ID

25165

Description

AMC-053 Lymphoma Disease Activity and Measurement Form (L02) Bortezomib, Ifosfamide, Carboplatin, and Etoposide, With or Without Rituximab, in Treating Patients With Relapsed or Refractory AIDS-Related Non-Hodgkin Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8D65AE6D-606C-8C36-E040-BB89AD435B36

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8D65AE6D-606C-8C36-E040-BB89AD435B36

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 8/28/17 8/28/17 -
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August 28, 2017

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Creative Commons BY-NC 3.0 Legacy
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AMC-053 Lymphoma Disease Activity and Measurement Form (L02)

English

Extra nodal involvement evaluation: please record all extra nodal sites of disease that were recorded as present (measurable or nonmeasurable) at the baseline evaluation, even if that site has resolved on this or previous evaluations, label the disease sites consistently (eg, if "Extra nodal site a" was lung at baseline, make sure that the same lung site is also labeled "Extra nodal site a" on all subsequent forms)

1 forms  
Header - Lymphoma Disease Activity and Measurement Form
Description

Header - Lymphoma Disease Activity and Measurement Form

Alias
UMLS CUI-1
C1320722
UMLS CUI-2
C1332051
Visit Number
Description

Visit number

Data type

integer

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16696
NCI Thesaurus Property
C25385
UMLS CUI [1]
C1549755
Extra Nodal Involvement Evaluation
Description

Extra Nodal Involvement Evaluation

Alias
UMLS CUI-1
C0012634
UMLS CUI-2
C1314939
UMLS CUI-3
C0220825
UMLS CUI-4
C1332051
Extranodal extension
Description

TumorExtranodalExtensionIndicator

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C25180
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus Property
C25270
NCI Thesaurus Property-2
C25504
UMLS CUI [1,1]
C0006826
UMLS CUI [1,2]
C0231448
UMLS CUI [1,3]
C1517067
Site of Involvement
Description

Disease Involvement Site

Data type

integer

Alias
NCI Thesaurus ValueDomain
C13717
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus Property
C25548
UMLS CUI [1,1]
C1515974
UMLS CUI [1,2]
C0012634
UMLS CUI [1,3]
C1314939
Other, specify
Description

DiseaseInvolvedSiteSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
NCI Thesaurus Property
C25341
NCI Thesaurus Property-2
C25547
NCI Thesaurus ObjectClass
C2991
UMLS CUI [1,1]
C1515974
UMLS CUI [1,2]
C0012634
UMLS CUI [1,3]
C1314939
Dimension 1
Description

TumorLargestDimensionMeasurement (cm)

Data type

float

Measurement units
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus Property
C25550
NCI Thesaurus Property-2
C25483
UMLS CUI [1,1]
C0006826
UMLS CUI [1,2]
C0242485
UMLS CUI [1,3]
C0443228
UMLS CUI [1,4]
C0439534
cm
Dimension 2
Description

TumorSecondDimensionMeasurement (cm)

Data type

float

Measurement units
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus Property
C25666
NCI Thesaurus Property-2
C25483
UMLS CUI [1,1]
C0006826
UMLS CUI [1,2]
C0242485
UMLS CUI [1,3]
C0439534
cm
Method of Evaluation
Description

Evaluation method

Data type

integer

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C20989
NCI Thesaurus Property
C16847
UMLS CUI [1]
C2911685
Other, specify
Description

Evaluation method, specify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
NCI Thesaurus ObjectClass
C20989
NCI Thesaurus Property
C16847
UMLS CUI [1]
C2911685
PET scan
Description

PositronEmissionTomographyDiagnosticImagingAssessmentStatus

Data type

integer

Alias
NCI Thesaurus Property
C20989
NCI Thesaurus ObjectClass
C17007
NCI Thesaurus ObjectClass-2
C16502
NCI Thesaurus ValueDomain
C25688
UMLS CUI [1,1]
C0032743
UMLS CUI [1,2]
C0449438
Lesion completely resolved
Description

MalignantNeoplasmCompleteRemissionObservedInd-3 (For "On treatment" and "Follow up" cycles only)

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
NCI Thesaurus ObjectClass
C9305
NCI Thesaurus Property
C4870
NCI Thesaurus Property-2
C25599
UMLS CUI [1,1]
C0006826
UMLS CUI [1,2]
C0677874
Is measurable disease present?
Description

Measurable Disease

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
NCI Thesaurus Property
C25626
NCI Thesaurus ObjectClass
C2991
NCI Thesaurus ObjectClass-2
C37894
UMLS CUI-1
C1513041
Has the patient been diagnosed with a new progression?
Description

DiseaseNewProgressionInd-2

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38147
NCI Thesaurus Property
C25586
NCI Thesaurus Property-2
C25331
NCI Thesaurus ObjectClass
C2991
UMLS CUI [1]
C0242656
Evaluation documented
Description

EvaluationPerformedInd-3

Data type

boolean

Alias
NCI Thesaurus ValueDomain
C38148
NCI Thesaurus ObjectClass
C25214
NCI Thesaurus Property
C38000
UMLS CUI [1]
C0220825
Lesion Assessment
Description

LesionFollow-UpAssessmentType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C3824
NCI Thesaurus Property
C20989
UMLS CUI [1,1]
C0221198
UMLS CUI [1,2]
C1522577
UMLS CUI [1,3]
C0332307
Comments
Description

Comments

Alias
UMLS CUI-1
C0947611
UMLS CUI-2
C1332051
Comments
Description

Research Comments

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS CUI [1,1]
C0947611
UMLS CUI [1,2]
C1332051
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Similar models

Extra nodal involvement evaluation: please record all extra nodal sites of disease that were recorded as present (measurable or nonmeasurable) at the baseline evaluation, even if that site has resolved on this or previous evaluations, label the disease sites consistently (eg, if "Extra nodal site a" was lung at baseline, make sure that the same lung site is also labeled "Extra nodal site a" on all subsequent forms)

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header - Lymphoma Disease Activity and Measurement Form
C1320722 (UMLS CUI-1)
C1332051 (UMLS CUI-2)
Visit number
Item
Visit Number
integer
C25337 (NCI Thesaurus ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI [1])
Item Group
Extra Nodal Involvement Evaluation
C0012634 (UMLS CUI-1)
C1314939 (UMLS CUI-2)
C0220825 (UMLS CUI-3)
C1332051 (UMLS CUI-4)
Extranodal extension
Item
Extranodal extension
boolean
C25180 (NCI Thesaurus ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C25270 (NCI Thesaurus Property)
C25504 (NCI Thesaurus Property-2)
C0006826 (UMLS CUI [1,1])
C0231448 (UMLS CUI [1,2])
C1517067 (UMLS CUI [1,3])
Item
Site of Involvement
integer
C13717 (NCI Thesaurus ValueDomain)
C2991 (NCI Thesaurus ObjectClass)
C25548 (NCI Thesaurus Property)
C1515974 (UMLS CUI [1,1])
C0012634 (UMLS CUI [1,2])
C1314939 (UMLS CUI [1,3])
CL.2
Code List
Site of Involvement
CL Item
Brain (1)
CL Item
Meninges (2)
CL Item
Lung (3)
CL Item
Liver (4)
CL Item
Kidney (5)
CL Item
Bone Marrow (6)
CL Item
Skin (7)
CL Item
Thyroid (8)
CL Item
Pleura (9)
CL Item
Epidural (10)
CL Item
Bone (11)
CL Item
Gastrointestinal Tract (12)
CL Item
Ascites (13)
CL Item
Other Specify (14)
DiseaseInvolvedSiteSpecify
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C25341 (NCI Thesaurus Property)
C25547 (NCI Thesaurus Property-2)
C2991 (NCI Thesaurus ObjectClass)
C1515974 (UMLS CUI [1,1])
C0012634 (UMLS CUI [1,2])
C1314939 (UMLS CUI [1,3])
Dimension 1
Item
Dimension 1
float
C25209 (NCI Thesaurus ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C25550 (NCI Thesaurus Property)
C25483 (NCI Thesaurus Property-2)
C0006826 (UMLS CUI [1,1])
C0242485 (UMLS CUI [1,2])
C0443228 (UMLS CUI [1,3])
C0439534 (UMLS CUI [1,4])
Dimension 2
Item
Dimension 2
float
C25209 (NCI Thesaurus ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C25666 (NCI Thesaurus Property)
C25483 (NCI Thesaurus Property-2)
C0006826 (UMLS CUI [1,1])
C0242485 (UMLS CUI [1,2])
C0439534 (UMLS CUI [1,3])
Item
Method of Evaluation
integer
C25284 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C2911685 (UMLS CUI [1])
CL.3
Code List
Method of Evaluation
CL Item
Palpation (1)
CL Item
X-ray (2)
CL Item
Ct Scan (3)
CL Item
Mri Scan (4)
CL Item
Ultrasound (5)
CL Item
Intravenous Pyelogram (6)
CL Item
Gallium Scan (7)
CL Item
Lymphangiogram (8)
CL Item
Bone Scan (9)
CL Item
Biopsy (10)
CL Item
Pet Scan (11)
CL Item
Pet/ct Scan (12)
CL Item
Peripheral Blood Counts (13)
CL Item
Aspirate, Bone Marrow (14)
CL Item
Bone Marrow Biopsy (15)
CL Item
Other (16)
Evaluation method, specify
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C2911685 (UMLS CUI [1])
Item
PET scan
integer
C20989 (NCI Thesaurus Property)
C17007 (NCI Thesaurus ObjectClass)
C16502 (NCI Thesaurus ObjectClass-2)
C25688 (NCI Thesaurus ValueDomain)
C0032743 (UMLS CUI [1,1])
C0449438 (UMLS CUI [1,2])
CL.4
Code List
PET scan
CL Item
Positive Finding (1)
CL Item
Negative (2)
Lesion completely resolved
Item
Lesion completely resolved
boolean
C38148 (NCI Thesaurus ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C4870 (NCI Thesaurus Property)
C25599 (NCI Thesaurus Property-2)
C0006826 (UMLS CUI [1,1])
C0677874 (UMLS CUI [1,2])
Measurable Disease
Item
Is measurable disease present?
boolean
C38148 (NCI Thesaurus ValueDomain)
C25626 (NCI Thesaurus Property)
C2991 (NCI Thesaurus ObjectClass)
C37894 (NCI Thesaurus ObjectClass-2)
C1513041 (UMLS CUI-1)
DiseaseNewProgressionInd-2
Item
Has the patient been diagnosed with a new progression?
boolean
C38147 (NCI Thesaurus ValueDomain)
C25586 (NCI Thesaurus Property)
C25331 (NCI Thesaurus Property-2)
C2991 (NCI Thesaurus ObjectClass)
C0242656 (UMLS CUI [1])
EvaluationPerformedInd-3
Item
Evaluation documented
boolean
C38148 (NCI Thesaurus ValueDomain)
C25214 (NCI Thesaurus ObjectClass)
C38000 (NCI Thesaurus Property)
C0220825 (UMLS CUI [1])
Item
Lesion Assessment
text
C25284 (NCI Thesaurus ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C0221198 (UMLS CUI [1,1])
C1522577 (UMLS CUI [1,2])
C0332307 (UMLS CUI [1,3])
CL.9
Code List
Lesion Assessment
CL Item
No Change (1)
CL Item
Improvement (2)
CL Item
Progression - Increase (3 - increase)
CL Item
Not Evaluated (4)
Item Group
Comments
C0947611 (UMLS CUI-1)
C1332051 (UMLS CUI-2)
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1,1])
C1332051 (UMLS CUI [1,2])
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