Description:

SOUTHWEST ONCOLOGY GROUP APL Disease Assessment Form (S0521) Combination Chemotherapy With or Without Gemtuzumab Followed By Tretinoin, Mercaptopurine, and Methotrexate or Observation in Treating Patients With Acute Promyelocytic Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=02C9A3A8-9B14-5BA0-E044-0003BA3F9857

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=02C9A3A8-9B14-5BA0-E044-0003BA3F9857
Keywords:
  1. 9/19/12 9/19/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
  3. 1/9/15 1/9/15 - Martin Dugas
Uploaded on:

January 9, 2015

DOI:
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License :
Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT00492856 Treatment - SOUTHWEST ONCOLOGY GROUP APL Disease Assessment Form (S0521) - 2415460v1.0

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  1. StudyEvent: SOUTHWEST ONCOLOGY GROUP APL Disease Assessment Form (S0521)
    1. No Instruction available.
Header
Participating Group Name
Patient And Disease Description
Vital Status
Physical
Has the patient had a documented clinical assessment for this cancer? (during the reporting period APL)
Response
Did the patient achieve a complete response according to clinical/ hematologic criteria during this reporting period? (CR, CRi, or PR see Section 10.0 for response criteria)
Relapse
Has the patient had a relapse of their disease following previous response (complete or partial See Section 10.0 for relapse criteria)
Laboratory Values And Extramedullary Disease: Peripheral Blood Examination
Did the patient have a peripheral blood examination during this reporting period? (aspiration and/or biopsy)
g/dL
1000/uL
1000/uL
%
%
%
Laboratory Values And Extramedullary Disease: Bone Marrow Examination
Did the patient have a bone marrow examination during this reporting period? (aspiration and/or biopsy)
%
%
Marrow Cellularity Status (Select one)
Laboratory Values And Extramedullary Disease: Extramedullary Disease Involvement
Was the patient examined for extramedullary disease during this reporting period?
Extramedullary Disease Involvement (Select all that apply)
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