E1906 Registration Worksheet (step 1) Comparing Three Different Combination Chemotherapy Regimens in Treating Patients With Relapsed or Refractory Acute Myeloid Leukemia NCT00634244 Source Form: NCI FormBuilder:

  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 1/23/15 1/23/15 - Martin Dugas
  4. 9/20/21 9/20/21 -
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September 20, 2021

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Creative Commons BY-NC 3.0 Legacy
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Registration Worksheet (step 1) AML (NCT00634244)

No Instruction available.

  1. StudyEvent: E1906 Registration Worksheet (step 1)
    1. No Instruction available.
Has the eligibility checklist been completed?
In the opinion of the investigator, is the patient eligible?
Has written informed consent been obtained?
Has HIPAA authorization been obtained?
Duration of first remission
I agree biopsies may be done to obtain research specimens.
I agree to provide additional specimens for research
My specimens may be kept for use in research to learn about, prevent, treat, or cure cancer.
My specimens may be kept for use in research about other health problems (for example: causes of diabetes, Alzheimer's disease, or heart disease)
Someone from this institution may contact me in the future to ask me to take part in more research.
Patient Demographics / Pre-treatment Characteristics
Patient's Sex
Patient's Race
Patient Ethnicity
Method of payment (check one)
Country of residence
I Have Reviewed The Above Data And Agree The Date Are Accurate And Correct

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