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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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    Similar models

    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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