ID

10553

Beschreibung

Acute Leukemia Disease Assessment Form NCT00049517 Combination Chemotherapy With or Without Monoclonal Antibody Therapy Followed by Stem Cell Transplant in Treating Patients With Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A727ECDC-BAED-2F88-E034-0003BA0B1A09

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A727ECDC-BAED-2F88-E034-0003BA0B1A09

Stichworte

Versionen (3)
  1. 2012-09-19 2012-09-19 -
  2. 2015-05-28 2015-05-28 -
  3. 2015-06-03 2015-06-03 -
Hochgeladen am

3 juni 2015

DOI

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Lizenz

Creative Commons BY-NC 3.0 Legacy
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    Acute Leukemia Disease Assessment Form NCT00049517

    Englisch

    No Instruction available.

    1 Formulare  
    1. StudyEvent: Acute Leukemia Disease Assessment Form
      1. No Instruction available.
    ECOG clinical trial administrative data
    Beschreibung

    ECOG clinical trial administrative data

    Registration Step
    Beschreibung

    RegistrationStep

    Datentyp

    text

    Cycle Number
    Beschreibung

    CycleNumber

    Datentyp

    text

    Patient?s Name
    Beschreibung

    Patient'sName

    Datentyp

    text

    ECOG Protocol No.
    Beschreibung

    ECOGProtocolNo.

    Datentyp

    text

    ECOG Protocol No.
    Beschreibung

    ECOGProtocolNo.

    Datentyp

    text

    ECOG Patient ID
    Beschreibung

    ECOGPatientID

    Datentyp

    text

    ECOG Patient ID
    Beschreibung

    ECOGPatientID

    Datentyp

    text

    Participating Group Protocol No.
    Beschreibung

    ParticipatingGroupProtocolNo.

    Datentyp

    text

    Participating Group Patient ID
    Beschreibung

    ParticipatingGroupPatientID

    Datentyp

    text

    Institution/Affiliate
    Beschreibung

    MainMemberInstitution/Affiliate

    Datentyp

    text

    Acute Leukemia Disease assessment
    Beschreibung

    Acute Leukemia Disease assessment

    Are data amended? (If yes, please circle amended items in red)
    Beschreibung

    AmendedDataInd

    Datentyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C25474
    UMLS 2011AA ObjectClass
    C1511726
    NCI Thesaurus Property
    C25416
    UMLS 2011AA Property
    C1691222
    Date of bone marrow biopsy
    Beschreibung

    BoneMarrowBiopsyDate

    Datentyp

    date

    Marrow blasts (%)
    Beschreibung

    BoneMarrow,Blasts,CellPercentage

    Datentyp

    double

    Marrow cellularity (%)
    Beschreibung

    BoneMarrow,CellularityPercentage

    Datentyp

    double

    Are all cell lines maturing?
    Beschreibung

    Areallcelllinesmaturing?

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    Are auer rods present?
    Beschreibung

    BoneMarrowAuerrods

    Datentyp

    text

    Is there extramedullary disease
    Beschreibung

    Isthereextramedullarydisease

    Datentyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    yes, specify sites (extramedullary disease)
    Beschreibung

    ExtramedullaryDisease,OtherSite

    Datentyp

    text

    Did the patient achieve a complete response according to clinical/hematologic criteria during this reporting period?
    Beschreibung

    CompleteResponseInd,Hematologic

    Datentyp

    text

    Date of complete response
    Beschreibung

    CRFirstObservedDate

    Datentyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C25755
    UMLS 2011AA ObjectClass
    C0871261
    NCI Thesaurus Property
    C15722
    UMLS 2011AA Property
    C0700325
    Comments
    Beschreibung

    Comments

    Datentyp

    text

    Investigator Signature
    Beschreibung

    InvestigatorSignature

    Datentyp

    text

    Alias
    NCI Thesaurus Property
    C25678
    UMLS 2011AA Property
    C1519316
    NCI Thesaurus ObjectClass
    C17089
    UMLS 2011AA ObjectClass
    C0035173
    Date
    Beschreibung

    InvestigatorSignatureDate

    Datentyp

    date

    Ccrr Module For Acute Leukemia Disease Assessment Form
    Beschreibung

    Ccrr Module For Acute Leukemia Disease Assessment Form

    specify sites of extramedullary disease
    Beschreibung

    specifysitesofextramedullarydisease

    Datentyp

    text

    Zum Seitenanfang zurückkehren

    Ähnliche Modelle

    No Instruction available.

    1 Formulare
    1. StudyEvent: Acute Leukemia Disease Assessment Form
      1. No Instruction available.
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datentyp
    Alias
    Item Group
    ECOG clinical trial administrative data
    RegistrationStep
    Item
    Registration Step
    text
    CycleNumber
    Item
    Cycle Number
    text
    Patient'sName
    Item
    Patient?s Name
    text
    ECOGProtocolNo.
    Item
    ECOG Protocol No.
    text
    ECOGProtocolNo.
    Item
    ECOG Protocol No.
    text
    ECOGPatientID
    Item
    ECOG Patient ID
    text
    ECOGPatientID
    Item
    ECOG Patient ID
    text
    ParticipatingGroupProtocolNo.
    Item
    Participating Group Protocol No.
    text
    ParticipatingGroupPatientID
    Item
    Participating Group Patient ID
    text
    MainMemberInstitution/Affiliate
    Item
    Institution/Affiliate
    text
    Item Group
    Acute Leukemia Disease assessment
    Item
    Are data amended? (If yes, please circle amended items in red)
    text
    C25474 (NCI Thesaurus ObjectClass)
    C1511726 (UMLS 2011AA ObjectClass)
    C25416 (NCI Thesaurus Property)
    C1691222 (UMLS 2011AA Property)
    CL.1
    Code List
    Are data amended? (If yes, please circle amended items in red)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    BoneMarrowBiopsyDate
    Item
    Date of bone marrow biopsy
    date
    BoneMarrow,Blasts,CellPercentage
    Item
    Marrow blasts (%)
    double
    BoneMarrow,CellularityPercentage
    Item
    Marrow cellularity (%)
    double
    Item
    Are all cell lines maturing?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.2
    Code List
    Are all cell lines maturing?
    CL Item
    No (no)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    Item
    Are auer rods present?
    text
    CL.3
    Code List
    Are auer rods present?
    CL Item
    Auer Rods Absent From Bone Marrow (absent)
    CL Item
    Auer Rods Present In Bone Marrow (present)
    Item
    Is there extramedullary disease
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    CL.4
    Code List
    Is there extramedullary disease
    CL Item
    No (no)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    ExtramedullaryDisease,OtherSite
    Item
    yes, specify sites (extramedullary disease)
    text
    Item
    Did the patient achieve a complete response according to clinical/hematologic criteria during this reporting period?
    text
    CL.5
    Code List
    Did the patient achieve a complete response according to clinical/hematologic criteria during this reporting period?
    CL Item
    Null (no)
    CL Item
    Null (yes)
    CL Item
    Null (unknown)
    CRFirstObservedDate
    Item
    Date of complete response
    date
    C25755 (NCI Thesaurus ObjectClass)
    C0871261 (UMLS 2011AA ObjectClass)
    C15722 (NCI Thesaurus Property)
    C0700325 (UMLS 2011AA Property)
    Comments
    Item
    Comments
    text
    InvestigatorSignature
    Item
    Investigator Signature
    text
    C25678 (NCI Thesaurus Property)
    C1519316 (UMLS 2011AA Property)
    C17089 (NCI Thesaurus ObjectClass)
    C0035173 (UMLS 2011AA ObjectClass)
    InvestigatorSignatureDate
    Item
    Date
    date
    Item Group
    Ccrr Module For Acute Leukemia Disease Assessment Form
    specifysitesofextramedullarydisease
    Item
    specify sites of extramedullary disease
    text
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