Description:

E2905 On-Study 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=0EA9BECA-9DE5-1273-E044-0003BA3F9857

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0EA9BECA-9DE5-1273-E044-0003BA3F9857
Keywords:
  1. 12/18/14 12/18/14 - Martin Dugas
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 6/16/15 6/16/15 -
  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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E2905 On-Study Form NCT00843882

Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files. NOTE: Submit bone marrow and cytogenics reports

Header
Reporting Period
Data amendment
Current Performance Status
ECOG Performance Status
Kg
cm
Is bone marrow iron stain available for patient
ng/ml
Does the patient have a history of thromboembolic events
Does the patient have any history of the following (If yes,)
Did it occur in the last 3 years (If yes,)
Baseline Abnormalities
Radiotherapy
Chemotherapy
Immunotherapy
Leukocyte Growth Factor
Was this disease MDS secondary due to treatment
Cytarabine
Azacitidine
Decitabine
Cyclosporin
ATG (anti-thymocyte globulin)
Thalidomide
Prior Darpoietin Alpha (DA)
Prior Epoetin Alpha
Did patient have prior EPO failure
Low EPO response profile (If no,)
Other prior erythropoietic growth factor (other than rhu-EPO and Darbepoetin Alfa)
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