ID

42022

Descripción

https://clinicaltrials.gov/show/NCT00989664 Patient Withdrawal from Study, Long Term Follow-Up for Survival & Disease Status and Notification of Patient Death Study ID: 104504 Clinical Study ID: BEX104504 Study Title: Multicenter, Pivotal Phase III Study of Iodine-131 Anti-B1 Antibody (Murine) Radioimmunotherapy for Chemotherapy Refractory Low Grade B Cell Lymphomas and Low Grade Lymphomas that have Transformed to Higher Grade Histologies Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00989664 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 2 Study Recruitment Status: Completed Generic Name: tositumomab Trade Name: Bexxar Study Indication: Lymphoma, Non-Hodgkin

Link

https://clinicaltrials.gov/show/NCT00989664

Palabras clave

Versiones (2)
  1. 25/5/18 25/5/18 -
  2. 15/3/21 15/3/21 - Dr. rer. medic Philipp Neuhaus
Titular de derechos de autor

GlaxoSmithKline (GSK)

Subido en

15 de marzo de 2021

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0
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Multicenter, Pivotal Phase III Study of Iodine-131 Anti-B1 Antibody (Murine) Radioimmunotherapy NCT00989664

Inglés

Patient Withdrawal from Study, Long Term Follow-Up for Survival & Disease Status and Notification of Patient Death

1 formularios  
Patient Withdrawal from Study
Descripción

Patient Withdrawal from Study

Alias
UMLS CUI-1
C0422727
Date of wlthdrawal from study
Descripción

Withdrawal date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0011008
Reason for withdrawal from study (check primary reason only)
Descripción

Reason for withdrawal from study

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0392360
UMLS CUI [1,3]
C0008976
Date of last contact
Descripción

Date of last contact

Tipo de datos

date

Alias
UMLS CUI [1]
C0805839
Explanation of withdrawal (when appropriate)
Descripción

Explanation of withdrawal

Tipo de datos

text

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0681841
Long Term Follow-Up for Survival & Disease Status
Descripción

Long Term Follow-Up for Survival & Disease Status

Alias
UMLS CUI-1
C1517942
Date of status
Descripción

Date of status

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0449437
Patient status:
Descripción

Patient status

Tipo de datos

integer

Alias
UMLS CUI [1]
C0449437
How was contact made:
Descripción

Way of contact

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1705415
UMLS CUI [1,2]
C0337611
Other way of contact
Descripción

Other way of contact

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1705415
UMLS CUI [1,2]
C0337611
Does the patient have an ongoing response to lodine-131 Tositumomab?
Descripción

(If yes, please complete Response Assessment Forms if applicable.)

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0768182
UMLS CUI [1,2]
C0521982
Has any additional therapy for NHL been administered?
Descripción

Since the time the last LTFU was completed, has any of the following occured: (If yes, specify below and provide applicable data)

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1706712
Has the patient had a documented diagnosis of myelodysplasia?
Descripción

Myelodysplasia

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0026985
If yes, date of diagnosis:
Descripción

(complete both AE & SAE CRFs)

Tipo de datos

date

Alias
UMLS CUI [1,1]
C2316983
UMLS CUI [1,2]
C0026985
Has the patient had a documented diagnosis of AML?
Descripción

AML

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0023467
If yes, date of diagnosis:
Descripción

(complete both AE & SAE CRFs)

Tipo de datos

date

Alias
UMLS CUI [1,1]
C2316983
UMLS CUI [1,2]
C0023467
Has the patient had a diagnosis of another malignancy?
Descripción

Other malignancy

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0006826
UMLS CUI [1,2]
C0205394
If yes, date of diagnosis:
Descripción

(complete both AE & SAE CRFs)

Tipo de datos

date

Alias
UMLS CUI [1,1]
C2316983
UMLS CUI [1,2]
C0006826
UMLS CUI [1,3]
C0205394
Type of malignancy:
Descripción

Type of malignancy

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0006826
UMLS CUI [1,2]
C0332307
Subsequent NHL Therapy since last LTFU
Descripción

Subsequent NHL Therapy since last LTFU

Alias
UMLS CUI-1
C2734539
UMLS CUI-2
C0008972
Subsequent NHL Therapy since last LTFU
Descripción

Subsequent NHL Therapy since last LTFU

Tipo de datos

text

Alias
UMLS CUI [1,1]
C2734539
UMLS CUI [1,2]
C0008972
Therapy Start date
Descripción

Therapy Start date

Tipo de datos

date

Alias
UMLS CUI [1]
C3173309
Therapy Stop Date
Descripción

Therapy Stop Date

Tipo de datos

date

Alias
UMLS CUI [1]
C1531784
Total # of Cycles
Descripción

Total # of Cycles

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0449788
UMLS CUI [1,2]
C1302181
Laboratory tests
Descripción

Laboratory tests

Alias
UMLS CUI-1
C0022885
TSH Date
Descripción

TSH Date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0040160
UMLS CUI [1,2]
C0011008
Result:
Descripción

TSH Result

Tipo de datos

float

Unidades de medida
  • 𝞵IU/mL
Alias
UMLS CUI [1,1]
C0202230
UMLS CUI [1,2]
C1274040
𝞵IU/mL
Has the patient begun thyroid replacement therapy since the last LTFU?
Descripción

Thyroid replacement therapy

Tipo de datos

boolean

Alias
UMLS CUI [1]
C2242640
If yes, start date:
Descripción

Therapy start date

Tipo de datos

date

Alias
UMLS CUI [1]
C3173309
Drug Name:
Descripción

Drug Name

Tipo de datos

text

Alias
UMLS CUI [1]
C0013227
Was a HAMA obtained since the last LTFU?
Descripción

HAMA

Tipo de datos

integer

Alias
UMLS CUI [1]
C1291910
If yes, enter accession #
Descripción

Accession #

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1510755
UMLS CUI [1,2]
C2826726
Administration
Descripción

Administration

Alias
UMLS CUI-1
C1320722
Investigator Signature:
Descripción

Investigator Signature

Tipo de datos

text

Alias
UMLS CUI [1]
C2346576
Date
Descripción

Date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0011008
Notification of death
Descripción

Notification of death

Alias
UMLS CUI-1
C0422202
UMLS CUI-2
C0007465
Cause of death (check one)
Descripción

If cause of death was related to complications of treatment, please describe or reference forms on which Information is recorded.

Tipo de datos

integer

Alias
UMLS CUI [1]
C0007465
Other Cause of Death:
Descripción

Other Cause of Death

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C1521902
Relationship of study drug to patient's death (check one)
Descripción

Relationship of study drug to patient's death

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0304229
Source of Information concerning death of patient
Descripción

Source of Information concerning death of patient

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0030705
UMLS CUI [1,2]
C0011065
UMLS CUI [1,3]
C0449416
Other Source of Information concerning death of patient
Descripción

Other Source

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0683836
UMLS CUI [1,2]
C0011065
UMLS CUI [1,3]
C0205394
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Similar models

Patient Withdrawal from Study, Long Term Follow-Up for Survival & Disease Status and Notification of Patient Death

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Patient Withdrawal from Study
C0422727 (UMLS CUI-1)
Withdrawal date
Item
Date of wlthdrawal from study
date
C2349954 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Reason for withdrawal from study (check primary reason only)
integer
C2349954 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C0008976 (UMLS CUI [1,3])
Reason for withdrawal from study
Code List
Reason for withdrawal from study (check primary reason only)
CL Item
Patient was lost to follow-up (explain below). (1)
CL Item
Patient wished to withdraw from study (explain below). (2)
CL Item
Patient received alternative therapy (explain below). (3)
CL Item
Patient had progressive disease. (4)
CL Item
Patient died (complete Form 39). (5)
CL Item
Other (specify) (6)
Date of last contact
Item
Date of last contact
date
C0805839 (UMLS CUI [1])
Explanation of withdrawal
Item
Explanation of withdrawal (when appropriate)
text
C2349954 (UMLS CUI [1,1])
C0681841 (UMLS CUI [1,2])
Item Group
Long Term Follow-Up for Survival & Disease Status
C1517942 (UMLS CUI-1)
Date of status
Item
Date of status
date
C0011008 (UMLS CUI [1,1])
C0449437 (UMLS CUI [1,2])
Item
Patient status:
integer
C0449437 (UMLS CUI [1])
Patient status
Code List
Patient status:
CL Item
Alive (1)
CL Item
Dead (complete "Notification of Patient Death" Form) (2)
CL Item
Lost to follow-up (3)
Item
How was contact made:
integer
C1705415 (UMLS CUI [1,1])
C0337611 (UMLS CUI [1,2])
Way of contact
Code List
How was contact made:
CL Item
Tumor registry (1)
CL Item
Contact with patient (2)
CL Item
Contact with MD (3)
CL Item
Contact with family (4)
CL Item
Other (5)
Other way of contact
Item
Other way of contact
text
C1705415 (UMLS CUI [1,1])
C0337611 (UMLS CUI [1,2])
Response to lodine-131 Tositumomab
Item
Does the patient have an ongoing response to lodine-131 Tositumomab?
boolean
C0768182 (UMLS CUI [1,1])
C0521982 (UMLS CUI [1,2])
Additional Therapy
Item
Has any additional therapy for NHL been administered?
boolean
C1706712 (UMLS CUI [1])
Myelodysplasia
Item
Has the patient had a documented diagnosis of myelodysplasia?
boolean
C0026985 (UMLS CUI [1])
Myelodysplasia diagnosis date
Item
If yes, date of diagnosis:
date
C2316983 (UMLS CUI [1,1])
C0026985 (UMLS CUI [1,2])
AML
Item
Has the patient had a documented diagnosis of AML?
boolean
C0023467 (UMLS CUI [1])
AML diagnosis date
Item
If yes, date of diagnosis:
date
C2316983 (UMLS CUI [1,1])
C0023467 (UMLS CUI [1,2])
Other malignancy
Item
Has the patient had a diagnosis of another malignancy?
boolean
C0006826 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Other malignancy diagnosis date
Item
If yes, date of diagnosis:
date
C2316983 (UMLS CUI [1,1])
C0006826 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Type of malignancy
Item
Type of malignancy:
text
C0006826 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Item Group
Subsequent NHL Therapy since last LTFU
C2734539 (UMLS CUI-1)
C0008972 (UMLS CUI-2)
Subsequent NHL Therapy since last LTFU
Item
Subsequent NHL Therapy since last LTFU
text
C2734539 (UMLS CUI [1,1])
C0008972 (UMLS CUI [1,2])
Therapy Start date
Item
Therapy Start date
date
C3173309 (UMLS CUI [1])
Therapy Stop Date
Item
Therapy Stop Date
date
C1531784 (UMLS CUI [1])
Total # of Cycles
Item
Total # of Cycles
integer
C0449788 (UMLS CUI [1,1])
C1302181 (UMLS CUI [1,2])
Item Group
Laboratory tests
C0022885 (UMLS CUI-1)
TSH Date
Item
TSH Date
date
C0040160 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
TSH Result
Item
Result:
float
C0202230 (UMLS CUI [1,1])
C1274040 (UMLS CUI [1,2])
Thyroid replacement therapy
Item
Has the patient begun thyroid replacement therapy since the last LTFU?
boolean
C2242640 (UMLS CUI [1])
Therapy start date
Item
If yes, start date:
date
C3173309 (UMLS CUI [1])
Drug Name
Item
Drug Name:
text
C0013227 (UMLS CUI [1])
Item
Was a HAMA obtained since the last LTFU?
integer
C1291910 (UMLS CUI [1])
HAMA
Code List
Was a HAMA obtained since the last LTFU?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not applicable (3)
Accession #
Item
If yes, enter accession #
integer
C1510755 (UMLS CUI [1,1])
C2826726 (UMLS CUI [1,2])
Item Group
Administration
C1320722 (UMLS CUI-1)
Investigator Signature
Item
Investigator Signature:
text
C2346576 (UMLS CUI [1])
Date
Item
Date
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
Notification of death
C0422202 (UMLS CUI-1)
C0007465 (UMLS CUI-2)
Item
Cause of death (check one)
integer
C0007465 (UMLS CUI [1])
Cause of death
Code List
Cause of death (check one)
CL Item
Progression of lymphoma (1)
CL Item
Complications related to drug (complete Adverse Experiences form) (2)
CL Item
Other (specify) (3)
Other Cause of Death
Item
Other Cause of Death:
text
C0007465 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
Item
Relationship of study drug to patient's death (check one)
integer
C0007465 (UMLS CUI [1,1])
C0304229 (UMLS CUI [1,2])
Relationship of study drug to patient's death
Code List
Relationship of study drug to patient's death (check one)
CL Item
None (1)
CL Item
Remote (2)
CL Item
Possible (3)
CL Item
Probable (4)
Item
Source of Information concerning death of patient
integer
C0030705 (UMLS CUI [1,1])
C0011065 (UMLS CUI [1,2])
C0449416 (UMLS CUI [1,3])
Source of Information concerning death of patient
Code List
Source of Information concerning death of patient
CL Item
Hospital physician (1)
CL Item
Patient's physician (2)
CL Item
Family (3)
CL Item
Newspaper (obituary) (4)
CL Item
Tumor registry (5)
CL Item
Other (specify) (6)
Other Source
Item
Other Source of Information concerning death of patient
text
C0683836 (UMLS CUI [1,1])
C0011065 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
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