STUDY/TRIAL
PATIENT
Unique Identification Code (UIC)
text
Hospital Unique Patient Number or Code
text
Initials
text
Date of Birth
date
Sex
text
ABO Group
text
Rh factor
integer
DISEASE
Date of diagnosis
date
Primary Disease Diagnosis
integer
SOLID TUMOURS
INITIAL DIAGNOSIS
integer
INITIAL DIAGNOSIS
integer
Clinical TNM classification Tumor
integer
Clinical TNM classification Tumor Nodes
integer
For metastases, 0 indicates “No metastasis”, 1 indicates “Metastasis” and X indicates “Not evaluable
integer
Disease-specific staging
integer
HISTOLOGICAL SUBCLASSIFICATION Describe
text
BREAST Cancer
integer
RECEPTOR STATUS Estrogen (ER)
integer
RECEPTOR STATUS Estrogen (ER)
float
RECEPTOR STATUS Progesterone (PgR)
integer
RECEPTOR STATUS Progesterone (PgR)
float
RECEPTOR STATUS HER2/neu (c-erb-B2)
integer
RECEPTOR STATUS HER2/neu (c-erb-B2)
integer
HISTOLOGICAL SUBCLASSIFICATION FOR BREAST CARCINOMA
Axillary lymph nodes
float
Axillary lymph nodes
float
Axillary lymph nodes
integer
S.B.R. (Scarff-Bloom-Richardson)
integer
Ductal carcinoma
integer
Lobular carcinoma
integer
CYTOGENETICS
TREATMENT GIVEN BEFORE THIS HSCT
if no: Includes a) Patients who have no surgery and go on to have high dose chemotherapy followed immediately by HSCT, or sequential chemotherapy, as the 1st line treatment; or b) Subsequent HSCT within a multiple/ sequential chemotherapy HSCT procedure if yes: Includes surgery or any other treatment, including chemotherapy, given prior to the HSCT and which is not considered part of the preparative (conditioning) regimen
integer
FIRST LINE TREATMENT
treatment start date
date
HSCT
integer
Upfront (treatment started with a program including high dose chemotherapy followed by HSCT or high dose sequential chemotherapy; adjuvant excluded) Adjuvant (HSCT done in adjuvant-setting)
integer
Modality
integer
Drugs
integer
Drugs
text
Modality Surgery
text
Modality
text
Status of disease after first line treatment (best response)
text
Criteria used for evaluation
text
Treatment given
text
TREATMENT HISTORY BEFORE HSCT
Date of HSCT
date
TREATMENT SUMMARY
integer
Chemotherapy
integer
Surgery
integer
Radiotherapy
integer
Modality
integer
STATUS OF DISEASE AT HSCT
STATUS OF DISEASE AT HSCT
integer
if CR please specify
integer
if Relapse please specify
integer
Complete remission (CR) Number
integer
Complete relapse Number
integer
(complete only for relapse)
integer
Organ involved
integer
Primary site affected
integer
ADDITIONAL TREATMENT POST-HSCT
BEST DISEASE RESPONSE AT 100 DAYS POST-HSCT
BEST RESPONSE AT 100 DAYS AFTER HSCT
text
LesionAssessmentDate
date
FORMS TO BE FILLED IN
TYPE OF TRANSPLANT
text
TYPE OF TRANSPLANT
text