GENERAL INFORMATION Patient
To be entered only if patient previously reported
integer
Hospital Unique Patient Number or Code
integer
First name(s)_surname(s)
text
Date of birth
date
Sex
text
ABO Group
integer
Rh factor
integer
DISEASE
Date of diagnosis
date
Check the disease for which this transplant was performed
integer
LYMPHOMA INITIAL DIAGNOSIS
Has the information requested in this section been submitted with a previous transplant registration for this patient?
integer
Non Hodgkin Lymphoma (NHL)
integer
Transformed from another type of lymphoma at HSCT?
boolean
Mature T-cell & NK-cell Neoplasms
integer
HODGKIN LYMPHOMAS
integer
ANN ARBOR STAGING FOR ADULT NON-BURKITT'S PATIENTS, MURPHY STAGE FOR BURKITT'S DISEASE AND PAEDIATRIC PATIENTS.
text
Systemic symptoms
text
DISEASE INVOLVEMENT AT DIAGNOSIS
integer
LDH LEVELS
integer
Specific sites of involvement
integer
TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT
Has the information requested in this section been submitted with a previous transplant registration for this patient?
integer
WAS THE PATIENT TREATED BEFORE THE 1ST TRANSPLANT PROCEDURE?
integer
Sequential number of this treatment
integer
Modality Chemo/drug/agent
text
If MoAB, radiolabelled
text
Radiotherapy
boolean
Response to this line of therapy
integer
ADDITIONAL TREATMENT GIVEN BEFORE THE 1ST TRANSPLANT?
text
Pharmacotherapy
boolean
Regimen
integer
Radiotherapy
boolean
Response to this line of therapy
text
DISEASE HISTORY BEFORE HSCT
Date of transplant
date
(since diagnosis if 1st transplant, or since last reported transplant)
integer
Modality used at least once
integer
Splenectomy
boolean
TYPE OF RELAPSE
integer
CR achieved before the 1st transplant
integer
TO BE COMPLETED ONLY IF PATIENT HAD A CR BEFORE THE 1ST TRANSPLANT
integer
STATUS OF DISEASE AT HSCT
If patient has ever achieved Complete remission
integer
RELAPSE
boolean
TYPE OF RELAPSE
integer
If patient has never achieved a Complete remission
integer
NUMBER OF THIS PR
text
DISEASE INVOLVEMENT AT TRANSPLANT
text
(if patient in CR at HSCT, indicate “No mass”)
text
Specific sites of disease
integer
Number of relapses in the last 12 months unknown
integer
ADDITIONAL TREATMENT POST-HSCT
Additional Disease Treatment
integer
Date started
date
Modality
integer
Radiotherapy
integer
BEST DISEASE RESPONSE AT 100 DAYS POST-HSCT
BEST RESPONSE AT 100 DAYS AFTER TRANSPLANTATION
integer
If Complete remission: Date of CR
date
FORMS TO BE FILLED IN