ID

13500

Beschrijving

Randomized study with a run-in dose-selection phase to assess the added value of Lenalidomide in combination with standard remission-induction chemotherapy and post-remission treatment in patients aged 18-65 years with previously untreated acute myeloid leukemia (AML) or high risk myelodysplasia (MDS) (IPSS-R risk score> 4.5) Form Description: Rapid Reporting Form

Trefwoorden

Versies (3)
  1. 06-11-15 06-11-15 -
  2. 01-01-16 01-01-16 -
  3. 11-02-16 11-02-16 -
Geüploaded op

11 februari 2016

DOI

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Creative Commons BY-NC 3.0
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Rapid Reporting Form HOVON 132 AML/SAKK 30/13 EudraCT 2013-002843-26

Engels

Rapid Reporting Form

1 Formulieren  
  1. StudyEvent: ODM
    1. Rapid Reporting Form
Form Relation
Beschrijving

Form Relation

Alias
UMLS CUI-1
C1276413
UMLS CUI-2
C2348792
Form related to induction cycle
Beschrijving

Form related to

Datatype

integer

Alias
UMLS CUI [1,1]
C1276413
UMLS CUI [1,2]
C2348792
Date evaluation was done
Beschrijving

Date

Datatype

date

Maateenheden
  • dd/mm/yyyy
Alias
UMLS CUI [1,1]
C0013221
UMLS CUI [1,2]
C1512043
UMLS CUI [1,3]
C0011008
dd/mm/yyyy
Treatment
Beschrijving

Treatment

Alias
UMLS CUI-1
C0087111
Has Induction cycle been given (either partially or completely)
Beschrijving

Has Induction cycle been given

Datatype

boolean

Alias
UMLS CUI [1]
C3179010
Dose level Lenalidomide (fill out 20 mg, 15 mg, 10 mg)
Beschrijving

Dose level

Datatype

float

Maateenheden
  • mg
Alias
UMLS CUI [1,1]
C0178602
UMLS CUI [1,2]
C1144149
mg
Date start of this induction cycle
Beschrijving

Induction start date

Datatype

date

Maateenheden
  • dd/mm/yyyy
Alias
UMLS CUI [1,1]
C3179010
UMLS CUI [1,2]
C0808070
dd/mm/yyyy
Planned start date next treatment
Beschrijving

Next start date

Datatype

date

Maateenheden
  • dd/mm/yyyy
Alias
UMLS CUI [1]
C1115731
dd/mm/yyyy
Planned next treatment
Beschrijving

Planned next treatment

Datatype

integer

Alias
UMLS CUI [1]
C3641097
Date off protocoll
Beschrijving

Date off protocoll

Datatype

date

Maateenheden
  • dd/mm/yyyy
Alias
UMLS CUI [1,1]
C2348563
UMLS CUI [1,2]
C0011008
dd/mm/yyyy
Survival Status
Beschrijving

Survival Status

Alias
UMLS CUI-1
C1148433
Date last known to be alive or death
Beschrijving

Date last contact

Datatype

date

Maateenheden
  • dd/mm/yyyy
Alias
UMLS CUI [1]
C0805839
dd/mm/yyyy
Survival Status
Beschrijving

Survival Status

Datatype

integer

Alias
UMLS CUI [1]
C1148433
Cause of death
Beschrijving

Cause of death

Datatype

integer

Alias
UMLS CUI [1]
C0007465
*Specify
Beschrijving

*Specify

Datatype

text

Alias
UMLS CUI [1]
C1521902
Toxicity
Beschrijving

Toxicity

Alias
UMLS CUI-1
C0013221
CTCAE grade ≥ 4 non hematological toxicity
Beschrijving

CTCAE grade ≥ 4 non hematological toxicity

Datatype

integer

Maateenheden
  • dd/mm/yyyy
Alias
UMLS CUI [1,1]
C0013221
UMLS CUI [1,2]
C1516728
CTCAE grade ≥ 4 non hematological toxicity Date onset
Beschrijving

CTCAE grade ≥ 4 non hematological toxicity Date onset

Datatype

date

Maateenheden
  • dd/mm/yyyy
Alias
UMLS CUI [1,1]
C0013221
UMLS CUI [1,2]
C1516728
UMLS CUI [1,3]
C0011008
dd/mm/yyyy
CTCAE grade ≥ 4 non hematological toxicity specification
Beschrijving

CTCAE grade ≥ 4 non hematological toxicity specification

Datatype

text

Alias
UMLS CUI [1,1]
C0013221
UMLS CUI [1,2]
C1516728
UMLS CUI [1,3]
C1521902
Recovery
Beschrijving

Recovery

Was ANC recovered to > 0.5x109/L
Beschrijving

ANC Recovery

Datatype

integer

Alias
UMLS CUI [1]
C0948762
Last date ANC was measured
Beschrijving

Last date ANC

Datatype

date

Maateenheden
  • dd/mm/yyyy
Alias
UMLS CUI [1,1]
C0948762
UMLS CUI [1,2]
C0011008
dd/mm/yyyy
First date ANC >0.5 x 109/L
Beschrijving

First date ANC

Datatype

date

Maateenheden
  • dd/mm/yyyy
Alias
UMLS CUI [1]
C1882078
dd/mm/yyyy
First date ANC >1.0 x 109/L
Beschrijving

First date ANC greater

Datatype

date

Maateenheden
  • dd/mm/yyyy
Alias
UMLS CUI [1,1]
C1882078
UMLS CUI [1,2]
C0011008
dd/mm/yyyy
Platelets recovered to > 50x109/L
Beschrijving

Platelets recovered

Datatype

integer

Alias
UMLS CUI [1]
C1882407
First date platelets >50 x 109/L
Beschrijving

First date blood platelets

Datatype

date

Maateenheden
  • dd/mm/yyyy
Alias
UMLS CUI [1,1]
C1882407
UMLS CUI [1,2]
C0011008
dd/mm/yyyy
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Similar models

Rapid Reporting Form

1 Formulieren
  1. StudyEvent: ODM
    1. Rapid Reporting Form
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Form Relation
C1276413 (UMLS CUI-1)
C2348792 (UMLS CUI-2)
Item
Form related to induction cycle
integer
C1276413 (UMLS CUI [1,1])
C2348792 (UMLS CUI [1,2])
Form related to
Code List
Form related to induction cycle
CL Item
induction cycle I  (1)
C1302181 (UMLS CUI-1)
CL Item
induction cycle II (2)
C3179010 (UMLS CUI-1)
Date
Item
Date evaluation was done
date
C0013221 (UMLS CUI [1,1])
C1512043 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item Group
Treatment
C0087111 (UMLS CUI-1)
Has Induction cycle been given
Item
Has Induction cycle been given (either partially or completely)
boolean
C3179010 (UMLS CUI [1])
Dose level
Item
Dose level Lenalidomide (fill out 20 mg, 15 mg, 10 mg)
float
C0178602 (UMLS CUI [1,1])
C1144149 (UMLS CUI [1,2])
Induction start date
Item
Date start of this induction cycle
date
C3179010 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Next start date
Item
Planned start date next treatment
date
C1115731 (UMLS CUI [1])
Item
Planned next treatment
integer
C3641097 (UMLS CUI [1])
Planned next treatment
Code List
Planned next treatment
CL Item
cycle II  (2)
C1302181 (UMLS CUI-1)
CL Item
cycle III  (3)
C1302181 (UMLS CUI-1)
CL Item
autoHSCT  (4)
C0194037 (UMLS CUI-1)
CL Item
alloHSCT  (5)
C1705576 (UMLS CUI-1)
CL Item
treatment off protocol (6)
C0087111 (UMLS CUI-1)
C1518546 (UMLS CUI-2)
Date off protocoll
Item
Date off protocoll
date
C2348563 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
Survival Status
C1148433 (UMLS CUI-1)
Date last contact
Item
Date last known to be alive or death
date
C0805839 (UMLS CUI [1])
Item
Survival Status
integer
C1148433 (UMLS CUI [1])
Survival Status
Code List
Survival Status
CL Item
alive (0)
C2584946 (UMLS CUI-1)
CL Item
dead (1)
C0011065 (UMLS CUI-1)
Item
Cause of death
integer
C0007465 (UMLS CUI [1])
Cause of death
Code List
Cause of death
CL Item
leukemia  (1)
C0023418 (UMLS CUI-1)
CL Item
pneumonia  (2)
C0032285 (UMLS CUI-1)
CL Item
other infection  (3)
C0009450 (UMLS CUI-1)
CL Item
hemorrhage (4)
C0019080 (UMLS CUI-1)
CL Item
veno-occlusive disease*  (5)
C0948441 (UMLS CUI-1)
CL Item
other* (8)
*Specify
Item
*Specify
text
C1521902 (UMLS CUI [1])
Item Group
Toxicity
C0013221 (UMLS CUI-1)
Item
CTCAE grade ≥ 4 non hematological toxicity
integer
C0013221 (UMLS CUI [1,1])
C1516728 (UMLS CUI [1,2])
CTCAE grade ≥ 4 non hematological toxicity Date onset
Code List
CTCAE grade ≥ 4 non hematological toxicity
CL Item
no (0)
CL Item
yes, fill out items 15 and 16 (1)
CTCAE grade ≥ 4 non hematological toxicity Date onset
Item
CTCAE grade ≥ 4 non hematological toxicity Date onset
date
C0013221 (UMLS CUI [1,1])
C1516728 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
CTCAE grade ≥ 4 non hematological toxicity specification
Item
CTCAE grade ≥ 4 non hematological toxicity specification
text
C0013221 (UMLS CUI [1,1])
C1516728 (UMLS CUI [1,2])
C1521902 (UMLS CUI [1,3])
Item Group
Recovery
Item
Was ANC recovered to > 0.5x109/L
integer
C0948762 (UMLS CUI [1])
ANC Recovery
Code List
Was ANC recovered to > 0.5x109/L
CL Item
no, give last date ANC was measured box 18 (0)
CL Item
yes, fill out date of recovery box 19 and/or 20 (1)
CL Item
never below (2)
Last date ANC
Item
Last date ANC was measured
date
C0948762 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
First date ANC
Item
First date ANC >0.5 x 109/L
date
C1882078 (UMLS CUI [1])
First date ANC greater
Item
First date ANC >1.0 x 109/L
date
C1882078 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Platelets recovered to > 50x109/L
integer
C1882407 (UMLS CUI [1])
Platelets recovered
Code List
Platelets recovered to > 50x109/L
CL Item
no  (0)
CL Item
yes, fill out date of recovery  (1)
CL Item
never below (2)
First date blood platelets
Item
First date platelets >50 x 109/L
date
C1882407 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
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