ID

43318

Beskrivning

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

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0EAB4E64-72BE-45B3-E044-0003BA3F9857

Nyckelord

  1. 2014-12-18 2014-12-18 - Martin Dugas
  2. 2015-01-08 2015-01-08 - Martin Dugas
  3. 2015-01-09 2015-01-09 - Martin Dugas
  4. 2015-06-16 2015-06-16 -
  5. 2021-09-20 2021-09-20 -
Uppladdad den

20 september 2021

DOI

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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
    Beskrivning

    Header

    ECOG Protocol Number
    Beskrivning

    Protocol Number ECOG

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1512162
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25491
    ECOG Patient ID
    Beskrivning

    Patient ID ECOG

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1512162
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25491
    DCI Name
    Beskrivning

    Generic drug form

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C3242750
    NCI Thesaurus Property
    C19464
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus ObjectClass-2
    C25452
    Registration Step
    Beskrivning

    Registration Number

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1514821
    NCI Thesaurus ObjectClass
    C25646
    UMLS CUI-2
    C0237753
    NCI Thesaurus Property
    C16154
    NCI Thesaurus ValueDomain-2
    C16154
    Report period
    Beskrivning

    Cycle number

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS CUI-1
    C2045829
    NCI Thesaurus Property
    C25214
    NCI Thesaurus Property-2
    C25616
    NCI Thesaurus ObjectClass
    C15368
    Patient demographics
    Beskrivning

    Patient demographics

    Patient Initials (Last, First)
    Beskrivning

    Patient Initials

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    ECOG Protocol Number
    Beskrivning

    Protocol Number ECOG

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1512162
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25491
    ECOG Patient ID
    Beskrivning

    Patient ID ECOG

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1512162
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25491
    Participating Group Protocol Number
    Beskrivning

    Study Number Participating Group

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Participating Group Patient ID
    Beskrivning

    Trial subject ID Participating Group

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Institution/Affiliate
    Beskrivning

    Institution Name

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass-2
    C21541
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ValueDomain-2
    C21541
    Data amendment
    Beskrivning

    Data amendment

    Please mark an 'X' if data have been amended. (Please circle amended items in red)
    Beskrivning

    Data amended

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    NCI Thesaurus Property
    C25416
    Date data amended (MM/DD/YYYY)
    Beskrivning

    Data amended date

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25474
    UMLS CUI-2
    C0011008
    NCI Thesaurus Property
    C25416
    NCI Thesaurus ValueDomain-2
    C25367
    Pre-registration Hematology/chemistry
    Beskrivning

    Pre-registration Hematology/chemistry

    Hemoglobin (Hgb) (g/dl), LLN
    Beskrivning

    Hemoglobin LLN

    Datatyp

    float

    Måttenheter
    • g/dL
    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0019046
    NCI Thesaurus Property
    C16676
    UMLS CUI-2
    C1518030
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus ValueDomain
    C25712
    NCI Thesaurus ValueDomain-2
    C38024
    NCI Thesaurus ValueDomain-3
    C25555
    g/dL
    Hemoglobin (Hgbg/dl)
    Beskrivning

    LaboratoryProcedureHemoglobinResultSpecifiedValue

    Datatyp

    float

    Måttenheter
    • g/dL
    Alias
    NCI Thesaurus Property
    C16676
    UMLS 2011AA Property
    C0019046
    NCI Thesaurus Property-2
    C20200
    UMLS 2011AA Property-2
    C1274040
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    g/dL
    Date (MM/DD/YYYY)
    Beskrivning

    LaboratoryProcedureHemoglobinResultDate

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus Property
    C16676
    UMLS 2011AA Property
    C0019046
    NCI Thesaurus Property-2
    C20200
    UMLS 2011AA Property-2
    C1274040
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    Peripheral platelet count, LLN (/mm^3x1000)
    Beskrivning

    Platelets LLN

    Datatyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0005821
    NCI Thesaurus Property
    C20200
    UMLS CUI-2
    C1518030
    NCI Thesaurus Property-2
    C12520
    NCI Thesaurus ValueDomain
    C25712
    NCI Thesaurus ValueDomain-2
    C25555
    Peripheral Platelet Count (/mm^3x1000)
    Beskrivning

    Platelets

    Datatyp

    float

    Måttenheter
    • 1000/uL
    Alias
    NCI Thesaurus Property
    C20200
    UMLS CUI-1
    C0005821
    NCI Thesaurus Property-2
    C12520
    NCI Thesaurus ObjectClass
    C25294
    NCI Thesaurus ValueDomain
    C25712
    1000/uL
    Date (MM/DD/YYYY)
    Beskrivning

    Platelets date

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C0005821
    NCI Thesaurus Property
    C20200
    UMLS CUI-2
    C0011008
    NCI Thesaurus Property-2
    C12520
    NCI Thesaurus ObjectClass
    C25294
    Peripheral Granulocytes Count LLN (AGC/ANC/mm^3)
    Beskrivning

    LaboratoryProcedureGranulocyteResultLowerLimitofNormalCount

    Datatyp

    float

    Måttenheter
    • mm3
    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus Property-2
    C12530
    UMLS 2011AA Property-2
    C0018183
    NCI Thesaurus ValueDomain
    C25463
    UMLS 2011AA ValueDomain
    C0750480
    NCI Thesaurus ValueDomain-2
    C25555
    UMLS 2011AA ValueDomain-2
    C1518030
    mm3
    Peripheral Granulocytes Count (AGC/ANC/mm^3 - Do not report % granulocytes: report absolute count without decimal.)
    Beskrivning

    Granulocyte count

    Datatyp

    float

    Måttenheter
    • 1000/uL
    Alias
    NCI Thesaurus Property
    C20200
    UMLS CUI-1
    C0857490
    NCI Thesaurus Property-2
    C12530
    NCI Thesaurus ValueDomain
    C25463
    NCI Thesaurus ObjectClass
    C25294
    1000/uL
    Date
    Beskrivning

    LaboratoryProcedureNeutrophilResultDate

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus Property
    C12533
    UMLS 2011AA Property
    C0027950
    NCI Thesaurus Property-2
    C20200
    UMLS 2011AA Property-2
    C1274040
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    Peripheral WBC Count (/mm^3 x 1000)
    Beskrivning

    LaboratoryProcedureLeukocyteResultSpecifiedValue

    Datatyp

    float

    Måttenheter
    • 1000/uL
    Alias
    NCI Thesaurus Property
    C12529
    UMLS 2011AA Property
    C0023516
    NCI Thesaurus Property-2
    C20200
    UMLS 2011AA Property-2
    C1274040
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    NCI Thesaurus ValueDomain-2
    C38024
    UMLS 2011AA ValueDomain-2
    C0205369
    1000/uL
    Peripheral WBC count, LLN
    Beskrivning

    LaboratoryProcedureLeukocyteResultLowerLimitofNormalValue

    Datatyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property
    C12529
    UMLS 2011AA Property
    C0023516
    NCI Thesaurus Property-2
    C20200
    UMLS 2011AA Property-2
    C1274040
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    NCI Thesaurus ValueDomain-2
    C25555
    UMLS 2011AA ValueDomain-2
    C1518030
    Date
    Beskrivning

    LaboratoryProcedureLeukocyteResultDate

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus Property
    C12529
    UMLS 2011AA Property
    C0023516
    NCI Thesaurus Property-2
    C20200
    UMLS 2011AA Property-2
    C1274040
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    Creatinine
    Beskrivning

    Creatinine, Serum

    Datatyp

    float

    Måttenheter
    • mg/dL
    Alias
    NCI Thesaurus Property
    C20200
    UMLS CUI-1
    C0201976
    NCI Thesaurus Property-2
    C399
    NCI Thesaurus ObjectClass
    C25294
    NCI Thesaurus ValueDomain
    C25712
    mg/dL
    Creatinine ULN (mg/dl)
    Beskrivning

    Creatinine, serum ULN

    Datatyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C0201976
    NCI Thesaurus Property
    C20200
    UMLS CUI-2
    C1519815
    NCI Thesaurus Property-2
    C399
    NCI Thesaurus ValueDomain
    C25712
    NCI Thesaurus ValueDomain-2
    C25706
    Date
    Beskrivning

    Laboratory Procedure Date

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C0022885
    NCI Thesaurus Property
    C25214
    UMLS CUI-2
    C0011008
    NCI Thesaurus Property-2
    C38000
    NCI Thesaurus ObjectClass
    C25294
    Mean pre-transfusion hemoglobin
    Beskrivning

    LaboratoryProcedureHemoglobinPriorBloodTransfusionOutcomeUnspecifiedValue

    Datatyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property
    C16676
    UMLS 2011AA Property
    C0019046
    NCI Thesaurus Property-2
    C25629
    UMLS 2011AA Property-2
    C0332152
    NCI Thesaurus Property-3
    C20200
    UMLS 2011AA Property-3
    C1274040
    NCI Thesaurus Property-4
    C15192
    UMLS 2011AA Property-4
    C0005841
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    Leukemia Assessment
    Beskrivning

    Leukemia Assessment

    MDS classification
    Beskrivning

    MyelodysplasticSyndromeWorldHealthOrganizationClassificationCategory

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25372
    UMLS 2011AA ValueDomain
    C0683312
    NCI Thesaurus ObjectClass
    C3247
    UMLS 2011AA ObjectClass
    C3463824
    NCI Thesaurus Property
    C25161
    UMLS 2011AA Property
    C0008902
    NCI Thesaurus Property-2
    C75419
    UMLS 2011AA Property-2
    C0043237
    Date of Initial Pathologic Diagnosis
    Beskrivning

    CancerInitialDiagnosisDate

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C9305
    UMLS 2011AA ObjectClass
    C0006826
    NCI Thesaurus Property
    C25509
    UMLS 2011AA Property
    C1279901
    NCI Thesaurus Property-2
    C15220
    UMLS 2011AA Property-2
    C0011900
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25367
    Date of Bone Marrow Biopsy (Aspirate)
    Beskrivning

    BoneMarrowBiopsyDate

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus Property
    C15189
    UMLS 2011AA Property
    C0005558
    NCI Thesaurus ObjectClass
    C12431
    UMLS 2011AA ObjectClass
    C0005953
    Marrow Blasts (%) (Highest)
    Beskrivning

    Blasts, Bone Marrow

    Datatyp

    float

    Måttenheter
    • %
    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C1982687
    NCI Thesaurus Property
    C12431
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus Property-3
    C12918
    NCI Thesaurus ValueDomain
    C25613
    NCI Thesaurus ValueDomain-2
    C25712
    %
    Marrow Cellularity (%)
    Beskrivning

    Bone Marrow Cellularity

    Datatyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C1561532
    NCI Thesaurus Property
    C12431
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus Property-3
    C37923
    NCI Thesaurus ValueDomain
    C25613
    NCI Thesaurus ValueDomain-2
    C25712
    Reason bone marrow cellularity was not recorded
    Beskrivning

    LaboratoryProcedureBoneMarrowCellularityNegationReportOutcomeReason

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property
    C25594
    UMLS 2011AA Property
    C1518422
    NCI Thesaurus Property-2
    C12431
    UMLS 2011AA Property-2
    C0005953
    NCI Thesaurus Property-3
    C25375
    UMLS 2011AA Property-3
    C0684224
    NCI Thesaurus Property-4
    C20200
    UMLS 2011AA Property-4
    C1274040
    NCI Thesaurus Property-5
    C37923
    UMLS 2011AA Property-5
    C1516377
    NCI Thesaurus ValueDomain
    C25638
    UMLS 2011AA ValueDomain
    C0392360
    Dysplasia
    Beskrivning

    DysplasiaPresentInd-3

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus Property
    C25626
    UMLS 2011AA Property
    C0150312
    NCI Thesaurus ObjectClass
    C4086
    UMLS 2011AA ObjectClass
    C0334044
    Specify type (mark all that apply)
    Beskrivning

    DysplasiaHistologyType

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus Property
    C16681
    UMLS 2011AA Property
    C0019638
    NCI Thesaurus ObjectClass
    C4086
    UMLS 2011AA ObjectClass
    C0334044
    Is cytogenetic abnormality present now
    Beskrivning

    CytogeneticAbnormalityPresentIndicator

    Datatyp

    text

    Alias
    NCI Thesaurus Property
    C25626
    UMLS 2011AA Property
    C0150312
    NCI Thesaurus ObjectClass
    C2950
    UMLS 2011AA ObjectClass
    C0008625
    NCI Metathesaurus ValueDomain
    C0021212
    Did the patient require packed red blood cell (PRBC) transfusions (in the last 8 weeks)
    Beskrivning

    PackedRedBloodCellTransfusionRequirementInd-3

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C15409
    UMLS 2011AA ObjectClass
    C0199962
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Total number of units PRBC (transfused in the last 8 weeks)
    Beskrivning

    PackedRedBloodCellTransfusionReceivedUnitCount

    Datatyp

    float

    Alias
    NCI Thesaurus ValueDomain
    C44278
    UMLS 2011AA ValueDomain
    C0439148
    NCI Thesaurus Property
    C25639
    UMLS 2011AA Property
    C1514756
    NCI Thesaurus ValueDomain-2
    C25463
    UMLS 2011AA ValueDomain-2
    C0750480
    NCI Thesaurus ObjectClass
    C15409
    UMLS 2011AA ObjectClass
    C0199962
    Date of First Transfusion (MM/DD/YYYY)
    Beskrivning

    PackedRedBloodCellTransfusionReceivedFirstDate

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus Property
    C25639
    UMLS 2011AA Property
    C1514756
    NCI Thesaurus ValueDomain-2
    C25509
    UMLS 2011AA ValueDomain-2
    C1279901
    NCI Thesaurus ObjectClass
    C15409
    UMLS 2011AA ObjectClass
    C0199962
    Date of most recent PRBC transfusion (MM/DD/YYYY)
    Beskrivning

    PackedRedBloodCellTransfusionReceivedMostRecentDate

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus Property
    C25639
    UMLS 2011AA Property
    C1514756
    NCI Thesaurus ObjectClass
    C15409
    UMLS 2011AA ObjectClass
    C0199962
    NCI Thesaurus ValueDomain-2
    C25577
    UMLS 2011AA ValueDomain-2
    C1513491
    International Prognostic Score (ipss)
    Beskrivning

    International Prognostic Score (ipss)

    Marrow Blasts (%) (Highest)
    Beskrivning

    Blasts, Bone Marrow

    Datatyp

    float

    Måttenheter
    • %
    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C1982687
    NCI Thesaurus Property
    C12431
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus Property-3
    C12918
    NCI Thesaurus ValueDomain
    C25613
    NCI Thesaurus ValueDomain-2
    C25712
    %
    Marrow Blasts (%) (Highest)
    Beskrivning

    Blasts, Bone Marrow

    Datatyp

    float

    Måttenheter
    • %
    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS CUI-1
    C1982687
    NCI Thesaurus Property
    C12431
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus Property-3
    C12918
    NCI Thesaurus ValueDomain
    C25613
    NCI Thesaurus ValueDomain-2
    C25712
    %
    Date (Highest - Record earliest date of the values - MM/DD/YYYY)
    Beskrivning

    MyelodysplasticSyndromeInternationalPrognosticScoreSystemDate

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C3247
    UMLS 2011AA ObjectClass
    C3463824
    NCI Thesaurus Property
    C20118
    UMLS 2011AA Property
    C1512894
    Date (Highest - Record earliest date of the values - MM/DD/YYYY)
    Beskrivning

    MyelodysplasticSyndromeInternationalPrognosticScoreSystemDate

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C3247
    UMLS 2011AA ObjectClass
    C3463824
    NCI Thesaurus Property
    C20118
    UMLS 2011AA Property
    C1512894
    Karyotype (Highest)
    Beskrivning

    KaryotypeDescriptionType

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C25215
    UMLS 2011AA ObjectClass
    C1261273
    NCI Thesaurus Property
    C25365
    UMLS 2011AA Property
    C0678257
    Karyotype (Highest)
    Beskrivning

    KaryotypeDescriptionType

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C25215
    UMLS 2011AA ObjectClass
    C1261273
    NCI Thesaurus Property
    C25365
    UMLS 2011AA Property
    C0678257
    Number of Cytopenias (Highest - Red blood cells- Hemoglobin <10 g/dl 100 g/L - White blood cells- Absolute neutrophil count <1800/microliter - Platelets- Platelet count <100,000/ microliter)
    Beskrivning

    CytopeniaAssessmentCount

    Datatyp

    float

    Alias
    NCI Thesaurus Property
    C25367
    NCI Thesaurus ValueDomain
    C25463
    UMLS 2011AA ValueDomain
    C0750480
    NCI Thesaurus ObjectClass
    C2979
    UMLS 2011AA ObjectClass
    C0010828
    Number of Cytopenias (Highest - Red blood cells- Hemoglobin <10 g/dl 100 g/L - White blood cells- Absolute neutrophil count <1800/microliter - Platelets- Platelet count <100,000/ microliter)
    Beskrivning

    CytopeniaAssessmentCount

    Datatyp

    float

    Alias
    NCI Thesaurus Property
    C25367
    NCI Thesaurus ValueDomain
    C25463
    UMLS 2011AA ValueDomain
    C0750480
    NCI Thesaurus ObjectClass
    C2979
    UMLS 2011AA ObjectClass
    C0010828
    International Prognostic Score (IPSS) (Highest)
    Beskrivning

    MyelodysplasticSyndromeInternationalPrognosticScoreSystemScore

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C3247
    UMLS 2011AA ObjectClass
    C3463824
    NCI Thesaurus Property
    C20118
    UMLS 2011AA Property
    C1512894
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    International Prognostic Score (IPSS) (Highest)
    Beskrivning

    MyelodysplasticSyndromeInternationalPrognosticScoreSystemScore

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C3247
    UMLS 2011AA ObjectClass
    C3463824
    NCI Thesaurus Property
    C20118
    UMLS 2011AA Property
    C1512894
    NCI Thesaurus ValueDomain
    C25338
    UMLS 2011AA ValueDomain
    C0449820
    Baseline Abnormalities
    Beskrivning

    Baseline Abnormalities

    CTC Adverse Event Term (Use CTCAE v4 terminology)
    Beskrivning

    AdverseEventCommonTerminologyforAdverseEventsVersion4TermName

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C41331
    UMLS 2011AA ObjectClass
    C0877248
    NCI Thesaurus Property
    C49704
    UMLS 2011AA Property
    C1516728
    NCI Thesaurus Property-2
    C45559
    UMLS 2011AA Property-2
    C1705313
    NCI Thesaurus ValueDomain
    C45255
    UMLS 2011AA ValueDomain
    C1708523
    NCI Thesaurus ValueDomain-2
    C49704
    UMLS 2011AA ValueDomain-2
    C1516728
    NCI Thesaurus ValueDomain-3
    C42614
    UMLS 2011AA ValueDomain-3
    C0027365
    NCI Thesaurus ValueDomain-4
    C45559
    UMLS 2011AA ValueDomain-4
    C1705313
    NCI Thesaurus ValueDomain-5
    C25714
    UMLS 2011AA ValueDomain-5
    C0333052
    CTC Adverse Event Grade (Use grade 1-4 per CTCAE v4)
    Beskrivning

    AdverseEventSeverityGrade

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C41331
    UMLS 2011AA ObjectClass
    C0877248
    NCI Thesaurus Property
    C48309
    UMLS 2011AA Property
    C0441800
    NCI Thesaurus Property-2
    C49705
    UMLS 2011AA Property-2
    C1710065
    NCI Thesaurus Property-3
    C25676
    UMLS 2011AA Property-3
    C0439793
    NCI Thesaurus ValueDomain
    C41331
    UMLS 2011AA ValueDomain
    C0877248
    NCI Thesaurus ValueDomain-2
    C48309
    UMLS 2011AA ValueDomain-2
    C0441800
    NCI Thesaurus ValueDomain-3
    C25676
    UMLS 2011AA ValueDomain-3
    C0439793
    Comments
    Beskrivning

    Comments

    Investigator Signature
    Beskrivning

    Investigator Signature

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C2346576
    NCI Thesaurus Property
    C25678
    NCI Thesaurus ObjectClass
    C17089
    Investigator Signature Date
    Beskrivning

    Investigator Signature Date

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2346576
    NCI Thesaurus Property
    C25678
    UMLS CUI-2
    C0011008
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus ObjectClass
    C17089

    Similar models

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

    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    Alias
    Item Group
    Header
    Protocol Number ECOG
    Item
    ECOG Protocol Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1512162 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25491 (NCI Thesaurus Property-2)
    Patient ID ECOG
    Item
    ECOG Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1512162 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25491 (NCI Thesaurus Property-2)
    Generic drug form
    Item
    DCI Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C3242750 (UMLS CUI-1)
    C19464 (NCI Thesaurus Property)
    C25474 (NCI Thesaurus ObjectClass)
    C25452 (NCI Thesaurus ObjectClass-2)
    Registration Number
    Item
    Registration Step
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1514821 (UMLS CUI-1)
    C25646 (NCI Thesaurus ObjectClass)
    C0237753 (UMLS CUI-2)
    C16154 (NCI Thesaurus Property)
    C16154 (NCI Thesaurus ValueDomain-2)
    Item
    Report period
    text
    C25284 (NCI Thesaurus ValueDomain)
    C2045829 (UMLS CUI-1)
    C25214 (NCI Thesaurus Property)
    C25616 (NCI Thesaurus Property-2)
    C15368 (NCI Thesaurus ObjectClass)
    Code List
    Report period
    CL Item
    Baseline Step 1 (Baseline Step 1)
    Item Group
    Patient demographics
    Patient Initials
    Item
    Patient Initials (Last, First)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Protocol Number ECOG
    Item
    ECOG Protocol Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1512162 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25491 (NCI Thesaurus Property-2)
    Patient ID ECOG
    Item
    ECOG Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1512162 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25491 (NCI Thesaurus Property-2)
    Study Number Participating Group
    Item
    Participating Group Protocol Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Trial subject ID Participating Group
    Item
    Participating Group Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Institution Name
    Item
    Institution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ValueDomain-2)
    Item Group
    Data amendment
    Data amended
    Item
    Please mark an 'X' if data have been amended. (Please circle amended items in red)
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C25416 (NCI Thesaurus Property)
    Data amended date
    Item
    Date data amended (MM/DD/YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25474 (NCI Thesaurus ObjectClass)
    C0011008 (UMLS CUI-2)
    C25416 (NCI Thesaurus Property)
    C25367 (NCI Thesaurus ValueDomain-2)
    Item Group
    Pre-registration Hematology/chemistry
    Hemoglobin LLN
    Item
    Hemoglobin (Hgb) (g/dl), LLN
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0019046 (UMLS CUI-1)
    C16676 (NCI Thesaurus Property)
    C1518030 (UMLS CUI-2)
    C20200 (NCI Thesaurus Property-2)
    C25712 (NCI Thesaurus ValueDomain)
    C38024 (NCI Thesaurus ValueDomain-2)
    C25555 (NCI Thesaurus ValueDomain-3)
    LaboratoryProcedureHemoglobinResultSpecifiedValue
    Item
    Hemoglobin (Hgbg/dl)
    float
    C16676 (NCI Thesaurus Property)
    C0019046 (UMLS 2011AA Property)
    C20200 (NCI Thesaurus Property-2)
    C1274040 (UMLS 2011AA Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    LaboratoryProcedureHemoglobinResultDate
    Item
    Date (MM/DD/YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C16676 (NCI Thesaurus Property)
    C0019046 (UMLS 2011AA Property)
    C20200 (NCI Thesaurus Property-2)
    C1274040 (UMLS 2011AA Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    Platelets LLN
    Item
    Peripheral platelet count, LLN (/mm^3x1000)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0005821 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property)
    C1518030 (UMLS CUI-2)
    C12520 (NCI Thesaurus Property-2)
    C25712 (NCI Thesaurus ValueDomain)
    C25555 (NCI Thesaurus ValueDomain-2)
    Platelets
    Item
    Peripheral Platelet Count (/mm^3x1000)
    float
    C20200 (NCI Thesaurus Property)
    C0005821 (UMLS CUI-1)
    C12520 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    Platelets date
    Item
    Date (MM/DD/YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0005821 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property)
    C0011008 (UMLS CUI-2)
    C12520 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    LaboratoryProcedureGranulocyteResultLowerLimitofNormalCount
    Item
    Peripheral Granulocytes Count LLN (AGC/ANC/mm^3)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C12530 (NCI Thesaurus Property-2)
    C0018183 (UMLS 2011AA Property-2)
    C25463 (NCI Thesaurus ValueDomain)
    C0750480 (UMLS 2011AA ValueDomain)
    C25555 (NCI Thesaurus ValueDomain-2)
    C1518030 (UMLS 2011AA ValueDomain-2)
    Granulocyte count
    Item
    Peripheral Granulocytes Count (AGC/ANC/mm^3 - Do not report % granulocytes: report absolute count without decimal.)
    float
    C20200 (NCI Thesaurus Property)
    C0857490 (UMLS CUI-1)
    C12530 (NCI Thesaurus Property-2)
    C25463 (NCI Thesaurus ValueDomain)
    C25294 (NCI Thesaurus ObjectClass)
    LaboratoryProcedureNeutrophilResultDate
    Item
    Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C12533 (NCI Thesaurus Property)
    C0027950 (UMLS 2011AA Property)
    C20200 (NCI Thesaurus Property-2)
    C1274040 (UMLS 2011AA Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    LaboratoryProcedureLeukocyteResultSpecifiedValue
    Item
    Peripheral WBC Count (/mm^3 x 1000)
    float
    C12529 (NCI Thesaurus Property)
    C0023516 (UMLS 2011AA Property)
    C20200 (NCI Thesaurus Property-2)
    C1274040 (UMLS 2011AA Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C38024 (NCI Thesaurus ValueDomain-2)
    C0205369 (UMLS 2011AA ValueDomain-2)
    LaboratoryProcedureLeukocyteResultLowerLimitofNormalValue
    Item
    Peripheral WBC count, LLN
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C12529 (NCI Thesaurus Property)
    C0023516 (UMLS 2011AA Property)
    C20200 (NCI Thesaurus Property-2)
    C1274040 (UMLS 2011AA Property-2)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C25555 (NCI Thesaurus ValueDomain-2)
    C1518030 (UMLS 2011AA ValueDomain-2)
    LaboratoryProcedureLeukocyteResultDate
    Item
    Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C12529 (NCI Thesaurus Property)
    C0023516 (UMLS 2011AA Property)
    C20200 (NCI Thesaurus Property-2)
    C1274040 (UMLS 2011AA Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    Creatinine, Serum
    Item
    Creatinine
    float
    C20200 (NCI Thesaurus Property)
    C0201976 (UMLS CUI-1)
    C399 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    Creatinine, serum ULN
    Item
    Creatinine ULN (mg/dl)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0201976 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property)
    C1519815 (UMLS CUI-2)
    C399 (NCI Thesaurus Property-2)
    C25712 (NCI Thesaurus ValueDomain)
    C25706 (NCI Thesaurus ValueDomain-2)
    Laboratory Procedure Date
    Item
    Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0022885 (UMLS CUI-1)
    C25214 (NCI Thesaurus Property)
    C0011008 (UMLS CUI-2)
    C38000 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    LaboratoryProcedureHemoglobinPriorBloodTransfusionOutcomeUnspecifiedValue
    Item
    Mean pre-transfusion hemoglobin
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C16676 (NCI Thesaurus Property)
    C0019046 (UMLS 2011AA Property)
    C25629 (NCI Thesaurus Property-2)
    C0332152 (UMLS 2011AA Property-2)
    C20200 (NCI Thesaurus Property-3)
    C1274040 (UMLS 2011AA Property-3)
    C15192 (NCI Thesaurus Property-4)
    C0005841 (UMLS 2011AA Property-4)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    Item Group
    Leukemia Assessment
    Item
    MDS classification
    text
    C25372 (NCI Thesaurus ValueDomain)
    C0683312 (UMLS 2011AA ValueDomain)
    C3247 (NCI Thesaurus ObjectClass)
    C3463824 (UMLS 2011AA ObjectClass)
    C25161 (NCI Thesaurus Property)
    C0008902 (UMLS 2011AA Property)
    C75419 (NCI Thesaurus Property-2)
    C0043237 (UMLS 2011AA Property-2)
    Code List
    MDS classification
    CL Item
    Chronic Myelomonocytic Leukemia (Chronic Myelomonocytic Leukemia)
    C3178 (NCI Thesaurus)
    C0023480 (UMLS 2011AA)
    CL Item
    Myelodysplastic Syndrome Associated With Isolated Del (5q) Chromosome Abnormality (MDS associated with isolated del(5q))
    C6867 (NCI Thesaurus)
    C1292779 (UMLS 2011AA)
    CL Item
    Myelodysplastic Syndrome, Unclassifiable (Myelodysplastic Syndrome, unclassified)
    C8648 (NCI Thesaurus)
    C0854809 (UMLS 2011AA)
    CL Item
    Refractory Anemia (Refractory Anemia)
    C2872 (NCI Thesaurus)
    C0002893 (UMLS 2011AA)
    CL Item
    Raeb-1 (Refractory anemia with excess blasts-1)
    C7167 (NCI Thesaurus)
    C1318550 (UMLS 2011AA)
    CL Item
    Raeb-2 (Refractory anemia with excess blasts-2)
    C7168 (NCI Thesaurus)
    C1318551 (UMLS 2011AA)
    CL Item
    Refractory Anemia With Ringed Sideroblasts (Refractory Anemia with Ringed Sideroblasts)
    C4036 (NCI Thesaurus)
    C1264195 (UMLS 2011AA)
    CL Item
    Refractory Cytopenia With Multilineage Dysplasia (Refractory Cytopenia with Multilineage Dysplasia)
    C8574 (NCI Thesaurus)
    C0796466 (UMLS 2011AA)
    CL Item
    Refractory Cytopenia With Multilineage Dysplasia And Ringed Sideroblasts (Refractory Cytopenia with Multilineage Dysplasia and Ringed Sideroblasts)
    C27726 (NCI Thesaurus)
    C1301356 (UMLS 2011AA)
    CancerInitialDiagnosisDate
    Item
    Date of Initial Pathologic Diagnosis
    date
    C9305 (NCI Thesaurus ObjectClass)
    C0006826 (UMLS 2011AA ObjectClass)
    C25509 (NCI Thesaurus Property)
    C1279901 (UMLS 2011AA Property)
    C15220 (NCI Thesaurus Property-2)
    C0011900 (UMLS 2011AA Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    BoneMarrowBiopsyDate
    Item
    Date of Bone Marrow Biopsy (Aspirate)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    C15189 (NCI Thesaurus Property)
    C0005558 (UMLS 2011AA Property)
    C12431 (NCI Thesaurus ObjectClass)
    C0005953 (UMLS 2011AA ObjectClass)
    Blasts, Bone Marrow
    Item
    Marrow Blasts (%) (Highest)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C1982687 (UMLS CUI-1)
    C12431 (NCI Thesaurus Property)
    C20200 (NCI Thesaurus Property-2)
    C12918 (NCI Thesaurus Property-3)
    C25613 (NCI Thesaurus ValueDomain)
    C25712 (NCI Thesaurus ValueDomain-2)
    Bone Marrow Cellularity
    Item
    Marrow Cellularity (%)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C1561532 (UMLS CUI-1)
    C12431 (NCI Thesaurus Property)
    C20200 (NCI Thesaurus Property-2)
    C37923 (NCI Thesaurus Property-3)
    C25613 (NCI Thesaurus ValueDomain)
    C25712 (NCI Thesaurus ValueDomain-2)
    Item
    Reason bone marrow cellularity was not recorded
    text
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C25594 (NCI Thesaurus Property)
    C1518422 (UMLS 2011AA Property)
    C12431 (NCI Thesaurus Property-2)
    C0005953 (UMLS 2011AA Property-2)
    C25375 (NCI Thesaurus Property-3)
    C0684224 (UMLS 2011AA Property-3)
    C20200 (NCI Thesaurus Property-4)
    C1274040 (UMLS 2011AA Property-4)
    C37923 (NCI Thesaurus Property-5)
    C1516377 (UMLS 2011AA Property-5)
    C25638 (NCI Thesaurus ValueDomain)
    C0392360 (UMLS 2011AA ValueDomain)
    Code List
    Reason bone marrow cellularity was not recorded
    CL Item
    Cellularity Status Of Bone Marrow Unknown, Procedure Resulted In No Material To Analyze (Dry Tap or inaspirable)
    CL Item
    Local Pathologist Did Not Quantify Cellularity (Local pathologist did not quantify cellularity)
    Item
    Dysplasia
    text
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C25626 (NCI Thesaurus Property)
    C0150312 (UMLS 2011AA Property)
    C4086 (NCI Thesaurus ObjectClass)
    C0334044 (UMLS 2011AA ObjectClass)
    Code List
    Dysplasia
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Item
    Specify type (mark all that apply)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C16681 (NCI Thesaurus Property)
    C0019638 (UMLS 2011AA Property)
    C4086 (NCI Thesaurus ObjectClass)
    C0334044 (UMLS 2011AA ObjectClass)
    Code List
    Specify type (mark all that apply)
    CL Item
    Erythroid (Erythroid)
    C13805 (NCI Thesaurus)
    C1516960 (UMLS 2011AA)
    CL Item
    Megakaryocyte (Megakaryocyte)
    C12553 (NCI Thesaurus)
    C0025166 (UMLS 2011AA)
    CL Item
    Myeloid (Myeloid)
    C13349 (NCI Thesaurus)
    C0439677 (UMLS 2011AA)
    Item
    Is cytogenetic abnormality present now
    text
    C25626 (NCI Thesaurus Property)
    C0150312 (UMLS 2011AA Property)
    C2950 (NCI Thesaurus ObjectClass)
    C0008625 (UMLS 2011AA ObjectClass)
    C0021212 (NCI Metathesaurus ValueDomain)
    Code List
    Is cytogenetic abnormality present now
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    Inevaluable (Inevaluable)
    Item
    Did the patient require packed red blood cell (PRBC) transfusions (in the last 8 weeks)
    text
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C15409 (NCI Thesaurus ObjectClass)
    C0199962 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Code List
    Did the patient require packed red blood cell (PRBC) transfusions (in the last 8 weeks)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    PackedRedBloodCellTransfusionReceivedUnitCount
    Item
    Total number of units PRBC (transfused in the last 8 weeks)
    float
    C44278 (NCI Thesaurus ValueDomain)
    C0439148 (UMLS 2011AA ValueDomain)
    C25639 (NCI Thesaurus Property)
    C1514756 (UMLS 2011AA Property)
    C25463 (NCI Thesaurus ValueDomain-2)
    C0750480 (UMLS 2011AA ValueDomain-2)
    C15409 (NCI Thesaurus ObjectClass)
    C0199962 (UMLS 2011AA ObjectClass)
    PackedRedBloodCellTransfusionReceivedFirstDate
    Item
    Date of First Transfusion (MM/DD/YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25639 (NCI Thesaurus Property)
    C1514756 (UMLS 2011AA Property)
    C25509 (NCI Thesaurus ValueDomain-2)
    C1279901 (UMLS 2011AA ValueDomain-2)
    C15409 (NCI Thesaurus ObjectClass)
    C0199962 (UMLS 2011AA ObjectClass)
    PackedRedBloodCellTransfusionReceivedMostRecentDate
    Item
    Date of most recent PRBC transfusion (MM/DD/YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25639 (NCI Thesaurus Property)
    C1514756 (UMLS 2011AA Property)
    C15409 (NCI Thesaurus ObjectClass)
    C0199962 (UMLS 2011AA ObjectClass)
    C25577 (NCI Thesaurus ValueDomain-2)
    C1513491 (UMLS 2011AA ValueDomain-2)
    Item Group
    International Prognostic Score (ipss)
    Blasts, Bone Marrow
    Item
    Marrow Blasts (%) (Highest)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C1982687 (UMLS CUI-1)
    C12431 (NCI Thesaurus Property)
    C20200 (NCI Thesaurus Property-2)
    C12918 (NCI Thesaurus Property-3)
    C25613 (NCI Thesaurus ValueDomain)
    C25712 (NCI Thesaurus ValueDomain-2)
    Blasts, Bone Marrow
    Item
    Marrow Blasts (%) (Highest)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C1982687 (UMLS CUI-1)
    C12431 (NCI Thesaurus Property)
    C20200 (NCI Thesaurus Property-2)
    C12918 (NCI Thesaurus Property-3)
    C25613 (NCI Thesaurus ValueDomain)
    C25712 (NCI Thesaurus ValueDomain-2)
    MyelodysplasticSyndromeInternationalPrognosticScoreSystemDate
    Item
    Date (Highest - Record earliest date of the values - MM/DD/YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C3247 (NCI Thesaurus ObjectClass)
    C3463824 (UMLS 2011AA ObjectClass)
    C20118 (NCI Thesaurus Property)
    C1512894 (UMLS 2011AA Property)
    MyelodysplasticSyndromeInternationalPrognosticScoreSystemDate
    Item
    Date (Highest - Record earliest date of the values - MM/DD/YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C3247 (NCI Thesaurus ObjectClass)
    C3463824 (UMLS 2011AA ObjectClass)
    C20118 (NCI Thesaurus Property)
    C1512894 (UMLS 2011AA Property)
    Item
    Karyotype (Highest)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C25215 (NCI Thesaurus ObjectClass)
    C1261273 (UMLS 2011AA ObjectClass)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    Code List
    Karyotype (Highest)
    CL Item
    Good (Good)
    C0205170 (NCI Metathesaurus)
    CL Item
    Intermediate (Intermediate)
    C0205103 (NCI Metathesaurus)
    CL Item
    Poor (POOR)
    Item
    Karyotype (Highest)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C25215 (NCI Thesaurus ObjectClass)
    C1261273 (UMLS 2011AA ObjectClass)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    Code List
    Karyotype (Highest)
    CL Item
    Good (Good)
    C0205170 (NCI Metathesaurus)
    CL Item
    Intermediate (Intermediate)
    C0205103 (NCI Metathesaurus)
    CL Item
    Poor (POOR)
    CytopeniaAssessmentCount
    Item
    Number of Cytopenias (Highest - Red blood cells- Hemoglobin <10 g/dl 100 g/L - White blood cells- Absolute neutrophil count <1800/microliter - Platelets- Platelet count <100,000/ microliter)
    float
    C25367 (NCI Thesaurus Property)
    C25463 (NCI Thesaurus ValueDomain)
    C0750480 (UMLS 2011AA ValueDomain)
    C2979 (NCI Thesaurus ObjectClass)
    C0010828 (UMLS 2011AA ObjectClass)
    CytopeniaAssessmentCount
    Item
    Number of Cytopenias (Highest - Red blood cells- Hemoglobin <10 g/dl 100 g/L - White blood cells- Absolute neutrophil count <1800/microliter - Platelets- Platelet count <100,000/ microliter)
    float
    C25367 (NCI Thesaurus Property)
    C25463 (NCI Thesaurus ValueDomain)
    C0750480 (UMLS 2011AA ValueDomain)
    C2979 (NCI Thesaurus ObjectClass)
    C0010828 (UMLS 2011AA ObjectClass)
    MyelodysplasticSyndromeInternationalPrognosticScoreSystemScore
    Item
    International Prognostic Score (IPSS) (Highest)
    text
    C3247 (NCI Thesaurus ObjectClass)
    C3463824 (UMLS 2011AA ObjectClass)
    C20118 (NCI Thesaurus Property)
    C1512894 (UMLS 2011AA Property)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    MyelodysplasticSyndromeInternationalPrognosticScoreSystemScore
    Item
    International Prognostic Score (IPSS) (Highest)
    text
    C3247 (NCI Thesaurus ObjectClass)
    C3463824 (UMLS 2011AA ObjectClass)
    C20118 (NCI Thesaurus Property)
    C1512894 (UMLS 2011AA Property)
    C25338 (NCI Thesaurus ValueDomain)
    C0449820 (UMLS 2011AA ValueDomain)
    Item Group
    Baseline Abnormalities
    AdverseEventCommonTerminologyforAdverseEventsVersion4TermName
    Item
    CTC Adverse Event Term (Use CTCAE v4 terminology)
    text
    C41331 (NCI Thesaurus ObjectClass)
    C0877248 (UMLS 2011AA ObjectClass)
    C49704 (NCI Thesaurus Property)
    C1516728 (UMLS 2011AA Property)
    C45559 (NCI Thesaurus Property-2)
    C1705313 (UMLS 2011AA Property-2)
    C45255 (NCI Thesaurus ValueDomain)
    C1708523 (UMLS 2011AA ValueDomain)
    C49704 (NCI Thesaurus ValueDomain-2)
    C1516728 (UMLS 2011AA ValueDomain-2)
    C42614 (NCI Thesaurus ValueDomain-3)
    C0027365 (UMLS 2011AA ValueDomain-3)
    C45559 (NCI Thesaurus ValueDomain-4)
    C1705313 (UMLS 2011AA ValueDomain-4)
    C25714 (NCI Thesaurus ValueDomain-5)
    C0333052 (UMLS 2011AA ValueDomain-5)
    Item
    CTC Adverse Event Grade (Use grade 1-4 per CTCAE v4)
    text
    C41331 (NCI Thesaurus ObjectClass)
    C0877248 (UMLS 2011AA ObjectClass)
    C48309 (NCI Thesaurus Property)
    C0441800 (UMLS 2011AA Property)
    C49705 (NCI Thesaurus Property-2)
    C1710065 (UMLS 2011AA Property-2)
    C25676 (NCI Thesaurus Property-3)
    C0439793 (UMLS 2011AA Property-3)
    C41331 (NCI Thesaurus ValueDomain)
    C0877248 (UMLS 2011AA ValueDomain)
    C48309 (NCI Thesaurus ValueDomain-2)
    C0441800 (UMLS 2011AA ValueDomain-2)
    C25676 (NCI Thesaurus ValueDomain-3)
    C0439793 (UMLS 2011AA ValueDomain-3)
    Code List
    CTC Adverse Event Grade (Use grade 1-4 per CTCAE v4)
    CL Item
    Mild Adverse Event (1)
    C84263 (NCI Thesaurus)
    C1513302 (UMLS 2011AA)
    CL Item
    Moderate Adverse Event (2)
    C84264 (NCI Thesaurus)
    C1513374 (UMLS 2011AA)
    CL Item
    Severe Adverse Event (3)
    C84265 (NCI Thesaurus)
    C2919019 (UMLS 2011AA)
    CL Item
    Life Threatening Adverse Event (4)
    C84266 (NCI Thesaurus)
    C1517874 (UMLS 2011AA)
    Item Group
    Comments
    Investigator Signature
    Item
    Investigator Signature
    text
    C25704 (NCI Thesaurus ValueDomain)
    C2346576 (UMLS CUI-1)
    C25678 (NCI Thesaurus Property)
    C17089 (NCI Thesaurus ObjectClass)
    Investigator Signature Date
    Item
    Investigator Signature Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2346576 (UMLS CUI-1)
    C25678 (NCI Thesaurus Property)
    C0011008 (UMLS CUI-2)
    C25367 (NCI Thesaurus ValueDomain-2)
    C17089 (NCI Thesaurus ObjectClass)

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