ID

3097

Description

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

Keywords

Versions (1)
  1. 9/19/12 9/19/12 -
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September 19, 2012

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Creative Commons BY-NC 3.0 Legacy
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NCT01193842 On-Study - AMC-075 Lymphoma Disease Activity and Measurement Form (L01) - 3206408v1.0

English

No Instruction available.

1 forms  
  1. StudyEvent: AMC-075 Lymphoma Disease Activity and Measurement Form (L01)
    1. No Instruction available.
Unnamed1
Description

Unnamed1

Visit Number
Description

HospitalAdmissionOrdinalNumber

Data type

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ObjectClass
C16696
UMLS 2011AA ObjectClass
C0019994
NCI Thesaurus Property
C25385
UMLS 2011AA Property
C0809949
Unnamed2
Description

Unnamed2

Reporting Period
Description

ReportingEvaluationPeriodType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C25214
UMLS 2011AA ObjectClass
C0220825
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
NCI Thesaurus ObjectClass
C25651
UMLS 2011AA ObjectClass
C0700287
Date of Evaluation (mm/dd/yyyy)
Description

LesionAssessmentDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ValueDomain
C25367
Nodal Involvement Evaluation
Description

Nodal Involvement Evaluation

Is there lymph node involvement (If Yes, continue. Otherwise, stop)
Description

LymphNodeInvolvementInd-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C12745
UMLS 2011AA ObjectClass
C0024204
NCI Thesaurus Property
C25547
Lymph Node Type
Description

LymphomaLymphNodeAnatomicSite

Data type

text

Alias
NCI Thesaurus ObjectClass
C12745
UMLS 2011AA ObjectClass
C0024204
NCI Thesaurus ObjectClass
C3208
UMLS 2011AA ObjectClass
C0024299
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus Property
C25421
UMLS 2011AA Property
C0002808
NCI Thesaurus ValueDomain
C13717
UMLS 2011AA ValueDomain
C1515974
Other specify
Description

LymphNodeAnatomicSiteSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus ObjectClass
C12745
UMLS 2011AA ObjectClass
C0024204
NCI Thesaurus Property
C25421
UMLS 2011AA Property
C0002808
Dimension 1 (cm)
Description

TumorLargestDimensionMeasurement

Data type

double

Measurement units
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25550
UMLS 2011AA Property
C0443228
NCI Thesaurus Property
C25483
UMLS 2011AA Property
C0439534
cm
Dimension 2 (cm)
Description

TumorSecondDimensionMeasurement

Data type

double

Measurement units
  • cm
Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
NCI Thesaurus ObjectClass
C3262
UMLS 2011AA ObjectClass
C0027651
NCI Thesaurus Property
C25666
UMLS 2011AA Property
C0205436
NCI Thesaurus Property
C25483
UMLS 2011AA Property
C0439534
cm
Method of Evaluation
Description

AssessmentMethodType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
Other, specify
Description

AssessmentMethodSpecify

Data type

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
PET scan (status for this visit)
Description

PositronEmissionTomographyDiagnosticImagingAssessmentStatus

Data type

text

Alias
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C17007
UMLS 2011AA ObjectClass
C0032743
NCI Thesaurus ObjectClass
C16502
UMLS 2011AA ObjectClass
C0011923
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Extra Nodal Involvement Evaluation
Description

Extra Nodal Involvement Evaluation

Lesion completely resolved (For "On treatment" and "Follow up" cycles only)
Description

MalignantNeoplasmCompleteRemissionObservedInd-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C4870
UMLS 2011AA Property
C0677874
NCI Thesaurus Property
C25599
UMLS 2011AA Property
C1441672
Is measurable disease present? (For "On treatment" and "Follow up" cycles only)
Description

MeasurableDiseasePresentInd-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C37894
UMLS 2011AA ObjectClass
C1513040
Has the patient been diagnosed with a new progression? (For "On treatment" and "Follow up" cycles only)
Description

DiseaseNewProgressionInd-2

Data type

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C25586
UMLS 2011AA Property
C0205314
NCI Thesaurus Property
C25331
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
Evaluation documented (For "On treatment" and "Follow up" cycles only)
Description

EvaluationPerformedInd-3

Data type

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C25214
UMLS 2011AA ObjectClass
C0220825
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
Lesion Assessment (For "On treatment" and "Follow up" cycles only)
Description

LesionFollow-UpAssessmentType

Data type

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
Comments
Description

Comments

Comments
Description

ResearchCommentsText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
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No Instruction available.

1 forms
  1. StudyEvent: AMC-075 Lymphoma Disease Activity and Measurement Form (L01)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Unnamed1
HospitalAdmissionOrdinalNumber
Item
Visit Number
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C0019994 (UMLS 2011AA ObjectClass)
C25385 (NCI Thesaurus Property)
C0809949 (UMLS 2011AA Property)
Item Group
Unnamed2
Item
Reporting Period
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus ObjectClass)
C0220825 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C25651 (NCI Thesaurus ObjectClass)
C0700287 (UMLS 2011AA ObjectClass)
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)
LesionAssessmentDate
Item
Date of Evaluation (mm/dd/yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)
Item Group
Nodal Involvement Evaluation
Item
Is there lymph node involvement (If Yes, continue. Otherwise, stop)
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25547 (NCI Thesaurus Property)
CL.2
Code List
Is there lymph node involvement (If Yes, continue. Otherwise, stop)
CL Item
No (NO)
CL Item
Yes (YES)
Item
Lymph Node Type
text
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C3208 (NCI Thesaurus ObjectClass)
C0024299 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25421 (NCI Thesaurus Property)
C0002808 (UMLS 2011AA Property)
C13717 (NCI Thesaurus ValueDomain)
C1515974 (UMLS 2011AA ValueDomain)
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)
LymphNodeAnatomicSiteSpecify
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C12745 (NCI Thesaurus ObjectClass)
C0024204 (UMLS 2011AA ObjectClass)
C25421 (NCI Thesaurus Property)
C0002808 (UMLS 2011AA Property)
TumorLargestDimensionMeasurement
Item
Dimension 1 (cm)
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25550 (NCI Thesaurus Property)
C0443228 (UMLS 2011AA Property)
C25483 (NCI Thesaurus Property)
C0439534 (UMLS 2011AA Property)
TumorSecondDimensionMeasurement
Item
Dimension 2 (cm)
double
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25666 (NCI Thesaurus Property)
C0205436 (UMLS 2011AA Property)
C25483 (NCI Thesaurus Property)
C0439534 (UMLS 2011AA Property)
Item
Method of Evaluation
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
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)
C0005558 (UMLS 2011AA)
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)
AssessmentMethodSpecify
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
Item
PET scan (status for this visit)
text
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C17007 (NCI Thesaurus ObjectClass)
C0032743 (UMLS 2011AA ObjectClass)
C16502 (NCI Thesaurus ObjectClass)
C0011923 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.5
Code List
PET scan (status for this visit)
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
Item
Lesion completely resolved (For "On treatment" and "Follow up" cycles only)
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C4870 (NCI Thesaurus Property)
C0677874 (UMLS 2011AA Property)
C25599 (NCI Thesaurus Property)
C1441672 (UMLS 2011AA Property)
CL.6
Code List
Lesion completely resolved (For "On treatment" and "Follow up" cycles only)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Is measurable disease present? (For "On treatment" and "Follow up" cycles only)
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C37894 (NCI Thesaurus ObjectClass)
C1513040 (UMLS 2011AA ObjectClass)
CL.7
Code List
Is measurable disease present? (For "On treatment" and "Follow up" cycles only)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Has the patient been diagnosed with a new progression? (For "On treatment" and "Follow up" cycles only)
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C25586 (NCI Thesaurus Property)
C0205314 (UMLS 2011AA Property)
C25331 (NCI Thesaurus Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
CL.8
Code List
Has the patient been diagnosed with a new progression? (For "On treatment" and "Follow up" cycles only)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Evaluation documented (For "On treatment" and "Follow up" cycles only)
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25214 (NCI Thesaurus ObjectClass)
C0220825 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
CL.9
Code List
Evaluation documented (For "On treatment" and "Follow up" cycles only)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
Lesion Assessment (For "On treatment" and "Follow up" cycles only)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
CL.10
Code List
Lesion Assessment (For "On treatment" and "Follow up" cycles only)
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
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
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