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ID
16581
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Palavras-chave
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- 25/07/2016 25/07/2016 -
- 04/08/2016 04/08/2016 -
- 28/11/2017 28/11/2017 - Julian Varghese
- 15/03/2021 15/03/2021 - Dr. rer. medic Philipp Neuhaus
- 20/09/2021 20/09/2021 -
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25 de julho de 2016
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Creative Commons BY-NC 3.0
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19pp General Info EBMT Aplastic Anemia 06AA
19pp General Info EBMT Aplastic Anemia 06AA
- StudyEvent: ODM
Similar models
19pp General Info EBMT Aplastic Anemia 06AA
- StudyEvent: ODM
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
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
Name of contact person
text
C0337611 (UMLS CUI [1])
Telephone
Item
Telephone number
integer
C1515258 (UMLS CUI [1])
ContactPersonFaxNumber
Item
Fax
text
C0027361 (UMLS CUI [1,1])
C0337611 (UMLS CUI [1,2])
C0085205 (UMLS CUI [1,3])
C0237753 (UMLS CUI [1,4])
C0337611 (UMLS CUI [1,2])
C0085205 (UMLS CUI [1,3])
C0237753 (UMLS CUI [1,4])
ContactPersonE-mailText
Item
E-mail
text
C0027361 (UMLS CUI [1,1])
C0337611 (UMLS CUI [1,2])
C0013849 (UMLS CUI [1,3])
C1527021 (UMLS CUI [1,4])
C0337611 (UMLS CUI [1,2])
C0013849 (UMLS CUI [1,3])
C1527021 (UMLS CUI [1,4])
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])
Code List
Patient following national / international study / trial
CL Item
no (1)
CL Item
yes (2)
CL Item
unknown (3)
Name of study / trial
Item
Name of study / trial
text
C0008976 (UMLS CUI [1])
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])
CL Item
Male (1)
CL Item
Female (2)
ABO Group
Item
ABO Group
integer
C0000778 (UMLS CUI [1])
CL Item
Absent (1)
CL Item
Present (2)
CL Item
Not evaluated (3)
Diagnose-Datum
Item
Date of diagnosis
date
C2316983 (UMLS CUI [1,1])
C1274082 (UMLS CUI [1,2])
C1274082 (UMLS CUI [1,2])
Item
Check the disease for which this transplant was performed
text
C0277554 (UMLS CUI [1])
CL Item
Acute Leukaemia (Acute Leukaemia)
CL Item
Acute Lymphoblastic Leukaemia (ALL) (Acute Lymphoblastic Leukaemia (ALL))
CL Item
Acute Myelogenous Leukaemia (AML) (Acute Myelogenous Leukaemia (AML))
CL Item
Autoimmune disease (Autoimmune disease)
CL Item
Bone marrow failure including Aplastic anaemia (Bone marrow failure including Aplastic anaemia)
CL Item
Chronic Leukaemia (Chronic Leukaemia)
CL Item
Chronic Lymphocytic Leukaemia (Chronic Lymphocytic Leukaemia)
CL Item
Chronic Myeloid Leukaemia (CML) (Chronic Myeloid Leukaemia (CML))
CL Item
Haemoglobinopathiy (Haemoglobinopathiy)
CL Item
Histiocytic disorders (Histiocytic disorders)
CL Item
Hodgkin´s Disease (Hodgkin´s Disease)
CL Item
Inherited disorders (Inherited disorders)
CL Item
Juvenile Idiopathic Arthritis (Juvenile Idiopathic Arthritis)
CL Item
Lymphoma (Lymphoma)
CL Item
MD/ MPN (MD/ MPN)
CL Item
MDS (MDS)
CL Item
Metabolic disorders (Metabolic disorders)
CL Item
Multiple Sclerosis (Multiple Sclerosis)
CL Item
Myelodysplastic syndromes (Myelodysplastic syndromes)
CL Item
Myeloma/ Plasma cell disorder (Myeloma/ Plasma cell disorder)
CL Item
Myeloproliferative neoplasm (Myeloproliferative neoplasm)
CL Item
Non Hodgkin (Non Hodgkin)
CL Item
Other diagnosis (Other diagnosis)
CL Item
Primary immune deficiencies (Primary immune deficiencies)
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
Solid Tumour (Solid Tumour)
CL Item
Systemic Lupus (Systemic Lupus)
CL Item
Systemic Sclerosis (Systemic Sclerosis)
Item Group
BONE MARROW FAILURE SYNDROME (INCLUDING APLASTIC ANAEMIA)
Item
TYPE OF TREATMENT BEING REGISTERED WITH THIS FORM If patients have undergone immunosuppression prior to HSCT tick both boxes
text
Code List
TYPE OF TREATMENT BEING REGISTERED WITH THIS FORM If patients have undergone immunosuppression prior to HSCT tick both boxes
CL Item
Includes HSCT registration (Includes HSCT registration)
CL Item
Immunosuppressive therapy (IS) (Immunosuppressive therapy (IS))
Acquired
Item
Acquired
boolean
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
CL Item
Very severe (Very severe)
Pure red cell aplasia (non constitutional PRCA)
Item
Pure red cell aplasia (non constitutional PRCA)
boolean
Paroxysmal nocturnal haemoglobinuria (PNH)
Item
Paroxysmal nocturnal haemoglobinuria (PNH)
boolean
Haemolytic
Item
Haemolytic
boolean
Aplastic
Item
Aplastic
boolean
Thrombotic
Item
Thrombotic
boolean
Other
Item
if other presentation, please specify
text
Pure white cell aplasia
Item
Pure white cell aplasia
boolean
Amegakaryocytic thrombocytopenia (non constitutional)
Item
Amegakaryocytic thrombocytopenia (non constitutional)
boolean
Other
Item
if other, please specify
text
Genetic
Item
Genetic
boolean
Fanconi
Item
Fanconi
boolean
FANC complementation group
Item
FANC complementation group
text
Diamond-Blackfan (congenital / constitutional PRCA)
Item
Diamond-Blackfan (congenital / constitutional PRCA)
boolean
Shwachman-Diamond Syndrome
Item
Shwachman-Diamond Syndrome
boolean
Dyserythropoietic Anaemia
Item
Dyserythropoietic Anaemia
boolean
Dyskeratosis congenita
Item
Dyskeratosis congenita
boolean
Amegakaryocytic thrombocytopaenia (constitutional)
Item
Amegakaryocytic thrombocytopaenia (constitutional)
boolean
Other
Item
if Other, please specify
text
CL Item
Idiopathic (Idiopathic)
CL Item
Post-hepatitis (Post-hepatitis)
CL Item
Toxic (includes drug induced) (Toxic (includes drug induced))
CL Item
Other (Other)
CL Item
Done: abnormal (Done: abnormal)
CL Item
Done: normal (Done: normal)
CL Item
Not Done or failed (Not Done or failed)
CL Item
Unknown (Unknown)
CL Item
Conventional (Conventional )
CL Item
FISH (FISH )
CL Item
Both (Both)
Number of metaphases with anomalies
Item
Number of metaphases with anomalies
text
number of metaphases examined
Item
number of metaphases examined
text
CL Item
Absent (1)
CL Item
Present (2)
CL Item
Absent (Absent )
CL Item
Present (Present)
Other or associated abnormalities (specify)
Item
Other or associated abnormalities (specify)
text
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Not evaluated (Not evaluated)
Haemoglobin
Item
Haemoglobin
float
C0019046 (UMLS CUI [1])
Platelets
Item
Platelet count
float
C0005821 (UMLS CUI [1])
Neutrophils
Item
Neutrophils
integer
C0948762 (UMLS CUI [1])
Reticulocytes
Item
Reticulocytes
float
Ferritin
Item
Ferritin
float
C0373607 (UMLS CUI [1])
CL Item
Not evaluated (1)
CL Item
Untransfused (2)
CL Item
Transfused (3)
CL Item
Not evaluated (1)
CL Item
Untransfused (2)
CL Item
Transfused (3)
CL Item
Yes (Yes )
CL Item
No (No )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Date of PNH test
Item
Date of PNH test
date
CL Item
Clone absent (Clone absent)
CL Item
Clone present (Clone present)
CL Item
Not evaluated (Not evaluated)
Size of the PNH
Item
Size of the PNH clone in %
text
CL Item
Granulocytes (Granulocytes)
CL Item
RBC (RBC)
CL Item
Both (Both)
CL Item
Other (Other)
CL Item
Not done (Not done)
Flow cytometry assessment done on
Item
If other, please specify
text
PNH diagnostics by other test
Item
PNH diagnostics by other test, specify (if type of test unknown, write “unknown” here)
text
CL Item
Clone absent (Clone absent)
CL Item
Clone present (Clone present)
CL Item
Not done (Not done)
Clinical manifestations of PNH
Item
Clinical manifestations of PNH
boolean
Item
WAS THE PATIENT TREATED BEFORE THE HSCT PROCEDURE?
integer
Code List
WAS THE PATIENT TREATED BEFORE THE HSCT PROCEDURE?
CL Item
No (1)
CL Item
Yes, Date started (2)
FIRST TREATMENT EPISODE FOR THIS REGISTRATION
Item
Date treatment started
date
SEQUENTIAL NUMBER OF THIS TREATMENT EPISODE
Item
SEQUENTIAL NUMBER OF THIS TREATMENT EPISODE (Other treatment episodes can have been registered for this patient with previous data submissions)
text
Item Group
IF 1ST TREATMENT EPISODE FOR THE PATIENT EVER
CL Item
< 20 UNITS (< 20 UNITS)
CL Item
> 50 UNITS (> 50 UNITS)
CL Item
20-50 UNITS (20-50 UNITS)
CL Item
NONE (NONE)
CL Item
UNKNOWN (UNKNOWN)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
CL Item
NONE (1)
CL Item
< 20 UNITS (2)
CL Item
20-50 UNITS (3)
CL Item
> 50 UNITS (4)
CL Item
UNKNOWN (5)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Haemoglobin
Item
Haemoglobin
float
C0019046 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated )
CL Item
Untransfused (Untransfused )
CL Item
Transfused (Transfused)
Platelets
Item
Platelet count
float
C0005821 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
CL Item
Untransfused (Untransfused )
CL Item
Transfused (Transfused)
Neutrophils
Item
Neutrophils
text
Reticulocytes
Item
Reticulocytes
float
Ferritin
Item
Ferritin
float
C0373607 (UMLS CUI [1])
CL Item
Failure of first line therapy (Failure of first line therapy)
CL Item
Relapse (Relapse)
CL Item
PR to previous treatment (PR to previous treatment)
CL Item
Secondary clonal disorder (Secondary clonal disorder)
CL Item
Other (Other)
CL Item
Unknown (Unknown)
REASON FOR THIS TREATMENT
Item
if other, please specify
text
CL Item
ATG Origin (ATG Origin)
CL Item
Cyclosporin A (Cyclosporin A)
CL Item
Cyclophosphamide (Cyclophosphamide)
CL Item
Mycophenolate mofetil (Mycophenolate mofetil)
CL Item
G-CSF (G-CSF)
CL Item
Erythropoietin (Erythropoietin)
CL Item
Corticosteroid (Corticosteroid)
CL Item
Androgens (Androgens)
CL Item
Rituximab (Mabthera) (Rituximab (Mabthera))
CL Item
Alemtuzumab (Campath) (Alemtuzumab (Campath))
CL Item
Other (Other)
Medication
Item
If other, please specify
text
Item
RESPONSE TO THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
text
Code List
RESPONSE TO THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
CL Item
Complete remission (Complete remission )
CL Item
Partial remission (transfusion and growth factor independent) (Partial remission (transfusion and growth factor independent))
CL Item
No response (No response )
CL Item
Progression (Progression )
CL Item
Not evaluable (Not evaluable)
CL Item
Other (Other)
CL Item
Unknown (Unknown)
RESPONSE TO THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
Item
if other, please specify
text
Date response evaluated
Item
Date response evaluated
date
SECONDARY CLONAL COMPLICATIONS
Item
SECONDARY CLONAL COMPLICATIONS
boolean
Date of diagnosis of MDS
Item
Date of diagnosis of MDS (if applicable)
date
MDS WHO classification
Item
MDS WHO classification
text
Date of diagnosis of PNH
Item
Date of diagnosis of PNH (if applicable)
date
Size of the PNH clone
Item
Size of the PNH clone
float
CL Item
Granulocytes (Granulocytes )
CL Item
RBC (RBC )
CL Item
Both (Both)
CL Item
Other (Other)
CL Item
FLWCYTAA (FLWCYTAA )
CL Item
Not done (Not done)
Clinical manifestations of PNH
Item
Clinical manifestations of PNH
boolean
Date of diagnosis of other
Item
Date of diagnosis of other (if applicable)
date
HAS THE PATIENT UNDERGONE AN ADDITIONAL EPISODE OF IMMUNOSUPPRESSIVE TREATMENT?
Item
HAS THE PATIENT UNDERGONE AN ADDITIONAL EPISODE OF IMMUNOSUPPRESSIVE TREATMENT? If HSCT registration also, please proceed to “Status before HSCT” on page 6 If only Immunosuppressive treatment continue to follow-up form
boolean
Item Group
ADDITIONAL IMMUNOSUPPRESSIVE TREATMENT EPISODE
Date treatment started
Item
Date treatment started
date
SEQUENTIAL NUMBER OF THIS TREATMENT EPISODE
Item
SEQUENTIAL NUMBER OF THIS TREATMENT EPISODE
text
CL Item
Failure of first line therapy (Failure of first line therapy )
CL Item
Relapse (Relapse )
CL Item
PR to previous treatment (PR to previous treatment)
CL Item
Secondary clonal disorder (Secondary clonal disorder )
CL Item
Other (Other )
CL Item
Unknown (Unknown)
REASON FOR THIS TREATMENT
Item
if other, please specify
text
Haemoglobin
Item
Haemoglobin
float
C0019046 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated )
CL Item
Untransfused (Untransfused )
CL Item
Transfused (Transfused)
Platelets
Item
Platelet count
float
C0005821 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
CL Item
Untransfused (Untransfused )
CL Item
Transfused (Transfused)
Neutrophils
Item
Neutrophils
text
Reticulocytes
Item
Reticulocytes
float
Ferritin
Item
Ferritin
float
C0373607 (UMLS CUI [1])
CL Item
Failure of first line therapy (Failure of first line therapy)
CL Item
Relapse (Relapse)
CL Item
PR to previous treatment (PR to previous treatment)
CL Item
Secondary clonal disorder (Secondary clonal disorder)
CL Item
Other (Other)
CL Item
Unknown (Unknown)
REASON FOR THIS TREATMENT
Item
if other, please specify
text
CL Item
ATG Origin (ATG Origin)
CL Item
Cyclosporin A (Cyclosporin A)
CL Item
Cyclophosphamide (Cyclophosphamide)
CL Item
Mycophenolate mofetil (Mycophenolate mofetil)
CL Item
G-CSF (G-CSF)
CL Item
Erythropoietin (Erythropoietin)
CL Item
Corticosteroid (Corticosteroid)
CL Item
Androgens (Androgens)
CL Item
Rituximab (Mabthera) (Rituximab (Mabthera))
CL Item
Alemtuzumab (Campath) (Alemtuzumab (Campath))
CL Item
Other (Other)
Medication
Item
If other, please specify
text
Item
RESPONSE TO THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
text
Code List
RESPONSE TO THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
CL Item
Complete remission (Complete remission )
CL Item
Partial remission (transfusion and growth factor independent) (Partial remission (transfusion and growth factor independent))
CL Item
No response (No response )
CL Item
Progression (Progression )
CL Item
Not evaluable (Not evaluable)
CL Item
Other (Other)
CL Item
Unknown (Unknown)
RESPONSE TO THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
Item
if other, please specify
text
Date response evaluated
Item
Date response evaluated
date
SECONDARY CLONAL COMPLICATIONS
Item
SECONDARY CLONAL COMPLICATIONS
boolean
Date of diagnosis of MDS
Item
Date of diagnosis of MDS (if applicable)
date
MDS WHO classification
Item
MDS WHO classification
text
Date of diagnosis of PNH
Item
Date of diagnosis of PNH (if applicable)
date
Size of the PNH clone
Item
Size of the PNH clone
float
CL Item
Granulocytes (Granulocytes )
CL Item
RBC (RBC )
CL Item
Both (Both)
CL Item
Other (Other)
CL Item
FLWCYTAA (FLWCYTAA )
CL Item
Not done (Not done)
Clinical manifestations of PNH
Item
Clinical manifestations of PNH
boolean
Date of diagnosis of other
Item
Date of diagnosis of other (if applicable)
date
HAS THE PATIENT UNDERGONE AN ADDITIONAL EPISODE OF IMMUNOSUPPRESSIVE TREATMENT?
Item
HAS THE PATIENT UNDERGONE AN ADDITIONAL EPISODE OF IMMUNOSUPPRESSIVE TREATMENT? If HSCT registration also, please proceed to “Status before HSCT” on page 6 If only Immunosuppressive treatment continue to follow-up form
boolean
Date of HSCT
Item
Date of HSCT
date
C2584899 (UMLS CUI [1])
CL Item
Done: abnormal (Done: abnormal)
CL Item
Done: normal (Done: normal)
CL Item
Not Done or failed (Not Done or failed)
CL Item
Unknown (Unknown)
CL Item
Conventional (Conventional )
CL Item
FISH (FISH )
CL Item
Both (Both)
Number of metaphases with anomalies
Item
Number of metaphases with anomalies
text
number of metaphases examined
Item
number of metaphases examined
text
CL Item
Absent (Absent)
CL Item
Not evaluated (Not evaluated)
CL Item
Present (Present)
Other or associated abnormalities (specify)
Item
Other or associated abnormalities (specify)
text
Haemoglobin
Item
Haemoglobin
float
C0019046 (UMLS CUI [1])
Platelets
Item
Platelet count
float
C0005821 (UMLS CUI [1])
Neutrophils
Item
Neutrophils
integer
C0948762 (UMLS CUI [1])
Reticulocytes
Item
Reticulocytes
float
Ferritin
Item
Ferritin
float
C0373607 (UMLS CUI [1])
CL Item
Not evaluated (1)
CL Item
Untransfused (2)
CL Item
Transfused (3)
CL Item
Not evaluated (1)
CL Item
Untransfused (2)
CL Item
Transfused (3)
CL Item
Yes (Yes )
CL Item
No (No )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Date of PNH test
Item
Date of PNH test
date
CL Item
Clone absent (Clone absent)
CL Item
Clone present (Clone present)
CL Item
Not evaluated (Not evaluated)
Size of the PNH
Item
Size of the PNH clone in %
text
CL Item
Granulocytes (Granulocytes)
CL Item
RBC (RBC)
CL Item
Both (Both)
CL Item
Other (Other)
CL Item
Not done (Not done)
Flow cytometry assessment done on
Item
If other, please specify
text
PNH diagnostics by other test
Item
PNH diagnostics by other test, specify (if type of test unknown, write “unknown” here)
text
CL Item
Clone absent (Clone absent)
CL Item
Clone present (Clone present)
CL Item
Not done (Not done)
Clinical manifestations of PNH
Item
Clinical manifestations of PNH
boolean
CL Item
< 20 UNITS (< 20 UNITS)
CL Item
> 50 UNITS (> 50 UNITS)
CL Item
20-50 UNITS (20-50 UNITS)
CL Item
NONE (NONE)
CL Item
UNKNOWN (UNKNOWN)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
CL Item
NONE (1)
CL Item
< 20 UNITS (2)
CL Item
20-50 UNITS (3)
CL Item
> 50 UNITS (4)
CL Item
UNKNOWN (5)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Item
ADDITIONAL DISEASE TREATMENT if yes
integer
C1706712 (UMLS CUI [1])
CL Item
Planned (planned before HSCT took place) (1)
CL Item
Not planned (for relapse/progression or persistent disease) (2)
CL Item
Complete remission (Complete remission )
CL Item
Partial remission (transfusion and growth factor independent) (Partial remission (transfusion and growth factor independent))
CL Item
No response (No response )
CL Item
Progression (Progression )
CL Item
Not evaluable (Not evaluable)
CL Item
Other (Other)
CL Item
Unknown (Unknown)
BEST RESPONSE AT 100 DAYS AFTER HSCT
Item
if other, please specify
text
Date response evaluated
Item
Date response evaluated
date
CL Item
ALLOgraft or Synergenic graft, proceed to Allograft form (ALLOgraft or Synergenic graft, proceed to Allograft form)
CL Item
AUTOgraft, proceed to Autograft form (AUTOgraft, proceed to Autograft form)
CL Item
Other, contact the EBMT Central Registry Office for instructions (Other, contact the EBMT Central Registry Office for instructions)
Item Group
BONE MARROW FAILURE SYNDROME (INCLUDING APLASTIC ANAEMIA)
Unique Identification Code (UIC)
Item
Unique Identification Code (UIC) (if known)
text
C2348585 (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)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Name of study / trial
Item
Name of study / trial
text
C0008976 (UMLS CUI [1])
Hospital Unique Patient Number
Item
Hospital Unique Patient Number
text
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])
C0011008 (UMLS CUI [1,2])
Date last contact
Item
Date of Last Contact or Death
date
C0805839 (UMLS CUI [1])
Item Group
GRAFT VERSUS HOST DISEASE (GvHD) SINCE LAST REPORT
CL Item
grade 0 (Absent) (1)
CL Item
grade I (2)
CL Item
grade II (3)
CL Item
grade III (4)
CL Item
grade IV (5)
CL Item
Not evaluated (6)
Item
If present GvHD, Maximum grade
integer
C0856825 (UMLS CUI [1,1])
C0441800 (UMLS CUI [1,2])
C0441800 (UMLS CUI [1,2])
CL Item
New onset (1)
CL Item
Recurrent (2)
CL Item
Persistent (3)
CL Item
Tapering (1)
CL Item
DLI (2)
CL Item
Unexplained (3)
Date onset of this episode
Item
Date onset of this episode
date
Item
Date onset of this episode
integer
C0574845 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
CL Item
Not applicable (1)
CL Item
None (0)
CL Item
Stage 1 (1)
CL Item
Stage 2 (2)
CL Item
Stage 3 (3)
CL Item
Stage 4 (4)
CL Item
Evaluated (Evaluated)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item
Stage liver
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C0023884 (UMLS CUI [1,3])
C1306673 (UMLS CUI [1,2])
C0023884 (UMLS CUI [1,3])
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])
C1306673 (UMLS CUI [1,2])
C0021853 (UMLS CUI [1,3])
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)
Resolution
Item
aGvHD Resolution
boolean
C0856825 (UMLS CUI [1,1])
C1514893 (UMLS CUI [1,2])
C1514893 (UMLS CUI [1,2])
aGvHD Date of resolution
Item
Date of resolution
date
C0856825 (UMLS CUI [1,1])
C1514893 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
C1514893 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
CL Item
No (No)
CL Item
Present continuously since last reported episode (Present continuously since last reported episode)
CL Item
Resolved (Resolved)
CL Item
Yes (Yes)
Date of onset
Item
Date of onset
date
CL Item
Limited (Limited )
CL Item
Extensive (Extensive)
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])
C0011008 (UMLS CUI [1,2])
Infection related complications
Item
Infection related complications
boolean
C0009450 (UMLS CUI [1,1])
C0009566 (UMLS CUI [1,2])
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
Retinitis
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Retinitis
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Other
Item
if other type of pathogen, please specify
text
Item
NON INFECTION RELATED COMPLICATIONS
integer
C0009566 (UMLS CUI [1])
CL Item
No complications (1)
CL Item
Yes (2)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Idiopathic pneumonia syndrome
Item
Idiopathic pneumonia syndrome
date
C1504431 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
VOD
Item
VOD
date
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Cataract
Item
Cataract
date
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Haemorrhagic cystitis, non infectious
Item
Haemorrhagic cystitis, non infectious
date
Item
Haemorrhagic cystitis, non infectious
text
C0085692 (UMLS CUI [1])
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
ARDS, non infectious
Item
ARDS, non infectious
date
Item
Multiorgan failure, non infectious
integer
C0026766 (UMLS CUI [1])
CL Item
no (no )
CL Item
unknown (unknown)
CL Item
yes (yes )
Multiorgan failure, non infectious
Item
Multiorgan failure, non infectious
date
Item
(Check all that are applicable for this period HSCT-associated microangiopathy
text
C0155765 (UMLS CUI [1])
Code List
(Check all that are applicable for this period HSCT-associated microangiopathy
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
HSCT-associated microangiopathy
Item
HSCT-associated microangiopathy
date
Item
(Check all that are applicable for this period) Renal failure requiring dialysis
text
C0035078 (UMLS CUI [1])
Code List
(Check all that are applicable for this period) Renal failure requiring dialysis
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Renal failure requiring dialysis
Item
Renal failure requiring dialysis
date
Item
(Check all that are applicable for this period) Haemolytic anaemia due to blood group
integer
C0002878 (UMLS CUI [1])
Code List
(Check all that are applicable for this period) Haemolytic anaemia due to blood group
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Haemolytic anaemia due to blood group
Item
Haemolytic anaemia due to blood group
date
Item
Check all that are applicable for this period) Aseptic bone necrosis
text
C0158452 (UMLS CUI [1])
Code List
Check all that are applicable for this period) Aseptic bone necrosis
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Aseptic bone necrosis
Item
Aseptic bone necrosis
date
Other
Item
(Check all that are applicable for this period) if other, please specify
text
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Yes (Yes)
CL Item
Full (donor >95 %) (1)
CL Item
Mixed (partial) (2)
CL Item
Autologous reconstitution (recipient >95 %) (3)
CL Item
Aplasia (4)
CL Item
Not evaluated (5)
Date of Test
Item
Date of Test
date
C0024671 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
Identification of donor or Cord Blood Unit given by the centre
Item
Identification of donor or Cord Blood Unit given by the centre
text
Number in the infusion order
Item
Number in the infusion order (if applicable)
text
C0237753 (UMLS CUI [1])
Item
Number in the infusion order (if applicable)
integer
C2348184 (UMLS CUI [1])
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-Cell
Item
Cell type on which test was performed (% Donor cells): B-Cells
float
C0004561 (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
Item
if other, please specify
text
Item
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
integer
Code List
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
CL Item
Previously reported (1)
CL Item
Yes (2)
CL Item
No at date of this follow-up (3)
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
Item
if yes, date of diagnosis
date
CL Item
AML (AML )
CL Item
MDS (MDS )
CL Item
Lymphoproliferative disorder (Lymphoproliferative disorder)
CL Item
Other (Other)
Diagnosis
Item
if other, please specify
text
Additional treatment
Item
Treatment given since last report
boolean
C1706712 (UMLS CUI [1])
Date started
Item
Date started
date
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
C0012634 (UMLS CUI [1])
CL Item
CR (CR)
CL Item
Not evaluated (Not evaluated)
CL Item
Not in CR (Not in CR)
CL Item
Donor lymphocyte infusion (DLI) (1)
CL Item
Mesenchymal cells (2)
CL Item
Other (3)
CL Item
Unknown (4)
Nucleated cells
Item
Number of Nucleated cells infused (DLI only)
text
C1180059 (UMLS CUI [1])
Item
If DLI, specify the number of cells infused by type: Nucleated cells
text
C1180059 (UMLS CUI [1])
CL Item
Evaluated (Evaluated)
CL Item
Not evaluated (Not evaluated)
CL Item
unknown (unknown)
Item
If DLI, specify the number of cells infused by type: CD 34+
text
C3538723 (UMLS CUI [1])
CL Item
Evaluated (Evaluated)
CL Item
Not Evaluated (Not Evaluated)
CL Item
Unknown (Unknown)
CL Item
Evaluated (Evaluated )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Evaluated (Evaluated)
CL Item
Not Evaluated (Not Evaluated)
CL Item
Unknown (Unknown)
Chronological number of this cell therapy for this patient
Item
Chronological number of this cell therapy for this patient
text
Item
Indication (check all that apply)
text
C3146298 (UMLS CUI [1,1])
C0302189 (UMLS CUI [1,2])
C0302189 (UMLS CUI [1,2])
CL Item
Loss/decreased chimaerism (Loss/decreased chimaerism)
CL Item
Mixed chimaerism (Mixed chimaerism)
CL Item
Other (Other)
CL Item
Planned/ protocol (Planned/ protocol)
CL Item
Prophylactic (Prophylactic)
CL Item
Treatment for disease (Treatment for disease)
CL Item
Treatment of GvHD (Treatment of GvHD)
CL Item
Treatment PTLD, EBV, lymphoma (Treatment PTLD, EBV, lymphoma)
CL Item
Treatment viral infection (Treatment viral infection)
Indication
Item
if other, please specify
text
Infusion count
Item
Number of infusions within 10 weeks (count only infusions that are part of same regimen and given for the same indication)
float
C0574032 (UMLS CUI [1,1])
C0750480 (UMLS CUI [1,2])
C0750480 (UMLS CUI [1,2])
CL Item
grade 0 (absent) (1)
CL Item
grade 1 (2)
CL Item
grade 2 (3)
CL Item
grade 3 (4)
CL Item
grade 4 (5)
CL Item
present, grade unknown (6)
Item
ADDITIONAL IMMUNOSUPPRESSIVE (DISEASE) TREATMENT
text
Code List
ADDITIONAL IMMUNOSUPPRESSIVE (DISEASE) TREATMENT
CL Item
No additional therapy except transfusions (No additional therapy except transfusions)
CL Item
Yes: Planned (planned before HSCT took place) (Yes: Planned (planned before HSCT took place) )
CL Item
Yes: Not planned (for relapse/progression or persistent disease) (Yes: Not planned (for relapse/progression or persistent disease))
Item Group
FIRST IMMUNOSUPPRESSIVE TREATMENT EPISODE FOR THIS FOLLOW UP
SEQUENTIAL NUMBER OF THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
Item
SEQUENTIAL NUMBER OF THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
text
CL Item
Failure of previous treatment (Failure of previous treatment )
CL Item
Relapse (Relapse )
CL Item
PR to previous treatment (PR to previous treatment)
CL Item
Secondary clonal disorder (Secondary clonal disorder )
CL Item
Other (Other)
CL Item
Unknown (Unknown)
CL Item
< 20 UNITS (< 20 UNITS)
CL Item
> 50 UNITS (> 50 UNITS)
CL Item
20-50 UNITS (20-50 UNITS)
CL Item
NONE (NONE)
CL Item
UNKNOWN (UNKNOWN)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
CL Item
<20 units (<20 units )
CL Item
20-50 units (20-50 units )
CL Item
>50 units (>50 units )
CL Item
None (None )
CL Item
unknown (unknown)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Haemoglobin
Item
Haemoglobin
float
C0019046 (UMLS CUI [1])
Platelets
Item
Platelet count
float
C0005821 (UMLS CUI [1])
Neutrophils
Item
Neutrophils
integer
C0948762 (UMLS CUI [1])
Reticulocytes
Item
Reticulocytes
float
Ferritin
Item
Ferritin
float
C0373607 (UMLS CUI [1])
CL Item
Not evaluated (1)
CL Item
Untransfused (2)
CL Item
Transfused (3)
CL Item
Not evaluated (1)
CL Item
Untransfused (2)
CL Item
Transfused (3)
CL Item
ATG Origin (ATG Origin)
CL Item
Cyclosporin A (Cyclosporin A)
CL Item
Cyclophosphamide (Cyclophosphamide)
CL Item
Mycophenolate mofetil (Mycophenolate mofetil)
CL Item
G-CSF (G-CSF)
CL Item
Erythropoietin (Erythropoietin)
CL Item
Corticosteroid (Corticosteroid)
CL Item
Androgens (Androgens)
CL Item
Rituximab (Mabthera) (Rituximab (Mabthera))
CL Item
Alemtuzumab (Campath) (Alemtuzumab (Campath))
CL Item
Other (Other)
Medication
Item
If other, please specify
text
Item
RESPONSE TO THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
text
Code List
RESPONSE TO THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
CL Item
Complete remission (Complete remission )
CL Item
Partial remission (transfusion and growth factor independent) (Partial remission (transfusion and growth factor independent))
CL Item
No response (No response )
CL Item
Progression (Progression )
CL Item
Not evaluable (Not evaluable)
CL Item
Other (Other)
CL Item
Unknown (Unknown)
RESPONSE TO THIS IMMUNOSUPPRESSIVE TREATMENT EPISODE
Item
if other, please specify
text
Date response evaluated
Item
Date response evaluated
date
SECONDARY CLONAL COMPLICATIONS
Item
SECONDARY CLONAL COMPLICATIONS
boolean
Date of diagnosis of MDS
Item
Date of diagnosis of MDS (if applicable)
date
MDS WHO classification
Item
MDS WHO classification
text
Date of diagnosis of PNH
Item
Date of diagnosis of PNH (if applicable)
date
Size of the PNH clone
Item
Size of the PNH clone
float
CL Item
Granulocytes (Granulocytes )
CL Item
RBC (RBC )
CL Item
Both (Both)
CL Item
Other (Other)
CL Item
FLWCYTAA (FLWCYTAA )
CL Item
Not done (Not done)
Clinical manifestations of PNH
Item
Clinical manifestations of PNH
boolean
Date of diagnosis of other
Item
Date of diagnosis of other (if applicable)
date
HAS THE PATIENT UNDERGONE AN ADDITIONAL EPISODE OF IMMUNOSUPPRESSIVE TREATMENT?
Item
HAS THE PATIENT UNDERGONE AN ADDITIONAL EPISODE OF IMMUNOSUPPRESSIVE TREATMENT? If HSCT registration also, please proceed to “Status before HSCT” on page 6 If only Immunosuppressive treatment continue to follow-up form
boolean
Item Group
FIRST EVIDENCE OF DISEASE WORSENING SINCE LAST HSCT
Item
Relapse or progression
integer
C0035020 (UMLS CUI [1,1])
C1704632 (UMLS CUI [1,2])
C1704632 (UMLS CUI [1,2])
CL Item
Previously reported (1)
CL Item
No (2)
CL Item
yes (3)
CL Item
Continuous progression since transplant (4)
CL Item
Unknown (5)
RELAPSE OR PROGRESSION
Item
if yes, date diagnosed
date
CL Item
No response (No response)
CL Item
Complete Remission (Complete Remission)
CL Item
Partial Remission (Partial Remission)
CL Item
Relapse/Progression (Relapse/Progression)
Date of PNH test
Item
Date of PNH test
date
Size of the PNH clone
Item
Size of the PNH clone in %
text
CL Item
Granulocytes (Granulocytes )
CL Item
RBC (RBC )
CL Item
Both (Both)
CL Item
Other (Other)
CL Item
Not done (Not done)
Flow cytometry assessment done on
Item
if other, please specify
text
Clinical manifestations of PNH
Item
Clinical manifestations of PNH
boolean
Item
Has patient or partner become pregnant after this HSCT?
integer
Code List
Has patient or partner become pregnant after this HSCT?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
CL Item
alive (0)
CL Item
dead (1)
CL Item
Karnofsky (1)
CL Item
Lansky (2)
CL Item
100 (Normal, NED) (1)
CL Item
10 (Moribund) (10)
CL Item
Not evaluated (11)
CL Item
Unknown (12)
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
Relapse or progression (1)
CL Item
Secondary malignancy (including lymphoproliferative disease) (2)
CL Item
HSCT related cause (3)
CL Item
Unknown (4)
CL Item
Other (5)
Cause of death
Item
Other cause of death:please specify
text
C0007465 (UMLS CUI [1])
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])
C0018133 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): GvHD
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
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])
C0206061 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Interstitial Pneumonitis
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
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])
C0919924 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Pulmonary toxicity
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
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])
C0009450 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Infection
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Infection:
Item
bacterial viral fungal parasitic unknown
text
Item
Rejection / poor graft function
integer
C0018129 (UMLS CUI [1])
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])
C0948441 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Veno-Occlusive disease (VOD)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
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])
C0019080 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Haemorrhage
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
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])
C0876994 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Cardiac toxicity
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
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])
C3160947 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Central nervous system toxicity
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
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])
C1142499 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Gastro intestinal toxicity
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
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])
C1167791 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Skin toxicity
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
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])
C0035078 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Renal failure
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
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])
C0026766 (UMLS CUI [1,2])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Multiple organ failure
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
COMMENTS
Item
COMMENTS
text
IDENTIFICATION & SIGNATURE
Item
IDENTIFICATION & SIGNATURE
text