ID

42171

Beschrijving

ODM form derived from EBMT Allograft. please refer to: http://www.ebmt.org/Contents/Data-Management/Registrystructure/MED-ABdatacollectionforms/Pages/MED-AB-data-collection-forms.aspx

Link

http://www.ebmt.org/Contents/Data-Management/Registrystructure/MED-ABdatacollectionforms/Pages/MED-AB-data-collection-forms.aspx

Trefwoorden

  1. 14-07-16 14-07-16 -
  2. 21-08-16 21-08-16 -
  3. 13-04-21 13-04-21 - Dr. rer. medic Philipp Neuhaus
  4. 20-09-21 20-09-21 -
Geüploaded op

13 april 2021

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0

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EBMT Allograft

EBMT Allograft

  1. StudyEvent: ODM
    1. EBMT Allograft
ANTIBODIES IN THE PATIENT
Beschrijving

ANTIBODIES IN THE PATIENT

HIV
Beschrijving

HIV

Datatype

integer

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

HIV ANTIGENS

Datatype

integer

Alias
UMLS CUI [1]
C0019686
CMV
Beschrijving

CMV

Datatype

integer

Alias
UMLS CUI [1]
C0582172
EBV
Beschrijving

EBV

Datatype

integer

Alias
UMLS CUI [1]
C0014644
HBVs
Beschrijving

HBV

Datatype

integer

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

HBVs

Datatype

integer

Alias
UMLS CUI [1]
C0019165
HBVc
Beschrijving

HBVc

Datatype

integer

Alias
UMLS CUI [1]
C1440681
HBVe
Beschrijving

HBVe

Datatype

integer

Alias
UMLS CUI [1]
C0019167
HCV
Beschrijving

HCV

Datatype

integer

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

HCV ANTIGENS

Datatype

integer

Alias
UMLS CUI [1]
C0121459
HTLV
Beschrijving

HTLV

Datatype

integer

Alias
UMLS CUI [1]
C0086427
Toxoplasmosis
Beschrijving

Toxoplasmosis

Datatype

integer

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

if other Antibodies in the patient

Datatype

integer

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

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

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

FUNGAL INFECTION

Datatype

integer

Alias
UMLS CUI [1]
C0026946
Candida
Beschrijving

Candida

Datatype

integer

Alias
UMLS CUI [1]
C0006837
Aspergillus
Beschrijving

Aspergillus

Datatype

integer

Alias
UMLS CUI [1]
C0004034
Pneumocystis carinii
Beschrijving

Pneumocystis carinii

Datatype

integer

Alias
UMLS CUI [1]
C0032276
Other
Beschrijving

Other

Datatype

boolean

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

Other

Datatype

integer

Alias
UMLS CUI [1]
C0205394
PERFORMANCE SCORE
Beschrijving

PERFORMANCE SCORE

Type of score used
Beschrijving

score

Datatype

integer

Alias
UMLS CUI [1]
C1518965
Score
Beschrijving

Performance score

Datatype

integer

Alias
UMLS CUI [1]
C1518965
Weight
Beschrijving

Weight

Datatype

float

Maateenheden
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Height
Beschrijving

Height

Datatype

float

Maateenheden
  • cm
Alias
UMLS CUI [1]
C0005890
cm
DONOR AND STEM CELL SOURCE
Beschrijving

DONOR AND STEM CELL SOURCE

Multiple donors
Beschrijving

Multiple donors

Datatype

boolean

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

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

Datatype

float

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

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

Datatype

integer

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

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

Datatype

integer

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

(if multiple donors or stem cell products)

Datatype

integer

Alias
UMLS CUI [1]
C0574032
HLA MATCH TYPE
Beschrijving

(DONOR RELATION WITH PATIENT)

Datatype

text

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

Name of the Donor registry

Datatype

integer

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

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

Datatype

integer

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

Name of the Cord blood bank

Datatype

integer

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

Eurocord code for the cord blood bank

Datatype

integer

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

HLA MISMATCHES BETWEEN DONOR AND PATIENT

Serology A
Beschrijving

Serology A

Datatype

integer

Alias
UMLS CUI [1]
C0019728
Serology B
Beschrijving

Serology B

Datatype

integer

Alias
UMLS CUI [1]
C0019737
Serology C
Beschrijving

Serology C

Datatype

integer

Alias
UMLS CUI [1]
C0019751
Serology DRB1
Beschrijving

Serology DRB1

Datatype

integer

Alias
UMLS CUI [1]
C0122040
Serology DQB1
Beschrijving

Serology DQB1

Datatype

integer

Alias
UMLS CUI [1]
C0122020
Serology DPB1
Beschrijving

Serology DPB1

Datatype

integer

Alias
UMLS CUI [1]
C0555918
DNA A
Beschrijving

DNA A

Datatype

text

Alias
UMLS CUI [1]
C0019729
DNA B
Beschrijving

DNA B

Datatype

integer

Alias
UMLS CUI [1]
C0019738
DNA C
Beschrijving

DNA C

Datatype

integer

Alias
UMLS CUI [1]
C0019752
DNA DRB1
Beschrijving

DNA DRB1

Datatype

integer

Alias
UMLS CUI [1]
C1705258
DNA DQB1
Beschrijving

DNA DQB1

Datatype

integer

Alias
UMLS CUI [1]
C0122020
DNA DPB1
Beschrijving

DNA DPB1

Datatype

integer

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

BLOOD GROUP, DATE OF BIRTH AND SEX OF DONOR

ABO group
Beschrijving

ABO group

Datatype

integer

Alias
UMLS CUI [1]
C0000778
Date of birth
Beschrijving

Date of birth

Datatype

date

Alias
UMLS CUI [1]
C0421451
Sex
Beschrijving

Sex

Datatype

integer

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

STATUS OF THE DONOR OR CORD BLOOD UNIT BEFORE HSCT

HIV
Beschrijving

HIV

Datatype

integer

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

HIV ANTIGENS

Datatype

integer

Alias
UMLS CUI [1]
C0019686
CMV
Beschrijving

CMV

Datatype

integer

Alias
UMLS CUI [1]
C0582172
EBV
Beschrijving

EBV

Datatype

integer

Alias
UMLS CUI [1]
C0014644
HBVs
Beschrijving

HBV

Datatype

integer

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

HBVs

Datatype

integer

Alias
UMLS CUI [1]
C0019165
HBVc
Beschrijving

HBVc

Datatype

integer

Alias
UMLS CUI [1]
C1440681
HBVe
Beschrijving

HBVe

Datatype

integer

Alias
UMLS CUI [1]
C0019167
HCV
Beschrijving

HCV

Datatype

integer

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

HCV ANTIGENS

Datatype

integer

Alias
UMLS CUI [1]
C0121459
HTLV
Beschrijving

HTLV

Datatype

integer

Alias
UMLS CUI [1]
C0086427
Toxoplasmosis
Beschrijving

Toxoplasmosis

Datatype

integer

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

if other Antibodies in the patient

Datatype

integer

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

Date of harvest or cord blood collection

Datatype

date

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

GROWTH FACTORS

Datatype

integer

Alias
UMLS CUI [1]
C0018284
HISTOCOMPATIBILITY RESULTS
Beschrijving

HISTOCOMPATIBILITY RESULTS

Laboratory / Hospital
Beschrijving

Laboratory / Hospital

Datatype

integer

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

Unit

Datatype

integer

Alias
UMLS CUI [1]
C1519795
Contact number
Beschrijving

telephone number

Datatype

integer

Alias
UMLS CUI [1]
C1515258
Technique Used
Beschrijving

Technique

Datatype

integer

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

Serology (antigenic) HLA typing

Datatype

boolean

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

DNA (Allelic/molecular) HLA typing done

DNA (Allelic/molecular) HLA typing done
Beschrijving

DNA (Allelic/molecular) HLA typing done

Datatype

boolean

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

DNA (Allelic/molecular) HLA typing done: Locus

Datatype

integer

Alias
UMLS CUI [1]
C1321760
HLA string
Beschrijving

HLA string

Datatype

integer

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

NMDP code

Datatype

integer

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

Serology (antigenic) HLA typing done

Serology (antigenic) HLA typing done
Beschrijving

Serology (antigenic) HLA typing done

Datatype

boolean

Alias
UMLS CUI [1]
C0242318
HLA Serology
Beschrijving

HLA Serology

Datatype

integer

Alias
UMLS CUI [1]
C0242318
GRAFT MANIPULATION
Beschrijving

GRAFT MANIPULATION

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

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

Datatype

integer

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

Number in the infusion order

Datatype

text

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

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

Datatype

boolean

Alias
UMLS CUI [1]
C0677960
NEGATIVE SELECTION
Beschrijving

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

Datatype

integer

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

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

Datatype

integer

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

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

Datatype

integer

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

Monoclonal antibodies

Datatype

integer

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

Monoclonal antibodies: if yes

Datatype

integer

Alias
UMLS CUI [1]
C0003250
EXPANSION
Beschrijving

EXPANSION

Datatype

integer

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

GENE MANIPULATION

Datatype

integer

Alias
UMLS CUI [1]
C0947647
CELL INFUSION
Beschrijving

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)
Beschrijving

Identification of donor or Cord Blood Unit given by the centre

Datatype

text

Number in the infusion order (if applicable)
Beschrijving

Number in the infusion order

Datatype

text

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

Route of infusion

Datatype

text

Route of infusion: If other, please specify:
Beschrijving

Route of infusion: If other, please specify:

Datatype

integer

Alias
UMLS CUI [1]
C1827465
Infusion method
Beschrijving

Infusion method

Datatype

integer

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

Infusion method: if other, please specify

Datatype

integer

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

CELL VIABILITY RESULTS AT HSCT CENTRE

Tests performed after thawing of an aliquot on
Beschrijving

Tests performed after thawing of an aliquot on

Datatype

integer

Alias
UMLS CUI [1]
C1521902
Method used
Beschrijving

Method used

Datatype

integer

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

Viability of all cells

Datatype

float

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

Viability of CD34+ cells

Datatype

float

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

CELLS INFUSED FROM THIS DONOR AND STEM CELL SOURCE COMBINATION

Bone Marrow: Total number of cells actually infused
Beschrijving

Bone Marrow: Total number of cells actually infused

Datatype

integer

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

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

Datatype

integer

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

Peripheral Blood: Total number of cells actually infused

Datatype

integer

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

Peripheral Blood: Total number of cells actually infused

Datatype

integer

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

Cord Blood: Total number of cellsactually infused

Datatype

integer

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

Cord Blood: Total number of cellsa ctually infused

Datatype

integer

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

HSC TRANSPLANTATION

Chronological number of HSCT for this patient
Beschrijving

Chronological number

Datatype

integer

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

Donor the same as for previous HSCT?

Datatype

integer

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

Date of previous HSCT

Datatype

date

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

Type of HSCT

Datatype

integer

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

Reason for this transplant

Datatype

integer

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

HSCT part of a multiple sequential graft protocol

Datatype

integer

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

Type of multiple graft protocol

Datatype

integer

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

Graft number in the protocol

Datatype

integer

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

total number of HSCTs in the program

Datatype

integer

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

PREPARATIVE TREATMENT (conditioning)

PREPARATIVE (CONDITIONING) REGIMEN GIVEN
Beschrijving

PREPARATIVE (CONDITIONING) REGIMEN GIVEN

Datatype

boolean

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

Was regimen intended to be myeloablative

Datatype

integer

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

Main reason (tick only one)

Datatype

integer

Alias
UMLS CUI [1]
C1831742
Drugs
Beschrijving

(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

Datatype

integer

Alias
UMLS CUI [1]
C0013227
Drugs
Beschrijving

Drugs

NAME OF DRUG
Beschrijving

NAME OF DRUG

Datatype

text

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

AS PER PROTOCOL (DAILY DOSE BY NUMBER OF DAYS)

Datatype

integer

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

MONOCLONAL ANTIBODY

Datatype

integer

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

UNITS IF RADIO LABELLED

Datatype

integer

Alias
UMLS CUI [1]
C0041697
Route of administration
Beschrijving

Route of administration

Datatype

integer

Alias
UMLS CUI [1]
C0013153
Animal origin
Beschrijving

For ALG, ATG (ALS, ATS):

Datatype

integer

Alias
UMLS CUI [1]
C3494749
TBI
Beschrijving

(If yes, complete TBI Form)

Datatype

integer

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

Total dose

Datatype

float

Alias
UMLS CUI [1]
C2919490
Number of fractions
Beschrijving

Number of fractions

Datatype

float

Alias
UMLS CUI [1]
C0454266
radiation days
Beschrijving

radiation days

Datatype

integer

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

TLI / TNI / TAI

Datatype

integer

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

Local radiotherapy

Datatype

integer

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

TREATMENT DURING THE IMMEDIATE POST-TRANSPLANT PERIOD

GROWTH FACTORS (CYTOKINES)
Beschrijving

(excluding growth factors administered for engraftment failure)

Datatype

integer

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

GROWTH FACTORS: If yes, please specify

Datatype

text

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

Date started

Datatype

date

Alias
UMLS CUI [1]
C3173309
CELLULAR THERAPY
Beschrijving

CELLULAR THERAPY

Datatype

integer

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

(can be the same as HSCT date)

Datatype

date

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

CELLULAR THERAPY

Datatype

integer

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

Number of cells infused by type

Nucleated cells
Beschrijving

Nucleated cells

Datatype

float

Maateenheden
  • /kg*
Alias
UMLS CUI [1]
C1180059
/kg*
Nucleated cells
Beschrijving

Nucleated cells

Datatype

integer

Maateenheden
  • (/kg*
Alias
UMLS CUI [1]
C1180059
CD 34+ (cells/kg*)
Beschrijving

CD 34+

Datatype

integer

Maateenheden
  • cells/kg*
Alias
UMLS CUI [1]
C3538723
cells/kg*
CD 34+ (cells/kg*)
Beschrijving

CD 34+ (cells/kg*)

Datatype

integer

Maateenheden
  • cells/kg*
Alias
UMLS CUI [1]
C3538723
CD 3+ (cells/kg*)
Beschrijving

CD 3+

Datatype

float

Maateenheden
  • cells/kg*
Alias
UMLS CUI [1]
C0483189
cells/kg*
CD 3+ (cells/kg*)
Beschrijving

CD 3+ (cells/kg*)

Datatype

integer

Maateenheden
  • cells/kg*
Alias
UMLS CUI [1]
C0483189
Total number of cells infused
Beschrijving

Total number of cells infused

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

All cells

Datatype

float

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

Chronological number of this cell therapy for this patient

Datatype

integer

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

(check all that apply)

Datatype

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
Beschrijving

Number of infusions within 10 weeks

Datatype

integer

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

GVHD PREVENTION IN THE RECIPIENT (THERAPEUTIC IMMUNOSUPPRESSION)

Datatype

integer

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

chemotherapy

Datatype

integer

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

Monoclonal antibodies

Datatype

integer

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

Drugs: If Other, please specify

Datatype

integer

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

GRAFT PERFORMANCE

GRAFT PERFORMANCE
Beschrijving

Haemopoietic reconstitution (Engraftment)

Datatype

integer

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

Neutrophils

Datatype

integer

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

Platelets

Datatype

integer

Alias
UMLS CUI [1]
C0005821
Date last assessment
Beschrijving

Date last assessment

Datatype

date

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

Date of graft failure

Datatype

date

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

HAEMOPOIETIC CHIMAERISM

Datatype

integer

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

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

undefined item
Beschrijving

undefined item

Datatype

text

Date of test
Beschrijving

Date of test

Datatype

date

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

Identification

Datatype

text

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

Number in the infusion order

Datatype

text

Alias
UMLS CUI [1]
C0237753
Cell type on which test was performed (% Donor Cells): BM
Beschrijving

Bone marrow

Datatype

float

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

PB mononuclear cells (PBMC)

Datatype

float

Maateenheden
  • %
Alias
UMLS CUI [1]
C1321301
%
Cell type on which test was performed
Beschrijving

T-cell

Datatype

float

Cell type on which test was performed (% Donor cells): B-Cells
Beschrijving

B-Cells

Datatype

float

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

Red blood cells

Datatype

float

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

Monocytes

Datatype

float

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

PMNs (neutrophils)

Datatype

float

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

Lymphocytes, NOS

Datatype

float

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

Myeloid cells, NOS

Datatype

float

Maateenheden
  • %
Alias
UMLS CUI [1]
C0887899
%
Cell type on which test was performed (% Donor cells): Other
Beschrijving

Other cell type - value

Datatype

float

Maateenheden
  • %
Alias
UMLS CUI [1,1]
C0449475
UMLS CUI [1,2]
C1522609
%
Test used
Beschrijving

Laboratory tests

Datatype

integer

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

TREATMENT FOR FAILURE

Datatype

integer

ACUTE GRAFT VERSUS HOST DISEASE (GvHD)
Beschrijving

ACUTE GRAFT VERSUS HOST DISEASE (GvHD)

Maximum grade ACUTE GRAFT VERSUS HOST DISEASE (AGVHD)
Beschrijving

Maximum grade

Datatype

integer

Date of onset
Beschrijving

Date of onset

Datatype

date

Alias
UMLS CUI [1]
C0574845
Stage skin
Beschrijving

aGvHD Stage Skin

Datatype

integer

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

aGvHD Stage liver

Datatype

integer

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

aGvHD stage gut

Datatype

integer

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

aGvHD Resolution

Datatype

integer

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

aGvHD Date of resolution

Datatype

date

Maateenheden
  • yyyy/mm/dd
Alias
UMLS CUI [1,1]
C0856825
UMLS CUI [1,2]
C1514893
UMLS CUI [1,3]
C0011008
yyyy/mm/dd
Treatment
Beschrijving

Treatment

Datatype

boolean

Treatment, if yes
Beschrijving

Treatment

Datatype

text

COMPLICATIONS WITHIN THE FIRST 100 DAYS.
Beschrijving

COMPLICATIONS WITHIN THE FIRST 100 DAYS.

INFECTION RELATED COMPLICATIONS
Beschrijving

INFECTION RELATED COMPLICATIONS

Datatype

boolean

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

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

Datatype

integer

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

NON INFECTION RELATED COMPLICATIONS

Datatype

integer

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

Idiopathic pneumonia syndrome

Datatype

text

Alias
UMLS CUI [1]
C1504431
Specify: VOD
Beschrijving

VOD

Datatype

text

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

Haemorrhagic cystitis, non infectious

Datatype

text

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

ARDS, non infectious

Datatype

text

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

Multiorgan failure, non infectious

Datatype

integer

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

HSCT-associated microangiopathy

Datatype

text

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

Renal failure requiring dialysis

Datatype

text

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

Haemolytic anaemia due to blood group

Datatype

text

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

Other type of infection

Datatype

boolean

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

Idiopathic pneumonia syndrome date

Datatype

date

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

Date VOD

Datatype

date

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

Date Haemorrhagic cystitis, non infectious

Datatype

date

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

Date ARDS, non infectious

Datatype

date

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

Date Multiorgan failure, non infectious

Datatype

date

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

Date HSCT-associated microangiopathy

Datatype

date

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

Date Renal failure requiring dialysis

Datatype

date

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

DAte Haemolytic anaemia due to blood group

Datatype

date

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

Date of other Type

Datatype

date

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

STATUS AT 100 DAYS

Date of Last Contact
Beschrijving

LastContactDate

Datatype

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
Beschrijving

Presence of cGVHD

Datatype

integer

Alias
UMLS CUI [1]
C0867389
Onset
Beschrijving

Date of Onset

Datatype

date

Alias
UMLS CUI [1]
C0574845
cGvHD grade
Beschrijving

cGvHD grade

Datatype

integer

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

Organs affected

Datatype

integer

Alias
UMLS CUI [1]
C0449642
Relapse or progression
Beschrijving

Relapse or progression

Datatype

integer

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

RELAPSE OR PROGRESSION: If yes, date diagnosed

Datatype

date

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

Method of detection

Cinical/haematological relapse or progression
Beschrijving

Clinical/hematological

Datatype

integer

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

Cinical/haematological relapse or progression

Datatype

date

Date first seen
Beschrijving

Cinical/haematological relapse or progression

Datatype

date

Cytogenetic relapse or progression
Beschrijving

Cytogenetic relapse or progression

Datatype

integer

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

Cytogenetic relapse or progression: Date assessed

Datatype

date

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

Cytogenetic relapse or progression: Date first seen

Datatype

date

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

Molecular relapse or progression

Datatype

integer

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

Molecular relapse or progression: date assessed

Datatype

date

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

Molecular relapse or progression: Date first seen

Datatype

date

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

LAST DISEASE STATUS

Clinical/haematological
Beschrijving

Clincal/Hematological evaluation

Datatype

integer

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

Date of Evaluation

Datatype

date

Maateenheden
  • yyyy/mm/dd
Alias
UMLS CUI [1]
C2985720
yyyy/mm/dd
Cytogenetic/FISH
Beschrijving

Cytogenetics/FISH

Datatype

integer

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

Last date assessed

Datatype

date

Molecular
Beschrijving

Molecular

Datatype

text

Alias
UMLS CUI [1]
C0026376
Survival Status
Beschrijving

Survival Status

Datatype

integer

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

Performance Score

Datatype

text

Alias
UMLS CUI [1]
C1518965
Score
Beschrijving

Performance score

Datatype

integer

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

Cause of death

Datatype

integer

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

GvHD

Datatype

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
Beschrijving

Interstitial Pneumonitis

Datatype

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
Beschrijving

Pulmonary toxicity

Datatype

text

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

Infection

Datatype

integer

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

Rejection / poor graft function

Datatype

integer

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

Veno-Occlusive disease (VOD)

Datatype

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
Beschrijving

Haemorrhage

Datatype

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
Beschrijving

Cardiac toxicity

Datatype

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
Beschrijving

Central nervous system toxicity

Datatype

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
Beschrijving

Gastro intestinal toxicity

Datatype

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
Beschrijving

Skin toxicity

Datatype

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
Beschrijving

Renal failure

Datatype

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
Beschrijving

Multiple organ failure

Datatype

text

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

COMMENTS

Datatype

text

Alias
UMLS CUI [1]
C0947611
IDENTIFICATION & SIGNATURE
Beschrijving

IDENTIFICATION & SIGNATURE

Datatype

text

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

ADDITIONAL NOTES IF APPLICABLE

ALLOGRAFT APPENDIX
Beschrijving

ALLOGRAFT APPENDIX

Ethnicity
Beschrijving

Ethnicity

Datatype

text

Alias
UMLS CUI [1]
C0015031
Race
Beschrijving

Race

Datatype

text

Alias
UMLS CUI [1]
C0034510
COMORBID CONDITIONS
Beschrijving

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

Datatype

boolean

Alias
UMLS CUI [1]
C1275743
Solid tumor
Beschrijving

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

Datatype

integer

Alias
UMLS CUI [1]
C0280100
Inflammatory bowel disease
Beschrijving

Crohn's disease or ulcerative colitis

Datatype

integer

Alias
UMLS CUI [1]
C0021390
Infection
Beschrijving

Infection

Datatype

integer

Alias
UMLS CUI [1]
C0009450
Diabetes
Beschrijving

Requiring treatment with insulin or oral hypoglycemics but not diet alone

Datatype

integer

Alias
UMLS CUI [1]
C0011849
Serum creatinine
Beschrijving

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

Datatype

integer

Maateenheden
  • mg/dL
Alias
UMLS CUI [1]
C0201976
Chronic hepatitis
Beschrijving

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

Datatype

integer

Alias
UMLS CUI [1]
C0019189
Liver cirrhosis
Beschrijving

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

Datatype

integer

Alias
UMLS CUI [1]
C0023890
Arrhythmia
Beschrijving

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

Datatype

integer

Alias
UMLS CUI [1]
C0003811
Coronary artery disease
Beschrijving

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

Datatype

integer

Alias
UMLS CUI [1]
C1956346
Cerebrovascular disease
Beschrijving

Transient ischemic attack or cerebrovascular accident

Datatype

integer

Alias
UMLS CUI [1]
C0007820
Heart valve disease
Beschrijving

Except mitral valve prolapse

Datatype

integer

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

FEV1

Datatype

integer

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

Pulmonary: severeor dyspnea at rest or requiring oxygen

Datatype

integer

Alias
UMLS CUI [1]
C0860906
Obesity
Beschrijving

Patients with a body mass index > 35 kg/m2

Datatype

integer

Alias
UMLS CUI [1]
C0028754
Peptic ulcer
Beschrijving

Peptic ulcer

Datatype

integer

Alias
UMLS CUI [1]
C0030920
Psychiatric disturbance
Beschrijving

Depression or anxiety requiring psychiatric consult or treatment

Datatype

integer

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

comorbidity

Datatype

text

Alias
UMLS CUI [1]
C0009488

Similar models

EBMT Allograft

  1. StudyEvent: ODM
    1. EBMT Allograft
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
ANTIBODIES IN THE PATIENT
Item
HIV
integer
C0019682 (UMLS CUI [1])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
Code List
Candida
CL Item
Yes  (Yes )
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Aspergillus
integer
C0004034 (UMLS CUI [1])
Code List
Aspergillus
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item
Pneumocystis carinii
integer
C0032276 (UMLS CUI [1])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
Code List
Type of previous HSCT
CL Item
Allo (Allo)
CL Item
Auto (Auto)
Item
Reason for this transplant
integer
C1718260 (UMLS CUI [1])
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])
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])
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])
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])
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])
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])
Code List
UNITS IF RADIO LABELLED
CL Item
mCi (1)
CL Item
mBq (2)
Item
Route of administration
integer
C0013153 (UMLS CUI [1])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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
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
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])
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])
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])
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])
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
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
Code List
Survival Status
CL Item
alive (0)
CL Item
dead (1)
Item
If alive: Type of score used:
text
C1518965 (UMLS CUI [1])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
Code List
Ethnicity
CL Item
Hispanic or Latino (1)
CL Item
Not Hispanic or Latino (2)
Item
Race
text
C0034510 (UMLS CUI [1])
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])
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])
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])
Code List
Infection
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
Item
Diabetes
integer
C0011849 (UMLS CUI [1])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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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