Item
HIV
integer
C0019682 (UMLS CUI [1])
CL Item
Negative (Negative )
C0205160 (UMLS CUI-1)
CL Item
Positive (Positive )
C1446409 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated )
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
HIV ANTIGENS (if testing applicable)
integer
C0019686 (UMLS CUI [1])
Code List
HIV ANTIGENS (if testing applicable)
CL Item
Negative (Negative )
C0205160 (UMLS CUI-1)
CL Item
Positive (Positive )
C1446409 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated )
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
CMV
integer
C0582172 (UMLS CUI [1])
CL Item
Negative (Negative )
C0205160 (UMLS CUI-1)
CL Item
Positive (Positive )
C1446409 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated )
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
EBV
integer
C0014644 (UMLS CUI [1])
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVs
integer
C0019163 (UMLS CUI [1])
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVs ANTIGENS (if testing applicable)
integer
C0019165 (UMLS CUI [1])
Code List
HBVs ANTIGENS (if testing applicable)
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVc
integer
C1440681 (UMLS CUI [1])
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVe
integer
C0019167 (UMLS CUI [1])
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
HCV
integer
C0220847 (UMLS CUI [1])
CL Item
Negative (Negative)
CL Item
Positive (Positive)
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
HCV ANTIGENS (if testing applicable)
integer
C0121459 (UMLS CUI [1])
Code List
HCV ANTIGENS (if testing applicable)
CL Item
Negative (Negative)
CL Item
Positive (Positive)
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
HTLV
integer
C0086427 (UMLS CUI [1])
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
Toxoplasmosis
integer
C0040558 (UMLS CUI [1])
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
if other Antibodies in the patient
integer
C0205394 (UMLS CUI [1])
Code List
if other Antibodies in the patient
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Specify (Specify)
Item
PRE-TRANSPLANT HISTORY OF DOCUMENTED INVASIVE FUNGAL INFECTION SINCE INITIAL DIAGNOSIS
integer
C0026946 (UMLS CUI [1])
Code List
PRE-TRANSPLANT HISTORY OF DOCUMENTED INVASIVE FUNGAL INFECTION SINCE INITIAL DIAGNOSIS
CL Item
No (No)
C1298908 (UMLS CUI-1)
CL Item
Yes (Yes)
C1705108 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Candida
integer
C0006837 (UMLS CUI [1])
CL Item
Unknown (Unknown)
Item
Aspergillus
integer
C0004034 (UMLS CUI [1])
CL Item
Unknown (Unknown)
Item
Pneumocystis carinii
integer
C0032276 (UMLS CUI [1])
Code List
Pneumocystis carinii
CL Item
Unknown (Unknown)
Other
Item
Other
boolean
C0205394 (UMLS CUI [1])
Other
Item
Other if yes, please specify
integer
C0205394 (UMLS CUI [1])
Multiple donors
Item
Multiple donors
boolean
C0013018 (UMLS CUI [1])
Number of donors or different stem cell products of same donor or cord blood units
Item
different stem cell products of same donor or cord blood units
float
C0038250 (UMLS CUI [1])
Item
SOURCE OF STEM CELLS FOR THIS DONOR/PRODUCT
integer
C0038250 (UMLS CUI [1,1])
C0449416 (UMLS CUI [1,2])
Code List
SOURCE OF STEM CELLS FOR THIS DONOR/PRODUCT
CL Item
Bone marrow (Bone marrow)
CL Item
Peripheral blood (Peripheral blood)
CL Item
Cord blood (Cord blood)
Identification of Donor or Cord Blood Unit given by the centre
Item
Identification of Donor or Cord Blood Unit
integer
C1550613 (UMLS CUI [1])
Number in the infusion order
Item
Number in the infusion order
integer
C0574032 (UMLS CUI [1])
Item
HLA MATCH TYPE
text
C0242318 (UMLS CUI [1])
CL Item
HLA-identical sibling (may include non-monozygotic twin) (HLA-identical sibling (may include non-monozygotic twin))
CL Item
Syngeneic (monozygotic twin) (Syngeneic (monozygotic twin))
CL Item
HLA-matched other relative (HLA-matched other relative)
CL Item
HLA-mismatched relative:Degree of allele mismatch (HLA-mismatched relative:Degree of allele mismatch)
CL Item
1 HLA antigen mismatch ALLMISRL (1 HLA antigen mismatch ALLMISRL)
CL Item
> 2 HLA antigen mismatch (> 2 HLA antigen mismatch)
CL Item
Unrelated donor (Unrelated donor)
Name of the Donor registry
Item
Name of the Donor registry
integer
C1549696 (UMLS CUI [1])
BMDW / WMDA code for the donor registry (up to 4 characters)
Item
BMDW / WMDA code for the donor registry (up to 4 characters)
integer
C2987198 (UMLS CUI [1])
Name of the Cord blood bank
Item
Name of the Cord blood bank
integer
C0005770 (UMLS CUI [1])
Eurocord code for the cord blood bank
Item
Eurocord code for the cord blood bank
integer
C0005770 (UMLS CUI [1,1])
C0805701 (UMLS CUI [1,2])
Item
HIV
integer
C0019682 (UMLS CUI [1])
CL Item
Negative (Negative )
C0205160 (UMLS CUI-1)
CL Item
Positive (Positive )
C1446409 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated )
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
HIV ANTIGENS (if testing applicable)
integer
C0019686 (UMLS CUI [1])
Code List
HIV ANTIGENS (if testing applicable)
CL Item
Negative (Negative )
C0205160 (UMLS CUI-1)
CL Item
Positive (Positive )
C1446409 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated )
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
CMV
integer
C0582172 (UMLS CUI [1])
CL Item
Negative (Negative )
C0205160 (UMLS CUI-1)
CL Item
Positive (Positive )
C1446409 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated )
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
EBV
integer
C0014644 (UMLS CUI [1])
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVs
integer
C0019163 (UMLS CUI [1])
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVs ANTIGENS (if testing applicable)
integer
C0019165 (UMLS CUI [1])
Code List
HBVs ANTIGENS (if testing applicable)
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVc
integer
C1440681 (UMLS CUI [1])
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVe
integer
C0019167 (UMLS CUI [1])
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
HCV
integer
C0220847 (UMLS CUI [1])
CL Item
Negative (Negative)
CL Item
Positive (Positive)
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
HCV ANTIGENS (if testing applicable)
integer
C0121459 (UMLS CUI [1])
Code List
HCV ANTIGENS (if testing applicable)
CL Item
Negative (Negative)
CL Item
Positive (Positive)
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
HTLV
integer
C0086427 (UMLS CUI [1])
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
Toxoplasmosis
integer
C0040558 (UMLS CUI [1])
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item
if other Antibodies in the patient
integer
C0205394 (UMLS CUI [1])
Code List
if other Antibodies in the patient
CL Item
Negative (Negative )
CL Item
Positive (Positive )
CL Item
Specify (Specify)
Date of harvest or cord blood collection
Item
Date of harvest or cord blood collection
date
C1512335 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
GROWTH FACTORS ADMINISTERED TO THE DONOR
integer
C0018284 (UMLS CUI [1])
Code List
GROWTH FACTORS ADMINISTERED TO THE DONOR
CL Item
Unknown (Unknown)
Laboratory / Hospital
Item
Laboratory / Hospital
integer
C0022877 (UMLS CUI [1,1])
|C0019994 (UMLS CUI [1,2])
Unit
Item
Unit
integer
C1519795 (UMLS CUI [1])
telephone number
Item
Contact number
integer
C1515258 (UMLS CUI [1])
Technique
Item
Technique Used
integer
C0034925 (UMLS CUI [1,1])
C0449851 (UMLS CUI [1,2])
Serology (antigenic) HLA typing
Item
Serology (antigenic) HLA typing done
boolean
C0242318 (UMLS CUI [1])
DNA (Allelic/molecular) HLA typing done
Item
DNA (Allelic/molecular) HLA typing done
boolean
C0242318 (UMLS CUI [1])
Item
DNA (Allelic/molecular) HLA typing done: Locus
integer
C1321760 (UMLS CUI [1])
Code List
DNA (Allelic/molecular) HLA typing done: Locus
HLA string
Item
HLA string
integer
C1547402 (UMLS CUI [1,1])
C0019721 (UMLS CUI [1,2])
NMDP code
Item
NMDP code
integer
C1882036 (UMLS CUI [1,1])
C1827636 (UMLS CUI [1,2])
Serology (antigenic) HLA typing done
Item
Serology (antigenic) HLA typing done
boolean
C0242318 (UMLS CUI [1])
Item
HLA Serology
integer
C0242318 (UMLS CUI [1])
CL Item
A (A)
C0019728 (UMLS CUI-1)
CL Item
B (B)
C0019737 (UMLS CUI-1)
CL Item
C (C)
C0019751 (UMLS CUI-1)
CL Item
DRB1 (DRB1)
C0122040 (UMLS CUI-1)
CL Item
DQB1 (DQB1)
C0122020 (UMLS CUI-1)
CL Item
DPB1 (DPB1)
C0555918 (UMLS CUI-1)
Identification of donor or Cord Blood Unit given by the centre
Item
Identification of donor or Cord Blood Unit given by the centre
integer
C1827636 (UMLS CUI [1])
Number in the infusion order
Item
Number in the infusion order (if applicable)
text
C0237753 (UMLS CUI [1])
GRAFT MANIPULATION EX-VIVO (INCLUDING T-CELL DEPLETION)
Item
GRAFT MANIPULATION EX-VIVO (INCLUDING T-CELL DEPLETION)
boolean
C0677960 (UMLS CUI [1])
Item
NEGATIVE SELECTION
integer
C2347338 (UMLS CUI [1])
Code List
NEGATIVE SELECTION
CL Item
Unknown (Unknown)
Item
if negative selection, specify
integer
C2347338 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
Code List
if negative selection, specify
CL Item
B-cell depletion by MoAB (B-cell depletion by MoAB )
C1171324 (UMLS CUI-1)
CL Item
NK cell depletion by MoAB (NK cell depletion by MoAB )
C0022688 (UMLS CUI-1)
CL Item
Elutriation (Elutriation )
C0872136 (UMLS CUI-1)
CL Item
Other (Other)
C0205394 (UMLS CUI-1)
CL Item
T-cell depletion by MoAB (do not enter (T-cell depletion by MoAB (do not enter )
C0677960 (UMLS CUI-1)
Item
if positive selection, splease specify:
integer
C2347644 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
Code List
if positive selection, splease specify:
CL Item
No (No)
C1298908 (UMLS CUI-1)
CL Item
Yes: Monoclonal antibodies (Yes: Monoclonal antibodies)
C3542957 (UMLS CUI-1)
CL Item
unknown (unknown)
C0439673 (UMLS CUI-1)
Item
Monoclonal antibodies
integer
C3542957 (UMLS CUI [1])
Code List
Monoclonal antibodies
CL Item
Unknown (Unknown)
Item
Monoclonal antibodies: if yes
integer
C0003250 (UMLS CUI [1])
Code List
Monoclonal antibodies: if yes
CL Item
CD 34+ (CD 34+ )
C3538723 (UMLS CUI-1)
CL Item
Other (Other)
C0205394 (UMLS CUI-1)
Item
EXPANSION
integer
C0040290 (UMLS CUI [1])
CL Item
Unknown (Unknown)
Item
GENE MANIPULATION (gene transfer/transduction)
integer
C0947647 (UMLS CUI [1])
Code List
GENE MANIPULATION (gene transfer/transduction)
CL Item
Unknown (Unknown)
Identification of donor or Cord Blood Unit given by the centre
Item
IF MULTIPLE DONORS: Identification of donor or Cord Blood Unit given by the centre (please, use same ID as in the preceding sheets)
text
Number in the infusion order
Item
Number in the infusion order (if applicable)
text
C0237753 (UMLS CUI [1])
Item
CELL INFUSION METHOD Fill in for Cord Blood HSCT only
text
Code List
CELL INFUSION METHOD Fill in for Cord Blood HSCT only
CL Item
Intravenous (IV) (Intravenous (IV))
CL Item
intrabone / intramedullary (intrabone / intramedullary)
CL Item
Other, specify (Other, specify)
CL Item
unknown (unknown)
Route of infusion: If other, please specify:
Item
Route of infusion: If other, please specify:
integer
C1827465 (UMLS CUI [1])
Item
Infusion method
integer
C0574032 (UMLS CUI [1])
Code List
Infusion method
CL Item
Wash (Rubinstein/New York) (Wash (Rubinstein/New York))
CL Item
Other, specify (Other, specify)
Infusion method: if other, please specify
Item
Infusion method: if other, please specify
integer
C0574032 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
Item
Tests performed after thawing of an aliquot on
integer
C1521902 (UMLS CUI [1])
Code List
Tests performed after thawing of an aliquot on
CL Item
Contiguous segment (Contiguous segment )
C1511492 (UMLS CUI-1)
CL Item
Reference bag (Reference bag )
C0034925 (UMLS CUI-1)
CL Item
unknown (unknown)
C0439673 (UMLS CUI-1)
Item
Method used
integer
C0871511 (UMLS CUI [1])
CL Item
7-AAD (7-AAD)
C0049832 (UMLS CUI-1)
CL Item
Acridine orange-ethidium iodide (Acridine orange-ethidium iodide)
C0001185 (UMLS CUI-1)
CL Item
Trypan blue (Tryptan blue)
C0041213 (UMLS CUI-1)
CL Item
Other, specify (Other, specify)
C1299220 (UMLS CUI-1)
CL Item
Acridine orange-ethidium bromide (Acridine orange-ethidium bromide)
C0001185 (UMLS CUI-1)
CL Item
unknown (unknown)
C0439673 (UMLS CUI-1)
Viability of all cells
Item
Viability of all cells
float
C1516362 (UMLS CUI [1])
Viability of CD34+ cells
Item
Viability of CD34+ cells
float
C1516362 (UMLS CUI [1,1])
C0882849 (UMLS CUI [1,2])
Item
Bone Marrow: Total number of cells actually infused
integer
C2145394 (UMLS CUI [1,1])
C0005953 (UMLS CUI [1,2])
Code List
Bone Marrow: Total number of cells actually infused
CL Item
CD 34+ (cells/kg*) (1)
CL Item
Nucleated cells (/kg*) (2)
CL Item
T-cells (CD 3+) (cells/kg*) (3)
Item
Bone Marrow: Total number of cells actually infused, specify:
integer
C2145394 (UMLS CUI [1,1])
C0005953 (UMLS CUI [1,2])
Code List
Bone Marrow: Total number of cells actually infused, specify:
CL Item
Not evaluated (Not evaluated )
CL Item
unknown (unknown)
Item
Peripheral Blood: Total number of cells actually infused
integer
C0229664 (UMLS CUI [1,1])
C2145394 (UMLS CUI [1,2])
Code List
Peripheral Blood: Total number of cells actually infused
CL Item
T-cells (CD 3+) (cells/kg*) (1)
CL Item
Nucleated cells (/kg*) (2)
CL Item
CD 34+ (cells/kg*) (3)
Item
Peripheral Blood: Total number of cells actually infused
integer
C0229664 (UMLS CUI [1,1])
C2145394 (UMLS CUI [1,2])
Code List
Peripheral Blood: Total number of cells actually infused
Item
Cord Blood: Total number of cellsactually infused
integer
C0162371 (UMLS CUI [1,1])
C2145394 (UMLS CUI [1,2])
Code List
Cord Blood: Total number of cellsactually infused
CL Item
CD 34+ (cells/kg*) (1)
C0054953 (UMLS CUI-1)
CL Item
Nucleated cells (/kg*) (2)
C1180059 (UMLS CUI-1)
CL Item
T-cells (CD 3+) (cells/kg*) (3)
C0039194 (UMLS CUI-1)
Item
Cord Blood: Total number of cellsa ctually infused
integer
C0162371 (UMLS CUI [1,1])
C2145394 (UMLS CUI [1,2])
Code List
Cord Blood: Total number of cellsa ctually infused
CL Item
Not evaluated (Not evaluated )
CL Item
unknown (unknown)
Chronological number
Item
Chronological number of HSCT for this patient
integer
C1318453 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Item
Donor the same as for previous HSCT?
integer
C0013018 (UMLS CUI [1,1])
C0472699 (UMLS CUI [1,2])
Code List
Donor the same as for previous HSCT?
CL Item
Previous HSCT(s) autologous (Previous HSCT(s) autologous)
Date of previous HSCT
Item
Date of previous HSCT
date
C0018956 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Type of previous HSCT
integer
C0472699 (UMLS CUI [1])
Code List
Type of previous HSCT
Item
Reason for this transplant
integer
C1718260 (UMLS CUI [1])
Code List
Reason for this transplant
CL Item
Relapse/progression after previous HSCT (Relapse/progression after previous HSCT)
CL Item
Graft failure after allo BMT (Graft failure after allo BMT)
Item
HSCT part of a multiple sequential graft protocol
integer
C0442711 (UMLS CUI [1])
Code List
HSCT part of a multiple sequential graft protocol
CL Item
Unknown (Unknown)
Type of multiple graft protocol
Item
Type of multiple graft protocol
integer
C0442711 (UMLS CUI [1])
Graft number in the protocol
Item
Graft number in the protocol
integer
C1961139 (UMLS CUI [1])
total number of HSCTs in the program
Item
total number of HSCTs in the program
integer
C0449788 (UMLS CUI [1,1])
C0472699 (UMLS CUI [1,2])
PREPARATIVE (CONDITIONING) REGIMEN GIVEN
Item
PREPARATIVE (CONDITIONING) REGIMEN GIVEN
boolean
C1882454 (UMLS CUI [1])
Item
Was regimen intended to be myeloablative
integer
C1882454 (UMLS CUI [1,1])
C1513784 (UMLS CUI [1,2])
Code List
Was regimen intended to be myeloablative
CL Item
Unknown (Unknown)
Item
Reason not myeloablative
integer
C1831742 (UMLS CUI [1])
Code List
Reason not myeloablative
CL Item
Age of recipient (Age of recipient)
CL Item
Comorbid conditions (Comorbid conditions)
CL Item
Prior HSCT (Prior HSCT)
CL Item
Protocol driven (Protocol driven)
CL Item
Other, specify (Other, specify)
Item
Drugs
integer
C0013227 (UMLS CUI [1])
CL Item
Unknown (Unknown)
NAME OF DRUG
Item
NAME OF DRUG
text
C3273235 (UMLS CUI [1])
CUMULATIVE DOSE
Item
PRESCRIBED CUMULATIVE DOSE AS PER PROTOCOL (DAILY DOSE BY NUMBER OF DAYS)
integer
C2986497 (UMLS CUI [1])
Item
IF MONOCLONAL ANTIBODY, RADIO LABELLED?
integer
C0003250 (UMLS CUI [1])
Code List
IF MONOCLONAL ANTIBODY, RADIO LABELLED?
Item
UNITS IF RADIO LABELLED
integer
C0041697 (UMLS CUI [1])
Code List
UNITS IF RADIO LABELLED
Item
Route of administration
integer
C0013153 (UMLS CUI [1])
Code List
Route of administration
Item
Animal origin
integer
C3494749 (UMLS CUI [1])
CL Item
Other, specify (Other, specify)
Item
TBI
integer
C1456496 (UMLS CUI [1])
CL Item
Unknown (Unknown)
Total dose
Item
Total dose (Gy)
float
C2919490 (UMLS CUI [1])
Number of fractions
Item
Number of fractions
float
C0454266 (UMLS CUI [1])
radiation days
Item
radiation days
integer
C3693616 (UMLS CUI [1])
Item
TLI / TNI / TAI
integer
C3670574 (UMLS CUI [1])
C0077401 (UMLS CUI [2])
Code List
TLI / TNI / TAI
CL Item
Unknown (Unknown)
Item
Local radiotherapy
integer
C1522449 (UMLS CUI [1])
Code List
Local radiotherapy
CL Item
Unknown (Unknown)
Item
GROWTH FACTORS (CYTOKINES)
integer
C0018284 (UMLS CUI [1])
Code List
GROWTH FACTORS (CYTOKINES)
GROWTH FACTORS: If yes, please specify
Item
GROWTH FACTORS: If yes, please specify
text
C0018284 (UMLS CUI [1,1])
C4035158 (UMLS CUI [1,2])
Date started
Item
Date started
date
C3173309 (UMLS CUI [1])
Item
CELLULAR THERAPY
integer
C0302189 (UMLS CUI [1])
Code List
CELLULAR THERAPY
CL Item
Unknown (Unknown)
Date of first infusion
Item
Date of first infusion
date
C0574032 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
CELLULAR THERAPY: if yes, specify:
integer
C0302189 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
Code List
CELLULAR THERAPY: if yes, specify:
CL Item
Donor lymphocyte infusion (DLI) (only lymphocytes from same donor(s) as HSCT) (Donor lymphocyte infusion (DLI) (only lymphocytes from same donor(s) as HSCT))
CL Item
Mesenchymal cells (Mesenchymal cells)
CL Item
Unknown (Unknown)
All cells
Item
All cells (cells/kg*) (non DLI only)
float
C2322965 (UMLS CUI [1])
Chronological number of this cell therapy for this patient
Item
Chronological number of this cell therapy for this patient
integer
C0302189 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Item
Indication
text
C3146298 (UMLS CUI [1])
CL Item
Planned/protocol (Planned/protocol )
CL Item
Treatment for disease (Treatment for disease)
CL Item
Loss/decreased chimaerism (Loss/decreased chimaerism )
CL Item
Mixed chimaerism (Mixed chimaerism)
CL Item
Treatment of GvHD (Treatment of GvHD )
CL Item
Treatment viral infection (Treatment viral infection)
CL Item
Treatment PTLD, EBV lymphoma (Treatment PTLD, EBV lymphoma)
Number of infusions within 10 weeks
Item
Number of infusions within 10 weeks count only infusions that are part of same regimen and given for the same indication
integer
C0449788 (UMLS CUI [1,1])
C0574032 (UMLS CUI [1,2])
Item
GVHD PREVENTION IN THE RECIPIENT (THERAPEUTIC IMMUNOSUPPRESSION)
integer
C0018133 (UMLS CUI [1,1])
C0199176 (UMLS CUI [1,2])
Code List
GVHD PREVENTION IN THE RECIPIENT (THERAPEUTIC IMMUNOSUPPRESSION)
Item
chemotherapy
integer
C0392920 (UMLS CUI [1])
CL Item
Cyclosporine (Cyclosporine)
CL Item
Methotrexate (Methotrexate)
CL Item
ATG/ALG (if started after day 0) (ATG/ALG (if started after day 0))
CL Item
Corticosteroids (if started after day 0) (Corticosteroids (if started after day 0))
CL Item
Mycophenolate (Mycophenolate)
CL Item
Tacrolimus (Tacrolimus)
CL Item
Monoclonal antibodies, specify (Monoclonal antibodies, specify)
CL Item
Extra-corporeal photopheresis (ECP) (Extra-corporeal photopheresis (ECP))
Monoclonal antibodies
Item
Monoclonal antibodies, specify
integer
C3542957 (UMLS CUI [1])
Drugs: If Other, please specify
Item
Drugs: If Other, please specify
integer
C0013227 (UMLS CUI [1,1])
C4035158 (UMLS CUI [1,2])
Item
GRAFT PERFORMANCE
integer
C0301944 (UMLS CUI [1])
Code List
GRAFT PERFORMANCE
CL Item
No reconstitution (No reconstitution)
CL Item
Lost graft (Lost graft)
Item
Neutrophils > 0.5 x 109/l reached?
integer
C0948762 (UMLS CUI [1])
Code List
Neutrophils > 0.5 x 109/l reached?
CL Item
Never below this level (Never below this level)
Item
Platelets > 20 x 109/l reached?
integer
C0005821 (UMLS CUI [1])
Code List
Platelets > 20 x 109/l reached?
CL Item
Never below this level (3)
Date last assessment
Item
Date last assessment
date
C2985720 (UMLS CUI [1])
Date of graft failure
Item
Date of graft failure
date
C1262018 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Overall chimaerism
integer
C0333678 (UMLS CUI [1])
Code List
Overall chimaerism
CL Item
Full (donor >95 %) (Full (donor >95 %) )
CL Item
Mixed (partial) (Mixed (partial))
CL Item
Autologous reconstitution (recipient >95 %) (Autologous reconstitution (recipient >95 %) )
CL Item
Aplasia (Aplasia)
CL Item
Not evaluated (Not evaluated)
Date of test
Item
Date of test
date
Identification
Item
Identification of donor or Cord Blood Unit given by the centre
text
C1718162 (UMLS CUI [1])
Number in the infusion order
Item
Number in the infusion order (if applicable)
text
C0237753 (UMLS CUI [1])
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
float
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
float
C0449475 (UMLS CUI [1,1])
C1522609 (UMLS CUI [1,2])
Item
Test used
integer
C0022885 (UMLS CUI [1])
CL Item
Molecular (Molecular)
CL Item
Cytogenetic (Cytogenetic)
CL Item
ABO group (ABO group)
CL Item
unknown (unknown)
Item
TREATMENT FOR FAILURE (If engraftment failure)
integer
Code List
TREATMENT FOR FAILURE (If engraftment failure)
CL Item
Growth factors GRFAIGRF (2)
CL Item
Subsequent transplant (please complete a new transplant form) (3)
CL Item
AUTOgraft (must have prior conditioning) (4)
CL Item
Autologous PBSC re-infusion (no preparative treatment or conditioning) (6)
CL Item
Autologous BM re-infusion (no preparative treatment or conditioning) (7)
Item
Maximum grade ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)
integer
Code List
Maximum grade ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)
CL Item
grade 0 (Absent) (1)
CL Item
Not evaluated (6)
Date of onset
Item
Date of onset
date
C0574845 (UMLS CUI [1])
Item
Stage skin
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C1306673 (UMLS CUI [1,3])
CL Item
Not evaluated (6)
Item
Stage liver
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C0023884 (UMLS CUI [1,3])
CL Item
Not evaluated (6)
Item
Stage gut
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C0021853 (UMLS CUI [1,3])
CL Item
Not evaluated (6)
Item
Resolution
integer
C0856825 (UMLS CUI [1,1])
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])
Treatment
Item
Treatment
boolean
Item
Treatment, if yes
text
Code List
Treatment, if yes
CL Item
Corticosteroids (Corticosteroids)
CL Item
ATG/ALG (ATG/ALG)
INFECTION RELATED COMPLICATIONS
Item
INFECTION RELATED COMPLICATIONS
boolean
C0009450 (UMLS CUI [1,1])
C0009566 (UMLS CUI [1,2])
Item
Pathogen
integer
C0450254 (UMLS CUI [1])
CL Item
Bacteraemia/ fungemia / viremia / parasites (1)
CL Item
Multiorgan failure due to infection (4)
CL Item
CNS infection (7)
CL Item
Gut infection (8)
Item
NON INFECTION RELATED COMPLICATIONS
integer
C0009566 (UMLS CUI [1])
Code List
NON INFECTION RELATED COMPLICATIONS
CL Item
No complications (1)
Item
Specify: Idiopathic pneumonia syndrome
text
C1504431 (UMLS CUI [1])
Code List
Specify: Idiopathic pneumonia syndrome
CL Item
Unknown (Unknown)
Item
Specify: VOD
text
C0948441 (UMLS CUI [1])
CL Item
Unknown (Unknown)
Item
Specify: Haemorrhagic cystitis, non infectious
text
C0085692 (UMLS CUI [1])
Code List
Specify: Haemorrhagic cystitis, non infectious
CL Item
Unknown (Unknown)
Item
Specify: ARDS, non infectious
text
C0035222 (UMLS CUI [1])
Code List
Specify: ARDS, non infectious
CL Item
Unknown (Unknown)
Item
Multiorgan failure, non infectious
integer
C0026766 (UMLS CUI [1])
Code List
Multiorgan failure, non infectious
Item
Specify: HSCT-associated microangiopathy
text
C0155765 (UMLS CUI [1])
Code List
Specify: HSCT-associated microangiopathy
CL Item
Unknown (Unknown)
Item
Specify: Renal failure requiring dialysis
text
C0035078 (UMLS CUI [1])
Code List
Specify: Renal failure requiring dialysis
CL Item
Unknown (Unknown)
Item
Specify: Haemolytic anaemia due to blood group
text
C0002878 (UMLS CUI [1])
Code List
Specify: Haemolytic anaemia due to blood group
CL Item
Unknown (Unknown)
Other type of infection
Item
Other type of infection
boolean
C0457463 (UMLS CUI [1])
Idiopathic pneumonia syndrome date
Item
Idiopathic pneumonia syndrome date
date
C1504431 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date VOD
Item
Date VOD
date
C0948441 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date Haemorrhagic cystitis, non infectious
Item
Date Haemorrhagic cystitis, non infectious
date
C0085692 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date ARDS, non infectious
Item
Date ARDS, non infectious
date
C0035222 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date Multiorgan failure, non infectious
Item
Date Multiorgan failure, non infectious
date
C0026766 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date HSCT-associated microangiopathy
Item
Date HSCT-associated microangiopathy
date
C0155765 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date Renal failure requiring dialysis
Item
Date Renal failure requiring dialysis
date
C0035078 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
DAte Haemolytic anaemia due to blood group
Item
DAte Haemolytic anaemia due to blood group
date
C0002878 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date of other Type
Item
Date of other Type
date
C2316983 (UMLS CUI [1,1])
C0220886 (UMLS CUI [1,2])
LastContactDate
Item
Date of Last Contact
date
C0011008 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C1705415 (UMLS CUI [1,3])
C1517741 (UMLS CUI [1,4])
Item
Presence of cGVHD
integer
C0867389 (UMLS CUI [1])
Code List
Presence of cGVHD
CL Item
Yes, First Episode (2)
CL Item
Yes, Recurrence (3)
Date of Onset
Item
Onset
date
C0574845 (UMLS CUI [1])
Item
cGvHD grade
integer
C0867389 (UMLS CUI [1,1])
C0441800 (UMLS CUI [1,2])
CL Item
not evaluated (3)
Item
Organs affected
integer
C0449642 (UMLS CUI [1])
Code List
Organs affected
CL Item
Other, specify (7)
Item
Relapse or progression
integer
C0035020 (UMLS CUI [1])
C0242656 (UMLS CUI [2])
Code List
Relapse or progression
CL Item
Previously reported (1)
CL Item
Continuous progression since transplant (4)
RELAPSE OR PROGRESSION: If yes, date diagnosed
Item
RELAPSE OR PROGRESSION: If yes, date diagnosed
date
C0035020 (UMLS CUI [1])
C0242656 (UMLS CUI [2])
C2316983 (UMLS CUI [3])
Item
Cinical/haematological relapse or progression
integer
C0018939 (UMLS CUI [1,1])
C0205210 (UMLS CUI [1,2])
Code List
Cinical/haematological relapse or progression
CL Item
Not evaluated (3)
Cinical/haematological relapse or progression
Item
Date assessed
date
Cinical/haematological relapse or progression
Item
Date first seen
date
Item
Cytogenetic relapse or progression
integer
C0010802 (UMLS CUI [1])
Code List
Cytogenetic relapse or progression
CL Item
Not evaluated (3)
Cytogenetic relapse or progression: Date assessed
Item
Cytogenetic relapse or progression: Date assessed
date
C0010802 (UMLS CUI [1,1])
C0035020 (UMLS CUI [1,2])
C2985720 (UMLS CUI [1,3])
Cytogenetic relapse or progression: Date first seen
Item
Cytogenetic relapse or progression: Date first seen
date
C0035020 (UMLS CUI [1,1])
C3483766 (UMLS CUI [1,2])
Item
Molecular relapse or progression
integer
C0026376 (UMLS CUI [1])
Code List
Molecular relapse or progression
CL Item
Not evaluated (3)
Molecular relapse or progression: date assessed
Item
date
C0035020 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Molecular relapse or progression: Date first seen
Item
Molecular relapse or progression: Date first seen
date
C3483766 (UMLS CUI [1,1])
C0035020 (UMLS CUI [1,2])
Item
Clinical/haematological
integer
C0018939 (UMLS CUI [1,1])
C0205210 (UMLS CUI [1,2])
Code List
Clinical/haematological
CL Item
Not evaluated (3)
Date of Evaluation
Item
Last date evaluated/Last date assessed
date
C2985720 (UMLS CUI [1])
Item
Cytogenetic/FISH
integer
C0010802 (UMLS CUI [1,1])
C0162789 (UMLS CUI [1,2])
Code List
Cytogenetic/FISH
CL Item
Yes: Considered disease relapse/progression No (2)
CL Item
Yes: Considered disease relapse/progression Yes (3)
CL Item
Yes: Considered disease relapse/progression Not evaluated (4)
Last date assessed
Item
Last date assessed
date
Item
Molecular
text
C0026376 (UMLS CUI [1])
CL Item
No Considered disease relapse/progression (No Considered disease relapse/progression)
CL Item
Yes Considered disease relapse/progression (Yes Considered disease relapse/progression)
CL Item
Not evaluated (Not evaluated)
Item
Survival Status
integer
C1148433 (UMLS CUI [1])
Code List
Survival Status
Item
If alive: Type of score used:
text
C1518965 (UMLS CUI [1])
Code List
If alive: Type of score used:
CL Item
Karnofsky (Karnofsky)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item
Score
integer
C1518965 (UMLS CUI [1])
CL Item
100 (Normal, NED) (1)
CL Item
10 (Moribund) (10)
CL Item
Not evaluated (11)
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)
Item
Cause of death (if dead)
integer
C0007465 (UMLS CUI [1])
Code List
Cause of death (if dead)
CL Item
Relapse or progression (1)
CL Item
Secondary malignancy (including lymphoproliferative disease) (2)
CL Item
Transplantation related cause (3)
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])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): GvHD
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])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Interstitial Pneumonitis
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])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Pulmonary toxicity
CL Item
Unknown (Unknown)
Item
Infection:
integer
C0009450 (UMLS CUI [1])
Item
Rejection / poor graft function
integer
C0018129 (UMLS CUI [1])
Code List
Rejection / poor graft function
Item
Veno-Occlusive disease (VOD)
integer
C0007465 (UMLS CUI [1,1])
C0948441 (UMLS CUI [1,2])
Code List
Veno-Occlusive disease (VOD)
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])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Haemorrhage
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])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Cardiac toxicity
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])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Central nervous system toxicity
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])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Gastro intestinal toxicity
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])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Skin toxicity
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])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Renal failure
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])
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Multiple organ failure
CL Item
Unknown (Unknown)
COMMENTS
Item
COMMENTS
text
C0947611 (UMLS CUI [1])
IDENTIFICATION & SIGNATURE
Item
IDENTIFICATION & SIGNATURE
text
C0205396 (UMLS CUI [1,1])
C1519316 (UMLS CUI [1,2])
Item
Ethnicity
text
C0015031 (UMLS CUI [1])
CL Item
Hispanic or Latino (1)
CL Item
Not Hispanic or Latino (2)
Item
Race
text
C0034510 (UMLS CUI [1])
CL Item
American Indian or Alaska Native (4)
CL Item
Native Hawaiian or Pacific Native (5)
COMORBID CONDITIONS
Item
COMORBID CONDITIONS
boolean
C1275743 (UMLS CUI [1])
Item
Solid tumor
integer
C0280100 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
Item
Inflammatory bowel disease
integer
C0021390 (UMLS CUI [1])
Code List
Inflammatory bowel disease
CL Item
Not evaluated (Not evaluated)
Item
Infection
integer
C0009450 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
Item
Diabetes
integer
C0011849 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
Item
Serum creatinine
integer
C0201976 (UMLS CUI [1])
Code List
Serum creatinine
CL Item
Not evaluated (Not evaluated)
Item
Chronic hepatitis
integer
C0019189 (UMLS CUI [1])
Code List
Chronic hepatitis
CL Item
Not evaluated (Not evaluated)
Item
Liver cirrhosis
integer
C0023890 (UMLS CUI [1])
Code List
Liver cirrhosis
CL Item
Not evaluated (Not evaluated)
Item
Arrhythmia
integer
C0003811 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
Item
Coronary artery disease
integer
C1956346 (UMLS CUI [1])
Code List
Coronary artery disease
CL Item
Not evaluated (Not evaluated)
Item
Cerebrovascular disease
integer
C0007820 (UMLS CUI [1])
Code List
Cerebrovascular disease
CL Item
Not evaluated (Not evaluated)
Item
Heart valve disease
integer
C0018824 (UMLS CUI [1])
Code List
Heart valve disease
CL Item
Not evaluated (Not evaluated)
Item
FEV1 66-80%
integer
C0748133 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
Item
FEV1 ≤ 65%
integer
C0860906 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
Item
Obesity
integer
C0028754 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
Item
Peptic ulcer
integer
C0030920 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
Item
Psychiatric disturbance
integer
C0004936 (UMLS CUI [1])
Code List
Psychiatric disturbance
CL Item
Not evaluated (Not evaluated)
comorbidity
Item
other comorbidity, please specify
text
C0009488 (UMLS CUI [1])