ID
2022
Description
E2906 Engraftment Form - Arm G 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=7583518B-5574-8F0A-E040-BB89AD437B26
Link
Keywords
Versions (2)
- 9/19/12 9/19/12 -
- 1/8/15 1/8/15 - Martin Dugas
Uploaded on
September 19, 2012
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License
Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT01041703 Treatment - E2906 Engraftment Form - Arm G - 2951586v1.0
INSTRUCTIONS: Complete this form after the allogeneic transplant (30 days post transplant and 100 days post transplant). 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
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
Engraftment
Description
TransplantNeutrophilEngraftmentInd-3
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C12981
- UMLS 2011AA ObjectClass
- C0332835
- NCI Thesaurus Property
- C12533
- UMLS 2011AA Property
- C0027950
- NCI Thesaurus Property
- C37947
- UMLS 2011AA Property
- C0301944
Description
TransplantNeutrophilEngraftmentDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C12981
- UMLS 2011AA ObjectClass
- C0332835
- NCI Thesaurus Property
- C12533
- UMLS 2011AA Property
- C0027950
- NCI Thesaurus Property
- C37947
- UMLS 2011AA Property
- C0301944
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain
- C25367
Description
TransplantPlateletEngraftmentInd-3
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C12981
- UMLS 2011AA ObjectClass
- C0332835
- NCI Thesaurus Property
- C37947
- UMLS 2011AA Property
- C0301944
- NCI Thesaurus Property
- C12520
- UMLS 2011AA Property
- C0005821
Description
TransplantPlateletEngraftmentDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C12981
- UMLS 2011AA ObjectClass
- C0332835
- NCI Thesaurus Property
- C37947
- UMLS 2011AA Property
- C0301944
- NCI Thesaurus Property
- C12520
- UMLS 2011AA Property
- C0005821
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ValueDomain
- C25367
Description
LaboratoryProcedurePost-OperativeElevatedPlateletResultInd-2
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C25493
- UMLS 2011AA Property
- C0205250
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property
- C12520
- UMLS 2011AA Property
- C0005821
- NCI Thesaurus Property
- C25623
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Description
MalignantNeoplasmAllogeneicHematopoieticStemCellTransplantationBestResponseDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C9305
- UMLS 2011AA ObjectClass
- C0006826
- NCI Thesaurus Property
- C50995
- UMLS 2011AA Property
- C1704632
- NCI Thesaurus Property
- C46089
- UMLS 2011AA Property
- C1705576
- NCI Thesaurus Property
- C25432
- UMLS 2011AA Property
- C1522427
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
LaboratoryProcedureCytogeneticAnalysisChimerismOutcomePercentageValue
Data type
double
Measurement units
- %
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
- NCI Thesaurus Property
- C18280
- UMLS 2011AA Property
- C0752095
- NCI Thesaurus Property
- C62582
- UMLS 2011AA Property
- C0333678
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus ValueDomain
- C25613
- UMLS 2011AA ValueDomain
- C0439165
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
Description
LaboratoryProcedureText
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus Property
- C25218
- UMLS 2011AA Property
- C1948041
- NCI Thesaurus ObjectClass
- C37984
- UMLS 2011AA ObjectClass
- C0022877
Description
SpecimenCollectedDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C19157
- UMLS 2011AA ObjectClass
- C0370003
- NCI Thesaurus Property
- C25452
- NCI Thesaurus Property
- C25275
- UMLS 2011AA Property
- C2745955
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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INSTRUCTIONS: Complete this form after the allogeneic transplant (30 days post transplant and 100 days post transplant). Submit original to the ECOG Coordinating Center; keep a copy for your files
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C21541 (NCI Thesaurus ValueDomain)
C0018704 (UMLS 2011AA ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus Property)
C0220825 (UMLS 2011AA Property)
C25616 (NCI Thesaurus Property)
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C25474 (NCI Thesaurus ObjectClass)
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C0442732 (UMLS 2011AA ValueDomain)
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C0011065 (UMLS 2011AA Property)
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