ID

13714

Beskrivning

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

Länk

http://www.ebmt.org/

Nyckelord

Versioner (2)
  1. 2016-02-21 2016-02-21 -
  2. 2016-02-29 2016-02-29 -
Uppladdad den

29 februari 2016

DOI

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Licens

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

Engelsk

Specifications of the disease EBMT CML

1 Formulär  
Initial Diagnosis
Beskrivning

Initial Diagnosis

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

Previous HSCT registration

Datatyp

text

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

Translocation (9;22)

Datatyp

text

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

bcr-abl

Datatyp

text

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

Status of disease at diagnosis

Datatyp

text

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

Initial Diagnosis - Cytogenetics

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

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

Datatyp

text

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

Translocation

Datatyp

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
Beskrivning

Translocation: Specification

Datatyp

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
Beskrivning

Deletion

Datatyp

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
Beskrivning

Deletion: Specification

Datatyp

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
Beskrivning

Inversion

Datatyp

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
Beskrivning

Inversion: Specification

Datatyp

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
Beskrivning

Isochromosome

Datatyp

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
Beskrivning

Isochromosome: Specification

Datatyp

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)
Beskrivning

Multiple (=>3)

Datatyp

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
Beskrivning

Multiple (=>3): Specification

Datatyp

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
Beskrivning

Hypodiploid

Datatyp

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
Beskrivning

Hypodiploid: Specification

Datatyp

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
Beskrivning

Hyperdiploid

Datatyp

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
Beskrivning

Hyperdiploid: Specification

Datatyp

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)
Beskrivning

Monosomy

Datatyp

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
Beskrivning

Monosomy: Specification

Datatyp

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
Beskrivning

Trisomy

Datatyp

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
Beskrivning

Trisomy: Specification

Datatyp

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
Beskrivning

Cytogenetics - Abnormalities

Datatyp

text

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

Number of abnormal metaphases

Datatyp

float

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

Number of examined metaphases

Datatyp

float

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

Initial Diagnosis - Haematological values

Evaluated?: Hb (g/dL)
Beskrivning

Hb

Datatyp

boolean

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

Hb: value

Datatyp

float

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

Platelets

Datatyp

boolean

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

Platelets: value

Datatyp

float

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

White Blood Count

Datatyp

boolean

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

White Blood Count: Specifcation

Datatyp

float

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

basophils

Datatyp

boolean

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

basophils: percentage

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1,1]
C0200641
UMLS CUI [1,2]
C0439165
%
Evaluated?: % blasts
Beskrivning

blasts

Datatyp

boolean

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

blasts: percentage

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1,1]
C0523113
UMLS CUI [1,2]
C0439165
%
Evaluated?: % blasts
Beskrivning

Bone marrow: blasts

Datatyp

boolean

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

Bone marrow: blasts: percentage

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1,1]
C1982687
UMLS CUI [1,2]
C0439165
%
Palpable Splenomegaly
Beskrivning

Palpable Splenomegaly

Datatyp

text

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

Physical examination: Splenomegaly

Datatyp

boolean

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

Physical examination: Splenomegaly value

Datatyp

float

Måttenheter
  • 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?
Beskrivning

Imaging: Splenomegaly

Datatyp

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)
Beskrivning

Imaging: Splenomegaly value

Datatyp

float

Måttenheter
  • cm
Alias
UMLS CUI [1,1]
C0038002
UMLS CUI [1,2]
C0011923
UMLS CUI [1,3]
C1522609
cm
Pre-HSCT Treatment
Beskrivning

Pre-HSCT Treatment

Primary Treamtent
Beskrivning

Primary Treatment

Datatyp

text

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

Start Date

Datatyp

date

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

Chemotherapy/ Drugs

Datatyp

text

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

Imatinib

Datatyp

boolean

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

Imatinib: duration

Datatyp

durationDatetime

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

Dasatinib

Datatyp

boolean

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

Dasatinib: duration

Datatyp

durationDatetime

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

Nilotinib

Datatyp

boolean

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

Nilotinib: duration

Datatyp

durationDatetime

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

Interferon alpha

Datatyp

boolean

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

Interferon alpha: duration

Datatyp

durationDatetime

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

Hydroxyurea

Datatyp

boolean

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

Hydroxyurea: duration

Datatyp

durationDatetime

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

Busulfan

Datatyp

boolean

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

Busulfan: duration

Datatyp

durationDatetime

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

Cytosine arabinoside (ARAC)

Datatyp

boolean

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

Cytosine arabinoside (ARAC): duration

Datatyp

durationDatetime

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

Other Chemotherapy

Datatyp

boolean

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

Chemotherapy/ Drugs

Datatyp

durationDatetime

Alias
UMLS CUI [1]
C0392920
Other treatment
Beskrivning

Other treatment

Datatyp

text

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

Specification Other treatment

Datatyp

text

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

HSCT Date and Type

Date of HSCT
Beskrivning

Date of HSCT

Datatyp

date

Alias
UMLS CUI [1]
C2584899
Splenectomy performed?
Beskrivning

Splenectomy

Datatyp

boolean

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

Date of Splenectomy

Datatyp

date

Alias
UMLS CUI [1]
C2584899
HSCT Type
Beskrivning

HSCT Type

Datatyp

text

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

Reason for HSCT

Datatyp

text

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

Other Reason for HSCT

Datatyp

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)
Beskrivning

Secondary Reason for HSCT

Datatyp

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:
Beskrivning

Other Secondary Reason for HSCT

Datatyp

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")
Beskrivning

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

Date of Collection
Beskrivning

Date of Collection

Datatyp

date

Alias
UMLS CUI [1]
C2584899
Disease Status
Beskrivning

Disease Status

Datatyp

text

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

Number of Chronic phase

Datatyp

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
Beskrivning

Haematological remission

Datatyp

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
Beskrivning

Cytogenetic remission

Datatyp

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
Beskrivning

Molecular remission

Datatyp

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)
Beskrivning

Translocation (9;22)

Datatyp

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:
Beskrivning

Translocation (9;22): percentage

Datatyp

float

Måttenheter
  • %
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:
Beskrivning

Translocation (9;22): number metaphases

Datatyp

float

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

FISH analysis

Datatyp

text

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

FISH analysis: percentage

Datatyp

float

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

FISH analysis: number of examined cells

Datatyp

float

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

Additional cytogenetic analysis

Datatyp

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
Beskrivning

Molecular marker BCR-ABL

Datatyp

text

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

Status of disease at HSCT

Phase of Disease
Beskrivning

Status of Disease

Datatyp

text

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

Chronic Phase

Datatyp

text

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

Haematological remission

Datatyp

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
Beskrivning

Cytogenetic remission

Datatyp

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
Beskrivning

Molecular remission

Datatyp

text

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

Accelerated Phase

Datatyp

text

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

Number of Blast crisis

Datatyp

text

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

Specification of blast crisis

Datatyp

text

Alias
UMLS CUI [1]
C0005699
Cytogenetics at HSCT
Beskrivning

Cytogenetics at HSCT

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

Translocation (9;22)

Datatyp

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:
Beskrivning

Translocation (9;22): percentage

Datatyp

float

Måttenheter
  • %
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:
Beskrivning

Translocation (9;22): number of examined metaphases

Datatyp

float

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

FISH analysis

Datatyp

text

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

FISH analysis: percentage

Datatyp

float

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

FISH analysis t(9;22)

Datatyp

float

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

Additional cytogenetic analysis

Datatyp

text

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

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

Molecular Marker BCR-ABL
Beskrivning

BCR-ABL

Datatyp

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)
Beskrivning

BCR-ABL

Datatyp

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)
Beskrivning

BCR-ABL

Datatyp

float

Måttenheter
  • 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)
Beskrivning

BCR-ABL

Datatyp

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)
Beskrivning

BCR-ABL

Datatyp

float

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

BCR-ABL: ratio

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1]
C0456603
%
Haematological values at HSCT
Beskrivning

Haematological values at HSCT

Evaluated?: Hb (g/dL)
Beskrivning

Hb

Datatyp

boolean

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

Hb: value

Datatyp

float

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

Platelets

Datatyp

boolean

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

Platelets: value

Datatyp

float

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

White Blood Count

Datatyp

boolean

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

White Blood Count: value

Datatyp

float

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

basophils

Datatyp

boolean

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

basophils: percentage

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1,1]
C0200641
UMLS CUI [1,2]
C0439165
%
Evaluated?: % blasts
Beskrivning

blasts

Datatyp

boolean

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

blasts: percentage

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1,1]
C0523113
UMLS CUI [1,2]
C0439165
%
Evaluated?: % blasts
Beskrivning

Bone marrow: blasts

Datatyp

boolean

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

Bone marrow: blasts: percentage

Datatyp

float

Måttenheter
  • %
Alias
UMLS CUI [1,1]
C1982687
UMLS CUI [1,2]
C0439165
%
Large foci or clusters in BM
Beskrivning

Large foci or clusters in BM

Datatyp

text

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

Extramedullary blast proliferation

Datatyp

text

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

Palpable Splenomegaly

Datatyp

text

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

Physical examination: Splenomegaly

Datatyp

boolean

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

Physical Examination: Splenomegaly value

Datatyp

float

Måttenheter
  • 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?
Beskrivning

Imaging: Splenomegaly

Datatyp

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)
Beskrivning

Imaging: Splenomegaly value

Datatyp

float

Måttenheter
  • cm
Alias
UMLS CUI [1,1]
C0038002
UMLS CUI [1,2]
C0011923
UMLS CUI [1,3]
C1522609
cm
Additional Treatment Post-HSCT
Beskrivning

Additional Treatment Post-HSCT

Additional Treatment
Beskrivning

Additional Treatment

Datatyp

text

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

Specification Additional Treatment

Datatyp

text

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

Imatinib

Datatyp

boolean

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

Imatinib: duration

Datatyp

durationDatetime

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

Dasatinib

Datatyp

boolean

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

Dasatinib: duration

Datatyp

durationDatetime

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

Nilotinib

Datatyp

boolean

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

Nilotinib: duration

Datatyp

durationDatetime

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

Interferon alpha

Datatyp

boolean

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

Interferon alpha: duration

Datatyp

durationDatetime

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

Other Additional Treatment

Datatyp

boolean

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

Other Additional Treatment: duration

Datatyp

durationDatetime

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

Other Treatment

Datatyp

text

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

Other Treatment: Specification

Datatyp

text

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

Disease Status at Day +100 post HSCT

Molecular remission
Beskrivning

Molecular remission

Datatyp

text

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

Cytogenetic remission

Datatyp

text

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

Haematological remission

Datatyp

text

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

Forms to be filled in

Type of Transplant
Beskrivning

Type of Transplant

Datatyp

text

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

Specification Type of Transplant

Datatyp

text

Alias
UMLS CUI [1,1]
C0472699
UMLS CUI [1,2]
C2348235
Tillbaka till toppen

Similar models

Specifications of the disease EBMT CML

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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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