ID
44676
Description
CALGB: 10201On-Study Form Daunorubicin and Cytarabine With or Without Oblimersen in Treating Older Patients With Previously Untreated Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD838530-D422-2F4D-E034-0003BA12F5E7
Link
Keywords
Versions (3)
- 9/19/12 9/19/12 -
- 1/9/15 1/9/15 - Martin Dugas
- 9/27/21 9/27/21 -
Uploaded on
September 27, 2021
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT00085124 On-Study - CALGB: 10201On-Study Form - 2057573v3.0
Instructions: Complete and submit thie form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Cirlce amended items and check "Amended data" box to teh right. If submitting by mail, retain a copy for your records and send the original form for mazimum clarity in transmission and fax to 919-416-4990. If submistting electronically, click the Send button when you have completed the PDF version of the form.
Description
Patient Description
Description
InitialDiagnosisDate
Data type
date
Description
FirstAbnormalBoneMarrowPriorMyelodysplasticSyndromeFindingDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C25401
- UMLS 2011AA ObjectClass
- C0205161
- NCI Thesaurus ObjectClass-2
- C12431
- UMLS 2011AA ObjectClass-2
- C0005953
- NCI Thesaurus ObjectClass-3
- C25509
- UMLS 2011AA ObjectClass-3
- C1279901
- NCI Thesaurus Property
- C3247
- UMLS 2011AA Property
- C3463824
- NCI Thesaurus Property-2
- C25629
- UMLS 2011AA Property-2
- C0332152
- NCI Thesaurus Property-3
- C61036
- UMLS 2011AA Property-3
- C0243095
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
Leukemia/MDSClassification
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS 2011AA ValueDomain
- C0683312
- NCI Thesaurus ObjectClass
- C3161
- UMLS 2011AA ObjectClass
- C0023418
- NCI Thesaurus Property
- C25161
- UMLS 2011AA Property
- C0008902
Description
LeukemiaClassification,Other
Data type
text
Description
Onset,AML
Data type
text
Description
ExtramedullaryDisease
Data type
text
Description
DiseaseInvolvementSite,Other
Data type
text
Description
BoneMarrowAuerrods
Data type
boolean
Description
Organ Involvement
Description
Splenomegaly,Palpation
Data type
text
Alias
- NCI Thesaurus Property
- C16950
- UMLS 2011AA Property
- C0030247
- NCI Thesaurus ObjectClass
- C3384
- UMLS 2011AA ObjectClass
- C0038002
Description
Splenomegaly,Imaging
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C3384
- UMLS 2011AA ObjectClass
- C0038002
- NCI Thesaurus Property
- C19477
- UMLS 2011AA Property
- C1704254
Description
Hepatomegaly,Palpation
Data type
text
Alias
- NCI Thesaurus Property
- C16950
- UMLS 2011AA Property
- C0030247
- NCI Thesaurus ObjectClass
- C3100
- UMLS 2011AA ObjectClass
- C0017924
Description
Hepatomegaly,Imaging
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C3100
- UMLS 2011AA ObjectClass
- C0017924
- NCI Thesaurus Property
- C19477
- UMLS 2011AA Property
- C1704254
Description
Lymphadenopathy,Palpation
Data type
text
Alias
- NCI Thesaurus Property
- C16950
- UMLS 2011AA Property
- C0030247
- NCI Thesaurus ObjectClass
- C3206
- UMLS 2011AA ObjectClass
- C0024228
Description
Lymphadenopathy,Imaging
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C3206
- UMLS 2011AA ObjectClass
- C0024228
- NCI Thesaurus Property
- C19477
- UMLS 2011AA Property
- C1704254
Description
Current Symptoms
Description
CurrentInfection
Data type
text
Description
AdverseEventHemorrhageSymptomStatus
Data type
text
Alias
- NCI Thesaurus Property
- C26791
- UMLS 2011AA Property
- C0019080
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property-2
- C4876
- UMLS 2011AA Property-2
- C1457887
- NCI Thesaurus ValueDomain
- C25688
- UMLS 2011AA ValueDomain
- C0449438
Description
Lab Data At Study Entry
Description
Lab,Renal,Creatinine
Data type
float
Description
Lab,Hepatic,Bilirubin
Data type
float
Description
Lab,Chemistry,LactateDehydrogenase
Data type
float
Description
Lab,Chemistry,LactateDehydrogenase,ULN
Data type
float
Description
Lab,Hepatic,SGOT
Data type
float
Description
SGOTLabUpperLimitNormalValue
Data type
float
Alias
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain-2
- C25706
- UMLS 2011AA ValueDomain-2
- C1519815
Description
Lab,Hepatic,SGPT
Data type
float
Description
SGPTLabUpperLimitNormalValue
Data type
float
Alias
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain-2
- C25706
- UMLS 2011AA ValueDomain-2
- C1519815
Description
Lab,Hepatic,AlkalinePhosphatase
Data type
float
Description
Alkaline Phosphatase ULN
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0151420
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C16276
- NCI Thesaurus ValueDomain
- C25712
- NCI Thesaurus ValueDomain-2
- C25706
Description
%LVEFbyMUGA
Data type
text
Description
CompletedBy
Data type
text
Description
DateCompleted
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Description
%LVEFbyECHO
Data type
text
Description
Ccrr Module For Calgb: 10201on-study Form
Similar models
Instructions: Complete and submit thie form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Cirlce amended items and check "Amended data" box to teh right. If submitting by mail, retain a copy for your records and send the original form for mazimum clarity in transmission and fax to 919-416-4990. If submistting electronically, click the Send button when you have completed the PDF version of the form.
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0205161 (UMLS 2011AA ObjectClass)
C12431 (NCI Thesaurus ObjectClass-2)
C0005953 (UMLS 2011AA ObjectClass-2)
C25509 (NCI Thesaurus ObjectClass-3)
C1279901 (UMLS 2011AA ObjectClass-3)
C3247 (NCI Thesaurus Property)
C3463824 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property-2)
C0332152 (UMLS 2011AA Property-2)
C61036 (NCI Thesaurus Property-3)
C0243095 (UMLS 2011AA Property-3)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0683312 (UMLS 2011AA ValueDomain)
C3161 (NCI Thesaurus ObjectClass)
C0023418 (UMLS 2011AA ObjectClass)
C25161 (NCI Thesaurus Property)
C0008902 (UMLS 2011AA Property)
C0030247 (UMLS 2011AA Property)
C3384 (NCI Thesaurus ObjectClass)
C0038002 (UMLS 2011AA ObjectClass)
C0038002 (UMLS 2011AA ObjectClass)
C19477 (NCI Thesaurus Property)
C1704254 (UMLS 2011AA Property)
C0030247 (UMLS 2011AA Property)
C3100 (NCI Thesaurus ObjectClass)
C0017924 (UMLS 2011AA ObjectClass)
C0017924 (UMLS 2011AA ObjectClass)
C19477 (NCI Thesaurus Property)
C1704254 (UMLS 2011AA Property)
C0030247 (UMLS 2011AA Property)
C3206 (NCI Thesaurus ObjectClass)
C0024228 (UMLS 2011AA ObjectClass)
C0024228 (UMLS 2011AA ObjectClass)
C19477 (NCI Thesaurus Property)
C1704254 (UMLS 2011AA Property)
C0549184 (UMLS 2011AA)
C2945599 (UMLS 2011AA)
C0019080 (UMLS 2011AA Property)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property-2)
C1457887 (UMLS 2011AA Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C0549184 (UMLS 2011AA)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C1519815 (UMLS 2011AA ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C1519815 (UMLS 2011AA ValueDomain-2)
C0151420 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C16276 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C0011008 (UMLS 2011AA ValueDomain)