English

EBMT Allograft

1 forms  
  1. StudyEvent: ODM
    1. EBMT Allograft
ANTIBODIES IN THE PATIENT
Description

ANTIBODIES IN THE PATIENT

HIV
Description

HIV

Data type

integer

Alias
UMLS CUI [1]
C0019682
HIV ANTIGENS (if testing applicable)
Description

HIV ANTIGENS

Data type

integer

Alias
UMLS CUI [1]
C0019686
CMV
Description

CMV

Data type

integer

Alias
UMLS CUI [1]
C0582172
EBV
Description

EBV

Data type

integer

Alias
UMLS CUI [1]
C0014644
HBVs
Description

HBV

Data type

integer

Alias
UMLS CUI [1]
C0019163
HBVs ANTIGENS (if testing applicable)
Description

HBVs

Data type

integer

Alias
UMLS CUI [1]
C0019165
HBVc
Description

HBVc

Data type

integer

Alias
UMLS CUI [1]
C1440681
HBVe
Description

HBVe

Data type

integer

Alias
UMLS CUI [1]
C0019167
HCV
Description

HCV

Data type

integer

Alias
UMLS CUI [1]
C0220847
HCV ANTIGENS (if testing applicable)
Description

HCV ANTIGENS

Data type

integer

Alias
UMLS CUI [1]
C0121459
HTLV
Description

HTLV

Data type

integer

Alias
UMLS CUI [1]
C0086427
Toxoplasmosis
Description

Toxoplasmosis

Data type

integer

Alias
UMLS CUI [1]
C0040558
if other Antibodies in the patient
Description

if other Antibodies in the patient

Data type

integer

Alias
UMLS CUI [1]
C0205394
PRE-TRANSPLANT HISTORY OF DOCUMENTED INVASIVE FUNGAL INFECTION SINCE INITIAL DIAGNOSIS
Description

PRE-TRANSPLANT HISTORY OF DOCUMENTED INVASIVE FUNGAL INFECTION SINCE INITIAL DIAGNOSIS

PRE-TRANSPLANT HISTORY OF DOCUMENTED INVASIVE FUNGAL INFECTION SINCE INITIAL DIAGNOSIS
Description

FUNGAL INFECTION

Data type

integer

Alias
UMLS CUI [1]
C0026946
Candida
Description

Candida

Data type

integer

Alias
UMLS CUI [1]
C0006837
Aspergillus
Description

Aspergillus

Data type

integer

Alias
UMLS CUI [1]
C0004034
Pneumocystis carinii
Description

Pneumocystis carinii

Data type

integer

Alias
UMLS CUI [1]
C0032276
Other
Description

Other

Data type

boolean

Alias
UMLS CUI [1]
C0205394
Other if yes, please specify
Description

Other

Data type

integer

Alias
UMLS CUI [1]
C0205394
PERFORMANCE SCORE
Description

PERFORMANCE SCORE

Type of score used
Description

score

Data type

integer

Alias
UMLS CUI [1]
C1518965
Score
Description

Performance score

Data type

integer

Alias
UMLS CUI [1]
C1518965
Weight
Description

Weight

Data type

float

Measurement units
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Height
Description

Height

Data type

float

Measurement units
  • cm
Alias
UMLS CUI [1]
C0005890
cm
DONOR AND STEM CELL SOURCE
Description

DONOR AND STEM CELL SOURCE

Multiple donors
Description

Multiple donors

Data type

boolean

Alias
UMLS CUI [1]
C0013018
different stem cell products of same donor or cord blood units
Description

Make as many copies of the DONOR and HISTOCOMPATIBILITY sections as there are donors. Complete all of them and include them all in your report. For each donor Indicate in all pages their number in the infusion order and their Donor ID if known

Data type

float

Alias
UMLS CUI [1]
C0038250
SOURCE OF STEM CELLS FOR THIS DONOR/PRODUCT
Description

Tick only one. If same donor has donated stem cells from more than one source, fill the information under a separate donor form

Data type

integer

Alias
UMLS CUI [1,1]
C0038250
UMLS CUI [1,2]
C0449416
Identification of Donor or Cord Blood Unit
Description

given by the centre (can be the family relation if a related donor; if unrelated donor use the ID provided by the Donor Registry)

Data type

integer

Alias
UMLS CUI [1]
C1550613
Number in the infusion order
Description

(if multiple donors or stem cell products)

Data type

integer

Alias
UMLS CUI [1]
C0574032
HLA MATCH TYPE
Description

(DONOR RELATION WITH PATIENT)

Data type

text

Alias
UMLS CUI [1]
C0242318
Name of the Donor registry
Description

Name of the Donor registry

Data type

integer

Alias
UMLS CUI [1]
C1549696
BMDW / WMDA code for the donor registry (up to 4 characters)
Description

(This information can be found in http://www.bmdw.org under “Participating Registries”)

Data type

integer

Alias
UMLS CUI [1]
C2987198
Name of the Cord blood bank
Description

Name of the Cord blood bank

Data type

integer

Alias
UMLS CUI [1]
C0005770
Eurocord code for the cord blood bank
Description

Eurocord code for the cord blood bank

Data type

integer

Alias
UMLS CUI [1,1]
C0005770
UMLS CUI [1,2]
C0805701
HLA MISMATCHES BETWEEN DONOR AND PATIENT
Description

HLA MISMATCHES BETWEEN DONOR AND PATIENT

Serology A
Description

Serology A

Data type

integer

Alias
UMLS CUI [1]
C0019728
Serology B
Description

Serology B

Data type

integer

Alias
UMLS CUI [1]
C0019737
Serology C
Description

Serology C

Data type

integer

Alias
UMLS CUI [1]
C0019751
Serology DRB1
Description

Serology DRB1

Data type

integer

Alias
UMLS CUI [1]
C0122040
Serology DQB1
Description

Serology DQB1

Data type

integer

Alias
UMLS CUI [1]
C0122020
Serology DPB1
Description

Serology DPB1

Data type

integer

Alias
UMLS CUI [1]
C0555918
DNA A
Description

DNA A

Data type

text

Alias
UMLS CUI [1]
C0019729
DNA B
Description

DNA B

Data type

integer

Alias
UMLS CUI [1]
C0019738
DNA C
Description

DNA C

Data type

integer

Alias
UMLS CUI [1]
C0019752
DNA DRB1
Description

DNA DRB1

Data type

integer

Alias
UMLS CUI [1]
C1705258
DNA DQB1
Description

DNA DQB1

Data type

integer

Alias
UMLS CUI [1]
C0122020
DNA DPB1
Description

DNA DPB1

Data type

integer

Alias
UMLS CUI [1]
C0555918
BLOOD GROUP, DATE OF BIRTH AND SEX OF DONOR
Description

BLOOD GROUP, DATE OF BIRTH AND SEX OF DONOR

ABO group
Description

ABO group

Data type

integer

Alias
UMLS CUI [1]
C0000778
Date of birth
Description

Date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Sex
Description

Sex

Data type

integer

Alias
UMLS CUI [1]
C0079399
STATUS OF THE DONOR OR CORD BLOOD UNIT BEFORE HSCT
Description

STATUS OF THE DONOR OR CORD BLOOD UNIT BEFORE HSCT

HIV
Description

HIV

Data type

integer

Alias
UMLS CUI [1]
C0019682
HIV ANTIGENS (if testing applicable)
Description

HIV ANTIGENS

Data type

integer

Alias
UMLS CUI [1]
C0019686
CMV
Description

CMV

Data type

integer

Alias
UMLS CUI [1]
C0582172
EBV
Description

EBV

Data type

integer

Alias
UMLS CUI [1]
C0014644
HBVs
Description

HBV

Data type

integer

Alias
UMLS CUI [1]
C0019163
HBVs ANTIGENS (if testing applicable)
Description

HBVs

Data type

integer

Alias
UMLS CUI [1]
C0019165
HBVc
Description

HBVc

Data type

integer

Alias
UMLS CUI [1]
C1440681
HBVe
Description

HBVe

Data type

integer

Alias
UMLS CUI [1]
C0019167
HCV
Description

HCV

Data type

integer

Alias
UMLS CUI [1]
C0220847
HCV ANTIGENS (if testing applicable)
Description

HCV ANTIGENS

Data type

integer

Alias
UMLS CUI [1]
C0121459
HTLV
Description

HTLV

Data type

integer

Alias
UMLS CUI [1]
C0086427
Toxoplasmosis
Description

Toxoplasmosis

Data type

integer

Alias
UMLS CUI [1]
C0040558
if other Antibodies in the patient
Description

if other Antibodies in the patient

Data type

integer

Alias
UMLS CUI [1]
C0205394
Date of harvest or cord blood collection
Description

Date of harvest or cord blood collection

Data type

date

Alias
UMLS CUI [1,1]
C1512335
UMLS CUI [1,2]
C0011008
GROWTH FACTORS ADMINISTERED TO THE DONOR
Description

GROWTH FACTORS

Data type

integer

Alias
UMLS CUI [1]
C0018284
HISTOCOMPATIBILITY RESULTS
Description

HISTOCOMPATIBILITY RESULTS

Laboratory / Hospital
Description

Laboratory / Hospital

Data type

integer

Alias
UMLS CUI [1,1]
C0022877
UMLS CUI [1,2]
C0019994
Unit
Description

Unit

Data type

integer

Alias
UMLS CUI [1]
C1519795
Contact number
Description

telephone number

Data type

integer

Alias
UMLS CUI [1]
C1515258
Technique Used
Description

Technique

Data type

integer

Alias
UMLS CUI [1,1]
C0034925
UMLS CUI [1,2]
C0449851
Serology (antigenic) HLA typing done
Description

Serology (antigenic) HLA typing

Data type

boolean

Alias
UMLS CUI [1]
C0242318
DNA (Allelic/molecular) HLA typing done
Description

DNA (Allelic/molecular) HLA typing done

DNA (Allelic/molecular) HLA typing done
Description

DNA (Allelic/molecular) HLA typing done

Data type

boolean

Alias
UMLS CUI [1]
C0242318
DNA (Allelic/molecular) HLA typing done: Locus
Description

DNA (Allelic/molecular) HLA typing done: Locus

Data type

integer

Alias
UMLS CUI [1]
C1321760
HLA string
Description

HLA string

Data type

integer

Alias
UMLS CUI [1,1]
C1547402
UMLS CUI [1,2]
C0019721
NMDP code
Description

NMDP code

Data type

integer

Alias
UMLS CUI [1,1]
C1882036
UMLS CUI [1,2]
C1827636
Serology (antigenic) HLA typing done
Description

Serology (antigenic) HLA typing done

Serology (antigenic) HLA typing done
Description

Serology (antigenic) HLA typing done

Data type

boolean

Alias
UMLS CUI [1]
C0242318
HLA Serology
Description

HLA Serology

Data type

integer

Alias
UMLS CUI [1]
C0242318
GRAFT MANIPULATION
Description

GRAFT MANIPULATION

Identification of donor or Cord Blood Unit given by the centre
Description

IF MULTIPLE DONORS (please, use same ID as in the preceding sheets)

Data type

integer

Alias
UMLS CUI [1]
C1827636
Number in the infusion order (if applicable)
Description

Number in the infusion order

Data type

text

Alias
UMLS CUI [1]
C0237753
GRAFT MANIPULATION EX-VIVO (INCLUDING T-CELL DEPLETION)
Description

GRAFT MANIPULATION EX-VIVO (INCLUDING T-CELL DEPLETION)

Data type

boolean

Alias
UMLS CUI [1]
C0677960
NEGATIVE SELECTION
Description

GRAFT MANIPULATION EX-VIVO (INCLUDING T-CELL DEPLETION)

Data type

integer

Alias
UMLS CUI [1]
C2347338
if negative selection, specify
Description

GRAFT MANIPULATION EX-VIVO (INCLUDING T-CELL DEPLETION)

Data type

integer

Alias
UMLS CUI [1,1]
C2347338
UMLS CUI [1,2]
C1521902
if positive selection, splease specify:
Description

GRAFT MANIPULATION EX-VIVO (INCLUDING T-CELL DEPLETION)

Data type

integer

Alias
UMLS CUI [1,1]
C2347644
UMLS CUI [1,2]
C1521902
Monoclonal antibodies
Description

Monoclonal antibodies

Data type

integer

Alias
UMLS CUI [1]
C3542957
Monoclonal antibodies: if yes
Description

Monoclonal antibodies: if yes

Data type

integer

Alias
UMLS CUI [1]
C0003250
EXPANSION
Description

EXPANSION

Data type

integer

Alias
UMLS CUI [1]
C0040290
GENE MANIPULATION (gene transfer/transduction)
Description

GENE MANIPULATION

Data type

integer

Alias
UMLS CUI [1]
C0947647
CELL INFUSION
Description

CELL INFUSION

IF MULTIPLE DONORS: Identification of donor or Cord Blood Unit given by the centre (please, use same ID as in the preceding sheets)
Description

Identification of donor or Cord Blood Unit given by the centre

Data type

text

Number in the infusion order (if applicable)
Description

Number in the infusion order

Data type

text

Alias
UMLS CUI [1]
C0237753
CELL INFUSION METHOD Fill in for Cord Blood HSCT only
Description

Route of infusion

Data type

text

Route of infusion: If other, please specify:
Description

Route of infusion: If other, please specify:

Data type

integer

Alias
UMLS CUI [1]
C1827465
Infusion method
Description

Infusion method

Data type

integer

Alias
UMLS CUI [1]
C0574032
Infusion method: if other, please specify
Description

Infusion method: if other, please specify

Data type

integer

Alias
UMLS CUI [1,1]
C0574032
UMLS CUI [1,2]
C1521902
CELL VIABILITY RESULTS AT HSCT CENTRE
Description

CELL VIABILITY RESULTS AT HSCT CENTRE

Tests performed after thawing of an aliquot on
Description

Tests performed after thawing of an aliquot on

Data type

integer

Alias
UMLS CUI [1]
C1521902
Method used
Description

Method used

Data type

integer

Alias
UMLS CUI [1]
C0871511
Viability of all cells
Description

Viability of all cells

Data type

float

Alias
UMLS CUI [1]
C1516362
Viability of CD34+ cells
Description

Viability of CD34+ cells

Data type

float

Alias
UMLS CUI [1,1]
C1516362
UMLS CUI [1,2]
C0882849
CELLS INFUSED FROM THIS DONOR AND STEM CELL SOURCE COMBINATION
Description

CELLS INFUSED FROM THIS DONOR AND STEM CELL SOURCE COMBINATION

Bone Marrow: Total number of cells actually infused
Description

Bone Marrow: Total number of cells actually infused

Data type

integer

Alias
UMLS CUI [1,1]
C2145394
UMLS CUI [1,2]
C0005953
Bone Marrow: Total number of cells actually infused, specify:
Description

Bone Marrow: Total number of cells actually infused, specify:

Data type

integer

Alias
UMLS CUI [1,1]
C2145394
UMLS CUI [1,2]
C0005953
Peripheral Blood: Total number of cells actually infused
Description

Peripheral Blood: Total number of cells actually infused

Data type

integer

Alias
UMLS CUI [1,1]
C0229664
UMLS CUI [1,2]
C2145394
Peripheral Blood: Total number of cells actually infused
Description

Peripheral Blood: Total number of cells actually infused

Data type

integer

Alias
UMLS CUI [1,1]
C0229664
UMLS CUI [1,2]
C2145394
Cord Blood: Total number of cellsactually infused
Description

Cord Blood: Total number of cellsactually infused

Data type

integer

Alias
UMLS CUI [1,1]
C0162371
UMLS CUI [1,2]
C2145394
Cord Blood: Total number of cellsa ctually infused
Description

Cord Blood: Total number of cellsa ctually infused

Data type

integer

Alias
UMLS CUI [1,1]
C0162371
UMLS CUI [1,2]
C2145394
HSC TRANSPLANTATION
Description

HSC TRANSPLANTATION

Chronological number of HSCT for this patient
Description

Chronological number

Data type

integer

Alias
UMLS CUI [1,1]
C1318453
UMLS CUI [1,2]
C0449788
Donor the same as for previous HSCT?
Description

Donor the same as for previous HSCT?

Data type

integer

Alias
UMLS CUI [1,1]
C0013018
UMLS CUI [1,2]
C0472699
Date of previous HSCT
Description

Date of previous HSCT

Data type

date

Alias
UMLS CUI [1,1]
C0018956
UMLS CUI [1,2]
C0011008
Type of previous HSCT
Description

Type of HSCT

Data type

integer

Alias
UMLS CUI [1]
C0472699
Reason for this transplant
Description

Reason for this transplant

Data type

integer

Alias
UMLS CUI [1]
C1718260
HSCT part of a multiple sequential graft protocol
Description

HSCT part of a multiple sequential graft protocol

Data type

integer

Alias
UMLS CUI [1]
C0442711
Type of multiple graft protocol
Description

Type of multiple graft protocol

Data type

integer

Alias
UMLS CUI [1]
C0442711
Graft number in the protocol
Description

Graft number in the protocol

Data type

integer

Alias
UMLS CUI [1]
C1961139
total number of HSCTs in the program
Description

total number of HSCTs in the program

Data type

integer

Alias
UMLS CUI [1,1]
C0449788
UMLS CUI [1,2]
C0472699
PREPARATIVE TREATMENT (conditioning)
Description

PREPARATIVE TREATMENT (conditioning)

PREPARATIVE (CONDITIONING) REGIMEN GIVEN
Description

PREPARATIVE (CONDITIONING) REGIMEN GIVEN

Data type

boolean

Alias
UMLS CUI [1]
C1882454
Was regimen intended to be myeloablative
Description

Was regimen intended to be myeloablative

Data type

integer

Alias
UMLS CUI [1,1]
C1882454
UMLS CUI [1,2]
C1513784
Reason not myeloablative
Description

Main reason (tick only one)

Data type

integer

Alias
UMLS CUI [1]
C1831742
Drugs
Description

(include any active agent be it chemo, monoclonal antibody, polyclonal antibody, serotherapy, etc.) NOTE: ONLY AGENTS GIVEN BEFORE THE DATE OF THE 1ST CELL INFUSION (DAY 0) SHOULD BE LISTED HERE

Data type

integer

Alias
UMLS CUI [1]
C0013227
Drugs
Description

Drugs

NAME OF DRUG
Description

NAME OF DRUG

Data type

text

Alias
UMLS CUI [1]
C3273235
PRESCRIBED CUMULATIVE DOSE AS PER PROTOCOL (DAILY DOSE BY NUMBER OF DAYS)
Description

AS PER PROTOCOL (DAILY DOSE BY NUMBER OF DAYS)

Data type

integer

Alias
UMLS CUI [1]
C2986497
IF MONOCLONAL ANTIBODY, RADIO LABELLED?
Description

MONOCLONAL ANTIBODY

Data type

integer

Alias
UMLS CUI [1]
C0003250
UNITS IF RADIO LABELLED
Description

UNITS IF RADIO LABELLED

Data type

integer

Alias
UMLS CUI [1]
C0041697
Route of administration
Description

Route of administration

Data type

integer

Alias
UMLS CUI [1]
C0013153
Animal origin
Description

For ALG, ATG (ALS, ATS):

Data type

integer

Alias
UMLS CUI [1]
C3494749
TBI
Description

(If yes, complete TBI Form)

Data type

integer

Alias
UMLS CUI [1]
C1456496
Total dose (Gy)
Description

Total dose

Data type

float

Alias
UMLS CUI [1]
C2919490
Number of fractions
Description

Number of fractions

Data type

float

Alias
UMLS CUI [1]
C0454266
radiation days
Description

radiation days

Data type

integer

Alias
UMLS CUI [1]
C3693616
TLI / TNI / TAI
Description

TLI / TNI / TAI

Data type

integer

Alias
UMLS CUI [1]
C3670574
UMLS CUI [2]
C0077401
Local radiotherapy
Description

Local radiotherapy

Data type

integer

Alias
UMLS CUI [1]
C1522449
TREATMENT DURING THE IMMEDIATE POST-TRANSPLANT PERIOD
Description

TREATMENT DURING THE IMMEDIATE POST-TRANSPLANT PERIOD

GROWTH FACTORS (CYTOKINES)
Description

(excluding growth factors administered for engraftment failure)

Data type

integer

Alias
UMLS CUI [1]
C0018284
GROWTH FACTORS: If yes, please specify
Description

GROWTH FACTORS: If yes, please specify

Data type

text

Alias
UMLS CUI [1,1]
C0018284
UMLS CUI [1,2]
C4035158
Date started
Description

Date started

Data type

date

Alias
UMLS CUI [1]
C3173309
CELLULAR THERAPY
Description

CELLULAR THERAPY

Data type

integer

Alias
UMLS CUI [1]
C0302189
Date of first infusion
Description

(can be the same as HSCT date)

Data type

date

Alias
UMLS CUI [1,1]
C0574032
UMLS CUI [1,2]
C0011008
CELLULAR THERAPY: if yes, specify:
Description

CELLULAR THERAPY

Data type

integer

Alias
UMLS CUI [1,1]
C0302189
UMLS CUI [1,2]
C1521902
Number of cells infused by type
Description

Number of cells infused by type

Nucleated cells
Description

Nucleated cells

Data type

float

Measurement units
  • /kg*
Alias
UMLS CUI [1]
C1180059
/kg*
Nucleated cells
Description

Nucleated cells

Data type

integer

Measurement units
  • (/kg*
Alias
UMLS CUI [1]
C1180059
CD 34+ (cells/kg*)
Description

CD 34+

Data type

integer

Measurement units
  • cells/kg*
Alias
UMLS CUI [1]
C3538723
cells/kg*
CD 34+ (cells/kg*)
Description

CD 34+ (cells/kg*)

Data type

integer

Measurement units
  • cells/kg*
Alias
UMLS CUI [1]
C3538723
CD 3+ (cells/kg*)
Description

CD 3+

Data type

float

Measurement units
  • cells/kg*
Alias
UMLS CUI [1]
C0483189
cells/kg*
CD 3+ (cells/kg*)
Description

CD 3+ (cells/kg*)

Data type

integer

Measurement units
  • cells/kg*
Alias
UMLS CUI [1]
C0483189
Total number of cells infused
Description

Total number of cells infused

All cells (cells/kg*) (non DLI only)
Description

All cells

Data type

float

Measurement units
  • cells/kg*
Alias
UMLS CUI [1]
C2322965
cells/kg*
Chronological number of this cell therapy for this patient
Description

Chronological number of this cell therapy for this patient

Data type

integer

Alias
UMLS CUI [1,1]
C0302189
UMLS CUI [1,2]
C0449788
Indication
Description

(check all that apply)

Data type

text

Alias
UMLS CUI [1]
C3146298
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 within 10 weeks

Data type

integer

Alias
UMLS CUI [1,1]
C0449788
UMLS CUI [1,2]
C0574032
GVHD PREVENTION IN THE RECIPIENT (THERAPEUTIC IMMUNOSUPPRESSION)
Description

GVHD PREVENTION IN THE RECIPIENT (THERAPEUTIC IMMUNOSUPPRESSION)

Data type

integer

Alias
UMLS CUI [1,1]
C0018133
UMLS CUI [1,2]
C0199176
chemotherapy
Description

chemotherapy

Data type

integer

Alias
UMLS CUI [1]
C0392920
Monoclonal antibodies, specify
Description

Monoclonal antibodies

Data type

integer

Alias
UMLS CUI [1]
C3542957
Drugs: If Other, please specify
Description

Drugs: If Other, please specify

Data type

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C4035158
GRAFT PERFORMANCE
Description

GRAFT PERFORMANCE

GRAFT PERFORMANCE
Description

Haemopoietic reconstitution (Engraftment)

Data type

integer

Alias
UMLS CUI [1]
C0301944
Neutrophils > 0.5 x 109/l reached?
Description

Neutrophils

Data type

integer

Alias
UMLS CUI [1]
C0948762
Platelets > 20 x 109/l reached?
Description

Platelets

Data type

integer

Alias
UMLS CUI [1]
C0005821
Date last assessment
Description

Date last assessment

Data type

date

Alias
UMLS CUI [1]
C2985720
Date of graft failure
Description

Date of graft failure

Data type

date

Alias
UMLS CUI [1,1]
C1262018
UMLS CUI [1,2]
C0011008
Overall chimaerism
Description

HAEMOPOIETIC CHIMAERISM

Data type

integer

Alias
UMLS CUI [1]
C0333678
DATE(S) AND RESULTS OF ALL TESTS DONE FOR ALL DONORS
Description

DATE(S) AND RESULTS OF ALL TESTS DONE FOR ALL DONORS

undefined item
Description

undefined item

Data type

text

Date of test
Description

Date of test

Data type

date

Identification of donor or Cord Blood Unit given by the centre
Description

Identification

Data type

text

Alias
UMLS CUI [1]
C1718162
Number in the infusion order (if applicable)
Description

Number in the infusion order

Data type

text

Alias
UMLS CUI [1]
C0237753
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
Description

T-cell

Data type

float

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 (% Donor cells): Other
Description

Other cell type - value

Data type

float

Measurement units
  • %
Alias
UMLS CUI [1,1]
C0449475
UMLS CUI [1,2]
C1522609
%
Test used
Description

Laboratory tests

Data type

integer

Alias
UMLS CUI [1]
C0022885
TREATMENT FOR FAILURE (If engraftment failure)
Description

TREATMENT FOR FAILURE

Data type

integer

ACUTE GRAFT VERSUS HOST DISEASE (GvHD)
Description

ACUTE GRAFT VERSUS HOST DISEASE (GvHD)

Maximum grade ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)
Description

Maximum grade

Data type

integer

Date of onset
Description

Date of onset

Data type

date

Alias
UMLS CUI [1]
C0574845
Stage skin
Description

aGvHD Stage Skin

Data type

integer

Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C1306673
UMLS CUI [1,3]
C1306673
Stage liver
Description

aGvHD Stage liver

Data type

integer

Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C1306673
UMLS CUI [1,3]
C0023884
Stage gut
Description

aGvHD stage gut

Data type

integer

Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C1306673
UMLS CUI [1,3]
C0021853
Resolution
Description

aGvHD Resolution

Data type

integer

Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C1514893
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
Treatment
Description

Treatment

Data type

boolean

Treatment, if yes
Description

Treatment

Data type

text

COMPLICATIONS WITHIN THE FIRST 100 DAYS.
Description

COMPLICATIONS WITHIN THE FIRST 100 DAYS.

INFECTION RELATED COMPLICATIONS
Description

INFECTION RELATED COMPLICATIONS

Data type

boolean

Alias
UMLS CUI [1,1]
C0009450
UMLS CUI [1,2]
C0009566
Pathogen
Description

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

Data type

integer

Alias
UMLS CUI [1]
C0450254
NON INFECTION RELATED COMPLICATIONS
Description

NON INFECTION RELATED COMPLICATIONS

Data type

integer

Alias
UMLS CUI [1]
C0009566
Specify: Idiopathic pneumonia syndrome
Description

Idiopathic pneumonia syndrome

Data type

text

Alias
UMLS CUI [1]
C1504431
Specify: VOD
Description

VOD

Data type

text

Alias
UMLS CUI [1]
C0948441
Specify: Haemorrhagic cystitis, non infectious
Description

Haemorrhagic cystitis, non infectious

Data type

text

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

ARDS, non infectious

Data type

text

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

Multiorgan failure, non infectious

Data type

integer

Alias
UMLS CUI [1]
C0026766
Specify: HSCT-associated microangiopathy
Description

HSCT-associated microangiopathy

Data type

text

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

Renal failure requiring dialysis

Data type

text

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

Haemolytic anaemia due to blood group

Data type

text

Alias
UMLS CUI [1]
C0002878
Other type of infection
Description

Other type of infection

Data type

boolean

Alias
UMLS CUI [1]
C0457463
Idiopathic pneumonia syndrome date
Description

Idiopathic pneumonia syndrome date

Data type

date

Alias
UMLS CUI [1,1]
C1504431
UMLS CUI [1,2]
C0011008
Date VOD
Description

Date VOD

Data type

date

Alias
UMLS CUI [1,1]
C0948441
UMLS CUI [1,2]
C0011008
Date Haemorrhagic cystitis, non infectious
Description

Date Haemorrhagic cystitis, non infectious

Data type

date

Alias
UMLS CUI [1,1]
C0085692
UMLS CUI [1,2]
C0011008
Date ARDS, non infectious
Description

Date ARDS, non infectious

Data type

date

Alias
UMLS CUI [1,1]
C0035222
UMLS CUI [1,2]
C0011008
Date Multiorgan failure, non infectious
Description

Date Multiorgan failure, non infectious

Data type

date

Alias
UMLS CUI [1,1]
C0026766
UMLS CUI [1,2]
C0011008
Date HSCT-associated microangiopathy
Description

Date HSCT-associated microangiopathy

Data type

date

Alias
UMLS CUI [1,1]
C0155765
UMLS CUI [1,2]
C0011008
Date Renal failure requiring dialysis
Description

Date Renal failure requiring dialysis

Data type

date

Alias
UMLS CUI [1,1]
C0035078
UMLS CUI [1,2]
C0011008
DAte Haemolytic anaemia due to blood group
Description

DAte Haemolytic anaemia due to blood group

Data type

date

Alias
UMLS CUI [1,1]
C0002878
UMLS CUI [1,2]
C0011008
Date of other Type
Description

Date of other Type

Data type

date

Alias
UMLS CUI [1,1]
C2316983
UMLS CUI [1,2]
C0220886
STATUS AT 100 DAYS
Description

STATUS AT 100 DAYS

Date of Last Contact
Description

LastContactDate

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0011008
UMLS CUI [1,3]
C1705415
UMLS CUI [1,4]
C1517741
Presence of cGVHD
Description

Presence of cGVHD

Data type

integer

Alias
UMLS CUI [1]
C0867389
Onset
Description

Date of Onset

Data type

date

Alias
UMLS CUI [1]
C0574845
cGvHD grade
Description

cGvHD grade

Data type

integer

Alias
UMLS CUI [1,1]
C0867389
UMLS CUI [1,2]
C0441800
Organs affected
Description

Organs affected

Data type

integer

Alias
UMLS CUI [1]
C0449642
Relapse or progression
Description

Relapse or progression

Data type

integer

Alias
UMLS CUI [1]
C0035020
UMLS CUI [2]
C0242656
RELAPSE OR PROGRESSION: If yes, date diagnosed
Description

RELAPSE OR PROGRESSION: If yes, date diagnosed

Data type

date

Alias
UMLS CUI [1]
C0035020
UMLS CUI [2]
C0242656
UMLS CUI [3]
C2316983
Method of detection
Description

Method of detection

Cinical/haematological relapse or progression
Description

Clinical/hematological

Data type

integer

Alias
UMLS CUI [1,1]
C0018939
UMLS CUI [1,2]
C0205210
Date assessed
Description

Cinical/haematological relapse or progression

Data type

date

Date first seen
Description

Cinical/haematological relapse or progression

Data type

date

Cytogenetic relapse or progression
Description

Cytogenetic relapse or progression

Data type

integer

Alias
UMLS CUI [1]
C0010802
Cytogenetic relapse or progression: Date assessed
Description

Cytogenetic relapse or progression: Date assessed

Data type

date

Alias
UMLS CUI [1,1]
C0010802
UMLS CUI [1,2]
C0035020
UMLS CUI [1,3]
C2985720
Cytogenetic relapse or progression: Date first seen
Description

Cytogenetic relapse or progression: Date first seen

Data type

date

Alias
UMLS CUI [1,1]
C0035020
UMLS CUI [1,2]
C3483766
Molecular relapse or progression
Description

Molecular relapse or progression

Data type

integer

Alias
UMLS CUI [1]
C0026376
Molecular relapse or progression: date assessed
Description

Molecular relapse or progression: date assessed

Data type

date

Alias
UMLS CUI [1,1]
C0035020
UMLS CUI [1,2]
C0011008
Molecular relapse or progression: Date first seen
Description

Molecular relapse or progression: Date first seen

Data type

date

Alias
UMLS CUI [1,1]
C3483766
UMLS CUI [1,2]
C0035020
LAST DISEASE STATUS
Description

LAST DISEASE STATUS

Clinical/haematological
Description

Clincal/Hematological evaluation

Data type

integer

Alias
UMLS CUI [1,1]
C0018939
UMLS CUI [1,2]
C0205210
Last date evaluated/Last date assessed
Description

Date of Evaluation

Data type

date

Measurement units
  • yyyy/mm/dd
Alias
UMLS CUI [1]
C2985720
yyyy/mm/dd
Cytogenetic/FISH
Description

Cytogenetics/FISH

Data type

integer

Alias
UMLS CUI [1,1]
C0010802
UMLS CUI [1,2]
C0162789
Last date assessed
Description

Last date assessed

Data type

date

Molecular
Description

Molecular

Data type

text

Alias
UMLS CUI [1]
C0026376
Survival Status
Description

Survival Status

Data type

integer

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

Performance Score

Data type

text

Alias
UMLS CUI [1]
C1518965
Score
Description

Performance score

Data type

integer

Alias
UMLS CUI [1]
C1518965
Cause of death (if dead)
Description

Cause of death

Data type

integer

Alias
UMLS CUI [1]
C0007465
If dead and HSCT related cause of death, specify (check as many as apppropriate): GvHD
Description

GvHD

Data type

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0018133
If dead and HSCT related cause of death, specify (check as many as apppropriate): Interstitial Pneumonitis
Description

Interstitial Pneumonitis

Data type

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0206061
If dead and HSCT related cause of death, specify (check as many as apppropriate): Pulmonary toxicity
Description

Pulmonary toxicity

Data type

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0919924
Infection:
Description

Infection

Data type

integer

Alias
UMLS CUI [1]
C0009450
Rejection / poor graft function
Description

Rejection / poor graft function

Data type

integer

Alias
UMLS CUI [1]
C0018129
Veno-Occlusive disease (VOD)
Description

Veno-Occlusive disease (VOD)

Data type

integer

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0948441
If dead and HSCT related cause of death, specify (check as many as apppropriate): Haemorrhage
Description

Haemorrhage

Data type

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0019080
If dead and HSCT related cause of death, specify (check as many as apppropriate): Cardiac toxicity
Description

Cardiac toxicity

Data type

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0876994
If dead and HSCT related cause of death, specify (check as many as apppropriate): Central nervous system toxicity
Description

Central nervous system toxicity

Data type

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C3160947
If dead and HSCT related cause of death, specify (check as many as apppropriate): Gastro intestinal toxicity
Description

Gastro intestinal toxicity

Data type

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C1142499
If dead and HSCT related cause of death, specify (check as many as apppropriate): Skin toxicity
Description

Skin toxicity

Data type

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C1167791
If dead and HSCT related cause of death, specify (check as many as apppropriate): Renal failure
Description

Renal failure

Data type

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0035078
If dead and HSCT related cause of death, specify (check as many as apppropriate): Multiple organ failure
Description

Multiple organ failure

Data type

text

Alias
UMLS CUI [1,1]
C0007465
UMLS CUI [1,2]
C0026766
COMMENTS
Description

COMMENTS

Data type

text

Alias
UMLS CUI [1]
C0947611
IDENTIFICATION & SIGNATURE
Description

IDENTIFICATION & SIGNATURE

Data type

text

Alias
UMLS CUI [1,1]
C0205396
UMLS CUI [1,2]
C1519316
ADDITIONAL NOTES IF APPLICABLE
Description

ADDITIONAL NOTES IF APPLICABLE

ALLOGRAFT APPENDIX
Description

ALLOGRAFT APPENDIX

Ethnicity
Description

Ethnicity

Data type

text

Alias
UMLS CUI [1]
C0015031
Race
Description

Race

Data type

text

Alias
UMLS CUI [1]
C0034510
COMORBID CONDITIONS
Description

Was there any clinically significant co-existing disease or organ impairment at time of patient assessment prior to preparative (conditioning) regimen?

Data type

boolean

Alias
UMLS CUI [1]
C1275743
Solid tumor
Description

Treated at any time point in the patient's past history, excluding nonmelanoma skin cancer

Data type

integer

Alias
UMLS CUI [1]
C0280100
Inflammatory bowel disease
Description

Crohn's disease or ulcerative colitis

Data type

integer

Alias
UMLS CUI [1]
C0021390
Infection
Description

Infection

Data type

integer

Alias
UMLS CUI [1]
C0009450
Diabetes
Description

Requiring treatment with insulin or oral hypoglycemics but not diet alone

Data type

integer

Alias
UMLS CUI [1]
C0011849
Serum creatinine
Description

Renal: moderate/severeor >177 μmol/L, on dialysis, or prior renal transplantation

Data type

integer

Measurement units
  • mg/dL
Alias
UMLS CUI [1]
C0201976
Chronic hepatitis
Description

, bilirubine between Upper Limit Normal (ULN) and 1.5 x the ULN, or AST/ALT between ULN and 2.5 × ULN

Data type

integer

Alias
UMLS CUI [1]
C0019189
Liver cirrhosis
Description

, bilirubine greater than 1.5 × ULN, or AST/ALT greater than 2.5 × ULN

Data type

integer

Alias
UMLS CUI [1]
C0023890
Arrhythmia
Description

Atrial fibrillation or flutter, sick sinus syndrome, or ventricular arrhythmias

Data type

integer

Alias
UMLS CUI [1]
C0003811
Coronary artery disease
Description

Coronary artery disease, congestive heart failure, myocardial infarction, or EF ≤ 50%

Data type

integer

Alias
UMLS CUI [1]
C1956346
Cerebrovascular disease
Description

Transient ischemic attack or cerebrovascular accident

Data type

integer

Alias
UMLS CUI [1]
C0007820
Heart valve disease
Description

Except mitral valve prolapse

Data type

integer

Alias
UMLS CUI [1]
C0018824
FEV1 66-80%
Description

FEV1

Data type

integer

Alias
UMLS CUI [1]
C0748133
FEV1 ≤ 65%
Description

Pulmonary: severeor dyspnea at rest or requiring oxygen

Data type

integer

Alias
UMLS CUI [1]
C0860906
Obesity
Description

Patients with a body mass index > 35 kg/m2

Data type

integer

Alias
UMLS CUI [1]
C0028754
Peptic ulcer
Description

Peptic ulcer

Data type

integer

Alias
UMLS CUI [1]
C0030920
Psychiatric disturbance
Description

Depression or anxiety requiring psychiatric consult or treatment

Data type

integer

Alias
UMLS CUI [1]
C0004936
other comorbidity, please specify
Description

comorbidity

Data type

text

Alias
UMLS CUI [1]
C0009488
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Similar models

EBMT Allograft

1 forms
  1. StudyEvent: ODM
    1. EBMT Allograft
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
ANTIBODIES IN THE PATIENT
Item
HIV
integer
C0019682 (UMLS CUI [1])
HIV
Code List
HIV
CL Item
Negative  (Negative )
C0205160 (UMLS CUI-1)
CL Item
Positive  (Positive )
C1446409 (UMLS CUI-1)
CL Item
Not evaluated  (Not evaluated )
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
HIV ANTIGENS (if testing applicable)
integer
C0019686 (UMLS CUI [1])
HIV
Code List
HIV ANTIGENS (if testing applicable)
CL Item
Negative  (Negative )
C0205160 (UMLS CUI-1)
CL Item
Positive  (Positive )
C1446409 (UMLS CUI-1)
CL Item
Not evaluated  (Not evaluated )
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
CMV
integer
C0582172 (UMLS CUI [1])
CMV
Code List
CMV
CL Item
Negative  (Negative )
C0205160 (UMLS CUI-1)
CL Item
Positive  (Positive )
C1446409 (UMLS CUI-1)
CL Item
Not evaluated  (Not evaluated )
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
EBV
integer
C0014644 (UMLS CUI [1])
EBV
Code List
EBV
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVs
integer
C0019163 (UMLS CUI [1])
HBVs
Code List
HBVs
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVs ANTIGENS (if testing applicable)
integer
C0019165 (UMLS CUI [1])
HBVs
Code List
HBVs ANTIGENS (if testing applicable)
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVc
integer
C1440681 (UMLS CUI [1])
HBVc
Code List
HBVc
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVe
integer
C0019167 (UMLS CUI [1])
HBVe
Code List
HBVe
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
HCV
integer
C0220847 (UMLS CUI [1])
HCV
Code List
HCV
CL Item
Negative (Negative)
CL Item
Positive (Positive)
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
HCV ANTIGENS (if testing applicable)
integer
C0121459 (UMLS CUI [1])
HCV
Code List
HCV ANTIGENS (if testing applicable)
CL Item
Negative (Negative)
CL Item
Positive (Positive)
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
HTLV
integer
C0086427 (UMLS CUI [1])
HTLV.I
Code List
HTLV
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
Toxoplasmosis
integer
C0040558 (UMLS CUI [1])
Toxoplasmosis
Code List
Toxoplasmosis
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
if other Antibodies in the patient
integer
C0205394 (UMLS CUI [1])
Other
Code List
if other Antibodies in the patient
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Specify (Specify)
Item Group
PRE-TRANSPLANT HISTORY OF DOCUMENTED INVASIVE FUNGAL INFECTION SINCE INITIAL DIAGNOSIS
Item
PRE-TRANSPLANT HISTORY OF DOCUMENTED INVASIVE FUNGAL INFECTION SINCE INITIAL DIAGNOSIS
integer
C0026946 (UMLS CUI [1])
PRE-TRANSPLANT HISTORY OF DOCUMENTED INVASIVE FUNGAL INFECTION SINCE INITIAL DIAGNOSIS
Code List
PRE-TRANSPLANT HISTORY OF DOCUMENTED INVASIVE FUNGAL INFECTION SINCE INITIAL DIAGNOSIS
CL Item
No (No)
C1298908 (UMLS CUI-1)
CL Item
Yes (Yes)
C1705108 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Candida
integer
C0006837 (UMLS CUI [1])
Candida
Code List
Candida
CL Item
Yes  (Yes )
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Aspergillus
integer
C0004034 (UMLS CUI [1])
Aspergillus
Code List
Aspergillus
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Pneumocystis carinii
integer
C0032276 (UMLS CUI [1])
Pneumocystis carinii
Code List
Pneumocystis carinii
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
Other
Item
Other
boolean
C0205394 (UMLS CUI [1])
Other
Item
Other if yes, please specify
integer
C0205394 (UMLS CUI [1])
Item Group
PERFORMANCE SCORE
Item
Type of score used
integer
C1518965 (UMLS CUI [1])
Type of score used
Code List
Type of score used
CL Item
Karnofsky (Karnofsky)
C0206065 (UMLS CUI-1)
CL Item
Lansky (Lansky)
C1522275 (UMLS CUI-1)
CL Item
Not evaluated (Not evaluated)
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
Score
integer
C1518965 (UMLS CUI [1])
Performance score
Code List
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)
Weight
Item
Weight
float
C0005910 (UMLS CUI [1])
Height
Item
Height
float
C0005890 (UMLS CUI [1])
Item Group
DONOR AND STEM CELL SOURCE
Multiple donors
Item
Multiple donors
boolean
C0013018 (UMLS CUI [1])
Number of donors or different stem cell products of same donor or cord blood units
Item
different stem cell products of same donor or cord blood units
float
C0038250 (UMLS CUI [1])
Item
SOURCE OF STEM CELLS FOR THIS DONOR/PRODUCT
integer
C0038250 (UMLS CUI [1,1])
C0449416 (UMLS CUI [1,2])
SOURCE OF STEM CELLS FOR THIS DONOR/PRODUCT
Code List
SOURCE OF STEM CELLS FOR THIS DONOR/PRODUCT
CL Item
Bone marrow (Bone marrow)
CL Item
Peripheral blood (Peripheral blood)
CL Item
Cord blood (Cord blood)
Identification of Donor or Cord Blood Unit given by the centre
Item
Identification of Donor or Cord Blood Unit
integer
C1550613 (UMLS CUI [1])
Number in the infusion order
Item
Number in the infusion order
integer
C0574032 (UMLS CUI [1])
Item
HLA MATCH TYPE
text
C0242318 (UMLS CUI [1])
HLA MATCH TYPE
Code List
HLA MATCH TYPE
CL Item
HLA-identical sibling (may include non-monozygotic twin) (HLA-identical sibling (may include non-monozygotic twin))
CL Item
Syngeneic (monozygotic twin) (Syngeneic (monozygotic twin))
CL Item
HLA-matched other relative (HLA-matched other relative)
CL Item
HLA-mismatched relative:Degree of allele mismatch (HLA-mismatched relative:Degree of allele mismatch)
CL Item
1 HLA antigen mismatch ALLMISRL (1 HLA antigen mismatch ALLMISRL)
CL Item
> 2 HLA antigen mismatch (> 2 HLA antigen mismatch)
CL Item
Unrelated donor (Unrelated donor)
Name of the Donor registry
Item
Name of the Donor registry
integer
C1549696 (UMLS CUI [1])
BMDW / WMDA code for the donor registry (up to 4 characters)
Item
BMDW / WMDA code for the donor registry (up to 4 characters)
integer
C2987198 (UMLS CUI [1])
Name of the Cord blood bank
Item
Name of the Cord blood bank
integer
C0005770 (UMLS CUI [1])
Eurocord code for the cord blood bank
Item
Eurocord code for the cord blood bank
integer
C0005770 (UMLS CUI [1,1])
C0805701 (UMLS CUI [1,2])
Item Group
HLA MISMATCHES BETWEEN DONOR AND PATIENT
Item
Serology A
integer
C0019728 (UMLS CUI [1])
Serology
Code List
Serology A
CL Item
match (0)
CL Item
one mismatch (1)
CL Item
2 mismatches (2)
CL Item
not evaluated (N/E)
Item
Serology B
integer
C0019737 (UMLS CUI [1])
Serology
Code List
Serology B
CL Item
match (0)
CL Item
one mismatch (1)
CL Item
2 mismatches (2)
CL Item
not evaluated (N/E)
Item
Serology C
integer
C0019751 (UMLS CUI [1])
Serology
Code List
Serology C
CL Item
match (0)
CL Item
one mismatch (1)
CL Item
2 mismatches (2)
CL Item
not evaluated (N/E)
Item
Serology DRB1
integer
C0122040 (UMLS CUI [1])
Serology
Code List
Serology DRB1
CL Item
match  (0)
CL Item
one mismatch (1)
CL Item
2 mismatches  (2)
CL Item
not evaluated (N/E)
Item
Serology DQB1
integer
C0122020 (UMLS CUI [1])
Serology
Code List
Serology DQB1
CL Item
match  (0)
CL Item
one mismatch (1)
CL Item
2 mismatches  (2)
CL Item
not evaluated (N/E)
Item
Serology DPB1
integer
C0555918 (UMLS CUI [1])
Serology
Code List
Serology DPB1
CL Item
match  (0)
CL Item
one mismatch (1)
CL Item
2 mismatches  (2)
CL Item
not evaluated (N/E)
Item
DNA A
text
C0019729 (UMLS CUI [1])
DNA
Code List
DNA A
CL Item
match  (0)
CL Item
one mismatch (1)
CL Item
2 mismatches  (2)
CL Item
not evaluated (N/E)
Item
DNA B
integer
C0019738 (UMLS CUI [1])
DNA
Code List
DNA B
CL Item
match  (0)
CL Item
one mismatch (1)
CL Item
2 mismatches  (2)
CL Item
not evaluated (N/E)
Item
DNA C
integer
C0019752 (UMLS CUI [1])
DNA
Code List
DNA C
CL Item
match  (0)
CL Item
one mismatch (1)
CL Item
2 mismatches  (2)
CL Item
not evaluated (N/E)
Item
DNA DRB1
integer
C1705258 (UMLS CUI [1])
DNA
Code List
DNA DRB1
CL Item
match  (0)
CL Item
one mismatch (1)
CL Item
2 mismatches  (2)
CL Item
not evaluated (N/E)
Item
DNA DQB1
integer
C0122020 (UMLS CUI [1])
DNA
Code List
DNA DQB1
CL Item
match  (0)
CL Item
one mismatch (1)
CL Item
2 mismatches  (2)
CL Item
not evaluated (N/E)
Item
DNA DPB1
integer
C0555918 (UMLS CUI [1])
DNA
Code List
DNA DPB1
CL Item
match  (0)
CL Item
one mismatch (1)
CL Item
2 mismatches  (2)
CL Item
not evaluated (N/E)
Item Group
BLOOD GROUP, DATE OF BIRTH AND SEX OF DONOR
Item
ABO group
integer
C0000778 (UMLS CUI [1])
ABO group
Code List
ABO group
CL Item
A (A)
CL Item
B (B)
CL Item
AB (AB)
CL Item
O (O)
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Item
Sex
integer
C0079399 (UMLS CUI [1])
Sex
Code List
Sex
CL Item
Male (1)
C1706180 (UMLS CUI-1)
CL Item
Female (2)
C0015780 (UMLS CUI-1)
Item Group
STATUS OF THE DONOR OR CORD BLOOD UNIT BEFORE HSCT
Item
HIV
integer
C0019682 (UMLS CUI [1])
HIV
Code List
HIV
CL Item
Negative  (Negative )
C0205160 (UMLS CUI-1)
CL Item
Positive  (Positive )
C1446409 (UMLS CUI-1)
CL Item
Not evaluated  (Not evaluated )
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
HIV ANTIGENS (if testing applicable)
integer
C0019686 (UMLS CUI [1])
HIV
Code List
HIV ANTIGENS (if testing applicable)
CL Item
Negative  (Negative )
C0205160 (UMLS CUI-1)
CL Item
Positive  (Positive )
C1446409 (UMLS CUI-1)
CL Item
Not evaluated  (Not evaluated )
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
CMV
integer
C0582172 (UMLS CUI [1])
CMV
Code List
CMV
CL Item
Negative  (Negative )
C0205160 (UMLS CUI-1)
CL Item
Positive  (Positive )
C1446409 (UMLS CUI-1)
CL Item
Not evaluated  (Not evaluated )
C3846720 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
Item
EBV
integer
C0014644 (UMLS CUI [1])
EBV
Code List
EBV
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVs
integer
C0019163 (UMLS CUI [1])
HBVs
Code List
HBVs
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVs ANTIGENS (if testing applicable)
integer
C0019165 (UMLS CUI [1])
HBVs
Code List
HBVs ANTIGENS (if testing applicable)
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVc
integer
C1440681 (UMLS CUI [1])
HBVc
Code List
HBVc
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
HBVe
integer
C0019167 (UMLS CUI [1])
HBVe
Code List
HBVe
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
HCV
integer
C0220847 (UMLS CUI [1])
HCV
Code List
HCV
CL Item
Negative (Negative)
CL Item
Positive (Positive)
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
HCV ANTIGENS (if testing applicable)
integer
C0121459 (UMLS CUI [1])
HCV
Code List
HCV ANTIGENS (if testing applicable)
CL Item
Negative (Negative)
CL Item
Positive (Positive)
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
HTLV
integer
C0086427 (UMLS CUI [1])
HTLV.I
Code List
HTLV
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
Toxoplasmosis
integer
C0040558 (UMLS CUI [1])
Toxoplasmosis
Code List
Toxoplasmosis
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Not evaluated  (Not evaluated )
CL Item
Unknown (Unknown)
Item
if other Antibodies in the patient
integer
C0205394 (UMLS CUI [1])
Other
Code List
if other Antibodies in the patient
CL Item
Negative  (Negative )
CL Item
Positive  (Positive )
CL Item
Specify (Specify)
Date of harvest or cord blood collection
Item
Date of harvest or cord blood collection
date
C1512335 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
GROWTH FACTORS ADMINISTERED TO THE DONOR
integer
C0018284 (UMLS CUI [1])
GROWTH FACTORS ADMINISTERED TO THE DONOR
Code List
GROWTH FACTORS ADMINISTERED TO THE DONOR
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Item Group
HISTOCOMPATIBILITY RESULTS
Laboratory / Hospital
Item
Laboratory / Hospital
integer
C0022877 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Unit
Item
Unit
integer
C1519795 (UMLS CUI [1])
telephone number
Item
Contact number
integer
C1515258 (UMLS CUI [1])
Technique
Item
Technique Used
integer
C0034925 (UMLS CUI [1,1])
C0449851 (UMLS CUI [1,2])
Serology (antigenic) HLA typing
Item
Serology (antigenic) HLA typing done
boolean
C0242318 (UMLS CUI [1])
Item Group
DNA (Allelic/molecular) HLA typing done
DNA (Allelic/molecular) HLA typing done
Item
DNA (Allelic/molecular) HLA typing done
boolean
C0242318 (UMLS CUI [1])
Item
DNA (Allelic/molecular) HLA typing done: Locus
integer
C1321760 (UMLS CUI [1])
Locus
Code List
DNA (Allelic/molecular) HLA typing done: Locus
CL Item
A (A)
CL Item
B (B)
CL Item
C (C)
CL Item
DRB1 (DRB1)
CL Item
DQB1 (DQB1)
CL Item
DPB1 (DPB1)
HLA string
Item
HLA string
integer
C1547402 (UMLS CUI [1,1])
C0019721 (UMLS CUI [1,2])
NMDP code
Item
NMDP code
integer
C1882036 (UMLS CUI [1,1])
C1827636 (UMLS CUI [1,2])
Item Group
Serology (antigenic) HLA typing done
Serology (antigenic) HLA typing done
Item
Serology (antigenic) HLA typing done
boolean
C0242318 (UMLS CUI [1])
Item
HLA Serology
integer
C0242318 (UMLS CUI [1])
Serology
Code List
HLA Serology
CL Item
A (A)
C0019728 (UMLS CUI-1)
CL Item
B (B)
C0019737 (UMLS CUI-1)
CL Item
C (C)
C0019751 (UMLS CUI-1)
CL Item
DRB1 (DRB1)
C0122040 (UMLS CUI-1)
CL Item
DQB1 (DQB1)
C0122020 (UMLS CUI-1)
CL Item
DPB1 (DPB1)
C0555918 (UMLS CUI-1)
Item Group
GRAFT MANIPULATION
Identification of donor or Cord Blood Unit given by the centre
Item
Identification of donor or Cord Blood Unit given by the centre
integer
C1827636 (UMLS CUI [1])
Number in the infusion order
Item
Number in the infusion order (if applicable)
text
C0237753 (UMLS CUI [1])
GRAFT MANIPULATION EX-VIVO (INCLUDING T-CELL DEPLETION)
Item
GRAFT MANIPULATION EX-VIVO (INCLUDING T-CELL DEPLETION)
boolean
C0677960 (UMLS CUI [1])
Item
NEGATIVE SELECTION
integer
C2347338 (UMLS CUI [1])
GRAFT MANIPULATION EX-VIVO (INCLUDING T-CELL DEPLETION)
Code List
NEGATIVE SELECTION
CL Item
No  (No )
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Item
if negative selection, specify
integer
C2347338 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
GRAFT MANIPULATION EX-VIVO (INCLUDING T-CELL DEPLETION)
Code List
if negative selection, specify
CL Item
B-cell depletion by MoAB  (B-cell depletion by MoAB )
C1171324 (UMLS CUI-1)
CL Item
NK cell depletion by MoAB  (NK cell depletion by MoAB )
C0022688 (UMLS CUI-1)
CL Item
Elutriation  (Elutriation )
C0872136 (UMLS CUI-1)
CL Item
Other (Other)
C0205394 (UMLS CUI-1)
CL Item
T-cell depletion by MoAB (do not enter  (T-cell depletion by MoAB (do not enter )
C0677960 (UMLS CUI-1)
Item
if positive selection, splease specify:
integer
C2347644 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
GRAFT MANIPULATION EX-VIVO (INCLUDING T-CELL DEPLETION)
Code List
if positive selection, splease specify:
CL Item
No (No)
C1298908 (UMLS CUI-1)
CL Item
Yes: Monoclonal antibodies (Yes: Monoclonal antibodies)
C3542957 (UMLS CUI-1)
CL Item
unknown (unknown)
C0439673 (UMLS CUI-1)
Item
Monoclonal antibodies
integer
C3542957 (UMLS CUI [1])
Monoclonal antibodies
Code List
Monoclonal antibodies
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Item
Monoclonal antibodies: if yes
integer
C0003250 (UMLS CUI [1])
Monoclonal antibodies
Code List
Monoclonal antibodies: if yes
CL Item
CD 34+  (CD 34+ )
C3538723 (UMLS CUI-1)
CL Item
Other (Other)
C0205394 (UMLS CUI-1)
Item
EXPANSION
integer
C0040290 (UMLS CUI [1])
EXPANSION
Code List
EXPANSION
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Item
GENE MANIPULATION (gene transfer/transduction)
integer
C0947647 (UMLS CUI [1])
GENE MANIPULATION
Code List
GENE MANIPULATION (gene transfer/transduction)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Item Group
CELL INFUSION
Identification of donor or Cord Blood Unit given by the centre
Item
IF MULTIPLE DONORS: Identification of donor or Cord Blood Unit given by the centre (please, use same ID as in the preceding sheets)
text
Number in the infusion order
Item
Number in the infusion order (if applicable)
text
C0237753 (UMLS CUI [1])
Item
CELL INFUSION METHOD Fill in for Cord Blood HSCT only
text
Route of infusion
Code List
CELL INFUSION METHOD Fill in for Cord Blood HSCT only
CL Item
Intravenous (IV) (Intravenous (IV))
CL Item
intrabone / intramedullary (intrabone / intramedullary)
CL Item
Other, specify (Other, specify)
CL Item
unknown (unknown)
Route of infusion: If other, please specify:
Item
Route of infusion: If other, please specify:
integer
C1827465 (UMLS CUI [1])
Item
Infusion method
integer
C0574032 (UMLS CUI [1])
Infusion method
Code List
Infusion method
CL Item
DMSO (DMSO)
CL Item
Wash (Rubinstein/New York) (Wash (Rubinstein/New York))
CL Item
Other, specify (Other, specify)
Infusion method: if other, please specify
Item
Infusion method: if other, please specify
integer
C0574032 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
Item Group
CELL VIABILITY RESULTS AT HSCT CENTRE
Item
Tests performed after thawing of an aliquot on
integer
C1521902 (UMLS CUI [1])
Tests performed after thawing of an aliquot on
Code List
Tests performed after thawing of an aliquot on
CL Item
Contiguous segment  (Contiguous segment )
C1511492 (UMLS CUI-1)
CL Item
Reference bag  (Reference bag )
C0034925 (UMLS CUI-1)
CL Item
unknown (unknown)
C0439673 (UMLS CUI-1)
Item
Method used
integer
C0871511 (UMLS CUI [1])
Method used
Code List
Method used
CL Item
7-AAD (7-AAD)
C0049832 (UMLS CUI-1)
CL Item
Acridine orange-ethidium iodide (Acridine orange-ethidium iodide)
C0001185 (UMLS CUI-1)
CL Item
Trypan blue (Tryptan blue)
C0041213 (UMLS CUI-1)
CL Item
Other, specify (Other, specify)
C1299220 (UMLS CUI-1)
CL Item
Acridine orange-ethidium bromide (Acridine orange-ethidium bromide)
C0001185 (UMLS CUI-1)
CL Item
unknown (unknown)
C0439673 (UMLS CUI-1)
Viability of all cells
Item
Viability of all cells
float
C1516362 (UMLS CUI [1])
Viability of CD34+ cells
Item
Viability of CD34+ cells
float
C1516362 (UMLS CUI [1,1])
C0882849 (UMLS CUI [1,2])
Item Group
CELLS INFUSED FROM THIS DONOR AND STEM CELL SOURCE COMBINATION
Item
Bone Marrow: Total number of cells actually infused
integer
C2145394 (UMLS CUI [1,1])
C0005953 (UMLS CUI [1,2])
Bone Marrow: Total number of cells actually infused
Code List
Bone Marrow: Total number of cells actually infused
CL Item
CD 34+ (cells/kg*)  (1)
CL Item
Nucleated cells (/kg*) (2)
CL Item
T-cells (CD 3+) (cells/kg*) (3)
Item
Bone Marrow: Total number of cells actually infused, specify:
integer
C2145394 (UMLS CUI [1,1])
C0005953 (UMLS CUI [1,2])
Bone Marrow
Code List
Bone Marrow: Total number of cells actually infused, specify:
CL Item
Not evaluated  (Not evaluated )
CL Item
unknown (unknown)
Item
Peripheral Blood: Total number of cells actually infused
integer
C0229664 (UMLS CUI [1,1])
C2145394 (UMLS CUI [1,2])
Peripheral Blood: Total number of cells actually infused
Code List
Peripheral Blood: Total number of cells actually infused
CL Item
T-cells (CD 3+) (cells/kg*)  (1)
CL Item
Nucleated cells (/kg*) (2)
CL Item
CD 34+ (cells/kg*) (3)
Item
Peripheral Blood: Total number of cells actually infused
integer
C0229664 (UMLS CUI [1,1])
C2145394 (UMLS CUI [1,2])
Peripheral Blood: Total number of cells actually infused
Code List
Peripheral Blood: Total number of cells actually infused
CL Item
unknown (1)
CL Item
not evluated (2)
Item
Cord Blood: Total number of cellsactually infused
integer
C0162371 (UMLS CUI [1,1])
C2145394 (UMLS CUI [1,2])
Cord Blood: Total number of cellsactually infused
Code List
Cord Blood: Total number of cellsactually infused
CL Item
CD 34+ (cells/kg*)  (1)
C0054953 (UMLS CUI-1)
CL Item
Nucleated cells (/kg*) (2)
C1180059 (UMLS CUI-1)
CL Item
T-cells (CD 3+) (cells/kg*) (3)
C0039194 (UMLS CUI-1)
Item
Cord Blood: Total number of cellsa ctually infused
integer
C0162371 (UMLS CUI [1,1])
C2145394 (UMLS CUI [1,2])
Cord Blood
Code List
Cord Blood: Total number of cellsa ctually infused
CL Item
Not evaluated  (Not evaluated )
CL Item
unknown (unknown)
Item Group
HSC TRANSPLANTATION
Chronological number
Item
Chronological number of HSCT for this patient
integer
C1318453 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Item
Donor the same as for previous HSCT?
integer
C0013018 (UMLS CUI [1,1])
C0472699 (UMLS CUI [1,2])
Donor the same as for previous HSCT?
Code List
Donor the same as for previous HSCT?
CL Item
No  (No )
CL Item
Yes  (Yes )
CL Item
Previous HSCT(s) autologous (Previous HSCT(s) autologous)
Date of previous HSCT
Item
Date of previous HSCT
date
C0018956 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Type of previous HSCT
integer
C0472699 (UMLS CUI [1])
Type of previous HSCT
Code List
Type of previous HSCT
CL Item
Allo (Allo)
CL Item
Auto (Auto)
Item
Reason for this transplant
integer
C1718260 (UMLS CUI [1])
Reason for this transplant
Code List
Reason for this transplant
CL Item
Relapse/progression after previous HSCT (Relapse/progression after previous HSCT)
CL Item
Graft failure after allo BMT (Graft failure after allo BMT)
CL Item
Other (Other)
Item
HSCT part of a multiple sequential graft protocol
integer
C0442711 (UMLS CUI [1])
HSCT part of a multiple sequential graft protocol
Code List
HSCT part of a multiple sequential graft protocol
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Type of multiple graft protocol
Item
Type of multiple graft protocol
integer
C0442711 (UMLS CUI [1])
Graft number in the protocol
Item
Graft number in the protocol
integer
C1961139 (UMLS CUI [1])
total number of HSCTs in the program
Item
total number of HSCTs in the program
integer
C0449788 (UMLS CUI [1,1])
C0472699 (UMLS CUI [1,2])
Item Group
PREPARATIVE TREATMENT (conditioning)
PREPARATIVE (CONDITIONING) REGIMEN GIVEN
Item
PREPARATIVE (CONDITIONING) REGIMEN GIVEN
boolean
C1882454 (UMLS CUI [1])
Item
Was regimen intended to be myeloablative
integer
C1882454 (UMLS CUI [1,1])
C1513784 (UMLS CUI [1,2])
Was regimen intended to be myeloablative
Code List
Was regimen intended to be myeloablative
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Item
Reason not myeloablative
integer
C1831742 (UMLS CUI [1])
Reason not myeloablative
Code List
Reason not myeloablative
CL Item
Age of recipient (Age of recipient)
CL Item
Comorbid conditions (Comorbid conditions)
CL Item
Prior HSCT (Prior HSCT)
CL Item
Protocol driven (Protocol driven)
CL Item
Other, specify (Other, specify)
Item
Drugs
integer
C0013227 (UMLS CUI [1])
Drugs
Code List
Drugs
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Item Group
Drugs
NAME OF DRUG
Item
NAME OF DRUG
text
C3273235 (UMLS CUI [1])
CUMULATIVE DOSE
Item
PRESCRIBED CUMULATIVE DOSE AS PER PROTOCOL (DAILY DOSE BY NUMBER OF DAYS)
integer
C2986497 (UMLS CUI [1])
Item
IF MONOCLONAL ANTIBODY, RADIO LABELLED?
integer
C0003250 (UMLS CUI [1])
IF MONOCLONAL ANTIBODY, RADIO LABELLED?
Code List
IF MONOCLONAL ANTIBODY, RADIO LABELLED?
CL Item
No (1)
CL Item
Yes (2)
CL Item
Unknown (3)
Item
UNITS IF RADIO LABELLED
integer
C0041697 (UMLS CUI [1])
UNITS IF RADIO LABELLED
Code List
UNITS IF RADIO LABELLED
CL Item
mCi (1)
CL Item
mBq (2)
Item
Route of administration
integer
C0013153 (UMLS CUI [1])
ADDITIONAL DRUG INFORMATION
Code List
Route of administration
CL Item
Oral  (Oral )
CL Item
IV  (IV )
CL Item
Both (Both)
Item
Animal origin
integer
C3494749 (UMLS CUI [1])
Animal origin
Code List
Animal origin
CL Item
Horse  (Horse )
CL Item
Rabbit  (Rabbit )
CL Item
Other, specify (Other, specify)
Item
TBI
integer
C1456496 (UMLS CUI [1])
TBI
Code List
TBI
CL Item
No  (No )
CL Item
Yes  (Yes )
CL Item
Unknown (Unknown)
Total dose
Item
Total dose (Gy)
float
C2919490 (UMLS CUI [1])
Number of fractions
Item
Number of fractions
float
C0454266 (UMLS CUI [1])
radiation days
Item
radiation days
integer
C3693616 (UMLS CUI [1])
Item
TLI / TNI / TAI
integer
C3670574 (UMLS CUI [1])
C0077401 (UMLS CUI [2])
TLI / TNI / TAI
Code List
TLI / TNI / TAI
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Item
Local radiotherapy
integer
C1522449 (UMLS CUI [1])
Local radiotherapy
Code List
Local radiotherapy
CL Item
No  (No )
CL Item
Yes  (Yes )
CL Item
Unknown (Unknown)
Item Group
TREATMENT DURING THE IMMEDIATE POST-TRANSPLANT PERIOD
Item
GROWTH FACTORS (CYTOKINES)
integer
C0018284 (UMLS CUI [1])
GROWTH FACTORS (CYTOKINES)
Code List
GROWTH FACTORS (CYTOKINES)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
nknown (nknown)
GROWTH FACTORS: If yes, please specify
Item
GROWTH FACTORS: If yes, please specify
text
C0018284 (UMLS CUI [1,1])
C4035158 (UMLS CUI [1,2])
Date started
Item
Date started
date
C3173309 (UMLS CUI [1])
Item
CELLULAR THERAPY
integer
C0302189 (UMLS CUI [1])
CELLULAR THERAPY
Code List
CELLULAR THERAPY
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Date of first infusion
Item
Date of first infusion
date
C0574032 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
CELLULAR THERAPY: if yes, specify:
integer
C0302189 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
CELLULAR THERAPY
Code List
CELLULAR THERAPY: if yes, specify:
CL Item
Donor lymphocyte infusion (DLI) (only lymphocytes from same donor(s) as HSCT) (Donor lymphocyte infusion (DLI) (only lymphocytes from same donor(s) as HSCT))
CL Item
Mesenchymal cells (Mesenchymal cells)
CL Item
Other (Other)
CL Item
Unknown (Unknown)
Item Group
Number of cells infused by type
Nucleated cells
Item
Nucleated cells
float
C1180059 (UMLS CUI [1])
Item
Nucleated cells
integer
C1180059 (UMLS CUI [1])
Nucleated cells (/kg*)
Code List
Nucleated cells
CL Item
Not evaluated (Not evaluated)
CL Item
unknown (unknown)
CD 34+
Item
CD 34+ (cells/kg*)
integer
C3538723 (UMLS CUI [1])
Item
CD 34+ (cells/kg*)
integer
C3538723 (UMLS CUI [1])
CD 34+ (cells/kg*)
Code List
CD 34+ (cells/kg*)
CL Item
Not evaluated (1)
CL Item
unknown (2)
CD 3+
Item
CD 3+ (cells/kg*)
float
C0483189 (UMLS CUI [1])
Item
CD 3+ (cells/kg*)
integer
C0483189 (UMLS CUI [1])
CD 3+ (cells/kg*)
Code List
CD 3+ (cells/kg*)
CL Item
Not evaluated (1)
CL Item
unknown (2)
Item Group
Total number of cells infused
All cells
Item
All cells (cells/kg*) (non DLI only)
float
C2322965 (UMLS CUI [1])
Chronological number of this cell therapy for this patient
Item
Chronological number of this cell therapy for this patient
integer
C0302189 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Item
Indication
text
C3146298 (UMLS CUI [1])
Indication
Code List
Indication
CL Item
Planned/protocol  (Planned/protocol )
CL Item
Treatment for disease (Treatment for disease)
CL Item
Loss/decreased chimaerism  (Loss/decreased chimaerism )
CL Item
Mixed chimaerism (Mixed chimaerism)
CL Item
Treatment of GvHD  (Treatment of GvHD )
CL Item
Treatment viral infection (Treatment viral infection)
CL Item
Treatment PTLD, EBV lymphoma (Treatment PTLD, EBV lymphoma)
CL Item
Other (Other)
Number of infusions within 10 weeks
Item
Number of infusions within 10 weeks count only infusions that are part of same regimen and given for the same indication
integer
C0449788 (UMLS CUI [1,1])
C0574032 (UMLS CUI [1,2])
Item
GVHD PREVENTION IN THE RECIPIENT (THERAPEUTIC IMMUNOSUPPRESSION)
integer
C0018133 (UMLS CUI [1,1])
C0199176 (UMLS CUI [1,2])
GVHD PREVENTION IN THE RECIPIENT (THERAPEUTIC IMMUNOSUPPRESSION)
Code List
GVHD PREVENTION IN THE RECIPIENT (THERAPEUTIC IMMUNOSUPPRESSION)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Unknown (3)
Item
chemotherapy
integer
C0392920 (UMLS CUI [1])
Drugs
Code List
chemotherapy
CL Item
Cyclosporine (Cyclosporine)
CL Item
Methotrexate (Methotrexate)
CL Item
ATG/ALG (if started after day 0) (ATG/ALG (if started after day 0))
CL Item
Corticosteroids (if started after day 0) (Corticosteroids (if started after day 0))
CL Item
Mycophenolate (Mycophenolate)
CL Item
Tacrolimus (Tacrolimus)
CL Item
Monoclonal antibodies, specify (Monoclonal antibodies, specify)
CL Item
Extra-corporeal photopheresis (ECP) (Extra-corporeal photopheresis (ECP))
CL Item
Other (Other)
Monoclonal antibodies
Item
Monoclonal antibodies, specify
integer
C3542957 (UMLS CUI [1])
Drugs: If Other, please specify
Item
Drugs: If Other, please specify
integer
C0013227 (UMLS CUI [1,1])
C4035158 (UMLS CUI [1,2])
Item Group
GRAFT PERFORMANCE
Item
GRAFT PERFORMANCE
integer
C0301944 (UMLS CUI [1])
GRAFT PERFORMANCE
Code List
GRAFT PERFORMANCE
CL Item
Yes (Yes)
CL Item
No reconstitution (No reconstitution)
CL Item
Lost graft (Lost graft)
Item
Neutrophils > 0.5 x 109/l reached?
integer
C0948762 (UMLS CUI [1])
Neutrophils > 0.5 x 109/l reached?
Code List
Neutrophils > 0.5 x 109/l reached?
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Never below this level (Never below this level)
Item
Platelets > 20 x 109/l reached?
integer
C0005821 (UMLS CUI [1])
Platelets > 20 x 109/l reached?
Code List
Platelets > 20 x 109/l reached?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Never below this level (3)
Date last assessment
Item
Date last assessment
date
C2985720 (UMLS CUI [1])
Date of graft failure
Item
Date of graft failure
date
C1262018 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Overall chimaerism
integer
C0333678 (UMLS CUI [1])
HAEMOPOIETIC CHIMAERISM
Code List
Overall chimaerism
CL Item
Full (donor >95 %)  (Full (donor >95 %) )
CL Item
Mixed (partial) (Mixed (partial))
CL Item
Autologous reconstitution (recipient >95 %)  (Autologous reconstitution (recipient >95 %) )
CL Item
Aplasia (Aplasia)
CL Item
Not evaluated (Not evaluated)
Item Group
DATE(S) AND RESULTS OF ALL TESTS DONE FOR ALL DONORS
undefined item
Item
text
Date of test
Item
Date of test
date
Identification
Item
Identification of donor or Cord Blood Unit given by the centre
text
C1718162 (UMLS CUI [1])
Number in the infusion order
Item
Number in the infusion order (if applicable)
text
C0237753 (UMLS CUI [1])
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-cell
Item
Cell type on which test was performed
float
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 cell type - value
Item
Cell type on which test was performed (% Donor cells): Other
float
C0449475 (UMLS CUI [1,1])
C1522609 (UMLS CUI [1,2])
Item
Test used
integer
C0022885 (UMLS CUI [1])
Laboratory tests
Code List
Test used
CL Item
FISH (FISH)
CL Item
Molecular (Molecular)
CL Item
Cytogenetic (Cytogenetic)
CL Item
ABO group (ABO group)
CL Item
Other (Other)
CL Item
unknown (unknown)
Item
TREATMENT FOR FAILURE (If engraftment failure)
integer
TREATMENT FOR FAILURE
Code List
TREATMENT FOR FAILURE (If engraftment failure)
CL Item
No (1)
CL Item
Growth factors GRFAIGRF (2)
CL Item
Subsequent transplant (please complete a new transplant form) (3)
CL Item
AUTOgraft (must have prior conditioning) (4)
CL Item
ALLOgraft (5)
CL Item
Autologous PBSC re-infusion (no preparative treatment or conditioning) (6)
CL Item
Autologous BM re-infusion (no preparative treatment or conditioning) (7)
CL Item
Other (8)
Item Group
ACUTE GRAFT VERSUS HOST DISEASE (GvHD)
Item
Maximum grade ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)
integer
Maximum grade
Code List
Maximum grade ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)
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)
Date of onset
Item
Date of onset
date
C0574845 (UMLS CUI [1])
Item
Stage skin
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C1306673 (UMLS CUI [1,3])
aGvHD Stage Skin
Code List
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)
Item
Stage liver
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C0023884 (UMLS CUI [1,3])
aGvHD Stage liver
Code List
Stage liver
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)
Item
Stage gut
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C0021853 (UMLS CUI [1,3])
aGvHD stage gut
Code List
Stage gut
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)
Item
Resolution
integer
C0856825 (UMLS CUI [1,1])
C1514893 (UMLS CUI [1,2])
aGvHD Resolution
Code List
Resolution
CL Item
No  (1)
CL Item
Yes (2)
aGvHD Date of resolution
Item
Date of resolution
date
C0856825 (UMLS CUI [1,1])
C1514893 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Treatment
Item
Treatment
boolean
Item
Treatment, if yes
text
Treatment
Code List
Treatment, if yes
CL Item
Corticosteroids (Corticosteroids)
CL Item
ATG/ALG (ATG/ALG)
CL Item
MoAB (MoAB)
CL Item
Other (Other)
Item Group
COMPLICATIONS WITHIN THE FIRST 100 DAYS.
INFECTION RELATED COMPLICATIONS
Item
INFECTION RELATED COMPLICATIONS
boolean
C0009450 (UMLS CUI [1,1])
C0009566 (UMLS CUI [1,2])
Item
Pathogen
integer
C0450254 (UMLS CUI [1])
Pathogen
Code List
Pathogen
CL Item
Bacteraemia/ fungemia / viremia / parasites (1)
CL Item
Septic shock (2)
CL Item
ARDS (3)
CL Item
Multiorgan failure due to infection (4)
CL Item
Pneumonia (5)
CL Item
Hepatitis (6)
CL Item
CNS infection (7)
CL Item
Gut infection (8)
CL Item
Retinitis (9)
CL Item
Cystitis (10)
CL Item
Other (11)
Item
NON INFECTION RELATED COMPLICATIONS
integer
C0009566 (UMLS CUI [1])
NON INFECTION RELATED COMPLICATIONS
Code List
NON INFECTION RELATED COMPLICATIONS
CL Item
No complications (1)
CL Item
Yes (2)
Item
Specify: Idiopathic pneumonia syndrome
text
C1504431 (UMLS CUI [1])
Idiopathic pneumonia syndrome
Code List
Specify: Idiopathic pneumonia syndrome
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Specify: VOD
text
C0948441 (UMLS CUI [1])
VOD
Code List
Specify: VOD
CL Item
Yes (Yes)
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Specify: Haemorrhagic cystitis, non infectious
text
C0085692 (UMLS CUI [1])
Haemorrhagic cystitis, non infectious
Code List
Specify: Haemorrhagic cystitis, non infectious
CL Item
Yes  (Yes )
CL Item
No  (No )
CL Item
Unknown (Unknown)
Item
Specify: ARDS, non infectious
text
C0035222 (UMLS CUI [1])
ARDS, non infectious
Code List
Specify: ARDS, non infectious
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Multiorgan failure, non infectious
integer
C0026766 (UMLS CUI [1])
Multiorgan failure, non infectious
Code List
Multiorgan failure, non infectious
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Specify: HSCT-associated microangiopathy
text
C0155765 (UMLS CUI [1])
HSCT-associated microangiopathy
Code List
Specify: HSCT-associated microangiopathy
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Specify: Renal failure requiring dialysis
text
C0035078 (UMLS CUI [1])
Renal failure requiring dialysis
Code List
Specify: Renal failure requiring dialysis
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Specify: Haemolytic anaemia due to blood group
text
C0002878 (UMLS CUI [1])
Haemolytic anaemia due to blood group
Code List
Specify: Haemolytic anaemia due to blood group
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Other type of infection
Item
Other type of infection
boolean
C0457463 (UMLS CUI [1])
Idiopathic pneumonia syndrome date
Item
Idiopathic pneumonia syndrome date
date
C1504431 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date VOD
Item
Date VOD
date
C0948441 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date Haemorrhagic cystitis, non infectious
Item
Date Haemorrhagic cystitis, non infectious
date
C0085692 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date ARDS, non infectious
Item
Date ARDS, non infectious
date
C0035222 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date Multiorgan failure, non infectious
Item
Date Multiorgan failure, non infectious
date
C0026766 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date HSCT-associated microangiopathy
Item
Date HSCT-associated microangiopathy
date
C0155765 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date Renal failure requiring dialysis
Item
Date Renal failure requiring dialysis
date
C0035078 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
DAte Haemolytic anaemia due to blood group
Item
DAte Haemolytic anaemia due to blood group
date
C0002878 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date of other Type
Item
Date of other Type
date
C2316983 (UMLS CUI [1,1])
C0220886 (UMLS CUI [1,2])
Item Group
STATUS AT 100 DAYS
LastContactDate
Item
Date of Last Contact
date
C0011008 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C1705415 (UMLS CUI [1,3])
C1517741 (UMLS CUI [1,4])
Item
Presence of cGVHD
integer
C0867389 (UMLS CUI [1])
Presence of cGVHD
Code List
Presence of cGVHD
CL Item
No (1)
CL Item
Yes, First Episode (2)
CL Item
Yes, Recurrence (3)
Date of Onset
Item
Onset
date
C0574845 (UMLS CUI [1])
Item
cGvHD grade
integer
C0867389 (UMLS CUI [1,1])
C0441800 (UMLS CUI [1,2])
cGvHD grade
Code List
cGvHD grade
CL Item
limited (1)
CL Item
Extensive (2)
CL Item
not evaluated (3)
Item
Organs affected
integer
C0449642 (UMLS CUI [1])
Organs affected
Code List
Organs affected
CL Item
Skin (1)
CL Item
Gut (2)
CL Item
Liver (3)
CL Item
Mouth (4)
CL Item
Eyes (5)
CL Item
Lung (6)
CL Item
Other, specify (7)
CL Item
Unknown (8)
Item
Relapse or progression
integer
C0035020 (UMLS CUI [1])
C0242656 (UMLS CUI [2])
Relapse or progression
Code List
Relapse or progression
CL Item
Previously reported (1)
CL Item
No (2)
CL Item
yes (3)
CL Item
Continuous progression since transplant (4)
CL Item
Unknown (5)
RELAPSE OR PROGRESSION: If yes, date diagnosed
Item
RELAPSE OR PROGRESSION: If yes, date diagnosed
date
C0035020 (UMLS CUI [1])
C0242656 (UMLS CUI [2])
C2316983 (UMLS CUI [3])
Item Group
Method of detection
Item
Cinical/haematological relapse or progression
integer
C0018939 (UMLS CUI [1,1])
C0205210 (UMLS CUI [1,2])
Clinical/hematological
Code List
Cinical/haematological relapse or progression
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
Cinical/haematological relapse or progression
Item
Date assessed
date
Cinical/haematological relapse or progression
Item
Date first seen
date
Item
Cytogenetic relapse or progression
integer
C0010802 (UMLS CUI [1])
Cytogenetic relapse or progression
Code List
Cytogenetic relapse or progression
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
Cytogenetic relapse or progression: Date assessed
Item
Cytogenetic relapse or progression: Date assessed
date
C0010802 (UMLS CUI [1,1])
C0035020 (UMLS CUI [1,2])
C2985720 (UMLS CUI [1,3])
Cytogenetic relapse or progression: Date first seen
Item
Cytogenetic relapse or progression: Date first seen
date
C0035020 (UMLS CUI [1,1])
C3483766 (UMLS CUI [1,2])
Item
Molecular relapse or progression
integer
C0026376 (UMLS CUI [1])
Molecular relapse or progression
Code List
Molecular relapse or progression
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
Molecular relapse or progression: date assessed
Item
date
C0035020 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Molecular relapse or progression: Date first seen
Item
Molecular relapse or progression: Date first seen
date
C3483766 (UMLS CUI [1,1])
C0035020 (UMLS CUI [1,2])
Item Group
LAST DISEASE STATUS
Item
Clinical/haematological
integer
C0018939 (UMLS CUI [1,1])
C0205210 (UMLS CUI [1,2])
Clinical/haematological
Code List
Clinical/haematological
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
Date of Evaluation
Item
Last date evaluated/Last date assessed
date
C2985720 (UMLS CUI [1])
Item
Cytogenetic/FISH
integer
C0010802 (UMLS CUI [1,1])
C0162789 (UMLS CUI [1,2])
Cytogenetics/FISH
Code List
Cytogenetic/FISH
CL Item
No (1)
CL Item
Yes: Considered disease relapse/progression No (2)
CL Item
Yes: Considered disease relapse/progression Yes (3)
CL Item
Yes: Considered disease relapse/progression Not evaluated (4)
Last date assessed
Item
Last date assessed
date
Item
Molecular
text
C0026376 (UMLS CUI [1])
Molecular
Code List
Molecular
CL Item
No (No)
CL Item
yes (yes)
CL Item
No Considered disease relapse/progression (No Considered disease relapse/progression)
CL Item
Yes Considered disease relapse/progression (Yes Considered disease relapse/progression)
CL Item
Not evaluated (Not evaluated)
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:
text
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
Score
integer
C1518965 (UMLS CUI [1])
Performance score
Code List
Score
CL Item
100 (Normal, NED) (1)
CL Item
10 (Moribund) (10)
CL Item
Not evaluated (11)
CL Item
Unknown (12)
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)
Item
Cause of death (if dead)
integer
C0007465 (UMLS CUI [1])
Cause of death
Code List
Cause of death (if dead)
CL Item
Relapse or progression (1)
CL Item
Secondary malignancy (including lymphoproliferative disease) (2)
CL Item
Transplantation related cause  (3)
CL Item
Unknown (4)
CL Item
Other (5)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): GvHD
text
C0007465 (UMLS CUI [1,1])
C0018133 (UMLS CUI [1,2])
GvHD
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): GvHD
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Interstitial Pneumonitis
text
C0007465 (UMLS CUI [1,1])
C0206061 (UMLS CUI [1,2])
Interstitial Pneumonitis
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Interstitial Pneumonitis
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Pulmonary toxicity
text
C0007465 (UMLS CUI [1,1])
C0919924 (UMLS CUI [1,2])
Pulmonary toxicity
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Pulmonary toxicity
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Item
Infection:
integer
C0009450 (UMLS CUI [1])
Infection
Code List
Infection:
CL Item
bacterial  (1)
CL Item
viral  (2)
CL Item
fungal  (3)
CL Item
parasitic  (4)
CL Item
unknown (5)
Item
Rejection / poor graft function
integer
C0018129 (UMLS CUI [1])
Rejection / poor graft function
Code List
Rejection / poor graft function
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Veno-Occlusive disease (VOD)
integer
C0007465 (UMLS CUI [1,1])
C0948441 (UMLS CUI [1,2])
Veno-Occlusive disease (VOD)
Code List
Veno-Occlusive disease (VOD)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Haemorrhage
text
C0007465 (UMLS CUI [1,1])
C0019080 (UMLS CUI [1,2])
Haemorrhage
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Haemorrhage
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Cardiac toxicity
text
C0007465 (UMLS CUI [1,1])
C0876994 (UMLS CUI [1,2])
Cardiac toxicity
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Cardiac toxicity
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Central nervous system toxicity
text
C0007465 (UMLS CUI [1,1])
C3160947 (UMLS CUI [1,2])
Central nervous system toxicity
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Central nervous system toxicity
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Gastro intestinal toxicity
text
C0007465 (UMLS CUI [1,1])
C1142499 (UMLS CUI [1,2])
Gastro intestinal toxicity
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Gastro intestinal toxicity
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Skin toxicity
text
C0007465 (UMLS CUI [1,1])
C1167791 (UMLS CUI [1,2])
Skin toxicity
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Skin toxicity
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Renal failure
text
C0007465 (UMLS CUI [1,1])
C0035078 (UMLS CUI [1,2])
Renal failure
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Renal failure
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Item
If dead and HSCT related cause of death, specify (check as many as apppropriate): Multiple organ failure
text
C0007465 (UMLS CUI [1,1])
C0026766 (UMLS CUI [1,2])
Multiple organ failure
Code List
If dead and HSCT related cause of death, specify (check as many as apppropriate): Multiple organ failure
CL Item
No  (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
COMMENTS
Item
COMMENTS
text
C0947611 (UMLS CUI [1])
IDENTIFICATION & SIGNATURE
Item
IDENTIFICATION & SIGNATURE
text
C0205396 (UMLS CUI [1,1])
C1519316 (UMLS CUI [1,2])
Item Group
ADDITIONAL NOTES IF APPLICABLE
Item Group
ALLOGRAFT APPENDIX
Item
Ethnicity
text
C0015031 (UMLS CUI [1])
Ethnicity
Code List
Ethnicity
CL Item
Hispanic or Latino (1)
CL Item
Not Hispanic or Latino (2)
Item
Race
text
C0034510 (UMLS CUI [1])
Race
Code List
Race
CL Item
White (1)
CL Item
Black (2)
CL Item
Asian (3)
CL Item
American Indian or Alaska Native (4)
CL Item
Native Hawaiian or Pacific Native (5)
CL Item
Other (6)
COMORBID CONDITIONS
Item
COMORBID CONDITIONS
boolean
C1275743 (UMLS CUI [1])
Item
Solid tumor
integer
C0280100 (UMLS CUI [1])
Solid tumor, previously present
Code List
Solid tumor
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
Inflammatory bowel disease
integer
C0021390 (UMLS CUI [1])
Inflammatory bowel disease
Code List
Inflammatory bowel disease
CL Item
No  (No )
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
Infection
integer
C0009450 (UMLS CUI [1])
Infection
Code List
Infection
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
Diabetes
integer
C0011849 (UMLS CUI [1])
Diabetes
Code List
Diabetes
CL Item
No  (No )
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
Serum creatinine
integer
C0201976 (UMLS CUI [1])
Renal: moderate/severe
Code List
Serum creatinine
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
Chronic hepatitis
integer
C0019189 (UMLS CUI [1])
Hepatic: mild
Code List
Chronic hepatitis
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
Liver cirrhosis
integer
C0023890 (UMLS CUI [1])
Hepatic: moderate/severe
Code List
Liver cirrhosis
CL Item
No (No)
CL Item
Yes  (Yes )
CL Item
Not evaluated (Not evaluated)
Item
Arrhythmia
integer
C0003811 (UMLS CUI [1])
Arrhythmia
Code List
Arrhythmia
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
Coronary artery disease
integer
C1956346 (UMLS CUI [1])
Cardiac
Code List
Coronary artery disease
CL Item
No (No)
CL Item
yes (yes)
CL Item
Not evaluated (Not evaluated)
Item
Cerebrovascular disease
integer
C0007820 (UMLS CUI [1])
Cerebrovascular disease
Code List
Cerebrovascular disease
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
Heart valve disease
integer
C0018824 (UMLS CUI [1])
Heart valve disease
Code List
Heart valve disease
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
FEV1 66-80%
integer
C0748133 (UMLS CUI [1])
Pulmonary: moderate
Code List
FEV1 66-80%
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
FEV1 ≤ 65%
integer
C0860906 (UMLS CUI [1])
Pulmonary: severe
Code List
FEV1 ≤ 65%
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
Obesity
integer
C0028754 (UMLS CUI [1])
Obesity
Code List
Obesity
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
Peptic ulcer
integer
C0030920 (UMLS CUI [1])
Peptic ulcer
Code List
Peptic ulcer
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
Psychiatric disturbance
integer
C0004936 (UMLS CUI [1])
Psychiatric disturbance
Code List
Psychiatric disturbance
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
comorbidity
Item
other comorbidity, please specify
text
C0009488 (UMLS CUI [1])
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