ID

7236

Descrizione

Primary Amyloidosis - On-Study Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D6E2AA52-99FE-5B44-E034-0003BA12F5E7

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D6E2AA52-99FE-5B44-E034-0003BA12F5E7

Keywords

versioni (4)
  1. 20/09/12 20/09/12 -
  2. 09/01/15 09/01/15 - Martin Dugas
  3. 09/01/15 09/01/15 - Martin Dugas
  4. 27/06/15 27/06/15 -
Caricato su

9 gennaio 2015

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0 Legacy
Commenti del modello :

Puoi commentare il modello dati qui. Tramite i fumetti nei gruppi di articoli e articoli è possibile aggiungere commenti a quelli in modo specifico.

Torna ai commenti del modello
Commenti del gruppo di articoli per :

Commenti dell'articolo per :

Per scaricare i modelli di dati devi essere registrato. Per favore accesso o registrati GRATIS.

On-Study - Primary Amyloidosis - On-Study Form - 2275605v3.0

Inglese

No Instruction available.

1 moduli  
  1. StudyEvent: Primary Amyloidosis - On-Study Form
    1. No Instruction available.
Crf Header
Descrizione

Crf Header

Coordinating Group Protocol No.
Descrizione

Protocol ID Coordinating Group

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1711341
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Coordinating Group Code
Descrizione

Coordinating Group Code

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS CUI-1
C1711341
NCI Thesaurus ObjectClass
C17005
UMLS CUI-2
C0805701
NCI Thesaurus ObjectClass-2
C25462
NCI Thesaurus Property
C25364
Protocol Title
Descrizione

Protocol Title

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986303
NCI Thesaurus ObjectClass
C25320
NCI Thesaurus Property
C42774
Patient Study ID
Descrizione

Patient Study ID

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25462
NCI Thesaurus Property-2
C25364
Institution/Affiliate
Descrizione

Institution Name

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass-2
C21541
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Other Patient ID
Descrizione

Trial subject ID Participating Group

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Participating Group Code
Descrizione

ParticipatingGroupIdentifierCode

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
NCI Thesaurus ObjectClass
C25608
UMLS 2011AA ObjectClass
C0679823
NCI Thesaurus ObjectClass-2
C17005
UMLS 2011AA ObjectClass-2
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Name (initials acceptable)
Descrizione

PatientName

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Amyloid: Form Administration
Descrizione

Amyloid: Form Administration

Person Completing Form
Descrizione

Person Completing Form

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C1550483
NCI Thesaurus ObjectClass
C25657
NCI Thesaurus Property
C25364
Are data amended (If data are amended, please circle in red when using paper form)
Descrizione

Data amended

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Amyloid: Disease Description
Descrizione

Amyloid: Disease Description

Date of Initial Pathologic Diagnosis
Descrizione

CancerInitialDiagnosisDate

Tipo di dati

date

Alias
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C25509
UMLS 2011AA Property
C1279901
NCI Thesaurus Property-2
C15220
UMLS 2011AA Property-2
C0011900
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25367
Heart (Clinical Involvement?* Y=yes, N=no *Symptomatic)
Descrizione

HeartInvolvedInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C12727
UMLS 2011AA ObjectClass
C0018787
NCI Thesaurus Property
C25547
Kidney
Descrizione

KidneyDiseasePresentInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C12415
UMLS 2011AA ObjectClass
C0022646
NCI Thesaurus ObjectClass-2
C2991
UMLS 2011AA ObjectClass-2
C0012634
Liver
Descrizione

LiverInvolvedInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C12392
UMLS 2011AA ObjectClass
C0023884
NCI Thesaurus Property
C25547
Stomach
Descrizione

StomachInvolvedInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25547
NCI Metathesaurus ObjectClass
C0038351
Gastrointestinal/small bowel
Descrizione

SmallBowelGastrointestinalInvolvedInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C13359
UMLS 2011AA Property
C0521362
NCI Thesaurus ObjectClass
C12386
UMLS 2011AA ObjectClass
C0021852
NCI Thesaurus Property-2
C25547
Colon/rectum
Descrizione

RectumColonInvolvedInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C12382
UMLS 2011AA ObjectClass
C0009368
NCI Thesaurus ObjectClass-2
C12390
UMLS 2011AA ObjectClass-2
C0034896
NCI Thesaurus Property
C25547
Peripheral Nerve Neuropathy
Descrizione

PeripheralNeuropathySymptomInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C4876
UMLS 2011AA Property
C1457887
NCI Thesaurus ObjectClass
C4731
UMLS 2011AA ObjectClass
C0031117
NCI Thesaurus ObjectClass-2
C25233
UMLS 2011AA ObjectClass-2
C0205100
Soft Tissue
Descrizione

SoftTissueInvolvedInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25547
NCI Thesaurus ObjectClass
C12801
UMLS 2011AA ObjectClass
C0040300
NCI Thesaurus ObjectClass-2
C25255
UMLS 2011AA ObjectClass-2
C0205358
Skin
Descrizione

SkinInvolvedInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C12470
UMLS 2011AA ObjectClass
C1123023
NCI Thesaurus Property
C25547
Macroglossia
Descrizione

MacroglossiaSymptomInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C4876
UMLS 2011AA Property
C1457887
NCI Metathesaurus ObjectClass
C0024421
Autonomic Nerve Neuropathy (** Note: Autonomic neuropathy includes any gastroparesis, pseudo-obstruction, and/or orthostatic hypotension not attributable to medications or volume depletion.)
Descrizione

AutonomicNeuropathyInvolvedInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25547
NCI Thesaurus ObjectClass
C27033
UMLS 2011AA ObjectClass
C0259749
Other
Descrizione

OtherSiteInvolvedInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ObjectClass
C17649
UMLS 2011AA ObjectClass
C0205394
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25547
NCI Metathesaurus ObjectClass
CL111053
Other Site Name (If yes,)
Descrizione

OtherDiseaseSiteName

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS 2011AA ValueDomain
C1547383
NCI Thesaurus ObjectClass
C17649
UMLS 2011AA ObjectClass
C0205394
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus ObjectClass-2
C2991
UMLS 2011AA ObjectClass-2
C0012634
Biopsy done (Y=yes, N=no)
Descrizione

BiopsyPerformedInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C15189
UMLS 2011AA ObjectClass
C0005558
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
Biopsy Result (If done,)
Descrizione

BiopsyResultType

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C15189
UMLS 2011AA ObjectClass
C0005558
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
Dominant Presentation (at Diagnosis check only one)
Descrizione

DominantMyelomaSymptomType

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C3242
UMLS 2011AA ObjectClass
C0026764
NCI Thesaurus Property
C4876
UMLS 2011AA Property
C1457887
NCI Thesaurus ObjectClass-2
C25487
UMLS 2011AA ObjectClass-2
C1527180
Other specify
Descrizione

DominantMyelomaSymptomSpecify

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C3242
UMLS 2011AA ObjectClass
C0026764
NCI Thesaurus Property
C4876
UMLS 2011AA Property
C1457887
NCI Thesaurus ObjectClass-2
C25487
UMLS 2011AA ObjectClass-2
C1527180
Disease Symptoms Present (at Diagnosis)
Descrizione

MyelomaSymptomType

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C3242
UMLS 2011AA ObjectClass
C0026764
NCI Thesaurus Property
C4876
UMLS 2011AA Property
C1457887
Other specify
Descrizione

MyelomaSymptomSpecify

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C3242
UMLS 2011AA ObjectClass
C0026764
NCI Thesaurus Property
C4876
UMLS 2011AA Property
C1457887
Serum Total Protein (SPEP at diagnosis)
Descrizione

LaboratoryProcedureTotalSerumProteinOutcomeUnspecifiedValue

Tipo di dati

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C25304
UMLS 2011AA Property
C0439810
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus Property-3
C17126
UMLS 2011AA Property-3
C0036825
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Serum M-Protein Spike (SPEP If immunofixation is positive but M-spike is not quantifiable, enter .01 or follow protocol guidelines for entering M-spike.)
Descrizione

LaboratoryProcedureSerumMProteinOutcomeUnspecifiedValue

Tipo di dati

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C13325
UMLS 2011AA Property
C0229671
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus Property-3
C17788
UMLS 2011AA Property-3
C0700271
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Serum M-Protein by Immunofixation (at diagnosis)
Descrizione

SerumProteinMonoclonalDetectedType

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C13325
UMLS 2011AA ObjectClass
C0229671
NCI Thesaurus ObjectClass-2
C17021
UMLS 2011AA ObjectClass-2
C0033684
NCI Metathesaurus Property
C0746619
NCI Thesaurus Property
C25481
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Serum Heavy Chain (If positive or equivocal, check all that apply)
Descrizione

LaboratoryProcedureImmunoglobulinHeavyChainOutcomeType

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C16717
UMLS 2011AA Property
C0021034
NCI Thesaurus Property-2
C13325
UMLS 2011AA Property-2
C0229671
NCI Thesaurus Property-3
C20200
UMLS 2011AA Property-3
C1274040
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Serum Light Chain (check all that apply)
Descrizione

LaboratoryProcedureImmunoglobulinLightChainProteinResultType

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property-2
C17021
UMLS 2011AA Property-2
C0033684
NCI Thesaurus Property-3
C16720
UMLS 2011AA Property-3
C0021038
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Biclonal
Descrizione

LaboratoryProcedureBiclonalGammopathyOutcomeInd-2

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property-2
C74936
Yes specify
Descrizione

LaboratoryProcedureBiclonalGammopathyOutcomeSpecify

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property-2
C74936
Oligoclonal
Descrizione

SerumProteinOligoclonalInd-2

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Metathesaurus ObjectClass
C0229671
NCI Metathesaurus Property
CL145970
Yes specify
Descrizione

SerumOligoclonalProteinSpecify

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Metathesaurus ObjectClass
C0229671
NCI Metathesaurus Property
CL145970
Urine Total Protein (UPEP at diagnosis)
Descrizione

LaboratoryProcedureTotalUrineProteinOutcomeUnspecifiedValue

Tipo di dati

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C25304
UMLS 2011AA Property
C0439810
NCI Thesaurus Property-2
C13283
UMLS 2011AA Property-2
C0042036
NCI Thesaurus Property-3
C20200
UMLS 2011AA Property-3
C1274040
NCI Thesaurus Property-4
C17021
UMLS 2011AA Property-4
C0033684
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Urine M-Protein Light Chain Excretion (If immunofixation is positive but M-protein is not quantifiable, enter .01 or follow protocol guidelines for entering M-protein.)
Descrizione

LaboratoryProcedureUrineMProteinImmunoglobulinLightChainOutcomeUnspecifiedValue

Tipo di dati

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C13283
UMLS 2011AA Property
C0042036
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus Property-3
C17788
UMLS 2011AA Property-3
C0700271
NCI Thesaurus Property-4
C16720
UMLS 2011AA Property-4
C0021038
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
Unit of Measure
Descrizione

AssessmentLabUOM

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C37984
UMLS 2011AA Property
C0022877
NCI Thesaurus ValueDomain
C25709
UMLS 2011AA ValueDomain
C1519795
Unit of Measure
Descrizione

AssessmentLabUOM

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C37984
UMLS 2011AA Property
C0022877
NCI Thesaurus ValueDomain
C25709
UMLS 2011AA ValueDomain
C1519795
Urine M-Protein by Immunofixation (at diagnosis)
Descrizione

MonoclonalProteinUrineImmunofixationType

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C17021
UMLS 2011AA ObjectClass
C0033684
NCI Metathesaurus ObjectClass
C0746619
NCI Thesaurus Property
C13283
UMLS 2011AA Property
C0042036
NCI Metathesaurus Property
CL201583
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Urine Light Chain (If positive or equivocal,)
Descrizione

UrineProteinLightChainAnalysisImmunofixationType

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C13283
UMLS 2011AA ObjectClass
C0042036
NCI Thesaurus ObjectClass-2
C17021
UMLS 2011AA ObjectClass-2
C0033684
NCI Metathesaurus Property
CL201583
NCI Metathesaurus Property-2
CL105192
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Amyloid: Prior Treatment
Descrizione

Amyloid: Prior Treatment

Prior Treatment? (If yes, respond to treatment-specific questions below.)
Descrizione

CancerPriorTreatmentInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C9305
UMLS 2011AA ObjectClass
C0006826
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus Property-2
C15368
No. of Planned Regimens (If yes, Note: Multiple drug/staged regimens count as 1; e.g., VAD + transplant)
Descrizione

PriorTreatmentPlannedRegimenCount

Tipo di dati

float

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C25619
UMLS 2011AA Property
C1301732
NCI Thesaurus Property-2
C15697
UMLS 2011AA Property-2
C0040808
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Prior Treatment Regimen Name(s) (* Prior Treatment Regimen Name)
Descrizione

MyelomaTreatmentPriorRegimenType

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C3242
UMLS 2011AA ObjectClass
C0026764
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus Property-2
C15697
UMLS 2011AA Property-2
C0040808
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Other Prior Regimen Name (** If Other specify)
Descrizione

PriorTreatmentRegimenSpecify

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C15697
UMLS 2011AA Property
C0040808
Prior Treatment Regimen Start Date
Descrizione

PriorTreatmentRegimenBeginDate

Tipo di dati

date

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C15697
UMLS 2011AA Property
C0040808
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25431
UMLS 2011AA ValueDomain-2
C0439659
Prior Treatment Regimen End Date
Descrizione

PriorTreatmentRegimenEndDate

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C15697
UMLS 2011AA Property
C0040808
Reason Stopped (? Reason Stopped)
Descrizione

PriorTreatmentDiscontinuedReason

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25638
UMLS 2011AA ValueDomain
C0392360
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C25484
UMLS 2011AA Property
C1444662
Hematologic Response (? Hematologic Response)
Descrizione

MyelomaTreatmentPriorResponseHematologicType

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C3242
UMLS 2011AA ObjectClass
C0026764
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus Property-2
C25629
UMLS 2011AA Property-2
C0332152
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Organ Response (? Organ Response)
Descrizione

MyelomaTreatmentPriorResponseOrganInd-3

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C3242
UMLS 2011AA ObjectClass
C0026764
NCI Thesaurus ObjectClass-2
C15368
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus Property-2
C25629
UMLS 2011AA Property-2
C0332152
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ValueDomain-2
C13018
UMLS 2011AA ValueDomain-2
C0178784
Prior Bone Marrow or Peripheral Blood Stem Cell Transplant?
Descrizione

PriorBMSCTAdministeredInd-3

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C25437
UMLS 2011AA ObjectClass-2
C0842093
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
Prior Transplant Type (If yes,)
Descrizione

PriorTransplantAdministeredType

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C12981
UMLS 2011AA ObjectClass-2
C0332835
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
Number of autologous transplants
Descrizione

AutologousTransplantPriorAdministeredCount

Tipo di dati

float

Alias
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Thesaurus ObjectClass-2
C28000
UMLS 2011AA ObjectClass-2
C0439859
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Date of Last Transplant
Descrizione

PriorTransplantLastDate

Tipo di dati

date

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C12981
UMLS 2011AA ObjectClass-2
C0332835
NCI Thesaurus Property
C25551
UMLS 2011AA Property
C1517741
NCI Thesaurus Property-2
C25275
UMLS 2011AA Property-2
C2745955
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25551
UMLS 2011AA ValueDomain-2
C1517741
Number of allogeneic transplants
Descrizione

AllogeneicTransplantPriorAdministeredCount

Tipo di dati

float

Alias
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Thesaurus ObjectClass-2
C28343
UMLS 2011AA ObjectClass-2
C1515895
NCI Thesaurus Property
C25629
UMLS 2011AA Property
C0332152
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Allogeneic Transplant Type
Descrizione

PriorTransplantAllogenicAdministeredType

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C12981
UMLS 2011AA ObjectClass-2
C0332835
NCI Thesaurus Property
C28343
UMLS 2011AA Property
C1515895
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Date of Transplant
Descrizione

PriorTransplantDate

Tipo di dati

date

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C12981
UMLS 2011AA ObjectClass-2
C0332835
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25367
DLI
Descrizione

PriorTransplantLymphocyteInfusionInd-2

Tipo di dati

boolean

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C12981
UMLS 2011AA ObjectClass-2
C0332835
NCI Thesaurus Property
C15388
UMLS 2011AA Property
C0574032
NCI Thesaurus Property-2
C12535
UMLS 2011AA Property-2
C0024264
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Date of Last DLI (If yes,)
Descrizione

PriorTransplantLymphocyteInfusionLastDate

Tipo di dati

date

Alias
NCI Thesaurus ObjectClass
C25629
UMLS 2011AA ObjectClass
C0332152
NCI Thesaurus ObjectClass-2
C12981
UMLS 2011AA ObjectClass-2
C0332835
NCI Thesaurus Property
C15388
UMLS 2011AA Property
C0574032
NCI Thesaurus Property-2
C12535
UMLS 2011AA Property-2
C0024264
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25551
UMLS 2011AA ValueDomain-2
C1517741
Total body irradiation
Descrizione

PriorRTTotal-BodyIrradiationAdministeredInd-3

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C15313
UMLS 2011AA ObjectClass
C1522449
NCI Thesaurus ObjectClass-2
C25629
UMLS 2011AA ObjectClass-2
C0332152
NCI Thesaurus Property
C15350
UMLS 2011AA Property
C0043162
NCI Thesaurus Property-2
C25382
UMLS 2011AA Property-2
C1521801
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Ritorna all'inizio della pagina

Similar models

No Instruction available.

1 moduli
  1. StudyEvent: Primary Amyloidosis - On-Study Form
    1. No Instruction available.
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Crf Header
Protocol ID Coordinating Group
Item
Coordinating Group Protocol No.
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1711341 (UMLS CUI-2)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Coordinating Group Code
Item
Coordinating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C1711341 (UMLS CUI-1)
C17005 (NCI Thesaurus ObjectClass)
C0805701 (UMLS CUI-2)
C25462 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
Protocol Title
Item
Protocol Title
text
C25191 (NCI Thesaurus ValueDomain)
C2986303 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C42774 (NCI Thesaurus Property)
Patient Study ID
Item
Patient Study ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25462 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Institution Name
Item
Institution/Affiliate
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Trial subject ID Participating Group
Item
Other Patient ID
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
ParticipatingGroupIdentifierCode
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
C25608 (NCI Thesaurus ObjectClass)
C0679823 (UMLS 2011AA ObjectClass)
C17005 (NCI Thesaurus ObjectClass-2)
C1257890 (UMLS 2011AA ObjectClass-2)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientName
Item
Patient Name (initials acceptable)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Item Group
Amyloid: Form Administration
Person Completing Form
Item
Person Completing Form
text
C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
Data amended
Item
Are data amended (If data are amended, please circle in red when using paper form)
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Item Group
Amyloid: Disease Description
CancerInitialDiagnosisDate
Item
Date of Initial Pathologic Diagnosis
date
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C15220 (NCI Thesaurus Property-2)
C0011900 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
HeartInvolvedInd-3
Item
Heart (Clinical Involvement?* Y=yes, N=no *Symptomatic)
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C12727 (NCI Thesaurus ObjectClass)
C0018787 (UMLS 2011AA ObjectClass)
C25547 (NCI Thesaurus Property)
KidneyDiseasePresentInd-3
Item
Kidney
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C12415 (NCI Thesaurus ObjectClass)
C0022646 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass-2)
C0012634 (UMLS 2011AA ObjectClass-2)
LiverInvolvedInd-3
Item
Liver
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C12392 (NCI Thesaurus ObjectClass)
C0023884 (UMLS 2011AA ObjectClass)
C25547 (NCI Thesaurus Property)
StomachInvolvedInd-3
Item
Stomach
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25547 (NCI Thesaurus Property)
C0038351 (NCI Metathesaurus ObjectClass)
SmallBowelGastrointestinalInvolvedInd-3
Item
Gastrointestinal/small bowel
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C13359 (NCI Thesaurus Property)
C0521362 (UMLS 2011AA Property)
C12386 (NCI Thesaurus ObjectClass)
C0021852 (UMLS 2011AA ObjectClass)
C25547 (NCI Thesaurus Property-2)
RectumColonInvolvedInd-3
Item
Colon/rectum
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C12382 (NCI Thesaurus ObjectClass)
C0009368 (UMLS 2011AA ObjectClass)
C12390 (NCI Thesaurus ObjectClass-2)
C0034896 (UMLS 2011AA ObjectClass-2)
C25547 (NCI Thesaurus Property)
PeripheralNeuropathySymptomInd-3
Item
Peripheral Nerve Neuropathy
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C4731 (NCI Thesaurus ObjectClass)
C0031117 (UMLS 2011AA ObjectClass)
C25233 (NCI Thesaurus ObjectClass-2)
C0205100 (UMLS 2011AA ObjectClass-2)
SoftTissueInvolvedInd-3
Item
Soft Tissue
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25547 (NCI Thesaurus Property)
C12801 (NCI Thesaurus ObjectClass)
C0040300 (UMLS 2011AA ObjectClass)
C25255 (NCI Thesaurus ObjectClass-2)
C0205358 (UMLS 2011AA ObjectClass-2)
SkinInvolvedInd-3
Item
Skin
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C12470 (NCI Thesaurus ObjectClass)
C1123023 (UMLS 2011AA ObjectClass)
C25547 (NCI Thesaurus Property)
MacroglossiaSymptomInd-3
Item
Macroglossia
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C0024421 (NCI Metathesaurus ObjectClass)
AutonomicNeuropathyInvolvedInd-3
Item
Autonomic Nerve Neuropathy (** Note: Autonomic neuropathy includes any gastroparesis, pseudo-obstruction, and/or orthostatic hypotension not attributable to medications or volume depletion.)
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25547 (NCI Thesaurus Property)
C27033 (NCI Thesaurus ObjectClass)
C0259749 (UMLS 2011AA ObjectClass)
OtherSiteInvolvedInd-3
Item
Other
boolean
C17649 (NCI Thesaurus ObjectClass)
C0205394 (UMLS 2011AA ObjectClass)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25547 (NCI Thesaurus Property)
CL111053 (NCI Metathesaurus ObjectClass)
OtherDiseaseSiteName
Item
Other Site Name (If yes,)
text
C25191 (NCI Thesaurus ValueDomain)
C1547383 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus ObjectClass)
C0205394 (UMLS 2011AA ObjectClass)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass-2)
C0012634 (UMLS 2011AA ObjectClass-2)
BiopsyPerformedInd-3
Item
Biopsy done (Y=yes, N=no)
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
Item
Biopsy Result (If done,)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C15189 (NCI Thesaurus ObjectClass)
C0005558 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
CL.15
Code List
Biopsy Result (If done,)
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Dominant Presentation (at Diagnosis check only one)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3242 (NCI Thesaurus ObjectClass)
C0026764 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C25487 (NCI Thesaurus ObjectClass-2)
C1527180 (UMLS 2011AA ObjectClass-2)
CL.16
Code List
Dominant Presentation (at Diagnosis check only one)
CL Item
Heart (Heart)
C12727 (NCI Thesaurus)
C0018787 (UMLS 2011AA)
CL Item
Kidney (Kidney)
C12415 (NCI Thesaurus)
C0022646 (UMLS 2011AA)
CL Item
Liver (Liver)
C12392 (NCI Thesaurus)
C0023884 (UMLS 2011AA)
CL Item
Stomach (stomach)
C12391 (NCI Thesaurus)
C0038351 (UMLS 2011AA)
CL Item
Gastrointestinal/small Bowel (Gastrointestinal/small bowel)
CL Item
Colon/rectum (Colon/rectum)
CL Item
Peripheral Nerve Neuropathy (Peripheral Nerve Neuropathy)
CL Item
Autonomic Nerve Neuropathy (Autonomic Nerve Neuropathy)
CL Item
Soft Tissue (Soft Tissue)
C12471 (NCI Thesaurus)
C0225317 (UMLS 2011AA)
CL Item
Skin (Skin)
C12470 (NCI Thesaurus)
C1123023 (UMLS 2011AA)
CL Item
Macroglossia (Macroglossia)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
DominantMyelomaSymptomSpecify
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C3242 (NCI Thesaurus ObjectClass)
C0026764 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C25487 (NCI Thesaurus ObjectClass-2)
C1527180 (UMLS 2011AA ObjectClass-2)
Item
Disease Symptoms Present (at Diagnosis)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3242 (NCI Thesaurus ObjectClass)
C0026764 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
CL.17
Code List
Disease Symptoms Present (at Diagnosis)
CL Item
Fatigue (Fatigue)
C3036 (NCI Thesaurus)
C0015672 (UMLS 2011AA)
CL Item
Leg Swelling (Leg swelling)
CL Item
Painful/numb Feet (Painful/numb feet)
CL Item
Carpal Tunnel (Carpal tunnel)
CL Item
Purpura (skin) (Purpura (skin))
CL Item
Diarrhea (Diarrhea)
C2987 (NCI Thesaurus)
C0011991 (UMLS 2011AA)
CL Item
Syncope (Syncope)
C35053 (NCI Thesaurus)
C0039070 (UMLS 2011AA)
CL Item
Light-headedness (Light-headedness)
CL Item
Macroglossia (Macroglossia)
CL Item
Weight Loss >= 10% Of Body Weight (Weight loss >= 10% of body weight)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
MyelomaSymptomSpecify
Item
Other specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C3242 (NCI Thesaurus ObjectClass)
C0026764 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
LaboratoryProcedureTotalSerumProteinOutcomeUnspecifiedValue
Item
Serum Total Protein (SPEP at diagnosis)
float
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25304 (NCI Thesaurus Property)
C0439810 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C17126 (NCI Thesaurus Property-3)
C0036825 (UMLS 2011AA Property-3)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
LaboratoryProcedureSerumMProteinOutcomeUnspecifiedValue
Item
Serum M-Protein Spike (SPEP If immunofixation is positive but M-spike is not quantifiable, enter .01 or follow protocol guidelines for entering M-spike.)
float
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C13325 (NCI Thesaurus Property)
C0229671 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C17788 (NCI Thesaurus Property-3)
C0700271 (UMLS 2011AA Property-3)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
Item
Serum M-Protein by Immunofixation (at diagnosis)
text
C13325 (NCI Thesaurus ObjectClass)
C0229671 (UMLS 2011AA ObjectClass)
C17021 (NCI Thesaurus ObjectClass-2)
C0033684 (UMLS 2011AA ObjectClass-2)
C0746619 (NCI Metathesaurus Property)
C25481 (NCI Thesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.19
Code List
Serum M-Protein by Immunofixation (at diagnosis)
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Equivocal (Equivocal)
C86071 (NCI Thesaurus)
C0332241 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Serum Heavy Chain (If positive or equivocal, check all that apply)
text
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C16717 (NCI Thesaurus Property)
C0021034 (UMLS 2011AA Property)
C13325 (NCI Thesaurus Property-2)
C0229671 (UMLS 2011AA Property-2)
C20200 (NCI Thesaurus Property-3)
C1274040 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.20
Code List
Serum Heavy Chain (If positive or equivocal, check all that apply)
CL Item
G (G)
CL Item
A (A)
C14653 (NCI Thesaurus)
CL Item
M (M)
CL Item
D (D)
C25321 (NCI Thesaurus)
C0443203 (UMLS 2011AA)
CL Item
E (E)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Serum Light Chain (check all that apply)
text
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C17021 (NCI Thesaurus Property-2)
C0033684 (UMLS 2011AA Property-2)
C16720 (NCI Thesaurus Property-3)
C0021038 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.21
Code List
Serum Light Chain (check all that apply)
CL Item
Kappa (Kappa)
CL Item
Lambda (Lambda)
C0926407 (NCI Metathesaurus)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
LaboratoryProcedureBiclonalGammopathyOutcomeInd-2
Item
Biclonal
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C74936 (NCI Thesaurus Property-2)
LaboratoryProcedureBiclonalGammopathyOutcomeSpecify
Item
Yes specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C74936 (NCI Thesaurus Property-2)
SerumProteinOligoclonalInd-2
Item
Oligoclonal
boolean
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C0229671 (NCI Metathesaurus ObjectClass)
CL145970 (NCI Metathesaurus Property)
SerumOligoclonalProteinSpecify
Item
Yes specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C0229671 (NCI Metathesaurus ObjectClass)
CL145970 (NCI Metathesaurus Property)
LaboratoryProcedureTotalUrineProteinOutcomeUnspecifiedValue
Item
Urine Total Protein (UPEP at diagnosis)
float
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25304 (NCI Thesaurus Property)
C0439810 (UMLS 2011AA Property)
C13283 (NCI Thesaurus Property-2)
C0042036 (UMLS 2011AA Property-2)
C20200 (NCI Thesaurus Property-3)
C1274040 (UMLS 2011AA Property-3)
C17021 (NCI Thesaurus Property-4)
C0033684 (UMLS 2011AA Property-4)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
LaboratoryProcedureUrineMProteinImmunoglobulinLightChainOutcomeUnspecifiedValue
Item
Urine M-Protein Light Chain Excretion (If immunofixation is positive but M-protein is not quantifiable, enter .01 or follow protocol guidelines for entering M-protein.)
float
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C13283 (NCI Thesaurus Property)
C0042036 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C17788 (NCI Thesaurus Property-3)
C0700271 (UMLS 2011AA Property-3)
C16720 (NCI Thesaurus Property-4)
C0021038 (UMLS 2011AA Property-4)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
Item
Unit of Measure
text
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C37984 (NCI Thesaurus Property)
C0022877 (UMLS 2011AA Property)
C25709 (NCI Thesaurus ValueDomain)
C1519795 (UMLS 2011AA ValueDomain)
CL.24
Code List
Unit of Measure
CL Item
Milligrams/24 Hours (mg/24 hrs)
CL Item
Grams/24 Hours (g/24 hrs)
Item
Unit of Measure
text
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C37984 (NCI Thesaurus Property)
C0022877 (UMLS 2011AA Property)
C25709 (NCI Thesaurus ValueDomain)
C1519795 (UMLS 2011AA ValueDomain)
CL.24
Code List
Unit of Measure
CL Item
Milligrams/24 Hours (mg/24 hrs)
CL Item
Grams/24 Hours (g/24 hrs)
Item
Urine M-Protein by Immunofixation (at diagnosis)
text
C17021 (NCI Thesaurus ObjectClass)
C0033684 (UMLS 2011AA ObjectClass)
C0746619 (NCI Metathesaurus ObjectClass)
C13283 (NCI Thesaurus Property)
C0042036 (UMLS 2011AA Property)
CL201583 (NCI Metathesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.25
Code List
Urine M-Protein by Immunofixation (at diagnosis)
CL Item
Negative (Negative)
C25247 (NCI Thesaurus)
C0205160 (UMLS 2011AA)
CL Item
Positive (Positive)
C25246 (NCI Thesaurus)
C1446409 (UMLS 2011AA)
CL Item
Equivocal (Equivocal)
C86071 (NCI Thesaurus)
C0332241 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Urine Light Chain (If positive or equivocal,)
text
C13283 (NCI Thesaurus ObjectClass)
C0042036 (UMLS 2011AA ObjectClass)
C17021 (NCI Thesaurus ObjectClass-2)
C0033684 (UMLS 2011AA ObjectClass-2)
CL201583 (NCI Metathesaurus Property)
CL105192 (NCI Metathesaurus Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.26
Code List
Urine Light Chain (If positive or equivocal,)
CL Item
Kappa (Kappa)
CL Item
Lambda (Lambda)
C0926407 (NCI Metathesaurus)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item Group
Amyloid: Prior Treatment
CancerPriorTreatmentInd-3
Item
Prior Treatment? (If yes, respond to treatment-specific questions below.)
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C15368 (NCI Thesaurus Property-2)
PriorTreatmentPlannedRegimenCount
Item
No. of Planned Regimens (If yes, Note: Multiple drug/staged regimens count as 1; e.g., VAD + transplant)
float
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25619 (NCI Thesaurus Property)
C1301732 (UMLS 2011AA Property)
C15697 (NCI Thesaurus Property-2)
C0040808 (UMLS 2011AA Property-2)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
Item
Prior Treatment Regimen Name(s) (* Prior Treatment Regimen Name)
text
C3242 (NCI Thesaurus ObjectClass)
C0026764 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C15697 (NCI Thesaurus Property-2)
C0040808 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.28
Code List
Prior Treatment Regimen Name(s) (* Prior Treatment Regimen Name)
CL Item
Adriamycin (Adriamycin)
CL Item
Alpha-interferon (Alpha-interferon)
CL Item
Carmustine (bcnu) (Carmustine (BCNU))
CL Item
Colchicine (Colchicine)
C385 (NCI Thesaurus)
C0009262 (UMLS 2011AA)
CL Item
Cyclophosphamide (Cyclophosphamide)
C405 (NCI Thesaurus)
C0010583 (UMLS 2011AA)
CL Item
Dexamethasone (Dexamethasone)
C422 (NCI Thesaurus)
C0011777 (UMLS 2011AA)
CL Item
Iododeoxyrubicin (Iododeoxyrubicin)
CL Item
Melphalan (lpam) (Melphalan (LPAM))
CL Item
Mp (MP)
CL Item
Ps-341 (PS-341)
CL Item
Revimid (Revimid)
CL Item
Thalidomide (Thalidomide)
C870 (NCI Thesaurus)
C0039736 (UMLS 2011AA)
CL Item
Vincristine (vcr) (Vincristine (VCR))
CL Item
Vad (VAD)
CL Item
Prednisone (Prednisone)
C770 (NCI Thesaurus)
C0032952 (UMLS 2011AA)
CL Item
Corticosteroids (Corticosteroids)
CL Item
Interferon (Interferon)
C20493 (NCI Thesaurus)
C0733470 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
PriorTreatmentRegimenSpecify
Item
Other Prior Regimen Name (** If Other specify)
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
PriorTreatmentRegimenBeginDate
Item
Prior Treatment Regimen Start Date
date
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C0439659 (UMLS 2011AA ValueDomain-2)
PriorTreatmentRegimenEndDate
Item
Prior Treatment Regimen End Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C15697 (NCI Thesaurus Property)
C0040808 (UMLS 2011AA Property)
Item
Reason Stopped (? Reason Stopped)
text
C25638 (NCI Thesaurus ValueDomain)
C0392360 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25484 (NCI Thesaurus Property)
C1444662 (UMLS 2011AA Property)
CL.29
Code List
Reason Stopped (? Reason Stopped)
CL Item
Completed Treatment (Completed treatment)
CL Item
Alternative Treatment (Alternative treatment)
CL Item
Response/improvement (Response/Improvement)
CL Item
Patient Refusal (Patient refusal)
CL Item
Toxicity (Toxicity)
C27990 (NCI Thesaurus)
C0600688 (UMLS 2011AA)
CL Item
Progression (Progression)
C25331 (NCI Thesaurus)
C25331 (NCI Thesaurus-2)
CL Item
Maintenance Only (Maintenance only)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Hematologic Response (? Hematologic Response)
text
C3242 (NCI Thesaurus ObjectClass)
C0026764 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property-2)
C0332152 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.30
Code List
Hematologic Response (? Hematologic Response)
CL Item
Complete Response (Complete Response)
CL Item
Partial Response (Partial Response)
C18212 (NCI Thesaurus)
CL Item
Progression (Progression)
C25331 (NCI Thesaurus)
CL Item
Inevaluable (Inevaluable)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Organ Response (? Organ Response)
text
C3242 (NCI Thesaurus ObjectClass)
C0026764 (UMLS 2011AA ObjectClass)
C15368 (NCI Thesaurus ObjectClass-2)
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C25629 (NCI Thesaurus Property-2)
C0332152 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C13018 (NCI Thesaurus ValueDomain-2)
C0178784 (UMLS 2011AA ValueDomain-2)
CL.31
Code List
Organ Response (? Organ Response)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
PriorBMSCTAdministeredInd-3
Item
Prior Bone Marrow or Peripheral Blood Stem Cell Transplant?
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C25437 (NCI Thesaurus ObjectClass-2)
C0842093 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
Item
Prior Transplant Type (If yes,)
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C12981 (NCI Thesaurus ObjectClass-2)
C0332835 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
CL.33
Code List
Prior Transplant Type (If yes,)
CL Item
Autologous (Autologous)
C28000 (NCI Thesaurus)
C0439859 (UMLS 2011AA)
CL Item
Allogeneic (Allogeneic)
AutologousTransplantPriorAdministeredCount
Item
Number of autologous transplants
float
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C28000 (NCI Thesaurus ObjectClass-2)
C0439859 (UMLS 2011AA ObjectClass-2)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
PriorTransplantLastDate
Item
Date of Last Transplant
date
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C12981 (NCI Thesaurus ObjectClass-2)
C0332835 (UMLS 2011AA ObjectClass-2)
C25551 (NCI Thesaurus Property)
C1517741 (UMLS 2011AA Property)
C25275 (NCI Thesaurus Property-2)
C2745955 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25551 (NCI Thesaurus ValueDomain-2)
C1517741 (UMLS 2011AA ValueDomain-2)
AllogeneicTransplantPriorAdministeredCount
Item
Number of allogeneic transplants
float
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C28343 (NCI Thesaurus ObjectClass-2)
C1515895 (UMLS 2011AA ObjectClass-2)
C25629 (NCI Thesaurus Property)
C0332152 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
Item
Allogeneic Transplant Type
text
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C12981 (NCI Thesaurus ObjectClass-2)
C0332835 (UMLS 2011AA ObjectClass-2)
C28343 (NCI Thesaurus Property)
C1515895 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.34
Code List
Allogeneic Transplant Type
CL Item
Mini (non-myeloablative) (Mini (non-myeloablative))
CL Item
Myeloablative (Myeloablative)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
PriorTransplantDate
Item
Date of Transplant
date
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C12981 (NCI Thesaurus ObjectClass-2)
C0332835 (UMLS 2011AA ObjectClass-2)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
PriorTransplantLymphocyteInfusionInd-2
Item
DLI
boolean
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C12981 (NCI Thesaurus ObjectClass-2)
C0332835 (UMLS 2011AA ObjectClass-2)
C15388 (NCI Thesaurus Property)
C0574032 (UMLS 2011AA Property)
C12535 (NCI Thesaurus Property-2)
C0024264 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
PriorTransplantLymphocyteInfusionLastDate
Item
Date of Last DLI (If yes,)
date
C25629 (NCI Thesaurus ObjectClass)
C0332152 (UMLS 2011AA ObjectClass)
C12981 (NCI Thesaurus ObjectClass-2)
C0332835 (UMLS 2011AA ObjectClass-2)
C15388 (NCI Thesaurus Property)
C0574032 (UMLS 2011AA Property)
C12535 (NCI Thesaurus Property-2)
C0024264 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25551 (NCI Thesaurus ValueDomain-2)
C1517741 (UMLS 2011AA ValueDomain-2)
Item
Total body irradiation
text
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25629 (NCI Thesaurus ObjectClass-2)
C0332152 (UMLS 2011AA ObjectClass-2)
C15350 (NCI Thesaurus Property)
C0043162 (UMLS 2011AA Property)
C25382 (NCI Thesaurus Property-2)
C1521801 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.36
Code List
Total body irradiation
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Ritorna all'inizio della pagina 

Contatto

Si prega di utilizzare questo modulo per feedback, domande e suggerimenti per miglioramenti.

I campi contrassegnati da * sono obbligatori.

Aiuto

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial