ID

15077

Descripción

International Collaborative Treatment Protocol For Children And Adolescents With Acute Lymphoblastic Leukemia. Phase 3 Study. Initial survey. Please send this document within one month after diagnosis to the study centre. Clinical Trial Number: NCT01117441.

Palabras clave

Versiones (1)
  1. 15/5/16 15/5/16 -
Subido en

15 de mayo de 2016

DOI

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Licencia

Creative Commons BY-NC-ND 3.0
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Initial survey AIEOP-BFM ALL 2009 DRKS00003772 NCT01117441

Inglés

Initial survey AIEOP-BFM ALL 2009 NCT01117441

1 formularios  
Patient Information
Descripción

Patient Information

Alias
UMLS CUI-1
C1955348
Patient Study ID
Descripción

Patient Study ID

Tipo de datos

text

Alias
UMLS CUI [1]
C2348585
Patient date of birth
Descripción

Patient date of birth

Tipo de datos

date

Alias
UMLS CUI [1]
C0421451
Informed consent
Descripción

Informed consent

Tipo de datos

text

Alias
UMLS CUI [1]
C0021430
Anamnesis
Descripción

Anamnesis

Alias
UMLS CUI-1
C0199182
Hospital stay during the last four weeks before diagnosis
Descripción

Hospital stay

Tipo de datos

boolean

Alias
UMLS CUI [1]
C3489408
Hospital stay: If "Yes", specify hospital:
Descripción

Hospital stay: Hospital

Tipo de datos

text

Alias
UMLS CUI [1,1]
C3489408
UMLS CUI [1,2]
C0019994
Hospital stay: If "Yes", specify date of hospitalisation:
Descripción

Hospital stay: Date of hospitalisation

Tipo de datos

date

Alias
UMLS CUI [1,1]
C3489408
UMLS CUI [1,2]
C0019993
UMLS CUI [1,3]
C0011008
Hospital stay: If "Yes", specify date of discharge:
Descripción

Hospital stay: Date of discharge

Tipo de datos

date

Alias
UMLS CUI [1,1]
C3489408
UMLS CUI [1,2]
C2361123
Birth weight
Descripción

Birth weight

Tipo de datos

float

Unidades de medida
  • g
Alias
UMLS CUI [1]
C0005612
g
Birth size
Descripción

Birth size

Tipo de datos

text

Unidades de medida
  • cm
Alias
UMLS CUI [1,1]
C0005901
UMLS CUI [1,2]
C2599577
cm
Gestational age
Descripción

Gestational age

Tipo de datos

text

Unidades de medida
  • Weeks of pregnancy
Alias
UMLS CUI [1]
C0017504
Weeks of pregnancy
Medical assisted reproduction
Descripción

Medical assisted reproduction

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0493980
Number of siblings
Descripción

Number of siblings

Tipo de datos

float

Alias
UMLS CUI [1,1]
C0037047
UMLS CUI [1,2]
C0237753
Number of half siblings
Descripción

Number of half siblings

Tipo de datos

float

Alias
UMLS CUI [1,1]
C0237753
UMLS CUI [1,2]
C0337505
Number of not biological siblings
Descripción

Number of not biological siblings

Tipo de datos

float

Alias
UMLS CUI [1,1]
C0337502
UMLS CUI [1,2]
C1518422
UMLS CUI [1,3]
C0237753
Multiple birth offspring
Descripción

Multiple birth offspring

Tipo de datos

text

Alias
UMLS CUI [1]
C0026753
Multiple birth offspring If "Yes", specify zygosity:
Descripción

Multiple birth offspring: zygosity

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0026753
UMLS CUI [1,2]
C1710709
Fever > 38,5 °C
Descripción

Fever

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0015967
Pathogen detection
Descripción

Pathogen detection

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1740302
Pathogen detection If "Yes", specify:
Descripción

Pathogen detection: specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1740302
UMLS CUI [1,2]
C2348235
CRP increase
Descripción

CRP increase

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0201657
UMLS CUI [1,2]
C0442805
CRP measurement: If a positive CRP increase, specify:
Descripción

CRP measurement

Tipo de datos

float

Unidades de medida
  • mg/dL
Alias
UMLS CUI [1]
C0201657
mg/dL
Previous disease: Malignancies
Descripción

Malignancies

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0006826
Previous disease: Malignancies: If "Yes", specify:
Descripción

Malignancies: specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0006826
UMLS CUI [1,2]
C2348235
Previous disease: Immune deficiency
Descripción

Immune deficiency

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1855771
Previous disease: Immune deficiency If "Yes", specify:
Descripción

Immune deficiency: specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1855771
UMLS CUI [1,2]
C2348235
Previous disease: Haematological disease
Descripción

Haematological disease

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0018939
Previous disease: Haematological disease If "Yes", specify:
Descripción

Haematological disease: specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0018939
UMLS CUI [1,2]
C2348235
Previous disease: Chronic virus infection
Descripción

Chronic virus infection

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C3829806
UMLS CUI [1,2]
C0042769
Previous disease: Chronic virus infection If "Yes", specify:
Descripción

Chronic virus infection: specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C3829806
UMLS CUI [1,2]
C0042769
UMLS CUI [1,3]
C2348235
Previous disease: Chromosomal aberration/ hereditary disease
Descripción

Chromosomal aberration/ hereditary disease

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0008625
UMLS CUI [2]
C0019247
Previous disease: Chromosomal aberration/ hereditary disease If "Yes", specify:
Descripción

Chromosomal aberration/ hereditary disease: specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0008625
UMLS CUI [1,2]
C2348235
UMLS CUI [2,1]
C0019247
UMLS CUI [2,2]
C2348235
Previous disease: Metabolic disease
Descripción

Metabolic disease

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0025517
Previous disease: Metabolic disease If "Yes", specify:
Descripción

Metabolic disease: specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0025517
UMLS CUI [1,2]
C2348235
Previous disease: Autoimmune disease
Descripción

Autoimmune disease

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0004364
Previous disease: Autoimmune disease If "Yes", specify:
Descripción

Autoimmune disease: specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0004364
UMLS CUI [1,2]
C2348235
Previous disease: Cardiac disease
Descripción

Cardiac disease

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0018799
Previous disease: Cardiac disease If "Yes", specify:
Descripción

Cardiac disease: specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0018799
UMLS CUI [1,2]
C2348235
Previous disease: Chronic disease
Descripción

Chronic disease

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0008679
Previous disease: Chronic disease If "Yes", specify:
Descripción

Chronic disease: specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0008679
UMLS CUI [1,2]
C2348235
Siblings suffering from malignancy
Descripción

Siblings suffering from malignancy

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0337502
UMLS CUI [1,2]
C0006826
Siblings suffering from malignancy If "Yes", specify:
Descripción

Siblings suffering from malignancy specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0337502
UMLS CUI [1,2]
C0006826
UMLS CUI [1,3]
C2348235
Mother suffering from malignancy
Descripción

Mother suffering from malignancy

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0026591
UMLS CUI [1,2]
C0006826
Mother suffering from malignancy If "Yes", specify:
Descripción

Mother suffering from malignancy specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0026591
UMLS CUI [1,2]
C0006826
UMLS CUI [1,3]
C2348235
Parents of mother suffering from malignancy
Descripción

Parents of mother suffering from malignancy

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0337471
UMLS CUI [1,2]
C2347083
UMLS CUI [1,3]
C0006826
Mother of mother suffering from malignancy If "Yes, mother's mother", specify:
Descripción

Mother of mother suffering from malignancy

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0337474
UMLS CUI [1,2]
C2347083
UMLS CUI [1,3]
C0006826
UMLS CUI [1,4]
C2348235
Father of mother suffering from malignancy If "Yes, mother's father", specify:
Descripción

Father of mother suffering from malignancy

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0337475
UMLS CUI [1,2]
C2347083
UMLS CUI [1,3]
C0006826
UMLS CUI [1,4]
C2348235
Siblings of mother suffering from malignancy
Descripción

Siblings of mother suffering from malignancy

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0037047
UMLS CUI [1,2]
C2347083
UMLS CUI [1,3]
C0006826
Siblings of mother suffering from malignancy: If "Yes", specify:
Descripción

Siblings of mother suffering from malignancy specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0037047
UMLS CUI [1,2]
C2347083
UMLS CUI [1,3]
C0006826
UMLS CUI [1,4]
C2348235
Niece/nephew of mother suffering from malignancy
Descripción

Niece/nephew of mother suffering from malignancy

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C1553703
UMLS CUI [1,2]
C2347083
UMLS CUI [1,3]
C0006826
Niece/nephew of mother suffering from malignancy specification If "Yes", specify:
Descripción

Niece/nephew of mother suffering from malignancy specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1553703
UMLS CUI [1,2]
C2347083
UMLS CUI [1,3]
C0006826
UMLS CUI [1,4]
C2348235
Father suffering from malignancy
Descripción

Father suffering from malignancy

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0015671
UMLS CUI [1,2]
C0006826
Father suffering from malignancy If "Yes", specify:
Descripción

Father suffering from malignancy specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0015671
UMLS CUI [1,2]
C0006826
UMLS CUI [1,3]
C2348235
Parents of father suffering from malignancy
Descripción

Parents of father suffering from malignancy

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0337471
UMLS CUI [1,2]
C2347452
UMLS CUI [1,3]
C0006826
Mother of father suffering from malignancy If "Yes, father's mother", specify:
Descripción

Mother of father suffering from malignancy

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0337474
UMLS CUI [1,2]
C2347452
UMLS CUI [1,3]
C0006826
UMLS CUI [1,4]
C2348235
Father of father suffering from malignancy If "Yes, father's father", specify:
Descripción

Father of father suffering from malignancy

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0337475
UMLS CUI [1,2]
C2347452
UMLS CUI [1,3]
C0006826
UMLS CUI [1,4]
C2348235
Siblings of father suffering from malignancy
Descripción

Siblings of father suffering from malignancy

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0037047
UMLS CUI [1,2]
C2347452
UMLS CUI [1,3]
C0006826
Siblings of mother suffering from malignancy
Descripción

Siblings of mother suffering from malignancy

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0037047
UMLS CUI [1,2]
C2347452
UMLS CUI [1,3]
C0006826
UMLS CUI [1,4]
C2348235
Niece/nephew of father suffering from malignancy
Descripción

Niece/nephew of father suffering from malignancy

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C1553703
UMLS CUI [1,2]
C2347452
UMLS CUI [1,3]
C0006826
Niece/nephew of father suffering from malignancy If "Yes", specify:
Descripción

Niece/nephew of father suffering from malignancy

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1553703
UMLS CUI [1,2]
C2347452
UMLS CUI [1,3]
C0006826
UMLS CUI [1,4]
C2348235
Diagnosis
Descripción

Diagnosis

Alias
UMLS CUI-1
C0011900
Hospital admission date (in hospital of study centre)
Descripción

Hospital admission date

Tipo de datos

date

Alias
UMLS CUI [1]
C0806429
Leukopheresis performed?
Descripción

Leukopheresis

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0023416
Leukopheresis: If "Yes", specify start date:
Descripción

Leukopheresis start date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0023416
UMLS CUI [1,2]
C0808070
Leukopheresis: If "Yes", specify end date:
Descripción

Leukopheresis end date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0023416
UMLS CUI [1,2]
C0806020
Weight
Descripción

Weight

Tipo de datos

float

Unidades de medida
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Height
Descripción

Height

Tipo de datos

float

Unidades de medida
  • cm
Alias
UMLS CUI [1]
C0005890
cm
Blood analysis
Descripción

Blood analysis

Alias
UMLS CUI-1
C0018941
Date of initial blood analysis (first hospital admission, before transfusion)
Descripción

Initial blood analysis: date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0205265
UMLS CUI [1,3]
C0018941
Initial blood analysis: leukocytes
Descripción

Initial blood analysis: leukocytes

Tipo de datos

float

Unidades de medida
  • /μl
Alias
UMLS CUI [1,1]
C0023508
UMLS CUI [1,2]
C0205265
UMLS CUI [1,3]
C0018941
/μl
Inital blood analysis: blasts
Descripción

Inital blood analysis: blasts

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1,1]
C0523113
UMLS CUI [1,2]
C0205265
UMLS CUI [1,3]
C0018941
%
Initial blood analysis: platelets
Descripción

Initial blood analysis: platelets

Tipo de datos

float

Unidades de medida
  • /μl
Alias
UMLS CUI [1,1]
C0032181
UMLS CUI [1,2]
C0205265
UMLS CUI [1,3]
C0018941
/μl
Initial blood analysis: haemoglobin
Descripción

Initial blood analysis: haemoglobin

Tipo de datos

float

Unidades de medida
  • g/dL
Alias
UMLS CUI [1,1]
C0518015
UMLS CUI [1,2]
C0205265
UMLS CUI [1,3]
C0018941
g/dL
Date of blood analysis at diagnosis (usually at bone-marrow-puncture; if there was no BMP perfomed before therapy start, take blood analysis wich was relevant for diagnosis)
Descripción

Blood analysis at diagnosis: date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0011900
UMLS CUI [1,3]
C0018941
Blood analysis at diagnosis: leukocytes
Descripción

Blood analysis at diagnosis: leukocytes

Tipo de datos

float

Unidades de medida
  • /μl
Alias
UMLS CUI [1,1]
C0023508
UMLS CUI [1,2]
C0011900
UMLS CUI [1,3]
C0018941
/μl
Blood analysis at diagnosis: blasts
Descripción

Blood analysis at diagnosis: blasts

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1,1]
C0523113
UMLS CUI [1,2]
C0011900
UMLS CUI [1,3]
C0018941
%
Date of blood analysis at therapy start (Day 1 of the pre phase)
Descripción

Blood analysis at therapy start: date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C2114713
UMLS CUI [1,3]
C0018941
Blood analysis at therapy start: leukocytes
Descripción

Blood analysis at therapy start: leukocytes

Tipo de datos

float

Unidades de medida
  • /μl
Alias
UMLS CUI [1,1]
C0023508
UMLS CUI [1,2]
C2114713
UMLS CUI [1,3]
C0018941
/μl
Blood analysis at therapy start: blasts
Descripción

Blood analysis at therapy start: blasts

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1,1]
C0523113
UMLS CUI [1,2]
C2114713
UMLS CUI [1,3]
C0018941
%
Initial CNS status
Descripción

Initial CNS status

Alias
UMLS CUI-1
C0449389
UMLS CUI-2
C0205265
Initial lumbar puncture: date
Descripción

Initial lumbar puncture: date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C2584899
UMLS CUI [1,2]
C0205265
UMLS CUI [1,3]
C0553794
Cerebrospinal fluid contaminated with blood (macroscopically)
Descripción

Cerebrospinal fluid contaminated with blood

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0007806
UMLS CUI [1,2]
C2349974
UMLS CUI [1,3]
C0005767
Cerebrospinal fluid: Cell count performed? (with haemocytometer)
Descripción

Cerebrospinal fluid: cell count

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1317024
Cerebrospinal fluid: If cell count performed, specify erythrocytes:
Descripción

Cerebrospinal fluid: erythrocytes

Tipo de datos

float

Unidades de medida
  • /μl
Alias
UMLS CUI [1]
C2026591
/μl
Cerebrospinal fluid: If cell count performed, specify nucleated cells:
Descripción

Cerebrospinal fluid: nucleated cells

Tipo de datos

float

Unidades de medida
  • /μl
Alias
UMLS CUI [1]
C2926229
/μl
Cytomorphological assessment of cytospin
Descripción

Cytomorphological assessment of cytospin compound

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1271796
UMLS CUI [1,2]
C0543482
UMLS CUI [1,3]
C0010819
Cytomorphological blasts in cytospin compound?
Descripción

Blasts in cytospin compound

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0523113
UMLS CUI [1,2]
C1271796
Initial diagnostic imaging of CNS
Descripción

Initial diagnostic imaging of CNS

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0011923
UMLS CUI [1,2]
C0205265
UMLS CUI [1,3]
C3714787
Initial diagnostic imaging of CNS If performed, specify date of procedure:
Descripción

Initial diagnostic imaging of CNS: Date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C2584899
UMLS CUI [1,2]
C0011923
UMLS CUI [1,3]
C0205265
UMLS CUI [1,4]
C3714787
Cerebral mass or leptomeningeal involvement found in imaging
Descripción

Cerebral mass or leptomeningeal involvement

Tipo de datos

text

Alias
UMLS CUI [1]
C0742078
UMLS CUI [2]
C3160796
Examination of cranial nerves: cranial nerves dysfunction?
Descripción

Examination of cranial nerves

Tipo de datos

text

Alias
UMLS CUI [1]
C0558819
Examination of cranial nerves: If performed, specify date:
Descripción

Date of examination of cranial nerves

Tipo de datos

date

Alias
UMLS CUI [1,1]
C2826643
UMLS CUI [1,2]
C0558819
Treatment of CNS
Descripción

Treatment of CNS

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C3714787
Multi-organ involvement
Descripción

Multi-organ involvement

Alias
UMLS CUI-1
C0457577
Liver size (palpatoric): performed?
Descripción

Liver size

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0426688
Liver size (palpatoric) If performed, specify value: (in cm under costal arch in MCL)
Descripción

Liver size value

Tipo de datos

float

Unidades de medida
  • cm
Alias
UMLS CUI [1,1]
C0426688
UMLS CUI [1,2]
C1522609
cm
Spleen size (palpatoric): performed?
Descripción

Spleen size

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0030250
Spleen size (palpatoric) If performed, specify value: (in cm under costal arch in MCL)
Descripción

Spleen size value

Tipo de datos

float

Unidades de medida
  • cm
Alias
UMLS CUI [1,1]
C0030250
UMLS CUI [1,2]
C1522609
cm
Involvement of mediastinum
Descripción

Involvement of mediastinum

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0025066
UMLS CUI [1,2]
C1314939
Involvement of testicles
Descripción

Involvement of testicles

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0039597
UMLS CUI [1,2]
C1314939
Prednisone response (on day 8 of cytoreductive pre-phase)
Descripción

Prednisone response (on day 8 of cytoreductive pre-phase)

Alias
UMLS CUI-1
C0032952
UMLS CUI-2
C0871261
Date (on day 8 of cytoreductive pre-phase)
Descripción

Date

Tipo de datos

date

Alias
UMLS CUI [1]
C0011008
Leukocytes
Descripción

Leukocytes

Tipo de datos

float

Unidades de medida
  • /μl
Alias
UMLS CUI [1]
C0023508
/μl
Blasts (peripher)
Descripción

Blasts

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0523113
%
Cumulative dose of prednisone (7 days)
Descripción

Cumulative dose of prednisone

Tipo de datos

float

Unidades de medida
  • mg
Alias
UMLS CUI [1,1]
C0032952
UMLS CUI [1,2]
C2986497
mg
Comments
Descripción

Comments

Alias
UMLS CUI-1
C0947611
Comments
Descripción

Comments

Tipo de datos

text

Alias
UMLS CUI [1]
C0947611
Identification and Signature
Descripción

Identification and Signature

Alias
UMLS CUI-1
C0205396
UMLS CUI-3
C1519316
Investigator's name
Descripción

Investigator's name

Tipo de datos

text

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0027365
Date of report
Descripción

Date of report

Tipo de datos

date

Alias
UMLS CUI [1]
C1302584
Investigator's signature
Descripción

Investigator's signature

Tipo de datos

text

Alias
UMLS CUI [1]
C2346576
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Similar models

Initial survey AIEOP-BFM ALL 2009 NCT01117441

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Patient Information
C1955348 (UMLS CUI-1)
Patient Study ID
Item
Patient Study ID
text
C2348585 (UMLS CUI [1])
Patient date of birth
Item
Patient date of birth
date
C0421451 (UMLS CUI [1])
Informed consent
Item
Informed consent
text
C0021430 (UMLS CUI [1])
Item Group
Anamnesis
C0199182 (UMLS CUI-1)
Hospital stay
Item
Hospital stay during the last four weeks before diagnosis
boolean
C3489408 (UMLS CUI [1])
Hospital stay: Hospital
Item
Hospital stay: If "Yes", specify hospital:
text
C3489408 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Hospital stay: Date of hospitalisation
Item
Hospital stay: If "Yes", specify date of hospitalisation:
date
C3489408 (UMLS CUI [1,1])
C0019993 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Hospital stay: Date of discharge
Item
Hospital stay: If "Yes", specify date of discharge:
date
C3489408 (UMLS CUI [1,1])
C2361123 (UMLS CUI [1,2])
Birth weight
Item
Birth weight
float
C0005612 (UMLS CUI [1])
Birth size
Item
Birth size
text
C0005901 (UMLS CUI [1,1])
C2599577 (UMLS CUI [1,2])
Gestational age
Item
Gestational age
text
C0017504 (UMLS CUI [1])
Medical assisted reproduction
Item
Medical assisted reproduction
boolean
C0493980 (UMLS CUI [1])
Number of siblings
Item
Number of siblings
float
C0037047 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Number of half siblings
Item
Number of half siblings
float
C0237753 (UMLS CUI [1,1])
C0337505 (UMLS CUI [1,2])
Number of not biological siblings
Item
Number of not biological siblings
float
C0337502 (UMLS CUI [1,1])
C1518422 (UMLS CUI [1,2])
C0237753 (UMLS CUI [1,3])
Item
Multiple birth offspring
text
C0026753 (UMLS CUI [1])
Multiple birth offspring
Code List
Multiple birth offspring
CL Item
no (no)
CL Item
yes, twins (yes, twins)
CL Item
yes, multiples (yes, multiples)
Item
Multiple birth offspring If "Yes", specify zygosity:
text
C0026753 (UMLS CUI [1,1])
C1710709 (UMLS CUI [1,2])
Multiple birth offspring: zygosity
Code List
Multiple birth offspring If "Yes", specify zygosity:
CL Item
dizygotic (dizygotic)
CL Item
monozygotic (monozygotic)
Fever
Item
Fever > 38,5 °C
boolean
C0015967 (UMLS CUI [1])
Pathogen detection
Item
Pathogen detection
boolean
C1740302 (UMLS CUI [1])
Pathogen detection: specification
Item
Pathogen detection If "Yes", specify:
text
C1740302 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
CRP increase
Item
CRP increase
boolean
C0201657 (UMLS CUI [1,1])
C0442805 (UMLS CUI [1,2])
CRP measurement
Item
CRP measurement: If a positive CRP increase, specify:
float
C0201657 (UMLS CUI [1])
Malignancies
Item
Previous disease: Malignancies
boolean
C0006826 (UMLS CUI [1])
Malignancies: specification
Item
Previous disease: Malignancies: If "Yes", specify:
text
C0006826 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Immune deficiency
Item
Previous disease: Immune deficiency
boolean
C1855771 (UMLS CUI [1])
Immune deficiency: specification
Item
Previous disease: Immune deficiency If "Yes", specify:
text
C1855771 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Haematological disease
Item
Previous disease: Haematological disease
boolean
C0018939 (UMLS CUI [1])
Haematological disease: specification
Item
Previous disease: Haematological disease If "Yes", specify:
text
C0018939 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Chronic virus infection
Item
Previous disease: Chronic virus infection
boolean
C3829806 (UMLS CUI [1,1])
C0042769 (UMLS CUI [1,2])
Chronic virus infection: specification
Item
Previous disease: Chronic virus infection If "Yes", specify:
text
C3829806 (UMLS CUI [1,1])
C0042769 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Chromosomal aberration/ hereditary disease
Item
Previous disease: Chromosomal aberration/ hereditary disease
boolean
C0008625 (UMLS CUI [1])
C0019247 (UMLS CUI [2])
Chromosomal aberration/ hereditary disease: specification
Item
Previous disease: Chromosomal aberration/ hereditary disease If "Yes", specify:
text
C0008625 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
C0019247 (UMLS CUI [2,1])
C2348235 (UMLS CUI [2,2])
Metabolic disease
Item
Previous disease: Metabolic disease
boolean
C0025517 (UMLS CUI [1])
Metabolic disease: specification
Item
Previous disease: Metabolic disease If "Yes", specify:
text
C0025517 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Autoimmune disease
Item
Previous disease: Autoimmune disease
boolean
C0004364 (UMLS CUI [1])
Autoimmune disease: specification
Item
Previous disease: Autoimmune disease If "Yes", specify:
text
C0004364 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Cardiac disease
Item
Previous disease: Cardiac disease
boolean
C0018799 (UMLS CUI [1])
Cardiac disease: specification
Item
Previous disease: Cardiac disease If "Yes", specify:
text
C0018799 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Chronic disease
Item
Previous disease: Chronic disease
boolean
C0008679 (UMLS CUI [1])
Chronic disease: specification
Item
Previous disease: Chronic disease If "Yes", specify:
text
C0008679 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Siblings suffering from malignancy
Item
Siblings suffering from malignancy
boolean
C0337502 (UMLS CUI [1,1])
C0006826 (UMLS CUI [1,2])
Siblings suffering from malignancy specification
Item
Siblings suffering from malignancy If "Yes", specify:
text
C0337502 (UMLS CUI [1,1])
C0006826 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Mother suffering from malignancy
Item
Mother suffering from malignancy
boolean
C0026591 (UMLS CUI [1,1])
C0006826 (UMLS CUI [1,2])
Mother suffering from malignancy specification
Item
Mother suffering from malignancy If "Yes", specify:
text
C0026591 (UMLS CUI [1,1])
C0006826 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Item
Parents of mother suffering from malignancy
text
C0337471 (UMLS CUI [1,1])
C2347083 (UMLS CUI [1,2])
C0006826 (UMLS CUI [1,3])
Parents of mother suffering from malignancy
Code List
Parents of mother suffering from malignancy
CL Item
no (no)
CL Item
yes, mother's mother (yes, mother's mother)
CL Item
yes, mother's father (yes, mother's father)
Mother of mother suffering from malignancy
Item
Mother of mother suffering from malignancy If "Yes, mother's mother", specify:
text
C0337474 (UMLS CUI [1,1])
C2347083 (UMLS CUI [1,2])
C0006826 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Father of mother suffering from malignancy
Item
Father of mother suffering from malignancy If "Yes, mother's father", specify:
text
C0337475 (UMLS CUI [1,1])
C2347083 (UMLS CUI [1,2])
C0006826 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Siblings of mother suffering from malignancy
Item
Siblings of mother suffering from malignancy
boolean
C0037047 (UMLS CUI [1,1])
C2347083 (UMLS CUI [1,2])
C0006826 (UMLS CUI [1,3])
Siblings of mother suffering from malignancy specification
Item
Siblings of mother suffering from malignancy: If "Yes", specify:
text
C0037047 (UMLS CUI [1,1])
C2347083 (UMLS CUI [1,2])
C0006826 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Niece/nephew of mother suffering from malignancy
Item
Niece/nephew of mother suffering from malignancy
boolean
C1553703 (UMLS CUI [1,1])
C2347083 (UMLS CUI [1,2])
C0006826 (UMLS CUI [1,3])
Niece/nephew of mother suffering from malignancy specification
Item
Niece/nephew of mother suffering from malignancy specification If "Yes", specify:
text
C1553703 (UMLS CUI [1,1])
C2347083 (UMLS CUI [1,2])
C0006826 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Father suffering from malignancy
Item
Father suffering from malignancy
boolean
C0015671 (UMLS CUI [1,1])
C0006826 (UMLS CUI [1,2])
Father suffering from malignancy specification
Item
Father suffering from malignancy If "Yes", specify:
text
C0015671 (UMLS CUI [1,1])
C0006826 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Item
Parents of father suffering from malignancy
text
C0337471 (UMLS CUI [1,1])
C2347452 (UMLS CUI [1,2])
C0006826 (UMLS CUI [1,3])
Parents of father suffering from malignancy
Code List
Parents of father suffering from malignancy
CL Item
no (no)
CL Item
yes, father's mother (yes, father's mother)
CL Item
yes, father's father (yes, fathers father)
Mother of father suffering from malignancy
Item
Mother of father suffering from malignancy If "Yes, father's mother", specify:
text
C0337474 (UMLS CUI [1,1])
C2347452 (UMLS CUI [1,2])
C0006826 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Father of father suffering from malignancy
Item
Father of father suffering from malignancy If "Yes, father's father", specify:
text
C0337475 (UMLS CUI [1,1])
C2347452 (UMLS CUI [1,2])
C0006826 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Siblings of father suffering from malignancy
Item
Siblings of father suffering from malignancy
boolean
C0037047 (UMLS CUI [1,1])
C2347452 (UMLS CUI [1,2])
C0006826 (UMLS CUI [1,3])
Siblings of mother suffering from malignancy
Item
Siblings of mother suffering from malignancy
text
C0037047 (UMLS CUI [1,1])
C2347452 (UMLS CUI [1,2])
C0006826 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Niece/nephew of father suffering from malignancy
Item
Niece/nephew of father suffering from malignancy
boolean
C1553703 (UMLS CUI [1,1])
C2347452 (UMLS CUI [1,2])
C0006826 (UMLS CUI [1,3])
Niece/nephew of father suffering from malignancy
Item
Niece/nephew of father suffering from malignancy If "Yes", specify:
text
C1553703 (UMLS CUI [1,1])
C2347452 (UMLS CUI [1,2])
C0006826 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Item Group
Diagnosis
C0011900 (UMLS CUI-1)
Hospital admission date
Item
Hospital admission date (in hospital of study centre)
date
C0806429 (UMLS CUI [1])
Leukopheresis
Item
Leukopheresis performed?
boolean
C0023416 (UMLS CUI [1])
Leukopheresis start date
Item
Leukopheresis: If "Yes", specify start date:
date
C0023416 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Leukopheresis end date
Item
Leukopheresis: If "Yes", specify end date:
date
C0023416 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Weight
Item
Weight
float
C0005910 (UMLS CUI [1])
Height
Item
Height
float
C0005890 (UMLS CUI [1])
Item Group
Blood analysis
C0018941 (UMLS CUI-1)
Initial blood analysis: date
Item
Date of initial blood analysis (first hospital admission, before transfusion)
date
C0011008 (UMLS CUI [1,1])
C0205265 (UMLS CUI [1,2])
C0018941 (UMLS CUI [1,3])
Initial blood analysis: leukocytes
Item
Initial blood analysis: leukocytes
float
C0023508 (UMLS CUI [1,1])
C0205265 (UMLS CUI [1,2])
C0018941 (UMLS CUI [1,3])
Inital blood analysis: blasts
Item
Inital blood analysis: blasts
float
C0523113 (UMLS CUI [1,1])
C0205265 (UMLS CUI [1,2])
C0018941 (UMLS CUI [1,3])
Initial blood analysis: platelets
Item
Initial blood analysis: platelets
float
C0032181 (UMLS CUI [1,1])
C0205265 (UMLS CUI [1,2])
C0018941 (UMLS CUI [1,3])
Initial blood analysis: haemoglobin
Item
Initial blood analysis: haemoglobin
float
C0518015 (UMLS CUI [1,1])
C0205265 (UMLS CUI [1,2])
C0018941 (UMLS CUI [1,3])
Blood analysis at diagnosis: date
Item
Date of blood analysis at diagnosis (usually at bone-marrow-puncture; if there was no BMP perfomed before therapy start, take blood analysis wich was relevant for diagnosis)
date
C0011008 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
C0018941 (UMLS CUI [1,3])
Blood analysis at diagnosis: leukocytes
Item
Blood analysis at diagnosis: leukocytes
float
C0023508 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
C0018941 (UMLS CUI [1,3])
Blood analysis at diagnosis: blasts
Item
Blood analysis at diagnosis: blasts
float
C0523113 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
C0018941 (UMLS CUI [1,3])
Blood analysis at therapy start: date
Item
Date of blood analysis at therapy start (Day 1 of the pre phase)
date
C0011008 (UMLS CUI [1,1])
C2114713 (UMLS CUI [1,2])
C0018941 (UMLS CUI [1,3])
Blood analysis at therapy start: leukocytes
Item
Blood analysis at therapy start: leukocytes
float
C0023508 (UMLS CUI [1,1])
C2114713 (UMLS CUI [1,2])
C0018941 (UMLS CUI [1,3])
Blood analysis at therapy start: blasts
Item
Blood analysis at therapy start: blasts
float
C0523113 (UMLS CUI [1,1])
C2114713 (UMLS CUI [1,2])
C0018941 (UMLS CUI [1,3])
Item Group
Initial CNS status
C0449389 (UMLS CUI-1)
C0205265 (UMLS CUI-2)
Initial lumbar puncture: date
Item
Initial lumbar puncture: date
date
C2584899 (UMLS CUI [1,1])
C0205265 (UMLS CUI [1,2])
C0553794 (UMLS CUI [1,3])
Cerebrospinal fluid contaminated with blood
Item
Cerebrospinal fluid contaminated with blood (macroscopically)
boolean
C0007806 (UMLS CUI [1,1])
C2349974 (UMLS CUI [1,2])
C0005767 (UMLS CUI [1,3])
Cerebrospinal fluid: cell count
Item
Cerebrospinal fluid: Cell count performed? (with haemocytometer)
boolean
C1317024 (UMLS CUI [1])
Cerebrospinal fluid: erythrocytes
Item
Cerebrospinal fluid: If cell count performed, specify erythrocytes:
float
C2026591 (UMLS CUI [1])
Cerebrospinal fluid: nucleated cells
Item
Cerebrospinal fluid: If cell count performed, specify nucleated cells:
float
C2926229 (UMLS CUI [1])
Item
Cytomorphological assessment of cytospin
text
C1271796 (UMLS CUI [1,1])
C0543482 (UMLS CUI [1,2])
C0010819 (UMLS CUI [1,3])
Cytomorphological assessment of cytospin
Code List
Cytomorphological assessment of cytospin
CL Item
performed: assessment in study centre (performed: assessment in study centre)
CL Item
performed: assessment locally only (please add all results) (performed: assessment locally only (please add all results))
CL Item
not performed: no cytospin compounds prepared (not performed: no cytospin compounds prepared)
CL Item
not performed: cytospin compounds not evaluable (not performed: cytospin compounds not evaluable)
Blasts in cytospin compound
Item
Cytomorphological blasts in cytospin compound?
boolean
C0523113 (UMLS CUI [1,1])
C1271796 (UMLS CUI [1,2])
Item
Initial diagnostic imaging of CNS
text
C0011923 (UMLS CUI [1,1])
C0205265 (UMLS CUI [1,2])
C3714787 (UMLS CUI [1,3])
Initial diagnostic imaging of CNS
Code List
Initial diagnostic imaging of CNS
CL Item
performed: MRI (performed: MRI)
CL Item
performed: CT (performed: CT)
CL Item
not performed (not performed)
Initial diagnostic imaging of CNS: Date
Item
Initial diagnostic imaging of CNS If performed, specify date of procedure:
date
C2584899 (UMLS CUI [1,1])
C0011923 (UMLS CUI [1,2])
C0205265 (UMLS CUI [1,3])
C3714787 (UMLS CUI [1,4])
Item
Cerebral mass or leptomeningeal involvement found in imaging
text
C0742078 (UMLS CUI [1])
C3160796 (UMLS CUI [2])
Cerebral mass or leptomeningeal involvement
Code List
Cerebral mass or leptomeningeal involvement found in imaging
CL Item
yes (please add results and images on CD-ROM) (yes (please add results and images on CD-ROM))
CL Item
no (no)
Item
Examination of cranial nerves: cranial nerves dysfunction?
text
C0558819 (UMLS CUI [1])
Examination of cranial nerves
Code List
Examination of cranial nerves: cranial nerves dysfunction?
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Examination of cranial nerves not performed (Examination of cranial nerves not performed)
Date of examination of cranial nerves
Item
Examination of cranial nerves: If performed, specify date:
date
C2826643 (UMLS CUI [1,1])
C0558819 (UMLS CUI [1,2])
Item
Treatment of CNS
text
C0087111 (UMLS CUI [1,1])
C3714787 (UMLS CUI [1,2])
Treatment of CNS
Code List
Treatment of CNS
CL Item
Like "CNS negative" (Like "CNS negative")
CL Item
Like "CNS negative" and additional MTX (i.th.) in protocol IA (Like "CNS negative" and additional MTX (i.th.) in protocol IA)
CL Item
Like "CNS positive" (Like "CNS positive")
Item Group
Multi-organ involvement
C0457577 (UMLS CUI-1)
Liver size
Item
Liver size (palpatoric): performed?
boolean
C0426688 (UMLS CUI [1])
Liver size value
Item
Liver size (palpatoric) If performed, specify value: (in cm under costal arch in MCL)
float
C0426688 (UMLS CUI [1,1])
C1522609 (UMLS CUI [1,2])
Spleen size
Item
Spleen size (palpatoric): performed?
boolean
C0030250 (UMLS CUI [1])
Spleen size value
Item
Spleen size (palpatoric) If performed, specify value: (in cm under costal arch in MCL)
float
C0030250 (UMLS CUI [1,1])
C1522609 (UMLS CUI [1,2])
Item
Involvement of mediastinum
text
C0025066 (UMLS CUI [1,1])
C1314939 (UMLS CUI [1,2])
Involvement of mediastinum
Code List
Involvement of mediastinum
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
No examination performed (No examination performed)
Item
Involvement of testicles
text
C0039597 (UMLS CUI [1,1])
C1314939 (UMLS CUI [1,2])
Involvement of testicles
Code List
Involvement of testicles
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
No examinatin performed (No examinatin performed)
Item Group
Prednisone response (on day 8 of cytoreductive pre-phase)
C0032952 (UMLS CUI-1)
C0871261 (UMLS CUI-2)
Date
Item
Date (on day 8 of cytoreductive pre-phase)
date
C0011008 (UMLS CUI [1])
Leukocytes
Item
Leukocytes
float
C0023508 (UMLS CUI [1])
Blasts
Item
Blasts (peripher)
float
C0523113 (UMLS CUI [1])
Cumulative dose of prednisone
Item
Cumulative dose of prednisone (7 days)
float
C0032952 (UMLS CUI [1,1])
C2986497 (UMLS CUI [1,2])
Item Group
Comments
C0947611 (UMLS CUI-1)
Comments
Item
Comments
text
C0947611 (UMLS CUI [1])
Item Group
Identification and Signature
C0205396 (UMLS CUI-1)
C1519316 (UMLS CUI-3)
Investigator's name
Item
Investigator's name
text
C2346576 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
Date of report
Item
Date of report
date
C1302584 (UMLS CUI [1])
Investigator's signature
Item
Investigator's signature
text
C2346576 (UMLS CUI [1])
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