CL Item
CRi (8)
CL Item
CRp (9)
CL Item
Partial remission (10)
CL Item
Patient dead (11)
CL Item
Progression / refractory (12)
CL Item
can not be assessed (13)
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