ID
16064
Beschrijving
ODM form derived from 16pp General Info EBMT Lymphoma 04. please refer to: http://www.ebmt.org/Contents/Data-Management/Registrystructure/MED-ABdatacollectionforms/Pages/MED-AB-data-collection-forms.aspx
Link
Trefwoorden
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- 27-09-17 27-09-17 -
- 27-09-17 27-09-17 -
- 20-09-21 20-09-21 -
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27 september 2017
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Creative Commons BY-NC 3.0
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General Info EBMT Lymphoma
16pp General Info EBMT Lymphoma 04
- StudyEvent: ODM
Beschrijving
GENERAL INFORMATION Patient
Beschrijving
To be entered only if patient previously reported
Datatype
integer
Alias
- UMLS CUI [1]
- C2348585
Beschrijving
Hospital Unique Patient Number or Code
Datatype
integer
Alias
- UMLS CUI [1]
- C2926025
Beschrijving
First name(s)_surname(s)
Datatype
text
Alias
- UMLS CUI [1]
- C2986440
Beschrijving
Date of birth
Datatype
date
Alias
- UMLS CUI [1]
- C0421451
Beschrijving
Sex
Datatype
text
Alias
- UMLS CUI [1]
- C0079399
Beschrijving
ABO Group
Datatype
integer
Alias
- UMLS CUI [1]
- C0000778
Beschrijving
Rh factor
Datatype
integer
Alias
- UMLS CUI [1]
- C0035403
Beschrijving
DISEASE
Beschrijving
Date of diagnosis
Datatype
date
Alias
- UMLS CUI [1]
- C2316983
Beschrijving
Check the disease for which this transplant was performed
Datatype
integer
Alias
- UMLS CUI [1]
- C0277554
Beschrijving
LYMPHOMA INITIAL DIAGNOSIS
Beschrijving
Has the information requested in this section been submitted with a previous transplant registration for this patient?
Datatype
integer
Alias
- UMLS CUI [1]
- C0421512
Beschrijving
Non Hodgkin Lymphoma (NHL)
Datatype
integer
Alias
- UMLS CUI [1]
- C0024305
Beschrijving
Transformed from another type of lymphoma at HSCT?
Datatype
boolean
Alias
- UMLS CUI [1]
- C0854868
Beschrijving
Mature T-cell & NK-cell Neoplasms
Datatype
integer
Alias
- UMLS CUI [1]
- C1336554
Beschrijving
HODGKIN LYMPHOMAS
Datatype
integer
Alias
- UMLS CUI [1]
- C0019829
Beschrijving
ANN ARBOR STAGING FOR ADULT NON-BURKITT'S PATIENTS, MURPHY STAGE FOR BURKITT'S DISEASE AND PAEDIATRIC PATIENTS.
Datatype
text
Alias
- UMLS CUI [1]
- C1300072
Beschrijving
Systemic symptoms
Datatype
text
Alias
- UMLS CUI [1]
- C2039684
Beschrijving
DISEASE INVOLVEMENT AT DIAGNOSIS
Datatype
integer
Alias
- UMLS CUI [1]
- C1272779
Beschrijving
LDH LEVELS
Datatype
integer
Alias
- UMLS CUI [1]
- C0022917
Beschrijving
Specific sites of involvement
Datatype
integer
Alias
- UMLS CUI [1]
- C2046538
Beschrijving
TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT
Beschrijving
Has the information requested in this section been submitted with a previous transplant registration for this patient?
Datatype
integer
Alias
- UMLS CUI [1]
- C1514821
Beschrijving
WAS THE PATIENT TREATED BEFORE THE 1ST TRANSPLANT PROCEDURE?
Datatype
integer
Alias
- UMLS CUI [1]
- C0040732
Beschrijving
Sequential number of this treatment
Datatype
integer
Alias
- UMLS CUI [1]
- C0087111
Beschrijving
Modality Chemo/drug/agent
Datatype
text
Alias
- UMLS CUI [1]
- C0695347
Beschrijving
If MoAB, radiolabelled
Datatype
text
Alias
- UMLS CUI [1]
- C0392292
Beschrijving
Radiotherapy
Datatype
boolean
Alias
- UMLS CUI [1]
- C1522449
Beschrijving
Response to this line of therapy
Datatype
integer
Alias
- UMLS CUI [1]
- C0521982
Beschrijving
ADDITIONAL TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT?
Datatype
text
Alias
- UMLS CUI [1]
- C1706712
Beschrijving
Pharmacotherapy
Datatype
boolean
Alias
- UMLS CUI [1]
- C0013216
Beschrijving
Regimen
Datatype
integer
Alias
- UMLS CUI [1]
- C0392920
Beschrijving
Radiotherapy
Datatype
boolean
Alias
- UMLS CUI [1]
- C1522449
Beschrijving
Response to this line of therapy
Datatype
text
Alias
- UMLS CUI [1]
- C0871261
Beschrijving
DISEASE HISTORY BEFORE HSCT
Beschrijving
Date of transplant
Datatype
date
Alias
- UMLS CUI [1,1]
- C0472699
- UMLS CUI [1,2]
- C0011008
Beschrijving
(since diagnosis if 1st transplant, or since last reported transplant)
Datatype
integer
Alias
- UMLS CUI [1]
- C1708063
Beschrijving
Modality used at least once
Datatype
integer
Alias
- UMLS CUI [1]
- C0695347
Beschrijving
Splenectomy
Datatype
boolean
Alias
- UMLS CUI [1]
- C0037995
Beschrijving
TYPE OF RELAPSE
Datatype
integer
Alias
- UMLS CUI [1]
- C0205336
Beschrijving
CR achieved before the 1st transplant
Datatype
integer
Alias
- UMLS CUI [1]
- C0677874
Beschrijving
TO BE COMPLETED ONLY IF PATIENT HAD A CR BEFORE THE 1ST TRANSPLANT
Datatype
integer
Alias
- UMLS CUI [1]
- C0035020
Beschrijving
STATUS OF DISEASE AT HSCT
Beschrijving
If patient has ever achieved Complete remission
Datatype
integer
Alias
- UMLS CUI [1]
- C0677874
Beschrijving
RELAPSE
Datatype
boolean
Alias
- UMLS CUI [1]
- C0277556
Beschrijving
TYPE OF RELAPSE
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0035020
- UMLS CUI [1,2]
- C0035020
Beschrijving
If patient has never achieved a Complete remission
Datatype
integer
Alias
- UMLS CUI [1]
- C0677874
Beschrijving
NUMBER OF THIS PR
Datatype
text
Alias
- UMLS CUI [1]
- C1521726
Beschrijving
DISEASE INVOLVEMENT AT TRANSPLANT
Datatype
text
Alias
- UMLS CUI [1]
- C0012634
Beschrijving
(if patient in CR at HSCT, indicate “No mass”)
Datatype
text
Alias
- UMLS CUI [1]
- C3272927
Beschrijving
Specific sites of disease
Datatype
integer
Alias
- UMLS CUI [1]
- C0027653
Beschrijving
Number of relapses in the last 12 months unknown
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0035020
- UMLS CUI [1,2]
- C0237753
Beschrijving
ADDITIONAL TREATMENT POST-HSCT
Beschrijving
Additional Disease Treatment
Datatype
integer
Alias
- UMLS CUI [1]
- C1706712
Beschrijving
Date started
Datatype
date
Alias
- UMLS CUI [1]
- C2712338
Beschrijving
Modality
Datatype
integer
Alias
- UMLS CUI [1]
- C0695347
Beschrijving
Radiotherapy
Datatype
integer
Alias
- UMLS CUI [1]
- C1522449
Beschrijving
BEST DISEASE RESPONSE AT 100 DAYS POST-HSCT
Beschrijving
BEST RESPONSE AT 100 DAYS AFTER TRANSPLANTATION
Datatype
integer
Alias
- UMLS CUI [1]
- C1704632
Beschrijving
If Complete remission: Date of CR
Datatype
date
Alias
- UMLS CUI [1,1]
- C4050094
- UMLS CUI [1,2]
- C2316983
Beschrijving
FORMS TO BE FILLED IN
Similar models
16pp General Info EBMT Lymphoma 04
- StudyEvent: ODM
C3826859 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
C0237753 (UMLS CUI [1,2])
C0677874 (UMLS CUI-2)
C0032743 (UMLS CUI-2)
C2316983 (UMLS CUI [1,2])