ID

1958

Description

CGV Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF18B4D3-D937-1066-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF18B4D3-D937-1066-E034-0003BA3F9857

Keywords

  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 6/9/15 6/9/15 -
Uploaded on

September 19, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy

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Leukemia, Myelocytic, Acute null Treatment - CGV - 2394552v3.0

No Instruction available.

Unnamed 1
Description

Unnamed 1

Visit Number
Description

HospitalAdmissionOrdinalNumber

Data type

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16696
UMLS 2011AA ObjectClass
C0019994
NCI Thesaurus Property
C25385
UMLS 2011AA Property
C0809949
Segment
Description

Segment

Data type

text

Start of assessment period
Description

Startofassessmentperiod

Data type

text

End of assessment period
Description

Endofassessmentperiod

Data type

text

Answer Questions 3-8 Relating To Acute Gvhd
Description

Answer Questions 3-8 Relating To Acute Gvhd

Maximum overall grade of acute GVHD during this assessment period
Description

AcuteGraftVersusHostDiseaseTransplantAssessedGrade

Data type

text

Alias
NCI Thesaurus ObjectClass
C4980
UMLS 2011AA ObjectClass
C0856825
NCI Thesaurus ObjectClass
C14140
UMLS 2011AA ObjectClass
C0205178
NCI Thesaurus Property
C25217
UMLS 2011AA Property
C1516048
NCI Thesaurus Property
C12981
UMLS 2011AA Property
C0332835
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
Did clinical signs and/or symptoms of acute GVHD develop during this assessment
Description

DidthepatientdevelopacuteGVHD?

Data type

text

Date of diagnosis of acute GVHD
Description

TransplantAcuteGVHDBeginDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Thesaurus Property
C14140
UMLS 2011AA Property
C0205178
NCI Metathesaurus Property
C0018133
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C25431
UMLS 2011AA ValueDomain
C0439659
Record method used to diagnose acute GVHD
Description

RecordmethodusedtodiagnoseacuteGVHD

Data type

text

Was prophylaxis for GVHD given during this assessment period
Description

WasprophylaxisforGVHDgivenduringthisassessmentperiod

Data type

text

If Yes, Specify All Immuno Suppressants Used For Gvhd Prophylaxis
Description

If Yes, Specify All Immuno Suppressants Used For Gvhd Prophylaxis

Cyclosporine
Description

MedicationGraftVersusHostDiseaseAdministeredType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C459
UMLS 2011AA ObjectClass
C0013227
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
NCI Metathesaurus ObjectClass
C0018133
Specify other agent used
Description

PriorChemotherapyOtherName

Data type

text

Alias
NCI Thesaurus ObjectClass
C15632
UMLS 2011AA ObjectClass
C0392920
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ValueDomain
C17649
UMLS 2011AA ValueDomain
C0205394
Tacrolimus
Description

Tacrolimus

Data type

text

Sirolumis
Description

Sirolumis

Data type

text

MMF
Description

MMF

Data type

text

Prednisone
Description

Prednisone

Data type

text

Other
Description

Other

Data type

text

If no, specify the date GVHD prophylaxis was discontinued
Description

Ifno,specifythedateGVHDprophylaxiswasdiscontinued

Data type

text

Answer Questions 9-19 Relating To Chronic Gvhd
Description

Answer Questions 9-19 Relating To Chronic Gvhd

Maximum overall severity of chronic GVHD during this assessment period
Description

SeverityName

Data type

text

Alias
NCI Thesaurus ObjectClass
C25499
UMLS 2011AA ObjectClass
C0441471
NCI Thesaurus ValueDomain
C42614
UMLS 2011AA ValueDomain
C0027365
NCI Thesaurus Property
C25676
UMLS 2011AA Property
C0439793
Maximum overall grade of chronic GVHD during this assessment period
Description

ChronicGraftVersusHostDiseaseTransplantOutcomeGrade

Data type

text

Alias
NCI Thesaurus ObjectClass
C14141
UMLS 2011AA ObjectClass
C0205191
NCI Metathesaurus ObjectClass
C0018133
NCI Thesaurus Property
C12981
UMLS 2011AA Property
C0332835
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ValueDomain
C48309
UMLS 2011AA ValueDomain
C0441800
Current Karnofsky/Lansky score
Description

KarnofskyPerformanceStatusScore

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C20641
UMLS 2011AA ObjectClass
C1518965
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
Record method used to diagnose chronic GVHD
Description

DiagnosisMethodType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus ObjectClass
C15220
UMLS 2011AA ObjectClass
C0011900
Current platelet count
Description

LaboratoryProcedurePlateletResultSpecifiedValue

Data type

double

Measurement units
  • 1000/uL
Alias
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property
C12520
UMLS 2011AA Property
C0005821
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
1000/uL
Date of diagnosis of chronic GVHD
Description

RelevantDiagnosticTestResultDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
Current weight
Description

PatientWeightMeasurement

Data type

double

Measurement units
  • Kg
Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25208
UMLS 2011AA Property
C0043100
Kg
Alkaline phosphatase at time of diagnosis
Description

HepaticAlkalinePhosphataseLabValue

Data type

double

Alias
NCI Thesaurus ObjectClass
C13308
UMLS 2011AA ObjectClass
C0205054
NCI Thesaurus Property
C37984
UMLS 2011AA Property
C0022877
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus Property
C16276
UMLS 2011AA Property
C0002059
Total bilirubin at time of diagnosis
Description

HepaticBilirubinLabValue

Data type

double

Measurement units
  • mg/dL
Alias
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property
C305
UMLS 2011AA Property
C0005437
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
mg/dL
Body surface area involved with rash at time of diagnosis
Description

PatientBodySurfaceAreaMeasurement

Data type

double

Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25157
UMLS 2011AA Property
C0005902
Indicate The Maximum Severity Of Involvement For The Following Organ Systems During This Assessment Period
Description

Indicate The Maximum Severity Of Involvement For The Following Organ Systems During This Assessment Period

Dyspnea
Description

CommonToxicityCriteriaAdverseEventDyspneaGrade

Data type

double

Alias
NCI Thesaurus Property
C2998
UMLS 2011AA Property
C0013404
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
Pulmonary fibrosis
Description

CommonToxicityCriteriaAdverseEventPulmonaryFibrosisGrade

Data type

double

Alias
NCI Thesaurus Property
C26869
UMLS 2011AA Property
C0034069
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
FEV1
Description

CommonToxicityCriteriaAdverseEventForcedExpiratoryVolumein1SecondGrade

Data type

double

Alias
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
NCI Thesaurus Property
C38084
UMLS 2011AA Property
C0849974
Oxygen saturation
Description

OxygenSaturation

Data type

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Metathesaurus ObjectClass
C0150411
NCI Metathesaurus Property
CL105480
Nausea and vomiting
Description

CommonToxicityCriteriaAdverseEventNauseaGrade

Data type

double

Alias
NCI Thesaurus Property
C3258
UMLS 2011AA Property
C0027497
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
Diarrhea
Description

CommonToxicityCriteriaAdverseEventDiarrheaGrade

Data type

double

Alias
NCI Thesaurus Property
C2987
UMLS 2011AA Property
C0011991
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
Malabsorption
Description

CommonToxicityCriteriaAdverseEventGastrointestinalMalabsorptionSyndromeGrade

Data type

double

Alias
NCI Thesaurus Property
C13359
UMLS 2011AA Property
C0521362
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
NCI Metathesaurus Property
C0024523
Bilirubin level
Description

CTCAdverseEventBilirubinGrade

Data type

double

Alias
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus Property
C305
UMLS 2011AA Property
C0005437
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
NCI Thesaurus ValueDomain
C305
UMLS 2011AA ValueDomain
C0005437
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
Vaginitis
Description

CommonToxicityCriteriaAdverseEventVaginitisGrade

Data type

double

Alias
NCI Thesaurus Property
C26911
UMLS 2011AA Property
C0042267
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
Myositis
Description

CommonToxicityCriteriaAdverseEventMyositisGrade

Data type

double

Alias
NCI Thesaurus ObjectClass
C49704
UMLS 2011AA ObjectClass
C1516728
NCI Thesaurus ValueDomain
C18000
UMLS 2011AA ValueDomain
C0919553
NCI Metathesaurus Property
C0027121
Specify other organ
Description

DiseaseInvolvedSiteSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C25547
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
Extent of skin involvement
Description

Extentofskininvolvement

Data type

text

If there is skin involvement, indicate the type of rash
Description

Ifthereisskininvolvement,indicatethetypeofrash

Data type

text

Lichenoid
Description

Lichenoid

Data type

text

Maculpapular
Description

Maculpapular

Data type

text

Sclerodermatous
Description

Sclerodermatous

Data type

text

Xerophthalmia
Description

Xerophthalmia

Data type

text

Bronchiolitis obliterans
Description

Bronchiolitisobliterans

Data type

text

Esophagus
Description

Esophagus

Data type

text

Answer one of the next two questions
Description

Answeroneofthenexttwoquestions

Data type

text

Diarrhea (number of stools)
Description

Diarrhea(numberofstools)

Data type

text

Diarrhea (volume of stools)
Description

Diarrhea(volumeofstools)

Data type

text

Contractures
Description

Contractures

Data type

text

Eosinophilia
Description

Eosinophilia

Data type

text

Serositis
Description

Serositis

Data type

text

Fascitis
Description

Fascitis

Data type

text

Was there other organ involvement
Description

Wasthereotherorganinvolvement

Data type

text

Answer Questions 42-48 Related To Biopsies Performed During This Assessment Period
Description

Answer Questions 42-48 Related To Biopsies Performed During This Assessment Period

Were any biopsies performed during this assessment period for suspected GVHD
Description

BiopsyPerformedInd-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C15189
UMLS 2011AA ObjectClass
C0005558
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
Date of biopsy
Description

BiopsyDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C25367
NCI Thesaurus ObjectClass
C15189
UMLS 2011AA ObjectClass
C0005558
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
Result of biopsy
Description

BiopsyResultType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C15189
UMLS 2011AA ObjectClass
C0005558
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
Type of biopsy
Description

Typeofbiopsy

Data type

text

Answer Questions 49-52 Relating To Gvhd
Description

Answer Questions 49-52 Relating To Gvhd

Was a specific therapy used to treat GVHD during this assessment period
Description

WasaspecifictherapyusedtotreatGVHDduringthisassessmentperiod

Data type

text

If Yes, Indicate Whether Or Not The Agents Listed Below Were Used To Treat Gvhd During This Assessment Period
Description

If Yes, Indicate Whether Or Not The Agents Listed Below Were Used To Treat Gvhd During This Assessment Period

Other
Description

OtherMedicationAdministrationInd-3

Data type

text

Alias
NCI Thesaurus ObjectClass
C17649
UMLS 2011AA ObjectClass
C0205394
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C459
UMLS 2011AA ObjectClass
C0013227
NCI Thesaurus Property
C25409
UMLS 2011AA Property
C1533734
Specify other agent used
Description

other,specify

Data type

text

Alias
NCI Thesaurus ObjectClass
C25179
UMLS 2011AA ObjectClass
C0019993
NCI Thesaurus Property
C25365
UMLS 2011AA Property
C0678257
Has treatment been discontinued
Description

PatientOff-TreatmentInd

Data type

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25601
UMLS 2011AA Property
C1518544
If yes, enter date of discontinuation
Description

OffTreatmentDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25601
UMLS 2011AA ObjectClass
C1518544
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
ALS, ALG, ATS, ATG
Description

ALS,ALG,ATS,ATG

Data type

text

Azathioprine
Description

Azathioprine

Data type

text

Cyclosporine
Description

Cyclosporine

Data type

text

Systemic corticosteriods
Description

Systemiccorticosteriods

Data type

text

Topical corticosteroids
Description

Topicalcorticosteroids

Data type

text

Thalidomide
Description

Thalidomide

Data type

text

Tacrolimus
Description

Tacrolimus

Data type

text

Mycophenolate Mofetil
Description

MycophenolateMofetil

Data type

text

PUVA (Psoralen and UVA)
Description

PUVA(PsoralenandUVA)

Data type

text

ECP (Extra-corporeal photopheresis)
Description

ECP(Extra-corporealphotopheresis)

Data type

text

Sirolumis
Description

Sirolumis

Data type

text

Etretinate
Description

Etretinate

Data type

text

Lamprene
Description

Lamprene

Data type

text

Etanercept
Description

Etanercept

Data type

text

Zenapax
Description

Zenapax

Data type

text

Chloroquine phosphate
Description

Chloroquinephosphate

Data type

text

In vivo anti T-lymphocyte monoclonal antibody
Description

InvivoantiT-lymphocytemonoclonalantibody

Data type

text

Specify in vivo anti T-lymphocyte monoclonal antibody used
Description

SpecifyinvivoantiT-lymphocytemonoclonalantibodyused

Data type

text

Specify in vivo immunotoxin
Description

Specifyinvivoimmunotoxin

Data type

text

Indicate the best response to GVHD therapy during this assessment period
Description

IndicatethebestresponsetoGVHDtherapyduringthisassessmentperiod

Data type

text

Answer Questions 53-56 Relating To Current Patient Status
Description

Answer Questions 53-56 Relating To Current Patient Status

Are symptoms of GVHD still present
Description

DiseaseSymptomInd-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus Property
C4876
UMLS 2011AA Property
C1457887
Current Karnofsky/Lansky score
Description

KarnofskyPerformanceStatusScore

Data type

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C20641
UMLS 2011AA ObjectClass
C1518965
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
Current platelet count
Description

LaboratoryProcedurePlateletResultSpecifiedValue

Data type

double

Measurement units
  • 1000/uL
Alias
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property
C12520
UMLS 2011AA Property
C0005821
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
1000/uL
Current weight
Description

PatientWeightMeasurement

Data type

double

Measurement units
  • Kg
Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25208
UMLS 2011AA Property
C0043100
Kg
Comments
Description

ResearchCommentsText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411

Similar models

No Instruction available.

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Unnamed 1
HospitalAdmissionOrdinalNumber
Item
Visit Number
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C0019994 (UMLS 2011AA ObjectClass)
C25385 (NCI Thesaurus Property)
C0809949 (UMLS 2011AA Property)
Segment
Item
Segment
text
Startofassessmentperiod
Item
Start of assessment period
text
Endofassessmentperiod
Item
End of assessment period
text
Item Group
Answer Questions 3-8 Relating To Acute Gvhd
Item
Maximum overall grade of acute GVHD during this assessment period
text
C4980 (NCI Thesaurus ObjectClass)
C0856825 (UMLS 2011AA ObjectClass)
C14140 (NCI Thesaurus ObjectClass)
C0205178 (UMLS 2011AA ObjectClass)
C25217 (NCI Thesaurus Property)
C1516048 (UMLS 2011AA Property)
C12981 (NCI Thesaurus Property)
C0332835 (UMLS 2011AA Property)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
Code List
Maximum overall grade of acute GVHD during this assessment period
CL Item
0 (No symptoms of acute GVHD)
C0919414 (NCI Metathesaurus)
CL Item
1 (I)
CL Item
2 (II)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (III)
CL Item
4 (IV)
Item
Did clinical signs and/or symptoms of acute GVHD develop during this assessment
text
Code List
Did clinical signs and/or symptoms of acute GVHD develop during this assessment
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
TransplantAcuteGVHDBeginDate
Item
Date of diagnosis of acute GVHD
date
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C14140 (NCI Thesaurus Property)
C0205178 (UMLS 2011AA Property)
C0018133 (NCI Metathesaurus Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25431 (NCI Thesaurus ValueDomain)
C0439659 (UMLS 2011AA ValueDomain)
Item
Record method used to diagnose acute GVHD
text
Code List
Record method used to diagnose acute GVHD
CL Item
Histologic Evidence (Histologic Evidence)
CL Item
Clinical Evidence (Clinical Evidence)
CL Item
Both (Both)
Item
Was prophylaxis for GVHD given during this assessment period
text
Code List
Was prophylaxis for GVHD given during this assessment period
CL Item
Yes (Yes)
CL Item
No (No)
Item Group
If Yes, Specify All Immuno Suppressants Used For Gvhd Prophylaxis
Item
Cyclosporine
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C459 (NCI Thesaurus ObjectClass)
C0013227 (UMLS 2011AA ObjectClass)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C0018133 (NCI Metathesaurus ObjectClass)
Code List
Cyclosporine
CL Item
Cyclosporine (Yes)
C406 (NCI Thesaurus)
C0010592 (UMLS 2011AA)
CL Item
No (No)
PriorChemotherapyOtherName
Item
Specify other agent used
text
C15632 (NCI Thesaurus ObjectClass)
C0392920 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ValueDomain)
C0205394 (UMLS 2011AA ValueDomain)
Item
Tacrolimus
text
Code List
Tacrolimus
CL Item
Yes (Yes)
CL Item
No (No)
Item
Sirolumis
text
Code List
Sirolumis
CL Item
Yes (Yes)
CL Item
No (No)
Item
MMF
text
Code List
MMF
CL Item
Yes (Yes)
CL Item
No (No)
Item
Prednisone
text
Code List
Prednisone
CL Item
Yes (Yes)
CL Item
No (No)
Item
Other
text
Code List
Other
CL Item
Yes (Yes)
CL Item
No (No)
Ifno,specifythedateGVHDprophylaxiswasdiscontinued
Item
If no, specify the date GVHD prophylaxis was discontinued
text
Item Group
Answer Questions 9-19 Relating To Chronic Gvhd
Item
Maximum overall severity of chronic GVHD during this assessment period
text
C25499 (NCI Thesaurus ObjectClass)
C0441471 (UMLS 2011AA ObjectClass)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C25676 (NCI Thesaurus Property)
C0439793 (UMLS 2011AA Property)
Code List
Maximum overall severity of chronic GVHD during this assessment period
CL Item
No symptoms of chronic GVHD (No symptoms of chronic GVHD)
CL Item
Mild (Mild)
C70666 (NCI Thesaurus)
C2945599 (UMLS 2011AA)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
Item
Maximum overall grade of chronic GVHD during this assessment period
text
C14141 (NCI Thesaurus ObjectClass)
C0205191 (UMLS 2011AA ObjectClass)
C0018133 (NCI Metathesaurus ObjectClass)
C12981 (NCI Thesaurus Property)
C0332835 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C48309 (NCI Thesaurus ValueDomain)
C0441800 (UMLS 2011AA ValueDomain)
Code List
Maximum overall grade of chronic GVHD during this assessment period
CL Item
Limited (Limited)
CL110648 (NCI Metathesaurus)
CL Item
Extensive (Extensive)
C47863 (NCI Thesaurus)
C0205231 (UMLS 2011AA)
CL Item
Did clinical signs and/or symptoms of chronic GVHD develop during this assessment (Did clinical signs and/or symptoms of chronic GVHD develop during this assessment)
CL Item
Yes (Yes)
CL Item
No (No)
Item
Current Karnofsky/Lansky score
text
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C1518965 (UMLS 2011AA ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
Code List
Current Karnofsky/Lansky score
CL Item
Normal, No Complaints, No Evidence Of Disease (100 (Normal; No Complaints/Fully Active))
CL Item
Able To Carry On Normal Activity; Minor Signs Or Symptoms Of Disease (90 (Normal activity/minor restriction in strenuous play))
CL Item
Normal Activity With Effort; Some Signs Or Symptoms Of Disease (80 (Normal acitvity with efforts/restricted in strenuous play))
CL Item
Cares For Self, Unable To Carry On Normal Activity Or To Do Active Work (70 (Unable to carry on normal activity/less time spent in play))
CL Item
Requires Occasional Assistance, But Is Able To Care For Most Of His/her Needs (60 (Requires occasional assistance/minimal active play))
CL Item
Requires Considerable Assistance And Frequent Medical Care (50 (Requires considerable assistance/no active play))
CL Item
Disabled, Requires Special Care And Assistance (40 (Disabled/Able to initiate quiet activities))
CL Item
Severely Disabled, Hospitalization Indicated. Death Not Imminent (30 (Severely disabled/needs assistance for quiet play))
CL Item
Very Sick, Hospitalization Indicated. Death Not Imminent (20 (Very sick/limited to very passive activity))
CL Item
Moribund, Fatal Processes Progressing Rapidly (10 (Moribund; Completely disabled))
Item
Record method used to diagnose chronic GVHD
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C15220 (NCI Thesaurus ObjectClass)
C0011900 (UMLS 2011AA ObjectClass)
Code List
Record method used to diagnose chronic GVHD
CL Item
Histology (Histologic Evidence)
C16681 (NCI Thesaurus)
C0019638 (UMLS 2011AA)
C16681 (NCI Thesaurus)
C0019638 (UMLS 2011AA)
CL Item
Clinical (Clinical Evidence)
C25398 (NCI Thesaurus)
C0205210 (UMLS 2011AA)
CL Item
Both (Both)
LaboratoryProcedurePlateletResultSpecifiedValue
Item
Current platelet count
double
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C12520 (NCI Thesaurus Property)
C0005821 (UMLS 2011AA Property)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
RelevantDiagnosticTestResultDate
Item
Date of diagnosis of chronic GVHD
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
PatientWeightMeasurement
Item
Current weight
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25208 (NCI Thesaurus Property)
C0043100 (UMLS 2011AA Property)
HepaticAlkalinePhosphataseLabValue
Item
Alkaline phosphatase at time of diagnosis
double
C13308 (NCI Thesaurus ObjectClass)
C0205054 (UMLS 2011AA ObjectClass)
C37984 (NCI Thesaurus Property)
C0022877 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C16276 (NCI Thesaurus Property)
C0002059 (UMLS 2011AA Property)
HepaticBilirubinLabValue
Item
Total bilirubin at time of diagnosis
double
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C305 (NCI Thesaurus Property)
C0005437 (UMLS 2011AA Property)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
PatientBodySurfaceAreaMeasurement
Item
Body surface area involved with rash at time of diagnosis
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
Item Group
Indicate The Maximum Severity Of Involvement For The Following Organ Systems During This Assessment Period
Item
Dyspnea
double
C2998 (NCI Thesaurus Property)
C0013404 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
Code List
Dyspnea
CL Item
Asymptomatic (Asymptomatic)
CL Item
Dyspnea with exertion (Dyspnea with exertion)
CL Item
Dyspnea with normal activities (Dyspnea with normal activities)
CL Item
Dyspnea at rest (Dyspnea at rest)
Item
Pulmonary fibrosis
double
C26869 (NCI Thesaurus Property)
C0034069 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
Code List
Pulmonary fibrosis
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Minimal Radiographic Findings (or Patchy Or Bi-basilar Changes) With Estimated Radiographic Proportion Of Total Lung Volume That Is Fibrotic Of <25% (Minimal radiographic findings)
CL Item
Patchy Or Bi-basilar Changes With Estimated Radiographic Proportion Of Total Lung Volume That Is Fibrotic Of 25 - <50% (Patchy or Bi-basilar radiographic findings)
CL Item
Extensive radiographic findings (Extensive radiographic findings)
CL Item
Not done (Not done)
Item
FEV1
double
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
C38084 (NCI Thesaurus Property)
C0849974 (UMLS 2011AA Property)
Code List
FEV1
CL Item
>= 90% Of Pretreatment Or Normal Value (100-90%)
CL Item
90 - 75% Of Predicted Value (<90-75%)
CL Item
<75 - 50% Of Predicted Value (<75-50%)
CL Item
<50 - 25% Of Predicted Value (<50-25%)
CL Item
<25% Of Predicted Value (<25%)
Item
Oxygen saturation
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0150411 (NCI Metathesaurus ObjectClass)
CL105480 (NCI Metathesaurus Property)
Code List
Oxygen saturation
CL Item
No symptoms (No symptoms)
CL Item
Desaturation with exercise (Desaturation with exercise)
CL Item
Requires supplemental oxygen (Requires supplemental oxygen)
Item
Nausea and vomiting
double
C3258 (NCI Thesaurus Property)
C0027497 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
Code List
Nausea and vomiting
CL Item
None (No protracted nausea and vomiting)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Persistent nausea, vomiting, or anorexia (Persistent nausea, vomiting, or anorexia)
Item
Diarrhea
double
C2987 (NCI Thesaurus Property)
C0011991 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
Code List
Diarrhea
CL Item
None (None)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Persisting less than 2 weeks (Persisting less than 2 weeks)
CL Item
Persisting more than 2 weeks (Persisting more than 2 weeks)
Item
Malabsorption
double
C13359 (NCI Thesaurus Property)
C0521362 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
C0024523 (NCI Metathesaurus Property)
Code List
Malabsorption
CL Item
None (No symptoms)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Altered Diet; Oral Therapies Indicated (e.g., Enzymes, Medications, Dietary Supplements) (Altered diet, oral therapies indicated (e.g., enzymes, medications, dietary supplements))
CL Item
Inability To Aliment Adequately Via Gi Tract (i.e., Tpn Indicated) (Inability to aliment adequately via GI tract (e.g., TPN indicated))
CL Item
Life-threatening Consequences (Life-threatening consequences)
CL Item
Death (Death)
C28554 (NCI Thesaurus)
C0011065 (UMLS 2011AA)
Item
Bilirubin level
double
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C305 (NCI Thesaurus Property)
C0005437 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C305 (NCI Thesaurus ValueDomain)
C0005437 (UMLS 2011AA ValueDomain)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
Code List
Bilirubin level
CL Item
bilirubin <2.0 mg/dL (bilirubin <2.0 mg/dL)
CL Item
bilirubin 2.0-3.0 mg/dL (bilirubin 2.0-3.0 mg/dL)
CL Item
bilirubin 3.1-6.0 mg/dL (bilirubin 3.1-6.0 mg/dL)
CL Item
bilirubin 6.1-15.0 mg/dL (bilirubin 6.1-15.0 mg/dL)
CL Item
bilirubin >15.0 mg/dL (bilirubin >15.0 mg/dL)
Item
Vaginitis
double
C26911 (NCI Thesaurus Property)
C0042267 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
Code List
Vaginitis
CL Item
None (No symptoms or not applicable)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
CL Item
Mild, Intervention Not Indicated (Mild, intervention not indicated)
CL Item
Moderate, Intervention Indicated (Moderate, intervention indicated)
CL Item
Severe, Not Relieved With Treatment; Ulceration, But Operative Intervention Not Indicated (Severe, not relieved with treatment;ulceration)
Item
Myositis
double
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
C0027121 (NCI Metathesaurus Property)
Code List
Myositis
CL Item
Yes (Yes)
CL Item
None (No)
C41132 (NCI Thesaurus)
C0549184 (UMLS 2011AA)
DiseaseInvolvedSiteSpecify
Item
Specify other organ
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25547 (NCI Thesaurus Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
Item
Extent of skin involvement
text
Code List
Extent of skin involvement
CL Item
No Rash (No Rash)
CL Item
<25% of BSA involvement (<25% of BSA involvement)
CL Item
25-50% of BSA involvement (25-50% of BSA involvement)
CL Item
>50% of BSA involvement (>50% of BSA involvement)
CL Item
Generalized involvement (Generalized involvement)
Ifthereisskininvolvement,indicatethetypeofrash
Item
If there is skin involvement, indicate the type of rash
text
Item
Lichenoid
text
Code List
Lichenoid
CL Item
Yes (Yes)
CL Item
No (No)
Item
Maculpapular
text
Code List
Maculpapular
CL Item
Yes (Yes)
CL Item
No (No)
Item
Sclerodermatous
text
Code List
Sclerodermatous
CL Item
yes (yes)
CL Item
No (No)
Item
Xerophthalmia
text
Code List
Xerophthalmia
CL Item
No symptoms (No symptoms)
CL Item
Minimal symptoms, normal diet (Minimal symptoms, normal diet)
CL Item
Symptomatic but can eat and swallow modified diet (Symptomatic but can eat and swallow modified diet)
CL Item
Symptomatic and unable to adequately aliment or hydrate orally (Symptomatic and unable to adequately aliment or hydrate orally)
Item
Bronchiolitis obliterans
text
Code List
Bronchiolitis obliterans
CL Item
Yes, histologic diagnosis (Yes, histologic diagnosis)
CL Item
Yes, clinical diagnosis (Yes, clinical diagnosis)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Esophagus
text
Code List
Esophagus
CL Item
No changes (No changes)
CL Item
Symptomatic but can ear regular diet (Symptomatic but can ear regular diet)
CL Item
Dysphagia or odynophagia requiring dietary changes (Dysphagia or odynophagia requiring dietary changes)
CL Item
Need for parenteral nutrition (Need for parenteral nutrition)
Answeroneofthenexttwoquestions
Item
Answer one of the next two questions
text
Item
Diarrhea (number of stools)
text
Code List
Diarrhea (number of stools)
CL Item
Increase of <4 stools/day over baseline; mild increase in ostomy output compared to baseline (Increase of <4 stools/day over baseline; mild increase in ostomy output compared to baseline)
CL Item
Increase of 4-6 stools;IV fluids indicated <24 hrs;moderate increase in ostomy output (Increase of 4-6 stools;IV fluids indicated <24 hrs;moderate increase in ostomy output)
CL Item
Increase of 7 or more stools/day, IV fluids indicated <24 hrs;moderate increase in ostomy output (Increase of 7 or more stools/day, IV fluids indicated <24 hrs;moderate increase in ostomy output)
CL Item
Life-threatening consequences (e.g., hemodynamic collapse) (Life-threatening consequences (e.g., hemodynamic collapse))
CL Item
Death (Death)
Item
Diarrhea (volume of stools)
text
Code List
Diarrhea (volume of stools)
CL Item
Diarrhea less than or equal to 500 mL/day or <280 mL/m^s (Diarrhea less than or equal to 500 mL/day or <280 mL/m^s)
CL Item
Diarrhea >500 but less than or equal to 1000 mL/day or 280-555 mL/m^2 (Diarrhea >500 but less than or equal to 1000 mL/day or 280-555 mL/m^2)
CL Item
Diarrhea >1000 but less than or equal to 1500 mL/day or 556-833 mL/m^2 (Diarrhea >1000 but less than or equal to 1500 mL/day or 556-833 mL/m^2)
CL Item
Diarrhea >1500 mL/day or >833 mL/m^2 (Diarrhea >1500 mL/day or >833 mL/m^2)
CL Item
Severe abdominal pain with or without ileus, stool with frank blood or melena (Severe abdominal pain with or without ileus, stool with frank blood or melena)
Item
Contractures
text
Code List
Contractures
CL Item
No symptoms (No symptoms)
CL Item
Mild joint contractures (does not affect ADL) (Mild joint contractures (does not affect ADL))
CL Item
Severe joint contractures (intereferes with ADL) (Severe joint contractures (intereferes with ADL))
Item
Eosinophilia
text
Code List
Eosinophilia
CL Item
Yes (Yes)
CL Item
No (No)
Item
Serositis
text
Code List
Serositis
CL Item
Yes (Yes)
CL Item
No (No)
Item
Fascitis
text
Code List
Fascitis
CL Item
Yes (Yes)
CL Item
No (No)
Wasthereotherorganinvolvement
Item
Was there other organ involvement
text
Item Group
Answer Questions 42-48 Related To Biopsies Performed During This Assessment Period
Item
Were any biopsies performed during this assessment period for suspected GVHD
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
Code List
Were any biopsies performed during this assessment period for suspected GVHD
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
BiopsyDate
Item
Date of biopsy
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
Item
Result of biopsy
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
Code List
Result of biopsy
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Equivocal (Equivocal)
C86071 (NCI Thesaurus)
C0332241 (UMLS 2011AA)
Item
Type of biopsy
text
Code List
Type of biopsy
CL Item
Skin biopsy (Skin biopsy)
CL Item
Oral biopsy (Oral biopsy)
CL Item
Upper GI biopsy (Upper GI biopsy)
CL Item
Lower GI biopsy (Lower GI biopsy)
CL Item
Liver biopsy (Liver biopsy)
CL Item
Lung biopse (Lung biopse)
Item Group
Answer Questions 49-52 Relating To Gvhd
Item
Was a specific therapy used to treat GVHD during this assessment period
text
Code List
Was a specific therapy used to treat GVHD during this assessment period
CL Item
Yes, initiated this assessment period (Yes, initiated this assessment period)
CL Item
Yes, continuing from previous assessment period (Yes, continuing from previous assessment period)
CL Item
No (No)
Item Group
If Yes, Indicate Whether Or Not The Agents Listed Below Were Used To Treat Gvhd During This Assessment Period
Item
Other
text
C17649 (NCI Thesaurus ObjectClass)
C0205394 (UMLS 2011AA ObjectClass)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C459 (NCI Thesaurus ObjectClass)
C0013227 (UMLS 2011AA ObjectClass)
C25409 (NCI Thesaurus Property)
C1533734 (UMLS 2011AA Property)
Code List
Other
CL Item
Yes (Yes, still taking drug)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No (No, drug not given)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
other,specify
Item
Specify other agent used
text
C25179 (NCI Thesaurus ObjectClass)
C0019993 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
Item
Has treatment been discontinued
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25601 (NCI Thesaurus Property)
C1518544 (UMLS 2011AA Property)
Code List
Has treatment been discontinued
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
OffTreatmentDate
Item
If yes, enter date of discontinuation
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25601 (NCI Thesaurus ObjectClass)
C1518544 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
Item
ALS, ALG, ATS, ATG
text
Code List
ALS, ALG, ATS, ATG
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Azathioprine
text
Code List
Azathioprine
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Cyclosporine
text
Code List
Cyclosporine
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Systemic corticosteriods
text
Code List
Systemic corticosteriods
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Topical corticosteroids
text
Code List
Topical corticosteroids
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Thalidomide
text
Code List
Thalidomide
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Tacrolimus
text
Code List
Tacrolimus
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Mycophenolate Mofetil
text
Code List
Mycophenolate Mofetil
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
PUVA (Psoralen and UVA)
text
Code List
PUVA (Psoralen and UVA)
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
ECP (Extra-corporeal photopheresis)
text
Code List
ECP (Extra-corporeal photopheresis)
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Sirolumis
text
Code List
Sirolumis
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Etretinate
text
Code List
Etretinate
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Lamprene
text
Code List
Lamprene
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Etanercept
text
Code List
Etanercept
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Zenapax
text
Code List
Zenapax
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Chloroquine phosphate
text
Code List
Chloroquine phosphate
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
In vivo anti T-lymphocyte monoclonal antibody
text
Code List
In vivo anti T-lymphocyte monoclonal antibody
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Item
Specify in vivo anti T-lymphocyte monoclonal antibody used
text
Code List
Specify in vivo anti T-lymphocyte monoclonal antibody used
CL Item
In vivo immunotoxin (In vivo immunotoxin)
CL Item
Yes, still taking drug (Yes, still taking drug)
CL Item
Yes, no longer taking drug (Yes, no longer taking drug)
CL Item
No, drug not given (No, drug not given)
Specifyinvivoimmunotoxin
Item
Specify in vivo immunotoxin
text
IndicatethebestresponsetoGVHDtherapyduringthisassessmentperiod
Item
Indicate the best response to GVHD therapy during this assessment period
text
Item Group
Answer Questions 53-56 Relating To Current Patient Status
Item
Are symptoms of GVHD still present
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
Code List
Are symptoms of GVHD still present
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Current Karnofsky/Lansky score
text
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C1518965 (UMLS 2011AA ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
Code List
Current Karnofsky/Lansky score
CL Item
Normal, No Complaints, No Evidence Of Disease (100 (Normal; No Complaints/Fully Active))
CL Item
Able To Carry On Normal Activity; Minor Signs Or Symptoms Of Disease (90 (Normal activity/minor restriction in strenuous play))
CL Item
Normal Activity With Effort; Some Signs Or Symptoms Of Disease (80 (Normal acitvity with efforts/restricted in strenuous play))
CL Item
Cares For Self, Unable To Carry On Normal Activity Or To Do Active Work (70 (Unable to carry on normal activity/less time spent in play))
CL Item
Requires Occasional Assistance, But Is Able To Care For Most Of His/her Needs (60 (Requires occasional assistance/minimal active play))
CL Item
Requires Considerable Assistance And Frequent Medical Care (50 (Requires considerable assistance/no active play))
CL Item
Disabled, Requires Special Care And Assistance (40 (Disabled/Able to initiate quiet activities))
CL Item
Severely Disabled, Hospitalization Indicated. Death Not Imminent (30 (Severely disabled/needs assistance for quiet play))
CL Item
Very Sick, Hospitalization Indicated. Death Not Imminent (20 (Very sick/limited to very passive activity))
CL Item
Moribund, Fatal Processes Progressing Rapidly (10 (Moribund; Completely disabled))
LaboratoryProcedurePlateletResultSpecifiedValue
Item
Current platelet count
double
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C12520 (NCI Thesaurus Property)
C0005821 (UMLS 2011AA Property)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
PatientWeightMeasurement
Item
Current weight
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25208 (NCI Thesaurus Property)
C0043100 (UMLS 2011AA Property)
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)

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