Description:

E2905 Baseline Step 1 Disease Evaluation Form NCT00843882 Lenalidomide With or Without Epoetin Alfa in Treating Patients With Myelodysplastic Syndrome and Anemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0EAB4E64-72BE-45B3-E044-0003BA3F9857

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0EAB4E64-72BE-45B3-E044-0003BA3F9857
Keywords:
  1. 12/18/14 12/18/14 - Martin Dugas
  2. 1/8/15 1/8/15 - Martin Dugas
  3. 1/9/15 1/9/15 - Martin Dugas
  4. 6/16/15 6/16/15 -
  5. 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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E2905 Baseline Step 1 Disease Evaluation Form 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
Report period
Patient demographics
Data amendment
Pre-registration Hematology/chemistry
g/dL
g/dL
1000/uL
mm3
1000/uL
1000/uL
mg/dL
Leukemia Assessment
MDS classification
%
Reason bone marrow cellularity was not recorded
Dysplasia
Specify type (mark all that apply)
Is cytogenetic abnormality present now
Did the patient require packed red blood cell (PRBC) transfusions (in the last 8 weeks)
International Prognostic Score (ipss)
%
%
Karyotype (Highest)
Karyotype (Highest)
Baseline Abnormalities
CTC Adverse Event Grade (Use grade 1-4 per CTCAE v4)
Comments

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