PATIENT
To be entered only if patient previously reported
integer
Hospital Unique Patient Number or Code
integer
First name(s) - surname(s) (Registration will not be accepted if this item is left blank)
text
Patient Birth Date
date
PatientGender
integer
ABO Group
integer
Rh factor
integer
DISEASE
Date of Diagnosis
date
Check the disease for which this transplant was performed
integer
Non infection related complications
boolean
PLASMA CELL DISORDERS (INCLUDING MULTIPLE MYELOMA)
Submitted Previously
integer
Select one
integer
(check light and heavy chain types)
text
(check light chain type only)
integer
SALMON AND DURIE
integer
STAGE AT DIAGNOSIS: ISS Stage
integer
CYTOGENETICS AND MOLECULAR DATA
integer
Number of abnormal metaphases
float
Number of examined metaphases
float
IF ABNORMAL, INDICATE ABNORMALITIES FOUND
integer
Other or associated abnormalities
text
Molecular analysis
integer
CLINICAL AND LABORATORY DATA
integer
INVOLVEMENT AT DIAGNOSIS Bone structure
integer
Extramedullary involvement
integer
Extramedullary involvement
integer
PRE-HSCT TREATMENT
Previous treatment
text
counted from diagnosis, or last HSCT if applicable
integer
Modality Chemo/Drugs
boolean
Modality Chemo/Drugs regimen
integer
Modality Radiotherapy
boolean
Response see manual for full definition of each response
integer
HSCT
STATUS OF DISEASE AT COLLECTION
SEE MANUAL FOR FULL DEFINITION OF EACH DISEASE STATUS
integer
STATUS OF DISEASE AT COLLECTION
integer
STATUS OF DISEASE AT COLLECTION
integer
STATUS OF DISEASE AT COLLECTION
integer
(COMPLETE ONLY IF STATUS IS STABLE DIEASE OR PR) (not applicable for non secretory myelona) PLATEAU
integer
CLINICAL AND LABORATORY DATA
integer
Bone structure
integer
ADDITIONAL TREATMENT POST-HSCT
Additional Disease Treatment
integer
If Yes
integer
(including MoAB, etc.)
integer
if other, please specify
integer
Radiotherapy
integer
Other Treatment
text
STATUS OF DISEASE AT 100 DAYS AFTER HSCT
(see manual for full definition of each response)
integer
If sCR or CR: NUMBER OF THIS COMPLETE REMISSION
integer
BEST RESPONSE TO HSCT AT 100 DAYS
integer
CR Date
date
Otherwise
date
(COMPLETE ONLY IF STATUS IS STABLE DISEASE OR PR) (not applicable for non secretory myelona)
integer
FORMS TO BE FILLED IN