Unnamed2
Patient Initials
text
Protocol Number ECOG
text
Patient ID ECOG
text
Study Number Participating Group
text
Trial subject ID Participating Group
text
Institution Name
text
Unnamed3
Data amended
text
Data amended date
date
On Treatment
Cycle number
text
Cycle number
text
Chemotherapy cycle
text
Chemotherapy cycle
text
Off Treatment
PersonOff-TreatmentTimePeriodType
text
Unnamed5
MyelodysplasticSyndromeWorldHealthOrganizationClassificationCategory
text
BoneMarrowBiopsyInd
boolean
BoneMarrowBiopsyDate
date
LaboratoryProcedureBoneMarrowBlastCellOutcomePercentageValue
float
LaboratoryProcedureBoneMarrowCellularityOutcomePercentageValue
float
LaboratoryProcedureBoneMarrowCellularityNegationReportOutcomeReason
text
DysplasiaPresentInd-3
text
DysplasiaHistologyType
text
CytogeneticAbnormalityPresentIndicator
text
Section Ii
PackedRedBloodCellTransfusionRequirementInd-3
text
PackedRedBloodCellTransfusionReceivedUnitCount
float
PackedRedBloodCellTransfusionReceivedFirstDate
date
PackedRedBloodCellTransfusionReceivedMostRecentDate
date
Mds Response
MyelodysplasticSyndromeResponseType
text
MyelodysplasticSyndromeResponseFirstDate
date
MyelodysplasticSyndromeResponseDiagnosisDate
date
DiseaseRelapseInd-3
boolean
DiseaseRelapseDate
date
DiseaseMyelodysplasticSyndromeHematologyResponseType
text
DiseaseMyelodysplasticSyndromeHematologyResponseFirstDate
date
DiseaseMyelodysplasticSyndromeHematologyResponseDiagnosisDate
date
Cytogenetic Response
Comments
Investigator Signature
text
Investigator Signature Date
date