ID
6278
Description
CALGB 10201 REGISTRATION WORKSHEET 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=B228B8A4-E2DC-4D1A-E034-0003BA12F5E7
Link
Keywords
Versions (3)
- 12/18/14 12/18/14 - Martin Dugas
- 1/9/15 1/9/15 - Martin Dugas
- 9/20/21 9/20/21 -
Uploaded on
December 18, 2014
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT00085124 Registration - CALGB 10201 REGISTRATION WORKSHEET - 2076520v3.0
A Phase III Study of Daunorubicin and Cytarabine +/- G3139 (Genasense) in Previously Untreated Patients with Acute Myeloid Leukemia
- StudyEvent: CALGB 10201 REGISTRATION WORKSHEET
Description
Patient Demographics/pre-treatment Characteristics
Description
PatientInitialsName
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25536
- UMLS 2011AA Property
- C1555582
Description
PatientSocialSecurityNumber
Data type
double
Description
PatientBirthDate
Data type
date
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25275
- UMLS 2011AA Property
- C2745955
Description
PatientHospitalNumber
Data type
text
Description
PatientGender
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25372
- UMLS 2011AA ValueDomain
- C0683312
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C17357
- UMLS 2011AA Property
- C0079399
Description
PatientRace
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C17049
- UMLS 2011AA Property
- C0034510
Description
PatientEthnicity
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C17049
- UMLS 2011AA Property
- C0034510
Description
PerformanceStatus
Data type
text
Description
PatientHeight
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25347
- UMLS 2011AA Property
- C0489786
Description
PatientWeight
Data type
double
Description
BodySurfaceArea
Data type
double
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25157
- UMLS 2011AA Property
- C0005902
Description
PatientPaymentType
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25371
- UMLS 2011AA Property
- C0680264
Description
PatientAddress,PostalCode
Data type
double
Description
PatientAddress,Country
Data type
text
Description
Certification Of Eligibility
Description
Protocol Design
Description
Initial Patient Consent For Specimen Use
Description
PatientInitialConsent,Specimen,Patient'scancerresearchInd
Data type
text
Description
PatientInitialConsent,Specimen,Researchunrelatedtopatient'scancerInd
Data type
text
Description
PatientInitialConsent,Specimen,ContactInd
Data type
text
Description
Registration Information
Description
PatientStudyID,ParticipatingGroup
Data type
text
Description
CALGBPatientID
Data type
text
Description
RegistrationDate
Data type
text
Description
SignatureofPersonCompletingThisForm
Data type
text
Description
Ccrr Module For Calgb 10201 Registration Worksheet
Description
InstitutionName
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus ObjectClass
- C21541
- UMLS 2011AA ObjectClass
- C0018704
- NCI Thesaurus ValueDomain
- C21541
- UMLS 2011AA ValueDomain
- C0018704
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Description
AffiliateName
Data type
text
Description
CALGBPatientID
Data type
text
Description
RegisteredInvestigatorName
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS 2011AA ValueDomain
- C1547383
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C17089
- UMLS 2011AA ObjectClass
- C0035173
Description
ParticipatingGroupName
Data type
text
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A Phase III Study of Daunorubicin and Cytarabine +/- G3139 (Genasense) in Previously Untreated Patients with Acute Myeloid Leukemia
- StudyEvent: CALGB 10201 REGISTRATION WORKSHEET
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