Description:

E2905 Follow Up Disease Evaluation Form Lenalidomide With or Without Epoetin Alfa in Treating Patients With Myelodysplastic Syndrome and Anemia NCT00843882 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0F12A9EE-8D74-6165-E044-0003BA3F9857

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0F12A9EE-8D74-6165-E044-0003BA3F9857
Keywords:
  1. 12/18/14 12/18/14 - Martin Dugas
  2. 1/8/15 1/8/15 - Martin Dugas
  3. 1/23/15 1/23/15 - Martin Dugas
  4. 9/20/21 9/20/21 -
Uploaded on:

September 20, 2021

DOI:
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License :
Creative Commons BY-NC 3.0 Legacy
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Follow Up Disease Evaluation Form (E2905 NCT00843882)

INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files

Header
On Treatment
On Treatment Report Period (Step 2 - Choose one x)
Off Treatment
Off Treatment Report Period (since registration - Choose one x)
Unnamed5
MDS classification
Was bone marrow biopsy done
%
%
Reason bone marrow cellularity was not recorded
Dysplasia
Dysplasia type
Is cytogenetic abnormality present now
Section Ii
Did the patient require packed red blood cell (PRBC) transfusions (in the last 8 weeks)
Mds Response
Best response to date
Relapse
If Hematologic improvement
Cytogenetic Response

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