ID

26141

Beschrijving

AMC-075 Lymphoma Disease Activity and Measurement Form (L01) Vorinostat and Combination Chemotherapy With Rituximab in Treating Patients With Previously Untreated HIV-Related Diffuse Large B-Cell Non-Hodgkin Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9F166B5D-4C13-06F1-E040-BB89AD434FAE

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9F166B5D-4C13-06F1-E040-BB89AD434FAE

Trefwoorden

Versies (1)
  1. 09-10-17 09-10-17 -
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AIDS Malignancy Consortium

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9 oktober 2017

DOI

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Creative Commons BY-NC 3.0
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AMC-075 Lymphoma Disease Activity and Measurement Form (L01)

Engels

No Instruction available.

1 Formulieren  
  1. StudyEvent: AMC-075 Lymphoma Disease Activity and Measurement Form (L01)
    1. No Instruction available.
Header - Lymphoma Disease Activity and Measurement Form
Beschrijving

Header - Lymphoma Disease Activity and Measurement Form

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

Visit number

Datatype

integer

Alias
NCI Thesaurus ValueDomain
C25337
NCI Thesaurus ObjectClass
C16696
NCI Thesaurus Property
C25385
UMLS CUI [1]
C1549755
Reporting Period
Beschrijving

Reporting Period

Alias
UMLS CUI-1
C2347804
UMLS CUI-2
C1332051
Reporting Period
Beschrijving

Clinical Trial Period

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C25214
NCI Thesaurus Property
C25616
NCI Thesaurus ObjectClass-2
C25651
UMLS CUI-1
C2347804
Date of Evaluation
Beschrijving

Date of Evaluation

Datatype

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C3824
NCI Thesaurus Property
C20989
NCI Thesaurus ValueDomain-2
C25367
UMLS CUI [1,1]
C0220825
UMLS CUI [1,2]
C0011008
Nodal Involvement Evaluation
Beschrijving

Nodal Involvement Evaluation

Alias
UMLS CUI-1
C0441949
UMLS CUI-2
C0220825
UMLS CUI-3
C1332051
Is there lymph node involvement
Beschrijving

lymph node involvement

Datatype

boolean

Alias
NCI Thesaurus ValueDomain
C38148
NCI Thesaurus ObjectClass
C12745
NCI Thesaurus Property
C25547
UMLS CUI [1]
C0806692
Lymph Node Type
Beschrijving

LymphomaLymphNodeAnatomicSite

Datatype

text

Alias
NCI Thesaurus ObjectClass
C12745
NCI Thesaurus ObjectClass-2
C3208
NCI Thesaurus Property
C25341
NCI Thesaurus Property-2
C25421
NCI Thesaurus ValueDomain
C13717
UMLS CUI [1,1]
C0024204
UMLS CUI [1,2]
C0332307
UMLS CUI [1,3]
C1515974
Other specify
Beschrijving

LymphNodeAnatomicSiteSpecify

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25685
NCI Thesaurus Property
C25341
NCI Thesaurus ObjectClass
C12745
NCI Thesaurus Property-2
C25421
UMLS CUI [1,1]
C0024204
UMLS CUI [1,2]
C0332307
UMLS CUI [1,3]
C1515974
Dimension 1
Beschrijving

TumorLargestDimensionMeasurement (cm)

Datatype

float

Maateenheden
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus Property
C25550
NCI Thesaurus Property-2
C25483
UMLS CUI [1,1]
C0221198
UMLS CUI [1,2]
C0439534
cm
Dimension 2
Beschrijving

TumorSecondDimensionMeasurement (cm)

Datatype

float

Maateenheden
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
NCI Thesaurus ObjectClass
C3262
NCI Thesaurus Property
C25666
NCI Thesaurus Property-2
C25483
UMLS CUI [1,1]
C0221198
UMLS CUI [1,2]
C0439534
cm
Method of Evaluation
Beschrijving

Evaluation method

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C20989
NCI Thesaurus Property
C16847
UMLS CUI-1
C2911685
Other, specify
Beschrijving

Method of Evaluation

Datatype

text

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

PositronEmissionTomographyDiagnosticImagingAssessmentStatus (status for this visit)

Datatype

text

Alias
NCI Thesaurus Property
C20989
NCI Thesaurus ObjectClass
C17007
NCI Thesaurus ObjectClass-2
C16502
NCI Thesaurus ValueDomain
C25688
UMLS CUI [1]
C0032743
Extra Nodal Involvement Evaluation
Beschrijving

Extra Nodal Involvement Evaluation

Alias
UMLS CUI-1
C0012634
UMLS CUI-2
C1314939
UMLS CUI-3
C0220825
UMLS CUI-4
C1332051
Lesion completely resolved
Beschrijving

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

Datatype

boolean

Alias
NCI Thesaurus ValueDomain
C38148
NCI Thesaurus ObjectClass
C9305
NCI Thesaurus Property
C4870
NCI Thesaurus Property-2
C25599
UMLS CUI [1,1]
C0677874
UMLS CUI [1,2]
C0221198
Is measurable disease present?
Beschrijving

Measurable Disease

Datatype

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?
Beschrijving

Disease Progression

Datatype

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
Beschrijving

Evaluation

Datatype

boolean

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

Lesion Follow-Up Assessment Type

Datatype

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
Beschrijving

Comments

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

Research Comments

Datatype

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

No Instruction available.

1 Formulieren
  1. StudyEvent: AMC-075 Lymphoma Disease Activity and Measurement Form (L01)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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
Reporting Period
C2347804 (UMLS CUI-1)
C1332051 (UMLS CUI-2)
Item
Reporting Period
text
C25284 (NCI Thesaurus ValueDomain)
C25214 (NCI Thesaurus ObjectClass)
C25616 (NCI Thesaurus Property)
C25651 (NCI Thesaurus ObjectClass-2)
C2347804 (UMLS CUI-1)
CL.1
Code List
Reporting Period
CL Item
Baseline (Baseline)
C25213 (NCI Thesaurus)
C1442488 (UMLS 2011AA)
CL Item
On Treatment (On treatment)
CL Item
Follow-up (Follow-up)
C16033 (NCI Thesaurus)
C1522577 (UMLS 2011AA)
Date of Evaluation
Item
Date of Evaluation
date
C25164 (NCI Thesaurus ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
C0220825 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
Nodal Involvement Evaluation
C0441949 (UMLS CUI-1)
C0220825 (UMLS CUI-2)
C1332051 (UMLS CUI-3)
lymph node involvement
Item
Is there lymph node involvement
boolean
C38148 (NCI Thesaurus ValueDomain)
C12745 (NCI Thesaurus ObjectClass)
C25547 (NCI Thesaurus Property)
C0806692 (UMLS CUI [1])
Item
Lymph Node Type
text
C12745 (NCI Thesaurus ObjectClass)
C3208 (NCI Thesaurus ObjectClass-2)
C25341 (NCI Thesaurus Property)
C25421 (NCI Thesaurus Property-2)
C13717 (NCI Thesaurus ValueDomain)
C0024204 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C1515974 (UMLS CUI [1,3])
CL.3
Code List
Lymph Node Type
CL Item
Waldeyer's Ring (Waldeyer's Ring)
CL Item
Pre-auricular (Pre-Auricular)
CL Item
Cervical (Cervical)
C12844 (NCI Thesaurus)
C0205064 (UMLS 2011AA)
CL Item
Supraclavicular (Supraclavicular)
C25329 (NCI Thesaurus)
C0589496 (UMLS 2011AA)
CL Item
Infraclavicular/axillary/pectoral (Infraclavicular/Axiliary/Pectoral)
CL Item
Epitrochlear/brachial (Epitrochlear/Brachial)
CL Item
Hilar (Hilar)
C25724 (NCI Thesaurus)
C0205150 (UMLS 2011AA)
CL Item
Mediastinal (Mediastinal)
C25310 (NCI Thesaurus)
C1522718 (UMLS 2011AA)
CL Item
Porta Hepatis (Porta Hepatis)
C0227498 (NCI Metathesaurus)
CL Item
Splenic Hilar (Splenic Hilar)
CL Item
Celiac Axis/retrocrural/upper Para-aortic (Celiac Axis/Retrocrular/Upper Para-Aortic)
CL Item
Lower Para-aortic (Lower Para-Aortic)
CL Item
Mesenteric (Mesenteric)
C25226 (NCI Thesaurus)
C0025474 (UMLS 2011AA)
CL Item
Inguinal/femoral/iliac (inguinal/femoral/iliac)
CL Item
Other Nodal (Other Nodal)
CL Item
Spleen (Spleen)
C12432 (NCI Thesaurus)
C0037993 (UMLS 2011AA)
Lymph Node Type
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C25341 (NCI Thesaurus Property)
C12745 (NCI Thesaurus ObjectClass)
C25421 (NCI Thesaurus Property-2)
C0024204 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C1515974 (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)
C0221198 (UMLS CUI [1,1])
C0439534 (UMLS CUI [1,2])
Dimension 2
Item
Dimension 2
float
C25209 (NCI Thesaurus ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C25666 (NCI Thesaurus Property)
C25483 (NCI Thesaurus Property-2)
C0221198 (UMLS CUI [1,1])
C0439534 (UMLS CUI [1,2])
Item
Method of Evaluation
text
C25284 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C2911685 (UMLS CUI-1)
CL.4
Code List
Method of Evaluation
CL Item
Palpation (Palpation)
CL Item
X-ray (X-Ray)
C17262 (NCI Thesaurus)
C0017011 (UMLS 2011AA)
CL Item
Ct Scan (CT scan)
CL Item
Mri Scan (MRI scan)
CL Item
Ultrasound (Ultrasound)
C64384 (NCI Thesaurus)
C1456803 (UMLS 2011AA)
CL Item
Intravenous Pyelogram (IVP)
CL Item
Gallium Scan (Gallium scan)
C38087 (NCI Thesaurus)
C0521316 (UMLS 2011AA)
CL Item
Lymphangiogram (Lymphangiogram)
C16805 (NCI Thesaurus)
C0024219 (UMLS 2011AA)
CL Item
Bone Scan (Bone Scan)
C17646 (NCI Thesaurus)
C0203668 (UMLS 2011AA)
CL Item
Biopsy (Biopsy)
C15189 (NCI Thesaurus)
C0005558 (UMLS 2011AA)
C15189 (NCI Thesaurus-3)
C0005558 (UMLS 2011AA-4)
CL Item
Pet Scan (PET scan)
CL Item
Pet/ct Scan (PET/CT scan)
CL Item
Peripheral Blood Counts (Peripheral Blood Counts)
CL Item
Aspirate, Bone Marrow (Bone Marrow Aspirate)
C15644 (NCI Thesaurus)
C0398523 (UMLS 2011AA)
CL Item
Bone Marrow Biopsy (Bone Marrow Biopsy)
C15193 (NCI Thesaurus)
C0005954 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
Method of Evaluation
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C2911685 (UMLS CUI [1])
Item
PET scan
text
C20989 (NCI Thesaurus Property)
C17007 (NCI Thesaurus ObjectClass)
C16502 (NCI Thesaurus ObjectClass-2)
C25688 (NCI Thesaurus ValueDomain)
C0032743 (UMLS CUI [1])
CL.5
Code List
PET scan
CL Item
Positive Finding (Positive)
C38758 (NCI Thesaurus)
C1514241 (UMLS 2011AA)
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
Item Group
Extra Nodal Involvement Evaluation
C0012634 (UMLS CUI-1)
C1314939 (UMLS CUI-2)
C0220825 (UMLS CUI-3)
C1332051 (UMLS CUI-4)
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)
C0677874 (UMLS CUI [1,1])
C0221198 (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])
Disease 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)
C0242656 (UMLS CUI [1])
Evaluation
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.10
Code List
Lesion Assessment
CL Item
No Change (no change)
CL Item
Improvement (improvement)
CL Item
Progression - Increase (progression - increase)
CL Item
Not Evaluated (Not evaluated)
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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