COG AALL08B1 OPEN Registration Worksheet Step 2 - 3371785v1.0

AALL08B1 Stratum (Select appropriate stratum)

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)

AALL08B1 Treatment

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.)

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.)

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)

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)

Does the patient have testicular disease (Patient is not eligible if he has testicular disease)

Have all institutional, FDA, and NCI requirements for human studies been met?

Date Informed Consent Signed (MM/DD/CCYY Date entered is the date last authorized signature is obtained)

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