ID
1976
Beskrivning
CALGB: 10201On-Study Form Daunorubicin and Cytarabine With or Without Oblimersen in Treating Older Patients With Previously Untreated Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD838530-D422-2F4D-E034-0003BA12F5E7
Länk
Nyckelord
Versioner (3)
- 2012-09-19 2012-09-19 -
- 2015-01-09 2015-01-09 - Martin Dugas
- 2021-09-27 2021-09-27 -
Uppladdad den
19 september 2012
DOI
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Licens
Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT00085124 On-Study - CALGB: 10201On-Study Form - 2057573v3.0
Instructions: Complete and submit thie form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Cirlce amended items and check "Amended data" box to teh right. If submitting by mail, retain a copy for your records and send the original form for mazimum clarity in transmission and fax to 919-416-4990. If submistting electronically, click the Send button when you have completed the PDF version of the form.
Beskrivning
Patient Description
Beskrivning
InitialDiagnosisDate
Datatyp
date
Beskrivning
FirstAbnormalBoneMarrowPriorMyelodysplasticSyndromeFindingDate
Datatyp
date
Alias
- NCI Thesaurus ObjectClass
- C25401
- UMLS 2011AA ObjectClass
- C0205161
- NCI Thesaurus ObjectClass
- C12431
- UMLS 2011AA ObjectClass
- C0005953
- NCI Thesaurus ObjectClass
- C25509
- UMLS 2011AA ObjectClass
- C1279901
- NCI Thesaurus Property
- C3247
- UMLS 2011AA Property
- C0026986
- NCI Thesaurus Property
- C25629
- UMLS 2011AA Property
- C0332152
- NCI Thesaurus Property
- C61036
- UMLS 2011AA Property
- C0243095
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
Leukemia/MDSClassification
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS 2011AA ValueDomain
- C0683312
- NCI Thesaurus ObjectClass
- C3161
- UMLS 2011AA ObjectClass
- C0023418
- NCI Thesaurus Property
- C25161
- UMLS 2011AA Property
- C0008902
Beskrivning
LeukemiaClassification,Other
Datatyp
text
Beskrivning
Onset,AML
Datatyp
text
Beskrivning
ExtramedullaryDisease
Datatyp
text
Beskrivning
DiseaseInvolvementSite,Other
Datatyp
text
Beskrivning
BoneMarrowAuerrods
Datatyp
text
Beskrivning
Organ Involvement
Beskrivning
Splenomegaly,Palpation
Datatyp
text
Alias
- NCI Thesaurus Property
- C16950
- UMLS 2011AA Property
- C0030247
- NCI Thesaurus ObjectClass
- C3384
- UMLS 2011AA ObjectClass
- C0038002
Beskrivning
Splenomegaly,Imaging
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C3384
- UMLS 2011AA ObjectClass
- C0038002
- NCI Thesaurus Property
- C19477
- UMLS 2011AA Property
- C1704254
Beskrivning
Hepatomegaly,Palpation
Datatyp
text
Alias
- NCI Thesaurus Property
- C16950
- UMLS 2011AA Property
- C0030247
- NCI Thesaurus ObjectClass
- C3100
- UMLS 2011AA ObjectClass
- C0017924
Beskrivning
Hepatomegaly,Imaging
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C3100
- UMLS 2011AA ObjectClass
- C0017924
- NCI Thesaurus Property
- C19477
- UMLS 2011AA Property
- C1704254
Beskrivning
Lymphadenopathy,Palpation
Datatyp
text
Alias
- NCI Thesaurus Property
- C16950
- UMLS 2011AA Property
- C0030247
- NCI Thesaurus ObjectClass
- C3206
- UMLS 2011AA ObjectClass
- C0024228
Beskrivning
Lymphadenopathy,Imaging
Datatyp
text
Alias
- NCI Thesaurus ObjectClass
- C3206
- UMLS 2011AA ObjectClass
- C0024228
- NCI Thesaurus Property
- C19477
- UMLS 2011AA Property
- C1704254
Beskrivning
Current Symptoms
Beskrivning
CurrentInfection
Datatyp
text
Beskrivning
AdverseEventHemorrhageSymptomStatus
Datatyp
text
Alias
- NCI Thesaurus Property
- C26791
- UMLS 2011AA Property
- C0019080
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C4876
- UMLS 2011AA Property
- C1457887
- NCI Thesaurus ValueDomain
- C25688
- UMLS 2011AA ValueDomain
- C0449438
Beskrivning
Lab Data At Study Entry
Beskrivning
Lab,Renal,Creatinine
Datatyp
double
Beskrivning
Lab,Hepatic,Bilirubin
Datatyp
double
Beskrivning
Lab,Chemistry,LactateDehydrogenase
Datatyp
double
Beskrivning
Lab,Chemistry,LactateDehydrogenase,ULN
Datatyp
double
Beskrivning
Lab,Hepatic,SGOT
Datatyp
double
Beskrivning
SGOTLabUpperLimitNormalValue
Datatyp
double
Alias
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25706
- UMLS 2011AA ValueDomain
- C1519815
Beskrivning
Lab,Hepatic,SGPT
Datatyp
double
Beskrivning
SGPTLabUpperLimitNormalValue
Datatyp
double
Alias
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25706
- UMLS 2011AA ValueDomain
- C1519815
Beskrivning
Lab,Hepatic,AlkalinePhosphatase
Datatyp
double
Beskrivning
LaboratoryProcedureAlkalinePhosphataseResultUpperLimitNormalValue
Datatyp
double
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C16276
- UMLS 2011AA Property
- C0002059
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25706
- UMLS 2011AA ValueDomain
- C1519815
Beskrivning
%LVEFbyMUGA
Datatyp
text
Beskrivning
CompletedBy
Datatyp
text
Beskrivning
DateCompleted
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beskrivning
%LVEFbyECHO
Datatyp
text
Beskrivning
Ccrr Module For Calgb: 10201on-study Form
Similar models
Instructions: Complete and submit thie form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Cirlce amended items and check "Amended data" box to teh right. If submitting by mail, retain a copy for your records and send the original form for mazimum clarity in transmission and fax to 919-416-4990. If submistting electronically, click the Send button when you have completed the PDF version of the form.
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25536 (NCI Thesaurus Property)
C1555582 (UMLS 2011AA Property)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0205161 (UMLS 2011AA ObjectClass)
C12431 (NCI Thesaurus ObjectClass)
C0005953 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus ObjectClass)
C1279901 (UMLS 2011AA ObjectClass)
C3247 (NCI Thesaurus Property)
C0026986 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C61036 (NCI Thesaurus Property)
C0243095 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C3161 (NCI Thesaurus ObjectClass)
C0023418 (UMLS 2011AA ObjectClass)
C25161 (NCI Thesaurus Property)
C0008902 (UMLS 2011AA Property)
C0030247 (UMLS 2011AA Property)
C3384 (NCI Thesaurus ObjectClass)
C0038002 (UMLS 2011AA ObjectClass)
C0038002 (UMLS 2011AA ObjectClass)
C19477 (NCI Thesaurus Property)
C1704254 (UMLS 2011AA Property)
C0030247 (UMLS 2011AA Property)
C3100 (NCI Thesaurus ObjectClass)
C0017924 (UMLS 2011AA ObjectClass)
C0017924 (UMLS 2011AA ObjectClass)
C19477 (NCI Thesaurus Property)
C1704254 (UMLS 2011AA Property)
C0030247 (UMLS 2011AA Property)
C3206 (NCI Thesaurus ObjectClass)
C0024228 (UMLS 2011AA ObjectClass)
C0024228 (UMLS 2011AA ObjectClass)
C19477 (NCI Thesaurus Property)
C1704254 (UMLS 2011AA Property)
C0549184 (UMLS 2011AA)
C2945599 (UMLS 2011AA)
C0019080 (UMLS 2011AA Property)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C0549184 (UMLS 2011AA)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C16276 (NCI Thesaurus Property)
C0002059 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)