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ID
16064
Beskrivning
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
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Nyckelord
Versioner (3)
- 2017-09-27 2017-09-27 -
- 2017-09-27 2017-09-27 -
- 2021-09-20 2021-09-20 -
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27 september 2017
DOI
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General Info EBMT Lymphoma
16pp General Info EBMT Lymphoma 04
- StudyEvent: ODM
Similar models
16pp General Info EBMT Lymphoma 04
- StudyEvent: ODM
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
EBMT Centre Identification Code (CIC)
Item
EBMT Centre Identification Code (CIC)
integer
C2348585 (UMLS CUI [1,1])
C3826859 (UMLS CUI [1,2])
C3826859 (UMLS CUI [1,2])
Hospital
Item
Hospital
text
C0019994 (UMLS CUI [1])
Unit
Item
Unit
integer
C1519795 (UMLS CUI [1])
Contact person
Item
Contact person
text
C0337611 (UMLS CUI [1])
Telephone
Item
Telephone number
integer
C1515258 (UMLS CUI [1])
Fax
Item
Fax
integer
C1549619 (UMLS CUI [1])
E-Mail
Item
E-Mail
integer
C1705961 (UMLS CUI [1])
Date of this report
Item
Date of this report
date
C1302584 (UMLS CUI [1])
Item
Patient following national / international study / trial
integer
C1997894 (UMLS CUI [1])
CL Item
No (1)
C1298908 (UMLS CUI-1)
CL Item
Yes (2)
C1705108 (UMLS CUI-1)
CL Item
Not evaluated (3)
C3846720 (UMLS CUI-1)
CL Item
Unknown (4)
C0439673 (UMLS CUI-1)
Name of study / trial
Item
Name of study / trial
integer
C0008976 (UMLS CUI [1])
Unique Identification Code (UIC)
Item
Unique Identification Code (UIC)
integer
C2348585 (UMLS CUI [1])
Hospital Unique Patient Number or Code
Item
Hospital Unique Patient Number or Code
integer
C2926025 (UMLS CUI [1])
Initials
Item
Initials
text
C2986440 (UMLS CUI [1])
Date of birth
Item
Date of birth:
date
C0421451 (UMLS CUI [1])
CL Item
Male (1)
C1706180 (UMLS CUI-1)
CL Item
Female (2)
C0015780 (UMLS CUI-1)
ABO Group
Item
ABO Group
integer
C0000778 (UMLS CUI [1])
CL Item
Absent (1)
C2699077 (UMLS CUI-1)
CL Item
Present (2)
C2699078 (UMLS CUI-1)
CL Item
Not evaluated (3)
C3846720 (UMLS CUI-1)
Date of diagnosis
Item
Date of diagnosis
date
C2316983 (UMLS CUI [1])
CL Item
Acute Leukaemia (Acute Leukaemia)
C0085669 (UMLS CUI-1)
CL Item
Acute Myelogenous Leukaemia (AML) (Acute Myelogenous Leukaemia (AML))
C0023467 (UMLS CUI-1)
CL Item
Acute Lymphoblastic Leukaemia (ALL) (Acute Lymphoblastic Leukaemia (ALL))
C0023449 (UMLS CUI-1)
CL Item
Secondary Acute Leukaemia (do not use if transformed from MDS/MPN) (Secondary Acute Leukaemia (do not use if transformed from MDS/MPN))
C0856053 (UMLS CUI-1)
CL Item
Chronic Leukaemia (Chronic Leukaemia)
C0856053 (UMLS CUI-1)
CL Item
Chronic Myeloid Leukaemia (CML) (Chronic Myeloid Leukaemia (CML))
C0023473 (UMLS CUI-1)
CL Item
Chronic Lymphocytic Leukaemia (Chronic Lymphocytic Leukaemia)
C0023434 (UMLS CUI-1)
CL Item
Lymphoma (Lymphoma)
C0024299 (UMLS CUI-1)
CL Item
Non Hodgkin (Non Hodgkin)
C0024305 (UMLS CUI-1)
CL Item
Myeloma/ Plasma cell disorder (Myeloma/ Plasma cell disorder)
C0026764 (UMLS CUI-1)
CL Item
Solid Tumour (Solid Tumour)
C0006826 (UMLS CUI-1)
CL Item
Myelodysplastic syndromes (Myelodysplastic syndromes)
C0280450 (UMLS CUI-1)
CL Item
MDS (MDS)
C3463824 (UMLS CUI-1)
CL Item
MD/ MPN (MD/ MPN)
C1292778 (UMLS CUI-1)
CL Item
Myeloproliferative neoplasm (Myeloproliferative neoplasm)
C1333046 (UMLS CUI-1)
CL Item
Bone marrow failure including Aplastic anaemia (Bone marrow failure including Aplastic anaemia)
C0002874 (UMLS CUI-1)
CL Item
Inherited disorders (Inherited disorders)
C0019247 (UMLS CUI-1)
CL Item
Primary immune deficiencies (Primary immune deficiencies)
C0398686 (UMLS CUI-1)
CL Item
Metabolic disorders (Metabolic disorders)
C0025517 (UMLS CUI-1)
CL Item
Histiocytic disorders (Histiocytic disorders)
C0398597 (UMLS CUI-1)
CL Item
Autoimmune disease (Autoimmune disease)
C0004364 (UMLS CUI-1)
CL Item
Juvenile Idiopathic Arthritis (Juvenile Idiopathic Arthritis)
C1444841 (UMLS CUI-1)
CL Item
Multiple Sclerosis (Multiple Sclerosis)
C0026769 (UMLS CUI-1)
CL Item
Systemic Lupus (Systemic Lupus)
C0024141 (UMLS CUI-1)
CL Item
Systemic Sclerosis (Systemic Sclerosis)
C0036421 (UMLS CUI-1)
CL Item
Haemoglobinopathy (Haemoglobinopathiy)
C0019045 (UMLS CUI-1)
CL Item
Other diagnosis (Other diagnosis)
C0205394 (UMLS CUI-1)
CL Item
Hodgkin´s Disease (Hodgkin´s Disease)
C0019829 (UMLS CUI-1)
Item
Has the information requested in this section been submitted with a previous transplant registration for this patient?
integer
C0421512 (UMLS CUI [1])
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)
CL Item
B-Cell Lymphomas (1)
C0079731 (UMLS CUI-1)
CL Item
Splenic marginal zone lymphoma (2)
C0349632 (UMLS CUI-1)
CL Item
Extranodal marginal zone lymphoma of mucosa associated lymphoid tissue (MALT) (3)
C0242647 (UMLS CUI-1)
CL Item
Nodal marginal zone lymphoma (4)
C0855140 (UMLS CUI-1)
CL Item
Lymphoplasmacytic lymphoma (LPL) (5)
C0334633 (UMLS CUI-1)
CL Item
Waldenstrom macroglobulinaemia (6)
C0024419 (UMLS CUI-1)
CL Item
(LPL with monoclonal IgM) (7)
C0334633 (UMLS CUI-1)
CL Item
Follicular lymphoma (8)
C0024301 (UMLS CUI-1)
CL Item
9 (9)
CL Item
Primary cutaneous follicle centre lymphoma (10)
C1333171 (UMLS CUI-1)
CL Item
Mantle cell lymphoma (11)
C1333095 (UMLS CUI-1)
CL Item
Diffuse large B-cell lymphoma (DLBCL), (NOS) (12)
C0079744 (UMLS CUI-1)
CL Item
T-cell/hystiocyte rich large B cell lymphoma (13)
C0079744 (UMLS CUI-1)
CL Item
Primary DLBCL of the CNS (14)
C0079744 (UMLS CUI-1)
CL Item
Primary cutaneous DLBCL, leg type (15)
C1275325 (UMLS CUI-1)
CL Item
EBV positive DLBCL of the elderly (16)
C2700007 (UMLS CUI-1)
CL Item
DLBCL associated with chronic inflammation (17)
C2699776 (UMLS CUI-1)
CL Item
Lymphomatoid granulomatosis (18)
C0024307 (UMLS CUI-1)
CL Item
Primary mediastinal (thymic) large B-cell lymphoma (19)
C1292754 (UMLS CUI-1)
CL Item
Intravascular large B-cell lymphoma (20)
C0334660 (UMLS CUI-1)
CL Item
ALK positive large B-cell lymphoma (21)
C1333294 (UMLS CUI-1)
CL Item
Plasmablastic lymphoma (22)
C3472614 (UMLS CUI-1)
CL Item
Large B-cell lymphoma arising in HHV8- associated multicentric Castleman disease (23)
C3472615 (UMLS CUI-1)
CL Item
Primary effusion lymphoma (PEL) (24)
C1292753 (UMLS CUI-1)
CL Item
Burkitt lymphoma (BL) (25)
C0006413 (UMLS CUI-1)
CL Item
B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma (Intermediate DLCBL/BL) (26)
C2698294 (UMLS CUI-1)
CL Item
B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma (Intermediate DLCBL/HD) (27)
C1333878 (UMLS CUI-1)
CL Item
Other B-cell, specify: (28)
C1709657 (UMLS CUI-1)
Transformed from another type of lymphoma at HSCT?
Item
Transformed from another type of lymphoma at HSCT?
boolean
C0854868 (UMLS CUI [1])
Item
T-CELL AND NK-CELL NON HODGKIN LYMPHOMAS (NHL)
integer
C1336554 (UMLS CUI [1])
CL Item
T-cell large granular lymphocytic leukaemia (1)
C1955861 (UMLS CUI-1)
CL Item
Aggressive NK-cell leukaemia (2)
C1292777 (UMLS CUI-1)
CL Item
Systemic EBV positive T-cell lymphoproliferative disease of childhood (3)
C2699838 (UMLS CUI-1)
CL Item
Hydroa vacciniforme-like lymphoma (4)
C1708397 (UMLS CUI-1)
CL Item
Adult T-cell leukaemia/lymphoma (5)
C0023493 (UMLS CUI-1)
CL Item
Extranodal NK/T-cell lymphoma, nasal type (6)
C0392788 (UMLS CUI-1)
CL Item
Enteropathy-associated T-cell lymphoma (7)
C0456889 (UMLS CUI-1)
CL Item
Hepatosplenic T-cell lymphoma (8)
C1333984 (UMLS CUI-1)
CL Item
Subcutaneous panniculitis-like T-cell lymphoma (9)
C0522624 (UMLS CUI-1)
CL Item
Mycosis fungoides (MF) (10)
C0026948 (UMLS CUI-1)
CL Item
Sézary syndrome (11)
C0036920 (UMLS CUI-1)
CL Item
Lymphomatoid papulosis (12)
C0206182 (UMLS CUI-1)
CL Item
Primary cutaneous anaplastic large cell lymphoma (13)
C1275326 (UMLS CUI-1)
CL Item
Primary cutaneous gamma-delta T-cell lymphoma (14)
C1707547 (UMLS CUI-1)
CL Item
Primary cutaneous CD8 positive aggressive epidermotropic cytotoxic T-cell lymphoma (15)
C0079772 (UMLS CUI-1)
CL Item
Primary cutaneous CD4 positive small/medium T-cell lymphoma (16)
C1301363 (UMLS CUI-1)
CL Item
Peripheral T-cell lymphoma, NOS (PTCL) (17)
C0079774 (UMLS CUI-1)
CL Item
Angioimmunoblastic T-cell lymphoma (18)
C0020981 (UMLS CUI-1)
CL Item
Anaplastic large-cell lymphoma (ALCL), ALK-positive (19)
C1332079 (UMLS CUI-1)
CL Item
Anaplastic large-cell lymphoma (ALCL), ALK-negative (20)
C1332078 (UMLS CUI-1)
CL Item
Other T-cell, specify (21)
C3845569 (UMLS CUI-1)
CL Item
Nodular lymphocyte (Nodular lymphocyte predominant)
C1334968 (UMLS CUI-1)
CL Item
Classical predominant (Classical predominant)
C1333064 (UMLS CUI-1)
CL Item
Nodular sclerosis classical (Nodular sclerosis classical)
C0152268 (UMLS CUI-1)
CL Item
Lymphocyte-rich classical (Lymphocyte-rich classical)
C1266194 (UMLS CUI-1)
CL Item
Mixed cellularity classical (Mixed cellularity classical)
C0152266 (UMLS CUI-1)
CL Item
Lymphocyte-depleted classical (Lymphocyte-depleted classical)
C0152267 (UMLS CUI-1)
CL Item
Other, specify (Other, specify)
C1299220 (UMLS CUI-1)
CL Item
I (I)
CL Item
II (II)
CL Item
III (III)
CL Item
IV (IV)
CL Item
Absent (A) (Absent (A))
CL Item
Present (B) (Present (B))
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
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)
CL Item
Normal (1)
C0853788 (UMLS CUI-1)
CL Item
Elevated (2)
C0151754 (UMLS CUI-1)
CL Item
Not evaluated (3)
C3846720 (UMLS CUI-1)
CL Item
Unknown (4)
C0439673 (UMLS CUI-1)
CL Item
Nodes below the diaphragm (1)
C0854726 (UMLS CUI-1)
CL Item
Bone marrow (2)
C2046619 (UMLS CUI-1)
CL Item
Extranodal (CNS) (3)
C3164318 (UMLS CUI-1)
CL Item
Mediastinum (4)
C1334658 (UMLS CUI-1)
CL Item
Extranodal (testis /ovary) (5)
C2046656 (UMLS CUI-1)
CL Item
Nodes above the diaphragm (6)
CL Item
Lung (7)
C2046647 (UMLS CUI-1)
CL Item
Liver (8)
C2046646 (UMLS CUI-1)
CL Item
Spleen (9)
C2853781 (UMLS CUI-1)
CL Item
Other (10)
C0205394 (UMLS CUI-1)
Item
Has the information requested in this section been submitted with a previous transplant registration for this patient?
integer
C1514821 (UMLS CUI [1])
Code List
Has the information requested in this section been submitted with a previous transplant registration for this patient?
CL Item
No: proceed with this section (No: proceed with this section)
CL Item
Yes: go to page 5, ”Disease History before HSCT" (Yes: go to page 5, ”Disease History before HSCT")
Item
WAS THE PATIENT TREATED BEFORE THE 1ST TRANSPLANT PROCEDURE?
integer
C0040732 (UMLS CUI [1])
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)
integer
C0087111 (UMLS CUI [1])
Item
Modality Chemo/drug/agent (including MoAB, etc.)
text
C0695347 (UMLS CUI [1])
CL Item
No (No )
CL Item
Yes: Regimen (Yes: Regimen)
CL Item
Unknown (Unknown)
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
integer
C0521982 (UMLS CUI [1])
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
C1706712 (UMLS CUI [1])
Code List
ADDITIONAL TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT?
CL Item
Unknown (Unknown)
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")
Pharmacotherapy
Item
Chemo/drug/agent
boolean
C0013216 (UMLS CUI [1])
Regimen
Item
Treatment Regimen
integer
C0392920 (UMLS CUI [1])
Radiotherapy
Item
Radiotherapy
boolean
C1522449 (UMLS CUI [1])
CL Item
Complete remission (Complete remission )
C0677874 (UMLS CUI-1)
CL Item
Partial remission (> 50 %) ( Partial remission (> 50 %) )
C1521726 (UMLS CUI-1)
CL Item
No response (< 50 %) (No response (< 50 %))
C3844738 (UMLS CUI-1)
Date of transplant
Item
Date of transplant
date
C0472699 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
Total number of lines before this transplant
Item
Total number of lines before this transplant
integer
C1708063 (UMLS CUI [1])
CL Item
Chemotherapy (1)
C0392920 (UMLS CUI-1)
CL Item
MoAB (Immunotherapy) (2)
C0279694 (UMLS CUI-1)
CL Item
Radiotherapy (3)
C1522449 (UMLS CUI-1)
Splenectomy
Item
Splenectomy
boolean
C0037995 (UMLS CUI [1])
CL Item
Untreated (untested) (Untreated (untested))
CL Item
Sensitive (responding) (Sensitive (responding))
CL Item
Resistant (Resistant)
Item
Complete remission achieved before the 1st transplant
integer
C0677874 (UMLS CUI [1])
Code List
Complete remission achieved before the 1st transplant
CL Item
Yes: Date of first CR (Yes: Date of first CR)
CL Item
No (No)
CL Item
Number of treatment lines necessary to reach this first remission (3)
CL Item
Number of CR’s (4)
Item
1st Relapse before the 1st transplant
integer
C0035020 (UMLS CUI [1])
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
CL Item
No (2)
C1298908 (UMLS CUI-1)
Item
If patient has ever achieved Complete remission
integer
C0677874 (UMLS CUI [1])
CL Item
Complete remission (CR) (Complete remission (CR))
C0677874 (UMLS CUI-1)
CL Item
Unconfirmed (Unconfirmed)
C1547326 (UMLS CUI-1)
CL Item
Confirmed -By CT scan (Confirmed -By CT scan)
C0040405 (UMLS CUI-1)
CL Item
Confirmed -By PET (Confirmed -By PET)
C0032743 (UMLS CUI-1)
CL Item
Relapse (Relapse)
C0277556 (UMLS CUI-1)
RELAPSE
Item
RELAPSE
boolean
C0277556 (UMLS CUI [1])
CL Item
Untreated (untested) (Untreated (untested))
C0332155 (UMLS CUI-1)
CL Item
Sensitive (responding) (Sensitive (responding))
C0332324 (UMLS CUI-1)
CL Item
Resistant (Resistant)
C3844738 (UMLS CUI-1)
Item
If patient has never achieved a Complete remission
integer
C0677874 (UMLS CUI [1])
Code List
If patient has never achieved a Complete remission
CL Item
At diagnosis (untreated) (At diagnosis (untreated))
C0332155 (UMLS CUI-1)
CL Item
Primary refractory disease ( Primary refractory disease)
C1514815 (UMLS CUI-1)
CL Item
Very good 1st PR (> 90 %) (Very good 1st PR (> 90 %))
C1521726 (UMLS CUI-1)
CL Item
PR ( PR)
C1521726 (UMLS CUI-1)
CL Item
Progression (Progression)
C0242656 (UMLS CUI-1)
CL Item
1st (1st)
CL Item
2nd (2nd)
CL Item
3rd or higher (3rd or higher)
Item
DISEASE INVOLVEMENT AT TRANSPLANT
text
C0012634 (UMLS CUI [1])
CL Item
Yes (Yes )
C1705108 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
CL Item
No (No )
C1298908 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated )
C3846720 (UMLS CUI-1)
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
C0027653 (UMLS CUI [1])
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)
C0854726 (UMLS CUI-1)
CL Item
Extranodal (CNS) (2)
C3164318 (UMLS CUI-1)
CL Item
Mediastinum (3)
C1334658 (UMLS CUI-1)
CL Item
Extranodal (testis /ovary) (4)
C2046656 (UMLS CUI-1)
CL Item
Nodes above the diaphragm (5)
C1336486 (UMLS CUI-1)
CL Item
Lung (6)
C2046647 (UMLS CUI-1)
CL Item
Liver (7)
C2046646 (UMLS CUI-1)
CL Item
Spleen (8)
C2853781 (UMLS CUI-1)
CL Item
Bone marrow (9)
C2046619 (UMLS CUI-1)
Item
Number of relapses in the last 12 months unknown
integer
C0035020 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
C0237753 (UMLS CUI [1,2])
Code List
Number of relapses in the last 12 months unknown
CL Item
1st (1)
CL Item
2nd (2)
CL Item
3rd or higher (3)
CL Item
No (No)
C1298908 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
CL Item
Yes: Planned (planned before HSCT took place) (Yes: Planned (planned before HSCT took place))
C3641097 (UMLS CUI-1)
CL Item
Not planned (for relapse/progression or persistent disease) ( Not planned (for relapse/progression or persistent disease))
C0087111 (UMLS CUI-1)
Date started
Item
Start of treatment
date
C2712338 (UMLS CUI [1])
CL Item
Chemo (Chemo)
CL Item
drug (drug)
CL Item
agent (including MoAB, vaccination, etc.) (agent (including MoAB, vaccination, etc.))
CL Item
yes no=no not known=not known (yes)
Item
BEST RESPONSE AT 100 DAYS AFTER TRANSPLANTATION
integer
C1704632 (UMLS CUI [1])
Code List
BEST RESPONSE AT 100 DAYS AFTER TRANSPLANTATION
CL Item
Complete remission (maintained or achieved) (Complete remission (maintained or achieved) )
C0677874 (UMLS CUI-1)
CL Item
Partial remission (> 50 %) ( Partial remission (> 50 %) )
C1521726 (UMLS CUI-1)
CL Item
No response (< 50 %) ( No response (< 50 %))
C0871261 (UMLS CUI-1)
CL Item
Progression ( Progression )
C0242656 (UMLS CUI-1)
CL Item
Early death/Not evaluable ( Early death/Not evaluable)
C1836407 (UMLS CUI-1)
CL Item
Complete remission confirmed by CT scan ( By CT scan)
C0040398 (UMLS CUI-1)
C0677874 (UMLS CUI-2)
C0677874 (UMLS CUI-2)
CL Item
Complete remission confirmed by PET ( By PET)
C0677874 (UMLS CUI-1)
C0032743 (UMLS CUI-2)
C0032743 (UMLS CUI-2)
CL Item
( )
If Complete remission: Date of CR
Item
If Complete remission: Date of CR
date
C4050094 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
C2316983 (UMLS CUI [1,2])
CL Item
AUTOgraft, proceed to Autograft form (1)
C0040736 (UMLS CUI-1)
CL Item
ALLOgraft or Syngeneic graft, proceed to Allograft form (2)
C0040739 (UMLS CUI-1)