ANHL01P1: Rapid Toxicity Reporting Form Rituximab, Rasburicase, and Combination Chemotherapy in Treating Young Patients With Newly Diagnosed Advanced B-Cell Leukemia or Lymphoma NCT00057811 Source Form: NCI FormBuilder:


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January 8, 2015

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Rapid Toxicity Reporting Form ANHL01P1 (NCT00057811)

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  1. StudyEvent: ANHL01P1: Rapid Toxicity Reporting Form
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Clinical Data
Treatment Assignment (Required field)
Tumor Reduction (Please choose one)
Did patient have residual disease following 1st cycle (CYM-RM1) of consolidation? (Required for Consolidation 1st Cycle CYM-RM1 only of Group B Sub-Pilot or Group B Pilot)
Did patient experience Stevens-Johnson Syndrome (SJS)? (Required field)
Did patient experience Toxic Epidermal Necrosis (TEN)? (Required field)
Did patient experience delayed recovery? (Required field)
Toxic Death (Required field)

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