Description:

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: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B9F50C5F-ABA8-2543-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B9F50C5F-ABA8-2543-E034-0003BA12F5E7

Keywords:
Versions (2) ▾
  1. 8/27/12
  2. 1/8/15
Uploaded on:

January 8, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Rapid Toxicity Reporting Form ANHL01P1 (NCT00057811)

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  1. StudyEvent: ANHL01P1: Rapid Toxicity Reporting Form
    1. No Instruction available.
Header
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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