Hairy Cell Leukemia (HCL) - Follow-Up Form Source Form: NCI FormBuilder:


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January 8, 2015

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Follow-Up - Hairy Cell Leukemia (HCL) - Follow-Up Form - 2019377v3.0

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  1. StudyEvent: Hairy Cell Leukemia (HCL) - Follow-Up Form
    1. No Instruction available.
Crf Header
Leukemia/mds: Form Administration
Are data amended (If data are amended, please circle in red when using paper form)
Aml/all/apl: Vital Status
Patient's Vital Status
Primary Cause of Death (if dead check one)
Aml/all/apl: Disease Follow-up Status
Has the patient had a documented clinical assessment for this cancer? (during this reporting period)
Did the patient achieve a complete response according to clinical/ hematologic criteria (during this reporting period)
Cll: Notice Of Progression
Has the patient developed a first progression (or relapse) that has not been previously reported? (If assessed,)
Liver Assessment (If yes, indicate all evidence of progression from the following: refer to protocol criteria for guidelines on organ assessment)
Spleen Assessment
Lymph Node Assessment
Platelet Count
Hairy Cells
Allows Documentation Of Any Additional Cooments

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