ID

3196

Description

2455 Revision 2 - Selective Post-Transplant Essential Data Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9542E77F-E1CE-5D08-E040-BB89AD435C29

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9542E77F-E1CE-5D08-E040-BB89AD435C29

Keywords

Versions (1)
  1. 9/19/12 9/19/12 -
Uploaded on

September 19, 2012

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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Treatment - 2455 Revision 2 - Selective Post-Transplant Essential Data - 3160255v1.0

English

Note: "Greater than 100 Days Report" answer since last report

1 forms  
  1. StudyEvent: 2455 Revision 2 - Selective Post-Transplant Essential Data
    1. Note: "Greater than 100 Days Report" answer since last report
Registry Use Only
Description

Registry Use Only

Sequence number:
Description

ClinicalDataFormSequenceNumber

Data type

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C19464
UMLS 2011AA Property
C0376315
NCI Thesaurus ObjectClass
C15783
UMLS 2011AA ObjectClass
C1516606
NCI Thesaurus ValueDomain
C25673
UMLS 2011AA ValueDomain
C1519249
Date received:
Description

ClinicalDataFormReceivedDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C19464
UMLS 2011AA Property
C0376315
NCI Thesaurus ValueDomain
C25639
UMLS 2011AA ValueDomain
C1514756
NCI Thesaurus ObjectClass
C15783
UMLS 2011AA ObjectClass
C1516606
Center Identification
Description

Center Identification

CIBMTR Center Number:
Description

HematopoieticStemCellTransplantationRecipientInstitution::CenterforInternationalBloodandMarrowTransplantResearchFacilityNumber

Data type

double

Alias
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass
C15342
UMLS 2011AA ObjectClass
C0029216
NCI Thesaurus Property
C53268
UMLS 2011AA Property
C1709854
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain
C41206
UMLS 2011AA ValueDomain
C1272753
NCI Thesaurus ValueDomain
C62574
UMLS 2011AA ValueDomain
C1547538
EBMT Code (CIC) Number
Description

OrganizationalUnit::EBMT(CIC)CodeNumber

Data type

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus Property
C25162
UMLS 2011AA Property
C0805701
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C41167
UMLS 2011AA ObjectClass
C0029246
Date of this report:
Description

ClinicalDataFormTodayDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C19464
UMLS 2011AA Property
C0376315
NCI Thesaurus ObjectClass
C15783
UMLS 2011AA ObjectClass
C1516606
NCI Thesaurus ValueDomain
C41134
UMLS 2011AA ValueDomain
C0750526
Follow-Up:
Description

RecipientTransplantationFollow-upTimepointType

Data type

text

Alias
NCI Thesaurus ObjectClass
C53268
UMLS 2011AA ObjectClass
C1709854
NCI Thesaurus ObjectClass
C15342
UMLS 2011AA ObjectClass
C0029216
NCI Thesaurus Property
C16033
UMLS 2011AA Property
C1522577
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ValueDomain
C68568
UMLS 2011AA ValueDomain
C2348792
annual, specify year:
Description

Follow-upReportPostTransplantationTimepointYearCount

Data type

double

Alias
NCI Thesaurus ObjectClass
C16033
UMLS 2011AA ObjectClass
C1522577
NCI Thesaurus ObjectClass
C25375
UMLS 2011AA ObjectClass
C0684224
NCI Thesaurus Property
C38008
UMLS 2011AA Property
C0687676
NCI Thesaurus Property
C15342
UMLS 2011AA Property
C0029216
NCI Thesaurus Property
C68568
UMLS 2011AA Property
C2348792
NCI Thesaurus ValueDomain
C29848
UMLS 2011AA ValueDomain
C0439234
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Recipient Identification
Description

Recipient Identification

CIBMTR Recipient ID:
Description

HematopoieticStemCellTransplantationRecipientIdentificationNumber

Data type

double

Alias
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass
C15342
UMLS 2011AA ObjectClass
C0029216
NCI Thesaurus Property
C53268
UMLS 2011AA Property
C1709854
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain
C25737
UMLS 2011AA ValueDomain
C0205396
Chronological number of this: HSCT:
Description

HematopoieticStemCellTransplantationOccurrenceTherapeuticProcedureNumber

Data type

double

Alias
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass
C15342
UMLS 2011AA ObjectClass
C0029216
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain
C49236
UMLS 2011AA ValueDomain
C0087111
Chronological number of this: DCI:
Description

DonorCellularInfusionOccurrenceTherapeuticProcedureNumber

Data type

double

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain
C49236
UMLS 2011AA ValueDomain
C0087111
NCI Thesaurus ObjectClass
C77273
UMLS 2011AA ObjectClass
C2699799
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
Date of HSCT for this follow - up:
Description

HematopoieticStemCellTransplantationOccurrenceDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass
C15342
UMLS 2011AA ObjectClass
C0029216
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C15342
UMLS 2011AA ValueDomain
C0029216
Did the recipient receive a subsequent HSCT since the date of contact from the last report?
Description

RecipientReceivedNextHematopoieticStemCellTransplantationSinceDateLastReportIndicator

Data type

text

Alias
NCI Thesaurus ObjectClass
C53268
UMLS 2011AA ObjectClass
C1709854
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass
C15342
UMLS 2011AA ObjectClass
C0029216
NCI Thesaurus ObjectClass
C25639
UMLS 2011AA ObjectClass
C1514756
NCI Thesaurus ObjectClass
C53286
UMLS 2011AA ObjectClass
C0332282
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus Property
C25375
UMLS 2011AA Property
C0684224
NCI Thesaurus Property
C25551
UMLS 2011AA Property
C1517741
NCI Thesaurus Property
C45325
UMLS 2011AA Property
C1711239
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain
C49488
UMLS 2011AA ValueDomain
C1705108
NCI Thesaurus ValueDomain
C49487
UMLS 2011AA ValueDomain
C1298908
NCI Thesaurus ValueDomain
C48660
UMLS 2011AA ValueDomain
C1272460
NCI Thesaurus ValueDomain
C17998
UMLS 2011AA ValueDomain
C0439673
NCI Thesaurus ValueDomain
C49484
UMLS 2011AA ValueDomain
C1272696
Date of subsequent HSCT:
Description

NextHematopoieticStemCellTransplantationOccurrenceDate

Data type

date

Alias
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass
C15342
UMLS 2011AA ObjectClass
C0029216
NCI Thesaurus ObjectClass
C53286
UMLS 2011AA ObjectClass
C0332282
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
New Malignancy, Lymphoproliferative Or Myeloproliferative Disorder
Description

New Malignancy, Lymphoproliferative Or Myeloproliferative Disorder

Did a new malignancy occur?
Description

NewMalignantNeoplasmLymphoproliferativeMyelodysplastic/MyeloproliferativeDiseasesandDisordersDiagnosisIND

Data type

text

Alias
NCI Thesaurus ObjectClass
C25586
UMLS 2011AA ObjectClass
C0205314
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C9308
UMLS 2011AA ObjectClass
C0024314
NCI Thesaurus ObjectClass
C27262
UMLS 2011AA ObjectClass
C1301355
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain
C49488
UMLS 2011AA ValueDomain
C1705108
NCI Thesaurus ValueDomain
C49487
UMLS 2011AA ValueDomain
C1298908
NCI Thesaurus ValueDomain
C48660
UMLS 2011AA ValueDomain
C1272460
NCI Thesaurus ValueDomain
C17998
UMLS 2011AA ValueDomain
C0439673
NCI Thesaurus ValueDomain
C49484
UMLS 2011AA ValueDomain
C1272696
For all new malignancies except for "other skin malignancy (basal cell, squamous)," was testing performed to determine the cell of origin?
Description

LaboratoryProcedureDiscoverNewMalignantCellOriginPerformanceNewMalignantCellOriginIndicator

Data type

text

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C25586
UMLS 2011AA Property
C0205314
NCI Thesaurus Property
C42703
UMLS 2011AA Property
C0439659
NCI Thesaurus Property
C12917
UMLS 2011AA Property
C0334227
NCI Thesaurus Property
C62262
UMLS 2011AA Property
C1880355
NCI Thesaurus Property
C60778
UMLS 2011AA Property
C1882330
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain
C25586
UMLS 2011AA ValueDomain
C0205314
NCI Thesaurus ValueDomain
C42703
UMLS 2011AA ValueDomain
C0439659
NCI Thesaurus ValueDomain
C12917
UMLS 2011AA ValueDomain
C0334227
Specify the cell origin of the new malignancy:
Description

NewMalignantCellTypeNewMalignantCellOriginType

Data type

text

Alias
NCI Thesaurus ObjectClass
C25586
UMLS 2011AA ObjectClass
C0205314
NCI Thesaurus ObjectClass
C12917
UMLS 2011AA ObjectClass
C0334227
NCI Thesaurus Property
C25284
UMLS 2011AA Property
C0332307
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ValueDomain
C25586
UMLS 2011AA ValueDomain
C0205314
NCI Thesaurus ValueDomain
C42703
UMLS 2011AA ValueDomain
C0439659
NCI Thesaurus ValueDomain
C12917
UMLS 2011AA ValueDomain
C0334227
Is a copy of the lab report attached? (Is a copy of the cell origin evaluation VNTR, cytogenetics, FISH attached?)
Description

LaboratoryFindingReportInclusionYesorNoResponse

Data type

text

Alias
NCI Thesaurus ObjectClass
C25375
UMLS 2011AA ObjectClass
C0684224
NCI Thesaurus ObjectClass
C36292
UMLS 2011AA ObjectClass
C0587081
NCI Thesaurus Property
C25532
UMLS 2011AA Property
C1512693
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ValueDomain
C36292
UMLS 2011AA ValueDomain
C0587081
New Malignancy, Lymphoproliferative Or Myeloproliferative Disorder
Description

New Malignancy, Lymphoproliferative Or Myeloproliferative Disorder

Specify which new disease(s) occurred:
Description

NewMalignantNeoplasmLymphoproliferativeMyelodysplastic/MyeloproliferativeDiseasesandDisordersDiagnosisType

Data type

text

Alias
NCI Thesaurus ObjectClass
C25586
UMLS 2011AA ObjectClass
C0205314
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C9308
UMLS 2011AA ObjectClass
C0024314
NCI Thesaurus ObjectClass
C27262
UMLS 2011AA ObjectClass
C1301355
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ValueDomain
C9305
UMLS 2011AA ValueDomain
C0006826
Did a new malignancy occur?
Description

NewMalignantNeoplasmLymphoproliferativeMyelodysplastic/MyeloproliferativeDiseasesandDisordersDiagnosisIND

Data type

text

Alias
NCI Thesaurus ObjectClass
C25586
UMLS 2011AA ObjectClass
C0205314
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C9308
UMLS 2011AA ObjectClass
C0024314
NCI Thesaurus ObjectClass
C27262
UMLS 2011AA ObjectClass
C1301355
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain
C49488
UMLS 2011AA ValueDomain
C1705108
NCI Thesaurus ValueDomain
C49487
UMLS 2011AA ValueDomain
C1298908
NCI Thesaurus ValueDomain
C48660
UMLS 2011AA ValueDomain
C1272460
NCI Thesaurus ValueDomain
C17998
UMLS 2011AA ValueDomain
C0439673
NCI Thesaurus ValueDomain
C49484
UMLS 2011AA ValueDomain
C1272696
Date of diagnosis:
Description

DiagnosisPresentDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C15220
UMLS 2011AA ObjectClass
C0011900
Is the tumor EBV positive? (Answer only if the response to CDE 2677021 is "Lymphoma or lymphoproliferative disease.")
Description

LymphomaOrLymphoproliferativeDisorderEpstein-BarrVirusPositiveFindingIndicator

Data type

text

Alias
NCI Thesaurus ObjectClass
C14204
UMLS 2011AA ObjectClass
C0014644
NCI Thesaurus ObjectClass
C37998
UMLS 2011AA ObjectClass
C1518602
NCI Thesaurus ObjectClass
C9308
UMLS 2011AA ObjectClass
C0024314
NCI Thesaurus ObjectClass
C3208
UMLS 2011AA ObjectClass
C0024299
NCI Thesaurus Property
C38758
UMLS 2011AA Property
C1514241
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain
C49488
UMLS 2011AA ValueDomain
C1705108
NCI Thesaurus ValueDomain
C49487
UMLS 2011AA ValueDomain
C1298908
NCI Thesaurus ValueDomain
C48660
UMLS 2011AA ValueDomain
C1272460
NCI Thesaurus ValueDomain
C17998
UMLS 2011AA ValueDomain
C0439673
NCI Thesaurus ValueDomain
C49484
UMLS 2011AA ValueDomain
C1272696
Specify the new malignancy, lymphoproliferative or myeloproliferative disorder: (Answer only if the response to CDE 2677021 is "Other leukemia, including ALL," "Other skin malignancy basal cell, squamous," or "Other new malignancy.")
Description

NewMalignantNeoplasmLymphoproliferativeMyelodysplastic/MyeloproliferativeDiseasesandDisordersDiagnosisSpecifyText

Data type

text

Alias
NCI Thesaurus ObjectClass
C25586
UMLS 2011AA ObjectClass
C0205314
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C9308
UMLS 2011AA ObjectClass
C0024314
NCI Thesaurus ObjectClass
C27262
UMLS 2011AA ObjectClass
C1301355
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
New Malignancy, Lymphoproliferative Or Myeloproliferative Disorder ¿ Part 3 Of 3
Description

New Malignancy, Lymphoproliferative Or Myeloproliferative Disorder ¿ Part 3 Of 3

Is a copy of the pathology report attached? (Is a pathology / autopsy report or other documentation attached?)
Description

PathologyReportSubmissionYesNoCharacterIndicator

Data type

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus Property
C25375
UMLS 2011AA Property
C0684224
NCI Thesaurus ObjectClass
C18189
UMLS 2011AA ObjectClass
C0030664
NCI Thesaurus Property
C25695
UMLS 2011AA Property
C1515023
Survival
Description

Survival

Survival status at latest follow-up:
Description

RecipientLastFollow-upTimepointStatus

Data type

text

Alias
NCI Thesaurus ObjectClass
C53268
UMLS 2011AA ObjectClass
C1709854
NCI Thesaurus Property
C16033
UMLS 2011AA Property
C1522577
NCI Thesaurus Property
C68568
UMLS 2011AA Property
C2348792
NCI Thesaurus Property
C25551
UMLS 2011AA Property
C1517741
NCI Thesaurus Property
C25688
UMLS 2011AA Property
C0449438
NCI Thesaurus ValueDomain
C16033
UMLS 2011AA ValueDomain
C1522577
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Latest follow-up: (Last contact date:)
Description

LastFollow-upOccurrenceDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C16033
UMLS 2011AA ObjectClass
C1522577
NCI Thesaurus ObjectClass
C25551
UMLS 2011AA ObjectClass
C1517741
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
If necessary, please validate the last contact date response
Description

LastFollow-upOccurrenceDateValidationIndicator

Data type

text

Alias
NCI Thesaurus ObjectClass
C16033
UMLS 2011AA ObjectClass
C1522577
NCI Thesaurus ObjectClass
C25551
UMLS 2011AA ObjectClass
C1517741
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain
C16237
UMLS 2011AA ValueDomain
C1519941
Date of death:
Description

DeathOccurrenceDate

Data type

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C28554
UMLS 2011AA ObjectClass
C0011065
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
If necessary, please validate the death date response
Description

DeathOccurrenceDateValidationIndicator

Data type

text

Alias
NCI Thesaurus ObjectClass
C28554
UMLS 2011AA ObjectClass
C0011065
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain
C16237
UMLS 2011AA ValueDomain
C1519941
Main cause of death: (Check only one)
Description

DeathMainReasonType

Data type

text

Alias
NCI Thesaurus ObjectClass
C28554
UMLS 2011AA ObjectClass
C0011065
NCI Thesaurus Property
C25638
UMLS 2011AA Property
C0392360
NCI Thesaurus Property
C25562
UMLS 2011AA Property
C1542147
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
NCI Thesaurus ValueDomain
C28554
UMLS 2011AA ValueDomain
C0011065
Main cause of death: Other,specify (Specify other main cause of death:)
Description

MainReasonDeathOtherTypeDiagnosisSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C25638
UMLS 2011AA ObjectClass
C0392360
NCI Thesaurus ObjectClass
C28554
UMLS 2011AA ObjectClass
C0011065
NCI Thesaurus ObjectClass
C25562
UMLS 2011AA ObjectClass
C1542147
NCI Thesaurus Property
C25284
UMLS 2011AA Property
C0332307
NCI Thesaurus Property
C17649
UMLS 2011AA Property
C0205394
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Survival
Description

Survival

What are the HSCT related main cause(s) of death? (Check as many as appropriate)
Description

HematopoieticStemCellTransplantationRelationshipDeathMainReasonType

Data type

text

Alias
NCI Thesaurus ObjectClass
C25648
UMLS 2011AA ObjectClass
C0439849
NCI Thesaurus ObjectClass
C28554
UMLS 2011AA ObjectClass
C0011065
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass
C15342
UMLS 2011AA ObjectClass
C0029216
NCI Thesaurus Property
C25638
UMLS 2011AA Property
C0392360
NCI Thesaurus Property
C25562
UMLS 2011AA Property
C1542147
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
NCI Thesaurus ValueDomain
C25648
UMLS 2011AA ValueDomain
C0439849
NCI Thesaurus ValueDomain
C28554
UMLS 2011AA ValueDomain
C0011065
NCI Thesaurus ValueDomain
C12551
UMLS 2011AA ValueDomain
C0018956
NCI Thesaurus ValueDomain
C15342
UMLS 2011AA ValueDomain
C0029216
Did a particular HSCT-related main cause of death occur?
Description

HematopoieticStemCellTransplantationRelationshipDeathMainReasonIndicator

Data type

text

Alias
NCI Thesaurus ObjectClass
C25648
UMLS 2011AA ObjectClass
C0439849
NCI Thesaurus ObjectClass
C28554
UMLS 2011AA ObjectClass
C0011065
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass
C15342
UMLS 2011AA ObjectClass
C0029216
NCI Thesaurus Property
C25638
UMLS 2011AA Property
C0392360
NCI Thesaurus Property
C25562
UMLS 2011AA Property
C1542147
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ValueDomain
C49488
UMLS 2011AA ValueDomain
C1705108
NCI Thesaurus ValueDomain
C49487
UMLS 2011AA ValueDomain
C1298908
NCI Thesaurus ValueDomain
C48660
UMLS 2011AA ValueDomain
C1272460
NCI Thesaurus ValueDomain
C17998
UMLS 2011AA ValueDomain
C0439673
NCI Thesaurus ValueDomain
C49484
UMLS 2011AA ValueDomain
C1272696
Specify the other HSCT related main cause(s) of death: (Answer only if the response to CDE 2768637 is "Other.")
Description

HematopoieticStemCellTransplantationRelationshipDeathMainReasonDiagnosisSpecify

Data type

text

Alias
NCI Thesaurus ObjectClass
C25648
UMLS 2011AA ObjectClass
C0439849
NCI Thesaurus ObjectClass
C28554
UMLS 2011AA ObjectClass
C0011065
NCI Thesaurus ObjectClass
C12551
UMLS 2011AA ObjectClass
C0018956
NCI Thesaurus ObjectClass
C15342
UMLS 2011AA ObjectClass
C0029216
NCI Thesaurus Property
C25638
UMLS 2011AA Property
C0392360
NCI Thesaurus Property
C25562
UMLS 2011AA Property
C1542147
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Author Information
Description

Author Information

First Name
Description

PersonGiven/FirstName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property
C40974
UMLS 2011AA Property
C1443235
Last Name
Description

PersonFamily/LastName

Data type

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
NCI Thesaurus Property
C40975
UMLS 2011AA Property
C1301584
Telephone number:
Description

ContactPersonLocationTelephoneNumber

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C25461
UMLS 2011AA ObjectClass
C0337611
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain
C25395
UMLS 2011AA ValueDomain
C0039457
Fax number:
Description

ContactPersonLocationFaxNumber

Data type

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C25461
UMLS 2011AA ObjectClass
C0337611
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain
C25210
UMLS 2011AA ValueDomain
C0085205
E-mail address:
Description

PersonEmailAddressText

Data type

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C42775
UMLS 2011AA Property
C1705961
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Note: "Greater than 100 Days Report" answer since last report

1 forms
  1. StudyEvent: 2455 Revision 2 - Selective Post-Transplant Essential Data
    1. Note: "Greater than 100 Days Report" answer since last report
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Registry Use Only
ClinicalDataFormSequenceNumber
Item
Sequence number:
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C19464 (NCI Thesaurus Property)
C0376315 (UMLS 2011AA Property)
C15783 (NCI Thesaurus ObjectClass)
C1516606 (UMLS 2011AA ObjectClass)
C25673 (NCI Thesaurus ValueDomain)
C1519249 (UMLS 2011AA ValueDomain)
ClinicalDataFormReceivedDate
Item
Date received:
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C19464 (NCI Thesaurus Property)
C0376315 (UMLS 2011AA Property)
C25639 (NCI Thesaurus ValueDomain)
C1514756 (UMLS 2011AA ValueDomain)
C15783 (NCI Thesaurus ObjectClass)
C1516606 (UMLS 2011AA ObjectClass)
Item Group
Center Identification
HematopoieticStemCellTransplantationRecipientInstitution::CenterforInternationalBloodandMarrowTransplantResearchFacilityNumber
Item
CIBMTR Center Number:
double
C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass)
C0029216 (UMLS 2011AA ObjectClass)
C53268 (NCI Thesaurus Property)
C1709854 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C41206 (NCI Thesaurus ValueDomain)
C1272753 (UMLS 2011AA ValueDomain)
C62574 (NCI Thesaurus ValueDomain)
C1547538 (UMLS 2011AA ValueDomain)
OrganizationalUnit::EBMT(CIC)CodeNumber
Item
EBMT Code (CIC) Number
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25162 (NCI Thesaurus Property)
C0805701 (UMLS 2011AA Property)
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C41167 (NCI Thesaurus ObjectClass)
C0029246 (UMLS 2011AA ObjectClass)
ClinicalDataFormTodayDate
Item
Date of this report:
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C19464 (NCI Thesaurus Property)
C0376315 (UMLS 2011AA Property)
C15783 (NCI Thesaurus ObjectClass)
C1516606 (UMLS 2011AA ObjectClass)
C41134 (NCI Thesaurus ValueDomain)
C0750526 (UMLS 2011AA ValueDomain)
Item
Follow-Up:
text
C53268 (NCI Thesaurus ObjectClass)
C1709854 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass)
C0029216 (UMLS 2011AA ObjectClass)
C16033 (NCI Thesaurus Property)
C1522577 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C68568 (NCI Thesaurus ValueDomain)
C2348792 (UMLS 2011AA ValueDomain)
CL.1
Code List
Follow-Up:
CL Item
Integer::100 Day (Day 100)
C25301 (NCI Thesaurus)
C0439228 (UMLS 2011AA)
C45255 (NCI Thesaurus)
C1708523 (UMLS 2011AA)
CL Item
Integer::6 Month (6 Months)
C45255 (NCI Thesaurus)
C1708523 (UMLS 2011AA)
C29846 (NCI Thesaurus)
C0439231 (UMLS 2011AA)
CL Item
Annual (Annual)
C54647 (NCI Thesaurus)
C0332181 (UMLS 2011AA)
Follow-upReportPostTransplantationTimepointYearCount
Item
annual, specify year:
double
C16033 (NCI Thesaurus ObjectClass)
C1522577 (UMLS 2011AA ObjectClass)
C25375 (NCI Thesaurus ObjectClass)
C0684224 (UMLS 2011AA ObjectClass)
C38008 (NCI Thesaurus Property)
C0687676 (UMLS 2011AA Property)
C15342 (NCI Thesaurus Property)
C0029216 (UMLS 2011AA Property)
C68568 (NCI Thesaurus Property)
C2348792 (UMLS 2011AA Property)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
Item Group
Recipient Identification
HematopoieticStemCellTransplantationRecipientIdentificationNumber
Item
CIBMTR Recipient ID:
double
C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass)
C0029216 (UMLS 2011AA ObjectClass)
C53268 (NCI Thesaurus Property)
C1709854 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25737 (NCI Thesaurus ValueDomain)
C0205396 (UMLS 2011AA ValueDomain)
HematopoieticStemCellTransplantationOccurrenceTherapeuticProcedureNumber
Item
Chronological number of this: HSCT:
double
C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass)
C0029216 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C49236 (NCI Thesaurus ValueDomain)
C0087111 (UMLS 2011AA ValueDomain)
DonorCellularInfusionOccurrenceTherapeuticProcedureNumber
Item
Chronological number of this: DCI:
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C49236 (NCI Thesaurus ValueDomain)
C0087111 (UMLS 2011AA ValueDomain)
C77273 (NCI Thesaurus ObjectClass)
C2699799 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
HematopoieticStemCellTransplantationOccurrenceDate
Item
Date of HSCT for this follow - up:
date
C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass)
C0029216 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C15342 (NCI Thesaurus ValueDomain)
C0029216 (UMLS 2011AA ValueDomain)
Item
Did the recipient receive a subsequent HSCT since the date of contact from the last report?
text
C53268 (NCI Thesaurus ObjectClass)
C1709854 (UMLS 2011AA ObjectClass)
C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass)
C0029216 (UMLS 2011AA ObjectClass)
C25639 (NCI Thesaurus ObjectClass)
C1514756 (UMLS 2011AA ObjectClass)
C53286 (NCI Thesaurus ObjectClass)
C0332282 (UMLS 2011AA ObjectClass)
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25375 (NCI Thesaurus Property)
C0684224 (UMLS 2011AA Property)
C25551 (NCI Thesaurus Property)
C1517741 (UMLS 2011AA Property)
C45325 (NCI Thesaurus Property)
C1711239 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C49488 (NCI Thesaurus ValueDomain)
C1705108 (UMLS 2011AA ValueDomain)
C49487 (NCI Thesaurus ValueDomain)
C1298908 (UMLS 2011AA ValueDomain)
C48660 (NCI Thesaurus ValueDomain)
C1272460 (UMLS 2011AA ValueDomain)
C17998 (NCI Thesaurus ValueDomain)
C0439673 (UMLS 2011AA ValueDomain)
C49484 (NCI Thesaurus ValueDomain)
C1272696 (UMLS 2011AA ValueDomain)
CL.2
Code List
Did the recipient receive a subsequent HSCT since the date of contact from the last report?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
NextHematopoieticStemCellTransplantationOccurrenceDate
Item
Date of subsequent HSCT:
date
C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass)
C0029216 (UMLS 2011AA ObjectClass)
C53286 (NCI Thesaurus ObjectClass)
C0332282 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item Group
New Malignancy, Lymphoproliferative Or Myeloproliferative Disorder
Item
Did a new malignancy occur?
text
C25586 (NCI Thesaurus ObjectClass)
C0205314 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C9308 (NCI Thesaurus ObjectClass)
C0024314 (UMLS 2011AA ObjectClass)
C27262 (NCI Thesaurus ObjectClass)
C1301355 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C49488 (NCI Thesaurus ValueDomain)
C1705108 (UMLS 2011AA ValueDomain)
C49487 (NCI Thesaurus ValueDomain)
C1298908 (UMLS 2011AA ValueDomain)
C48660 (NCI Thesaurus ValueDomain)
C1272460 (UMLS 2011AA ValueDomain)
C17998 (NCI Thesaurus ValueDomain)
C0439673 (UMLS 2011AA ValueDomain)
C49484 (NCI Thesaurus ValueDomain)
C1272696 (UMLS 2011AA ValueDomain)
CL.8
Code List
Did a new malignancy occur?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item
For all new malignancies except for "other skin malignancy (basal cell, squamous)," was testing performed to determine the cell of origin?
text
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25586 (NCI Thesaurus Property)
C0205314 (UMLS 2011AA Property)
C42703 (NCI Thesaurus Property)
C0439659 (UMLS 2011AA Property)
C12917 (NCI Thesaurus Property)
C0334227 (UMLS 2011AA Property)
C62262 (NCI Thesaurus Property)
C1880355 (UMLS 2011AA Property)
C60778 (NCI Thesaurus Property)
C1882330 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C25586 (NCI Thesaurus ValueDomain)
C0205314 (UMLS 2011AA ValueDomain)
C42703 (NCI Thesaurus ValueDomain)
C0439659 (UMLS 2011AA ValueDomain)
C12917 (NCI Thesaurus ValueDomain)
C0334227 (UMLS 2011AA ValueDomain)
CL.4
Code List
For all new malignancies except for "other skin malignancy (basal cell, squamous)," was testing performed to determine the cell of origin?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Other Skin Malignant Neoplasm (The only new malignancy in this reporting period was "other skin malignancy(basal cell, squamous)")
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C12470 (NCI Thesaurus)
C1123023 (UMLS 2011AA)
C9305 (NCI Thesaurus)
C0006826 (UMLS 2011AA)
Item
Specify the cell origin of the new malignancy:
text
C25586 (NCI Thesaurus ObjectClass)
C0205314 (UMLS 2011AA ObjectClass)
C12917 (NCI Thesaurus ObjectClass)
C0334227 (UMLS 2011AA ObjectClass)
C25284 (NCI Thesaurus Property)
C0332307 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25586 (NCI Thesaurus ValueDomain)
C0205314 (UMLS 2011AA ValueDomain)
C42703 (NCI Thesaurus ValueDomain)
C0439659 (UMLS 2011AA ValueDomain)
C12917 (NCI Thesaurus ValueDomain)
C0334227 (UMLS 2011AA ValueDomain)
CL.5
Code List
Specify the cell origin of the new malignancy:
CL Item
Hematopoietic Stem Cell Graft Recipient (Recipient)
C53268 (NCI Thesaurus)
C1709854 (UMLS 2011AA)
C12551 (NCI Thesaurus)
C0018956 (UMLS 2011AA)
C12981 (NCI Thesaurus)
C0332835 (UMLS 2011AA)
CL Item
Donor (Donor)
C25168 (NCI Thesaurus)
C0040288 (UMLS 2011AA)
CL Item
Origin Unknown (Origin unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
C42703 (NCI Thesaurus)
C0439659 (UMLS 2011AA)
Item
Is a copy of the lab report attached? (Is a copy of the cell origin evaluation VNTR, cytogenetics, FISH attached?)
text
C25375 (NCI Thesaurus ObjectClass)
C0684224 (UMLS 2011AA ObjectClass)
C36292 (NCI Thesaurus ObjectClass)
C0587081 (UMLS 2011AA ObjectClass)
C25532 (NCI Thesaurus Property)
C1512693 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C36292 (NCI Thesaurus ValueDomain)
C0587081 (UMLS 2011AA ValueDomain)
CL.6
Code List
Is a copy of the lab report attached? (Is a copy of the cell origin evaluation VNTR, cytogenetics, FISH attached?)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
New Malignancy, Lymphoproliferative Or Myeloproliferative Disorder
Item
Specify which new disease(s) occurred:
text
C25586 (NCI Thesaurus ObjectClass)
C0205314 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C9308 (NCI Thesaurus ObjectClass)
C0024314 (UMLS 2011AA ObjectClass)
C27262 (NCI Thesaurus ObjectClass)
C1301355 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ValueDomain)
C0006826 (UMLS 2011AA ValueDomain)
CL.7
Code List
Specify which new disease(s) occurred:
CL Item
Acute Myeloid Leukemia (Acute myeloid leukemia (AML / ANLL))
C3171 (NCI Thesaurus)
C0023467 (UMLS 2011AA)
CL Item
Other Leukemia (Other leukemia including ALL)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C3161 (NCI Thesaurus)
C0023418 (UMLS 2011AA)
CL Item
Breast Carcinoma (Breast cancer)
C4872 (NCI Thesaurus)
C0678222 (UMLS 2011AA)
CL Item
Central Nervous System Neoplasm (Central nervous system (CNS) malignancy (glioblastoma, astrocytoma))
C9293 (NCI Thesaurus)
C0085136 (UMLS 2011AA)
CL Item
Clonality Cytogenetic Abnormality (Related by descent from clonal cytogenetic abnormality without leukemia or MDS)
C2950 (NCI Thesaurus)
C0008625 (UMLS 2011AA)
C18304 (NCI Thesaurus)
C1704387 (UMLS 2011AA)
CL Item
Malignant Gastrointestinal Neoplasm (Gastrointestinal malignancy (colon, rectum, stomach, pancreas, intestine))
C4890 (NCI Thesaurus)
C0685938 (UMLS 2011AA)
CL Item
Genitourinary System Malignant Neoplasm (Genitourinary malignancy (kidney, bladder, ovary, testicle, genitalia, uterus, cervix))
C9305 (NCI Thesaurus)
C0006826 (UMLS 2011AA)
C12810 (NCI Thesaurus)
C0042066 (UMLS 2011AA)
CL Item
Hodgkin's Lymphoma (Hodgkin disease)
C9357 (NCI Thesaurus)
C0019829 (UMLS 2011AA)
CL Item
Lung Carcinoma (Lung cancer)
C4878 (NCI Thesaurus)
C0684249 (UMLS 2011AA)
CL Item
Lymphoma Or Lymphoproliferative Disorder (Lymphoma or lymphoproliferative disease)
C37998 (NCI Thesaurus)
C1518602 (UMLS 2011AA)
C9308 (NCI Thesaurus)
C0024314 (UMLS 2011AA)
C3208 (NCI Thesaurus)
C0024299 (UMLS 2011AA)
CL Item
Melanoma (Melanoma)
C3224 (NCI Thesaurus)
C0025202 (UMLS 2011AA)
CL Item
Other Malignant Skin Neoplasm (Other skin malignancy (basal cell, squamous))
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C2920 (NCI Thesaurus)
C0007114 (UMLS 2011AA)
CL Item
Myelodysplastic/myeloproliferative Disease (Myelodysplasia (MDS), myeloproliferative (MPS) disorder)
C27262 (NCI Thesaurus)
C1301355 (UMLS 2011AA)
CL Item
Oropharyngeal Carcinoma (Oropharyngeal cancer (tongue, buccal mucosa))
C9105 (NCI Thesaurus)
C2349952 (UMLS 2011AA)
CL Item
Sarcoma (Sarcoma)
C9118 (NCI Thesaurus)
C1261473 (UMLS 2011AA)
CL Item
Thyroid Gland Carcinoma (Thyroid cancer)
C4815 (NCI Thesaurus)
C0549473 (UMLS 2011AA)
CL Item
Other Malignant Neoplasm (Other malignancy)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C9305 (NCI Thesaurus)
C0006826 (UMLS 2011AA)
Item
Did a new malignancy occur?
text
C25586 (NCI Thesaurus ObjectClass)
C0205314 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C9308 (NCI Thesaurus ObjectClass)
C0024314 (UMLS 2011AA ObjectClass)
C27262 (NCI Thesaurus ObjectClass)
C1301355 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C49488 (NCI Thesaurus ValueDomain)
C1705108 (UMLS 2011AA ValueDomain)
C49487 (NCI Thesaurus ValueDomain)
C1298908 (UMLS 2011AA ValueDomain)
C48660 (NCI Thesaurus ValueDomain)
C1272460 (UMLS 2011AA ValueDomain)
C17998 (NCI Thesaurus ValueDomain)
C0439673 (UMLS 2011AA ValueDomain)
C49484 (NCI Thesaurus ValueDomain)
C1272696 (UMLS 2011AA ValueDomain)
CL.8
Code List
Did a new malignancy occur?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
DiagnosisPresentDate
Item
Date of diagnosis:
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C15220 (NCI Thesaurus ObjectClass)
C0011900 (UMLS 2011AA ObjectClass)
Item
Is the tumor EBV positive? (Answer only if the response to CDE 2677021 is "Lymphoma or lymphoproliferative disease.")
text
C14204 (NCI Thesaurus ObjectClass)
C0014644 (UMLS 2011AA ObjectClass)
C37998 (NCI Thesaurus ObjectClass)
C1518602 (UMLS 2011AA ObjectClass)
C9308 (NCI Thesaurus ObjectClass)
C0024314 (UMLS 2011AA ObjectClass)
C3208 (NCI Thesaurus ObjectClass)
C0024299 (UMLS 2011AA ObjectClass)
C38758 (NCI Thesaurus Property)
C1514241 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C49488 (NCI Thesaurus ValueDomain)
C1705108 (UMLS 2011AA ValueDomain)
C49487 (NCI Thesaurus ValueDomain)
C1298908 (UMLS 2011AA ValueDomain)
C48660 (NCI Thesaurus ValueDomain)
C1272460 (UMLS 2011AA ValueDomain)
C17998 (NCI Thesaurus ValueDomain)
C0439673 (UMLS 2011AA ValueDomain)
C49484 (NCI Thesaurus ValueDomain)
C1272696 (UMLS 2011AA ValueDomain)
CL.9
Code List
Is the tumor EBV positive? (Answer only if the response to CDE 2677021 is "Lymphoma or lymphoproliferative disease.")
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
NewMalignantNeoplasmLymphoproliferativeMyelodysplastic/MyeloproliferativeDiseasesandDisordersDiagnosisSpecifyText
Item
Specify the new malignancy, lymphoproliferative or myeloproliferative disorder: (Answer only if the response to CDE 2677021 is "Other leukemia, including ALL," "Other skin malignancy basal cell, squamous," or "Other new malignancy.")
text
C25586 (NCI Thesaurus ObjectClass)
C0205314 (UMLS 2011AA ObjectClass)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C9308 (NCI Thesaurus ObjectClass)
C0024314 (UMLS 2011AA ObjectClass)
C27262 (NCI Thesaurus ObjectClass)
C1301355 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
Item Group
New Malignancy, Lymphoproliferative Or Myeloproliferative Disorder ¿ Part 3 Of 3
Item
Is a copy of the pathology report attached? (Is a pathology / autopsy report or other documentation attached?)
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C25375 (NCI Thesaurus Property)
C0684224 (UMLS 2011AA Property)
C18189 (NCI Thesaurus ObjectClass)
C0030664 (UMLS 2011AA ObjectClass)
C25695 (NCI Thesaurus Property)
C1515023 (UMLS 2011AA Property)
CL.10
Code List
Is a copy of the pathology report attached? (Is a pathology / autopsy report or other documentation attached?)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
Survival
Item
Survival status at latest follow-up:
text
C53268 (NCI Thesaurus ObjectClass)
C1709854 (UMLS 2011AA ObjectClass)
C16033 (NCI Thesaurus Property)
C1522577 (UMLS 2011AA Property)
C68568 (NCI Thesaurus Property)
C2348792 (UMLS 2011AA Property)
C25551 (NCI Thesaurus Property)
C1517741 (UMLS 2011AA Property)
C25688 (NCI Thesaurus Property)
C0449438 (UMLS 2011AA Property)
C16033 (NCI Thesaurus ValueDomain)
C1522577 (UMLS 2011AA ValueDomain)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.11
Code List
Survival status at latest follow-up:
CL Item
Life (Alive)
C37987 (NCI Thesaurus)
C0376558 (UMLS 2011AA)
CL Item
Death (Dead)
C28554 (NCI Thesaurus)
C0011065 (UMLS 2011AA)
LastFollow-upOccurrenceDate
Item
Latest follow-up: (Last contact date:)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C16033 (NCI Thesaurus ObjectClass)
C1522577 (UMLS 2011AA ObjectClass)
C25551 (NCI Thesaurus ObjectClass)
C1517741 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
Item
If necessary, please validate the last contact date response
text
C16033 (NCI Thesaurus ObjectClass)
C1522577 (UMLS 2011AA ObjectClass)
C25551 (NCI Thesaurus ObjectClass)
C1517741 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C16237 (NCI Thesaurus ValueDomain)
C1519941 (UMLS 2011AA ValueDomain)
CL.12
Code List
If necessary, please validate the last contact date response
CL Item
Date Estimate (Date estimated)
C25164 (NCI Thesaurus)
C0011008 (UMLS 2011AA)
C25498 (NCI Thesaurus)
C0750572 (UMLS 2011AA)
DeathOccurrenceDate
Item
Date of death:
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C28554 (NCI Thesaurus ObjectClass)
C0011065 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
Item
If necessary, please validate the death date response
text
C28554 (NCI Thesaurus ObjectClass)
C0011065 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C16237 (NCI Thesaurus ValueDomain)
C1519941 (UMLS 2011AA ValueDomain)
CL.13
Code List
If necessary, please validate the death date response
CL Item
Date Estimate (Date estimated)
C25164 (NCI Thesaurus)
C0011008 (UMLS 2011AA)
C25498 (NCI Thesaurus)
C0750572 (UMLS 2011AA)
Item
Main cause of death: (Check only one)
text
C28554 (NCI Thesaurus ObjectClass)
C0011065 (UMLS 2011AA ObjectClass)
C25638 (NCI Thesaurus Property)
C0392360 (UMLS 2011AA Property)
C25562 (NCI Thesaurus Property)
C1542147 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C28554 (NCI Thesaurus ValueDomain)
C0011065 (UMLS 2011AA ValueDomain)
CL.14
Code List
Main cause of death: (Check only one)
CL Item
And/or Persistent Recurrent Disease Disease Progression (Disease progression and/or persistent relapse)
C48928 (NCI Thesaurus)
C1706528 (UMLS 2011AA)
C38155 (NCI Thesaurus)
C0277556 (UMLS 2011AA)
C17747 (NCI Thesaurus)
C0242656 (UMLS 2011AA)
C43623 (NCI Thesaurus)
C0205322 (UMLS 2011AA)
CL Item
Transplantation Relationship Hematopoietic Stem Cell (HSCT related causes)
C25648 (NCI Thesaurus)
C0439849 (UMLS 2011AA)
C12551 (NCI Thesaurus)
C0018956 (UMLS 2011AA)
C15342 (NCI Thesaurus)
C0029216 (UMLS 2011AA)
CL Item
New Malignant Neoplasm (New malignancy)
C25586 (NCI Thesaurus)
C0205314 (UMLS 2011AA)
C9305 (NCI Thesaurus)
C0006826 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
MainReasonDeathOtherTypeDiagnosisSpecify
Item
Main cause of death: Other,specify (Specify other main cause of death:)
text
C25638 (NCI Thesaurus ObjectClass)
C0392360 (UMLS 2011AA ObjectClass)
C28554 (NCI Thesaurus ObjectClass)
C0011065 (UMLS 2011AA ObjectClass)
C25562 (NCI Thesaurus ObjectClass)
C1542147 (UMLS 2011AA ObjectClass)
C25284 (NCI Thesaurus Property)
C0332307 (UMLS 2011AA Property)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item Group
Survival
Item
What are the HSCT related main cause(s) of death? (Check as many as appropriate)
text
C25648 (NCI Thesaurus ObjectClass)
C0439849 (UMLS 2011AA ObjectClass)
C28554 (NCI Thesaurus ObjectClass)
C0011065 (UMLS 2011AA ObjectClass)
C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass)
C0029216 (UMLS 2011AA ObjectClass)
C25638 (NCI Thesaurus Property)
C0392360 (UMLS 2011AA Property)
C25562 (NCI Thesaurus Property)
C1542147 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C25648 (NCI Thesaurus ValueDomain)
C0439849 (UMLS 2011AA ValueDomain)
C28554 (NCI Thesaurus ValueDomain)
C0011065 (UMLS 2011AA ValueDomain)
C12551 (NCI Thesaurus ValueDomain)
C0018956 (UMLS 2011AA ValueDomain)
C15342 (NCI Thesaurus ValueDomain)
C0029216 (UMLS 2011AA ValueDomain)
CL.15
Code List
What are the HSCT related main cause(s) of death? (Check as many as appropriate)
CL Item
Graft Versus Host Disease (GVHD)
C3063 (NCI Thesaurus)
C0018133 (UMLS 2011AA)
CL Item
Cardiotoxicity (Cardiac toxicity)
C27994 (NCI Thesaurus)
C0876994 (UMLS 2011AA)
CL Item
Infection (Infection)
C26726 (NCI Thesaurus)
C0009450 (UMLS 2011AA)
CL Item
Toxicity Pulmonary (Pulmonary toxicity)
C13304 (NCI Thesaurus)
C2709248 (UMLS 2011AA)
C27990 (NCI Thesaurus)
C0600688 (UMLS 2011AA)
CL Item
Graft Rejection (Rejection / poor graft function)
C75570 (NCI Thesaurus)
C0018129 (UMLS 2011AA)
CL Item
Hepatic Veno-occlusive Disease (VOD)
C26793 (NCI Thesaurus)
C0019156 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
Item
Did a particular HSCT-related main cause of death occur?
text
C25648 (NCI Thesaurus ObjectClass)
C0439849 (UMLS 2011AA ObjectClass)
C28554 (NCI Thesaurus ObjectClass)
C0011065 (UMLS 2011AA ObjectClass)
C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass)
C0029216 (UMLS 2011AA ObjectClass)
C25638 (NCI Thesaurus Property)
C0392360 (UMLS 2011AA Property)
C25562 (NCI Thesaurus Property)
C1542147 (UMLS 2011AA Property)
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C49488 (NCI Thesaurus ValueDomain)
C1705108 (UMLS 2011AA ValueDomain)
C49487 (NCI Thesaurus ValueDomain)
C1298908 (UMLS 2011AA ValueDomain)
C48660 (NCI Thesaurus ValueDomain)
C1272460 (UMLS 2011AA ValueDomain)
C17998 (NCI Thesaurus ValueDomain)
C0439673 (UMLS 2011AA ValueDomain)
C49484 (NCI Thesaurus ValueDomain)
C1272696 (UMLS 2011AA ValueDomain)
CL.16
Code List
Did a particular HSCT-related main cause of death occur?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
HematopoieticStemCellTransplantationRelationshipDeathMainReasonDiagnosisSpecify
Item
Specify the other HSCT related main cause(s) of death: (Answer only if the response to CDE 2768637 is "Other.")
text
C25648 (NCI Thesaurus ObjectClass)
C0439849 (UMLS 2011AA ObjectClass)
C28554 (NCI Thesaurus ObjectClass)
C0011065 (UMLS 2011AA ObjectClass)
C12551 (NCI Thesaurus ObjectClass)
C0018956 (UMLS 2011AA ObjectClass)
C15342 (NCI Thesaurus ObjectClass)
C0029216 (UMLS 2011AA ObjectClass)
C25638 (NCI Thesaurus Property)
C0392360 (UMLS 2011AA Property)
C25562 (NCI Thesaurus Property)
C1542147 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item Group
Author Information
PersonGiven/FirstName
Item
First Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C40974 (NCI Thesaurus Property)
C1443235 (UMLS 2011AA Property)
PersonFamily/LastName
Item
Last Name
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C40975 (NCI Thesaurus Property)
C1301584 (UMLS 2011AA Property)
ContactPersonLocationTelephoneNumber
Item
Telephone number:
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus ObjectClass)
C0337611 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25395 (NCI Thesaurus ValueDomain)
C0039457 (UMLS 2011AA ValueDomain)
ContactPersonLocationFaxNumber
Item
Fax number:
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25461 (NCI Thesaurus ObjectClass)
C0337611 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C25210 (NCI Thesaurus ValueDomain)
C0085205 (UMLS 2011AA ValueDomain)
PersonEmailAddressText
Item
E-mail address:
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C42775 (NCI Thesaurus Property)
C1705961 (UMLS 2011AA Property)
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