ID

42109

Description

Bacteria:S. pneumoniae, Other gram positive (i.e.: other streptococci, staphylococci, listeria …), Haemophilus influenzae, Other gram negative (i.e.: E. coli klebsiella, proteus, serratia, pseudomonas …), Legionella sp, Mycobacteria sp, Other Fungi: Candida sp, Aspergillus sp, Pneumocystis carinii, Other Parasites: Toxoplasma gondii, Other Viruses: HSV, VZV, EBV,CMV, HHV-6,RSV, Other respiratory virus (influenza, parainfluenza, rhinovirus), Adenovirus, HBV, HCV, HIV, Papovavirus, Parvovirus,Other

Keywords

Versions (2)
  1. 6/15/16 6/15/16 -
  2. 4/10/21 4/10/21 - Ahmed Rafee, MD
Copyright Holder

folgt

Uploaded on

April 10, 2021

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Creative Commons BY 4.0
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EBMT PLASMA CELL DISORDERS (INCLUDING MULTIPLE MYELOMA)

English

EBMT PLASMA CELL DISORDERS (INCLUDING MULTIPLE MYELOMA)

1 forms  
PLASMA CELL DISORDERS (INCLUDING MULTIPLE MYELOMA)
Description

PLASMA CELL DISORDERS (INCLUDING MULTIPLE MYELOMA)

Unique Identification Code (UIC) (if known)
Description

Unique Identification Code (UIC)

Data type

text

Alias
UMLS CUI [1]
C2348585
Hospital Unique Patient Number
Description

Hospital Unique Patient Number

Data type

text

Alias
UMLS CUI [1]
C2348585
Date of this report
Description

Date of this report

Data type

date

Alias
UMLS CUI [1]
C1302584
Patient following national / international study / trial
Description

Patient in Trial

Data type

integer

Alias
UMLS CUI [1]
C1997894
Name of study / trial
Description

Name of study / trial

Data type

text

Alias
UMLS CUI [1]
C0008976
First name(s)_surname(s)
Description

Initials

Data type

text

Alias
UMLS CUI [1]
C2986440
Date of Birth
Description

Date of Birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Date of last HSCT for this patient
Description

Date of last HSCT for this patient

Data type

date

Alias
UMLS CUI [1,1]
C0472699
UMLS CUI [1,2]
C0011008
PATIENT LAST SEEN
Description

PATIENT LAST SEEN

Alias
UMLS CUI-1
C0805839
Date of Last Contact or Death
Description

Date last contact

Data type

date

Alias
UMLS CUI [1]
C0805839
Complete haematological remission obtained after the HSCT in the absence of additional disease treatment
Description

Complete haematological remission obtained after the HSCT in the absence of additional disease treatment

Data type

integer

Alias
UMLS CUI [1]
C0677874
GRAFT VERSUS HOST DISEASE (GvHD) SINCE LAST REPORT
Description

GRAFT VERSUS HOST DISEASE (GvHD) SINCE LAST REPORT

Acute Graft versus Host Disease (aGvHD) - Grade
Description

aGvHD Grade

Data type

integer

Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C0441800
ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)
Description

If present

Data type

integer

Alias
UMLS CUI [1]
C0441799
aGvHD Reason
Description

aGvHD Reason

Data type

integer

Alias
UMLS CUI [1,1]
C0392360
UMLS CUI [1,2]
C0856825
Date onset of this episode (if new or recurrent)
Description

Date onset of this episode

Data type

date

Measurement units
  • yyyy/mm/dd
Alias
UMLS CUI [1]
C0574845
yyyy/mm/dd
aGvHD Stage liver
Description

aGvHD Stage liver

Data type

integer

Alias
UMLS CUI [1]
C1610054
aGvHD Stage skin
Description

aGvHD Stage skin

Data type

integer

Alias
UMLS CUI [1]
C1610605
aGvHD Resolution
Description

aGvHD Resolution

Data type

boolean

Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C1514893
aGvHD Date of resolution
Description

aGvHD Date of resolution

Data type

date

Measurement units
  • yyyy/mm/dd
Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C1514893
UMLS CUI [1,3]
C0011008
yyyy/mm/dd
Chronic Graft versus Host Disease (cGvHD)
Description

Chronic Graft versus Host Disease (cGvHD)

Data type

integer

Alias
UMLS CUI [1]
C0867389
Chronic Graft versus Host Disease (cGvHD)
Description

if yes...

Data type

integer

Date of onset
Description

Date of onset

Data type

date

Alias
UMLS CUI [1]
C0574845
If present continously since last report, specify cGvHD gade:
Description

cGvHD grade

Data type

text

Alias
UMLS CUI [1,1]
C0867389
UMLS CUI [1,2]
C0441799
cGvHD Organs affected
Description

cGvHD Organs affected

Data type

integer

Alias
UMLS CUI [1,1]
C0867389
UMLS CUI [1,2]
C2095124
If resolved, specify the date of resolution:
Description

Date of Resolution

Data type

date

Alias
UMLS CUI [1,1]
C1514893
UMLS CUI [1,2]
C0011008
OTHER COMPLICATIONS SINCE LAST REPORT
Description

OTHER COMPLICATIONS SINCE LAST REPORT

Infection related complications
Description

Infection related complications

Data type

boolean

Alias
UMLS CUI [1,1]
C0009450
UMLS CUI [1,2]
C0009566
Bacteremia / fungemia / viremia / parasites
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary. Date Provide different dates for different episodes of the same complication if applicable.

Data type

integer

Alias
UMLS CUI [1]
C0004610
UMLS CUI [2]
C0085082
UMLS CUI [3]
C0042749
UMLS CUI [4]
C0030498
Septic shock
Description

Date Provide different dates for different episodes of the same complication if applicable. Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.

Data type

integer

Alias
UMLS CUI [1]
C0036983
ARDS
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.

Data type

integer

Alias
UMLS CUI [1]
C0035222
Multiorgan failure due to infection
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary. Provide different dates for different episodes of the same complication if applicable.

Data type

integer

Alias
UMLS CUI [1]
C0026766
Pneumonia
Description

Provide different dates for different episodes of the same complication if applicable. Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.

Data type

integer

Alias
UMLS CUI [1]
C0032285
Hepatitis
Description

Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.

Data type

integer

Alias
UMLS CUI [1]
C0019158
CNS infection
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary. Provide different dates for different episodes of the same complication if applicable.

Data type

integer

Alias
UMLS CUI [1]
C0007684
Gut infection
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary. Date Provide different dates for different episodes of the same complication if applicable.

Data type

integer

Alias
UMLS CUI [1]
C0178238
Skin infection
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary. Date Provide different dates for different episodes of the same complication if applicable.

Data type

integer

Alias
UMLS CUI [1]
C0037278
Cystitis
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary. Date Provide different dates for different episodes of the same complication if applicable.

Data type

integer

Alias
UMLS CUI [1]
C0010692
Retinitis
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary. Date Provide different dates for different episodes of the same complication if applicable.

Data type

integer

Alias
UMLS CUI [1]
C0035333
Other
Description

Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary. Date Provide different dates for different episodes of the same complication if applicable.

Data type

integer

Alias
UMLS CUI [1]
C0205394
Non infection related complications
Description

Non infection related complications

Data type

boolean

Alias
UMLS CUI [1]
C0009566
Idiopathic pneumonia syndrome
Description

Idiopathic pneumonia syndrome

Data type

integer

Alias
UMLS CUI [1]
C1504431
VOD
Description

NON INFECTION RELATED COMPLICATIONS VOTCO100

Data type

text

Alias
UMLS CUI [1]
C0948441
Cataract
Description

NON INFECTION RELATED COMPLICATIONS VOTCO100

Data type

integer

Alias
UMLS CUI [1]
C0086543
Haemorrhagic cystitis, non infectious
Description

NON INFECTION RELATED COMPLICATIONS VOTCO100

Data type

integer

Alias
UMLS CUI [1]
C0085692
ARDS, non infectious
Description

Specify:

Data type

integer

Alias
UMLS CUI [1]
C0035222
Multiorgan failure, non infectious
Description

Multiorgan failure, non infectious

Data type

integer

HSCT-associated microangiopathy
Description

Specify:

Data type

integer

Alias
UMLS CUI [1]
C0155765
Renal failure requiring dialysis
Description

NON INFECTION RELATED COMPLICATIONS VOTCO100

Data type

integer

Alias
UMLS CUI [1]
C0035078
Haemolytic anaemia due to blood group
Description

NON INFECTION RELATED COMPLICATIONS VOTCO100

Data type

integer

Alias
UMLS CUI [1]
C0002878
Aseptic bone necrosis
Description

NON INFECTION RELATED COMPLICATIONS VOTCO100

Data type

integer

Alias
UMLS CUI [1]
C0158452
Other INFECTION RELATED COMPLICATIONS if other, please specify
Description

NON INFECTION RELATED COMPLICATIONS

Data type

integer

Alias
UMLS CUI [1]
C3714514
Graft loss
Description

Graft loss

Data type

integer

Alias
UMLS CUI [1]
C0877042
Overall Chimerism
Description

Overall Chimerism

Data type

integer

Alias
UMLS CUI [1]
C0333678
Identification of donor or Cord Blood Unit given by the centre
Description

Identification

Data type

text

Alias
UMLS CUI [1]
C1718162
Date of Test
Description

Date of Test

Data type

date

Alias
UMLS CUI [1,1]
C0024671
UMLS CUI [1,2]
C0011008
Number in the infusion order (if applicable)
Description

Number in the infusion order (if applicable)

Data type

integer

Alias
UMLS CUI [1]
C2348184
Cell type on which test was performed (% Donor Cells): BM
Description

Bone marrow

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C0005953
%
Cell type on which test was performed (% Donor cells): PB mononuclear cells (PBMC)
Description

PB mononuclear cells (PBMC)

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C1321301
%
Cell type on which test was performed (% Donor cells): T-Cells (Indicate the date(s) and results of all tests done for all donors. Split the results by donor and by the cell type on which the test was performed if applicable. Copy this table as many times as necessary.)
Description

T-Cells

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C0039194
%
Cell type on which test was performed (% Donor cells): B-Cells
Description

B-Cells

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C0004561
%
Cell type on which test was performed (% Donor cells): Red blood cells
Description

Red blood cells

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C0014772
%
Cell type on which test was performed (% Donor cells): Monocytes
Description

Monocytes

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C0026473
%
Cell type on which test was performed (% Donor cells): PMNs (neutrophils)
Description

PMNs (neutrophils)

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C0200633
%
Cell type on which test was performed (% Donor cells): Lymphocytes, NOS
Description

Lymphocytes, NOS

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C0024264
%
Cell type on which test was performed (% Donor cells): Myeloid cells, NOS
Description

Myeloid cells, NOS

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1]
C0887899
%
Cell type on which test was performed
Description

Other

Data type

text

SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
Description

SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED

Data type

integer

If yes, specify date of diagnosis
Description

Date of diagnosis

Data type

date

Alias
UMLS CUI [1]
C2316983
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
Description

Diagnosis

Data type

text

if other, please specify
Description

Diagnosis

Data type

text

ADDITIONAL THERAPIES SINCE LAST FOLLOW UP
Description

ADDITIONAL THERAPIES SINCE LAST FOLLOW UP

ADDITIONAL Therapy SINCE LAST FOLLOW UP
Description

ADDITIONAL Therapy SINCE LAST FOLLOW UP

Data type

text

Alias
UMLS CUI [1]
C1706712
Date ADDITIONAL THERAPIES SINCE LAST FOLLOW UP started
Description

Date started

Data type

date

Alias
UMLS CUI [1,1]
C1706712
UMLS CUI [1,2]
C0808070
If yes: Cellular therapy
Description

(One cell therapy regimen is defined as any number of infusions given within 10 weeks for the same indication. If more than one regimen of cell therapy has been given since last report, copy this section and complete it as many times as necessary.)

Data type

integer

Alias
UMLS CUI [1]
C0302189
if yes, Disease status before this cellular therapy
Description

if yes, Disease status before this cellular therapy

Data type

integer

Alias
UMLS CUI [1]
C0018759
If yes: Type of cells
Description

Type of cells

Data type

integer

Alias
UMLS CUI [1]
C0302189
Number of cells infused by type
Description

Number of cells infused by type

Data type

integer

Measurement units
  • 10^8/kg
Total number of cells infused (non DLI only)
Description

All cells

Data type

integer

Measurement units
  • x10^6/kg
Alias
UMLS CUI [1]
C0007584
Chronological number of this cell therapy for this patient
Description

Chronological number

Data type

float

Alias
UMLS CUI [1]
C2348184
Indication (check all that apply)
Description

(check all that apply)

Data type

integer

Alias
UMLS CUI [1,1]
C3146298
UMLS CUI [1,2]
C0302189
Number of Infusions (within 10 weeks) (count only infusions that are part of same regimen and given for the same indication)
Description

Number of Infusions

Data type

float

Alias
UMLS CUI [1,1]
C2348184
UMLS CUI [1,2]
C1289919
Acute Graft versus Host Disease
Description

Maximum grade:(after this infusion but before any further infusion/ transplant)

Data type

integer

Alias
UMLS CUI [1]
C0856825
Disease treatment (apart from donor cell infusion or other type of cell therapy)
Description

Disease treatment

Data type

integer

Alias
UMLS CUI [1]
C0087111
FIRST EVIDENCE OF RELAPSE OR PROGRESSION SINCE LAST HSCT
Description

FIRST EVIDENCE OF RELAPSE OR PROGRESSION SINCE LAST HSCT

Relapse or Progression
Description

Relapse or Progression

Data type

integer

Alias
UMLS CUI [1]
C0277556
UMLS CUI [2]
C0242656
If yes, date diagnosed RELAPSE OR PROGRESSION
Description

If yes, date diagnosed

Data type

date

Alias
UMLS CUI [1,1]
C0035020
UMLS CUI [1,2]
C2316983
LAST DISEASE AND PATIENT STATUS
Description

LAST DISEASE AND PATIENT STATUS

last disease status
Description

Last Disease Status

Data type

integer

Alias
UMLS CUI [1]
C0421168
Has patient or partner become pregnant after this HSCT?
Description

Conception

Data type

integer

Alias
UMLS CUI [1]
C0032961
Survival Status
Description

Survival Status

Data type

integer

Alias
UMLS CUI [1]
C1148433
If alive: Type of score used:
Description

If alive: Type of score used:

Data type

integer

Alias
UMLS CUI [1]
C1518965
Performance score
Description

Performance score

Data type

integer

Alias
UMLS CUI [1]
C1518965
CAUSE OF DEATH
Description

CAUSE OF DEATH

Data type

integer

Alias
UMLS CUI [1]
C0007465
HSCT related cause of death
Description

HSCT related cause of death

Data type

integer

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0472699
ADDITIONAL NOTES IF APPLICABLE
Description

ADDITIONAL NOTES IF APPLICABLE

Comments
Description

Comments

Data type

integer

Alias
UMLS CUI [1]
C0947611
IDENTIFICATION & SIGNATURE
Description

IDENTIFICATION & SIGNATURE

Data type

integer

Alias
UMLS CUI [1,1]
C0205396
UMLS CUI [1,2]
C1519316
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Similar models

EBMT PLASMA CELL DISORDERS (INCLUDING MULTIPLE MYELOMA)

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
PLASMA CELL DISORDERS (INCLUDING MULTIPLE MYELOMA)
Unique Identification Code (UIC)
Item
Unique Identification Code (UIC) (if known)
text
C2348585 (UMLS CUI [1])
Hospital Unique Patient Number
Item
Hospital Unique Patient Number
text
C2348585 (UMLS CUI [1])
Date of this report
Item
Date of this report
date
C1302584 (UMLS CUI [1])
Item
Patient following national / international study / trial
integer
C1997894 (UMLS CUI [1])
Patient in Trial
Code List
Patient following national / international study / trial
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Name of study / trial
Item
Name of study / trial
text
C0008976 (UMLS CUI [1])
Initials
Item
First name(s)_surname(s)
text
C2986440 (UMLS CUI [1])
Date of Birth
Item
Date of Birth
date
C0421451 (UMLS CUI [1])
Date of last HSCT for this patient
Item
Date of last HSCT for this patient
date
C0472699 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
PATIENT LAST SEEN
C0805839 (UMLS CUI-1)
Date last contact
Item
Date of Last Contact or Death
date
C0805839 (UMLS CUI [1])
Item
Complete haematological remission obtained after the HSCT in the absence of additional disease treatment
integer
C0677874 (UMLS CUI [1])
Complete haematological remission obtained after the HSCT in the absence of additional disease treatment
Code List
Complete haematological remission obtained after the HSCT in the absence of additional disease treatment
CL Item
Previously reported (1)
C0205309 (UMLS CUI-1)
CL Item
Yes, date (2)
C1705108 (UMLS CUI-1)
CL Item
No  (3)
C1298908 (UMLS CUI-1)
CL Item
Unknown (4)
C0439673 (UMLS CUI-1)
Item Group
GRAFT VERSUS HOST DISEASE (GvHD) SINCE LAST REPORT
Item
Acute Graft versus Host Disease (aGvHD) - Grade
integer
C0856825 (UMLS CUI [1,1])
C0441800 (UMLS CUI [1,2])
aGvHD Grade
Code List
Acute Graft versus Host Disease (aGvHD) - Grade
CL Item
grade 0 (Absent) (1)
CL Item
grade I (2)
CL Item
grade II (3)
CL Item
grade III (4)
CL Item
grade IV (5)
CL Item
Not evaluated (6)
Item
ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)
integer
C0441799 (UMLS CUI [1])
ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)
Code List
ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)
CL Item
New onset (New onset)
C0746890 (UMLS CUI-1)
CL Item
Recurrent (Recurrent)
C2945760 (UMLS CUI-1)
CL Item
Persistent (Persistent)
C0205322 (UMLS CUI-1)
Item
aGvHD Reason
integer
C0392360 (UMLS CUI [1,1])
C0856825 (UMLS CUI [1,2])
aGvHD Reason
Code List
aGvHD Reason
CL Item
Tapering (1)
C0441640 (UMLS CUI-1)
CL Item
DLI (2)
C1512034 (UMLS CUI-1)
CL Item
Unexplained (3)
C0439673 (UMLS CUI-1)
Date onset of this episode
Item
Date onset of this episode (if new or recurrent)
date
C0574845 (UMLS CUI [1])
Item
aGvHD Stage liver
integer
C1610054 (UMLS CUI [1])
Stage skin
Code List
aGvHD Stage liver
CL Item
None (0)
CL Item
Stage 1 (1)
CL Item
Stage 2 (2)
CL Item
Stage 3 (3)
CL Item
Stage 4 (4)
Item
aGvHD Stage skin
integer
C1610605 (UMLS CUI [1])
aGvHD Stage liver
Code List
aGvHD Stage skin
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
Not evaluated (6)
CL Item
unknown (7)
aGvHD Resolution
Item
aGvHD Resolution
boolean
C0856825 (UMLS CUI [1,1])
C1514893 (UMLS CUI [1,2])
aGvHD Date of resolution
Item
aGvHD Date of resolution
date
C0856825 (UMLS CUI [1,1])
C1514893 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item
Chronic Graft versus Host Disease (cGvHD)
integer
C0867389 (UMLS CUI [1])
Chronic Graft versus Host Disease (cGvHD)
Code List
Chronic Graft versus Host Disease (cGvHD)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Present continuously since last reported episode (Present continuously since last reported episode)
CL Item
Resolved (Resolved)
Item
Chronic Graft versus Host Disease (cGvHD)
integer
Presence of cGVHD
Code List
Chronic Graft versus Host Disease (cGvHD)
CL Item
First episode (1)
CL Item
Recurrence (2)
Date of onset
Item
Date of onset
date
C0574845 (UMLS CUI [1])
Item
If present continously since last report, specify cGvHD gade:
text
C0867389 (UMLS CUI [1,1])
C0441799 (UMLS CUI [1,2])
cGvHD grade
Code List
If present continously since last report, specify cGvHD gade:
CL Item
Limited (Limited)
C0439801 (UMLS CUI-1)
CL Item
Extensive (Extensive)
C0205231 (UMLS CUI-1)
Item
cGvHD Organs affected
integer
C0867389 (UMLS CUI [1,1])
C2095124 (UMLS CUI [1,2])
Organs affected
Code List
cGvHD Organs affected
CL Item
Skin (1)
C1123023 (UMLS CUI-1)
CL Item
Gut (2)
C0021853 (UMLS CUI-1)
CL Item
Liver (3)
C0023884 (UMLS CUI-1)
CL Item
Mouth (4)
C0230028 (UMLS CUI-1)
CL Item
Eyes (5)
C0015392 (UMLS CUI-1)
CL Item
Lung (6)
C0024109 (UMLS CUI-1)
CL Item
Other, specify (7)
C1299220 (UMLS CUI-1)
CL Item
Unknown (8)
C0439673 (UMLS CUI-1)
Date of Resolution
Item
If resolved, specify the date of resolution:
date
C1514893 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
OTHER COMPLICATIONS SINCE LAST REPORT
Infection related complications
Item
Infection related complications
boolean
C0009450 (UMLS CUI [1,1])
C0009566 (UMLS CUI [1,2])
Item
Bacteremia / fungemia / viremia / parasites
integer
C0004610 (UMLS CUI [1])
C0085082 (UMLS CUI [2])
C0042749 (UMLS CUI [3])
C0030498 (UMLS CUI [4])
Bacteremia / fungemia / viremia / parasites
Code List
Bacteremia / fungemia / viremia / parasites
CL Item
Pathogen (1)
CL Item
Date (2)
Item
Septic shock
integer
C0036983 (UMLS CUI [1])
Septic shock
Code List
Septic shock
CL Item
Pathogen (1)
CL Item
Date (2)
Item
integer
C0035222 (UMLS CUI [1])
ARDS
Code List
ARDS
CL Item
Date (1)
CL Item
Pathogen (2)
Item
Multiorgan failure due to infection
integer
C0026766 (UMLS CUI [1])
Multiorgan failure due to infection
Code List
Multiorgan failure due to infection
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
Date (2)
C0011008 (UMLS CUI-1)
Item
Pneumonia
integer
C0032285 (UMLS CUI [1])
Pneumonia
Code List
Pneumonia
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
Date (2)
C0011008 (UMLS CUI-1)
Item
Hepatitis
integer
C0019158 (UMLS CUI [1])
Hepatitis
Code List
Hepatitis
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
Date (2)
C0011008 (UMLS CUI-1)
Item
CNS infection
integer
C0007684 (UMLS CUI [1])
CNS infection
Code List
CNS infection
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
Date (2)
C0011008 (UMLS CUI-1)
Item
Gut infection
integer
C0178238 (UMLS CUI [1])
Gut infection
Code List
Gut infection
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
Date (2)
C0011008 (UMLS CUI-1)
Item
Skin infection
integer
C0037278 (UMLS CUI [1])
Skin infection
Code List
Skin infection
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
Date (2)
C0011008 (UMLS CUI-1)
Item
Cystitis
integer
C0010692 (UMLS CUI [1])
Cystitis
Code List
Cystitis
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
Date (2)
C0011008 (UMLS CUI-1)
Item
Retinitis
integer
C0035333 (UMLS CUI [1])
Retinitis
Code List
Retinitis
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
Date (2)
C0011008 (UMLS CUI-1)
CL Item
Unknown (3)
C0439673 (UMLS CUI-1)
Item
Other
integer
C0205394 (UMLS CUI [1])
Other
Code List
Other
CL Item
Pathogen (1)
C0450254 (UMLS CUI-1)
CL Item
Date (2)
C0011008 (UMLS CUI-1)
Non infection related complications
Item
Non infection related complications
boolean
C0009566 (UMLS CUI [1])
Item
Idiopathic pneumonia syndrome
integer
C1504431 (UMLS CUI [1])
Idiopathic pneumonia syndrome
Code List
Idiopathic pneumonia syndrome
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Date (4)
Item
VOD
text
C0948441 (UMLS CUI [1])
VOD
Code List
VOD
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Date (Date)
Item
Cataract
integer
C0086543 (UMLS CUI [1])
Cataract
Code List
Cataract
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Date (4)
Item
Haemorrhagic cystitis, non infectious
integer
C0085692 (UMLS CUI [1])
Haemorrhagic cystitis, non infectious
Code List
Haemorrhagic cystitis, non infectious
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Date (4)
Item
ARDS, non infectious
integer
C0035222 (UMLS CUI [1])
ARDS, non infectious
Code List
ARDS, non infectious
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Date (4)
Item
Multiorgan failure, non infectious
integer
Multiorgan failure, non infectious
Code List
Multiorgan failure, non infectious
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
HSCT-associated microangiopathy
integer
C0155765 (UMLS CUI [1])
HSCT-associated microangiopathy
Code List
HSCT-associated microangiopathy
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Date (4)
Item
Renal failure requiring dialysis
integer
C0035078 (UMLS CUI [1])
Renal failure requiring dialysis
Code List
Renal failure requiring dialysis
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Date (4)
Item
Haemolytic anaemia due to blood group
integer
C0002878 (UMLS CUI [1])
Haemolytic anaemia due to blood group
Code List
Haemolytic anaemia due to blood group
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Date (4)
Item
Aseptic bone necrosis
integer
C0158452 (UMLS CUI [1])
Aseptic bone necrosis
Code List
Aseptic bone necrosis
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Date (4)
Other INFECTION RELATED COMPLICATIONS
Item
Other INFECTION RELATED COMPLICATIONS if other, please specify
integer
C3714514 (UMLS CUI [1])
Item
Graft loss
integer
C0877042 (UMLS CUI [1])
GRAFT ASSESSMENT AND HAEMOPOIETIC CHIMAERISM
Code List
Graft loss
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
Item
Overall Chimerism
integer
C0333678 (UMLS CUI [1])
Overall chimaerism
Code List
Overall Chimerism
CL Item
Full (donor > 95%) (1)
C0333678 (UMLS CUI-1)
CL Item
Mixed (partial) (2)
C3160715 (UMLS CUI-1)
CL Item
Autologuos reconstitution (recipient > 95%) (3)
C0301944 (UMLS CUI-1)
CL Item
Aplasia (4)
C0243065 (UMLS CUI-1)
CL Item
Not evaluated (5)
C3846720 (UMLS CUI-1)
Identification
Item
Identification of donor or Cord Blood Unit given by the centre
text
C1718162 (UMLS CUI [1])
Date of Test
Item
Date of Test
date
C0024671 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Number in the infusion order (if applicable)
integer
C2348184 (UMLS CUI [1])
Number in the infusion order (if applicable)
Code List
Number in the infusion order (if applicable)
CL Item
......... (1)
CL Item
N/A (2)
Bone marrow
Item
Cell type on which test was performed (% Donor Cells): BM
float
C0005953 (UMLS CUI [1])
PB mononuclear cells (PBMC)
Item
Cell type on which test was performed (% Donor cells): PB mononuclear cells (PBMC)
float
C1321301 (UMLS CUI [1])
T-Cells
Item
Cell type on which test was performed (% Donor cells): T-Cells (Indicate the date(s) and results of all tests done for all donors. Split the results by donor and by the cell type on which the test was performed if applicable. Copy this table as many times as necessary.)
float
C0039194 (UMLS CUI [1])
B-Cells
Item
Cell type on which test was performed (% Donor cells): B-Cells
float
C0004561 (UMLS CUI [1])
Red blood cells
Item
Cell type on which test was performed (% Donor cells): Red blood cells
float
C0014772 (UMLS CUI [1])
Monocytes
Item
Cell type on which test was performed (% Donor cells): Monocytes
float
C0026473 (UMLS CUI [1])
PMNs (neutrophils)
Item
Cell type on which test was performed (% Donor cells): PMNs (neutrophils)
float
C0200633 (UMLS CUI [1])
Lymphocytes, NOS
Item
Cell type on which test was performed (% Donor cells): Lymphocytes, NOS
float
C0024264 (UMLS CUI [1])
Myeloid cells, NOS
Item
Cell type on which test was performed (% Donor cells): Myeloid cells, NOS
float
C0887899 (UMLS CUI [1])
Other
Item
Cell type on which test was performed
text
Item
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
integer
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
Code List
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
CL Item
Previously reported (Previously reported)
CL Item
Yes (Yes)
CL Item
No at date of this follow-up (No at date of this follow-up)
Date of diagnosis
Item
If yes, specify date of diagnosis
date
C2316983 (UMLS CUI [1])
Item
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
text
Diagnosis
Code List
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
CL Item
AML (AML)
CL Item
MDS (MDS)
CL Item
Lymphoproliferative disorder (Lymphoproliferative disorder)
CL Item
Other (Other)
Diagnosis
Item
if other, please specify
text
Item Group
ADDITIONAL THERAPIES SINCE LAST FOLLOW UP
Item
ADDITIONAL Therapy SINCE LAST FOLLOW UP
text
C1706712 (UMLS CUI [1])
ADDITIONAL THERAPIES SINCE LAST FOLLOW UP
Code List
ADDITIONAL Therapy SINCE LAST FOLLOW UP
CL Item
No (No)
CL Item
Yes, date started (Yes, date started)
CL Item
Unknown (Unknown)
Date started
Item
Date ADDITIONAL THERAPIES SINCE LAST FOLLOW UP started
date
C1706712 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Item
If yes: Cellular therapy
integer
C0302189 (UMLS CUI [1])
Cellular therapy
Code List
If yes: Cellular therapy
CL Item
No  (1)
CL Item
Yes (Mark disease status before this cellular therapy) (2)
CL Item
Unknown (3)
Item
if yes, Disease status before this cellular therapy
integer
C0018759 (UMLS CUI [1])
CELLULAR THERAPY
Code List
if yes, Disease status before this cellular therapy
CL Item
CR (CR)
C0677874 (UMLS CUI-1)
CL Item
Not in CR (Not in CR)
C0677874 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated)
C3846720 (UMLS CUI-1)
Item
If yes: Type of cells
integer
C0302189 (UMLS CUI [1])
Type of cells
Code List
If yes: Type of cells
CL Item
Donor lymphocyte infusion (DLI) (1)
C1512034 (UMLS CUI-1)
CL Item
Mesenchymal cells (2)
C1257975 (UMLS CUI-1)
CL Item
Other (3)
C0205394 (UMLS CUI-1)
CL Item
Unknown (4)
C0439673 (UMLS CUI-1)
Item
Number of cells infused by type
integer
Nucleated cells
Code List
Number of cells infused by type
CL Item
Number of Nucleated cells infused (DLI only) (1)
C1180059 (UMLS CUI-1)
CL Item
CD 34+ (cells/kg*) (DLI only) (2)
C1955216 (UMLS CUI-1)
CL Item
CD 3+ (cells/kg*) (DLI only) (3)
C0483189 (UMLS CUI-1)
Item
Total number of cells infused (non DLI only)
integer
C0007584 (UMLS CUI [1])
All cells
Code List
Total number of cells infused (non DLI only)
CL Item
Number (1)
CL Item
Not evaluated (2)
CL Item
Unknown (3)
Chronological number
Item
Chronological number of this cell therapy for this patient
float
C2348184 (UMLS CUI [1])
Item
Indication (check all that apply)
integer
C3146298 (UMLS CUI [1,1])
C0302189 (UMLS CUI [1,2])
Indication
Code List
Indication (check all that apply)
CL Item
Planned/ protocol (Planned/ protocol)
CL Item
Treatment for disease (Treatment for disease)
CL Item
Prophylactic (Prophylactic)
CL Item
Mixed chimaerism (Mixed chimaerism)
CL Item
Treatment of GvHD (Treatment of GvHD)
CL Item
Treatment viral infection (Treatment viral infection)
CL Item
Loss/decreased chimaerism (Loss/decreased chimaerism)
CL Item
Treatment PTLD, EBV, lymphoma (Treatment PTLD, EBV, lymphoma)
CL Item
Other (Other)
Number of Infusions
Item
Number of Infusions (within 10 weeks) (count only infusions that are part of same regimen and given for the same indication)
float
C2348184 (UMLS CUI [1,1])
C1289919 (UMLS CUI [1,2])
Item
Acute Graft versus Host Disease
integer
C0856825 (UMLS CUI [1])
Acute Graft versus Host Disease
Code List
Acute Graft versus Host Disease
CL Item
grade 0 (absent) (grade 0 (absent))
CL Item
grade 1 (grade 1)
CL Item
grade 2 (grade 2)
CL Item
grade 3 (grade 3)
CL Item
grade 4 (grade 4)
CL Item
present, grade unknown (present, grade unknown)
Item
Disease treatment (apart from donor cell infusion or other type of cell therapy)
integer
C0087111 (UMLS CUI [1])
Disease treatment
Code List
Disease treatment (apart from donor cell infusion or other type of cell therapy)
CL Item
No (1)
CL Item
Yes: Planned (planned before HSCT took place) (2)
CL Item
Yes: Not planned (for relapse/progression or persistent disease) (3)
Item Group
FIRST EVIDENCE OF RELAPSE OR PROGRESSION SINCE LAST HSCT
Item
Relapse or Progression
integer
C0277556 (UMLS CUI [1])
C0242656 (UMLS CUI [2])
Relapse or Progression
Code List
Relapse or Progression
CL Item
Previously reported (Previously reported)
C0205309 (UMLS CUI-1)
CL Item
No (No)
C1298908 (UMLS CUI-1)
CL Item
Yes (Yes)
C1705108 (UMLS CUI-1)
CL Item
Continous progression since transplant (Continous progression since transplant)
C0242656 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
If yes, date diagnosed
Item
If yes, date diagnosed RELAPSE OR PROGRESSION
date
C0035020 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item Group
LAST DISEASE AND PATIENT STATUS
Item
last disease status
integer
C0421168 (UMLS CUI [1])
Disease response
Code List
last disease status
CL Item
Complete Remission (Complete Remission)
C0677874 (UMLS CUI-1)
CL Item
Stable disease (Stable disease)
C0677946 (UMLS CUI-1)
CL Item
Relapse (Relapse)
C0277556 (UMLS CUI-1)
CL Item
Treatment failure/ progression (Treatment failure/ progression)
C0242656 (UMLS CUI-1)
Item
Has patient or partner become pregnant after this HSCT?
integer
C0032961 (UMLS CUI [1])
Conception
Code List
Has patient or partner become pregnant after this HSCT?
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Item
Survival Status
integer
C1148433 (UMLS CUI [1])
Survival Status
Code List
Survival Status
CL Item
alive (0)
CL Item
dead (1)
Item
If alive: Type of score used:
integer
C1518965 (UMLS CUI [1])
Performance Score
Code List
If alive: Type of score used:
CL Item
Karnofsky (Karnofsky)
CL Item
Lansky (Lansky)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item
Performance score
integer
C1518965 (UMLS CUI [1])
Performance score
Code List
Performance score
CL Item
100 (Normal, NED) (1)
CL Item
90 (Normal activity)  (2)
CL Item
80 (Normal with effort) (3)
CL Item
70 (Cares for self) (4)
CL Item
60 (Requires occasional assistance) (5)
CL Item
50 (Requires assistance) (6)
CL Item
40 (Disabled) (7)
CL Item
30 (Severely disabled) (8)
CL Item
20 (Very sick) (9)
CL Item
10 (Moribund) (10)
CL Item
Not evaluated (11)
CL Item
Unknown (12)
Item
CAUSE OF DEATH
integer
C0007465 (UMLS CUI [1])
CAUSE OF DEATH
Code List
CAUSE OF DEATH
CL Item
Relapse or progression (Relapse or progression)
C0277556 (UMLS CUI-1)
C0242656 (UMLS CUI-2)
CL Item
Secondary malignancy (Secondary malignancy)
C3266877 (UMLS CUI-1)
CL Item
HSCT related cause (HSCT related cause)
C0472699 (UMLS CUI-1)
C0007465 (UMLS CUI-2)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
CL Item
Other (Other)
C0205394 (UMLS CUI-1)
Item
HSCT related cause of death
integer
C0007465 (UMLS CUI [1,1])
C0472699 (UMLS CUI [1,2])
HSCT related cause
Code List
HSCT related cause of death
CL Item
GvHD (1)
C0018133 (UMLS CUI-1)
CL Item
Interstitial pneumonitis (2)
C0206061 (UMLS CUI-1)
CL Item
Pulmonary toxicity (3)
C0919924 (UMLS CUI-1)
CL Item
Infection bacterial (4)
C0004623 (UMLS CUI-1)
CL Item
Infection viral (5)
C0042769 (UMLS CUI-1)
CL Item
Infection fungal (6)
C0026946 (UMLS CUI-1)
CL Item
Infection parasitic (7)
C0030498 (UMLS CUI-1)
CL Item
Infection unknown (8)
C0009450 (UMLS CUI-1)
CL Item
Rejection / poor graft function (9)
C1268811 (UMLS CUI-1)
CL Item
Veno-occlusive disease (VOD) (10)
C0948441 (UMLS CUI-1)
CL Item
Haemorrhage (11)
C0019080 (UMLS CUI-1)
CL Item
Cardiac toxicity (12)
C0876994 (UMLS CUI-1)
CL Item
Central nervous system toxicity (13)
C3160947 (UMLS CUI-1)
CL Item
Gastro intestinal toxicity (14)
C0007465 (UMLS CUI-1)
C1142499 (UMLS CUI-2)
CL Item
Skin toxicity (15)
C1167791 (UMLS CUI-1)
CL Item
Renal failure (16)
C1533077 (UMLS CUI-1)
CL Item
Multiple organ failure (17)
C0026766 (UMLS CUI-1)
CL Item
Other (18)
C0205394 (UMLS CUI-1)
Item Group
ADDITIONAL NOTES IF APPLICABLE
Comments
Item
Comments
integer
C0947611 (UMLS CUI [1])
IDENTIFICATION & SIGNATURE
Item
IDENTIFICATION & SIGNATURE
integer
C0205396 (UMLS CUI [1,1])
C1519316 (UMLS CUI [1,2])
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