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ID
14334
Beschreibung
DOCUMENTED PATHOGENS INFECTION 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 Fungi: Candida sp, Aspergillus sp, Pneumocystis carinii, Other Parasites:Toxoplasma gondii, other Viruses: HSV,VZV, EBV, CMV, HHV-6, RSV, Other respiratory virus (influenza, parainfluenza, rhinovirus), Adenovirus, HBV, HCV, HIV, Papovavirus, Parvovirus, Other
Stichworte
Versionen (2)
- 11.04.16 11.04.16 -
- 27.06.16 27.06.16 -
Hochgeladen am
11. April 2016
DOI
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15pp EBMT Multiple Sclerosis
15pp EBMT Multiple Sclerosis13MS
- StudyEvent: ODM
Ähnliche Modelle
15pp EBMT Multiple Sclerosis13MS
- StudyEvent: ODM
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
EBMT Centre Identification Code (CIC)
Item
EBMT Centre Identification Code (CIC)
text
C2348585 (UMLS CUI [1])
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])
ContactPersonE-mailText
Item
E-mail
text
C1527021 (UMLS CUI [1,1])
C0027361 (UMLS CUI [1,2])
C0013849 (UMLS CUI [1,3])
C0337611 (UMLS CUI [1,4])
C0027361 (UMLS CUI [1,2])
C0013849 (UMLS CUI [1,3])
C0337611 (UMLS CUI [1,4])
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])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
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)
Date of Diagnosis
Item
Date of Diagnosis
date
C2316983 (UMLS CUI [1])
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)
Primary Disease Diagnosis
Item
If other diagnosis, specify:
text
C0277554 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,2])
Neurologist Name
Item
Neurologist Name
text
Address
Item
Address
text
Fax
Item
Fax
text
C1549619 (UMLS CUI [1,1])
C0337611 (UMLS CUI [1,2])
C0030664 (UMLS CUI [1,3])
C0337611 (UMLS CUI [1,2])
C0030664 (UMLS CUI [1,3])
Email
Item
Email
text
C0013849 (UMLS CUI [1])
Item
has the information requested in this section been submitted with a previous HSCT registration?
text
C1514821 (UMLS CUI [1])
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
Did the patient meet the Poser criteria for clinically-definite Multiple Sclerosis? (Two attacks and clinical evidence of two separate lesions OR Two attacks; clinical evidence of one lesion and paraclinical evidence of another, separate lesion)
integer
Code List
Did the patient meet the Poser criteria for clinically-definite Multiple Sclerosis? (Two attacks and clinical evidence of two separate lesions OR Two attacks; clinical evidence of one lesion and paraclinical evidence of another, separate lesion)
CL Item
no (1)
CL Item
yes (2)
CL Item
unknown (3)
Item
Did the patient meet the criteria for laboratory-supported Multiple Sclerosis?
integer
Code List
Did the patient meet the criteria for laboratory-supported Multiple Sclerosis?
CL Item
no (1)
CL Item
yes (2)
CL Item
unknown (3)
CL Item
no Proceed to ”Date of HSCT” (1)
CL Item
yes (2)
THERAPIES Date started
Item
THERAPIES Date started
date
CL Item
no (1)
CL Item
yes (2)
CL Item
unknown (3)
CL Item
Cyclophosphamide (1)
CL Item
Mitoxantrone (2)
CL Item
Anti-lymphocyte antibodies/globulins (ALG) (3)
CL Item
Corticosteroids (4)
CL Item
Chronic low dose REGIMEN (5)
CL Item
Pulse high dose (6)
CL Item
Azathioprine (7)
CL Item
Cop-I (8)
CL Item
alphainterferon (9)
CL Item
beta-interferon (10)
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)
Other, specify modality
Item
Other, specify modality
text
Date of HSCT
Item
Date of HSCT
date
C2584899 (UMLS CUI [1])
CL Item
Allogeneic (1)
CL Item
Autologous: Mobilised (2)
CL Item
no (1)
CL Item
yes (2)
Date of Autologous: Mobilised
Item
Date of Autologous: Mobilised
date
Scripps neurological rating scale
Item
Scripps neurological rating scale Score
integer
CL Item
unknown (1)
CL Item
Not evaluated (2)
Kurtze functional systems
Item
Kurtze functional systems Overall score
text
CL Item
Unknown (1)
CL Item
Not evaluated (2)
Kurtze Expanded Disability Status
Item
Kurtze Expanded Disability Status Scale (EDSS)
text
CL Item
Unknown (1)
CL Item
Not evaluated (2)
Composite Scale Score
Item
Composite Scale Score
text
CL Item
unknown (1)
CL Item
not evaluated (2)
CL Item
Not done prior to mobilisation (Not done prior to mobilisation)
CL Item
Yes (Yes)
CL Item
Date unknown (Date unknown)
Date of most recent MRI scan of brain
Item
Date of most recent MRI scan of brain
date
CL Item
Number (Number)
CL Item
None (None)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Gadolinium-enhancing lesions present Number
Item
If Gadolinium-enhancing lesions present
integer
CL Item
Progressive relapsing (malignant) (Progressive relapsing (malignant))
CL Item
Primary progressive (Primary progressive)
CL Item
Secondary progressive (may have had previous Relapsing/Remitting) (Secondary progressive (may have had previous Relapsing/Remitting))
CL Item
Relapsing/Remitting (Relapsing/Remitting)
CL Item
Not evaluable, explain (Not evaluable, explain)
DISEASE COURSE
Item
If DISEASE COURSE not evaluable please explain
text
Item
Did the patient progress during the 2-years prior to mobilisation/HSCT?
text
Code List
Did the patient progress during the 2-years prior to mobilisation/HSCT?
CL Item
no (no )
CL Item
yes (yes)
CL Item
unknown (unknown)
number of relapses/progressions
Item
If the patient progress during the 2-years prior to mobilisation/HSCT?
integer
Scripps neurological rating scale
Item
Scripps neurological rating scale Score
text
CL Item
Unknown (1)
CL Item
Not evaluated (2)
Kurtze functional systems
Item
Kurtze functional systems Overall score
text
CL Item
Unknown (1)
CL Item
Not evaluated (2)
Kurtze Expanded Disability Status
Item
Kurtze Expanded Disability Status Scale (EDSS)
text
CL Item
Unknown (1)
CL Item
Not evaluated (2)
Composite Scale
Item
Composite Scale Score
text
CL Item
Unknown (1)
CL Item
Not evaluated (2)
CL Item
Not done prior to HSCT (Not done prior to HSCT)
CL Item
Yes: (Yes:)
Date of most recent MRI scan of brain
Item
If MRI BRAIN SCAN DONE Date of most recent MRI scan of brain:
date
CL Item
Date unknown (1)
CL Item
Number (Number)
CL Item
None (None)
CL Item
Unknown (Unknown)
Gadolinium-enhancing lesions present
Item
Gadolinium-enhancing lesions present
text
CL Item
no (no)
CL Item
yes (yes)
Date started if patient receive additional treatment post-HSCT
Item
Date started if patient receive additional treatment post-HSCT
date
CL Item
Relapse/progression (1)
CL Item
Continued from pre-HSCT (2)
CL Item
unknow (3)
CL Item
Planned per protocol (4)
CL Item
Other, specify (5)
Overall main reason
Item
If other, please specify
text
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
CL Item
Cyclophosphamide (1)
CL Item
Mitoxantrone (2)
CL Item
Anti-lymphocyte antibodies (3)
CL Item
Corticosteroids (4)
CL Item
Chronic low dose (5)
CL Item
REGIMEN Pulse high dose (6)
CL Item
Azathioprine (7)
CL Item
Cop-I (8)
CL Item
Alpha-interferon (9)
CL Item
Beta-interferon (10)
CL Item
no (no)
CL Item
yes (yes)
CL Item
unknown (unknown)
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)
Other modality
Item
If other modality please specify
text
DATE OF EVALUATION
Item
DATE OF EVALUATION
date
CLINICAL EVALUATION Scripps neurological rating scale
Item
CLINICAL EVALUATION Scripps neurological rating scale
float
Item
CLINICAL EVALUATION Scripps neurological rating scale
integer
Code List
CLINICAL EVALUATION Scripps neurological rating scale
CL Item
Unknown (1)
CL Item
Not evaluated (2)
CLINICAL EVALUATION Kurtze functional systems
Item
CLINICAL EVALUATION Kurtze functional systems
float
Item
CLINICAL EVALUATION Kurtze functional systems
integer
Code List
CLINICAL EVALUATION Kurtze functional systems
CL Item
unknown (1)
CL Item
not evaluated (2)
CLINICAL EVALUATION Kurtze Expanded Disability Status
Item
CLINICAL EVALUATION Kurtze Expanded Disability Status
float
Item
CLINICAL EVALUATION Kurtze Expanded Disability Status
integer
Code List
CLINICAL EVALUATION Kurtze Expanded Disability Status
CL Item
Unknown (1)
CL Item
Not evaluated (2)
CLINICAL EVALUATION Composite Scale
Item
CLINICAL EVALUATION Composite Scale
float
CL Item
Unknown (1)
CL Item
Not evaluated (2)
CL Item
Not done within 100 days from HSCT (Not done within 100 days from HSCT)
CL Item
Yes (Yes)
CL Item
Date unknown (Date unknown)
MRI BRAIN SCAN DONE
Item
If MRI BRAIN SCAN DONE Date of most recent MRI scan of brain
date
CL Item
No (1)
CL Item
Yes, Indicate new lesions present (2)
CL Item
Unknown (3)
CL Item
Gadolinium-enhancing (1)
CL Item
Unenhancing (2)
CL Item
Both (3)
CL Item
Unknown (4)
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))
TYPE OF TRANSPLANT
Item
If Other Type of Transplant please specify
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])
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])
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])
PATIENT LAST SEEN
Item
DATE OF LAST CONTACT OR DEATH
date
Item Group
GRAFT VERSUS HOST DISEASE (GvHD) SINCE LAST REPORT
CL Item
grade I (grade I)
CL Item
grade II (grade II)
CL Item
grade III (grade III)
CL Item
grade IV (grade IV)
CL Item
not evaluated (not evaluated)
CL Item
grade 0 (absent) (grade 0 (absent))
CL Item
New onset (1)
CL Item
Recurrent (2)
CL Item
Persistent (3)
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)
Item
Stage skin
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C1306673 (UMLS CUI [1,3])
C1306673 (UMLS CUI [1,2])
C1306673 (UMLS CUI [1,3])
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)
Item
Stage liver
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C0023884 (UMLS CUI [1,3])
C1306673 (UMLS CUI [1,2])
C0023884 (UMLS CUI [1,3])
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)
Item
Stage gut
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C0021853 (UMLS CUI [1,3])
C1306673 (UMLS CUI [1,2])
C0021853 (UMLS CUI [1,3])
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 resolutions
Item
aGvHD Date of resolutions
date
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)
Date of onset
Item
Date of onset
date
C0574845 (UMLS CUI [1])
CL Item
limited (1)
CL Item
Extensive (2)
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
cGvHD Resolved: Date of resolution
Item
cGvHD 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
Date Bacteremia / fungemia / viremia / parasites
Item
Date Bacteremia / fungemia / viremia / parasites
date
Pathogen Septic shock
Item
Pathogen Septic shock
text
Date Septic shock
Item
Date Septic shock
date
Pathogen ARDS
Item
Pathogen ARDS
text
Date ARDS
Item
Date ARDS
date
Pathogen Multiorgan failure due to infection
Item
Pathogen Multiorgan failure due to infection
text
Date Multiorgan failure due to infection
Item
Date Multiorgan failure due to infection
date
Pathogen Pneumonia
Item
Pathogen Pneumonia
text
Date Pneumonia
Item
Date Pneumonia
date
Pathogen Hepatitis
Item
Pathogen Hepatitis
text
Date Hepatitis
Item
Date Hepatitis
date
Pathogen CNS infection
Item
Pathogen CNS infection
text
Date CNS infection
Item
Date CNS infection
date
Pathogen Gut infection
Item
Pathogen Gut infection
text
Date Gut infection
Item
Date Gut infection
date
Pathogen Skin infection
Item
Pathogen Skin infection
text
Date Skin infection
Item
Date Skin infection
date
Pathogen Cystitis
Item
Pathogen Cystitis
text
Date Cystitis
Item
Date Cystitis
date
Pathogen Retinitis
Item
Pathogen Retinitis
text
Date Retinitis
Item
Date Retinitis
date
Other pathogen specified
Item
Other pathogen specified
text
Date Other Pathogen
Item
Date Other Pathogen
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
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 type of NON INFECTION RELATED COMPLICATIONS
Item
Other type of NON INFECTION RELATED COMPLICATIONS, please specify
text
Idiopathic pneumonia syndrome Date
Item
Idiopathic pneumonia syndrome Date
date
VOD Date
Item
VOD Date
date
Cataract Date
Item
Cataract Date
date
Haemorrhagic cystitis, non infectious Date
Item
Haemorrhagic cystitis, non infectious Date
date
ARDS, non infectious Date
Item
ARDS, non infectious Date
date
Multiorgan failure, non infectious Date
Item
Multiorgan failure, non infectious Date
date
HSCT-associated microangiopathy Date
Item
HSCT-associated microangiopathy Date
date
Renal failure requiring dialysis Date
Item
Renal failure requiring dialysis Date
date
Haemolytic anaemia due to blood group Date
Item
Haemolytic anaemia due to blood group Date
date
Aseptic bone necrosis Date
Item
Aseptic bone necrosis Date
date
Date of Other type of NON INFECTION RELATED COMPLICATIONS
Item
Date of Other type of NON INFECTION RELATED COMPLICATIONS
date
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 (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.)
date
C2826247 (UMLS CUI [1])
Identification
Item
Identification of donor or Cord Blood Unit given by the centre
text
C1718162 (UMLS CUI [1])
Number in the infusion order
Item
Number in the infusion order (if applicable)
text
C0237753 (UMLS CUI [1])
CL Item
N/A (1)
Item
Cell type on which test was performed % Donor cells B-Cells
integer
C0004561 (UMLS CUI [1])
Code List
Cell type on which test was performed % Donor cells B-Cells
CL Item
BM (1)
CL Item
PB mononuclear cells (PBMC) (2)
CL Item
T-cell (3)
CL Item
B-cells (4)
CL Item
Red blood cells (5)
CL Item
Monocytes (6)
CL Item
PMNs (neutrophils) (7)
CL Item
Lymphocytes, NOS (8)
CL Item
Myeloid cells, NOS (9)
CL Item
Other, specify (10)
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:
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 (Previously reported)
CL Item
Yes (Yes)
CL Item
No at date of this follow-up (No at date of this follow-up)
Date of Diagnosis
Item
Date of Diagnosis
date
C2316983 (UMLS CUI [1])
CL Item
AML (AML)
CL Item
MDS (MDS)
CL Item
Lymphoproliferative disorder (Lymphoproliferative disorder)
CL Item
Other (Other)
Other diagnosis
Item
Diagnosis, other:
text
C0205394 (UMLS CUI [1])
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Treatment given since last report
Item
If treatment given since last report
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 (CR)
CL Item
Not in CR (Not in CR)
CL Item
Not evaluated (Not evaluated)
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
text
Chronological number
Item
Chronological number of this cell therapy for this patient
float
C2348184 (UMLS CUI [1])
CL Item
Number (1)
CL Item
Not evaluated (2)
CL Item
Unknown (3)
Item
If DLI, specify the number of cells infused by type: CD 34+
text
C3538723 (UMLS CUI [1])
CL Item
Evaluated (Evaluated)
CL Item
Not Evaluated (Not Evaluated)
CL Item
Unknown (Unknown)
CL Item
Evaluated (Evaluated )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Evaluated (Evaluated)
CL Item
Not Evaluated (Not Evaluated)
CL Item
Unknown (Unknown)
CL Item
Planned/protocol (1)
CL Item
Treatment for disease (2)
CL Item
Prophylactic (3)
CL Item
Mixed chimaerism (4)
CL Item
Treatment of GvHD (5)
CL Item
Treatment viral infection (6)
CL Item
Loss/decreased chimaerism (7)
CL Item
Treatment PTLD, EBV lymphoma (8)
CL Item
Other, specify (9)
Infusion count
Item
Number of infusions within 10 weeks (count only infusions that are part of same regimen and given for the same indication)
float
C0574032 (UMLS CUI [1,1])
C0750480 (UMLS CUI [1,2])
C0750480 (UMLS CUI [1,2])
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)
Datestarted
Item
Date started
date
CL Item
Relapse/progression (Relapse/progression)
CL Item
Continued from pre-HSCT (Continued from pre-HSCT)
CL Item
unknow (unknow)
CL Item
Planned per protocol (Planned per protocol)
CL Item
Other (Other)
Overall main reason
Item
Of Other, please specify
text
CL Item
no (no)
CL Item
yes (yes)
CL Item
unknown (unknown)
CL Item
Cyclophosphamide (Cyclophosphamide)
CL Item
Mitoxantron (Mitoxantron)
CL Item
Anti-lymphocyte antibodies (Anti-lymphocyte antibodies)
CL Item
Corticosteroids (Corticosteroids)
CL Item
Chronic low dose (Chronic low dose)
CL Item
Pulse high dose (Pulse high dose)
CL Item
Azathioprine (Azathioprine)
CL Item
Cop-I (Cop-I)
CL Item
Alpha interferon (Alpha interferon)
CL Item
Beta Interferon (Beta Interferon)
CL Item
NO (NO)
CL Item
YES (YES)
CL Item
UNKNOWN (UNKNOWN)
CL Item
no (no)
CL Item
yes (yes)
CL Item
unknown (unknown)
CL Item
no (no)
CL Item
yes (yes )
CL Item
unknown (unknown)
Other modality
Item
if other please specify
text
Item Group
FIRST EVIDENCE OF DISEASE WORSENING SINCE LAST HSCT
CL Item
Previously reported (Previously reported)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Continuous worsening since HSCT (Continuous worsening since HSCT)
EventDiseaseResponseDate
Item
Date First Noted (mm-dd-yyyy)
date
C0011008 (UMLS CUI [1,1])
C0871261 (UMLS CUI [1,2])
C0441471 (UMLS CUI [1,3])
C0012634 (UMLS CUI [1,4])
C0871261 (UMLS CUI [1,2])
C0441471 (UMLS CUI [1,3])
C0012634 (UMLS CUI [1,4])
Number of relapses/progressions since last HSCT
Item
Number of relapses/progressions since last HSCT
float
Item
Number of relapses/progressions since last HSCT
integer
Code List
Number of relapses/progressions since last HSCT
CL Item
unknown (1)
Scripps neurological rating scale
Item
Scripps neurological rating scale Score
float
CL Item
Unknown (Unknown)
CL Item
Not evaluated (Not evaluated)
Kurtze functional systems
Item
Kurtze functional systems Overall score
float
CL Item
Unknown (Unknown)
CL Item
Not evaluated (Not evaluated)
Kurtze Expanded Disability Status
Item
Kurtze Expanded Disability Status Scale (EDSS)
float
CL Item
Unknown (Unknown)
CL Item
Not evaluated (Not evaluated)
Composite Scale
Item
Composite Scale Score
float
CL Item
Unknown (Unknown)
CL Item
Not evaluated (Not evaluated)
CL Item
Not done (Not done)
CL Item
Yes (Yes)
Date of most recent MRI scan of brain
Item
Date of most recent MRI scan of brain
date
CL Item
no (no)
CL Item
yes (yes)
CL Item
unknown (unknown)
CL Item
Gadolinium-enhancing (Gadolinium-enhancing)
CL Item
Unenhancing (Unenhancing)
CL Item
Both (Both)
CL Item
Unknown (Unknown)
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 (1)
CL Item
Lansky (2)
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
Not evaluated (11)
CL Item
Unknown (12)
CL Item
Relapse or progression (1)
CL Item
Secondary malignancy (including lymphoproliferative disease) (2)
CL Item
HSCT related cause (3)
CL Item
Unknown (4)
CL Item
Other (5)
CL Item
GvHD (1)
CL Item
Interstitial pneumonitis (2)
CL Item
Pulmonary toxicity (3)
CL Item
Infection bacterial (4)
CL Item
Infection viral (5)
CL Item
Infection fungal (6)
CL Item
Infection parasitic (7)
CL Item
Infection unknown (8)
CL Item
Rejection / poor graft function (9)
CL Item
Veno-occlusive disease (VOD) (10)
CL Item
Haemorrhage (11)
CL Item
Cardiac toxicity (12)
CL Item
Central nervous system toxicity (13)
CL Item
Gastro intestinal toxicity (14)
CL Item
Skin toxicity (15)
CL Item
Renal failure (16)
CL Item
Multiple organ failure (17)
CL Item
Other (18)
COMMENTS
Item
COMMENTS
text
Identification
Item
Identification
text
C0205396 (UMLS CUI [1])