Description:

CTEP Transplant CDEs Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0B976B1B-4AB1-64EE-E044-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0B976B1B-4AB1-64EE-E044-0003BA3F9857

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Versions (3) ▾
  1. 9/19/12
  2. 12/12/14
  3. 9/20/21
Uploaded on:

September 20, 2021

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License:
Creative Commons BY-NC 3.0 Legacy
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Leukemia, Myelocytic, Acute null - - CTEP Transplant CDEs - 2444533v1.0

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  1. StudyEvent: CTEP Transplant CDEs
    1. No Instruction available.
Transplantation
Did acute Graft vs. Host Disease occur
Did the patient receive protocol transplant?
Prior Transplant Thrombocytopenia Observed Ind-3
Prior Transplant Neutropenia Observed Ind-3
Prior Transplant Lymphopenia Observed Ind-3
Prior Transplant Lymphocyte Infusion Ind-2
Prior Transplant Allogenic Administered Type
Prior Transplant Administered Type
Prior HDC/ASCT Adjuvant Administered Ind-3
Prior BMSCT Administered Indicator
Prior BMSCT Administered Ind-3
Non-Protocol Therapy Concurrent Administered HDC-ASCT Ind-3
Non-Protocol BMT Performed Ind-3
HLA-DrB1 Transplant Compatible Ind-3
HLA-DQB1 Transplant Compatible Ind-3
HLA-C Antigens Transplant Compatible Ind-3
HLA-B Antigen Transplant Compatible Ind-3
HLA-A Antigen Transplant Compatible Ind-3
Disease Stage Based on Bone Marrow Biopsy Text Name
Diagnosis Lymphoproliferative Present Transplant Ind-3
Chronic GVHD Transplant Treatment Ind-3
Chronic Graft Versus Host Disease Transplant Outcome Grade
BMSCT Type
Acute Graft Versus Host Disease Transplant Assessed Grade
Treatment to Transplant Time UOM
Transplant T-Lymphocytesl Removed Type
Transplant Received Ind-2
Transplant Procedure Type
Transplant Platelet Lab Declining Ind-3
Transplant Platelet Engraftment Ind-3
Transplant Patient Human Immunodeficiency VirusAntibody Ind-3
Transplant Patient Herpes Simplex Virus Antibody Ind-3
Transplant Patient Hepatitis C Virus Antibody Ind-3
Transplant Patient Hepatitis B Virus Antibody Ind-3
Transplant Patient Hepatitis B Surface Antigens Ind-3
Transplant Patient Cytomegalovirus Antibody Ind-3
Transplant Patient Antibody Epstein-Barr Virus Ind-3
Transplant Neutrophil Lab Declining Ind-3
Transplant Neutrophil Engraftment Ind-3
Transplant Matching Method Type
Transplant Lymphocyte Lab Declining Ind-3
Transplant Lymphocyte Engraftment Ind-3
Transplant HLA Match Category
Transplant GVHD Severity Chronic Grade
Transplant GVHD Severity Acute Grade
Transplant Graft Versus Host Disease Involvement Chronic Site
Transplant Graft Versus Host Disease Involvement Acute Site
Transplant Donor Significant Personal Medical History Ind-3
Transplant Donor Rh Type
Transplant Donor Recipient Relationship Type
Transplant Donor Patient Relationship Type
Transplant Donor Matching Type
Transplant Donor Lymphocyte Administered Reason
Transplant Donor Human Immunodeficiency Virus Antibody Ind-3
Transplant Donor Herpes Simplex Virus Antibody Ind-3
Transplant Donor Hepatitis C Virus Antibody Ind-3
Transplant Donor Hepatitis B Virus Antibody Ind-3
Transplant Donor Hepatitis B Surface Antigen Ind-3
Transplant Donor Gender Type
Transplant Donor Epstein-Barr Virus Antibody Ind-3
Transplant Donor Cytomegalovirus Antibody Ind-3
Transplant Donor Antibody Hepatitis B Surface Antigen Ind-3
Transplant Donor ABO Status Blood Type
Transplant Delayed Failure Ind-3
Transplant Conditioning Regimen Text Type
Transplant Conditioning Regimen Indicator
Transplant Compatible Match Type
Transplant Chronic GVHD Occurrence Ind
Transplant Chronic GVHD End Type
Transplant Child Donor Ind-3
Transplant Cell Source Type
Transplant Cell Preparation Type
Stem Cell Transplant Received Ind-2
Stem Cell Transplant Engraftment Result Ind-3
Stem Cell Transplant Aministered Ind-3
Non-Protocol HDC/ASCT Ind
Non-protocol Chemotherapy Transplant Administered Ind-3
Have you ever received a kidney transplantation?
Autologous Transplant Prior Administered Ind-3
Allogeneic Transplant Prior Administered Ind-3

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