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Information:
Fel:
ID
14230
Beskrivning
DOCUMENTED PATHOGENS for INFECTIOUS RELATED COMPLICATIONS Bacteria: S. pneumoniae, Other gram positive (i.e.: other streptococci, staphylococci, listeria), Haemophilus influenzae, Other gram negative (i.e.: E. coli klebsiella, proteus, serratia, pseudomonas …), Legionella sp, Mycobacteria sp, other Viruses: HSV, VZV, EBV, CMV, HHV-6, RSV, Other respiratory virus, Adenovirus, HBV,HCV,HIV, Papovavirus, Parvovirus, Other Fungi: Candida sp, Aspergillus sp, Pneumocystis carinii, other Parasites: Toxoplasma gondii, other
Nyckelord
Versioner (3)
- 2016-04-05 2016-04-05 -
- 2016-07-27 2016-07-27 -
- 2021-09-17 2021-09-17 -
Uppladdad den
5 april 2016
DOI
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Creative Commons BY-NC 3.0
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EBMT Solid Tumors
14pp EBMT Solid Tumors 11SoTu
- StudyEvent: ODM
Similar models
14pp EBMT Solid Tumors 11SoTu
- StudyEvent: ODM
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
EBMT FORM GENERAL INFORMATION
Item
EBMT FORM GENERAL INFORMATION
text
Klinik
Item
Hospital
text
C0019994 (UMLS CUI [1])
Unit
Item
Unit
text
Contact person
Item
Name of contact person
text
C0337611 (UMLS CUI [1])
Patient phone number
Item
Telephone
text
C1515258 (UMLS CUI [1])
ContactPersonFaxNumber
Item
Fax
text
C0237753 (UMLS CUI [1,1])
C0027361 (UMLS CUI [1,2])
C0337611 (UMLS CUI [1,3])
C0085205 (UMLS CUI [1,4])
C0027361 (UMLS CUI [1,2])
C0337611 (UMLS CUI [1,3])
C0085205 (UMLS CUI [1,4])
E-mail
Item
E-mail address of contact number
text
C1705961 (UMLS CUI [1])
Date of this report
Item
Date of this report
date
C1302584 (UMLS CUI [1])
Item
Patient following national / international study / trial
integer
C1997894 (UMLS CUI [1])
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Name of study / trial
Item
Name of study / trial
text
Unique Identification Code (UIC)
Item
To be entered only if patient previously reported
text
C2348585 (UMLS CUI [1])
Hospital Unique Patient Number or Code
Item
Hospital Unique Patient Number or Code
text
C1827636 (UMLS CUI [1])
Initials
Item
First name(s)_surname(s)
text
C2986440 (UMLS CUI [1])
PersonBirthDate
Item
Date of Birth
date
C0011008 (UMLS CUI [1,1])
C0027361 (UMLS CUI [1,2])
C0005615 (UMLS CUI [1,3])
C0027361 (UMLS CUI [1,2])
C0005615 (UMLS CUI [1,3])
CL Item
Male (1)
CL Item
Female (2)
ABO Group
Item
ABO Group
text
CL Item
Absent (1)
CL Item
Present (2)
CL Item
Not evaluated (3)
Diagnose-Datum
Item
Date of diagnosis
date
C2316983 (UMLS CUI [1,1])
C1274082 (UMLS CUI [1,2])
C1274082 (UMLS CUI [1,2])
Item
Check the disease for which this transplant was performed
text
C0277554 (UMLS CUI [1])
CL Item
Acute Leukaemia (Acute Leukaemia)
CL Item
Acute Myelogenous Leukaemia (AML) (Acute Myelogenous Leukaemia (AML))
CL Item
Acute Lymphoblastic Leukaemia (ALL) (Acute Lymphoblastic Leukaemia (ALL))
CL Item
Secondary Acute Leukaemia (do not use if transformed from MDS/MPN) (Secondary Acute Leukaemia (do not use if transformed from MDS/MPN))
CL Item
Chronic Leukaemia (Chronic Leukaemia)
CL Item
Chronic Myeloid Leukaemia (CML) (Chronic Myeloid Leukaemia (CML))
CL Item
Chronic Lymphocytic Leukaemia (Chronic Lymphocytic Leukaemia)
CL Item
Lymphoma (Lymphoma)
CL Item
Non Hodgkin (Non Hodgkin)
CL Item
Hodgkin´s Disease (Hodgkin´s Disease)
CL Item
Myeloma/ Plasma cell disorder (Myeloma/ Plasma cell disorder)
CL Item
Solid Tumour (Solid Tumour)
CL Item
Myelodysplastic syndromes (Myelodysplastic syndromes)
CL Item
MDS (MDS)
CL Item
MD/ MPN (MD/ MPN)
CL Item
Myeloproliferative neoplasm (Myeloproliferative neoplasm)
CL Item
Bone marrow failure including Aplastic anaemia (Bone marrow failure including Aplastic anaemia)
CL Item
Inherited disorders (Inherited disorders)
CL Item
Primary immune deficiencies (Primary immune deficiencies)
CL Item
Metabolic disorders (Metabolic disorders)
CL Item
Histiocytic disorders (Histiocytic disorders)
CL Item
Autoimmune disease (Autoimmune disease)
CL Item
Juvenile Idiopathic Arthritis (Juvenile Idiopathic Arthritis)
CL Item
Multiple Sclerosis (Multiple Sclerosis)
CL Item
Systemic Lupus (Systemic Lupus)
CL Item
Systemic Sclerosis (Systemic Sclerosis)
CL Item
Haemoglobinopathiy (Haemoglobinopathiy)
CL Item
Other diagnosis (Other diagnosis)
CL Item
Bone sarcoma (excluding Ewing sarcoma/PNET) (1)
CL Item
Central nervous system tumors (include CNS PNET) (2)
CL Item
Colorectal (3)
CL Item
Ewing sarcoma/PNET, extra-skeletal (4)
CL Item
Ewing sarcoma/PNET, skeletal (5)
CL Item
Germ cell tumour, extragonadal only (6)
CL Item
Hepatobiliary (7)
CL Item
Lung cancer, non-small cell (8)
CL Item
Lung cancer, small cell (9)
CL Item
Medulloblastoma (10)
CL Item
Melanoma (11)
CL Item
Other, specify (12)
CL Item
Breas (13)
CL Item
Neuroblastoma (14)
CL Item
Ovarian (15)
CL Item
Pancreas (16)
CL Item
Prostate (17)
CL Item
Renal cell (18)
CL Item
Retinoblastoma (19)
CL Item
Rhabdomyosarcoma (20)
CL Item
Soft tissue sarcoma (21)
CL Item
Testicular (22)
CL Item
Thymoma (23)
CL Item
Wilms tumour (24)
INITIAL DIAGNOSIS
Item
if other specify
text
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
X (6)
CL Item
not evaluated (7)
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
X (5)
CL Item
not evaluated (6)
CL Item
unknown (7)
CL Item
0 (1)
CL Item
1 (2)
CL Item
X (3)
CL Item
not evaluated (4)
CL Item
unknown (5)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
HISTOLOGICAL SUBCLASSIFICATION Describe
Item
HISTOLOGICAL SUBCLASSIFICATION Describe
text
CL Item
Inflammatory (1)
CL Item
Non-inflammatory (2)
CL Item
Negative (1)
CL Item
Not evaluated (2)
CL Item
Positive (3)
CL Item
Unknown (4)
CL Item
Not evaluated (5)
CL Item
Unknown (6)
RECEPTOR STATUS Estrogen (ER)
Item
Values if RECEPTOR STATUS positive
float
CL Item
Negative (1)
CL Item
Not evaluated (2)
CL Item
Positive (3)
CL Item
Unknown (4)
CL Item
Not evaluated (5)
CL Item
Unknown (6)
RECEPTOR STATUS Progesterone (PgR)
Item
if Receptor Status positive Values
float
CL Item
Negative (1)
CL Item
Positive (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Item
if RECEPTOR STATUS HER2/neu (c-erb-B2) positiv Defined by
integer
Code List
if RECEPTOR STATUS HER2/neu (c-erb-B2) positiv Defined by
CL Item
IHC 3+ (1)
CL Item
IHC 2+ and FISH + (2)
CL Item
Unknown (3)
Item Group
HISTOLOGICAL SUBCLASSIFICATION FOR BREAST CARCINOMA
Axillary lymph nodes
Item
Number of positive Axillary lymph nodes
float
Axillary lymph nodes
Item
Number of examined Axillary lymph nodes
float
Axillary lymph nodes
Item
Axillary lymph nodes Not evaluated
integer
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
not evaluated (4)
CL Item
unknown (5)
CL Item
yes (1)
CL Item
no (2)
CL Item
not evaluated (3)
CL Item
unknown (4)
CL Item
yes (1)
CL Item
no (2)
CL Item
not evaluated (3)
CL Item
unknown (4)
CL Item
Normal (1)
CL Item
Abnormal (2)
CL Item
Not done (3)
CL Item
Unknown (4)
CHROMOSOME ANALYSIS
Item
CHROMOSOME ANALYSIS
text
CL Item
Evaluated: Absent (1)
CL Item
Evaluated: Present (2)
CL Item
Not evaluated (3)
CL Item
unknown (4)
CL Item
no (1)
CL Item
yes (2)
Date
Item
1st line treatment started
date
CL Item
yes (1)
CL Item
no (2)
CL Item
Upfront (1)
CL Item
Adjuvant (2)
CL Item
Chemotherapy (1)
CL Item
Adjuvant Chemotherapy (2)
CL Item
Neoadjuvant Chemotherapy (3)
CL Item
Surgery (4)
CL Item
Radiotherapy (5)
CL Item
Other (6)
CL Item
Anthracyclines (1)
CL Item
Taxanes (2)
CL Item
Platinum compounds (3)
CL Item
Antimetabolites (4)
CL Item
Cyclophosphamide or other alkylating agents (5)
CL Item
Vinca alcaloids (6)
CL Item
Etoposide (7)
CL Item
Other (8)
Drugs
Item
if other drugs
text
CL Item
Mastectomy (1)
CL Item
Conservative (2)
Modality
Item
if other Modality
text
Item
Status of disease after first line treatment (best response)
text
Code List
Status of disease after first line treatment (best response)
CL Item
Complete Remission (1)
CL Item
Partial Remission (2)
CL Item
Not Evaluable (3)
CL Item
Stable Disease (4)
CL Item
Refractory Disease (5)
CL Item
WHO criteria (1)
CL Item
RECIST criteria (2)
Item
ADDITIONAL LINES OF TREATMENT BEFORE THIS HSCT FOR RELAPSED/REFRACTORY DISEASE
text
Code List
ADDITIONAL LINES OF TREATMENT BEFORE THIS HSCT FOR RELAPSED/REFRACTORY DISEASE
CL Item
no (1)
CL Item
yes (2)
Date of HSCT
Item
Date of HSCT
date
C2584899 (UMLS CUI [1])
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
>4 (5)
CL Item
unknown (6)
CL Item
no (1)
CL Item
yes (2)
CL Item
unknown (3)
CL Item
no (1)
CL Item
yes (2)
CL Item
unknown (3)
CL Item
no (1)
CL Item
yes (2)
CL Item
unknown (3)
CL Item
no (1)
CL Item
yes (2)
CL Item
unknown (3)
Modality used at least once other
Item
if used other Modality at least
text
CL Item
Adjuvant (1)
CL Item
Never treated (upfront) (2)
CL Item
Primary refractory (3)
CL Item
Complete remission (CR) (4)
CL Item
1st Partial remission (PR1) (5)
CL Item
Relapse (6)
CL Item
Progressive disease (PD) (7)
CL Item
Confirmed (1)
CL Item
Unconfirmed (CRU*) (2)
CL Item
Unknown (3)
CL Item
Local (1)
CL Item
Metastatic (2)
CL Item
1st (1)
CL Item
2nd (2)
CL Item
3rd or higher (3)
CL Item
1st (1)
CL Item
2nd (2)
CL Item
3rd or higher (3)
CL Item
Sensitive (SR:>50% response) (1)
CL Item
Resistant (RR:<50% response) (2)
CL Item
Untreated (3)
CL Item
Nodes Below Diaphragm (1)
CL Item
Bone marrow (2)
CL Item
CNS (3)
CL Item
Mediastinum (4)
CL Item
Soft Tissue (5)
CL Item
Gastrointestinal tract (6)
CL Item
Liver (7)
CL Item
Nodes Above Diaphragm (8)
CL Item
Bone (9)
CL Item
Lungs (10)
CL Item
Heart (11)
CL Item
Skin (12)
CL Item
Urogenital tract (13)
CL Item
Ovaries/Testes (14)
Organ(s) involved
Item
if other Organ(s) involved please specify
text
CL Item
yes (1)
CL Item
no (2)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Planned (planned before HSCT took place) (1)
CL Item
Not planned (for relapse/progression or persistent disease) (2)
CL Item
Complete Remission (1)
CL Item
Very Good Partial Remission (2)
CL Item
Partial Remission (>50%) (3)
CL Item
Not Evaluable (4)
CL Item
Stable Disease (5)
CL Item
Progressive Disease (6)
CL Item
Minor Response (>25% and <50%) (7)
LesionAssessmentDate
Item
Date of Evaluation
date
C0011008 (UMLS CUI [1,1])
C0221198 (UMLS CUI [1,2])
C0031809 (UMLS CUI [1,3])
C0221198 (UMLS CUI [1,2])
C0031809 (UMLS CUI [1,3])
CL Item
AUTOgraft, proceed to Autograft form (1)
CL Item
ALLOgraft or Syngeneic graft, proceed to Allograft form (2)
CL Item
Other (3)
TYPE OF TRANSPLANT
Item
it other type of transplant contact the EBMT Central Registry Office for instructions
text
Unique Identification Code (UIC)
Item
Unique Identification Code (UIC) (if known)
text
C2348585 (UMLS CUI [1])
Date of this report
Item
Date of this report
date
C1302584 (UMLS CUI [1])
Item
Patient following national / international study / trial
integer
C1997894 (UMLS CUI [1])
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Name of study / trial
Item
Name of study / trial
text
Hospital Unique Patient Number
Item
Hospital Unique Patient Number
text
C2348585 (UMLS CUI [1])
Initials
Item
First name(s)_surname(s)
text
C2986440 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Date of last HSCT for this patient
Item
Date of last HSCT for this patient
date
C0472699 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
Date last contact
Item
Date of Last Contact or Death
date
C0805839 (UMLS CUI [1])
Item Group
GRAFT VERSUS HOST DISEASE (GvHD) SINCE LAST REPORT
CL Item
grade 0 (Absent) (1)
CL Item
grade I (2)
CL Item
grade II (3)
CL Item
grade III (4)
CL Item
grade IV (5)
CL Item
Not evaluated (6)
Item
If ACUTE GRAFT VERSUS HOST DISEASE (AGVHD) present
text
Code List
If ACUTE GRAFT VERSUS HOST DISEASE (AGVHD) present
CL Item
New onset (1)
CL Item
Recurrent (2)
CL Item
Persistent (3)
Item
Reason for ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)
text
Code List
Reason for ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)
CL Item
Tapering (1)
CL Item
DLI (2)
CL Item
Unexplained (3)
Date onset of this episode
Item
Date onset of this episode (if new or recurrent)
date
C0574845 (UMLS CUI [1])
CL Item
Not applicable (1)
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
Not evaluated (6)
CL Item
unknown (7)
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
Not evaluated (6)
CL Item
unknown (7)
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
Not evaluated (6)
CL Item
unknown (7)
CL Item
No (1)
CL Item
Yes (2)
aGvHD Date of resolution
Item
Date of resolution
date
C0856825 (UMLS CUI [1,1])
C1514893 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
C1514893 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Present continuously since last reported episode (Present continuously since last reported episode)
CL Item
Resolved (Resolved)
CL Item
First episode (1)
CL Item
Recurrence (2)
Date of onset
Item
Date of onset
date
C0574845 (UMLS CUI [1])
Item
If present continously since last report, specify cGvHD gade:
text
C0867389 (UMLS CUI [1,1])
C0441799 (UMLS CUI [1,2])
C0441799 (UMLS CUI [1,2])
CL Item
Limited (Limited)
CL Item
Extensive (Extensive)
CL Item
Skin (1)
CL Item
Gut (2)
CL Item
Liver (3)
CL Item
Mouth (4)
CL Item
Eyes (5)
CL Item
Lung (6)
CL Item
Other, specify (7)
CL Item
Unknown (8)
Organs affected
Item
If other Organs affected please specify
text
Resolved: Date of resolution
Item
Resolved: Date of resolution
date
CL Item
No complications (1)
CL Item
Yes (2)
Bacteremia / fungemia / viremia / parasites Pathogen
Item
Bacteremia / fungemia / viremia / parasites Pathogen
text
Bacteremia / fungemia / viremia / parasites Pathogen
Item
Bacteremia / fungemia / viremia / parasites Pathogen
date
SYSTEMIC SYMPTOMS OF INFECTION: Septic shock
Item
SYSTEMIC SYMPTOMS OF INFECTION: Septic shock
text
SYSTEMIC SYMPTOMS OF INFECTION: Septic shock
Item
SYSTEMIC SYMPTOMS OF INFECTION: Septic shock
date
SYSTEMIC SYMPTOMS OF INFECTION ARDS Pathogen
Item
SYSTEMIC SYMPTOMS OF INFECTION ARDS Pathogen
text
SYSTEMIC SYMPTOMS OF INFECTION ARDS Pathogen
Item
SYSTEMIC SYMPTOMS OF INFECTION ARDS Pathogen
date
SYSTEMIC SYMPTOMS OF INFECTION Multiorgan failure due to infection Pathogen
Item
SYSTEMIC SYMPTOMS OF INFECTION Multiorgan failure due to infection Pathogen
text
SYSTEMIC SYMPTOMS OF INFECTION Multiorgan failure due to infection Pathogen
Item
SYSTEMIC SYMPTOMS OF INFECTION Multiorgan failure due to infection Pathogen
date
CL Item
Pneumonia (Pneumonia)
CL Item
Hepatits (Hepatits)
CL Item
CNS infection (CNS infection)
CL Item
Gut infection (Gut infection)
CL Item
Skin infection (Skin infection)
CL Item
Cystitis (Cystitis)
CL Item
Retinitis (Retinitis)
CL Item
Other (Other)
ENDORGAN DISEASES
Item
ENDORGAN DISEASES
date
CL Item
No complications (1)
CL Item
yes (2)
Item
Specify: Idiopathic pneumonia syndrome
text
C1504431 (UMLS CUI [1])
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Specify: Haemorrhagic cystitis, non infectious
text
C0085692 (UMLS CUI [1])
CL Item
Yes (Yes )
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
yes (yes)
CL Item
no (no )
CL Item
unknown (unknown)
Item
Specify: HSCT-associated microangiopathy
text
C0155765 (UMLS CUI [1])
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Specify: Renal failure requiring dialysis
text
C0035078 (UMLS CUI [1])
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Specify: Haemolytic anaemia due to blood group
text
C0002878 (UMLS CUI [1])
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Other NON INFECTIOUS RELATED COMPLICATIONS
Item
Other NON INFECTIOUS RELATED COMPLICATIONS
text
Idiopathic pneumonia syndrome
Item
Idiopathic pneumonia syndrome
date
VOD
Item
VOD
date
Cataract
Item
Cataract
date
Haemorrhagic cystitis, non infectious
Item
Haemorrhagic cystitis, non infectious
date
ARDS, non infectious
Item
ARDS, non infectious
date
Multiorgan failure, non infectious
Item
Multiorgan failure, non infectious
date
HSCT-associated microangiopathy
Item
HSCT-associated microangiopathy
date
Renal failure requiring dialysis
Item
Renal failure requiring dialysis
date
Haemolytic anaemia due to blood group
Item
Haemolytic anaemia due to blood group
date
Aseptic bone necrosis
Item
Aseptic bone necrosis
date
Other NON INFECTIOUS RELATED COMPLICATIONS
Item
if Other NON INFECTIOUS RELATED COMPLICATIONS
date
Item Group
GRAFT ASSESSMENT AND HAEMOPOIETIC CHIMAERISM
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
CL Item
95%) (Full (donor >)
CL Item
Mixed (partial) (Mixed (partial))
CL Item
95%) (Autologuos reconstitution (recipient >)
CL Item
Aplasia (Aplasia)
CL Item
Not evaluated (Not evaluated)
Date of test
Item
Date of test
date
C2826247 (UMLS CUI [1])
Identification
Item
Identification of donor or Cord Blood Unit given by the centre
text
C1718162 (UMLS CUI [1])
Item
Number in the infusion order (if applicable)
integer
C2348184 (UMLS CUI [1])
CL Item
......... (1)
CL Item
N/A (2)
Bone marrow
Item
Cell type on which test was performed (% Donor Cells): BM
float
C0005953 (UMLS CUI [1])
PB mononuclear cells (PBMC)
Item
Cell type on which test was performed (% Donor cells): PB mononuclear cells (PBMC)
float
C1321301 (UMLS CUI [1])
T-Cell
Item
Cell type on which test was performed (% Donor cells):
float
B-Cells
Item
Cell type on which test was performed (% Donor cells): B-Cells
float
C0004561 (UMLS CUI [1])
Red blood cells
Item
Cell type on which test was performed (% Donor cells): Red blood cells
float
C0014772 (UMLS CUI [1])
Monocytes
Item
Cell type on which test was performed (% Donor cells): Monocytes
float
C0026473 (UMLS CUI [1])
PMNs (neutrophils)
Item
Cell type on which test was performed (% Donor cells): PMNs (neutrophils)
float
C0200633 (UMLS CUI [1])
Lymphocytes, NOS
Item
Cell type on which test was performed (% Donor cells): Lymphocytes, NOS
float
C0024264 (UMLS CUI [1])
Myeloid cells, NOS
Item
Cell type on which test was performed (% Donor cells): Myeloid cells, NOS
float
C0887899 (UMLS CUI [1])
Other cell type - value
Item
Cell type on which test was performed (% Donor cells): Other
float
C0449475 (UMLS CUI [1,1])
C1522609 (UMLS CUI [1,2])
C1522609 (UMLS CUI [1,2])
CL Item
FISH (FISH)
CL Item
Molecular (Molecular)
CL Item
Cytogenetic (Cytogenetic)
CL Item
ABO group (ABO group)
CL Item
Other (Other)
CL Item
unknown (unknown)
Specification other labaratory tests
Item
Test used: If other, specify: (Indicate the date(s) and results of all tests done for all donors. Split the results by donor and by the cell type on which the test was performed if applicable. Copy this table as many times as necessary.)
text
C0022885 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,2])
Item
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
text
Code List
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
CL Item
Previously reported (1)
CL Item
Yes (2)
CL Item
No at date of this follow-up (3)
date of diagnosis
Item
date of diagnosis
date
CL Item
AML (1)
CL Item
MDS (2)
CL Item
Lymphoproliferative disorder (3)
CL Item
Other (4)
Other diagnosis
Item
Diagnosis, other
text
C0205394 (UMLS CUI [1])
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Date started ADDITIONAL TREATMENT
Item
Date started ADDITIONAL TREATMENT
date
Item
If yes: Cellular therapy (One cell therapy regimen is defined as any number of infusions given within 10 weeks for the same indication. If more than one regimen of cell therapy has been given since last report, copy this section and complete it as many times as necessary.)
integer
C0302189 (UMLS CUI [1])
Code List
If yes: Cellular therapy (One cell therapy regimen is defined as any number of infusions given within 10 weeks for the same indication. If more than one regimen of cell therapy has been given since last report, copy this section and complete it as many times as necessary.)
CL Item
No (1)
CL Item
Yes (Mark disease status before this cellular therapy) (2)
CL Item
Unknown (3)
CL Item
CR (1)
CL Item
Not in CR (2)
CL Item
Not evaluated (3)
CL Item
Donor lymphocyte infusion (DLI) (1)
CL Item
Mesenchymal cells (2)
CL Item
Other (3)
CL Item
Unknown (4)
Type of cells
Item
If other type of cells, please specify
text
Nucleated cells (/kg*)
Item
Number of cells infused
integer
CL Item
Not evaluated (1)
CL Item
unknown (2)
CD 34+ (cells/kg*)
Item
Number of cells infused
integer
CL Item
Not evaluated (1)
CL Item
unknown (2)
CD 3+ (cells/kg*)
Item
Number of cells infused
integer
CL Item
Not evaluated (1)
CL Item
unknown (2)
All cells (cells/kg*)
Item
Total number of cells infused
integer
CL Item
Not evaluated (1)
CL Item
unknown (2)
Chronological number of this cell therapy for this patient
Item
Chronological number of this cell therapy for this patient
integer
C2348184 (UMLS CUI [1])
Item
Indication (check all that apply)
text
C3146298 (UMLS CUI [1,1])
C0302189 (UMLS CUI [1,2])
C0302189 (UMLS CUI [1,2])
CL Item
Planned/ protocol (Planned/ protocol)
CL Item
Treatment for disease (Treatment for disease)
CL Item
Prophylactic (Prophylactic)
CL Item
Mixed chimaerism (Mixed chimaerism)
CL Item
Treatment of GvHD (Treatment of GvHD)
CL Item
Treatment viral infection (Treatment viral infection)
CL Item
Loss/decreased chimaerism (Loss/decreased chimaerism)
CL Item
Treatment PTLD, EBV, lymphoma (Treatment PTLD, EBV, lymphoma)
CL Item
Other (Other)
Indication
Item
If other Indication, please specify
text
Number of Infusions
Item
Number of Infusions (within 10 weeks) (count only infusions that are part of same regimen and given for the same indication)
float
C2348184 (UMLS CUI [1,1])
C1289919 (UMLS CUI [1,2])
C1289919 (UMLS CUI [1,2])
Hospital Unique Patient Number (UPN)
Item
Hospital Unique Patient Number (UPN):
text
HSCT date
Item
HSCT date
date
Item
Acute Graft versus Host Disease (after this infusion but before any further infusion/ transplant) Maximum grade:
text
C0856825 (UMLS CUI [1])
Code List
Acute Graft versus Host Disease (after this infusion but before any further infusion/ transplant) Maximum grade:
CL Item
grade 0 (absent) (grade 0 (absent))
CL Item
grade 1 (grade 1)
CL Item
grade 2 (grade 2)
CL Item
grade 3 (grade 3)
CL Item
grade 4 (grade 4)
CL Item
present, grade unknown (present, grade unknown)
Item
Disease treatment (apart from donor cell infusion or other type of cell therapy)
integer
C0087111 (UMLS CUI [1])
Code List
Disease treatment (apart from donor cell infusion or other type of cell therapy)
CL Item
No (1)
CL Item
Yes: Planned (planned before HSCT took place) (2)
CL Item
Yes: Not planned (for relapse/progression or persistent disease) (3)
Item
Relapse or progression
integer
C0035020 (UMLS CUI [1,1])
C1704632 (UMLS CUI [1,2])
C1704632 (UMLS CUI [1,2])
CL Item
Previously reported (1)
CL Item
No (2)
CL Item
yes (3)
CL Item
Continuous progression since HSCT (4)
CL Item
Unknown (5)
RELAPSE OR PROGRESSION
Item
if yes, date diagnosed
date
CL Item
Local (1)
CL Item
Distant (2)
Item
Organs distant involved at relapse or progression
text
Code List
Organs distant involved at relapse or progression
CL Item
CNS (1)
CL Item
liver (2)
CL Item
nodes (3)
CL Item
bone marrow (4)
CL Item
bone (5)
CL Item
soft tissue (6)
CL Item
lung (7)
CL Item
pleura (8)
CL Item
other (9)
Other Distant Organs involved at relapse or progression
Item
If Other Distant Organs involved at relapse or progression
text
CL Item
Complete Remission (Complete Remission)
CL Item
Stable disease (Stable disease)
CL Item
Relapse (Relapse)
CL Item
Progression (Progression)
Item
Has patient or partner become pregnant after this HSCT?
text
C0032961 (UMLS CUI [1])
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
CL Item
alive (0)
CL Item
dead (1)
CL Item
Karnofsky (Karnofsky)
CL Item
Lansky (Lansky)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
100 (Normal, NED) (1)
CL Item
90 (Normal activity) (2)
CL Item
80 (Normal with effort) (3)
CL Item
70 (Cares for self) (4)
CL Item
60 (Requires occasional assistance) (5)
CL Item
50 (Requires assistance) (6)
CL Item
40 (Disabled) (7)
CL Item
30 (Severely disabled) (8)
CL Item
20 (Very sick) (9)
CL Item
10 (Moribund) (10)
CL Item
Relapse or progression (1)
CL Item
Secondary malignancy (2)
CL Item
HSCT related cause (3)
CL Item
Unknown (4)
CL Item
Other (5)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): GvHD
text
C0007465 (UMLS CUI [1,1])
C0018133 (UMLS CUI [1,2])
C0018133 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): GvHD
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Interstitial Pneumonitis
text
C0007465 (UMLS CUI [1,1])
C0206061 (UMLS CUI [1,2])
C0206061 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Interstitial Pneumonitis
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Pulmonary toxicity
text
C0007465 (UMLS CUI [1,1])
C0919924 (UMLS CUI [1,2])
C0919924 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Pulmonary toxicity
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Infection
text
C0007465 (UMLS CUI [1,1])
C0009450 (UMLS CUI [1,2])
C0009450 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Infection
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
yes (1)
CL Item
no (2)
CL Item
unknown (3)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Veno-Occlusive disease (VOD)
text
C0007465 (UMLS CUI [1,1])
C0948441 (UMLS CUI [1,2])
C0948441 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Veno-Occlusive disease (VOD)
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Haemorrhage
text
C0007465 (UMLS CUI [1,1])
C0019080 (UMLS CUI [1,2])
C0019080 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Haemorrhage
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Cardiac toxicity
text
C0007465 (UMLS CUI [1,1])
C0876994 (UMLS CUI [1,2])
C0876994 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Cardiac toxicity
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Central nervous system t8oxicity
text
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Central nervous system t8oxicity
CL Item
yes (1)
CL Item
no (2)
CL Item
unknown (3)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Gastro intestinal toxicity
text
C0007465 (UMLS CUI [1,1])
C1142499 (UMLS CUI [1,2])
C1142499 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Gastro intestinal toxicity
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Skin toxicity
text
C0007465 (UMLS CUI [1,1])
C1167791 (UMLS CUI [1,2])
C1167791 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Skin toxicity
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Renal failure
text
C0007465 (UMLS CUI [1,1])
C0035078 (UMLS CUI [1,2])
C0035078 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Renal failure
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Multiple organ failure
text
C0007465 (UMLS CUI [1,1])
C0026766 (UMLS CUI [1,2])
C0026766 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Multiple organ failure
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): other
text
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): other
CL Item
yes (1)
CL Item
no (2)
CL Item
unknown (3)
COMMENTS
Item
COMMENTS
text
Identification
Item
Identification
text
C0205396 (UMLS CUI [1])