ID
2009
Description
E2906 Donor/Transplant Form Clofarabine or Daunorubicin Hydrochloride and Cytarabine Followed By Decitabine or Observation in Treating Older Patients With Newly Diagnosed Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=842DEB36-F390-AD41-E040-BB89AD4373C4
Link
Keywords
Versions (3)
- 9/19/12 9/19/12 -
- 1/8/15 1/8/15 - Martin Dugas
- 6/8/15 6/8/15 -
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September 19, 2012
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License
Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT01041703 Treatment - E2906 Donor/Transplant Form - 3060356v1.0
INSTRUCTIONS: Complete this form after the allogeneic transplant (30 days post transplant or at the end of hospitalization). Submit original to the ECOG Coordinating Center; keep a copy for your files
Description
On Treatment
Description
TreatmentEvaluationPeriodType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus Property
- C25214
- UMLS 2011AA Property
- C0220825
- NCI Thesaurus Property
- C25616
- UMLS 2011AA Property
- C1948053
- NCI Thesaurus ObjectClass
- C15368
Description
Unnamed2
Description
DataAmendedText
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C25474
- UMLS 2011AA ObjectClass
- C1511726
- NCI Thesaurus Property
- C25416
- UMLS 2011AA Property
- C1691222
Description
DataAmendedDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C25474
- UMLS 2011AA ObjectClass
- C1511726
- NCI Thesaurus Property
- C25416
- UMLS 2011AA Property
- C1691222
- NCI Thesaurus ValueDomain
- C25367
Description
Vital Status
Description
PatientVitalStatus
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus ValueDomain
- C18003
- UMLS 2011AA ValueDomain
- C0442732
- NCI Thesaurus ValueDomain
- C25688
- UMLS 2011AA ValueDomain
- C0449438
- NCI Thesaurus Property
- C25717
- UMLS 2011AA Property
- C1148433
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
Description
PatientLastContactDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25461
- UMLS 2011AA Property
- C0337611
- NCI Thesaurus Property
- C25551
- UMLS 2011AA Property
- C1517741
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain
- C25367
Description
PatientDeathPatientDeathPrimaryReason
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C28554
- UMLS 2011AA Property
- C0011065
- NCI Thesaurus ValueDomain
- C25251
- UMLS 2011AA ValueDomain
- C0205225
Description
PatientDeathSpecify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C28554
- UMLS 2011AA Property
- C0011065
Description
Donor Information
Description
TransplantDonorPatientRelationshipType
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25168
- UMLS 2011AA ObjectClass
- C0040288
- NCI Thesaurus ObjectClass
- C12981
- UMLS 2011AA ObjectClass
- C0332835
- NCI Thesaurus Property
- C16960
- UMLS 2011AA Property
- C0030705
- NCI Metathesaurus Property
- CL110661
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Description
Allogeneic Transplant
Description
ProtocolTransplantPerformedInd-3
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus ObjectClass
- C12981
- UMLS 2011AA ObjectClass
- C0332835
- NCI Thesaurus ObjectClass
- C42651
- UMLS 2011AA ObjectClass
- C0442711
Description
ProtocolTransplantNotPerformedReason
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C12981
- UMLS 2011AA ObjectClass
- C0332835
- NCI Thesaurus ObjectClass
- C42651
- UMLS 2011AA ObjectClass
- C0442711
- NCI Thesaurus Property
- C49487
- UMLS 2011AA Property
- C1298908
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus ValueDomain
- C25638
- UMLS 2011AA ValueDomain
- C0392360
Description
TreatmentNotBeginDescriptionSpecify
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C25594
- UMLS 2011AA Property
- C1518422
- NCI Thesaurus Property
- C25431
- UMLS 2011AA Property
- C0439659
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
Description
Comments
Description
InvestigatorSignatureText
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus Property
- C25678
- UMLS 2011AA Property
- C1519316
- NCI Thesaurus ObjectClass
- C17089
- UMLS 2011AA ObjectClass
- C0035173
Description
InvestigatorSignatureDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus Property
- C25678
- UMLS 2011AA Property
- C1519316
- NCI Thesaurus ValueDomain
- C25367
- NCI Thesaurus ObjectClass
- C17089
- UMLS 2011AA ObjectClass
- C0035173
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C25367 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
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C0884358 (UMLS 2011AA Property)
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C0392360 (UMLS 2011AA ValueDomain)
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