ID

13714

Description

ODM derived from HSCT forms on http://www.ebmt.org/

Link

http://www.ebmt.org/

Keywords

Versions (2)
  1. 2/21/16 2/21/16 -
  2. 2/29/16 2/29/16 -
Uploaded on

February 29, 2016

DOI

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License

Creative Commons BY-NC-ND 3.0
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Specifications of the disease EBMT CML

English

Specifications of the disease EBMT CML

1 forms  
Initial Diagnosis
Description

Initial Diagnosis

has the information requested in this section been submitted with a previous HSCT registration?
Description

Previous HSCT registration

Data type

text

Alias
UMLS CUI [1]
C1514821
At least one investigation must be positive: Translocation (9;22)
Description

Translocation (9;22)

Data type

text

Alias
UMLS CUI [1]
C3897138
At least one investigation must be positive: bcr-abl
Description

bcr-abl

Data type

text

Alias
UMLS CUI [1]
C1835417
Status of disease at diagnosis
Description

Status of disease at diagnosis

Data type

text

Alias
UMLS CUI [1]
C0699749
Initial Diagnosis - Cytogenetics
Description

Initial Diagnosis - Cytogenetics

Cytogenetics other than for translocation (9;22) at diagnosis
Description

Cytogenetics other than for translocation (9;22) at diagnosis

Data type

text

Alias
UMLS CUI [1]
C0010802
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Translocation
Description

Translocation

Data type

boolean

Alias
UMLS CUI [1]
C0040715
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Translocation If yes, write chromosomes involved
Description

Translocation: Specification

Data type

text

Alias
UMLS CUI [1,1]
C0040715
UMLS CUI [1,2]
C2348235
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Deletion
Description

Deletion

Data type

boolean

Alias
UMLS CUI [1]
C1442161
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Deletion If yes, write chromosomes involved
Description

Deletion: Specification

Data type

text

Alias
UMLS CUI [1,1]
C1442161
UMLS CUI [1,2]
C2348235
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Inversion
Description

Inversion

Data type

boolean

Alias
UMLS CUI [1]
C0021943
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Inversion If yes, write chromosomes involved
Description

Inversion: Specification

Data type

text

Alias
UMLS CUI [1,1]
C0021943
UMLS CUI [1,2]
C2348235
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Isochromosome
Description

Isochromosome

Data type

boolean

Alias
UMLS CUI [1]
C0242621
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Isochromosome If yes, write chromosomes involved
Description

Isochromosome: Specification

Data type

text

Alias
UMLS CUI [1,1]
C0242621
UMLS CUI [1,2]
C2348235
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Multiple (=>3)
Description

Multiple (=>3)

Data type

boolean

Alias
UMLS CUI [1]
C0449822
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Multiple (=>3) If yes, write chromosomes involved
Description

Multiple (=>3): Specification

Data type

text

Alias
UMLS CUI [1,1]
C0449822
UMLS CUI [1,2]
C2348235
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Hypodiploid
Description

Hypodiploid

Data type

boolean

Alias
UMLS CUI [1]
C0333691
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Hypodiploid If yes, write chromosomes involved
Description

Hypodiploid: Specification

Data type

text

Alias
UMLS CUI [1,1]
C0333691
UMLS CUI [1,2]
C2348235
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Hyperdiploid
Description

Hyperdiploid

Data type

boolean

Alias
UMLS CUI [1]
C1305143
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Hyperdiploid If yes, write chromosomes involved
Description

Hyperdiploid: Specification

Data type

text

Alias
UMLS CUI [1,1]
C1305143
UMLS CUI [1,2]
C2348235
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Monosomy (include loss of arms)
Description

Monosomy

Data type

boolean

Alias
UMLS CUI [1]
C0026499
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Monosomy (include loss of arms) If yes, write chromosomes involved
Description

Monosomy: Specification

Data type

text

Alias
UMLS CUI [1,1]
C0026499
UMLS CUI [1,2]
C2348235
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Trisomy
Description

Trisomy

Data type

boolean

Alias
UMLS CUI [1]
C0041107
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Trisomy If yes, write chromosomes involved
Description

Trisomy: Specification

Data type

text

Alias
UMLS CUI [1,1]
C0041107
UMLS CUI [1,2]
C2348235
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Other
Description

Cytogenetics - Abnormalities

Data type

text

Alias
UMLS CUI [1]
C0008625
Number of metaphases with anomalies:
Description

Number of abnormal metaphases

Data type

float

Alias
UMLS CUI [1,1]
C1621812
UMLS CUI [1,2]
C0237753
Number of metaphases examined
Description

Number of examined metaphases

Data type

float

Alias
UMLS CUI [1,1]
C1621812
UMLS CUI [1,2]
C0237753
UMLS CUI [1,3]
C0260877
Initial Diagnosis - Haematological values
Description

Initial Diagnosis - Haematological values

Evaluated?: Hb (g/dL)
Description

Hb

Data type

boolean

Alias
UMLS CUI [1]
C0518015
If evaluated, specify: Hb (g/dL)
Description

Hb: value

Data type

float

Measurement units
  • g/dL
Alias
UMLS CUI [1,1]
C0518015
UMLS CUI [1,2]
C1522609
g/dL
Evaluated?: Platelets (10^9/ L)
Description

Platelets

Data type

boolean

Alias
UMLS CUI [1]
C0032181
If evaluated, specify: Platelets (10^9/ L)
Description

Platelets: value

Data type

float

Measurement units
  • 10^9/L
Alias
UMLS CUI [1,1]
C0032181
UMLS CUI [1,2]
C1522609
10^9/L
Evaluated?: White Blood Count (10^9/L)
Description

White Blood Count

Data type

boolean

Alias
UMLS CUI [1]
C0023508
If evaluated, specify: White Blood Count (10^9/ L)
Description

White Blood Count: Specifcation

Data type

float

Measurement units
  • 10^9/L
Alias
UMLS CUI [1,1]
C0023508
UMLS CUI [1,2]
C1522609
10^9/L
Evaluated?: % basophils
Description

basophils

Data type

boolean

Alias
UMLS CUI [1]
C0200641
If evaluated, specify: % basophils
Description

basophils: percentage

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1,1]
C0200641
UMLS CUI [1,2]
C0439165
%
Evaluated?: % blasts
Description

blasts

Data type

boolean

Alias
UMLS CUI [1]
C0523113
If evaluated, specify: % blasts
Description

blasts: percentage

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1,1]
C0523113
UMLS CUI [1,2]
C0439165
%
Evaluated?: % blasts
Description

Bone marrow: blasts

Data type

boolean

Alias
UMLS CUI [1]
C1982687
If evaluated, specify: % blasts
Description

Bone marrow: blasts: percentage

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1,1]
C1982687
UMLS CUI [1,2]
C0439165
%
Palpable Splenomegaly
Description

Palpable Splenomegaly

Data type

text

Alias
UMLS CUI [1]
C0038002
Palpable Splenomegaly: Physical examination: evaluated?
Description

Physical examination: Splenomegaly

Data type

boolean

Alias
UMLS CUI [1,1]
C0038002
UMLS CUI [1,2]
C0031809
Palpable Splenomegaly: Physical examination: If evaluated, specify: cm (below costal margin)
Description

Physical examination: Splenomegaly value

Data type

float

Measurement units
  • cm
Alias
UMLS CUI [1,1]
C0038002
UMLS CUI [1,2]
C0031809
UMLS CUI [1,3]
C1522609
cm
Palpable Splenomegaly: Spleen span in ultrasound or CT scan: evaluated?
Description

Imaging: Splenomegaly

Data type

boolean

Alias
UMLS CUI [1,1]
C0038002
UMLS CUI [1,2]
C0011923
Palpable Splenomegaly: Spleen span in ultrasound or CT scan: If evaluated, specify: cm (maximum diameter)
Description

Imaging: Splenomegaly value

Data type

float

Measurement units
  • cm
Alias
UMLS CUI [1,1]
C0038002
UMLS CUI [1,2]
C0011923
UMLS CUI [1,3]
C1522609
cm
Pre-HSCT Treatment
Description

Pre-HSCT Treatment

Primary Treamtent
Description

Primary Treatment

Data type

text

Alias
UMLS CUI [1]
C1708063
Start Date of Primary Treatment
Description

Start Date

Data type

date

Alias
UMLS CUI [1]
C0808070
Chemotherapy/ Drugts used for primary treatment
Description

Chemotherapy/ Drugs

Data type

text

Alias
UMLS CUI [1]
C0013216
Chemotherapy/ Drugs: Imatinib
Description

Imatinib

Data type

boolean

Alias
UMLS CUI [1]
C0935989
Chemotherapy/ Drugs: Imatinib If yes, specify duration
Description

Imatinib: duration

Data type

durationDatetime

Alias
UMLS CUI [1,1]
C0935989
UMLS CUI [1,2]
C0449238
Chemotherapy/ Drugs: Dasatinib
Description

Dasatinib

Data type

boolean

Alias
UMLS CUI [1]
C1455147
Chemotherapy/ Drugs: Dasatinib If yes, specify duration
Description

Dasatinib: duration

Data type

durationDatetime

Alias
UMLS CUI [1,1]
C1455147
UMLS CUI [1,2]
C0449238
Chemotherapy/ Drugs: Nilotinib
Description

Nilotinib

Data type

boolean

Alias
UMLS CUI [1]
C1721377
Chemotherapy/ Drugs: Nilotinib If yes, specify duration
Description

Nilotinib: duration

Data type

durationDatetime

Alias
UMLS CUI [1,1]
C1721377
UMLS CUI [1,2]
C0449238
Chemotherapy/ Drugs: Interferon alpha
Description

Interferon alpha

Data type

boolean

Alias
UMLS CUI [1]
C0002199
Chemotherapy/ Drugs: Interferon alpha If yes, specify duration
Description

Interferon alpha: duration

Data type

durationDatetime

Alias
UMLS CUI [1,1]
C0002199
UMLS CUI [1,2]
C0449238
Chemotherapy/ Drugs: Hydroxyurea
Description

Hydroxyurea

Data type

boolean

Alias
UMLS CUI [1]
C0020402
Chemotherapy/ Drugs: Hydroxyurea If yes, specify duration
Description

Hydroxyurea: duration

Data type

durationDatetime

Alias
UMLS CUI [1,1]
C0020402
UMLS CUI [1,2]
C0449238
Chemotherapy/ Drugs: Busulfan
Description

Busulfan

Data type

boolean

Alias
UMLS CUI [1]
C0006463
Chemotherapy/ Drugs: Busulfan If yes, specify duration
Description

Busulfan: duration

Data type

durationDatetime

Alias
UMLS CUI [1,1]
C0006463
UMLS CUI [1,2]
C0449238
Chemotherapy/ Drugs: Cytosine arabinoside (ARAC)
Description

Cytosine arabinoside (ARAC)

Data type

boolean

Alias
UMLS CUI [1]
C0010711
Chemotherapy/ Drugs: Cytosine arabinoside (ARAC) If yes, specify duration
Description

Cytosine arabinoside (ARAC): duration

Data type

durationDatetime

Alias
UMLS CUI [1,1]
C0010711
UMLS CUI [1,2]
C0449238
Chemotherapy/ Drugs: Other Chemotherapy
Description

Other Chemotherapy

Data type

boolean

Alias
UMLS CUI [1]
C0392920
Chemotherapy/ Drugs Other Chemotherapy If yes, specify duration
Description

Chemotherapy/ Drugs

Data type

durationDatetime

Alias
UMLS CUI [1]
C0392920
Other treatment
Description

Other treatment

Data type

text

Alias
UMLS CUI [1]
C0087111
Other treatment If yes, specify:
Description

Specification Other treatment

Data type

text

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C2348235
HSCT Date and Type
Description

HSCT Date and Type

Date of HSCT
Description

Date of HSCT

Data type

date

Alias
UMLS CUI [1]
C2584899
Splenectomy performed?
Description

Splenectomy

Data type

boolean

Alias
UMLS CUI [1]
C0037995
If Splenectomy performed, specify the date:
Description

Date of Splenectomy

Data type

date

Alias
UMLS CUI [1]
C2584899
HSCT Type
Description

HSCT Type

Data type

text

Alias
UMLS CUI [1]
C0472699
Main reason for HSCT (tick one main reason only)
Description

Reason for HSCT

Data type

text

Alias
UMLS CUI [1,1]
C0472699
UMLS CUI [1,2]
C0392360
Main reason for HSCT (tick one main reason only) If other, specify:
Description

Other Reason for HSCT

Data type

text

Alias
UMLS CUI [1,1]
C0472699
UMLS CUI [1,2]
C0392360
UMLS CUI [1,3]
C2348235
Secondary reason for HSCT (tick as many secondary as applicable)
Description

Secondary Reason for HSCT

Data type

text

Alias
UMLS CUI [1,1]
C0472699
UMLS CUI [1,2]
C0392360
UMLS CUI [1,3]
C0175668
Secondary reason for HSCT (tick as many secondary as applicable) If other, specify:
Description

Other Secondary Reason for HSCT

Data type

text

Alias
UMLS CUI [1,1]
C0472699
UMLS CUI [1,2]
C0392360
UMLS CUI [1,3]
C0175668
UMLS CUI [1,4]
C2348235
Only if autograft (For autograft only. If allograft proceed to "Status at HSCT")
Description

Only if autograft (For autograft only. If allograft proceed to "Status at HSCT")

Date of Collection
Description

Date of Collection

Data type

date

Alias
UMLS CUI [1]
C2584899
Disease Status
Description

Disease Status

Data type

text

Alias
UMLS CUI [1]
C0699749
Number of Chronic phase
Description

Number of Chronic phase

Data type

text

Alias
UMLS CUI [1,1]
C0237753
UMLS CUI [1,2]
C0457343
Remission Status (complete only if chronic phase, check all that apply): Haematological remission
Description

Haematological remission

Data type

text

Alias
UMLS CUI [1,1]
C0544452
UMLS CUI [1,2]
C0279810
Remission Status (complete only if chronic phase, check all that apply): Cytogenetic remission
Description

Cytogenetic remission

Data type

text

Alias
UMLS CUI [1,1]
C0544452
UMLS CUI [1,2]
C0010802
Remission Status (complete only if chronic phase, check all that apply): Molecular remission
Description

Molecular remission

Data type

text

Alias
UMLS CUI [1,1]
C0544452
UMLS CUI [1,2]
C0026376
Translocation (9;22) (to be completed only if disease status is not cytogenetic remission)
Description

Translocation (9;22)

Data type

text

Alias
UMLS CUI [1]
C3897138
Translocation (9;22) (to be completed only if disease status is not cytogenetic remission) If yes, specify percentage of Translocation (9;22) metaphases:
Description

Translocation (9;22): percentage

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1,1]
C3897138
UMLS CUI [1,2]
C0439165
%
Translocation (9;22) (to be completed only if disease status is not cytogenetic remission) If yes, specify number of examined metaphases:
Description

Translocation (9;22): number metaphases

Data type

float

Alias
UMLS CUI [1,1]
C3897138
UMLS CUI [1,2]
C0237753
FISH analysis t(9;22)
Description

FISH analysis

Data type

text

Alias
UMLS CUI [1]
C0162789
FISH analysis t(9;22) If positive, specify percentage of positive cells:
Description

FISH analysis: percentage

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1,1]
C0162789
UMLS CUI [1,2]
C2826772
%
FISH analysis t(9;22) If positive, specify number of examined cells:
Description

FISH analysis: number of examined cells

Data type

float

Alias
UMLS CUI [1,1]
C0162789
UMLS CUI [1,2]
C0237753
Additional cytogenetic analysis?
Description

Additional cytogenetic analysis

Data type

text

Alias
UMLS CUI [1]
C0752095
Molecular status of mobilised product (to be completed only if disease status is not molecular remission) Molecular marker BCR-ABL
Description

Molecular marker BCR-ABL

Data type

text

Alias
UMLS CUI [1]
C1835417
Status of disease at HSCT
Description

Status of disease at HSCT

Phase of Disease
Description

Status of Disease

Data type

text

Alias
UMLS CUI [1]
C0205390
If Chronic phase, specify number of chronic phase
Description

Chronic Phase

Data type

text

Alias
UMLS CUI [1]
C0237753
Remission Status (complete only if chronic phase, check all that apply): Haematological remission
Description

Haematological remission

Data type

text

Alias
UMLS CUI [1,1]
C0544452
UMLS CUI [1,2]
C0279810
Remission Status (complete only if chronic phase, check all that apply): Cytogenetic remission
Description

Cytogenetic remission

Data type

text

Alias
UMLS CUI [1,1]
C0544452
UMLS CUI [1,2]
C0010802
Remission Status (complete only if chronic phase, check all that apply): Molecular remission
Description

Molecular remission

Data type

text

Alias
UMLS CUI [1,1]
C0544452
UMLS CUI [1,2]
C0026376
If accelerated phase, specify number of accelerated phase
Description

Accelerated Phase

Data type

text

Alias
UMLS CUI [1]
C0237753
If blast crisis, specify number of blast crisis
Description

Number of Blast crisis

Data type

text

Alias
UMLS CUI [1,1]
C0237753
UMLS CUI [1,2]
C0005699
If blast crisis, specify:
Description

Specification of blast crisis

Data type

text

Alias
UMLS CUI [1]
C0005699
Cytogenetics at HSCT
Description

Cytogenetics at HSCT

Translocation (9;22) (to be completed only if disease status is not cytogenetic remission)
Description

Translocation (9;22)

Data type

text

Alias
UMLS CUI [1]
C3897138
Translocation (9;22) (to be completed only if disease status is not cytogenetic remission) If yes, specify percentage of Translocation (9;22) metaphases:
Description

Translocation (9;22): percentage

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1,1]
C3897138
UMLS CUI [1,2]
C0439165
%
Translocation (9;22) (to be completed only if disease status is not cytogenetic remission) If yes, specify number of examined metaphases:
Description

Translocation (9;22): number of examined metaphases

Data type

float

Alias
UMLS CUI [1,1]
C3897138
UMLS CUI [1,2]
C0237753
FISH analysis t(9;22)
Description

FISH analysis

Data type

text

Alias
UMLS CUI [1]
C0162789
FISH analysis t(9;22) If positive, specify percentage of positive cells:
Description

FISH analysis: percentage

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1,1]
C0162789
UMLS CUI [1,2]
C0439165
%
FISH analysis t(9;22) If positive, specify number of examined cells:
Description

FISH analysis t(9;22)

Data type

float

Alias
UMLS CUI [1]
C0162789
Additional cytogenetic analysis?
Description

Additional cytogenetic analysis

Data type

text

Alias
UMLS CUI [1]
C0752095
Molecular Status at HSCT (to be completed only if disease status is not molecular remission)
Description

Molecular Status at HSCT (to be completed only if disease status is not molecular remission)

Molecular Marker BCR-ABL
Description

BCR-ABL

Data type

text

Alias
UMLS CUI [1]
C1835417
If BCR-ABL pesent and disease status is not cytogenetic remission fill in the results: Evaluated?: BCR-ABL result (number of copies/ μg of RNA)
Description

BCR-ABL

Data type

boolean

Alias
UMLS CUI [1]
C1835417
If BCR-ABL pesent and disease status is not cytogenetic remission fill in the results: If evaluated, specify BCR-ABL result (number of copies/ μg of RNA)
Description

BCR-ABL

Data type

float

Measurement units
  • number of copies/ μg of RNA
Alias
UMLS CUI [1]
C1835417
number of copies/ μg of RNA
If BCR-ABL pesent and disease status is not cytogenetic remission fill in the results: Evaluated?: Control gene result (number of copies/ μg of RNA)
Description

BCR-ABL

Data type

boolean

Alias
UMLS CUI [1]
C0243148
If BCR-ABL pesent and disease status is not cytogenetic remission fill in the results: If evaluated, specify control gene result (number of copies/ μg of RNA)
Description

BCR-ABL

Data type

float

Measurement units
  • number of copies/ μg of RNA
Alias
UMLS CUI [1]
C0243148
number of copies/ μg of RNA
BCR-ABL/ control gene ratio: (%)
Description

BCR-ABL: ratio

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C0456603
%
Haematological values at HSCT
Description

Haematological values at HSCT

Evaluated?: Hb (g/dL)
Description

Hb

Data type

boolean

Alias
UMLS CUI [1]
C0518015
If evaluated, specify: Hb (g/dL)
Description

Hb: value

Data type

float

Measurement units
  • g/dL
Alias
UMLS CUI [1,1]
C0518015
UMLS CUI [1,2]
C1522609
g/dL
Evaluated?: Platelets (10^9/ L)
Description

Platelets

Data type

boolean

Alias
UMLS CUI [1]
C0032181
If evaluated, specify: Platelets (10^9/ L)
Description

Platelets: value

Data type

float

Measurement units
  • 10^9/L
Alias
UMLS CUI [1,1]
C0032181
UMLS CUI [1,2]
C1522609
10^9/L
Evaluated?: White Blood Count (10^9/L)
Description

White Blood Count

Data type

boolean

Alias
UMLS CUI [1]
C0023508
If evaluated, specify: White Blood Count (10^9/ L)
Description

White Blood Count: value

Data type

float

Measurement units
  • 10^9/L
Alias
UMLS CUI [1,1]
C0023508
UMLS CUI [1,2]
C1522609
10^9/L
Evaluated?: % basophils
Description

basophils

Data type

boolean

Alias
UMLS CUI [1]
C0200641
If evaluated, specify: % basophils
Description

basophils: percentage

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1,1]
C0200641
UMLS CUI [1,2]
C0439165
%
Evaluated?: % blasts
Description

blasts

Data type

boolean

Alias
UMLS CUI [1]
C0523113
If evaluated, specify: % blasts
Description

blasts: percentage

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1,1]
C0523113
UMLS CUI [1,2]
C0439165
%
Evaluated?: % blasts
Description

Bone marrow: blasts

Data type

boolean

Alias
UMLS CUI [1]
C1982687
If evaluated, specify: % blasts
Description

Bone marrow: blasts: percentage

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1,1]
C1982687
UMLS CUI [1,2]
C0439165
%
Large foci or clusters in BM
Description

Large foci or clusters in BM

Data type

text

Alias
UMLS CUI [1,1]
C1704332
UMLS CUI [1,2]
C1982687
Extramedullary blast proliferation
Description

Extramedullary blast proliferation

Data type

text

Alias
UMLS CUI [1,1]
C1517060
UMLS CUI [1,2]
C0549414
Palpable Splenomegaly
Description

Palpable Splenomegaly

Data type

text

Alias
UMLS CUI [1]
C0038002
Palpable Splenomegaly: Physical examination: evaluated?
Description

Physical examination: Splenomegaly

Data type

boolean

Alias
UMLS CUI [1,1]
C0038002
UMLS CUI [1,2]
C0031809
Palpable Splenomegaly: Physical examination: If evaluated, specify: cm (below costal margin)
Description

Physical Examination: Splenomegaly value

Data type

float

Measurement units
  • cm
Alias
UMLS CUI [1,1]
C0038002
UMLS CUI [1,2]
C0031809
UMLS CUI [1,3]
C1522609
cm
Palpable Splenomegaly: Spleen span in ultrasound or CT scan: evaluated?
Description

Imaging: Splenomegaly

Data type

boolean

Alias
UMLS CUI [1,1]
C0038002
UMLS CUI [1,2]
C0011923
Palpable Splenomegaly: Spleen span in ultrasound or CT scan: If evaluated, specify: cm (maximum diameter)
Description

Imaging: Splenomegaly value

Data type

float

Measurement units
  • cm
Alias
UMLS CUI [1,1]
C0038002
UMLS CUI [1,2]
C0011923
UMLS CUI [1,3]
C1522609
cm
Additional Treatment Post-HSCT
Description

Additional Treatment Post-HSCT

Additional Treatment
Description

Additional Treatment

Data type

text

Alias
UMLS CUI [1]
C1706712
Additional Treatment: If yes, specify:
Description

Specification Additional Treatment

Data type

text

Alias
UMLS CUI [1,1]
C1706712
UMLS CUI [1,2]
C2348235
If Additional Treatment, specify: Imatinib
Description

Imatinib

Data type

boolean

Alias
UMLS CUI [1]
C0935989
If Additional Treatment: Imatinib If yes, specify duration
Description

Imatinib: duration

Data type

durationDatetime

Alias
UMLS CUI [1,1]
C0935989
UMLS CUI [1,2]
C0449238
If Additional Treatment, specify: Dasatinib
Description

Dasatinib

Data type

boolean

Alias
UMLS CUI [1]
C1455147
If Additional Treatment: Dasatinib If yes, specify duration
Description

Dasatinib: duration

Data type

durationDatetime

Alias
UMLS CUI [1,1]
C1455147
UMLS CUI [1,2]
C0449238
If Additional Treatment, specify: Nilotinib
Description

Nilotinib

Data type

boolean

Alias
UMLS CUI [1]
C1721377
If Additional Treatment: Nilotinib If yes, specify duration
Description

Nilotinib: duration

Data type

durationDatetime

Alias
UMLS CUI [1,1]
C1721377
UMLS CUI [1,2]
C0449238
If Additional Treatment, specify: Interferon alpha
Description

Interferon alpha

Data type

boolean

Alias
UMLS CUI [1]
C0002199
If Additional Treatment: Interferon alpha If yes, specify duration
Description

Interferon alpha: duration

Data type

durationDatetime

Alias
UMLS CUI [1,1]
C0002199
UMLS CUI [1,2]
C0449238
If Additional Treatment, specify: Other chemo/ drug
Description

Other Additional Treatment

Data type

boolean

Alias
UMLS CUI [1]
C0392920
If Additional Treatment: Other chemo/ drug If yes, specify duration
Description

Other Additional Treatment: duration

Data type

durationDatetime

Alias
UMLS CUI [1,1]
C0392920
UMLS CUI [1,2]
C0449238
If additional treatment: Other treatment
Description

Other Treatment

Data type

text

Alias
UMLS CUI [1]
C1706712
If Other additinal treatment, specify
Description

Other Treatment: Specification

Data type

text

Alias
UMLS CUI [1,1]
C1706712
UMLS CUI [1,2]
C2348235
Disease Status at Day +100 post HSCT
Description

Disease Status at Day +100 post HSCT

Molecular remission
Description

Molecular remission

Data type

text

Alias
UMLS CUI [1,1]
C0544452
UMLS CUI [1,2]
C0026376
Cytogenetic remission
Description

Cytogenetic remission

Data type

text

Alias
UMLS CUI [1,1]
C0544452
UMLS CUI [1,2]
C0010802
Haematological remission
Description

Haematological remission

Data type

text

Alias
UMLS CUI [1,1]
C0544452
UMLS CUI [1,2]
C0279810
Forms to be filled in
Description

Forms to be filled in

Type of Transplant
Description

Type of Transplant

Data type

text

Alias
UMLS CUI [1]
C0559189
UMLS CUI [2]
C0040739
If other, specify:
Description

Specification Type of Transplant

Data type

text

Alias
UMLS CUI [1,1]
C0472699
UMLS CUI [1,2]
C2348235
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Similar models

Specifications of the disease EBMT CML

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Initial Diagnosis
Item
has the information requested in this section been submitted with a previous HSCT registration?
text
C1514821 (UMLS CUI [1])
Previous HSCT registration
Code List
has the information requested in this section been submitted with a previous HSCT registration?
CL Item
Yes: go to "Pre-HSCT treatment" (Yes: go to "Pre-HSCT treatment")
CL Item
No: Proceed with this section (No: Proceed with this section)
Item
At least one investigation must be positive: Translocation (9;22)
text
C3897138 (UMLS CUI [1])
Subclassification
Code List
At least one investigation must be positive: Translocation (9;22)
CL Item
Absent (Absent)
CL Item
Present (Present)
CL Item
Not evaluated (Not evaluated)
Item
At least one investigation must be positive: bcr-abl
text
C1835417 (UMLS CUI [1])
Subclassification
Code List
At least one investigation must be positive: bcr-abl
CL Item
Absent (Absent)
CL Item
Present (Present)
CL Item
Not evaluated (Not evaluated)
Item
Status of disease at diagnosis
text
C0699749 (UMLS CUI [1])
Status of disease at diagnosis
Code List
Status of disease at diagnosis
CL Item
Chronic phase (Chronic phase)
CL Item
Blast crisis (Blast crisis)
CL Item
Accelerated phase (Accelerated phase)
Item Group
Initial Diagnosis - Cytogenetics
Item
Cytogenetics other than for translocation (9;22) at diagnosis
text
C0010802 (UMLS CUI [1])
Cytogenetics other than for translocation (9;22) at diagnosis
Code List
Cytogenetics other than for translocation (9;22) at diagnosis
CL Item
Not done or failed (Not done or failed)
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
CL Item
Unknown (Unknown)
Translocation
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Translocation
boolean
C0040715 (UMLS CUI [1])
Translocation: Specification
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Translocation If yes, write chromosomes involved
text
C0040715 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Deletion
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Deletion
boolean
C1442161 (UMLS CUI [1])
Deletion: Specification
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Deletion If yes, write chromosomes involved
text
C1442161 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Inversion
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Inversion
boolean
C0021943 (UMLS CUI [1])
Inversion: Specification
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Inversion If yes, write chromosomes involved
text
C0021943 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Isochromosome
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Isochromosome
boolean
C0242621 (UMLS CUI [1])
Isochromosome: Specification
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Isochromosome If yes, write chromosomes involved
text
C0242621 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Multiple (=>3)
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Multiple (=>3)
boolean
C0449822 (UMLS CUI [1])
Multiple (=>3): Specification
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Multiple (=>3) If yes, write chromosomes involved
text
C0449822 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Hypodiploid
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Hypodiploid
boolean
C0333691 (UMLS CUI [1])
Hypodiploid: Specification
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Hypodiploid If yes, write chromosomes involved
text
C0333691 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Hyperdiploid
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Hyperdiploid
boolean
C1305143 (UMLS CUI [1])
Hyperdiploid: Specification
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Hyperdiploid If yes, write chromosomes involved
text
C1305143 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Monosomy
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Monosomy (include loss of arms)
boolean
C0026499 (UMLS CUI [1])
Monosomy: Specification
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Monosomy (include loss of arms) If yes, write chromosomes involved
text
C0026499 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Trisomy
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Trisomy
boolean
C0041107 (UMLS CUI [1])
Trisomy: Specification
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Trisomy If yes, write chromosomes involved
text
C0041107 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Cytogenetics - Abnormalities
Item
Cytogenetics other than for translocation (9;22) at diagnosis: If abnormal, indicate type of abnormalitiy: Other
text
C0008625 (UMLS CUI [1])
Number of abnormal metaphases
Item
Number of metaphases with anomalies:
float
C1621812 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Number of examined metaphases
Item
Number of metaphases examined
float
C1621812 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
C0260877 (UMLS CUI [1,3])
Item Group
Initial Diagnosis - Haematological values
Hb
Item
Evaluated?: Hb (g/dL)
boolean
C0518015 (UMLS CUI [1])
Hb: value
Item
If evaluated, specify: Hb (g/dL)
float
C0518015 (UMLS CUI [1,1])
C1522609 (UMLS CUI [1,2])
Platelets
Item
Evaluated?: Platelets (10^9/ L)
boolean
C0032181 (UMLS CUI [1])
Platelets: value
Item
If evaluated, specify: Platelets (10^9/ L)
float
C0032181 (UMLS CUI [1,1])
C1522609 (UMLS CUI [1,2])
White Blood Count
Item
Evaluated?: White Blood Count (10^9/L)
boolean
C0023508 (UMLS CUI [1])
White Blood Count: Specifcation
Item
If evaluated, specify: White Blood Count (10^9/ L)
float
C0023508 (UMLS CUI [1,1])
C1522609 (UMLS CUI [1,2])
basophils
Item
Evaluated?: % basophils
boolean
C0200641 (UMLS CUI [1])
basophils: percentage
Item
If evaluated, specify: % basophils
float
C0200641 (UMLS CUI [1,1])
C0439165 (UMLS CUI [1,2])
blasts
Item
Evaluated?: % blasts
boolean
C0523113 (UMLS CUI [1])
blasts: percentage
Item
If evaluated, specify: % blasts
float
C0523113 (UMLS CUI [1,1])
C0439165 (UMLS CUI [1,2])
Bone marrow: blasts
Item
Evaluated?: % blasts
boolean
C1982687 (UMLS CUI [1])
Bone marrow: blasts: percentage
Item
If evaluated, specify: % blasts
float
C1982687 (UMLS CUI [1,1])
C0439165 (UMLS CUI [1,2])
Item
Palpable Splenomegaly
text
C0038002 (UMLS CUI [1])
Palpable Splenomegaly
Code List
Palpable Splenomegaly
CL Item
Absent (Absent)
CL Item
Present (Present)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Physical examination: Splenomegaly
Item
Palpable Splenomegaly: Physical examination: evaluated?
boolean
C0038002 (UMLS CUI [1,1])
C0031809 (UMLS CUI [1,2])
Physical examination: Splenomegaly value
Item
Palpable Splenomegaly: Physical examination: If evaluated, specify: cm (below costal margin)
float
C0038002 (UMLS CUI [1,1])
C0031809 (UMLS CUI [1,2])
C1522609 (UMLS CUI [1,3])
Imaging: Splenomegaly
Item
Palpable Splenomegaly: Spleen span in ultrasound or CT scan: evaluated?
boolean
C0038002 (UMLS CUI [1,1])
C0011923 (UMLS CUI [1,2])
Imaging: Splenomegaly value
Item
Palpable Splenomegaly: Spleen span in ultrasound or CT scan: If evaluated, specify: cm (maximum diameter)
float
C0038002 (UMLS CUI [1,1])
C0011923 (UMLS CUI [1,2])
C1522609 (UMLS CUI [1,3])
Item Group
Pre-HSCT Treatment
Item
Primary Treamtent
text
C1708063 (UMLS CUI [1])
Primary Treatment
Code List
Primary Treamtent
CL Item
No (Proceed to Date of HSCT) (No (Proceed to Date of HSCT))
CL Item
Yes (continue and specify) (Yes (continue and specify))
Start Date
Item
Start Date of Primary Treatment
date
C0808070 (UMLS CUI [1])
Item
Chemotherapy/ Drugts used for primary treatment
text
C0013216 (UMLS CUI [1])
Chemotherapy/ Drugs
Code List
Chemotherapy/ Drugts used for primary treatment
CL Item
No  (No )
CL Item
Yes (continue and specify) (Yes)
CL Item
Unknown (Unknown)
Imatinib
Item
Chemotherapy/ Drugs: Imatinib
boolean
C0935989 (UMLS CUI [1])
Imatinib: duration
Item
Chemotherapy/ Drugs: Imatinib If yes, specify duration
durationDatetime
C0935989 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Dasatinib
Item
Chemotherapy/ Drugs: Dasatinib
boolean
C1455147 (UMLS CUI [1])
Dasatinib: duration
Item
Chemotherapy/ Drugs: Dasatinib If yes, specify duration
durationDatetime
C1455147 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Nilotinib
Item
Chemotherapy/ Drugs: Nilotinib
boolean
C1721377 (UMLS CUI [1])
Nilotinib: duration
Item
Chemotherapy/ Drugs: Nilotinib If yes, specify duration
durationDatetime
C1721377 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Interferon alpha
Item
Chemotherapy/ Drugs: Interferon alpha
boolean
C0002199 (UMLS CUI [1])
Interferon alpha: duration
Item
Chemotherapy/ Drugs: Interferon alpha If yes, specify duration
durationDatetime
C0002199 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Hydroxyurea
Item
Chemotherapy/ Drugs: Hydroxyurea
boolean
C0020402 (UMLS CUI [1])
Hydroxyurea: duration
Item
Chemotherapy/ Drugs: Hydroxyurea If yes, specify duration
durationDatetime
C0020402 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Busulfan
Item
Chemotherapy/ Drugs: Busulfan
boolean
C0006463 (UMLS CUI [1])
Busulfan: duration
Item
Chemotherapy/ Drugs: Busulfan If yes, specify duration
durationDatetime
C0006463 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Cytosine arabinoside (ARAC)
Item
Chemotherapy/ Drugs: Cytosine arabinoside (ARAC)
boolean
C0010711 (UMLS CUI [1])
Cytosine arabinoside (ARAC): duration
Item
Chemotherapy/ Drugs: Cytosine arabinoside (ARAC) If yes, specify duration
durationDatetime
C0010711 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Other Chemotherapy
Item
Chemotherapy/ Drugs: Other Chemotherapy
boolean
C0392920 (UMLS CUI [1])
Chemotherapy/ Drugs
Item
Chemotherapy/ Drugs Other Chemotherapy If yes, specify duration
durationDatetime
C0392920 (UMLS CUI [1])
Item
Other treatment
text
C0087111 (UMLS CUI [1])
Other treatment
Code List
Other treatment
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Specification Other treatment
Item
Other treatment If yes, specify:
text
C0087111 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Item Group
HSCT Date and Type
Date of HSCT
Item
Date of HSCT
date
C2584899 (UMLS CUI [1])
Splenectomy
Item
Splenectomy performed?
boolean
C0037995 (UMLS CUI [1])
Date of Splenectomy
Item
If Splenectomy performed, specify the date:
date
C2584899 (UMLS CUI [1])
Item
HSCT Type
text
C0472699 (UMLS CUI [1])
HSCT Type
Code List
HSCT Type
CL Item
Allogenic (Allogenic)
CL Item
Autologuos (Autologuos)
Item
Main reason for HSCT (tick one main reason only)
text
C0472699 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Reason for HSCT
Code List
Main reason for HSCT (tick one main reason only)
CL Item
Advanced phase (Advanced phase)
CL Item
Imatinib resistance (Imatinib resistance)
CL Item
Dasatinib resistance (Dasatinib resistance)
CL Item
Nilotinib resistance (Nilotinib resistance)
CL Item
Clonal evolution (Clonal evolution)
CL Item
Poor risk patient or high risk CML (e.g. Sokal > 1.2) (Poor risk patient or high risk CML (e.g. Sokal > 1.2))
CL Item
Abl mutation (Abl mutation)
CL Item
Standard indication at diagnosis (Standard indication at diagnosis)
CL Item
No engraftment after allo BMT (No engraftment after allo BMT)
CL Item
Clinical study (Clinical study)
CL Item
other (other)
Other Reason for HSCT
Item
Main reason for HSCT (tick one main reason only) If other, specify:
text
C0472699 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Item
Secondary reason for HSCT (tick as many secondary as applicable)
text
C0472699 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C0175668 (UMLS CUI [1,3])
Reason for HSCT
Code List
Secondary reason for HSCT (tick as many secondary as applicable)
CL Item
Advanced phase (Advanced phase)
CL Item
Imatinib resistance (Imatinib resistance)
CL Item
Dasatinib resistance (Dasatinib resistance)
CL Item
Nilotinib resistance (Nilotinib resistance)
CL Item
Clonal evolution (Clonal evolution)
CL Item
Poor risk patient or high risk CML (e.g. Sokal > 1.2) (Poor risk patient or high risk CML (e.g. Sokal > 1.2))
CL Item
Abl mutation (Abl mutation)
CL Item
Standard indication at diagnosis (Standard indication at diagnosis)
CL Item
No engraftment after allo BMT (No engraftment after allo BMT)
CL Item
Clinical study (Clinical study)
CL Item
other (other)
Other Secondary Reason for HSCT
Item
Secondary reason for HSCT (tick as many secondary as applicable) If other, specify:
text
C0472699 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C0175668 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Item Group
Only if autograft (For autograft only. If allograft proceed to "Status at HSCT")
Date of Collection
Item
Date of Collection
date
C2584899 (UMLS CUI [1])
Item
Disease Status
text
C0699749 (UMLS CUI [1])
Disease Status
Code List
Disease Status
CL Item
Chronic Phase (Chronic Phase)
Item
Number of Chronic phase
text
C0237753 (UMLS CUI [1,1])
C0457343 (UMLS CUI [1,2])
Disease Status
Code List
Number of Chronic phase
CL Item
1st (1st)
CL Item
2nd (2nd)
CL Item
3rd or higher (3rd or higher)
CL Item
Unknown (Unknown)
Item
Remission Status (complete only if chronic phase, check all that apply): Haematological remission
text
C0544452 (UMLS CUI [1,1])
C0279810 (UMLS CUI [1,2])
Disease Status
Code List
Remission Status (complete only if chronic phase, check all that apply): Haematological remission
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
Item
Remission Status (complete only if chronic phase, check all that apply): Cytogenetic remission
text
C0544452 (UMLS CUI [1,1])
C0010802 (UMLS CUI [1,2])
Disease Status
Code List
Remission Status (complete only if chronic phase, check all that apply): Cytogenetic remission
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
Item
Remission Status (complete only if chronic phase, check all that apply): Molecular remission
text
C0544452 (UMLS CUI [1,1])
C0026376 (UMLS CUI [1,2])
Disease Status
Code List
Remission Status (complete only if chronic phase, check all that apply): Molecular remission
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
Item
Translocation (9;22) (to be completed only if disease status is not cytogenetic remission)
text
C3897138 (UMLS CUI [1])
Cytogenetics of mobilsed product
Code List
Translocation (9;22) (to be completed only if disease status is not cytogenetic remission)
CL Item
Absent (Absent)
CL Item
Present (Present)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Translocation (9;22): percentage
Item
Translocation (9;22) (to be completed only if disease status is not cytogenetic remission) If yes, specify percentage of Translocation (9;22) metaphases:
float
C3897138 (UMLS CUI [1,1])
C0439165 (UMLS CUI [1,2])
Translocation (9;22): number metaphases
Item
Translocation (9;22) (to be completed only if disease status is not cytogenetic remission) If yes, specify number of examined metaphases:
float
C3897138 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Item
FISH analysis t(9;22)
text
C0162789 (UMLS CUI [1])
Cytogenetics of mobilised product
Code List
FISH analysis t(9;22)
CL Item
Negative (Negative)
CL Item
Positive (Positive)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
FISH analysis: percentage
Item
FISH analysis t(9;22) If positive, specify percentage of positive cells:
float
C0162789 (UMLS CUI [1,1])
C2826772 (UMLS CUI [1,2])
FISH analysis: number of examined cells
Item
FISH analysis t(9;22) If positive, specify number of examined cells:
float
C0162789 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Item
Additional cytogenetic analysis?
text
C0752095 (UMLS CUI [1])
Cytogenetics of mobilised product
Code List
Additional cytogenetic analysis?
CL Item
Normal (Normal)
CL Item
Abnormal (Abnormal)
CL Item
Not done or failed (Not done or failed)
CL Item
Unknown (Unknown)
Item
Molecular status of mobilised product (to be completed only if disease status is not molecular remission) Molecular marker BCR-ABL
text
C1835417 (UMLS CUI [1])
Molecular status of mobilised product
Code List
Molecular status of mobilised product (to be completed only if disease status is not molecular remission) Molecular marker BCR-ABL
CL Item
Absent (Absent)
CL Item
Present (Present)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item Group
Status of disease at HSCT
Item
Phase of Disease
text
C0205390 (UMLS CUI [1])
Status of Disease
Code List
Phase of Disease
CL Item
Chronic phase (Chronic phase)
CL Item
Acceleraed phase (Acceleraed phase)
CL Item
Blast Crisis (Blast Crisis)
Item
If Chronic phase, specify number of chronic phase
text
C0237753 (UMLS CUI [1])
Chronic Phase
Code List
If Chronic phase, specify number of chronic phase
CL Item
1st (1st)
CL Item
2nd (2nd)
CL Item
3rd or higer (3rd or higer)
CL Item
Unknown (Unknown)
Item
Remission Status (complete only if chronic phase, check all that apply): Haematological remission
text
C0544452 (UMLS CUI [1,1])
C0279810 (UMLS CUI [1,2])
Chronic Phase
Code List
Remission Status (complete only if chronic phase, check all that apply): Haematological remission
CL Item
Yes  (Yes)
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
Item
Remission Status (complete only if chronic phase, check all that apply): Cytogenetic remission
text
C0544452 (UMLS CUI [1,1])
C0010802 (UMLS CUI [1,2])
undefined item
Code List
Remission Status (complete only if chronic phase, check all that apply): Cytogenetic remission
CL Item
Yes  (Yes)
CL Item
No  (No)
CL Item
Not evaluated (Not evaluated)
Item
Remission Status (complete only if chronic phase, check all that apply): Molecular remission
text
C0544452 (UMLS CUI [1,1])
C0026376 (UMLS CUI [1,2])
undefined item
Code List
Remission Status (complete only if chronic phase, check all that apply): Molecular remission
CL Item
Yes  (Yes)
CL Item
No  (No)
CL Item
Not evaluated (Not evaluated)
Accelerated Phase
Item
If accelerated phase, specify number of accelerated phase
text
C0237753 (UMLS CUI [1])
Item
If blast crisis, specify number of blast crisis
text
C0237753 (UMLS CUI [1,1])
C0005699 (UMLS CUI [1,2])
undefined item
Code List
If blast crisis, specify number of blast crisis
CL Item
1st (1st)
CL Item
2nd (2nd)
CL Item
3rd or higer (3rd or higer)
Item
If blast crisis, specify:
text
C0005699 (UMLS CUI [1])
Blast crisis
Code List
If blast crisis, specify:
CL Item
Myeloid (Myeloid)
CL Item
Lymphoid (Lymphoid)
CL Item
Other (Erythrhoblastic or megakaryoblastic or mixed) (Other (Erythrhoblastic or megakaryoblastic or mixed))
Item Group
Cytogenetics at HSCT
Item
Translocation (9;22) (to be completed only if disease status is not cytogenetic remission)
text
C3897138 (UMLS CUI [1])
Translocation (9;22)
Code List
Translocation (9;22) (to be completed only if disease status is not cytogenetic remission)
CL Item
Absent  (Absent)
CL Item
Present  (Present)
CL Item
Not evaluated  (Not evaluated)
CL Item
Unknown (Unknown)
Translocation (9;22): percentage
Item
Translocation (9;22) (to be completed only if disease status is not cytogenetic remission) If yes, specify percentage of Translocation (9;22) metaphases:
float
C3897138 (UMLS CUI [1,1])
C0439165 (UMLS CUI [1,2])
Translocation (9;22): number of examined metaphases
Item
Translocation (9;22) (to be completed only if disease status is not cytogenetic remission) If yes, specify number of examined metaphases:
float
C3897138 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
FISH analysis
Item
FISH analysis t(9;22)
text
C0162789 (UMLS CUI [1])
FISH analysis: percentage
Item
FISH analysis t(9;22) If positive, specify percentage of positive cells:
float
C0162789 (UMLS CUI [1,1])
C0439165 (UMLS CUI [1,2])
FISH analysis t(9;22)
Item
FISH analysis t(9;22) If positive, specify number of examined cells:
float
C0162789 (UMLS CUI [1])
Item
Additional cytogenetic analysis?
text
C0752095 (UMLS CUI [1])
Additional cytogenetic analysis
Code List
Additional cytogenetic analysis?
CL Item
Normal  (Normal)
CL Item
Abnormal  (Abnormal)
CL Item
Not done or failed  (Not done or failed)
CL Item
Unknown (Unknown)
Item Group
Molecular Status at HSCT (to be completed only if disease status is not molecular remission)
Item
Molecular Marker BCR-ABL
text
C1835417 (UMLS CUI [1])
BCR-ABL
Code List
Molecular Marker BCR-ABL
CL Item
Absent  (Absent)
CL Item
Present (Present)
CL Item
Not evaluated  (Not evaluated)
CL Item
Unknown (Unknown)
BCR-ABL
Item
If BCR-ABL pesent and disease status is not cytogenetic remission fill in the results: Evaluated?: BCR-ABL result (number of copies/ μg of RNA)
boolean
C1835417 (UMLS CUI [1])
BCR-ABL
Item
If BCR-ABL pesent and disease status is not cytogenetic remission fill in the results: If evaluated, specify BCR-ABL result (number of copies/ μg of RNA)
float
C1835417 (UMLS CUI [1])
BCR-ABL
Item
If BCR-ABL pesent and disease status is not cytogenetic remission fill in the results: Evaluated?: Control gene result (number of copies/ μg of RNA)
boolean
C0243148 (UMLS CUI [1])
BCR-ABL
Item
If BCR-ABL pesent and disease status is not cytogenetic remission fill in the results: If evaluated, specify control gene result (number of copies/ μg of RNA)
float
C0243148 (UMLS CUI [1])
BCR-ABL: ratio
Item
BCR-ABL/ control gene ratio: (%)
float
C0456603 (UMLS CUI [1])
Item Group
Haematological values at HSCT
Hb
Item
Evaluated?: Hb (g/dL)
boolean
C0518015 (UMLS CUI [1])
Hb: value
Item
If evaluated, specify: Hb (g/dL)
float
C0518015 (UMLS CUI [1,1])
C1522609 (UMLS CUI [1,2])
Platelets
Item
Evaluated?: Platelets (10^9/ L)
boolean
C0032181 (UMLS CUI [1])
Platelets: value
Item
If evaluated, specify: Platelets (10^9/ L)
float
C0032181 (UMLS CUI [1,1])
C1522609 (UMLS CUI [1,2])
White Blood Count
Item
Evaluated?: White Blood Count (10^9/L)
boolean
C0023508 (UMLS CUI [1])
White Blood Count: value
Item
If evaluated, specify: White Blood Count (10^9/ L)
float
C0023508 (UMLS CUI [1,1])
C1522609 (UMLS CUI [1,2])
basophils
Item
Evaluated?: % basophils
boolean
C0200641 (UMLS CUI [1])
basophils: percentage
Item
If evaluated, specify: % basophils
float
C0200641 (UMLS CUI [1,1])
C0439165 (UMLS CUI [1,2])
blasts
Item
Evaluated?: % blasts
boolean
C0523113 (UMLS CUI [1])
blasts: percentage
Item
If evaluated, specify: % blasts
float
C0523113 (UMLS CUI [1,1])
C0439165 (UMLS CUI [1,2])
Bone marrow: blasts
Item
Evaluated?: % blasts
boolean
C1982687 (UMLS CUI [1])
Bone marrow: blasts: percentage
Item
If evaluated, specify: % blasts
float
C1982687 (UMLS CUI [1,1])
C0439165 (UMLS CUI [1,2])
Item
Large foci or clusters in BM
text
C1704332 (UMLS CUI [1,1])
C1982687 (UMLS CUI [1,2])
Bone marrow
Code List
Large foci or clusters in BM
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item
Extramedullary blast proliferation
text
C1517060 (UMLS CUI [1,1])
C0549414 (UMLS CUI [1,2])
Extramedullary blast proliferation
Code List
Extramedullary blast proliferation
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item
Palpable Splenomegaly
text
C0038002 (UMLS CUI [1])
Palpable Splenomegaly
Code List
Palpable Splenomegaly
CL Item
Absent  (Absent)
CL Item
Present  (Present)
CL Item
Not evaluated  (Not evaluated)
CL Item
Unknown (Unknown)
Physical examination: Splenomegaly
Item
Palpable Splenomegaly: Physical examination: evaluated?
boolean
C0038002 (UMLS CUI [1,1])
C0031809 (UMLS CUI [1,2])
Physical Examination: Splenomegaly value
Item
Palpable Splenomegaly: Physical examination: If evaluated, specify: cm (below costal margin)
float
C0038002 (UMLS CUI [1,1])
C0031809 (UMLS CUI [1,2])
C1522609 (UMLS CUI [1,3])
Imaging: Splenomegaly
Item
Palpable Splenomegaly: Spleen span in ultrasound or CT scan: evaluated?
boolean
C0038002 (UMLS CUI [1,1])
C0011923 (UMLS CUI [1,2])
Imaging: Splenomegaly value
Item
Palpable Splenomegaly: Spleen span in ultrasound or CT scan: If evaluated, specify: cm (maximum diameter)
float
C0038002 (UMLS CUI [1,1])
C0011923 (UMLS CUI [1,2])
C1522609 (UMLS CUI [1,3])
Item Group
Additional Treatment Post-HSCT
Item
Additional Treatment
text
C1706712 (UMLS CUI [1])
Additional Treatment
Code List
Additional Treatment
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Item
Additional Treatment: If yes, specify:
text
C1706712 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Additional Treatment
Code List
Additional Treatment: If yes, specify:
CL Item
Planned (planned before HSCT took place) (Planned (planned before HSCT took place))
CL Item
Not planned (for relapse/ progression or persistent disease) (Not planned (for relapse/ progression or persistent disease))
Imatinib
Item
If Additional Treatment, specify: Imatinib
boolean
C0935989 (UMLS CUI [1])
Imatinib: duration
Item
If Additional Treatment: Imatinib If yes, specify duration
durationDatetime
C0935989 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Dasatinib
Item
If Additional Treatment, specify: Dasatinib
boolean
C1455147 (UMLS CUI [1])
Dasatinib: duration
Item
If Additional Treatment: Dasatinib If yes, specify duration
durationDatetime
C1455147 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Nilotinib
Item
If Additional Treatment, specify: Nilotinib
boolean
C1721377 (UMLS CUI [1])
Nilotinib: duration
Item
If Additional Treatment: Nilotinib If yes, specify duration
durationDatetime
C1721377 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Interferon alpha
Item
If Additional Treatment, specify: Interferon alpha
boolean
C0002199 (UMLS CUI [1])
Interferon alpha: duration
Item
If Additional Treatment: Interferon alpha If yes, specify duration
durationDatetime
C0002199 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Other Additional Treatment
Item
If Additional Treatment, specify: Other chemo/ drug
boolean
C0392920 (UMLS CUI [1])
Other Additional Treatment: duration
Item
If Additional Treatment: Other chemo/ drug If yes, specify duration
durationDatetime
C0392920 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Item
If additional treatment: Other treatment
text
C1706712 (UMLS CUI [1])
Additional Treatment
Code List
If additional treatment: Other treatment
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Other Treatment: Specification
Item
If Other additinal treatment, specify
text
C1706712 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Item Group
Disease Status at Day +100 post HSCT
Item
Molecular remission
text
C0544452 (UMLS CUI [1,1])
C0026376 (UMLS CUI [1,2])
Molecular remission
Code List
Molecular remission
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
Item
Cytogenetic remission
text
C0544452 (UMLS CUI [1,1])
C0010802 (UMLS CUI [1,2])
Cytogenetic remission
Code List
Cytogenetic remission
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
Item
Haematological remission
text
C0544452 (UMLS CUI [1,1])
C0279810 (UMLS CUI [1,2])
Haematological remission
Code List
Haematological remission
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
Item Group
Forms to be filled in
Item
Type of Transplant
text
C0559189 (UMLS CUI [1])
C0040739 (UMLS CUI [2])
Type of Transplant
Code List
Type of Transplant
CL Item
AUTOgraft (proceed to Autograft form) (AUTOgraft (proceed to Autograft form))
CL Item
ALLOgraft or Syngeneic graft (proceed to Allograft form) (ALLOgraft or Syngeneic graft (proceed to Allograft form))
CL Item
Other (contact the EBMT Central Registry for instructions) (Other (contact the EBMT Central Registry for instructions))
Specification Type of Transplant
Item
If other, specify:
text
C0472699 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
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