ID

25174

Beskrivning

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

Länk

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 -
Uppladdad den

28 augusti 2017

DOI

För en begäran logga in.

Licens

Creative Commons BY-NC 3.0 Legacy
Modellkommentarer :

Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.

Tillbaka till modellkommentarer
Itemgroup-kommentar för :

Item-kommentar för :

Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.

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 

Kontakt

Använd detta formulär för feedback, frågor och förslag på förbättringar.

Fält markerade med * är obligatoriska.

Hjälp

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial