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Fehler:
ID
6251
Beschreibung
COG AALL08B1 OPEN Registration Worksheet Step 2 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=
Link
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=
Stichworte
Versionen (1)
- 18.12.14 18.12.14 - Martin Dugas
Hochgeladen am
18. Dezember 2014
DOI
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Creative Commons BY-NC 3.0 Legacy
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COG AALL08B1 OPEN Registration Worksheet Step 2 - 3371785v1.0
No Instruction available.
- StudyEvent: SE.0000
Ähnliche Modelle
No Instruction available.
- StudyEvent: SE.0000
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item
AALL08B1 Stratum (Select appropriate stratum)
text
CL Item
Non-down Syndrome Patient (Non-Down Syndrome Patient)
CL Item
Down Syndrome Patient (Down Syndrome Patient)
ChemotherapyAdministeredBeginDate
Item
Projected Treatment Start Date of systemic chemotherapy drug/treatment delivery (MM/DD/CCYY Study enrollment must take place within five 5 days of beginning protocol therapy. If enrollment takes place before starting therapy, the date protocol therapy is projected to start must be no later than five 5 calendar days after enrollment. Do not report intrathecal IT cytarabine as start date for Induction therapy, however, systemic drug/treatment delivery must begin within 72 hours of administering this IT therapy)
date
CL Item
Induction Therapy - Weeks 1 - 5 (Induction)
CL Item
Arm A: Post Induction Therapy For Mll-g (sr (Arm A: Post Induction)
CL Item
Arm B: Post Induction Therapy Without Lestaurtinib For Mll-r (ir/hr) (Arm B: Post Induction)
CL Item
Arm C: Post Induction Therapy With Lestaurtinib For Mll-r (ir/hr) (Arm C: Post Induction)
Item
Is the patient enrolled on study AALL08B1 (To be eligible, patients must be enrolled on COG AALL08B1 before treatment on AALL0932 begins with the exception of the first dose of intrathecal chemotherapy.)
text
Code List
Is the patient enrolled on study AALL08B1 (To be eligible, patients must be enrolled on COG AALL08B1 before treatment on AALL0932 begins with the exception of the first dose of intrathecal chemotherapy.)
CL Item
Yes (Yes)
CL Item
No (No)
Item
Does the patient have newly diagnosed B-precursor ALL (To be eligible, patient must be newly diagnosed with NCI Standard Risk B-precursor acute lymphoblastic leukemia ALL.)
text
Code List
Does the patient have newly diagnosed B-precursor ALL (To be eligible, patient must be newly diagnosed with NCI Standard Risk B-precursor acute lymphoblastic leukemia ALL.)
CL Item
Yes (Yes)
CL Item
No (No)
Item
Has the patient received Prior Treatment with cytotoxic chemotherapy for the current diagnosis of ALL or any cancer diagnosed previously (with exception of intrathecal cytarabine [Section 3.2.4] or steroids [Section 3.3.2] for the current ALL diagnosis)
text
Code List
Has the patient received Prior Treatment with cytotoxic chemotherapy for the current diagnosis of ALL or any cancer diagnosed previously (with exception of intrathecal cytarabine [Section 3.2.4] or steroids [Section 3.3.2] for the current ALL diagnosis)
CL Item
No (No)
CL Item
Yes (Yes)
Item
Does patient have CNS 3 involvement (CNS status must be known prior to enrollment as patients with CNS3 involvement are not eligible for this study. See Section 3.2.4 for details)
text
Code List
Does patient have CNS 3 involvement (CNS status must be known prior to enrollment as patients with CNS3 involvement are not eligible for this study. See Section 3.2.4 for details)
CL Item
Yes (Yes)
CL Item
No (No)
Item
Does the patient have testicular disease (Patient is not eligible if he has testicular disease)
text
Code List
Does the patient have testicular disease (Patient is not eligible if he has testicular disease)
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
N/a, Female (N/A, female)
Item
Have all institutional, FDA, and NCI requirements for human studies been met?
text
CL Item
No (No)
CL Item
Yes (Yes)
InformedConsentFormSignedDate
Item
Date Informed Consent Signed (MM/DD/CCYY Date entered is the date last authorized signature is obtained)
date
ResearchCommentsText
Item
Comments
text