ID
6477
Beschreibung
E3A06 Treatment Form (Arm A) Lenalidomide or Observation in Treating Patients With Asymptomatic High-Risk Smoldering Multiple Myeloma NCT01169337 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=86D1B322-221A-3014-E040-BB89AD432E00
Link
Stichworte
Versionen (2)
- 19.09.12 19.09.12 -
- 01.01.15 01.01.15 - Martin Dugas
Hochgeladen am
1. Januar 2015
DOI
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Lizenz
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Treatment Form Multiple Myeloma E3A06 Arm A
INSTRUCTIONS: Complete this form at the end of each cycle of Arm A Induction protocol treatment. Submit original to the ECOG Coordinating Center. Keep a copy for your files. Refer to forms packet for submission schedule
Beschreibung
On Treatment
Beschreibung
Cycle number
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C2045829
- NCI Thesaurus Property
- C25214
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ObjectClass
- C15368
Beschreibung
Chemotherapy cycle
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C25214
- UMLS CUI-1
- C1302181
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ValueDomain
- C25685
- NCI Thesaurus ValueDomain-2
- C25472
- NCI Thesaurus ValueDomain-3
- C25275
Beschreibung
Reporting Period Start Date
Datentyp
date
Maßeinheiten
- M D Y
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C25616
- NCI Thesaurus Property-2
- C25651
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25431
- UMLS CUI-1
- C2361257
Beschreibung
Reporting Period End Date
Datentyp
date
Maßeinheiten
- M D Y
Alias
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus Property
- C25616
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property-2
- C25651
- UMLS CUI-1
- C2361259
Beschreibung
Vital Status
Beschreibung
Patient Status
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C3846084
- NCI Thesaurus ValueDomain
- C18003
- NCI Thesaurus ValueDomain-2
- C25688
- NCI Thesaurus Property
- C25717
Beschreibung
Date last contact
Datentyp
date
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C0805839
- NCI Thesaurus Property
- C25461
- NCI Thesaurus Property-2
- C25551
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25367
Beschreibung
Primary Cause of Death
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS CUI-1
- C0007465
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C28554
- NCI Thesaurus ValueDomain-2
- C25251
Beschreibung
Cause of Death, specify
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS CUI-1
- C0007465
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C1521902
- NCI Thesaurus Property
- C28554
Beschreibung
Patient Characteristics
Beschreibung
Therapy Administered
Alias
- UMLS CUI-1
- C0087111
Beschreibung
Agent
Datentyp
text
Alias
- NCI Thesaurus Property
- C25364
- UMLS CUI-1
- C1521826
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus ValueDomain
- C1708
- NCI Thesaurus ValueDomain-2
- C42614
Beschreibung
Agent administered during reporting period
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS CUI-1
- C0450442
- NCI Thesaurus ObjectClass
- C1708
- UMLS CUI-2
- C1521801
- NCI Thesaurus Property
- C25382
Beschreibung
Patient Diary complete
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS CUI-1
- C3259162
- NCI Thesaurus Property
- C25250
- NCI Metathesaurus ObjectClass
- C0030705
Beschreibung
Concomitant Medication Start Date
Datentyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2826734
- NCI Thesaurus ValueDomain-2
- C25431
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus Property
- C25275
Beschreibung
Agent Total Dose
Datentyp
float
Maßeinheiten
- mg
Alias
- NCI Thesaurus ValueDomain
- C25304
- NCI Thesaurus Property
- C25379
- NCI Thesaurus ValueDomain-2
- C25488
- NCI Thesaurus ObjectClass
- C1708
- UMLS CUI-1
- C2986497
Beschreibung
Dose modification Lenalidomide
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS CUI-1
- C1707811
- NCI Thesaurus ObjectClass
- C2668
- UMLS CUI-2
- C1144149
- NCI Thesaurus ObjectClass-2
- C25488
- NCI Thesaurus Property
- C25572
Beschreibung
Dose modification Lenalidomide per protocol
Datentyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C2668
- UMLS CUI-1
- C1707811
- NCI Thesaurus ObjectClass-2
- C25488
- UMLS CUI-2
- C1144149
- NCI Thesaurus Property
- C25320
- UMLS CUI-3
- C1698058
- NCI Thesaurus Property-2
- C25572
- NCI Thesaurus ValueDomain
- C38147
Beschreibung
Dose modification begin date
Datentyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1707811
- NCI Thesaurus ValueDomain-2
- C25431
- UMLS CUI-2
- C0808070
- NCI Thesaurus ObjectClass
- C25488
- NCI Thesaurus Property
- C25572
Beschreibung
Dose modification end date
Datentyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1707811
- NCI Thesaurus ObjectClass
- C25488
- UMLS CUI-2
- C0806020
- NCI Thesaurus Property
- C25572
Beschreibung
Total Modified Dose
Datentyp
float
Maßeinheiten
- mg
Alias
- NCI Thesaurus ValueDomain
- C25304
- NCI Thesaurus ValueDomain-2
- C25488
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus Property
- C25572
- UMLS CUI-1
- C2986497
- UMLS CUI-2
- C0392747
Beschreibung
Dose Modification Status
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C25488
- UMLS CUI-1
- C1707811
- NCI Thesaurus ValueDomain
- C25688
- NCI Thesaurus Property
- C25572
Beschreibung
Dose Modification Reason
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS CUI-1
- C1707811
- NCI Thesaurus ObjectClass
- C25488
- UMLS CUI-2
- C0392360
- NCI Thesaurus Property
- C25572
Beschreibung
Dose Modification Reason, other
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS CUI-1
- C1707811
- NCI Thesaurus ObjectClass
- C25488
- UMLS CUI-2
- C3840932
- NCI Thesaurus Property
- C25572
Beschreibung
Deep Vein Thrombosis prophylaxis
Datentyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C49343
- UMLS CUI-1
- C0853245
- NCI Thesaurus ObjectClass-2
- C15368
- NCI Thesaurus ObjectClass-3
- C15405
- NCI Thesaurus Property
- C25639
- NCI Thesaurus ValueDomain
- C38147
Beschreibung
DVT prophylaxis daily dose
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C49343
- NCI Thesaurus ObjectClass-2
- C15405
- NCI Thesaurus Property
- C25473
- NCI Thesaurus Property-2
- C25256
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C0853245
- UMLS CUI-2
- C2348070
Beschreibung
Aspirin dose
Datentyp
float
Maßeinheiten
- mg
Alias
- NCI Thesaurus ObjectClass
- C49343
- NCI Thesaurus ObjectClass-2
- C15368
- NCI Thesaurus ObjectClass-3
- C15405
- NCI Thesaurus Property
- C17649
- NCI Thesaurus Property-2
- C25639
- NCI Thesaurus Property-3
- C287
- NCI Thesaurus Property-4
- C25256
- NCI Thesaurus ValueDomain
- C25488
- UMLS CUI-1
- C0004057
- UMLS CUI-2
- C0178602
Beschreibung
INR
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C0525032
- NCI Thesaurus Property
- C20200
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus Property-2
- C25352
Beschreibung
Chemotherapy delayed
Datentyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C25477
- NCI Thesaurus Property-2
- C25472
- UMLS CUI-1
- C1299577
- NCI Thesaurus Property-3
- C53286
- NCI Thesaurus ValueDomain
- C38147
Beschreibung
Non-protocol Therapy
Beschreibung
Non-protocol therapy
Datentyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C25590
- UMLS CUI-1
- C1518384
- NCI Thesaurus ObjectClass-2
- C16212
- UMLS CUI-2
- C0087111
- NCI Thesaurus Property
- C25320
- NCI Thesaurus Property-2
- C49236
- NCI Thesaurus Property-3
- C25456
- NCI Thesaurus Property-4
- C25382
- NCI Thesaurus ValueDomain
- C38148
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INSTRUCTIONS: Complete this form at the end of each cycle of Arm A Induction protocol treatment. Submit original to the ECOG Coordinating Center. Keep a copy for your files. Refer to forms packet for submission schedule
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C25320 (NCI Thesaurus ObjectClass)
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C21541 (NCI Thesaurus ObjectClass-2)
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C2346576 (UMLS CUI-1)
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C25678 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)
C2346576 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
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C25164 (NCI Thesaurus ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C2361257 (UMLS CUI-1)
C25616 (NCI Thesaurus Property)
C15368 (NCI Thesaurus ObjectClass)
C25651 (NCI Thesaurus Property-2)
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C1521826 (UMLS CUI-1)
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C1521801 (UMLS CUI-2)
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C3259162 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C0030705 (NCI Metathesaurus ObjectClass)
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C25431 (NCI Thesaurus ValueDomain-2)
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C25275 (NCI Thesaurus Property)
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C1707811 (UMLS CUI-1)
C25431 (NCI Thesaurus ValueDomain-2)
C0808070 (UMLS CUI-2)
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C1707811 (UMLS CUI-1)
C25688 (NCI Thesaurus ValueDomain)
C25572 (NCI Thesaurus Property)
C1707814 (UMLS 2011AA)
C49505 (NCI Thesaurus-3)
C1707814 (UMLS 2011AA-4)
C1707811 (UMLS CUI-1)
C25488 (NCI Thesaurus ObjectClass)
C0392360 (UMLS CUI-2)
C25572 (NCI Thesaurus Property)
C0877248 (UMLS 2011AA)
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C1707811 (UMLS CUI-1)
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C3840932 (UMLS CUI-2)
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