Description:

E2906 Hematology/Chemistry Form Clofarabine or Daunorubicin Hydrochloride and Cytarabine Followed By Decitabine or Observation in Treating Older Patients With Newly Diagnosed Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=755ADD70-A207-B92C-E040-BB89AD435B07

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=755ADD70-A207-B92C-E040-BB89AD435B07
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
  4. 1/9/15 1/9/15 - Martin Dugas
Uploaded on:

January 9, 2015

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Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT01041703 Lab - E2906 Hematology/Chemistry Form - 2950751v1.0

INSTRUCTIONS: See protocol for required lab schedule. Record the worst lab results (for the period you are reporting); batch and submit at the end of Induction, at the end of Consolidation I, at the end of Consolidation II, and at the time of required follow-ups until relapse/progression. NOTE: The end of a treatment period is defined as the occurrence of blood and bone marrow recovery. Report ALL labs obtained during the treatment period through recovery. Keep a copy for your files

Header
On Treatment
On Treatment Reporting Period (If this form covers an On Treatment Report Period Choose one)
Off Treatment
Off Treatment Reporting Period (If this form covers an Off Treatment Report Period Choose one since registration)
Unnamed2
Are data amended (If yes, please circle amended items in red)
Hematology/chemistry
mm3
%
%
%
1000/uL
mg/dL
1000/uL
g/dL
CTC Adverse Event Term (v4)
CTC AE Grade (v4.0)
U/L
U/L
mg/dL
mmol/L
mg/dL
mg/dL
CTC AE Attribution Code (v4.0)
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