ID
44676
Beschrijving
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
Trefwoorden
Versies (3)
- 19-09-12 19-09-12 -
- 09-01-15 09-01-15 - Martin Dugas
- 27-09-21 27-09-21 -
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27 september 2021
DOI
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Licentie
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.
Beschrijving
Patient Description
Beschrijving
InitialDiagnosisDate
Datatype
date
Beschrijving
FirstAbnormalBoneMarrowPriorMyelodysplasticSyndromeFindingDate
Datatype
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
Beschrijving
Leukemia/MDSClassification
Datatype
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
Beschrijving
LeukemiaClassification,Other
Datatype
text
Beschrijving
Onset,AML
Datatype
text
Beschrijving
ExtramedullaryDisease
Datatype
text
Beschrijving
DiseaseInvolvementSite,Other
Datatype
text
Beschrijving
BoneMarrowAuerrods
Datatype
boolean
Beschrijving
Organ Involvement
Beschrijving
Splenomegaly,Palpation
Datatype
text
Alias
- NCI Thesaurus Property
- C16950
- UMLS 2011AA Property
- C0030247
- NCI Thesaurus ObjectClass
- C3384
- UMLS 2011AA ObjectClass
- C0038002
Beschrijving
Splenomegaly,Imaging
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C3384
- UMLS 2011AA ObjectClass
- C0038002
- NCI Thesaurus Property
- C19477
- UMLS 2011AA Property
- C1704254
Beschrijving
Hepatomegaly,Palpation
Datatype
text
Alias
- NCI Thesaurus Property
- C16950
- UMLS 2011AA Property
- C0030247
- NCI Thesaurus ObjectClass
- C3100
- UMLS 2011AA ObjectClass
- C0017924
Beschrijving
Hepatomegaly,Imaging
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C3100
- UMLS 2011AA ObjectClass
- C0017924
- NCI Thesaurus Property
- C19477
- UMLS 2011AA Property
- C1704254
Beschrijving
Lymphadenopathy,Palpation
Datatype
text
Alias
- NCI Thesaurus Property
- C16950
- UMLS 2011AA Property
- C0030247
- NCI Thesaurus ObjectClass
- C3206
- UMLS 2011AA ObjectClass
- C0024228
Beschrijving
Lymphadenopathy,Imaging
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C3206
- UMLS 2011AA ObjectClass
- C0024228
- NCI Thesaurus Property
- C19477
- UMLS 2011AA Property
- C1704254
Beschrijving
Current Symptoms
Beschrijving
CurrentInfection
Datatype
text
Beschrijving
AdverseEventHemorrhageSymptomStatus
Datatype
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
Beschrijving
Lab Data At Study Entry
Beschrijving
Lab,Renal,Creatinine
Datatype
float
Beschrijving
Lab,Hepatic,Bilirubin
Datatype
float
Beschrijving
Lab,Chemistry,LactateDehydrogenase
Datatype
float
Beschrijving
Lab,Chemistry,LactateDehydrogenase,ULN
Datatype
float
Beschrijving
Lab,Hepatic,SGOT
Datatype
float
Beschrijving
SGOTLabUpperLimitNormalValue
Datatype
float
Alias
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain-2
- C25706
- UMLS 2011AA ValueDomain-2
- C1519815
Beschrijving
Lab,Hepatic,SGPT
Datatype
float
Beschrijving
SGPTLabUpperLimitNormalValue
Datatype
float
Alias
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain-2
- C25706
- UMLS 2011AA ValueDomain-2
- C1519815
Beschrijving
Lab,Hepatic,AlkalinePhosphatase
Datatype
float
Beschrijving
Alkaline Phosphatase ULN
Datatype
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
Beschrijving
%LVEFbyMUGA
Datatype
text
Beschrijving
CompletedBy
Datatype
text
Beschrijving
DateCompleted
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Beschrijving
%LVEFbyECHO
Datatype
text
Beschrijving
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)