ID

8314

Beschrijving

Multiple Myeloma - Treatment Summary Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D6792069-D295-0A74-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D6792069-D295-0A74-E034-0003BA12F5E7

Trefwoorden

Versies (3)
  1. 19-09-12 19-09-12 -
  2. 08-01-15 08-01-15 - Martin Dugas
  3. 09-01-15 09-01-15 - Martin Dugas
Geüploaded op

9 januari 2015

DOI

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Creative Commons BY-NC 3.0 Legacy
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    Treatment - Multiple Myeloma - Treatment Summary Form - 2273579v3.0

    Engels

    No Instruction available.

    1 Formulieren  
    1. StudyEvent: Multiple Myeloma - Treatment Summary Form
      1. No Instruction available.
    Crf Header
    Beschrijving

    Crf Header

    Coordinating Group Protocol No.
    Beschrijving

    Protocol ID Coordinating Group

    Datatype

    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
    Beschrijving

    Coordinating Group Code

    Datatype

    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
    Beschrijving

    Protocol Title

    Datatype

    text

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

    Patient Study ID

    Datatype

    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
    Beschrijving

    Institution Name

    Datatype

    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
    Beschrijving

    Trial subject ID Participating Group

    Datatype

    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
    Beschrijving

    ParticipatingGroupIdentifierCode

    Datatype

    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)
    Beschrijving

    Patient Name

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1299487
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25364
    Myeloma: Treatment Plan
    Beschrijving

    Myeloma: Treatment Plan

    First Date (any modality of) Protocol Therapy Was Given
    Beschrijving

    Treatment Start Date

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25509
    UMLS CUI-1
    C3173309
    NCI Thesaurus Property
    C25431
    NCI Thesaurus Property-2
    C25275
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25431
    Last Date (any modality of) protocol therapy was given
    Beschrijving

    Treatment End Date

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C1531784
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25275
    NCI Thesaurus Property-2
    C25496
    Reason Treatment Ended (check one)
    Beschrijving

    Off Treatment Reason

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638
    UMLS CUI-1
    C1518544
    NCI Thesaurus ObjectClass
    C25601
    UMLS CUI-2
    C0566251
    NCI Thesaurus Property
    C25365
    Other
    Beschrijving

    Off Treatment Reason, specify

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI-1
    C1518544
    NCI Thesaurus ObjectClass
    C25601
    UMLS CUI-2
    C0566251
    NCI Thesaurus Property
    C25365
    UMLS CUI-3
    C1521902
    Myeloma: Treatment Summary - Systemic Therapy
    Beschrijving

    Myeloma: Treatment Summary - Systemic Therapy

    Type of Systemic Therapy (check all that apply)
    Beschrijving

    Systemic Therapy Type

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS CUI-1
    C1515119
    NCI Thesaurus ObjectClass
    C15698
    UMLS CUI-2
    C0683312
    NCI Thesaurus Property
    C25365
    Other specify
    Beschrijving

    SystemicTherapyTypeSpecify

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C15698
    UMLS 2011AA ObjectClass
    C1515119
    NCI Thesaurus Property
    C25365
    UMLS 2011AA Property
    C0678257
    Start Date of First Dose of First Cycle
    Beschrijving

    TreatmentFirstCycleBeginDate

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25472
    UMLS 2011AA Property
    C1511572
    NCI Thesaurus Property-2
    C25509
    UMLS 2011AA Property-2
    C1279901
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25431
    UMLS 2011AA ValueDomain-2
    C0439659
    Start Date of First Dose of Last Cycle
    Beschrijving

    TreatmentLastCycleBeginDate

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25472
    UMLS 2011AA Property
    C1511572
    NCI Thesaurus Property-2
    C25551
    UMLS 2011AA Property-2
    C1517741
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25431
    UMLS 2011AA ValueDomain-2
    C0439659
    Total No. of Courses Administered
    Beschrijving

    AgentCourseCount

    Datatype

    float

    Alias
    NCI Thesaurus ValueDomain
    C25463
    UMLS 2011AA ValueDomain
    C0750480
    NCI Thesaurus Property
    C25379
    UMLS 2011AA Property
    C0750729
    NCI Thesaurus ObjectClass
    C1708
    UMLS 2011AA ObjectClass
    C0450442
    Agent Name (protocol specific)
    Beschrijving

    Agent

    Datatype

    text

    Alias
    NCI Thesaurus Property
    C25364
    UMLS CUI-1
    C1521826
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus ValueDomain
    C1708
    NCI Thesaurus ValueDomain-2
    C42614
    Total Agent Dose for Cycle 1 (Some groups may pre-print protocol agents with appropriate units.)
    Beschrijving

    AgentFirstCourseTotalDose

    Datatype

    float

    Alias
    NCI Thesaurus ObjectClass
    C1708
    UMLS 2011AA ObjectClass
    C0450442
    NCI Thesaurus Property
    C25509
    UMLS 2011AA Property
    C1279901
    NCI Thesaurus Property-2
    C25379
    UMLS 2011AA Property-2
    C0750729
    NCI Thesaurus ValueDomain
    C25304
    UMLS 2011AA ValueDomain
    C0439810
    NCI Thesaurus ValueDomain-2
    C25488
    UMLS 2011AA ValueDomain-2
    C0178602
    units (Vaccine name may be pre-printed with appropriate units.)
    Beschrijving

    Units

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C1708
    UMLS CUI-1
    C1519795
    NCI Thesaurus Property
    C25256
    NCI Thesaurus ValueDomain
    C25709
    Were there any dose modifications or additions/omissions to protocol treatment? (check one)
    Beschrijving

    Dose Modification

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass
    C25256
    NCI Thesaurus Property
    C25572
    NCI Thesaurus ValueDomain-2
    C25572
    Name of Therapy (If yes,)
    Beschrijving

    Therapy Modification

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1299575
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25572
    Reason for Therapy Modification
    Beschrijving

    Reason for Therapy Modification

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638
    UMLS CUI-1
    C1299575
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25572
    UMLS CUI-2
    C0392360
    Myeloma: Treatment Summary - Radiopharmaceuticals
    Beschrijving

    Myeloma: Treatment Summary - Radiopharmaceuticals

    Start Date of First Dose of First Cycle
    Beschrijving

    TreatmentFirstCycleBeginDate

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25472
    UMLS 2011AA Property
    C1511572
    NCI Thesaurus Property-2
    C25509
    UMLS 2011AA Property-2
    C1279901
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25431
    UMLS 2011AA ValueDomain-2
    C0439659
    Start Date of First Dose of Last Cycle
    Beschrijving

    TreatmentLastCycleBeginDate

    Datatype

    date

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25472
    UMLS 2011AA Property
    C1511572
    NCI Thesaurus Property-2
    C25551
    UMLS 2011AA Property-2
    C1517741
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25431
    UMLS 2011AA ValueDomain-2
    C0439659
    Total No. of Courses Administered
    Beschrijving

    AgentCourseCount

    Datatype

    float

    Alias
    NCI Thesaurus ValueDomain
    C25463
    UMLS 2011AA ValueDomain
    C0750480
    NCI Thesaurus Property
    C25379
    UMLS 2011AA Property
    C0750729
    NCI Thesaurus ObjectClass
    C1708
    UMLS 2011AA ObjectClass
    C0450442
    Agent Name (protocol specific)
    Beschrijving

    Agent

    Datatype

    text

    Alias
    NCI Thesaurus Property
    C25364
    UMLS CUI-1
    C1521826
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus ValueDomain
    C1708
    NCI Thesaurus ValueDomain-2
    C42614
    Total Agent Dose for Cycle 1 (Some groups may pre-print protocol agents with appropriate units.)
    Beschrijving

    AgentFirstCourseTotalDose

    Datatype

    float

    Alias
    NCI Thesaurus ObjectClass
    C1708
    UMLS 2011AA ObjectClass
    C0450442
    NCI Thesaurus Property
    C25509
    UMLS 2011AA Property
    C1279901
    NCI Thesaurus Property-2
    C25379
    UMLS 2011AA Property-2
    C0750729
    NCI Thesaurus ValueDomain
    C25304
    UMLS 2011AA ValueDomain
    C0439810
    NCI Thesaurus ValueDomain-2
    C25488
    UMLS 2011AA ValueDomain-2
    C0178602
    units (Vaccine name may be pre-printed with appropriate units.)
    Beschrijving

    Units

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C1708
    UMLS CUI-1
    C1519795
    NCI Thesaurus Property
    C25256
    NCI Thesaurus ValueDomain
    C25709
    Were there any dose modifications or additions/omissions to protocol treatment? (check one)
    Beschrijving

    Dose Modification

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass
    C25256
    NCI Thesaurus Property
    C25572
    NCI Thesaurus ValueDomain-2
    C25572
    Name of Therapy (If yes,)
    Beschrijving

    Therapy Modification

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1299575
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25572
    Reason for Therapy Modification
    Beschrijving

    Reason for Therapy Modification

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638
    UMLS CUI-1
    C1299575
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25572
    UMLS CUI-2
    C0392360
    Myeloma: Treatment Summary - Vaccine Therapy
    Beschrijving

    Myeloma: Treatment Summary - Vaccine Therapy

    Date of First Vaccination
    Beschrijving

    VaccineAdministeredFirstDate

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C923
    UMLS 2011AA ObjectClass
    C0042210
    NCI Thesaurus ValueDomain-2
    C25509
    UMLS 2011AA ValueDomain-2
    C1279901
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Date of Last Vaccination
    Beschrijving

    VaccineAdministeredLastDate

    Datatype

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C923
    UMLS 2011AA ObjectClass
    C0042210
    NCI Thesaurus ValueDomain-2
    C25551
    UMLS 2011AA ValueDomain-2
    C1517741
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Vaccination Site (s check all that apply)
    Beschrijving

    VaccineAdministeredSite

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C13717
    UMLS 2011AA ValueDomain
    C1515974
    NCI Thesaurus ObjectClass
    C923
    UMLS 2011AA ObjectClass
    C0042210
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Other specify
    Beschrijving

    VaccineAdministeredSpecify

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C923
    UMLS 2011AA ObjectClass
    C0042210
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Agent Name (protocol specific)
    Beschrijving

    Agent

    Datatype

    text

    Alias
    NCI Thesaurus Property
    C25364
    UMLS CUI-1
    C1521826
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus ValueDomain
    C1708
    NCI Thesaurus ValueDomain-2
    C42614
    Total Agent Dose for Cycle 1 (Some groups may pre-print protocol agents with appropriate units.)
    Beschrijving

    AgentFirstCourseTotalDose

    Datatype

    float

    Alias
    NCI Thesaurus ObjectClass
    C1708
    UMLS 2011AA ObjectClass
    C0450442
    NCI Thesaurus Property
    C25509
    UMLS 2011AA Property
    C1279901
    NCI Thesaurus Property-2
    C25379
    UMLS 2011AA Property-2
    C0750729
    NCI Thesaurus ValueDomain
    C25304
    UMLS 2011AA ValueDomain
    C0439810
    NCI Thesaurus ValueDomain-2
    C25488
    UMLS 2011AA ValueDomain-2
    C0178602
    units (Vaccine name may be pre-printed with appropriate units.)
    Beschrijving

    Units

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C1708
    UMLS CUI-1
    C1519795
    NCI Thesaurus Property
    C25256
    NCI Thesaurus ValueDomain
    C25709
    Were there any dose modifications or additions/omissions to protocol treatment? (check one)
    Beschrijving

    Dose Modification

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS CUI-1
    C1707811
    NCI Thesaurus ObjectClass
    C25256
    NCI Thesaurus Property
    C25572
    NCI Thesaurus ValueDomain-2
    C25572
    Name of Therapy (If yes,)
    Beschrijving

    Therapy Modification

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1299575
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25572
    Reason for Therapy Modification
    Beschrijving

    Reason for Therapy Modification

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25638
    UMLS CUI-1
    C1299575
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25572
    UMLS CUI-2
    C0392360
    Myeloma: Supportive Care
    Beschrijving

    Myeloma: Supportive Care

    Was any supportive care given during protocol treatment
    Beschrijving

    TreatmentProtocolSupportiveCareAdministeredInd-3

    Datatype

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C25320
    UMLS 2011AA ObjectClass
    C1507394
    NCI Thesaurus ObjectClass-2
    C49236
    UMLS 2011AA ObjectClass-2
    C0087111
    NCI Thesaurus Property
    C15747
    UMLS 2011AA Property
    C0344211
    NCI Thesaurus Property-2
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    Has the patient received any transfusions during this course of therapy? (If yes,)
    Beschrijving

    Transfusion

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS CUI-1
    C1879316
    NCI Thesaurus ObjectClass
    C15366
    NCI Thesaurus Property
    C25382
    Transfusion given (If yes, describe)
    Beschrijving

    TransfusionAdministeredType

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C15366
    UMLS 2011AA ObjectClass
    C0086818
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Other specify
    Beschrijving

    PlateletTransfusionAdministeredSpecify

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C15366
    UMLS 2011AA ObjectClass
    C0086818
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Has the patient received erythropoietin-type agents (e.g., Epogen, Procrit or Aranesp) (during this course of therapy?)
    Beschrijving

    Erythropoietin-type agents

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0014822
    NCI Thesaurus ObjectClass
    C20429
    NCI Thesaurus ObjectClass-2
    C37902
    NCI Thesaurus Property
    C25382
    Has the patient received bisphosphonates (during this course of therapy?)
    Beschrijving

    Bisphosphonates

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0012544
    NCI Thesaurus ObjectClass
    C443
    NCI Thesaurus ObjectClass-2
    C37902
    NCI Thesaurus Property
    C25382
    Myeloma: Treatment Schedule - Non-protocol Therapy
    Beschrijving

    Myeloma: Treatment Schedule - Non-protocol Therapy

    Was any non-protocol therapy given during protocol treatment?
    Beschrijving

    Non-protocol therapy

    Datatype

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C25590
    UMLS CUI-1
    C1518384
    NCI Thesaurus ObjectClass-2
    C16212
    UMLS CUI-2
    C0087111
    NCI Thesaurus Property
    C25320
    NCI Thesaurus Property-2
    C49236
    NCI Thesaurus Property-3
    C25456
    NCI Thesaurus Property-4
    C25382
    NCI Thesaurus ValueDomain
    C38148
    Non-protocol surgery?
    Beschrijving

    Non-protocolSurgeryPerformedInd-3

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus Property
    C38000
    UMLS 2011AA Property
    C0884358
    NCI Thesaurus ObjectClass
    C15329
    UMLS 2011AA ObjectClass
    C0543467
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass-2
    C1518384
    Yes specify
    Beschrijving

    Non-ProtocolSurgeryProcedureText

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C15329
    UMLS 2011AA ObjectClass
    C0543467
    NCI Thesaurus Property
    C15368
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass-2
    C1518384
    Non-Protocol Bone Marrow Transplant
    Beschrijving

    Non-ProtocolBMTPerformedInd-3

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus Property
    C38000
    UMLS 2011AA Property
    C0884358
    NCI Thesaurus ObjectClass
    C15194
    UMLS 2011AA ObjectClass
    C0005961
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass-2
    C1518384
    Yes specify
    Beschrijving

    Non-ProtocolTransplantAdministeredSpecify

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C12981
    UMLS 2011AA ObjectClass
    C0332835
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass-2
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Non-Protocol Chemotherapy
    Beschrijving

    Non-protocolChemotherapyAdministeredInd-3

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C15632
    UMLS 2011AA ObjectClass
    C0392920
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass-2
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Yes specify
    Beschrijving

    Non-protocolChemotherapyAdministeredText

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C15632
    UMLS 2011AA ObjectClass
    C0392920
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass-2
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Non-Protocol Immunotherapy?
    Beschrijving

    Non-ProtocolImmunotherapyAdministeredInd-3

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C15262
    UMLS 2011AA ObjectClass
    C0021083
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass-2
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Yes specify
    Beschrijving

    Non-ProtocolImmunotherapyAdministeredText

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C15262
    UMLS 2011AA ObjectClass
    C0021083
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass-2
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Non-Protocol Radiation Therapy?
    Beschrijving

    Non-protocolRadiationTherapyAdministeredInd-3

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C15313
    UMLS 2011AA ObjectClass
    C1522449
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass-2
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Yes specify
    Beschrijving

    Non-ProtocolRTAdministeredText

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C15313
    UMLS 2011AA ObjectClass
    C1522449
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass-2
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Non-Protocol Vaccine Therapy
    Beschrijving

    Non-ProtocolVaccineAdministeredInd-3

    Datatype

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    NCI Thesaurus ObjectClass
    C923
    UMLS 2011AA ObjectClass
    C0042210
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass-2
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Yes specify
    Beschrijving

    Non-ProtocolVaccineAdministeredSpecify

    Datatype

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C923
    UMLS 2011AA ObjectClass
    C0042210
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass-2
    C1518384
    NCI Thesaurus Property
    C25382
    UMLS 2011AA Property
    C1521801
    Other non-protocol Therapy
    Beschrijving

    Non-protocolTherapyOtherAdministeredInd-3

    Datatype

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass
    C1518384
    NCI Thesaurus Property
    C17649
    UMLS 2011AA Property
    C0205394
    NCI Thesaurus Property-2
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    Name of Other Non-Protocol Therapy (If yes,)
    Beschrijving

    Non-protocolTherapyOtherAdministeredName

    Datatype

    text

    Alias
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus ObjectClass-2
    C25590
    UMLS 2011AA ObjectClass
    C1518384
    NCI Thesaurus Property
    C17649
    UMLS 2011AA Property
    C0205394
    NCI Thesaurus Property-2
    C25382
    UMLS 2011AA Property-2
    C1521801
    NCI Thesaurus ValueDomain
    C42614
    UMLS 2011AA ValueDomain
    C0027365
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    1 Formulieren
    1. StudyEvent: Multiple Myeloma - Treatment Summary Form
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Datatype
    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)
    Patient Name
    Item
    Patient Name (initials acceptable)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1299487 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    Item Group
    Myeloma: Treatment Plan
    Treatment Start Date
    Item
    First Date (any modality of) Protocol Therapy Was Given
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25509 (NCI Thesaurus ObjectClass-2)
    C3173309 (UMLS CUI-1)
    C25431 (NCI Thesaurus Property)
    C25275 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    Treatment End Date
    Item
    Last Date (any modality of) protocol therapy was given
    date
    C25164 (NCI Thesaurus ValueDomain)
    C1531784 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass)
    C25275 (NCI Thesaurus Property)
    C25496 (NCI Thesaurus Property-2)
    Item
    Reason Treatment Ended (check one)
    text
    C25638 (NCI Thesaurus ValueDomain)
    C1518544 (UMLS CUI-1)
    C25601 (NCI Thesaurus ObjectClass)
    C0566251 (UMLS CUI-2)
    C25365 (NCI Thesaurus Property)
    CL.1
    Code List
    Reason Treatment Ended (check one)
    CL Item
    Treatment Completed Per Protocol Criteria (Treatment completed per protocol criteria)
    CL Item
    Disease Progression, Relapse During Active Treatment (Disease progression, relapse during active treatment)
    CL Item
    Adverse Event/side Effects/complications (Adverse Event/Side Effects/Complications)
    CL Item
    Death On Study (Death on study)
    CL Item
    Patient Withdrawal Or Refusal After Beginning Protocol Therapy (Patient withdrawal/refusal after beginning protocol therapy)
    CL Item
    Patient Withdrawal Or Refusal Before Beginning Protocol Therapy (Patient withdrawal/refusal prior to beginning protocol therapy)
    CL Item
    Alternative Therapy (Alternative therapy)
    CL Item
    Patient Off-treatment For Other Complicating Disease (Patient off-treatment for other complicating disease)
    CL Item
    Lost To Follow-up (Lost to follow-up)
    CL310949 (NCI Metathesaurus)
    CL Item
    Cytogenetic Resistance (Cytogenetic Resistance)
    CL Item
    Disease Progression Before Active Treatment (Disease Progression before active treatment)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    Off Treatment Reason, specify
    Item
    Other
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1518544 (UMLS CUI-1)
    C25601 (NCI Thesaurus ObjectClass)
    C0566251 (UMLS CUI-2)
    C25365 (NCI Thesaurus Property)
    C1521902 (UMLS CUI-3)
    Item Group
    Myeloma: Treatment Summary - Systemic Therapy
    Item
    Type of Systemic Therapy (check all that apply)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C1515119 (UMLS CUI-1)
    C15698 (NCI Thesaurus ObjectClass)
    C0683312 (UMLS CUI-2)
    C25365 (NCI Thesaurus Property)
    CL.2
    Code List
    Type of Systemic Therapy (check all that apply)
    CL Item
    Chemotherapy (Chemotherapy)
    C15632 (NCI Thesaurus)
    C0392920 (UMLS 2011AA)
    CL Item
    Immunotherapy (Immunotherapy)
    C15262 (NCI Thesaurus)
    C0021083 (UMLS 2011AA)
    CL Item
    Other Specify (Other)
    SystemicTherapyTypeSpecify
    Item
    Other specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C15698 (NCI Thesaurus ObjectClass)
    C1515119 (UMLS 2011AA ObjectClass)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    TreatmentFirstCycleBeginDate
    Item
    Start Date of First Dose of First Cycle
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25472 (NCI Thesaurus Property)
    C1511572 (UMLS 2011AA Property)
    C25509 (NCI Thesaurus Property-2)
    C1279901 (UMLS 2011AA Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    C0439659 (UMLS 2011AA ValueDomain-2)
    TreatmentLastCycleBeginDate
    Item
    Start Date of First Dose of Last Cycle
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25472 (NCI Thesaurus Property)
    C1511572 (UMLS 2011AA Property)
    C25551 (NCI Thesaurus Property-2)
    C1517741 (UMLS 2011AA Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    C0439659 (UMLS 2011AA ValueDomain-2)
    AgentCourseCount
    Item
    Total No. of Courses Administered
    float
    C25463 (NCI Thesaurus ValueDomain)
    C0750480 (UMLS 2011AA ValueDomain)
    C25379 (NCI Thesaurus Property)
    C0750729 (UMLS 2011AA Property)
    C1708 (NCI Thesaurus ObjectClass)
    C0450442 (UMLS 2011AA ObjectClass)
    Agent
    Item
    Agent Name (protocol specific)
    text
    C25364 (NCI Thesaurus Property)
    C1521826 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass)
    C1708 (NCI Thesaurus ValueDomain)
    C42614 (NCI Thesaurus ValueDomain-2)
    AgentFirstCourseTotalDose
    Item
    Total Agent Dose for Cycle 1 (Some groups may pre-print protocol agents with appropriate units.)
    float
    C1708 (NCI Thesaurus ObjectClass)
    C0450442 (UMLS 2011AA ObjectClass)
    C25509 (NCI Thesaurus Property)
    C1279901 (UMLS 2011AA Property)
    C25379 (NCI Thesaurus Property-2)
    C0750729 (UMLS 2011AA Property-2)
    C25304 (NCI Thesaurus ValueDomain)
    C0439810 (UMLS 2011AA ValueDomain)
    C25488 (NCI Thesaurus ValueDomain-2)
    C0178602 (UMLS 2011AA ValueDomain-2)
    Units
    Item
    units (Vaccine name may be pre-printed with appropriate units.)
    text
    C1708 (NCI Thesaurus ObjectClass)
    C1519795 (UMLS CUI-1)
    C25256 (NCI Thesaurus Property)
    C25709 (NCI Thesaurus ValueDomain)
    Item
    Were there any dose modifications or additions/omissions to protocol treatment? (check one)
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1707811 (UMLS CUI-1)
    C25256 (NCI Thesaurus ObjectClass)
    C25572 (NCI Thesaurus Property)
    C25572 (NCI Thesaurus ValueDomain-2)
    CL.6
    Code List
    Were there any dose modifications or additions/omissions to protocol treatment? (check one)
    CL Item
    Yes, Planned (i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned)
    CL Item
    Yes, Unplanned (i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Therapy Modification
    Item
    Name of Therapy (If yes,)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1299575 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass)
    C25572 (NCI Thesaurus Property)
    Reason for Therapy Modification
    Item
    Reason for Therapy Modification
    text
    C25638 (NCI Thesaurus ValueDomain)
    C1299575 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass)
    C25572 (NCI Thesaurus Property)
    C0392360 (UMLS CUI-2)
    Item Group
    Myeloma: Treatment Summary - Radiopharmaceuticals
    TreatmentFirstCycleBeginDate
    Item
    Start Date of First Dose of First Cycle
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25472 (NCI Thesaurus Property)
    C1511572 (UMLS 2011AA Property)
    C25509 (NCI Thesaurus Property-2)
    C1279901 (UMLS 2011AA Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    C0439659 (UMLS 2011AA ValueDomain-2)
    TreatmentLastCycleBeginDate
    Item
    Start Date of First Dose of Last Cycle
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25472 (NCI Thesaurus Property)
    C1511572 (UMLS 2011AA Property)
    C25551 (NCI Thesaurus Property-2)
    C1517741 (UMLS 2011AA Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    C0439659 (UMLS 2011AA ValueDomain-2)
    AgentCourseCount
    Item
    Total No. of Courses Administered
    float
    C25463 (NCI Thesaurus ValueDomain)
    C0750480 (UMLS 2011AA ValueDomain)
    C25379 (NCI Thesaurus Property)
    C0750729 (UMLS 2011AA Property)
    C1708 (NCI Thesaurus ObjectClass)
    C0450442 (UMLS 2011AA ObjectClass)
    Agent
    Item
    Agent Name (protocol specific)
    text
    C25364 (NCI Thesaurus Property)
    C1521826 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass)
    C1708 (NCI Thesaurus ValueDomain)
    C42614 (NCI Thesaurus ValueDomain-2)
    AgentFirstCourseTotalDose
    Item
    Total Agent Dose for Cycle 1 (Some groups may pre-print protocol agents with appropriate units.)
    float
    C1708 (NCI Thesaurus ObjectClass)
    C0450442 (UMLS 2011AA ObjectClass)
    C25509 (NCI Thesaurus Property)
    C1279901 (UMLS 2011AA Property)
    C25379 (NCI Thesaurus Property-2)
    C0750729 (UMLS 2011AA Property-2)
    C25304 (NCI Thesaurus ValueDomain)
    C0439810 (UMLS 2011AA ValueDomain)
    C25488 (NCI Thesaurus ValueDomain-2)
    C0178602 (UMLS 2011AA ValueDomain-2)
    Units
    Item
    units (Vaccine name may be pre-printed with appropriate units.)
    text
    C1708 (NCI Thesaurus ObjectClass)
    C1519795 (UMLS CUI-1)
    C25256 (NCI Thesaurus Property)
    C25709 (NCI Thesaurus ValueDomain)
    Item
    Were there any dose modifications or additions/omissions to protocol treatment? (check one)
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1707811 (UMLS CUI-1)
    C25256 (NCI Thesaurus ObjectClass)
    C25572 (NCI Thesaurus Property)
    C25572 (NCI Thesaurus ValueDomain-2)
    CL.6
    Code List
    Were there any dose modifications or additions/omissions to protocol treatment? (check one)
    CL Item
    Yes, Planned (i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned)
    CL Item
    Yes, Unplanned (i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Therapy Modification
    Item
    Name of Therapy (If yes,)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1299575 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass)
    C25572 (NCI Thesaurus Property)
    Reason for Therapy Modification
    Item
    Reason for Therapy Modification
    text
    C25638 (NCI Thesaurus ValueDomain)
    C1299575 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass)
    C25572 (NCI Thesaurus Property)
    C0392360 (UMLS CUI-2)
    Item Group
    Myeloma: Treatment Summary - Vaccine Therapy
    VaccineAdministeredFirstDate
    Item
    Date of First Vaccination
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C923 (NCI Thesaurus ObjectClass)
    C0042210 (UMLS 2011AA ObjectClass)
    C25509 (NCI Thesaurus ValueDomain-2)
    C1279901 (UMLS 2011AA ValueDomain-2)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    VaccineAdministeredLastDate
    Item
    Date of Last Vaccination
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C923 (NCI Thesaurus ObjectClass)
    C0042210 (UMLS 2011AA ObjectClass)
    C25551 (NCI Thesaurus ValueDomain-2)
    C1517741 (UMLS 2011AA ValueDomain-2)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Item
    Vaccination Site (s check all that apply)
    text
    C13717 (NCI Thesaurus ValueDomain)
    C1515974 (UMLS 2011AA ValueDomain)
    C923 (NCI Thesaurus ObjectClass)
    C0042210 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    CL.5
    Code List
    Vaccination Site (s check all that apply)
    CL Item
    Left Upper Extremity (Left Upper Extremity)
    CL Item
    Right Upper Extremity (Right Upper Extremity)
    CL Item
    Left Lower Extremity (Left Lower Extremity)
    CL Item
    Right Lower Extremity (Right Lower Extremity)
    CL Item
    Trunk (Trunk)
    C33816 (NCI Thesaurus)
    C0460005 (UMLS 2011AA)
    CL Item
    Other Specify (Other)
    VaccineAdministeredSpecify
    Item
    Other specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C923 (NCI Thesaurus ObjectClass)
    C0042210 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Agent
    Item
    Agent Name (protocol specific)
    text
    C25364 (NCI Thesaurus Property)
    C1521826 (UMLS CUI-1)
    C1708 (NCI Thesaurus ObjectClass)
    C1708 (NCI Thesaurus ValueDomain)
    C42614 (NCI Thesaurus ValueDomain-2)
    AgentFirstCourseTotalDose
    Item
    Total Agent Dose for Cycle 1 (Some groups may pre-print protocol agents with appropriate units.)
    float
    C1708 (NCI Thesaurus ObjectClass)
    C0450442 (UMLS 2011AA ObjectClass)
    C25509 (NCI Thesaurus Property)
    C1279901 (UMLS 2011AA Property)
    C25379 (NCI Thesaurus Property-2)
    C0750729 (UMLS 2011AA Property-2)
    C25304 (NCI Thesaurus ValueDomain)
    C0439810 (UMLS 2011AA ValueDomain)
    C25488 (NCI Thesaurus ValueDomain-2)
    C0178602 (UMLS 2011AA ValueDomain-2)
    Units
    Item
    units (Vaccine name may be pre-printed with appropriate units.)
    text
    C1708 (NCI Thesaurus ObjectClass)
    C1519795 (UMLS CUI-1)
    C25256 (NCI Thesaurus Property)
    C25709 (NCI Thesaurus ValueDomain)
    Item
    Were there any dose modifications or additions/omissions to protocol treatment? (check one)
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1707811 (UMLS CUI-1)
    C25256 (NCI Thesaurus ObjectClass)
    C25572 (NCI Thesaurus Property)
    C25572 (NCI Thesaurus ValueDomain-2)
    CL.6
    Code List
    Were there any dose modifications or additions/omissions to protocol treatment? (check one)
    CL Item
    Yes, Planned (i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned)
    CL Item
    Yes, Unplanned (i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned)
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Therapy Modification
    Item
    Name of Therapy (If yes,)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1299575 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass)
    C25572 (NCI Thesaurus Property)
    Reason for Therapy Modification
    Item
    Reason for Therapy Modification
    text
    C25638 (NCI Thesaurus ValueDomain)
    C1299575 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass)
    C25572 (NCI Thesaurus Property)
    C0392360 (UMLS CUI-2)
    Item Group
    Myeloma: Supportive Care
    TreatmentProtocolSupportiveCareAdministeredInd-3
    Item
    Was any supportive care given during protocol treatment
    boolean
    C25320 (NCI Thesaurus ObjectClass)
    C1507394 (UMLS 2011AA ObjectClass)
    C49236 (NCI Thesaurus ObjectClass-2)
    C0087111 (UMLS 2011AA ObjectClass-2)
    C15747 (NCI Thesaurus Property)
    C0344211 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    Item
    Has the patient received any transfusions during this course of therapy? (If yes,)
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1879316 (UMLS CUI-1)
    C15366 (NCI Thesaurus ObjectClass)
    C25382 (NCI Thesaurus Property)
    CL.8
    Code List
    Has the patient received any transfusions during this course of therapy? (If yes,)
    CL Item
    No Transfusion (No)
    CL Item
    Yes (Yes)
    C49488 (NCI Thesaurus)
    C1705108 (UMLS 2011AA)
    CL Item
    Unknown (Unknown)
    C17998 (NCI Thesaurus)
    C0439673 (UMLS 2011AA)
    Item
    Transfusion given (If yes, describe)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C15366 (NCI Thesaurus ObjectClass)
    C0086818 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    CL.9
    Code List
    Transfusion given (If yes, describe)
    CL Item
    Rbc (RBC)
    CL Item
    Platelets (Platelets)
    CL Item
    Both (Both)
    C49636 (NCI Thesaurus)
    C1706086 (UMLS 2011AA)
    CL Item
    Other (Other)
    C17649 (NCI Thesaurus)
    C0205394 (UMLS 2011AA)
    PlateletTransfusionAdministeredSpecify
    Item
    Other specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C15366 (NCI Thesaurus ObjectClass)
    C0086818 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Item
    Has the patient received erythropoietin-type agents (e.g., Epogen, Procrit or Aranesp) (during this course of therapy?)
    text
    C38148 (NCI Thesaurus ValueDomain)
    C0014822 (UMLS CUI-1)
    C20429 (NCI Thesaurus ObjectClass)
    C37902 (NCI Thesaurus ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    CL.10
    Code List
    Has the patient received erythropoietin-type agents (e.g., Epogen, Procrit or Aranesp) (during this course of therapy?)
    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)
    Item
    Has the patient received bisphosphonates (during this course of therapy?)
    text
    C38148 (NCI Thesaurus ValueDomain)
    C0012544 (UMLS CUI-1)
    C443 (NCI Thesaurus ObjectClass)
    C37902 (NCI Thesaurus ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    CL.11
    Code List
    Has the patient received bisphosphonates (during this course of therapy?)
    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)
    Item Group
    Myeloma: Treatment Schedule - Non-protocol Therapy
    Non-protocol therapy
    Item
    Was any non-protocol therapy given during protocol treatment?
    boolean
    C25590 (NCI Thesaurus ObjectClass)
    C1518384 (UMLS CUI-1)
    C16212 (NCI Thesaurus ObjectClass-2)
    C0087111 (UMLS CUI-2)
    C25320 (NCI Thesaurus Property)
    C49236 (NCI Thesaurus Property-2)
    C25456 (NCI Thesaurus Property-3)
    C25382 (NCI Thesaurus Property-4)
    C38148 (NCI Thesaurus ValueDomain)
    Non-protocolSurgeryPerformedInd-3
    Item
    Non-protocol surgery?
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C38000 (NCI Thesaurus Property)
    C0884358 (UMLS 2011AA Property)
    C15329 (NCI Thesaurus ObjectClass)
    C0543467 (UMLS 2011AA ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass-2)
    Non-ProtocolSurgeryProcedureText
    Item
    Yes specify
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C15329 (NCI Thesaurus ObjectClass)
    C0543467 (UMLS 2011AA ObjectClass)
    C15368 (NCI Thesaurus Property)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass-2)
    Non-ProtocolBMTPerformedInd-3
    Item
    Non-Protocol Bone Marrow Transplant
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C38000 (NCI Thesaurus Property)
    C0884358 (UMLS 2011AA Property)
    C15194 (NCI Thesaurus ObjectClass)
    C0005961 (UMLS 2011AA ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass-2)
    Non-ProtocolTransplantAdministeredSpecify
    Item
    Yes specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C12981 (NCI Thesaurus ObjectClass)
    C0332835 (UMLS 2011AA ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Non-protocolChemotherapyAdministeredInd-3
    Item
    Non-Protocol Chemotherapy
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C15632 (NCI Thesaurus ObjectClass)
    C0392920 (UMLS 2011AA ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Non-protocolChemotherapyAdministeredText
    Item
    Yes specify
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C15632 (NCI Thesaurus ObjectClass)
    C0392920 (UMLS 2011AA ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Non-ProtocolImmunotherapyAdministeredInd-3
    Item
    Non-Protocol Immunotherapy?
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C15262 (NCI Thesaurus ObjectClass)
    C0021083 (UMLS 2011AA ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Non-ProtocolImmunotherapyAdministeredText
    Item
    Yes specify
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C15262 (NCI Thesaurus ObjectClass)
    C0021083 (UMLS 2011AA ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Non-protocolRadiationTherapyAdministeredInd-3
    Item
    Non-Protocol Radiation Therapy?
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C15313 (NCI Thesaurus ObjectClass)
    C1522449 (UMLS 2011AA ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Non-ProtocolRTAdministeredText
    Item
    Yes specify
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C15313 (NCI Thesaurus ObjectClass)
    C1522449 (UMLS 2011AA ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Non-ProtocolVaccineAdministeredInd-3
    Item
    Non-Protocol Vaccine Therapy
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    C923 (NCI Thesaurus ObjectClass)
    C0042210 (UMLS 2011AA ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Non-ProtocolVaccineAdministeredSpecify
    Item
    Yes specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C923 (NCI Thesaurus ObjectClass)
    C0042210 (UMLS 2011AA ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass-2)
    C25382 (NCI Thesaurus Property)
    C1521801 (UMLS 2011AA Property)
    Non-protocolTherapyOtherAdministeredInd-3
    Item
    Other non-protocol Therapy
    boolean
    C15368 (NCI Thesaurus ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass)
    C17649 (NCI Thesaurus Property)
    C0205394 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    Non-protocolTherapyOtherAdministeredName
    Item
    Name of Other Non-Protocol Therapy (If yes,)
    text
    C15368 (NCI Thesaurus ObjectClass)
    C25590 (NCI Thesaurus ObjectClass-2)
    C1518384 (UMLS 2011AA ObjectClass)
    C17649 (NCI Thesaurus Property)
    C0205394 (UMLS 2011AA Property)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    C42614 (NCI Thesaurus ValueDomain)
    C0027365 (UMLS 2011AA ValueDomain)
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