ID

43882

Description

ODM form derived from 16pp General Info EBMT Lymphoma 04. please refer to: http://www.ebmt.org/Contents/Data-Management/Registrystructure/MED-ABdatacollectionforms/Pages/MED-AB-data-collection-forms.aspx

Link

http://www.ebmt.org/Contents/Data-Management/Registrystructure/MED-ABdatacollectionforms/Pages/MED-AB-data-collection-forms.aspx

Keywords

Versions (3)
  1. 9/27/17 9/27/17 -
  2. 9/27/17 9/27/17 -
  3. 9/20/21 9/20/21 -
Uploaded on

September 20, 2021

DOI

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License

Creative Commons BY-NC 3.0
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General Info EBMT Lymphoma

English

16pp General Info EBMT Lymphoma 04

1 forms  
GENERAL INFORMATION Team
Description

GENERAL INFORMATION Team

EBMT Centre Identification Code (CIC)
Description

EBMT Centre Identification Code (CIC)

Data type

integer

Alias
UMLS CUI [1,1]
C2348585
UMLS CUI [1,2]
C3826859
Hospital
Description

Hospital

Data type

text

Alias
UMLS CUI [1]
C0019994
Unit
Description

Unit

Data type

integer

Alias
UMLS CUI [1]
C1519795
Contact person
Description

Contact person

Data type

text

Alias
UMLS CUI [1]
C0337611
Telephone number
Description

Telephone

Data type

integer

Alias
UMLS CUI [1]
C1515258
Fax
Description

Fax

Data type

integer

Alias
UMLS CUI [1]
C1549619
E-Mail
Description

E-Mail

Data type

integer

Alias
UMLS CUI [1]
C1705961
Date of this report
Description

Date of this report

Data type

date

Alias
UMLS CUI [1]
C1302584
Patient following national / international study / trial
Description

STUDY/TRIAL

Data type

integer

Alias
UMLS CUI [1]
C1997894
Name of study / trial
Description

Name of study / trial

Data type

integer

Alias
UMLS CUI [1]
C0008976
GENERAL INFORMATION Patient
Description

GENERAL INFORMATION Patient

Unique Identification Code (UIC)
Description

To be entered only if patient previously reported

Data type

integer

Alias
UMLS CUI [1]
C2348585
Hospital Unique Patient Number or Code
Description

Hospital Unique Patient Number or Code

Data type

integer

Alias
UMLS CUI [1]
C2926025
Initials
Description

First name(s)_surname(s)

Data type

text

Alias
UMLS CUI [1]
C2986440
Date of birth:
Description

Date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Sex
Description

Sex

Data type

text

Alias
UMLS CUI [1]
C0079399
ABO Group
Description

ABO Group

Data type

integer

Alias
UMLS CUI [1]
C0000778
Rh factor
Description

Rh factor

Data type

integer

Alias
UMLS CUI [1]
C0035403
DISEASE
Description

DISEASE

Date of diagnosis
Description

Date of diagnosis

Data type

date

Alias
UMLS CUI [1]
C2316983
Primary Disease Diagnosis
Description

Check the disease for which this transplant was performed

Data type

integer

Alias
UMLS CUI [1]
C0277554
LYMPHOMA INITIAL DIAGNOSIS
Description

LYMPHOMA INITIAL DIAGNOSIS

Has the information requested in this section been submitted with a previous transplant registration for this patient?
Description

Has the information requested in this section been submitted with a previous transplant registration for this patient?

Data type

integer

Alias
UMLS CUI [1]
C0421512
Non Hodgkin Lymphoma (NHL)
Description

Non Hodgkin Lymphoma (NHL)

Data type

integer

Alias
UMLS CUI [1]
C0024305
Transformed from another type of lymphoma at HSCT?
Description

Transformed from another type of lymphoma at HSCT?

Data type

boolean

Alias
UMLS CUI [1]
C0854868
T-CELL AND NK-CELL NON HODGKIN LYMPHOMAS (NHL)
Description

Mature T-cell & NK-cell Neoplasms

Data type

integer

Alias
UMLS CUI [1]
C1336554
HODGKIN LYMPHOMA
Description

HODGKIN LYMPHOMAS

Data type

integer

Alias
UMLS CUI [1]
C0019829
Stage at diagnosis
Description

ANN ARBOR STAGING FOR ADULT NON-BURKITT'S PATIENTS, MURPHY STAGE FOR BURKITT'S DISEASE AND PAEDIATRIC PATIENTS.

Data type

text

Alias
UMLS CUI [1]
C1300072
Systemic symptoms
Description

Systemic symptoms

Data type

text

Alias
UMLS CUI [1]
C2039684
Size of largest mass
Description

DISEASE INVOLVEMENT AT DIAGNOSIS

Data type

integer

Alias
UMLS CUI [1]
C1272779
LDH Level
Description

LDH LEVELS

Data type

integer

Alias
UMLS CUI [1]
C0022917
Specific sites of involvement
Description

Specific sites of involvement

Data type

integer

Alias
UMLS CUI [1]
C2046538
TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT
Description

TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT

Has the information requested in this section been submitted with a previous transplant registration for this patient?
Description

Has the information requested in this section been submitted with a previous transplant registration for this patient?

Data type

integer

Alias
UMLS CUI [1]
C1514821
WAS THE PATIENT TREATED BEFORE THE 1ST TRANSPLANT PROCEDURE?
Description

WAS THE PATIENT TREATED BEFORE THE 1ST TRANSPLANT PROCEDURE?

Data type

integer

Alias
UMLS CUI [1]
C0040732
Sequential number of this treatment (counted from diagnosis)
Description

Sequential number of this treatment

Data type

integer

Alias
UMLS CUI [1]
C0087111
Modality Chemo/drug/agent (including MoAB, etc.)
Description

Modality Chemo/drug/agent

Data type

text

Alias
UMLS CUI [1]
C0695347
If MoAB, radiolabelled
Description

If MoAB, radiolabelled

Data type

text

Alias
UMLS CUI [1]
C0392292
Radiotherapy
Description

Radiotherapy

Data type

boolean

Alias
UMLS CUI [1]
C1522449
Response to this line of therapy
Description

Response to this line of therapy

Data type

integer

Alias
UMLS CUI [1]
C0521982
ADDITIONAL TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT?
Description

ADDITIONAL TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT?

Data type

text

Alias
UMLS CUI [1]
C1706712
Chemo/drug/agent
Description

Pharmacotherapy

Data type

boolean

Alias
UMLS CUI [1]
C0013216
Treatment Regimen
Description

Regimen

Data type

integer

Alias
UMLS CUI [1]
C0392920
Radiotherapy
Description

Radiotherapy

Data type

boolean

Alias
UMLS CUI [1]
C1522449
Response to this line of therapy
Description

Response to this line of therapy

Data type

text

Alias
UMLS CUI [1]
C0871261
DISEASE HISTORY BEFORE HSCT
Description

DISEASE HISTORY BEFORE HSCT

Date of transplant
Description

Date of transplant

Data type

date

Alias
UMLS CUI [1,1]
C0472699
UMLS CUI [1,2]
C0011008
Total number of lines before this transplant
Description

(since diagnosis if 1st transplant, or since last reported transplant)

Data type

integer

Alias
UMLS CUI [1]
C1708063
Modality used at least once
Description

Modality used at least once

Data type

integer

Alias
UMLS CUI [1]
C0695347
Splenectomy
Description

Splenectomy

Data type

boolean

Alias
UMLS CUI [1]
C0037995
TYPE OF RELAPSE
Description

TYPE OF RELAPSE

Data type

integer

Alias
UMLS CUI [1]
C0205336
Complete remission achieved before the 1st transplant
Description

CR achieved before the 1st transplant

Data type

integer

Alias
UMLS CUI [1]
C0677874
1st Relapse before the 1st transplant
Description

TO BE COMPLETED ONLY IF PATIENT HAD A CR BEFORE THE 1ST TRANSPLANT

Data type

integer

Alias
UMLS CUI [1]
C0035020
STATUS OF DISEASE AT HSCT
Description

STATUS OF DISEASE AT HSCT

If patient has ever achieved Complete remission
Description

If patient has ever achieved Complete remission

Data type

integer

Alias
UMLS CUI [1]
C0677874
RELAPSE
Description

RELAPSE

Data type

boolean

Alias
UMLS CUI [1]
C0277556
TYPE OF RELAPSE
Description

TYPE OF RELAPSE

Data type

integer

Alias
UMLS CUI [1,1]
C0035020
UMLS CUI [1,2]
C0035020
If patient has never achieved a Complete remission
Description

If patient has never achieved a Complete remission

Data type

integer

Alias
UMLS CUI [1]
C0677874
NUMBER OF THIS partial response
Description

NUMBER OF THIS PR

Data type

text

Alias
UMLS CUI [1]
C1521726
DISEASE INVOLVEMENT AT TRANSPLANT
Description

DISEASE INVOLVEMENT AT TRANSPLANT

Data type

text

Alias
UMLS CUI [1]
C0012634
Size of largest mass
Description

(if patient in CR at HSCT, indicate “No mass”)

Data type

text

Alias
UMLS CUI [1]
C3272927
Specific sites of disease (to be completed ONLY if patient NOT in CR at transplant)
Description

Specific sites of disease

Data type

integer

Alias
UMLS CUI [1]
C0027653
Number of relapses in the last 12 months unknown
Description

Number of relapses in the last 12 months unknown

Data type

integer

Alias
UMLS CUI [1,1]
C0035020
UMLS CUI [1,2]
C0237753
ADDITIONAL TREATMENT POST-HSCT
Description

ADDITIONAL TREATMENT POST-HSCT

Additional Disease Treatment
Description

Additional Disease Treatment

Data type

integer

Alias
UMLS CUI [1]
C1706712
Start of treatment
Description

Date started

Data type

date

Alias
UMLS CUI [1]
C2712338
Modality
Description

Modality

Data type

integer

Alias
UMLS CUI [1]
C0695347
Radiotherapy
Description

Radiotherapy

Data type

integer

Alias
UMLS CUI [1]
C1522449
BEST DISEASE RESPONSE AT 100 DAYS POST-HSCT
Description

BEST DISEASE RESPONSE AT 100 DAYS POST-HSCT

BEST RESPONSE AT 100 DAYS AFTER TRANSPLANTATION
Description

BEST RESPONSE AT 100 DAYS AFTER TRANSPLANTATION

Data type

integer

Alias
UMLS CUI [1]
C1704632
If Complete remission: Date of CR
Description

If Complete remission: Date of CR

Data type

date

Alias
UMLS CUI [1,1]
C4050094
UMLS CUI [1,2]
C2316983
FORMS TO BE FILLED IN
Description

FORMS TO BE FILLED IN

TYPE OF TRANSPLANT
Description

TYPE OF TRANSPLANT

Data type

integer

Alias
UMLS CUI [1]
C3840412
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Similar models

16pp General Info EBMT Lymphoma 04

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
GENERAL INFORMATION Team
EBMT Centre Identification Code (CIC)
Item
EBMT Centre Identification Code (CIC)
integer
C2348585 (UMLS CUI [1,1])
C3826859 (UMLS CUI [1,2])
Hospital
Item
Hospital
text
C0019994 (UMLS CUI [1])
Unit
Item
Unit
integer
C1519795 (UMLS CUI [1])
Contact person
Item
Contact person
text
C0337611 (UMLS CUI [1])
Telephone
Item
Telephone number
integer
C1515258 (UMLS CUI [1])
Fax
Item
Fax
integer
C1549619 (UMLS CUI [1])
E-Mail
Item
E-Mail
integer
C1705961 (UMLS CUI [1])
Date of this report
Item
Date of this report
date
C1302584 (UMLS CUI [1])
Item
Patient following national / international study / trial
integer
C1997894 (UMLS CUI [1])
Patient in Trial
Code List
Patient following national / international study / trial
CL Item
No (1)
C1298908 (UMLS CUI-1)
CL Item
Yes (2)
C1705108 (UMLS CUI-1)
CL Item
Not evaluated (3)
C3846720 (UMLS CUI-1)
CL Item
Unknown (4)
C0439673 (UMLS CUI-1)
Name of study / trial
Item
Name of study / trial
integer
C0008976 (UMLS CUI [1])
Item Group
GENERAL INFORMATION Patient
Unique Identification Code (UIC)
Item
Unique Identification Code (UIC)
integer
C2348585 (UMLS CUI [1])
Hospital Unique Patient Number or Code
Item
Hospital Unique Patient Number or Code
integer
C2926025 (UMLS CUI [1])
Initials
Item
Initials
text
C2986440 (UMLS CUI [1])
Date of birth
Item
Date of birth:
date
C0421451 (UMLS CUI [1])
Item
Sex
text
C0079399 (UMLS CUI [1])
Sex
Code List
Sex
CL Item
Male (1)
C1706180 (UMLS CUI-1)
CL Item
Female (2)
C0086287 (UMLS CUI-1)
ABO Group
Item
ABO Group
integer
C0000778 (UMLS CUI [1])
Item
Rh factor
integer
C0035403 (UMLS CUI [1])
Rh factor
Code List
Rh factor
CL Item
Absent (1)
C2699077 (UMLS CUI-1)
CL Item
Present  (2)
C2699078 (UMLS CUI-1)
CL Item
Not evaluated (3)
C3846720 (UMLS CUI-1)
Item Group
DISEASE
Date of diagnosis
Item
Date of diagnosis
date
C2316983 (UMLS CUI [1])
Item
Primary Disease Diagnosis
integer
C0277554 (UMLS CUI [1])
Primary Disease Diagnosis
Code List
Primary Disease Diagnosis
CL Item
Acute Leukaemia (Acute Leukaemia)
C0085669 (UMLS CUI-1)
CL Item
Acute Myelogenous Leukaemia (AML) (Acute Myelogenous Leukaemia (AML))
C0023467 (UMLS CUI-1)
CL Item
Acute Lymphoblastic Leukaemia (ALL) (Acute Lymphoblastic Leukaemia (ALL))
C0023449 (UMLS CUI-1)
CL Item
Secondary Acute Leukaemia (do not use if transformed from MDS/MPN) (Secondary Acute Leukaemia (do not use if transformed from MDS/MPN))
C0856053 (UMLS CUI-1)
CL Item
Chronic Leukaemia (Chronic Leukaemia)
C0856053 (UMLS CUI-1)
CL Item
Chronic Myeloid Leukaemia (CML) (Chronic Myeloid Leukaemia (CML))
C0023473 (UMLS CUI-1)
CL Item
Chronic Lymphocytic Leukaemia (Chronic Lymphocytic Leukaemia)
C0023434 (UMLS CUI-1)
CL Item
Lymphoma (Lymphoma)
C0024299 (UMLS CUI-1)
CL Item
Non Hodgkin (Non Hodgkin)
C0024305 (UMLS CUI-1)
CL Item
Myeloma/ Plasma cell disorder (Myeloma/ Plasma cell disorder)
C0026764 (UMLS CUI-1)
CL Item
Solid Tumour (Solid Tumour)
C0006826 (UMLS CUI-1)
CL Item
Myelodysplastic syndromes (Myelodysplastic syndromes)
C0280450 (UMLS CUI-1)
CL Item
MDS (MDS)
C3463824 (UMLS CUI-1)
CL Item
MD/ MPN (MD/ MPN)
C1292778 (UMLS CUI-1)
CL Item
Myeloproliferative neoplasm (Myeloproliferative neoplasm)
C1333046 (UMLS CUI-1)
CL Item
Bone marrow failure including Aplastic anaemia (Bone marrow failure including Aplastic anaemia)
C0002874 (UMLS CUI-1)
CL Item
Inherited disorders (Inherited disorders)
C0019247 (UMLS CUI-1)
CL Item
Primary immune deficiencies (Primary immune deficiencies)
C0398686 (UMLS CUI-1)
CL Item
Metabolic disorders (Metabolic disorders)
C0025517 (UMLS CUI-1)
CL Item
Histiocytic disorders (Histiocytic disorders)
C0398597 (UMLS CUI-1)
CL Item
Autoimmune disease (Autoimmune disease)
C0004364 (UMLS CUI-1)
CL Item
Juvenile Idiopathic Arthritis (Juvenile Idiopathic Arthritis)
C1444841 (UMLS CUI-1)
CL Item
Multiple Sclerosis (Multiple Sclerosis)
C0026769 (UMLS CUI-1)
CL Item
Systemic Lupus (Systemic Lupus)
C0024141 (UMLS CUI-1)
CL Item
Systemic Sclerosis (Systemic Sclerosis)
C0036421 (UMLS CUI-1)
CL Item
Haemoglobinopathy (Haemoglobinopathiy)
C0019045 (UMLS CUI-1)
CL Item
Other diagnosis (Other diagnosis)
C0205394 (UMLS CUI-1)
CL Item
Hodgkin´s Disease (Hodgkin´s Disease)
C0019829 (UMLS CUI-1)
Item Group
LYMPHOMA INITIAL DIAGNOSIS
Item
Has the information requested in this section been submitted with a previous transplant registration for this patient?
integer
C0421512 (UMLS CUI [1])
Has the information requested in this section been submitted with a previous transplant registration for this patient?
Code List
Has the information requested in this section been submitted with a previous transplant registration for this patient?
CL Item
Yes: go to page 4, Treatment given before the 1st transplant (1)
CL Item
No: proceed with this section (2)
CL Item
Non Hodgkin Lymphoma (NHL) (3)
Item
Non Hodgkin Lymphoma (NHL)
integer
C0024305 (UMLS CUI [1])
Non Hodgkin Lymphoma (NHL)
Code List
Non Hodgkin Lymphoma (NHL)
CL Item
B-Cell Lymphomas (1)
C0079731 (UMLS CUI-1)
CL Item
Splenic marginal zone lymphoma (2)
C0349632 (UMLS CUI-1)
CL Item
Extranodal marginal zone lymphoma of mucosa associated lymphoid tissue (MALT)  (3)
C0242647 (UMLS CUI-1)
CL Item
Nodal marginal zone lymphoma (4)
C0855140 (UMLS CUI-1)
CL Item
Lymphoplasmacytic lymphoma (LPL) (5)
C0334633 (UMLS CUI-1)
CL Item
Waldenstrom macroglobulinaemia (6)
C0024419 (UMLS CUI-1)
CL Item
(LPL with monoclonal IgM)  (7)
C0334633 (UMLS CUI-1)
CL Item
Follicular lymphoma (8)
C0024301 (UMLS CUI-1)
CL Item
9 (9)
CL Item
Primary cutaneous follicle centre lymphoma (10)
C1333171 (UMLS CUI-1)
CL Item
Mantle cell lymphoma (11)
C1333095 (UMLS CUI-1)
CL Item
Diffuse large B-cell lymphoma (DLBCL), (NOS) (12)
C0079744 (UMLS CUI-1)
CL Item
T-cell/hystiocyte rich large B cell lymphoma (13)
C0079744 (UMLS CUI-1)
CL Item
Primary DLBCL of the CNS (14)
C0079744 (UMLS CUI-1)
CL Item
Primary cutaneous DLBCL, leg type (15)
C1275325 (UMLS CUI-1)
CL Item
EBV positive DLBCL of the elderly (16)
C2700007 (UMLS CUI-1)
CL Item
DLBCL associated with chronic inflammation (17)
C2699776 (UMLS CUI-1)
CL Item
Lymphomatoid granulomatosis (18)
C0024307 (UMLS CUI-1)
CL Item
Primary mediastinal (thymic) large B-cell lymphoma (19)
C1292754 (UMLS CUI-1)
CL Item
Intravascular large B-cell lymphoma (20)
C0334660 (UMLS CUI-1)
CL Item
ALK positive large B-cell lymphoma (21)
C1333294 (UMLS CUI-1)
CL Item
Plasmablastic lymphoma (22)
C3472614 (UMLS CUI-1)
CL Item
Large B-cell lymphoma arising in HHV8- associated multicentric Castleman disease (23)
C3472615 (UMLS CUI-1)
CL Item
Primary effusion lymphoma (PEL) (24)
C1292753 (UMLS CUI-1)
CL Item
Burkitt lymphoma (BL) (25)
C0006413 (UMLS CUI-1)
CL Item
B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma (Intermediate DLCBL/BL) (26)
C2698294 (UMLS CUI-1)
CL Item
B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma (Intermediate DLCBL/HD) (27)
C1333878 (UMLS CUI-1)
CL Item
Other B-cell, specify: (28)
C1709657 (UMLS CUI-1)
Transformed from another type of lymphoma at HSCT?
Item
Transformed from another type of lymphoma at HSCT?
boolean
C0854868 (UMLS CUI [1])
Item
T-CELL AND NK-CELL NON HODGKIN LYMPHOMAS (NHL)
integer
C1336554 (UMLS CUI [1])
Mature T-cell & NK-cell Neoplasms
Code List
T-CELL AND NK-CELL NON HODGKIN LYMPHOMAS (NHL)
CL Item
T-cell large granular lymphocytic leukaemia (1)
C1955861 (UMLS CUI-1)
CL Item
Aggressive NK-cell leukaemia (2)
C1292777 (UMLS CUI-1)
CL Item
Systemic EBV positive T-cell lymphoproliferative disease of childhood (3)
C2699838 (UMLS CUI-1)
CL Item
Hydroa vacciniforme-like lymphoma (4)
C1708397 (UMLS CUI-1)
CL Item
Adult T-cell leukaemia/lymphoma (5)
C0023493 (UMLS CUI-1)
CL Item
Extranodal NK/T-cell lymphoma, nasal type (6)
C0392788 (UMLS CUI-1)
CL Item
Enteropathy-associated T-cell lymphoma (7)
C0456889 (UMLS CUI-1)
CL Item
Hepatosplenic T-cell lymphoma (8)
C1333984 (UMLS CUI-1)
CL Item
Subcutaneous panniculitis-like T-cell lymphoma (9)
C0522624 (UMLS CUI-1)
CL Item
Mycosis fungoides (MF) (10)
C0026948 (UMLS CUI-1)
CL Item
Sézary syndrome  (11)
C0036920 (UMLS CUI-1)
CL Item
Lymphomatoid papulosis (12)
C0206182 (UMLS CUI-1)
CL Item
Primary cutaneous anaplastic large cell lymphoma (13)
C1275326 (UMLS CUI-1)
CL Item
Primary cutaneous gamma-delta T-cell lymphoma (14)
C1707547 (UMLS CUI-1)
CL Item
Primary cutaneous CD8 positive aggressive epidermotropic cytotoxic T-cell lymphoma (15)
C0079772 (UMLS CUI-1)
CL Item
Primary cutaneous CD4 positive small/medium T-cell lymphoma (16)
C1301363 (UMLS CUI-1)
CL Item
Peripheral T-cell lymphoma, NOS (PTCL) (17)
C0079774 (UMLS CUI-1)
CL Item
Angioimmunoblastic T-cell lymphoma (18)
C0020981 (UMLS CUI-1)
CL Item
Anaplastic large-cell lymphoma (ALCL), ALK-positive (19)
C1332079 (UMLS CUI-1)
CL Item
Anaplastic large-cell lymphoma (ALCL), ALK-negative (20)
C1332078 (UMLS CUI-1)
CL Item
Other T-cell, specify (21)
C3845569 (UMLS CUI-1)
Item
HODGKIN LYMPHOMA
integer
C0019829 (UMLS CUI [1])
HODGKIN LYMPHOMAS
Code List
HODGKIN LYMPHOMA
CL Item
Nodular lymphocyte  (Nodular lymphocyte predominant)
C1334968 (UMLS CUI-1)
CL Item
Classical predominant (Classical predominant)
C1333064 (UMLS CUI-1)
CL Item
Nodular sclerosis classical (Nodular sclerosis classical)
C0152268 (UMLS CUI-1)
CL Item
Lymphocyte-rich classical (Lymphocyte-rich classical)
C1266194 (UMLS CUI-1)
CL Item
Mixed cellularity classical (Mixed cellularity classical)
C0152266 (UMLS CUI-1)
CL Item
Lymphocyte-depleted classical (Lymphocyte-depleted classical)
C0152267 (UMLS CUI-1)
CL Item
Other, specify (Other, specify)
C1299220 (UMLS CUI-1)
Item
Stage at diagnosis
text
C1300072 (UMLS CUI [1])
Stage
Code List
Stage at diagnosis
CL Item
I (I)
CL Item
II (II)
CL Item
III (III)
CL Item
IV (IV)
Item
Systemic symptoms
text
C2039684 (UMLS CUI [1])
Systemic symptoms
Code List
Systemic symptoms
CL Item
Absent (A) (Absent (A))
CL Item
Present (B) (Present (B))
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item
Size of largest mass
integer
C1272779 (UMLS CUI [1])
Size of largest mass
Code List
Size of largest mass
CL Item
< 5 cm  (1)
CL Item
5-10 cm  (2)
CL Item
> 10 cm  (3)
CL Item
No mass  (4)
CL Item
Unknown (5)
Item
LDH Level
integer
C0022917 (UMLS CUI [1])
LDH LEVELS
Code List
LDH Level
CL Item
Normal  (1)
C0853788 (UMLS CUI-1)
CL Item
Elevated  (2)
C0151754 (UMLS CUI-1)
CL Item
Not evaluated  (3)
C3846720 (UMLS CUI-1)
CL Item
Unknown (4)
C0439673 (UMLS CUI-1)
Item
Specific sites of involvement
integer
C2046538 (UMLS CUI [1])
Specific sites of involvement
Code List
Specific sites of involvement
CL Item
Nodes below the diaphragm  (1)
C0854726 (UMLS CUI-1)
CL Item
Bone marrow  (2)
C2046619 (UMLS CUI-1)
CL Item
Extranodal (CNS) (3)
C3164318 (UMLS CUI-1)
CL Item
Mediastinum  (4)
C1334658 (UMLS CUI-1)
CL Item
Extranodal (testis /ovary)  (5)
C2046656 (UMLS CUI-1)
CL Item
Nodes above the diaphragm (6)
CL Item
Lung  (7)
C2046647 (UMLS CUI-1)
CL Item
Liver  (8)
C2046646 (UMLS CUI-1)
CL Item
Spleen (9)
C2853781 (UMLS CUI-1)
CL Item
Other (10)
C0205394 (UMLS CUI-1)
Item Group
TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT
Item
Has the information requested in this section been submitted with a previous transplant registration for this patient?
integer
C1514821 (UMLS CUI [1])
Has the information requested in this section been submitted with a previous transplant registration for this patient?
Code List
Has the information requested in this section been submitted with a previous transplant registration for this patient?
CL Item
No: proceed with this section (No: proceed with this section)
CL Item
Yes: go to page 5, ”Disease History before HSCT" (Yes: go to page 5, ”Disease History before HSCT")
Item
WAS THE PATIENT TREATED BEFORE THE 1ST TRANSPLANT PROCEDURE?
integer
C0040732 (UMLS CUI [1])
WAS THE PATIENT TREATED BEFORE THE 1ST TRANSPLANT PROCEDURE?
Code List
WAS THE PATIENT TREATED BEFORE THE 1ST TRANSPLANT PROCEDURE?
CL Item
WAS THE PATIENT TREATED BEFORE THE 1ST TRANSPLANT PROCEDURE? (1)
CL Item
Yes Date started (2)
Sequential number of this treatment
Item
Sequential number of this treatment (counted from diagnosis)
integer
C0087111 (UMLS CUI [1])
Item
Modality Chemo/drug/agent (including MoAB, etc.)
text
C0695347 (UMLS CUI [1])
Modality Chemo/drug/agent
Code List
Modality Chemo/drug/agent (including MoAB, etc.)
CL Item
No  (No )
CL Item
Yes: Regimen (Yes: Regimen)
CL Item
Unknown (Unknown)
Item
If MoAB, radiolabelled
text
C0392292 (UMLS CUI [1])
Chemo/drug/agent
Code List
If MoAB, radiolabelled
CL Item
No  (No )
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
Radiotherapy
Item
Radiotherapy
boolean
C1522449 (UMLS CUI [1])
Item
Response to this line of therapy
integer
C0521982 (UMLS CUI [1])
Response to this line of therapy
Code List
Response to this line of therapy
CL Item
Complete remission  (Complete remission )
CL Item
Partial remission (> 50 %)  ( Partial remission (> 50 %) )
CL Item
No response (< 50 %) ( No response (< 50 %))
Item
ADDITIONAL TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT?
text
C1706712 (UMLS CUI [1])
ADDITIONAL TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT?
Code List
ADDITIONAL TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT?
CL Item
Unknown (Unknown)
CL Item
Yes Date started (Yes Date started)
CL Item
No – Proceed to page 5, ”Disease History before HSCT" (No – Proceed to page 5, ”Disease History before HSCT")
Pharmacotherapy
Item
Chemo/drug/agent
boolean
C0013216 (UMLS CUI [1])
Regimen
Item
Treatment Regimen
integer
C0392920 (UMLS CUI [1])
Radiotherapy
Item
Radiotherapy
boolean
C1522449 (UMLS CUI [1])
Item
Response to this line of therapy
text
C0871261 (UMLS CUI [1])
Response to this line of therapy
Code List
Response to this line of therapy
CL Item
Complete remission  (Complete remission )
C0677874 (UMLS CUI-1)
CL Item
Partial remission (> 50 %)  ( Partial remission (> 50 %) )
C1521726 (UMLS CUI-1)
CL Item
No response (< 50 %) (No response (< 50 %))
C3844738 (UMLS CUI-1)
Item Group
DISEASE HISTORY BEFORE HSCT
Date of transplant
Item
Date of transplant
date
C0472699 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Total number of lines before this transplant
Item
Total number of lines before this transplant
integer
C1708063 (UMLS CUI [1])
Item
Modality used at least once
integer
C0695347 (UMLS CUI [1])
MoAB (Immunotherapy)
Code List
Modality used at least once
CL Item
Chemotherapy (1)
C0392920 (UMLS CUI-1)
CL Item
MoAB (Immunotherapy) (2)
C0279694 (UMLS CUI-1)
CL Item
Radiotherapy (3)
C1522449 (UMLS CUI-1)
Splenectomy
Item
Splenectomy
boolean
C0037995 (UMLS CUI [1])
Item
TYPE OF RELAPSE
integer
C0205336 (UMLS CUI [1])
TYPE OF RELAPSE
Code List
TYPE OF RELAPSE
CL Item
Untreated (untested) (Untreated (untested))
CL Item
Sensitive (responding) (Sensitive (responding))
CL Item
Resistant (Resistant)
Item
Complete remission achieved before the 1st transplant
integer
C0677874 (UMLS CUI [1])
CR achieved before the 1st transplant
Code List
Complete remission achieved before the 1st transplant
CL Item
Yes: Date of first CR (Yes: Date of first CR)
CL Item
No (No)
CL Item
Number of treatment lines necessary to reach this first remission (3)
CL Item
Number of CR’s (4)
Item
1st Relapse before the 1st transplant
integer
C0035020 (UMLS CUI [1])
1st Relapse before the 1st transplant
Code List
1st Relapse before the 1st transplant
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
CL Item
No (2)
C1298908 (UMLS CUI-1)
Item Group
STATUS OF DISEASE AT HSCT
Item
If patient has ever achieved Complete remission
integer
C0677874 (UMLS CUI [1])
STATUS OF DISEASE AT HSCT
Code List
If patient has ever achieved Complete remission
CL Item
Complete remission (CR) (Complete remission (CR))
C0677874 (UMLS CUI-1)
CL Item
Unconfirmed (Unconfirmed)
C1547326 (UMLS CUI-1)
CL Item
Confirmed -By CT scan (Confirmed -By CT scan)
C0040405 (UMLS CUI-1)
CL Item
Confirmed -By PET (Confirmed -By PET)
C0032743 (UMLS CUI-1)
CL Item
Relapse (Relapse)
C0277556 (UMLS CUI-1)
RELAPSE
Item
RELAPSE
boolean
C0277556 (UMLS CUI [1])
Item
TYPE OF RELAPSE
integer
C0035020 (UMLS CUI [1,1])
C0035020 (UMLS CUI [1,2])
TYPE OF RELAPSE
Code List
TYPE OF RELAPSE
CL Item
Untreated (untested) (Untreated (untested))
C0332155 (UMLS CUI-1)
CL Item
Sensitive (responding) (Sensitive (responding))
C0332324 (UMLS CUI-1)
CL Item
Resistant (Resistant)
C3844738 (UMLS CUI-1)
Item
If patient has never achieved a Complete remission
integer
C0677874 (UMLS CUI [1])
If patient has never achieved a Complete remission
Code List
If patient has never achieved a Complete remission
CL Item
At diagnosis (untreated) (At diagnosis (untreated))
C0332155 (UMLS CUI-1)
CL Item
Primary refractory disease ( Primary refractory disease)
C1514815 (UMLS CUI-1)
CL Item
Very good 1st PR (> 90 %) (Very good 1st PR (> 90 %))
C1521726 (UMLS CUI-1)
CL Item
PR ( PR)
C1521726 (UMLS CUI-1)
CL Item
Progression (Progression)
C0242656 (UMLS CUI-1)
Item
NUMBER OF THIS partial response
text
C1521726 (UMLS CUI [1])
NUMBER OF THIS PR
Code List
NUMBER OF THIS partial response
CL Item
1st (1st)
CL Item
2nd (2nd)
CL Item
3rd or higher (3rd or higher)
Item
DISEASE INVOLVEMENT AT TRANSPLANT
text
C0012634 (UMLS CUI [1])
DISEASE INVOLVEMENT AT TRANSPLANT
Code List
DISEASE INVOLVEMENT AT TRANSPLANT
CL Item
Yes  (Yes )
C1705108 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
CL Item
No  (No )
C1298908 (UMLS CUI-1)
CL Item
Not evaluated  (Not evaluated )
C3846720 (UMLS CUI-1)
Item
Size of largest mass
text
C3272927 (UMLS CUI [1])
Size of largest mass
Code List
Size of largest mass
CL Item
< 5 cm  (< 5 cm )
CL Item
5-10 cm  ( 5-10 cm )
CL Item
> 10 cm  ( > 10 cm )
CL Item
No mass  ( No mass )
CL Item
Not evaluated ( Not evaluated)
Item
Specific sites of disease (to be completed ONLY if patient NOT in CR at transplant)
integer
C0027653 (UMLS CUI [1])
Specific sites of disease
Code List
Specific sites of disease (to be completed ONLY if patient NOT in CR at transplant)
CL Item
Nodes below the diaphragm Bone marrow  (1)
C0854726 (UMLS CUI-1)
CL Item
Extranodal (CNS) (2)
C3164318 (UMLS CUI-1)
CL Item
Mediastinum  (3)
C1334658 (UMLS CUI-1)
CL Item
Extranodal (testis /ovary)  (4)
C2046656 (UMLS CUI-1)
CL Item
Nodes above the diaphragm (5)
C1336486 (UMLS CUI-1)
CL Item
Lung  (6)
C2046647 (UMLS CUI-1)
CL Item
Liver  (7)
C2046646 (UMLS CUI-1)
CL Item
Spleen (8)
C2853781 (UMLS CUI-1)
CL Item
Bone marrow (9)
C2046619 (UMLS CUI-1)
Item
Number of relapses in the last 12 months unknown
integer
C0035020 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Number of relapses in the last 12 months unknown
Code List
Number of relapses in the last 12 months unknown
CL Item
1st (1)
CL Item
2nd (2)
CL Item
3rd or higher (3)
Item Group
ADDITIONAL TREATMENT POST-HSCT
Item
Additional Disease Treatment
integer
C1706712 (UMLS CUI [1])
Additional Disease Treatment
Code List
Additional Disease Treatment
CL Item
No (No)
C1298908 (UMLS CUI-1)
CL Item
Unknown (Unknown)
C0439673 (UMLS CUI-1)
CL Item
Yes: Planned (planned before HSCT took place) (Yes: Planned (planned before HSCT took place))
C3641097 (UMLS CUI-1)
CL Item
Not planned (for relapse/progression or persistent disease) ( Not planned (for relapse/progression or persistent disease))
C0087111 (UMLS CUI-1)
Date started
Item
Start of treatment
date
C2712338 (UMLS CUI [1])
Item
Modality
integer
C0695347 (UMLS CUI [1])
Chemo/drug/agent
Code List
Modality
CL Item
Chemo (Chemo)
CL Item
drug (drug)
CL Item
agent (including MoAB, vaccination, etc.) (agent (including MoAB, vaccination, etc.))
Item
Radiotherapy
integer
C1522449 (UMLS CUI [1])
Radiotherapy
Code List
Radiotherapy
CL Item
yes no=no not known=not known (yes)
Item Group
BEST DISEASE RESPONSE AT 100 DAYS POST-HSCT
Item
BEST RESPONSE AT 100 DAYS AFTER TRANSPLANTATION
integer
C1704632 (UMLS CUI [1])
BEST RESPONSE AT 100 DAYS AFTER TRANSPLANTATION
Code List
BEST RESPONSE AT 100 DAYS AFTER TRANSPLANTATION
CL Item
Complete remission (maintained or achieved)  (Complete remission (maintained or achieved) )
C0677874 (UMLS CUI-1)
CL Item
Partial remission (> 50 %)  ( Partial remission (> 50 %) )
C1521726 (UMLS CUI-1)
CL Item
No response (< 50 %) ( No response (< 50 %))
C0871261 (UMLS CUI-1)
CL Item
Progression  ( Progression )
C0242656 (UMLS CUI-1)
CL Item
Early death/Not evaluable ( Early death/Not evaluable)
C1836407 (UMLS CUI-1)
CL Item
Complete remission confirmed by CT scan ( By CT scan)
C0040398 (UMLS CUI-1)
C0677874 (UMLS CUI-2)
CL Item
Complete remission confirmed by PET ( By PET)
C0677874 (UMLS CUI-1)
C0032743 (UMLS CUI-2)
CL Item
 ( )
If Complete remission: Date of CR
Item
If Complete remission: Date of CR
date
C4050094 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item Group
FORMS TO BE FILLED IN
Item
TYPE OF TRANSPLANT
integer
C3840412 (UMLS CUI [1])
TYPE OF TRANSPLANT
Code List
TYPE OF TRANSPLANT
CL Item
AUTOgraft, proceed to Autograft form (1)
C0040736 (UMLS CUI-1)
CL Item
ALLOgraft or Syngeneic graft, proceed to Allograft form (2)
C0040739 (UMLS CUI-1)
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