ID
6477
Descripción
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
Palabras clave
Versiones (2)
- 19/9/12 19/9/12 -
- 1/1/15 1/1/15 - Martin Dugas
Subido en
1 de enero de 2015
DOI
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Licencia
Creative Commons BY-NC 3.0 Legacy
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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
Descripción
On Treatment
Descripción
Cycle number
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C2045829
- NCI Thesaurus Property
- C25214
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ObjectClass
- C15368
Descripción
Chemotherapy cycle
Tipo de datos
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
Descripción
Reporting Period Start Date
Tipo de datos
date
Unidades de medida
- 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
Descripción
Reporting Period End Date
Tipo de datos
date
Unidades de medida
- 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
Descripción
Vital Status
Descripción
Patient Status
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-1
- C3846084
- NCI Thesaurus ValueDomain
- C18003
- NCI Thesaurus ValueDomain-2
- C25688
- NCI Thesaurus Property
- C25717
Descripción
Date last contact
Tipo de datos
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
Descripción
Primary Cause of Death
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS CUI-1
- C0007465
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C28554
- NCI Thesaurus ValueDomain-2
- C25251
Descripción
Cause of Death, specify
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS CUI-1
- C0007465
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C1521902
- NCI Thesaurus Property
- C28554
Descripción
Patient Characteristics
Descripción
Therapy Administered
Alias
- UMLS CUI-1
- C0087111
Descripción
Agent
Tipo de datos
text
Alias
- NCI Thesaurus Property
- C25364
- UMLS CUI-1
- C1521826
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus ValueDomain
- C1708
- NCI Thesaurus ValueDomain-2
- C42614
Descripción
Agent administered during reporting period
Tipo de datos
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS CUI-1
- C0450442
- NCI Thesaurus ObjectClass
- C1708
- UMLS CUI-2
- C1521801
- NCI Thesaurus Property
- C25382
Descripción
Patient Diary complete
Tipo de datos
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS CUI-1
- C3259162
- NCI Thesaurus Property
- C25250
- NCI Metathesaurus ObjectClass
- C0030705
Descripción
Concomitant Medication Start Date
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2826734
- NCI Thesaurus ValueDomain-2
- C25431
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus Property
- C25275
Descripción
Agent Total Dose
Tipo de datos
float
Unidades de medida
- mg
Alias
- NCI Thesaurus ValueDomain
- C25304
- NCI Thesaurus Property
- C25379
- NCI Thesaurus ValueDomain-2
- C25488
- NCI Thesaurus ObjectClass
- C1708
- UMLS CUI-1
- C2986497
Descripción
Dose modification Lenalidomide
Tipo de datos
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
Descripción
Dose modification Lenalidomide per protocol
Tipo de datos
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
Descripción
Dose modification begin date
Tipo de datos
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
Descripción
Dose modification end date
Tipo de datos
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1707811
- NCI Thesaurus ObjectClass
- C25488
- UMLS CUI-2
- C0806020
- NCI Thesaurus Property
- C25572
Descripción
Total Modified Dose
Tipo de datos
float
Unidades de medida
- 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
Descripción
Dose Modification Status
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C25488
- UMLS CUI-1
- C1707811
- NCI Thesaurus ValueDomain
- C25688
- NCI Thesaurus Property
- C25572
Descripción
Dose Modification Reason
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25638
- UMLS CUI-1
- C1707811
- NCI Thesaurus ObjectClass
- C25488
- UMLS CUI-2
- C0392360
- NCI Thesaurus Property
- C25572
Descripción
Dose Modification Reason, other
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS CUI-1
- C1707811
- NCI Thesaurus ObjectClass
- C25488
- UMLS CUI-2
- C3840932
- NCI Thesaurus Property
- C25572
Descripción
Deep Vein Thrombosis prophylaxis
Tipo de datos
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
Descripción
DVT prophylaxis daily dose
Tipo de datos
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
Descripción
Aspirin dose
Tipo de datos
float
Unidades de medida
- 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
Descripción
INR
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C0525032
- NCI Thesaurus Property
- C20200
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus Property-2
- C25352
Descripción
Chemotherapy delayed
Tipo de datos
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
Descripción
Non-protocol Therapy
Descripción
Non-protocol therapy
Tipo de datos
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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