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25174

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AMC-053 Lymphoma Response Form (LYR) 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=8B73192C-C1AD-46D4-E040-BB89AD433800

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https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8B73192C-C1AD-46D4-E040-BB89AD433800

Nyckelord

Versioner (2)
  1. 2012-09-19 2012-09-19 -
  2. 2017-08-28 2017-08-28 -
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28 augusti 2017

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Creative Commons BY-NC 3.0 Legacy
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    AMC-053 Lymphoma Response Form (LYR)

    Engelsk

    This form is to be updated at each response assessment time point defined in the protocol

    1 Formulär  
    Extra Nodal Involvement Evaluation
    Beskrivning

    Extra Nodal Involvement Evaluation

    Alias
    UMLS CUI-1
    C0012634
    UMLS CUI-2
    C1314939
    UMLS CUI-3
    C0220825
    UMLS CUI-4
    C1332051
    Date of Last Clinical Assessment
    Beskrivning

    Follow-Up Date

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C9305
    NCI Thesaurus Property
    C16033
    NCI Thesaurus Property-2
    C25365
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    UMLS CUI [1,1]
    C1522577
    UMLS CUI [1,2]
    C0006826
    UMLS CUI [1,3]
    C0011008
    Complete Response
    Beskrivning

    Complete Response

    Alias
    UMLS CUI-1
    C0006826
    UMLS CUI-2
    C0677874
    UMLS CUI-3
    C1332051
    Is complete response first observed
    Beskrivning

    CompleteResponseFirstObservedInd-2 (CR)

    Datatyp

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C25755
    NCI Thesaurus ObjectClass-2
    C25250
    NCI Thesaurus Property
    C25509
    NCI Thesaurus Property-2
    C25599
    NCI Thesaurus ValueDomain
    C38147
    UMLS CUI [1,1]
    C0006826
    UMLS CUI [1,2]
    C0677874
    Complete Response
    Beskrivning

    Complete Response First Observed Date

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C25755
    NCI Thesaurus ObjectClass-2
    C25250
    NCI Thesaurus Property
    C25509
    NCI Thesaurus Property-2
    C25599
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    UMLS CUI [1,1]
    C0006826
    UMLS CUI [1,2]
    C0677874
    UMLS CUI [1,3]
    C0011008
    Is complete response confirmed
    Beskrivning

    CompleteResponseConfirmedInd-3 (CR)

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    NCI Thesaurus ObjectClass
    C25755
    NCI Thesaurus ObjectClass-2
    C25250
    NCI Thesaurus Property
    C25458
    UMLS CUI [1,1]
    C0006826
    UMLS CUI [1,2]
    C0677874
    UMLS CUI [1,3]
    C0750484
    Complete Response Confirmed Date
    Beskrivning

    CompleteResponseConfirmedDate (mm/dd/yyyy)

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ObjectClass
    C25755
    NCI Thesaurus ObjectClass-2
    C25250
    NCI Thesaurus Property
    C25458
    UMLS CUI [1,1]
    C0006826
    UMLS CUI [1,2]
    C0677874
    UMLS CUI [1,3]
    C0750484
    UMLS CUI [1,4]
    C0011008
    Complete Response Unconfirmed
    Beskrivning

    Complete Response Unconfirmed

    Alias
    UMLS CUI-1
    C0006826
    UMLS CUI-2
    C0677874
    UMLS CUI-3
    C1332051
    Is complete response uncertain first observed
    Beskrivning

    UncertainCompleteResponseFirstObservedInd-2

    Datatyp

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C25755
    NCI Thesaurus ObjectClass-2
    C25250
    NCI Thesaurus ObjectClass-3
    C47944
    NCI Thesaurus Property
    C25509
    NCI Thesaurus Property-2
    C25599
    NCI Thesaurus ValueDomain
    C38147
    UMLS CUI [1,1]
    C0006826
    UMLS CUI [1,2]
    C0677874
    UMLS CUI [1,3]
    C0087130
    Complete Response uncertain (CRu) First Observed Date
    Beskrivning

    UncertainCompleteResponseNon-HodgkinLymphomaObservedDate

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C47944
    NCI Metathesaurus ObjectClass
    C0677874
    NCI Thesaurus Property
    C3211
    NCI Thesaurus Property-2
    C25599
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    UMLS CUI [1,1]
    C0006826
    UMLS CUI [1,2]
    C0677874
    UMLS CUI [1,3]
    C0087130
    UMLS CUI [1,4]
    C0011008
    Is complete response, uncertain, confirmed
    Beskrivning

    UncertainCompleteResponseConfirmedInd-2 (CRU)

    Datatyp

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C25755
    NCI Thesaurus ObjectClass-2
    C25250
    NCI Thesaurus ObjectClass-3
    C47944
    NCI Thesaurus Property
    C25458
    NCI Thesaurus ValueDomain
    C38147
    UMLS CUI [1,1]
    C0006826
    UMLS CUI [1,2]
    C0677874
    UMLS CUI [1,3]
    C0087130
    UMLS CUI [1,4]
    C0750484
    Complete Response Uncertain (CRu) Confirmed Date
    Beskrivning

    UncertainCompleteResponseConfirmedDate

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C25755
    NCI Thesaurus ObjectClass-2
    C25250
    NCI Thesaurus ObjectClass-3
    C47944
    NCI Thesaurus Property
    C25458
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI [1,1]
    C0006826
    UMLS CUI [1,2]
    C0677874
    UMLS CUI [1,3]
    C0087130
    UMLS CUI [1,4]
    C0750484
    UMLS CUI [1,5]
    C0011008
    Partial Response
    Beskrivning

    Partial Response

    Alias
    UMLS CUI-1
    C1521726
    UMLS CUI-2
    C1332051
    Is partial response first observed
    Beskrivning

    PartialResponseFirstObservedInd-2 (PR)

    Datatyp

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C25755
    NCI Thesaurus ObjectClass-2
    C25378
    NCI Thesaurus Property
    C25509
    NCI Thesaurus Property-2
    C25599
    NCI Thesaurus ValueDomain
    C38147
    UMLS CUI [1]
    C1521726
    Partial Response
    Beskrivning

    Partial Response First Observed Date

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C25755
    NCI Thesaurus ObjectClass-2
    C25378
    NCI Thesaurus Property
    C25509
    NCI Thesaurus Property-2
    C25599
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    UMLS CUI [1,1]
    C1521726
    UMLS CUI [1,2]
    C0011008
    Is partial response confirmed
    Beskrivning

    PartialResponseConfirmedInd-3 (PR)

    Datatyp

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C25755
    NCI Thesaurus ObjectClass-2
    C25378
    NCI Thesaurus Property
    C25458
    NCI Thesaurus ValueDomain
    C38148
    NCI Thesaurus ValueDomain-2
    C25755
    UMLS CUI [1,1]
    C1521726
    UMLS CUI [1,2]
    C0750484
    Partial Response Confirmed Date
    Beskrivning

    PartialResponseConfirmedDate (mm/dd/yyyy)

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ObjectClass
    C25755
    NCI Thesaurus Property
    C25458
    NCI Thesaurus ObjectClass-2
    C25378
    UMLS CUI [1,1]
    C1521726
    UMLS CUI [1,2]
    C0750484
    UMLS CUI [1,3]
    C0011008
    Progressive Disease
    Beskrivning

    Progressive Disease

    Alias
    UMLS CUI-1
    C1335499
    UMLS CUI-2
    C1332051
    Has the patient been diagnosed with a new progression?
    Beskrivning

    Disease New Progression

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    NCI Thesaurus Property
    C25586
    NCI Thesaurus Property-2
    C25331
    NCI Thesaurus ObjectClass
    C2991
    UMLS CUI [1]
    C1335499
    Progressive Disease First Observed Date
    Beskrivning

    Progression First Observed Date

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C25331
    NCI Thesaurus Property
    C25509
    NCI Thesaurus Property-2
    C25599
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    UMLS CUI [1,1]
    C1335499
    UMLS CUI [1,2]
    C0011008
    Please indicate the site of progression
    Beskrivning

    Disease Progression Site

    Datatyp

    integer

    Alias
    NCI Thesaurus ValueDomain
    C13717
    NCI Thesaurus Property
    C25331
    NCI Thesaurus ObjectClass
    C2991
    UMLS CUI [1,1]
    C1515974
    UMLS CUI [1,2]
    C1335499
    Central Nervous System Progression
    Beskrivning

    Central Nervous System Progression

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    NCI Thesaurus Property
    C25331
    NCI Thesaurus ObjectClass
    C12438
    UMLS CUI [1,1]
    C0449389
    UMLS CUI [1,2]
    C1335499
    CNS - leptomeninges
    Beskrivning

    Leptomeninges CNS Involved

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    NCI Thesaurus ObjectClass
    C12438
    NCI Thesaurus Property
    C25547
    NCI Thesaurus ObjectClass-2
    C32979
    UMLS CUI [1]
    C0228126
    UMLS CUI [2,1]
    C0449389
    UMLS CUI [2,2]
    C1335499
    Brain - parenchymal
    Beskrivning

    Brain Parenchymal Involved

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    NCI Thesaurus ObjectClass
    C12439
    NCI Thesaurus Property
    C25547
    NCI Thesaurus Property-2
    C74601
    UMLS CUI [1,1]
    C0933845
    UMLS CUI [1,2]
    C0006104
    UMLS CUI [2,1]
    C0449389
    UMLS CUI [2,2]
    C1335499
    Comments
    Beskrivning

    Comments

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

    Research Comments

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393
    UMLS CUI [1,1]
    C0947611
    UMLS CUI [1,2]
    C1332051
    Tillbaka till toppen

    Similar models

    This form is to be updated at each response assessment time point defined in the protocol

    1 Formulär
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    Alias
    Item Group
    Extra Nodal Involvement Evaluation
    C0012634 (UMLS CUI-1)
    C1314939 (UMLS CUI-2)
    C0220825 (UMLS CUI-3)
    C1332051 (UMLS CUI-4)
    Follow-Up Date
    Item
    Date of Last Clinical Assessment
    date
    C9305 (NCI Thesaurus ObjectClass)
    C16033 (NCI Thesaurus Property)
    C25365 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    C1522577 (UMLS CUI [1,1])
    C0006826 (UMLS CUI [1,2])
    C0011008 (UMLS CUI [1,3])
    Item Group
    Complete Response
    C0006826 (UMLS CUI-1)
    C0677874 (UMLS CUI-2)
    C1332051 (UMLS CUI-3)
    Is complete response first observed
    Item
    Is complete response first observed
    boolean
    C25755 (NCI Thesaurus ObjectClass)
    C25250 (NCI Thesaurus ObjectClass-2)
    C25509 (NCI Thesaurus Property)
    C25599 (NCI Thesaurus Property-2)
    C38147 (NCI Thesaurus ValueDomain)
    C0006826 (UMLS CUI [1,1])
    C0677874 (UMLS CUI [1,2])
    Complete Response First Observed Date
    Item
    Complete Response
    date
    C25755 (NCI Thesaurus ObjectClass)
    C25250 (NCI Thesaurus ObjectClass-2)
    C25509 (NCI Thesaurus Property)
    C25599 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    C0006826 (UMLS CUI [1,1])
    C0677874 (UMLS CUI [1,2])
    C0011008 (UMLS CUI [1,3])
    Is complete response confirmed
    Item
    Is complete response confirmed
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C25755 (NCI Thesaurus ObjectClass)
    C25250 (NCI Thesaurus ObjectClass-2)
    C25458 (NCI Thesaurus Property)
    C0006826 (UMLS CUI [1,1])
    C0677874 (UMLS CUI [1,2])
    C0750484 (UMLS CUI [1,3])
    Complete Response Confirmed Date
    Item
    Complete Response Confirmed Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C25755 (NCI Thesaurus ObjectClass)
    C25250 (NCI Thesaurus ObjectClass-2)
    C25458 (NCI Thesaurus Property)
    C0006826 (UMLS CUI [1,1])
    C0677874 (UMLS CUI [1,2])
    C0750484 (UMLS CUI [1,3])
    C0011008 (UMLS CUI [1,4])
    Item Group
    Complete Response Unconfirmed
    C0006826 (UMLS CUI-1)
    C0677874 (UMLS CUI-2)
    C1332051 (UMLS CUI-3)
    Is complete response uncertain first observed
    Item
    Is complete response uncertain first observed
    boolean
    C25755 (NCI Thesaurus ObjectClass)
    C25250 (NCI Thesaurus ObjectClass-2)
    C47944 (NCI Thesaurus ObjectClass-3)
    C25509 (NCI Thesaurus Property)
    C25599 (NCI Thesaurus Property-2)
    C38147 (NCI Thesaurus ValueDomain)
    C0006826 (UMLS CUI [1,1])
    C0677874 (UMLS CUI [1,2])
    C0087130 (UMLS CUI [1,3])
    Complete Response uncertain (CRu) First Observed Date
    Item
    Complete Response uncertain (CRu) First Observed Date
    date
    C47944 (NCI Thesaurus ObjectClass)
    C0677874 (NCI Metathesaurus ObjectClass)
    C3211 (NCI Thesaurus Property)
    C25599 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    C0006826 (UMLS CUI [1,1])
    C0677874 (UMLS CUI [1,2])
    C0087130 (UMLS CUI [1,3])
    C0011008 (UMLS CUI [1,4])
    Is complete response, uncertain, confirmed
    Item
    Is complete response, uncertain, confirmed
    boolean
    C25755 (NCI Thesaurus ObjectClass)
    C25250 (NCI Thesaurus ObjectClass-2)
    C47944 (NCI Thesaurus ObjectClass-3)
    C25458 (NCI Thesaurus Property)
    C38147 (NCI Thesaurus ValueDomain)
    C0006826 (UMLS CUI [1,1])
    C0677874 (UMLS CUI [1,2])
    C0087130 (UMLS CUI [1,3])
    C0750484 (UMLS CUI [1,4])
    Complete Response Uncertain (CRu) Confirmed Date
    Item
    Complete Response Uncertain (CRu) Confirmed Date
    date
    C25755 (NCI Thesaurus ObjectClass)
    C25250 (NCI Thesaurus ObjectClass-2)
    C47944 (NCI Thesaurus ObjectClass-3)
    C25458 (NCI Thesaurus Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0006826 (UMLS CUI [1,1])
    C0677874 (UMLS CUI [1,2])
    C0087130 (UMLS CUI [1,3])
    C0750484 (UMLS CUI [1,4])
    C0011008 (UMLS CUI [1,5])
    Item Group
    Partial Response
    C1521726 (UMLS CUI-1)
    C1332051 (UMLS CUI-2)
    Is partial response first observed
    Item
    Is partial response first observed
    boolean
    C25755 (NCI Thesaurus ObjectClass)
    C25378 (NCI Thesaurus ObjectClass-2)
    C25509 (NCI Thesaurus Property)
    C25599 (NCI Thesaurus Property-2)
    C38147 (NCI Thesaurus ValueDomain)
    C1521726 (UMLS CUI [1])
    Partial Response First Observed Date
    Item
    Partial Response
    date
    C25755 (NCI Thesaurus ObjectClass)
    C25378 (NCI Thesaurus ObjectClass-2)
    C25509 (NCI Thesaurus Property)
    C25599 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    C1521726 (UMLS CUI [1,1])
    C0011008 (UMLS CUI [1,2])
    Is partial response confirmed
    Item
    Is partial response confirmed
    boolean
    C25755 (NCI Thesaurus ObjectClass)
    C25378 (NCI Thesaurus ObjectClass-2)
    C25458 (NCI Thesaurus Property)
    C38148 (NCI Thesaurus ValueDomain)
    C25755 (NCI Thesaurus ValueDomain-2)
    C1521726 (UMLS CUI [1,1])
    C0750484 (UMLS CUI [1,2])
    Partial Response Confirmed Date
    Item
    Partial Response Confirmed Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C25755 (NCI Thesaurus ObjectClass)
    C25458 (NCI Thesaurus Property)
    C25378 (NCI Thesaurus ObjectClass-2)
    C1521726 (UMLS CUI [1,1])
    C0750484 (UMLS CUI [1,2])
    C0011008 (UMLS CUI [1,3])
    Item Group
    Progressive Disease
    C1335499 (UMLS CUI-1)
    C1332051 (UMLS CUI-2)
    Disease New Progression
    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)
    C1335499 (UMLS CUI [1])
    Progression First Observed Date
    Item
    Progressive Disease First Observed Date
    date
    C25331 (NCI Thesaurus ObjectClass)
    C25509 (NCI Thesaurus Property)
    C25599 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    C1335499 (UMLS CUI [1,1])
    C0011008 (UMLS CUI [1,2])
    Item
    Please indicate the site of progression
    integer
    C13717 (NCI Thesaurus ValueDomain)
    C25331 (NCI Thesaurus Property)
    C2991 (NCI Thesaurus ObjectClass)
    C1515974 (UMLS CUI [1,1])
    C1335499 (UMLS CUI [1,2])
    CL.8
    Code List
    Please indicate the site of progression
    CL Item
    Original Site Only (1)
    CL Item
    New Site Only (2)
    CL Item
    New Site Plus Original Site (3)
    Central Nervous System Progression
    Item
    Central Nervous System Progression
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C25331 (NCI Thesaurus Property)
    C12438 (NCI Thesaurus ObjectClass)
    C0449389 (UMLS CUI [1,1])
    C1335499 (UMLS CUI [1,2])
    Leptomeninges CNS Involved
    Item
    CNS - leptomeninges
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C12438 (NCI Thesaurus ObjectClass)
    C25547 (NCI Thesaurus Property)
    C32979 (NCI Thesaurus ObjectClass-2)
    C0228126 (UMLS CUI [1])
    C0449389 (UMLS CUI [2,1])
    C1335499 (UMLS CUI [2,2])
    Brain Parenchymal Involved
    Item
    Brain - parenchymal
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C12439 (NCI Thesaurus ObjectClass)
    C25547 (NCI Thesaurus Property)
    C74601 (NCI Thesaurus Property-2)
    C0933845 (UMLS CUI [1,1])
    C0006104 (UMLS CUI [1,2])
    C0449389 (UMLS CUI [2,1])
    C1335499 (UMLS CUI [2,2])
    Item Group
    Comments
    C1332051 (UMLS CUI-1)
    C0947611 (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])
    Tillbaka till toppen 

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