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:

  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 -
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September 20, 2021

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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

On Treatment
On Treatment Report Period (Step 2 - Choose one x)
Off Treatment
Off Treatment Report Period (since registration - Choose one x)
MDS classification
Was bone marrow biopsy done
Reason bone marrow cellularity was not recorded
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
If Hematologic improvement
Cytogenetic Response

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