ID

15417

Descripción

DOCUMENTED PATHOGENS (Use this table for guidance on the pathogens of interest) 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

Palabras clave

Versiones (1)
  1. 31/5/16 31/5/16 -
Subido en

31 de mayo de 2016

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0
Comentarios del modelo :

Puede comentar sobre el modelo de datos aquí. A través de las burbujas de diálogo en los grupos de elementos y elementos, puede agregar comentarios específicos.

Volver a los comentarios del modelo
Comentarios de grupo de elementos para :

Comentarios del elemento para :

Para descargar modelos de datos, debe haber iniciado sesión. Por favor iniciar sesión o Registrate gratis.

General Info EBMT Lymphoma

Inglés

16pp General Info EBMT Lymphoma 04 Lym.

1 formularios  
GENERAL INFORMATION Team
Descripción

GENERAL INFORMATION Team

EBMT Centre Identification Code (CIC)
Descripción

EBMT Centre Identification Code (CIC)

Tipo de datos

text

Alias
UMLS CUI [1]
C2348585
Name of the hospital
Descripción

Hospital

Tipo de datos

text

Alias
UMLS CUI [1]
C0019994
Unit
Descripción

Unit

Tipo de datos

text

Contact person
Descripción

Contact person

Tipo de datos

text

Telephone number
Descripción

Telephone

Tipo de datos

integer

Alias
UMLS CUI [1]
C1515258
Fax
Descripción

Fax

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1549619
UMLS CUI [1,2]
C0337611
UMLS CUI [1,3]
C0030664
E-Mail
Descripción

E-Mail

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1705961
UMLS CUI [1,2]
C0337611
UMLS CUI [1,3]
C0030664
Date of this report
Descripción

Date of this report

Tipo de datos

date

Alias
UMLS CUI [1]
C1302584
Patient following national / international study / trial
Descripción

Patient in Trial

Tipo de datos

integer

Alias
UMLS CUI [1]
C1997894
Name of study / trial
Descripción

Name of study / trial

Tipo de datos

text

GENERAL INFORMATION Patient
Descripción

GENERAL INFORMATION Patient

To be entered only if patient previously reported
Descripción

Unique Identification Code (UIC)

Tipo de datos

text

Alias
UMLS CUI [1]
C2348585
Hospital Unique Patient Number or Code
Descripción

Hospital Unique Patient Number or Code

Tipo de datos

text

Alias
UMLS CUI [1]
C1827636
First name(s)_surname(s)
Descripción

Initials

Tipo de datos

text

Alias
UMLS CUI [1]
C2986440
Date of birth:
Descripción

Date of birth

Tipo de datos

date

Alias
UMLS CUI [1]
C0421451
Sex
Descripción

Sex

Tipo de datos

text

Alias
UMLS CUI [1]
C0079399
ABO Group
Descripción

ABO Group

Tipo de datos

text

Rh factor Donor a
Descripción

Rh factor

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0035403
UMLS CUI [1,2]
C0013018
DISEASE
Descripción

DISEASE

Date of diagnosis
Descripción

Date of diagnosis

Tipo de datos

date

Alias
UMLS CUI [1]
C2316983
Check the disease for which this transplant was performed
Descripción

Primary Disease Diagnosis

Tipo de datos

text

Alias
UMLS CUI [1]
C0277554
If other diagnosis, specify:
Descripción

Primary Disease Diagnosis

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0277554
UMLS CUI [1,2]
C2348235
LYMPHOMA INITIAL DIAGNOSIS
Descripción

LYMPHOMA INITIAL DIAGNOSIS

Has the information requested in this section been submitted with a previous transplant registration for this patient?
Descripción

Has the information requested in this section been submitted with a previous transplant registration for this patient?

Tipo de datos

integer

Mature B-cell Neoplasms
Descripción

Splenic marginal zone lymphoma

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Extranodal marginal zone lymphoma of mucosa associated lymphoid tissue (MALT)

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Nodal marginal zone lymphoma

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Nodal marginal zone lymphoma

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Lymphoplasmacytic lymphoma (LPL)

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Waldenstrom macroglobulinaemia (LPL with monoclonal IgM)

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Follicular lymphoma

Tipo de datos

integer

Mature B-cell Neoplasms
Descripción

Primary cutaneous follicle centre lymphoma

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Mantle cell lymphoma

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Diffuse large B-cell lymphoma (DLBCL), (NOS)

Tipo de datos

integer

Mature B-cell Neoplasms
Descripción

DLBCL associated with chronic inflammation

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Lymphomatoid granulomatosis

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Primary mediastinal (thymic) large B-cell lymphoma

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Intravascular large B-cell lymphoma

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

ALK positive large B-cell lymphoma

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Plasmablastic lymphoma

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Large B-cell lymphoma arising in HHV8- associated multicentric Castleman disease

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Primary effusion lymphoma (PEL)

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Burkitt lymphoma (BL)

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma (Intermediate DLCBL/BL)

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma (Intermediate DLCBL/HD

Tipo de datos

boolean

Mature B-cell Neoplasms
Descripción

Other B-cell, specify

Tipo de datos

text

Transformed from another type of lymphoma at HSCT?
Descripción

Transformed from another type of lymphoma at HSCT?

Tipo de datos

integer

T-CELL AND NK-CELL NON HODGKIN LYMPHOMAS (NHL)
Descripción

Mature T-cell & NK-cell Neoplasms

Tipo de datos

integer

HODGKIN LYMPHOMAS
Descripción

HODGKIN LYMPHOMAS

Tipo de datos

text

Stage at diagnosis
Descripción

Stage

Tipo de datos

text

Alias
UMLS CUI [1]
C1300072
STAGE AT DIAGNOSIS
Descripción

Systemic symptoms

Tipo de datos

text

DISEASE INVOLVEMENT AT DIAGNOSIS
Descripción

Size of largest mass

Tipo de datos

integer

LDH LEVELS
Descripción

LDH LEVELS

Tipo de datos

integer

Specific sites of involvement
Descripción

Specific sites of involvement

Tipo de datos

integer

TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT
Descripción

TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT

Has the information requested in this section been submitted with a previous transplant registration for this patient?
Descripción

Has the information requested in this section been submitted with a previous transplant registration for this patient?

Tipo de datos

text

WAS THE PATIENT TREATED BEFORE THE 1ST TRANSPLANT PROCEDURE?
Descripción

WAS THE PATIENT TREATED BEFORE THE 1ST TRANSPLANT PROCEDURE?

Tipo de datos

integer

Sequential number of this treatment (counted from diagnosis)
Descripción

Sequential number of this treatment

Tipo de datos

text

Modality Chemo/drug/agent (including MoAB, etc.)
Descripción

Modality Chemo/drug/agent

Tipo de datos

text

If MoAB, radiolabelled
Descripción

Chemo/drug/agent

Tipo de datos

text

Radiotherapy
Descripción

Radiotherapy

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1522449
Response to this line of therapy
Descripción

Response to this line of therapy

Tipo de datos

text

ADDITIONAL TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT?
Descripción

ADDITIONAL TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT?

Tipo de datos

text

Sequential number of this treatment (counted from diagnosis)
Descripción

Sequential number of this treatment

Tipo de datos

text

Chemo/drug/agent
Descripción

Pharmacotherapy

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0013216
Treatment Regimen
Descripción

Regimen

Tipo de datos

text

Alias
UMLS CUI [1]
C0949219
If MoAB, radiolabelled
Descripción

Chemo/drug/agent

Tipo de datos

integer

Radiotherapy
Descripción

Radiotherapy

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1522449
Response to this line of therapy
Descripción

Response to this line of therapy

Tipo de datos

text

DISEASE HISTORY BEFORE HSCT
Descripción

DISEASE HISTORY BEFORE HSCT

Date of transplant
Descripción

Date of transplant

Tipo de datos

date

Total number of lines before this transplant (since diagnosis if 1st transplant, or since last reported transplant)
Descripción

Total number of lines before this transplant

Tipo de datos

integer

Modality used at least once
Descripción

Chemotherapy

Tipo de datos

integer

Modality used at least once
Descripción

MoAB (Immunotherapy)

Tipo de datos

integer

Modality used at least once
Descripción

Radiotherapy

Tipo de datos

integer

Splenectomy
Descripción

Splenectomy

Tipo de datos

boolean

Splenectomy
Descripción

Splenectomy

Tipo de datos

date

CR achieved before the 1st transplant
Descripción

CR achieved before the 1st transplant

Tipo de datos

text

Number of treatment lines necessary to reach this first remission
Descripción

Number of treatment lines necessary to reach this first remission

Tipo de datos

float

Number of CR’s
Descripción

Number of CR’s

Tipo de datos

float

1st Relapse before the 1st transplant TO BE COMPLETED ONLY IF PATIENT HAD A CR BEFORE THE 1ST TRANSPLANT
Descripción

1st Relapse before the 1st transplant

Tipo de datos

integer

STATUS OF DISEASE AT HSCT
Descripción

STATUS OF DISEASE AT HSCT

If patient has ever achieved Complete remission
Descripción

STATUS OF DISEASE AT HSCT

Tipo de datos

text

NUMBER OF THIS REMISSION
Descripción

NUMBER OF THIS REMISSION

Tipo de datos

integer

NUMBER OF THIS RELAPSE
Descripción

NUMBER OF THIS RELAPSE

Tipo de datos

integer

TYPE OF RELAPSE
Descripción

TYPE OF RELAPSE

Tipo de datos

text

If patient has never achieved a Complete remission
Descripción

If patient has never achieved a Complete remission

Tipo de datos

text

NUMBER OF THIS PR
Descripción

NUMBER OF THIS PR

Tipo de datos

text

DISEASE INVOLVEMENT AT TRANSPLANT
Descripción

DISEASE INVOLVEMENT AT TRANSPLANT

Tipo de datos

text

Size of largest mass (if patient in CR at HSCT, indicate “No mass”)
Descripción

Size of largest mass

Tipo de datos

text

Specific sites of disease (to be completed ONLY if patient NOT in CR at transplant)
Descripción

Specific sites of disease

Tipo de datos

integer

ADDITIONAL TREATMENT POST-HSCT
Descripción

ADDITIONAL TREATMENT POST-HSCT

Additional Disease Treatment
Descripción

Additional Disease Treatment

Tipo de datos

text

Alias
UMLS CUI [1]
C1706712
ADDITIONAL DISEASE TREATMENT
Descripción

Date started

Tipo de datos

date

Chemo/drug/agent (including MoAB, vaccination, etc.)
Descripción

Chemo/drug/agent

Tipo de datos

text

Radiotherapy
Descripción

Radiotherapy

Tipo de datos

text

Alias
UMLS CUI [1]
C1522449
BEST DISEASE RESPONSE AT 100 DAYS POST-HSCT
Descripción

BEST DISEASE RESPONSE AT 100 DAYS POST-HSCT

BEST RESPONSE AT 100 DAYS AFTER TRANSPLANTATION
Descripción

BEST RESPONSE AT 100 DAYS AFTER TRANSPLANTATION

Tipo de datos

text

If Complete remission: Date of CR
Descripción

If Complete remission: Date of CR

Tipo de datos

date

FORMS TO BE FILLED IN
Descripción

FORMS TO BE FILLED IN

TYPE OF TRANSPLANT
Descripción

TYPE OF TRANSPLANT

Tipo de datos

integer

If  Other, contact the EBMT Central Registry Office for instructions
Descripción

TYPE OF TRANSPLANT

Tipo de datos

text

LYMPHOMA FOLLOW UP
Descripción

LYMPHOMA FOLLOW UP

Unique Identification Code (UIC) (if known)
Descripción

Unique Identification Code (UIC)

Tipo de datos

text

Date of this report
Descripción

Date of this report

Tipo de datos

date

Alias
UMLS CUI [1]
C1302584
Patient following national / international study / trial
Descripción

Patient in Trial

Tipo de datos

integer

Alias
UMLS CUI [1]
C1997894
Name of study / trial
Descripción

Name of study / trial

Tipo de datos

text

Hospital Unique Patient Number
Descripción

Hospital Unique Patient Number

Tipo de datos

text

Alias
UMLS CUI [1]
C2348585
First name(s)_surname(s)
Descripción

Initials

Tipo de datos

text

Alias
UMLS CUI [1]
C2986440
Date of birth
Descripción

Date of birth

Tipo de datos

date

Alias
UMLS CUI [1]
C0421451
Date of last HSCT for this patient
Descripción

Date of last HSCT for this patient

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0472699
UMLS CUI [1,2]
C0011008
DATE OF LAST CONTACT OR DEATH
Descripción

DATE OF LAST CONTACT OR DEATH

Tipo de datos

date

GRAFT VERSUS HOST DISEASE (GvHD) SINCE LAST REPORT
Descripción

GRAFT VERSUS HOST DISEASE (GvHD) SINCE LAST REPORT

Maximum Grade of Acute GVHD
Descripción

AcuteGraftVersusHostDiseaseMaximumOverallGrade

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C0806909
UMLS CUI [1,3]
C0441800
UMLS CUI [1,4]
C1561607
UMLS CUI [1,5]
C0856825
UMLS CUI [1,6]
C0441800
If present
Descripción

Maximum grade

Tipo de datos

integer

Maximum grade
Descripción

Reason

Tipo de datos

text

Date onset of this episode (if new or recurrent)
Descripción

Date onset of this episode

Tipo de datos

date

Unidades de medida
  • yyyy/mm/dd
Alias
UMLS CUI [1]
C0574845
yyyy/mm/dd
Date onset of this episode
Descripción

Date onset of this episode

Tipo de datos

integer

Stage skin
Descripción

aGvHD Stage Skin

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C1306673
UMLS CUI [1,3]
C1306673
Stage liver
Descripción

aGvHD Stage liver

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C1306673
UMLS CUI [1,3]
C0023884
Stage gut
Descripción

aGvHD stage gut

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C1306673
UMLS CUI [1,3]
C0021853
Resolution
Descripción

aGvHD Resolution

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C1514893
Date of resolution
Descripción

aGvHD Date of resolution

Tipo de datos

date

Unidades de medida
  • yyyy/mm/dd
Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C1514893
UMLS CUI [1,3]
C0011008
yyyy/mm/dd
Presence of cGvHD
Descripción

Chronic Graft versus Host Disease

Tipo de datos

text

Alias
UMLS CUI [1]
C0867389
Presence of cGVHD
Descripción

Presence of cGVHD

Tipo de datos

integer

Alias
UMLS CUI [1]
C0867389
Date of onset Date of onset
Descripción

Date of onset

Tipo de datos

date

Alias
UMLS CUI [1]
C0574845
cGvHD grade
Descripción

cGvHD grade

Tipo de datos

integer

Organs affected
Descripción

Organs affected

Tipo de datos

integer

Alias
UMLS CUI [1]
C0449642
If resolved, specify the date of resolution:
Descripción

Date of Resolution

Tipo de datos

date

Alias
UMLS CUI [1,1]
C1514893
UMLS CUI [1,2]
C0011008
OTHER COMPLICATIONS SINCE LAST REPORT
Descripción

OTHER COMPLICATIONS SINCE LAST REPORT

Infection related complications
Descripción

Infection related complications

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0009450
UMLS CUI [1,2]
C0009566
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary
Descripción

Bacteremia / fungemia / viremia / parasites

Tipo de datos

text

Date Provide different dates for different episodes of the same complication if applicable
Descripción

Bacteremia / fungemia / viremia / parasites

Tipo de datos

date

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary
Descripción

Septic shock

Tipo de datos

text

Date Provide different dates for different episodes of the same complication if applicable.
Descripción

Septic shock

Tipo de datos

date

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
Descripción

ARDS

Tipo de datos

text

Date Provide different dates for different episodes of the same complication if applicable.
Descripción

ARDS

Tipo de datos

date

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
Descripción

Multiorgan failure due to infection

Tipo de datos

text

Date Provide different dates for different episodes of the same complication if applicable.
Descripción

Multiorgan failure due to infection

Tipo de datos

date

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
Descripción

Pneumonia

Tipo de datos

text

Date Provide different dates for different episodes of the same complication if applicable.
Descripción

Pneumonia

Tipo de datos

date

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
Descripción

Hepatitis

Tipo de datos

text

Date Provide different dates for different episodes of the same complication if applicable.
Descripción

Hepatitis

Tipo de datos

date

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
Descripción

CNS infection

Tipo de datos

text

Date Provide different dates for different episodes of the same complication if applicable.
Descripción

CNS infection

Tipo de datos

date

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
Descripción

Gut infection

Tipo de datos

text

Date Provide different dates for different episodes of the same complication if applicable.
Descripción

Gut infection

Tipo de datos

date

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
Descripción

Skin infection

Tipo de datos

text

Date Provide different dates for different episodes of the same complication if applicable.
Descripción

Skin infection

Tipo de datos

date

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
Descripción

Cystitis

Tipo de datos

text

Date Provide different dates for different episodes of the same complication if applicable.
Descripción

Cystitis

Tipo de datos

date

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
Descripción

Other

Tipo de datos

text

Date Provide different dates for different episodes of the same complication if applicable
Descripción

Other

Tipo de datos

date

Non infection related complications
Descripción

Non infection related complications

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0009566
Specify: Idiopathic pneumonia syndrome
Descripción

Idiopathic pneumonia syndrome

Tipo de datos

text

Alias
UMLS CUI [1]
C1504431
Specify: VOD
Descripción

VOD

Tipo de datos

text

Alias
UMLS CUI [1]
C0948441
Specify: Cataract
Descripción

Cataract

Tipo de datos

text

Alias
UMLS CUI [1]
C0086543
Specify: Haemorrhagic cystitis, non infectious
Descripción

Haemorrhagic cystitis, non infectious

Tipo de datos

text

Alias
UMLS CUI [1]
C0085692
Specify: ARDS, non infectious
Descripción

ARDS, non infectious

Tipo de datos

text

Alias
UMLS CUI [1]
C0035222
Multiorgan failure, non infectious
Descripción

Multiorgan failure, non infectious

Tipo de datos

integer

Specify: HSCT-associated microangiopathy
Descripción

HSCT-associated microangiopathy

Tipo de datos

text

Alias
UMLS CUI [1]
C0155765
Specify: Renal failure requiring dialysis
Descripción

Renal failure requiring dialysis

Tipo de datos

text

Alias
UMLS CUI [1]
C0035078
Specify: Haemolytic anaemia due to blood group
Descripción

Haemolytic anaemia due to blood group

Tipo de datos

text

Alias
UMLS CUI [1]
C0002878
Specify: Aseptic bone necrosis
Descripción

Aseptic bone necrosis

Tipo de datos

text

Alias
UMLS CUI [1]
C0158452
Other
Descripción

Quality-of-LifeAssessmentOtherAssistanceInd-2

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C1512698
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C0281588
Idiopathic pneumonia syndrome
Descripción

Date Idiopathic pneumonia syndrome

Tipo de datos

date

Date VOD
Descripción

Date VOD

Tipo de datos

date

Date Cataract
Descripción

Date Cataract

Tipo de datos

date

Date Haemorrhagic cystitis, non infectious
Descripción

Date Haemorrhagic cystitis, non infectious

Tipo de datos

date

Date ARDS, non infectious
Descripción

Date ARDS, non infectious

Tipo de datos

date

Date Multiorgan failure, non infectious
Descripción

Date Multiorgan failure, non infectious

Tipo de datos

date

Date HSCT-associated microangiopathy
Descripción

Date HSCT-associated microangiopathy

Tipo de datos

date

Date Renal failure requiring dialysis
Descripción

Date Renal failure requiring dialysis

Tipo de datos

date

DAte Haemolytic anaemia due to blood group
Descripción

Date Haemolytic anaemia due to blood group

Tipo de datos

date

Date Aseptic bone necrosis
Descripción

DAte Aseptic bone necrosis

Tipo de datos

date

Graft loss
Descripción

Graft loss

Tipo de datos

text

Alias
UMLS CUI [1]
C0877042
Overall chimaerism
Descripción

Overall chimaerism

Tipo de datos

text

Alias
UMLS CUI [1]
C0333678
DATE(S) AND RESULTS OF ALL TESTS DONE FOR ALL DONORS
Descripción

DATE(S) AND RESULTS OF ALL TESTS DONE FOR ALL DONORS

Date of Test
Descripción

Date of Test

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0024671
UMLS CUI [1,2]
C0011008
Identification of donor or Cord Blood Unit given by the centre
Descripción

Identification

Tipo de datos

text

Alias
UMLS CUI [1]
C1718162
Number in the infusion order (if applicable)
Descripción

Number in the infusion order (if applicable)

Tipo de datos

integer

Alias
UMLS CUI [1]
C2348184
Cell type on which test was performed (% Donor Cells): BM
Descripción

Bone marrow

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0005953
%
Cell type on which test was performed (% Donor cells): PB mononuclear cells (PBMC)
Descripción

PB mononuclear cells (PBMC)

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1]
C1321301
%
Cell type on which test was performed (% Donor cells): T-Cells
Descripción

T-Cells

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0039194
%
Cell type on which test was performed (% Donor cells): B-Cells
Descripción

B-Cells

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0004561
%
Cell type on which test was performed (% Donor cells): Red blood cells
Descripción

Red blood cells

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0014772
%
Cell type on which test was performed (% Donor cells): Monocytes
Descripción

Monocytes

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0026473
%
Cell type on which test was performed (% Donor cells): PMNs (neutrophils)
Descripción

PMNs (neutrophils)

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0200633
%
Cell type on which test was performed (% Donor cells): Lymphocytes, NOS
Descripción

Lymphocytes, NOS

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0024264
%
Cell type on which test was performed (% Donor cells): Myeloid cells, NOS
Descripción

Myeloid cells, NOS

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0887899
%
Cell type on which test was performed (% Donor cells): Other (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.)
Descripción

Other cell type - value

Tipo de datos

float

Unidades de medida
  • %
Alias
UMLS CUI [1,1]
C0449475
UMLS CUI [1,2]
C1522609
%
Test used:
Descripción

Laboratory tests

Tipo de datos

text

Alias
UMLS CUI [1]
C0022885
Test used: If other, specify:
Descripción

Specification other labaratory tests

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0022885
UMLS CUI [1,2]
C2348235
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
Descripción

SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED

Tipo de datos

text

Diagnosis
Descripción

Diagnosis

Tipo de datos

integer

If other diagnosis, please specify
Descripción

Diagnosis

Tipo de datos

text

ADDITIONAL THERAPIES SINCE LAST FOLLOW UP
Descripción

ADDITIONAL THERAPIES SINCE LAST FOLLOW UP

Treatment given since last report
Descripción

Additional treatment

Tipo de datos

text

Alias
UMLS CUI [1]
C1706712
if yes, date started
Descripción

ADDITIONAL TREATMENT

Tipo de datos

date

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.)
Descripción

Cellular therapy

Tipo de datos

integer

Alias
UMLS CUI [1]
C0302189
Disease status before this cellular therapy
Descripción

Disease status before this cellular therapy

Tipo de datos

integer

If yes: Type of cells
Descripción

Type of cells

Tipo de datos

integer

Alias
UMLS CUI [1]
C0302189
Number of Nucleated cells infused (DLI only)
Descripción

Nucleated cells

Tipo de datos

integer

Unidades de medida
  • 10^8/kg
Alias
UMLS CUI [1]
C1180059
Number of CD3+ cells infused (DLI only)
Descripción

CD3

Tipo de datos

integer

Unidades de medida
  • x10^6/kg
Alias
UMLS CUI [1]
C0882828
If DLI, specify the number of cells infused by type: CD 3+
Descripción

CD 3+

Tipo de datos

text

Alias
UMLS CUI [1]
C3542405
Total number of cells infused (non DLI only)
Descripción

All cells

Tipo de datos

integer

Unidades de medida
  • x10^6/kg
Alias
UMLS CUI [1]
C0007584
Chronological number of this cell therapy for this patient
Descripción

Chronological number

Tipo de datos

float

Alias
UMLS CUI [1]
C2348184
Indication (check all that apply)
Descripción

Indication

Tipo de datos

text

Alias
UMLS CUI [1,1]
C3146298
UMLS CUI [1,2]
C0302189
Number of Infusions (within 10 weeks) (count only infusions that are part of same regimen and given for the same indication)
Descripción

Number of Infusions

Tipo de datos

float

Alias
UMLS CUI [1,1]
C2348184
UMLS CUI [1,2]
C1289919
Acute Graft versus Host Disease (after this infusion but before any further infusion/ transplant) Maximum grade:
Descripción

Acute Graft versus Host Disease

Tipo de datos

text

Alias
UMLS CUI [1]
C0856825
Disease treatment (apart from donor cell infusion or other type of cell therapy)
Descripción

Disease treatment

Tipo de datos

integer

Alias
UMLS CUI [1]
C0087111
Chemo/drug/agent
Descripción

Pharmacotherapy

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0013216
Radiotherapy
Descripción

Radiotherapy

Tipo de datos

text

Alias
UMLS CUI [1]
C1522449
Other treatment
Descripción

Other treatment

Tipo de datos

text

Alias
UMLS CUI [1]
C0087111
FIRST EVIDENCE OF RELAPSE OR PROGRESSION SINCE LAST HSCT
Descripción

FIRST EVIDENCE OF RELAPSE OR PROGRESSION SINCE LAST HSCT

Relapse or Progression
Descripción

Relapse or Progression

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0277556
UMLS CUI [1,2]
C0242656
last disease status
Descripción

Last Disease Status

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0332307
UMLS CUI [1,2]
C0012634
UMLS CUI [1,3]
C0678257
Has patient or partner become pregnant after this HSCT?
Descripción

Conception

Tipo de datos

text

Alias
UMLS CUI [1]
C0032961
Survival Status
Descripción

Survival Status

Tipo de datos

integer

Alias
UMLS CUI [1]
C1148433
If alive: Type of score used:
Descripción

Performance Score

Tipo de datos

text

Alias
UMLS CUI [1]
C1518965
Score
Descripción

Performance score

Tipo de datos

integer

Alias
UMLS CUI [1]
C1518965
If dead, specify cause of death:
Descripción

Cause of Death

Tipo de datos

text

Alias
UMLS CUI [1]
C0007465
If dead and HSCT related cause of death, specify (check as many as apppropriate): GvHD
Descripción

GvHD

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0018133
If dead and HSCT related cause of death, specify (check as many as apppropriate): Interstitial Pneumonitis
Descripción

Interstitial Pneumonitis

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0206061
If dead and HSCT related cause of death, specify (check as many as apppropriate): Pulmonary toxicity
Descripción

Pulmonary toxicity

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0919924
If dead and HSCT related cause of death, specify (check as many as apppropriate): Infection
Descripción

Infection

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0009450
Infection
Descripción

Infection HSCT

Tipo de datos

integer

Rejection / poor graft function (check as many as appropriate)
Descripción

Rejection / poor graft function

Tipo de datos

integer

If dead and HSCT related cause of death, specify (check as many as apppropriate): Veno-Occlusive disease (VOD)
Descripción

Veno-Occlusive disease (VOD)

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0948441
If dead and HSCT related cause of death, specify (check as many as apppropriate): Haemorrhage
Descripción

Haemorrhage

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0019080
If dead and HSCT related cause of death, specify (check as many as apppropriate): Cardiac toxicity
Descripción

Cardiac toxicity

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0876994
If dead and HSCT related cause of death, specify (check as many as apppropriate): Central nervous system toxicity
Descripción

Central nervous system toxicity

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C3160947
If dead and HSCT related cause of death, specify (check as many as apppropriate): Gastro intestinal toxicity
Descripción

Gastro intestinal toxicity

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C1142499
If dead and HSCT related cause of death, specify (check as many as apppropriate): Skin toxicity
Descripción

Skin toxicity

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C1167791
If dead and HSCT related cause of death, specify (check as many as apppropriate): Renal failure
Descripción

Renal failure

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0035078
If dead and HSCT related cause of death, specify (check as many as apppropriate): Multiple organ failure
Descripción

Multiple organ failure

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0026766
If dead and HSCT related cause of death, specify (check as many as apppropriate): Other
Descripción

Other

Tipo de datos

boolean

ADDITIONAL NOTES IF APPLICABLE
Descripción

ADDITIONAL NOTES IF APPLICABLE

Comments
Descripción

Comments

Tipo de datos

text

Identification
Descripción

IDENTIFICATION & SIGNATURE

Tipo de datos

text

Alias
UMLS CUI [1]
C0205396
Volver a la parte superior de la página

Similar models

16pp General Info EBMT Lymphoma 04 Lym.

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
GENERAL INFORMATION Team
EBMT Centre Identification Code (CIC)
Item
EBMT Centre Identification Code (CIC)
text
C2348585 (UMLS CUI [1])
Hospital
Item
Name of the hospital
text
C0019994 (UMLS CUI [1])
Unit
Item
Unit
text
Contact person
Item
Contact person
text
Telephone
Item
Telephone number
integer
C1515258 (UMLS CUI [1])
Fax
Item
Fax
text
C1549619 (UMLS CUI [1,1])
C0337611 (UMLS CUI [1,2])
C0030664 (UMLS CUI [1,3])
E-Mail
Item
E-Mail
text
C1705961 (UMLS CUI [1,1])
C0337611 (UMLS CUI [1,2])
C0030664 (UMLS CUI [1,3])
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])
Patient in Trial
Code List
Patient following national / international study / trial
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
Item Group
GENERAL INFORMATION Patient
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])
Item
Sex
text
C0079399 (UMLS CUI [1])
Sex
Code List
Sex
CL Item
Male (1)
CL Item
Female (2)
ABO Group
Item
ABO Group
text
Rh factor
Item
Rh factor Donor a
boolean
C0035403 (UMLS CUI [1,1])
C0013018 (UMLS CUI [1,2])
Item Group
DISEASE
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])
Primary Disease Diagnosis
Code List
Check the disease for which this transplant was performed
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])
Item Group
LYMPHOMA INITIAL DIAGNOSIS
Item
Has the information requested in this section been submitted with a previous transplant registration for this patient?
integer
Has the information requested in this section been submitted with a previous transplant registration for this patient?
Code List
Has the information requested in this section been submitted with a previous transplant registration for this patient?
CL Item
Yes: go to page 4, Treatment given before the 1st transplant (1)
CL Item
No: proceed with this section (2)
CL Item
Non Hodgkin Lymphoma (NHL) (3)
Splenic marginal zone lymphoma
Item
Mature B-cell Neoplasms
boolean
Extranodal marginal zone lymphoma of mucosa associated lymphoid tissue (MALT)
Item
Mature B-cell Neoplasms
boolean
Nodal marginal zone lymphoma
Item
Mature B-cell Neoplasms
boolean
Nodal marginal zone lymphoma
Item
Mature B-cell Neoplasms
boolean
Lymphoplasmacytic lymphoma (LPL)
Item
Mature B-cell Neoplasms
boolean
Waldenstrom macroglobulinaemia (LPL with monoclonal IgM)
Item
Mature B-cell Neoplasms
boolean
Item
Mature B-cell Neoplasms
integer
Follicular lymphoma
Code List
Mature B-cell Neoplasms
CL Item
Grade I  (1)
CL Item
Grade II  (2)
CL Item
Grade III  (3)
CL Item
Not evaluated (4)
Primary cutaneous follicle centre lymphoma
Item
Mature B-cell Neoplasms
boolean
Mantle cell lymphoma
Item
Mature B-cell Neoplasms
boolean
Item
Mature B-cell Neoplasms
integer
Diffuse large B-cell lymphoma (DLBCL), (NOS)
Code List
Mature B-cell Neoplasms
CL Item
T-cell/hystiocyte rich large B cell lymphoma (1)
CL Item
Primary DLBCL of the CNS (2)
CL Item
Primary cutaneous DLBCL, leg type (3)
CL Item
EBV positive DLBCL of the elderly (4)
DLBCL associated with chronic inflammation
Item
Mature B-cell Neoplasms
boolean
Lymphomatoid granulomatosis
Item
Mature B-cell Neoplasms
boolean
Primary mediastinal (thymic) large B-cell lymphoma
Item
Mature B-cell Neoplasms
boolean
Intravascular large B-cell lymphoma
Item
Mature B-cell Neoplasms
boolean
ALK positive large B-cell lymphoma
Item
Mature B-cell Neoplasms
boolean
Plasmablastic lymphoma
Item
Mature B-cell Neoplasms
boolean
Large B-cell lymphoma arising in HHV8- associated multicentric Castleman disease
Item
Mature B-cell Neoplasms
boolean
Primary effusion lymphoma (PEL)
Item
Mature B-cell Neoplasms
boolean
Burkitt lymphoma (BL)
Item
Mature B-cell Neoplasms
boolean
B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma (Intermediate DLCBL/BL)
Item
Mature B-cell Neoplasms
boolean
B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma (Intermediate DLCBL/HD
Item
Mature B-cell Neoplasms
boolean
Other B-cell, specify
Item
Mature B-cell Neoplasms
text
Item
Transformed from another type of lymphoma at HSCT?
integer
Transformed from another type of lymphoma at HSCT?
Code List
Transformed from another type of lymphoma at HSCT?
CL Item
No (1)
CL Item
Yes (2)
CL Item
Unknown (3)
Item
T-CELL AND NK-CELL NON HODGKIN LYMPHOMAS (NHL)
integer
Mature T-cell & NK-cell Neoplasms
Code List
T-CELL AND NK-CELL NON HODGKIN LYMPHOMAS (NHL)
CL Item
T-cell large granular lymphocytic leukaemia (1)
CL Item
Aggressive NK-cell leukaemia (2)
CL Item
Systemic EBV positive T-cell lymphoproliferative disease of childhood (3)
CL Item
Hydroa vacciniforme-like lymphoma (4)
CL Item
Adult T-cell leukaemia/lymphoma (5)
CL Item
Extranodal NK/T-cell lymphoma, nasal type (6)
CL Item
Enteropathy-associated T-cell lymphoma (7)
CL Item
Hepatosplenic T-cell lymphoma (8)
CL Item
Subcutaneous panniculitis-like T-cell lymphoma (9)
CL Item
Mycosis fungoides (MF) (10)
CL Item
Sézary syndrome  (11)
CL Item
Lymphomatoid papulosis (12)
CL Item
Primary cutaneous anaplastic large cell lymphoma (13)
CL Item
Primary cutaneous gamma-delta T-cell lymphoma (14)
CL Item
Primary cutaneous CD8 positive aggressive epidermotropic cytotoxic T-cell lymphoma (15)
CL Item
Primary cutaneous CD4 positive small/medium T-cell lymphoma (16)
CL Item
Peripheral T-cell lymphoma, NOS (PTCL) (17)
CL Item
Angioimmunoblastic T-cell lymphoma (18)
CL Item
Anaplastic large-cell lymphoma (ALCL), ALK-positive (19)
CL Item
Anaplastic large-cell lymphoma (ALCL), ALK-negative (20)
CL Item
Other T-cell, specify (21)
Item
HODGKIN LYMPHOMAS
text
HODGKIN LYMPHOMAS
Code List
HODGKIN LYMPHOMAS
CL Item
Nodular lymphocyte predominant (Nodular lymphocyte predominant)
CL Item
Classical predominant (Classical predominant)
CL Item
Nodular sclerosis classical (Nodular sclerosis classical)
CL Item
Lymphocyte-rich classical (Lymphocyte-rich classical)
CL Item
Mixed cellularity classical (Mixed cellularity classical)
CL Item
Lymphocyte-depleted classical (Lymphocyte-depleted classical)
CL Item
Other, specify (Other, specify)
Item
Stage at diagnosis
text
C1300072 (UMLS CUI [1])
Stage
Code List
Stage at diagnosis
CL Item
I (I)
CL Item
II (II)
CL Item
III (III)
CL Item
IV (IV)
Item
STAGE AT DIAGNOSIS
text
Systemic symptoms
Code List
STAGE AT DIAGNOSIS
CL Item
Absent (A) (Absent (A))
CL Item
Present (B) (Present (B))
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item
DISEASE INVOLVEMENT AT DIAGNOSIS
integer
Size of largest mass
Code List
DISEASE INVOLVEMENT AT DIAGNOSIS
CL Item
< 5 cm  (1)
CL Item
5-10 cm  (2)
CL Item
> 10 cm  (3)
CL Item
No mass  (4)
CL Item
Unknown (5)
Item
LDH LEVELS
integer
LDH LEVELS
Code List
LDH LEVELS
CL Item
Normal  (1)
CL Item
Elevated  (2)
CL Item
Not evaluated  (3)
CL Item
Unknown (4)
Item
Specific sites of involvement
integer
Specific sites of involvement
Code List
Specific sites of involvement
CL Item
Nodes below the diaphragm  (1)
CL Item
Bone marrow  (2)
CL Item
Extranodal (CNS) (3)
CL Item
Mediastinum  (4)
CL Item
Extranodal (testis /ovary)  (5)
CL Item
Nodes above the diaphragm (6)
CL Item
Lung  (7)
CL Item
Liver  (8)
CL Item
Spleen (9)
CL Item
Other (10)
Item Group
TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT
Item
Has the information requested in this section been submitted with a previous transplant registration for this patient?
text
Has the information requested in this section been submitted with a previous transplant registration for this patient?
Code List
Has the information requested in this section been submitted with a previous transplant registration for this patient?
CL Item
Yes: go to page 5, ”Disease History before HSCT" (Yes: go to page 5, ”Disease History before HSCT")
CL Item
No: proceed with this section (No: proceed with this section)
Item
WAS THE PATIENT TREATED BEFORE THE 1ST TRANSPLANT PROCEDURE?
integer
WAS THE PATIENT TREATED BEFORE THE 1ST TRANSPLANT PROCEDURE?
Code List
WAS THE PATIENT TREATED BEFORE THE 1ST TRANSPLANT PROCEDURE?
CL Item
WAS THE PATIENT TREATED BEFORE THE 1ST TRANSPLANT PROCEDURE? (1)
CL Item
Yes Date started (2)
Sequential number of this treatment
Item
Sequential number of this treatment (counted from diagnosis)
text
Item
Modality Chemo/drug/agent (including MoAB, etc.)
text
Modality Chemo/drug/agent
Code List
Modality Chemo/drug/agent (including MoAB, etc.)
CL Item
No  (No )
CL Item
Yes: Regimen (Yes: Regimen)
CL Item
Unknown (Unknown)
Item
If MoAB, radiolabelled
text
Chemo/drug/agent
Code List
If MoAB, radiolabelled
CL Item
No  (No )
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Radiotherapy
Item
Radiotherapy
boolean
C1522449 (UMLS CUI [1])
Item
Response to this line of therapy
text
Response to this line of therapy
Code List
Response to this line of therapy
CL Item
Complete remission  (Complete remission )
CL Item
Partial remission (> 50 %)  ( Partial remission (> 50 %) )
CL Item
No response (< 50 %) ( No response (< 50 %))
Item
ADDITIONAL TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT?
text
ADDITIONAL TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT?
Code List
ADDITIONAL TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT?
CL Item
Yes Date started ( Yes Date started)
CL Item
No – Proceed to page 5, ”Disease History before HSCT" (No – Proceed to page 5, ”Disease History before HSCT")
CL Item
Unknown (Unknown)
Sequential number of this treatment
Item
Sequential number of this treatment (counted from diagnosis)
text
Pharmacotherapy
Item
Chemo/drug/agent
boolean
C0013216 (UMLS CUI [1])
Regimen
Item
Treatment Regimen
text
C0949219 (UMLS CUI [1])
Item
If MoAB, radiolabelled
integer
Chemo/drug/agent
Code List
If MoAB, radiolabelled
CL Item
No (1)
CL Item
Yes (2)
CL Item
Unknown (3)
Radiotherapy
Item
Radiotherapy
boolean
C1522449 (UMLS CUI [1])
Item
Response to this line of therapy
text
Response to this line of therapy
Code List
Response to this line of therapy
CL Item
Complete remission  (Complete remission )
CL Item
Partial remission (> 50 %)  ( Partial remission (> 50 %) )
CL Item
No response (< 50 %) (No response (< 50 %))
Item Group
DISEASE HISTORY BEFORE HSCT
Date of transplant
Item
Date of transplant
date
Total number of lines before this transplant
Item
Total number of lines before this transplant (since diagnosis if 1st transplant, or since last reported transplant)
integer
Item
Modality used at least once
integer
Chemotherapy
Code List
Modality used at least once
CL Item
No  (1)
CL Item
Yes (2)
CL Item
Unknown (3)
Item
Modality used at least once
integer
MoAB (Immunotherapy)
Code List
Modality used at least once
CL Item
No  (1)
CL Item
Yes (2)
CL Item
Unknown (3)
Item
Modality used at least once
integer
Radiotherapy
Code List
Modality used at least once
CL Item
No (1)
CL Item
Yes (2)
CL Item
Unknown (3)
Splenectomy
Item
Splenectomy
boolean
Splenectomy
Item
Splenectomy
date
Item
CR achieved before the 1st transplant
text
CR achieved before the 1st transplant
Code List
CR achieved before the 1st transplant
CL Item
Yes: Date of first CR (Yes: Date of first CR)
CL Item
No (No)
Number of treatment lines necessary to reach this first remission
Item
Number of treatment lines necessary to reach this first remission
float
Number of CR’s
Item
Number of CR’s
float
Item
1st Relapse before the 1st transplant TO BE COMPLETED ONLY IF PATIENT HAD A CR BEFORE THE 1ST TRANSPLANT
integer
1st Relapse before the 1st transplant
Code List
1st Relapse before the 1st transplant TO BE COMPLETED ONLY IF PATIENT HAD A CR BEFORE THE 1ST TRANSPLANT
CL Item
Yes: Date of first relapse (1)
CL Item
No (2)
Item Group
STATUS OF DISEASE AT HSCT
Item
If patient has ever achieved Complete remission
text
STATUS OF DISEASE AT HSCT
Code List
If patient has ever achieved Complete remission
CL Item
Complete remission (CR) (Complete remission (CR))
CL Item
Unconfirmed (Unconfirmed)
CL Item
Confirmed -By CT scan (Confirmed -By CT scan)
CL Item
Confirmed -By PET (Confirmed -By PET)
CL Item
Relapse (Relapse)
Item
NUMBER OF THIS REMISSION
integer
NUMBER OF THIS REMISSION
Code List
NUMBER OF THIS REMISSION
CL Item
1st (1)
CL Item
2nd (2)
CL Item
3rd or higher (3)
Item
NUMBER OF THIS RELAPSE
integer
NUMBER OF THIS RELAPSE
Code List
NUMBER OF THIS RELAPSE
CL Item
1st (1)
CL Item
2nd (2)
CL Item
3rd or higher (3)
Item
TYPE OF RELAPSE
text
TYPE OF RELAPSE
Code List
TYPE OF RELAPSE
CL Item
Untreated (untested) (Untreated (untested))
CL Item
Sensitive (responding) (Sensitive (responding))
CL Item
Resistant (Resistant)
Item
If patient has never achieved a Complete remission
text
If patient has never achieved a Complete remission
Code List
If patient has never achieved a Complete remission
CL Item
At diagnosis (untreated) (At diagnosis (untreated))
CL Item
Primary refractory disease ( Primary refractory disease)
CL Item
Very good 1st PR (> 90 %) (Very good 1st PR (> 90 %))
CL Item
PR ( PR)
CL Item
Progression (Progression)
Item
NUMBER OF THIS PR
text
NUMBER OF THIS PR
Code List
NUMBER OF THIS PR
CL Item
1st (1st)
CL Item
2nd (2nd)
CL Item
3rd or higher (3rd or higher)
Item
DISEASE INVOLVEMENT AT TRANSPLANT
text
DISEASE INVOLVEMENT AT TRANSPLANT
Code List
DISEASE INVOLVEMENT AT TRANSPLANT
CL Item
Yes  (Yes )
CL Item
No  ( No )
CL Item
Not evaluated  ( Not evaluated )
CL Item
Unknown (Unknown)
Item
Size of largest mass (if patient in CR at HSCT, indicate “No mass”)
text
Size of largest mass
Code List
Size of largest mass (if patient in CR at HSCT, indicate “No mass”)
CL Item
< 5 cm  (< 5 cm )
CL Item
5-10 cm  ( 5-10 cm )
CL Item
> 10 cm  ( > 10 cm )
CL Item
No mass  ( No mass )
CL Item
Not evaluated ( Not evaluated)
Item
Specific sites of disease (to be completed ONLY if patient NOT in CR at transplant)
integer
Specific sites of disease
Code List
Specific sites of disease (to be completed ONLY if patient NOT in CR at transplant)
CL Item
Nodes below the diaphragm  Bone marrow  (1)
CL Item
Extranodal (CNS) (2)
CL Item
Mediastinum  (3)
CL Item
Extranodal (testis /ovary)  (4)
CL Item
Nodes above the diaphragm (5)
CL Item
Lung  (6)
CL Item
Liver  (7)
CL Item
Spleen (8)
CL Item
Other (9)
Item Group
ADDITIONAL TREATMENT POST-HSCT
Item
Additional Disease Treatment
text
C1706712 (UMLS CUI [1])
Additional Disease Treatment
Code List
Additional Disease Treatment
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes: Planned (planned before HSCT took place) (Yes: Planned (planned before HSCT took place))
CL Item
Not planned (for relapse/progression or persistent disease) ( Not planned (for relapse/progression or persistent disease))
Date started
Item
ADDITIONAL DISEASE TREATMENT
date
Item
Chemo/drug/agent (including MoAB, vaccination, etc.)
text
Chemo/drug/agent
Code List
Chemo/drug/agent (including MoAB, vaccination, etc.)
CL Item
Text (Text)
CL Item
Unknown (Unknown)
Item
Radiotherapy
text
C1522449 (UMLS CUI [1])
Radiotherapy
Code List
Radiotherapy
CL Item
yes no=no not known=not known (yes)
Item Group
BEST DISEASE RESPONSE AT 100 DAYS POST-HSCT
Item
BEST RESPONSE AT 100 DAYS AFTER TRANSPLANTATION
text
BEST RESPONSE AT 100 DAYS AFTER TRANSPLANTATION
Code List
BEST RESPONSE AT 100 DAYS AFTER TRANSPLANTATION
CL Item
Complete remission (maintained or achieved)  (Complete remission (maintained or achieved) )
CL Item
Partial remission (> 50 %)  ( Partial remission (> 50 %) )
CL Item
No response (< 50 %) ( No response (< 50 %))
CL Item
Unconfirmed CRCONFI1  ( Unconfirmed CRCONFI1 )
CL Item
Progression  ( Progression )
CL Item
Early death/Not evaluable ( Early death/Not evaluable)
CL Item
Confirmed:  ( Confirmed: )
CL Item
By CT scan ( By CT scan)
CL Item
By PET ( By PET)
If Complete remission: Date of CR
Item
If Complete remission: Date of CR
date
Item Group
FORMS TO BE FILLED IN
Item
TYPE OF TRANSPLANT
integer
TYPE OF TRANSPLANT
Code List
TYPE OF TRANSPLANT
CL Item
AUTOgraft, proceed to Autograft form (1)
CL Item
ALLOgraft or Syngeneic graft, proceed to Allograft form (2)
TYPE OF TRANSPLANT
Item
If  Other, contact the EBMT Central Registry Office for instructions
text
Item Group
LYMPHOMA FOLLOW UP
Unique Identification Code (UIC)
Item
Unique Identification Code (UIC) (if known)
text
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])
Patient in Trial
Code List
Patient following national / international study / trial
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])
DATE OF LAST CONTACT OR DEATH
Item
DATE OF LAST CONTACT OR DEATH
date
Item Group
GRAFT VERSUS HOST DISEASE (GvHD) SINCE LAST REPORT
Item
Maximum Grade of Acute GVHD
text
C0856825 (UMLS CUI [1,1])
C0806909 (UMLS CUI [1,2])
C0441800 (UMLS CUI [1,3])
C1561607 (UMLS CUI [1,4])
C0856825 (UMLS CUI [1,5])
C0441800 (UMLS CUI [1,6])
AcuteGraftVersusHostDiseaseMaximumOverallGrade
Code List
Maximum Grade of Acute GVHD
CL Item
Agvhd Grade 0 (0)
CL Item
Agvhd Grade I (I)
CL Item
Agvhd Grade Ii (II)
CL Item
Agvhd Grade Iii (III)
CL Item
Agvhd Grade Iv (IV)
CL Item
Agvhd Present, Grade Unknown (Present, grade unknown)
Item
If present
integer
Maximum grade
Code List
If present
CL Item
New onset  (1)
CL Item
Recurrent  (2)
CL Item
Persistent (3)
Item
Maximum grade
text
Reason
Code List
Maximum grade
CL Item
Tapering  (Tapering )
CL Item
DLI (DLI)
CL Item
Unexplained ( Unexplained)
Date onset of this episode
Item
Date onset of this episode (if new or recurrent)
date
C0574845 (UMLS CUI [1])
Item
Date onset of this episode
integer
Date onset of this episode
Code List
Date onset of this episode
CL Item
Not applicable (1)
Item
Stage skin
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C1306673 (UMLS CUI [1,3])
aGvHD Stage Skin
Code List
Stage skin
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])
aGvHD Stage liver
Code List
Stage liver
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])
aGvHD stage gut
Code List
Stage gut
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
Resolution
integer
C0856825 (UMLS CUI [1,1])
C1514893 (UMLS CUI [1,2])
aGvHD Resolution
Code List
Resolution
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])
Item
Presence of cGvHD
text
C0867389 (UMLS CUI [1])
Chronic Graft versus Host Disease
Code List
Presence of cGvHD
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Present continously since last reported episode (Present continously since last reported episode)
CL Item
Resolved (Resolved)
Item
Presence of cGVHD
integer
C0867389 (UMLS CUI [1])
Presence of cGVHD
Code List
Presence of cGVHD
CL Item
No (1)
CL Item
Yes, First Episode (2)
CL Item
Yes, Recurrence (3)
Date of onset
Item
Date of onset Date of onset
date
C0574845 (UMLS CUI [1])
Item
cGvHD grade
integer
cGvHD grade
Code List
cGvHD grade
CL Item
Limited (1)
CL Item
Extensive (2)
Item
Organs affected
integer
C0449642 (UMLS CUI [1])
Organs affected
Code List
Organs affected
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)
Date of Resolution
Item
If resolved, specify the date of resolution:
date
C1514893 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
OTHER COMPLICATIONS SINCE LAST REPORT
Infection related complications
Item
Infection related complications
boolean
C0009450 (UMLS CUI [1,1])
C0009566 (UMLS CUI [1,2])
Bacteremia / fungemia / viremia / parasites
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary
text
Bacteremia / fungemia / viremia / parasites
Item
Date Provide different dates for different episodes of the same complication if applicable
date
Septic shock
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary
text
Septic shock
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
ARDS
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
ARDS
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Multiorgan failure due to infection
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Multiorgan failure due to infection
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Pneumonia
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Pneumonia
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Hepatitis
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Hepatitis
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
CNS infection
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
CNS infection
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Gut infection
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Gut infection
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Skin infection
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Skin infection
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Cystitis
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Cystitis
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Other
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Other
Item
Date Provide different dates for different episodes of the same complication if applicable
date
Non infection related complications
Item
Non infection related complications
boolean
C0009566 (UMLS CUI [1])
Item
Specify: Idiopathic pneumonia syndrome
text
C1504431 (UMLS CUI [1])
Idiopathic pneumonia syndrome
Code List
Specify: Idiopathic pneumonia syndrome
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Specify: VOD
text
C0948441 (UMLS CUI [1])
VOD
Code List
Specify: VOD
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Specify: Cataract
text
C0086543 (UMLS CUI [1])
Cataract
Code List
Specify: Cataract
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Specify: Haemorrhagic cystitis, non infectious
text
C0085692 (UMLS CUI [1])
Haemorrhagic cystitis, non infectious
Code List
Specify: Haemorrhagic cystitis, non infectious
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Specify: ARDS, non infectious
text
C0035222 (UMLS CUI [1])
ARDS, non infectious
Code List
Specify: ARDS, non infectious
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Multiorgan failure, non infectious
integer
Multiorgan failure, non infectious
Code List
Multiorgan failure, non infectious
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Specify: HSCT-associated microangiopathy
text
C0155765 (UMLS CUI [1])
HSCT-associated microangiopathy
Code List
Specify: HSCT-associated microangiopathy
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Specify: Renal failure requiring dialysis
text
C0035078 (UMLS CUI [1])
Renal failure requiring dialysis
Code List
Specify: Renal failure requiring dialysis
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])
Haemolytic anaemia due to blood group
Code List
Specify: Haemolytic anaemia due to blood group
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Specify: Aseptic bone necrosis
text
C0158452 (UMLS CUI [1])
Aseptic bone necrosis
Code List
Specify: Aseptic bone necrosis
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Quality-of-LifeAssessmentOtherAssistanceInd-2
Item
Other
boolean
C1512698 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C0281588 (UMLS CUI [1,3])
Date Idiopathic pneumonia syndrome
Item
Idiopathic pneumonia syndrome
date
Date VOD
Item
Date VOD
date
Date Cataract
Item
Date Cataract
date
Date Haemorrhagic cystitis, non infectious
Item
Date Haemorrhagic cystitis, non infectious
date
Date ARDS, non infectious
Item
Date ARDS, non infectious
date
Date Multiorgan failure, non infectious
Item
Date Multiorgan failure, non infectious
date
Date HSCT-associated microangiopathy
Item
Date HSCT-associated microangiopathy
date
Date Renal failure requiring dialysis
Item
Date Renal failure requiring dialysis
date
Date Haemolytic anaemia due to blood group
Item
DAte Haemolytic anaemia due to blood group
date
DAte Aseptic bone necrosis
Item
Date Aseptic bone necrosis
date
Item
Graft loss
text
C0877042 (UMLS CUI [1])
Graft loss
Code List
Graft loss
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
Overall chimaerism
text
C0333678 (UMLS CUI [1])
Overall chimaerism
Code List
Overall chimaerism
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)
Item Group
DATE(S) AND RESULTS OF ALL TESTS DONE FOR ALL DONORS
Date of Test
Item
Date of Test
date
C0024671 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
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])
Number in the infusion order (if applicable)
Code List
Number in the infusion order (if applicable)
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-Cells
Item
Cell type on which test was performed (% Donor cells): T-Cells
float
C0039194 (UMLS CUI [1])
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 (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.)
float
C0449475 (UMLS CUI [1,1])
C1522609 (UMLS CUI [1,2])
Item
Test used:
text
C0022885 (UMLS CUI [1])
Laboratory tests
Code List
Test used:
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])
Item
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
text
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
Code List
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
CL Item
Previously reported (Previously reported)
CL Item
Yes, date of diagnosis (Yes, date of diagnosis)
CL Item
No at date of this follow-up (No at date of this follow-up)
Item
Diagnosis
integer
Diagnosis
Code List
Diagnosis
CL Item
AML (AML)
CL Item
MDS (MDS)
CL Item
Lymphoproliferative disorder (Lymphoproliferative disorder)
CL Item
Other (Other)
Diagnosis
Item
If other diagnosis, please specify
text
Item Group
ADDITIONAL THERAPIES SINCE LAST FOLLOW UP
Item
Treatment given since last report
text
C1706712 (UMLS CUI [1])
Additional treatment
Code List
Treatment given since last report
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
ADDITIONAL TREATMENT
Item
if yes, date started
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])
Cellular therapy
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)
Item
Disease status before this cellular therapy
integer
Disease status before this cellular therapy
Code List
Disease status before this cellular therapy
CL Item
CR  (1)
CL Item
Not in CR  (2)
CL Item
Not evaluated (3)
Item
If yes: Type of cells
integer
C0302189 (UMLS CUI [1])
Type of cells
Code List
If yes: Type of cells
CL Item
Donor lymphocyte infusion (DLI) (1)
CL Item
Mesenchymal cells (2)
CL Item
Other (3)
CL Item
Unknown (4)
Item
Number of Nucleated cells infused (DLI only)
integer
C1180059 (UMLS CUI [1])
Nucleated cells
Code List
Number of Nucleated cells infused (DLI only)
CL Item
Number (1)
CL Item
Not evaluated (2)
CL Item
Unknown (3)
Item
Number of CD3+ cells infused (DLI only)
integer
C0882828 (UMLS CUI [1])
CD3
Code List
Number of CD3+ cells infused (DLI only)
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 3+
text
C3542405 (UMLS CUI [1])
CD 3+
Code List
If DLI, specify the number of cells infused by type: CD 3+
CL Item
Evaluated  (Evaluated )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item
Total number of cells infused (non DLI only)
integer
C0007584 (UMLS CUI [1])
All cells
Code List
Total number of cells infused (non DLI only)
CL Item
Number (1)
CL Item
Not evaluated (2)
CL Item
Unknown (3)
Chronological number
Item
Chronological number of this cell therapy for this patient
float
C2348184 (UMLS CUI [1])
Item
Indication (check all that apply)
text
C3146298 (UMLS CUI [1,1])
C0302189 (UMLS CUI [1,2])
Indication
Code List
Indication (check all that apply)
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)
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])
Item
Acute Graft versus Host Disease (after this infusion but before any further infusion/ transplant) Maximum grade:
text
C0856825 (UMLS CUI [1])
Acute Graft versus Host Disease
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])
Disease treatment
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)
CL Item
Unknown (4)
Pharmacotherapy
Item
Chemo/drug/agent
boolean
C0013216 (UMLS CUI [1])
Item
Radiotherapy
text
C1522449 (UMLS CUI [1])
Radiotherapy
Code List
Radiotherapy
CL Item
yes no=no not known=not known (yes)
Item
Other treatment
text
C0087111 (UMLS CUI [1])
Other treatment
Code List
Other treatment
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Item Group
FIRST EVIDENCE OF RELAPSE OR PROGRESSION SINCE LAST HSCT
Item
Relapse or Progression
text
C0277556 (UMLS CUI [1,1])
C0242656 (UMLS CUI [1,2])
Relapse or Progression
Code List
Relapse or Progression
CL Item
Previously reported (Previously reported)
CL Item
No (No)
CL Item
Yes, date (Yes)
CL Item
Continous progression since transplant (Continous progression since transplant)
CL Item
Unknown (Unknown)
Item
last disease status
text
C0332307 (UMLS CUI [1,1])
C0012634 (UMLS CUI [1,2])
C0678257 (UMLS CUI [1,3])
Last Disease Status
Code List
last disease status
CL Item
Complete Remission (Complete Remission)
CL Item
Relapse (Relapse)
Item
Has patient or partner become pregnant after this HSCT?
text
C0032961 (UMLS CUI [1])
Conception
Code List
Has patient or partner become pregnant after this HSCT?
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Item
Survival Status
integer
C1148433 (UMLS CUI [1])
Survival Status
Code List
Survival Status
CL Item
alive (0)
CL Item
dead (1)
Item
If alive: Type of score used:
text
C1518965 (UMLS CUI [1])
Performance Score
Code List
If alive: Type of score used:
CL Item
Karnofsky (Karnofsky)
CL Item
Lansky (Lansky)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item
Score
integer
C1518965 (UMLS CUI [1])
Performance score
Code List
Score
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)
Item
If dead, specify cause of death:
text
C0007465 (UMLS CUI [1])
Cause of Death
Code List
If dead, specify cause of death:
CL Item
Relapse or progression (Relapse or progression)
CL Item
Secondary malignancy (including lymphoproliferative disease) (Secondary malignancy (including lymphoproliferative disease))
CL Item
HSCT related cause  (HSCT related cause )
CL Item
Unknown  (Unknown )
CL Item
Other (Other)
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])
GvHD
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])
Interstitial Pneumonitis
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])
Pulmonary toxicity
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])
Infection
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)
Item
Infection
integer
Infection HSCT
Code List
Infection
CL Item
bacterial (1)
CL Item
viral (2)
CL Item
fungal (3)
CL Item
parasitic (4)
CL Item
unknown (5)
Item
Rejection / poor graft function (check as many as appropriate)
integer
Rejection / poor graft function
Code List
Rejection / poor graft function (check as many as appropriate)
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])
Veno-Occlusive disease (VOD)
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])
Haemorrhage
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])
Cardiac toxicity
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 toxicity
text
C0007465 (UMLS CUI [1,1])
C3160947 (UMLS CUI [1,2])
Central nervous system toxicity
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Central nervous system 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): Gastro intestinal toxicity
text
C0007465 (UMLS CUI [1,1])
C1142499 (UMLS CUI [1,2])
Gastro intestinal toxicity
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])
Skin toxicity
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])
Renal failure
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])
Multiple organ failure
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)
Other
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Other
boolean
Item Group
ADDITIONAL NOTES IF APPLICABLE
Comments
Item
Comments
text
IDENTIFICATION & SIGNATURE
Item
Identification
text
C0205396 (UMLS CUI [1])
Volver a la parte superior de la página 

Contacto

Utilice este formulario para comentarios, preguntas y sugerencias.

Los campos marcados con * son obligatorios.

Ayuda

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial