ID

8892

Beskrivning

ENR Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF19AF22-C849-2763-E034-0003BA3F9857

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF19AF22-C849-2763-E034-0003BA3F9857

Nyckelord

Versioner (2)
  1. 2012-09-19 2012-09-19 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
Uppladdad den

9 januari 2015

DOI

För en begäran logga in.

Licens

Creative Commons BY-NC 3.0 Legacy
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Leukemia, Myelocytic, Acute null Treatment - ENR - 2395563v3.0

Engelsk

No Instruction available.

1 Formulär  
Aml T Cell Depletion - Segment A
Beskrivning

Aml T Cell Depletion - Segment A

Record date patient informed consent form was signed
Beskrivning

DateInformedConsentFormsignedbypatient

Datatyp

text

Record donor's birthdate
Beskrivning

Birth Date

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C0421451
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus Property
C25155
Record the proposed start date of conditioning
Beskrivning

Treatment Start Date

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C3173309
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C25431
NCI Thesaurus Property-2
C25275
Patient Inclusion Criteria
Beskrivning

Patient Inclusion Criteria

Were Auer rods present
Beskrivning

LaboratoryProcedureAuerRodsOutcomeStatus

Datatyp

boolean

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C12431
UMLS 2011AA Property
C0005953
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus Property-3
C25287
UMLS 2011AA Property-3
C0333828
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Date of most recent bone marrow aspirate
Beskrivning

BoneMarrowAspirateDate

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus ObjectClass
C12431
UMLS 2011AA ObjectClass
C0005953
NCI Thesaurus Property
C13347
UMLS 2011AA Property
C0370199
If yes, record the percentage of blasts in most recent biopsy
Beskrivning

Blasts, Bone Marrow

Datatyp

float

Måttenheter
  • %
Alias
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C1982687
NCI Thesaurus Property
C12431
NCI Thesaurus Property-2
C20200
NCI Thesaurus Property-3
C12918
NCI Thesaurus ValueDomain
C25613
NCI Thesaurus ValueDomain-2
C25712
%
If yes, record the percentage of blasts in most recent biopsy
Beskrivning

Blasts, Bone Marrow

Datatyp

float

Måttenheter
  • %
Alias
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C1982687
NCI Thesaurus Property
C12431
NCI Thesaurus Property-2
C20200
NCI Thesaurus Property-3
C12918
NCI Thesaurus ValueDomain
C25613
NCI Thesaurus ValueDomain-2
C25712
%
Date of bone marrow biopsy
Beskrivning

BoneMarrowBiopsyDate

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus Property
C15189
UMLS 2011AA Property
C0005558
NCI Thesaurus ObjectClass
C12431
UMLS 2011AA ObjectClass
C0005953
Record the patients Karnofsky performance status
Beskrivning

KarnofskyPerformanceStatusScore

Datatyp

text

Alias
NCI Thesaurus Property
C25367
NCI Thesaurus ObjectClass
C20641
UMLS 2011AA ObjectClass
C1518965
NCI Thesaurus ValueDomain
C25338
UMLS 2011AA ValueDomain
C0449820
Does the patient meet the World Health Organizations (WHO) criteria for do novo AML
Beskrivning

DoesthepatientmeettheWorldHealthOrganizations(WHO)criteriafordonovoAML

Datatyp

boolean

Record the patients most recent complete remission stage
Beskrivning

Recordthepatientsmostrecentcompleteremissionstage

Datatyp

text

Record the date the most recent complete remission
Beskrivning

Recordthedatethemostrecentcompleteremission

Datatyp

text

Was an adequate bone marrow aspirate performed within 4 weeks prior to the proposed conditioning date
Beskrivning

Wasanadequatebonemarrowaspirateperformedwithin4weekspriortotheproposedconditioningdate

Datatyp

boolean

If an adequate bone marrow aspirate was not perforned, was a bone marrow biopsy performed within 4 weeks prior to the proposed conditioning date
Beskrivning

Ifanadequatebonemarrowaspiratewasnotperforned,wasabonemarrowbiopsyperformedwithin4weekspriortotheproposedconditioningdate

Datatyp

boolean

Is there any evidence of a persistently abnormal leaukemia population by flow cytometry
Beskrivning

Isthereanyevidenceofapersistentlyabnormalleaukemiapopulationbyflowcytometry

Datatyp

boolean

Is there any evidence of extramedullary leukemia
Beskrivning

Isthereanyevidenceofextramedullaryleukemia

Datatyp

boolean

Does the patient have a history of CNS involvement
Beskrivning

DoesthepatienthaveahistoryofCNSinvolvement

Datatyp

boolean

If yes, is there any evidence of leukemia blasts in the CSF
Beskrivning

Ifyes,isthereanyevidenceofleukemiablastsintheCSF

Datatyp

boolean

Indicate the number of cycles of infuction chemotherapy (or in0induction for patients in 2nd CR) the patient received to achieve first or second complete remission
Beskrivning

Indicatethenumberofcyclesofinfuctionchemotherapy(orin0inductionforpatientsin2ndCR)thepatientreceivedtoachievefirstorsecondcompleteremission

Datatyp

text

Indicate the number of consolidation therapies the patient received prior to transplant (any consolidation regimen that does not require transplantation for hematopoetic recovery can be used)
Beskrivning

Indicatethenumberofconsolidationtherapiesthepatientreceivedpriortotransplant(anyconsolidationregimenthatdoesnotrequiretransplantationforhematopoeticrecoverycanbeused)

Datatyp

text

Left Ventricular Ejection Fraction
Beskrivning

Left Ventricular Ejection Fraction

Most recent value
Beskrivning

HeartLVEFTestPercentageValue

Datatyp

float

Måttenheter
  • %
Alias
NCI Thesaurus ObjectClass
C12727
UMLS 2011AA ObjectClass
C0018787
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus Property-2
C37946
UMLS 2011AA Property-2
C2700377
NCI Thesaurus ValueDomain
C25613
UMLS 2011AA ValueDomain
C0439165
NCI Thesaurus ValueDomain-2
C25712
UMLS 2011AA ValueDomain-2
C1522609
%
Date of assessment
Beskrivning

HeartLVEFTestDate

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C12727
UMLS 2011AA ObjectClass
C0018787
NCI Thesaurus Property
C25294
UMLS 2011AA Property
C0022885
NCI Thesaurus Property-2
C37946
UMLS 2011AA Property-2
C2700377
ULN for your institution
Beskrivning

ULNforyourinstitution

Datatyp

text

Bilirubin
Beskrivning

Bilirubin

Most recent value
Beskrivning

HepaticBilirubinLabValue

Datatyp

float

Måttenheter
  • mg/dL
Alias
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property-2
C305
UMLS 2011AA Property-2
C0005437
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
mg/dL
ULN for your institution
Beskrivning

HepaticBilirubinLabUpperLimitNormalValue

Datatyp

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property-2
C305
UMLS 2011AA Property-2
C0005437
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus ValueDomain-2
C25706
UMLS 2011AA ValueDomain-2
C1519815
Date of assessment
Beskrivning

LaboratoryProcedureBilirubinOutcomeDate

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property-2
C305
UMLS 2011AA Property-2
C0005437
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
Alt
Beskrivning

Alt

Most recent value
Beskrivning

ALTValue

Datatyp

float

Date of assessment
Beskrivning

SpecimenLaboratoryProcedureCollectionDate

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C25453
UMLS 2011AA Property
C1516698
NCI Thesaurus Property-2
C25294
UMLS 2011AA Property-2
C0022885
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
ULN for your institution
Beskrivning

ULNforyourinstitution

Datatyp

text

Ast
Beskrivning

Ast

Most recent value
Beskrivning

HepaticSGOT(AST)LabUnspecifiedValue

Datatyp

float

Alias
NCI Thesaurus ObjectClass
C13308
UMLS 2011AA ObjectClass
C0205054
NCI Thesaurus Property
C25202
UMLS 2011AA Property
C0242192
NCI Thesaurus Property-2
C37984
UMLS 2011AA Property-2
C0022877
NCI Thesaurus ValueDomain
C38046
UMLS 2011AA ValueDomain
C0205370
NCI Thesaurus ValueDomain-2
C25712
UMLS 2011AA ValueDomain-2
C1522609
ULN for your institution
Beskrivning

LaboratoryProcedureSerumGlutamicOxaloaceticTransferaseResultUnspecifiedUpperLimitofNormalValue

Datatyp

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS 2011AA ObjectClass
C0022885
NCI Thesaurus Property
C25202
UMLS 2011AA Property
C0242192
NCI Thesaurus Property-2
C20200
UMLS 2011AA Property-2
C1274040
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus ValueDomain-2
C25706
UMLS 2011AA ValueDomain-2
C1519815
Date of assessment
Beskrivning

SpecimenLaboratoryProcedureCollectionDate

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C25453
UMLS 2011AA Property
C1516698
NCI Thesaurus Property-2
C25294
UMLS 2011AA Property-2
C0022885
NCI Thesaurus ObjectClass
C19157
UMLS 2011AA ObjectClass
C0370003
Serum Creatinine
Beskrivning

Serum Creatinine

Most recent value
Beskrivning

RenalCreatinineLabSpecifiedValue

Datatyp

float

Måttenheter
  • mg/dL
Alias
NCI Thesaurus ObjectClass
C25225
UMLS 2011AA ObjectClass
C0022646
NCI Thesaurus Property
C399
UMLS 2011AA Property
C0010294
NCI Thesaurus Property-2
C25294
UMLS 2011AA Property-2
C0022885
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
mg/dL
ULN for your institution
Beskrivning

Creatinine, serum ULN

Datatyp

float

Måttenheter
  • mg/dL
Alias
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C0201976
NCI Thesaurus Property
C20200
UMLS CUI-2
C1519815
NCI Thesaurus Property-2
C399
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus ValueDomain-2
C25706
mg/dL
Date of assessment
Beskrivning

Laboratory Procedure Date

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C0022885
NCI Thesaurus Property
C25214
UMLS CUI-2
C0011008
NCI Thesaurus Property-2
C38000
NCI Thesaurus ObjectClass
C25294
Dlco (corrected For Hemoglobin)
Beskrivning

Dlco (corrected For Hemoglobin)

Most recent value
Beskrivning

LungCarbonMonoxideDiffusingCapabilityTestAssessmentPredictiveValuePercentageValue

Datatyp

float

Måttenheter
  • %
Alias
NCI Thesaurus ObjectClass
C12468
UMLS 2011AA ObjectClass
C0024109
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus Property-2
C38083
UMLS 2011AA Property-2
C1516251
NCI Thesaurus ValueDomain
C25613
UMLS 2011AA ValueDomain
C0439165
NCI Thesaurus ValueDomain-2
C25712
UMLS 2011AA ValueDomain-2
C1522609
NCI Thesaurus ValueDomain-3
C16238
UMLS 2011AA ValueDomain-3
C1514307
%
Date of assessment
Beskrivning

Laboratory Procedure Date

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C0022885
NCI Thesaurus Property
C25214
UMLS CUI-2
C0011008
NCI Thesaurus Property-2
C38000
NCI Thesaurus ObjectClass
C25294
ULN for your institution
Beskrivning

ULNforyourinstitution

Datatyp

text

Patient Exclusion Criteria
Beskrivning

Patient Exclusion Criteria

Date approved by medical monitor
Beskrivning

CriteriaApprovalDate

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Is the patient HIV seropositive
Beskrivning

AntibodyHIVTestStatus

Datatyp

boolean

Alias
NCI Thesaurus Property
C14219
UMLS 2011AA Property
C0019682
NCI Thesaurus ObjectClass
C16295
UMLS 2011AA ObjectClass
C0003241
NCI Thesaurus Property-2
C25294
UMLS 2011AA Property-2
C0022885
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Does the patient have uncontrolled diabetes mellitus
Beskrivning

Doesthepatienthaveuncontrolleddiabetes?

Datatyp

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
Is the patient diagnosed with an uncontrolled viral, bacterial, or fungal infection
Beskrivning

PatientInfectionInd-2

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C26726
UMLS 2011AA Property
C0009450
Is the donor pregant (positive serum or unie B-HCG) or breastfeeding
Beskrivning

PatientPregnancyInd

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25742
UMLS 2011AA Property
C0032961
Is the patient doagnosed with M3-AML (acute promyelocytic leukemia and in first complete remission)
Beskrivning

IsthepatientdoagnosedwithM3-AML(acutepromyelocyticleukemiaandinfirstcompleteremission)

Datatyp

boolean

Is the patient diagnosed with acute leukemia following blast transformation of prior chronic myelogenous leukemia (CML) or other myeloproliferative disease
Beskrivning

Isthepatientdiagnosedwithacuteleukemiafollowingblasttransformationofpriorchronicmyelogenousleukemia(CML)orothermyeloproliferativedisease

Datatyp

boolean

Is the patient diagnosed with M4Eo-AML with inv 16 and in first complete remission
Beskrivning

IsthepatientdiagnosedwithM4Eo-AMLwithinv16andinfirstcompleteremission

Datatyp

boolean

Is the patient diagnosed with AML with t(8;21) and in first complete remission
Beskrivning

IsthepatientdiagnosedwithAMLwitht(8;21)andinfirstcompleteremission

Datatyp

boolean

Is the patient participating in other clinical trails that involve investigational drugs or devices
Beskrivning

Isthepatientparticipatinginotherclinicaltrailsthatinvolveinvestigationaldrugsordevices

Datatyp

text

Does the patient have a history of cytopenia consistent with diagnoses of myelodysplastic syndrome (MDS) for more then 3 months prior to the diagnosis of Aml or does the patient have reatments-related AML
Beskrivning

Doesthepatienthaveahistoryofcytopeniaconsistentwithdiagnosesofmyelodysplasticsyndrome(MDS)formorethen3monthspriortothediagnosisofAmlordoesthepatienthavereatments-relatedAML

Datatyp

boolean

Does the patients have evidence of active Hepatitis B or C infection or evidence of cirrhosis
Beskrivning

DoesthepatientshaveevidenceofactiveHepatitisBorCinfectionorevidenceofcirrhosis

Datatyp

boolean

No
Beskrivning

No

Datatyp

text

Does the patient have a documented allergy to iron dextran or murine proteins and rabbit antithymocyte globulin
Beskrivning

Doesthepatienthaveadocumentedallergytoirondextranormurineproteinsandrabbitantithymocyteglobulin

Datatyp

boolean

Has the patient had a prior allogeneic or autologous transplant
Beskrivning

Hasthepatienthadapriorallogeneicorautologoustransplant

Datatyp

boolean

Donor Inclusion Criteria
Beskrivning

Donor Inclusion Criteria

Record date donor centent was signed
Beskrivning

InformedConsentFormSignedDate

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus ObjectClass
C16468
UMLS 2011AA ObjectClass
C0009797
NCI Thesaurus Property
C25679
Record donor's birthdate
Beskrivning

Birth Date

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C0421451
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus Property
C25155
Record donor's weight
Beskrivning

Patient Weight

Datatyp

float

Måttenheter
  • Kg
Alias
NCI Thesaurus ValueDomain
C25209
UMLS CUI-1
C0005910
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25208
Kg
Is the donor HIV seronegative within 30 days of apheresis collection
Beskrivning

HumanImmunodeficiencyVirusDiagnosisInd-3

Datatyp

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C14219
UMLS 2011AA ObjectClass
C0019682
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
Is the donor seronegative for hepatitis B surface antigen within 30 days of apheresis collection
Beskrivning

TransplantDonorHepatitisBSurfaceAntigenInd-3

Datatyp

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C25168
UMLS 2011AA ObjectClass
C0040288
NCI Thesaurus ObjectClass-2
C12981
UMLS 2011AA ObjectClass-2
C0332835
NCI Metathesaurus Property
C0019168
Is the donor seronegative for hepatitis C within 30 days of apheresis collection
Beskrivning

TransplantDonorHepatitisCVirusAntibodyInd-3

Datatyp

boolean

Alias
NCI Thesaurus ObjectClass
C25168
UMLS 2011AA ObjectClass
C0040288
NCI Thesaurus ObjectClass-2
C12981
UMLS 2011AA ObjectClass-2
C0332835
NCI Thesaurus Property
C14312
UMLS 2011AA Property
C0220847
NCI Thesaurus Property-2
C16295
UMLS 2011AA Property-2
C0003241
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Is the donor pregant (positive serum or unie B-HCG) or breastfeeding
Beskrivning

PatientPregnancyInd

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25742
UMLS 2011AA Property
C0032961
Is the donor seronegative for syphilis within 30 days fo apheresis collection
Beskrivning

Isthedonorseronegativeforsyphiliswithin30daysfoapheresiscollection

Datatyp

boolean

Is the donor agreeable to second donation of PBSC in the event of graft failure of EBV-related lymphopropliferative diesase, if necessary
Beskrivning

IsthedonoragreeabletoseconddonationofPBSCintheeventofgraftfailureofEBV-relatedlymphopropliferativediesase,ifnecessary

Datatyp

boolean

Is the donor agreeable to undergo general anesthesia and bone marrow donation, if necessary
Beskrivning

Isthedonoragreeabletoundergogeneralanesthesiaandbonemarrowdonation,ifnecessary

Datatyp

boolean

Does the donor have adequate veins for leukapheresis or agress to placement fo a central catheter
Beskrivning

Doesthedonorhaveadequateveinsforleukapheresisoragresstoplacementfoacentralcatheter

Datatyp

boolean

Does the donor have evidence of active infection (including urinary tract infection or respiratory tract infection) or viral hepatitis exposure (on screeninig), unless only HBs, AB+ and HBV DNA negative
Beskrivning

Doesthedonorhaveevidenceofactiveinfection(includingurinarytractinfectionorrespiratorytractinfection)orviralhepatitisexposure(onscreeninig),unlessonlyHBs,AB+andHBVDNAnegative

Datatyp

boolean

Does the donoe have any factors which place him-her at increase rick for complications from leukopharesis of G-CSF therapy (e.g., autoimmune disease, sickle cell trait, symptomatic coronary artery disease requiring therapy)
Beskrivning

Doesthedonoehaveanyfactorswhichplacehim-heratincreaserickforcomplicationsfromleukopharesisofG-CSFtherapy(e.g.,autoimmunedisease,sicklecelltrait,symptomaticcoronaryarterydiseaserequiringtherapy)

Datatyp

boolean

Hla Typing
Beskrivning

Hla Typing

Type of HLA Match required by this protocol
Beskrivning

HLAType

Datatyp

text

Recipient Hla Typing
Beskrivning

Recipient Hla Typing

Hla-a
Beskrivning

Hla-a

Typing method
Beskrivning

TransplantMatchingMethodType

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Metathesaurus Property
C0150103
Antigens/alleles provided
Beskrivning

Antigens/allelesprovided

Datatyp

text

1st
Beskrivning

1st

Datatyp

text

2nd
Beskrivning

2nd

Datatyp

text

Hla-b
Beskrivning

Hla-b

Typing method
Beskrivning

TransplantMatchingMethodType

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Metathesaurus Property
C0150103
Antigens/alleles provided
Beskrivning

Antigens/allelesprovided

Datatyp

text

1st
Beskrivning

1st

Datatyp

text

2nd
Beskrivning

2nd

Datatyp

text

Hla-c
Beskrivning

Hla-c

1st
Beskrivning

1st

Datatyp

text

2nd
Beskrivning

2nd

Datatyp

text

Hla-drb1
Beskrivning

Hla-drb1

Typing method
Beskrivning

TransplantMatchingMethodType

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Metathesaurus Property
C0150103
Antigens/alleles provided
Beskrivning

Antigens/allelesprovided

Datatyp

text

1st
Beskrivning

1st

Datatyp

text

2nd
Beskrivning

2nd

Datatyp

text

Donor Hla Typing
Beskrivning

Donor Hla Typing

Hla-a
Beskrivning

Hla-a

Typing method
Beskrivning

TransplantMatchingMethodType

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Metathesaurus Property
C0150103
Antigens/alleles provided
Beskrivning

Antigens/allelesprovided

Datatyp

text

1st
Beskrivning

1st

Datatyp

text

2nd
Beskrivning

2nd

Datatyp

text

Hla-b
Beskrivning

Hla-b

Typing method
Beskrivning

TransplantMatchingMethodType

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Metathesaurus Property
C0150103
Antigens/alleles provided
Beskrivning

Antigens/allelesprovided

Datatyp

text

1st
Beskrivning

1st

Datatyp

text

2nd
Beskrivning

2nd

Datatyp

text

Hla-c
Beskrivning

Hla-c

1st
Beskrivning

1st

Datatyp

text

2nd
Beskrivning

2nd

Datatyp

text

Hla-drb1
Beskrivning

Hla-drb1

Typing method
Beskrivning

TransplantMatchingMethodType

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
NCI Thesaurus Property
C16847
UMLS 2011AA Property
C0449851
NCI Thesaurus ObjectClass
C12981
UMLS 2011AA ObjectClass
C0332835
NCI Metathesaurus Property
C0150103
Comments
Beskrivning

Research Comments

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
Antigens/alleles provided
Beskrivning

Antigens/allelesprovided

Datatyp

text

1st
Beskrivning

1st

Datatyp

text

2nd
Beskrivning

2nd

Datatyp

text

HLA Match score required by this protocol
Beskrivning

HLAMatchscorerequiredbythisprotocol

Datatyp

text

Locus-A calculated HLA Match score
Beskrivning

Locus-AcalculatedHLAMatchscore

Datatyp

text

Locus-B calculated HLA Match score
Beskrivning

Locus-BcalculatedHLAMatchscore

Datatyp

text

Locus-DRB1 calculated HLA Match score
Beskrivning

Locus-DRB1calculatedHLAMatchscore

Datatyp

text

Total calculated HLA Match score
Beskrivning

TotalcalculatedHLAMatchscore

Datatyp

text

Do you agree with the calculated HLA Match score
Beskrivning

DoyouagreewiththecalculatedHLAMatchscore

Datatyp

boolean

Indicate your institution's HLA Match score for this participant
Beskrivning

Indicateyourinstitution'sHLAMatchscoreforthisparticipant

Datatyp

text

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1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Aml T Cell Depletion - Segment A
DateInformedConsentFormsignedbypatient
Item
Record date patient informed consent form was signed
text
Birth Date
Item
Record donor's birthdate
date
C25164 (NCI Thesaurus ValueDomain)
C0421451 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain-2)
C25155 (NCI Thesaurus Property)
Treatment Start Date
Item
Record the proposed start date of conditioning
date
C25164 (NCI Thesaurus ValueDomain)
C3173309 (UMLS CUI-1)
C15368 (NCI Thesaurus ObjectClass)
C25431 (NCI Thesaurus Property)
C25275 (NCI Thesaurus Property-2)
Item Group
Patient Inclusion Criteria
LaboratoryProcedureAuerRodsOutcomeStatus
Item
Were Auer rods present
boolean
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C12431 (NCI Thesaurus Property)
C0005953 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25287 (NCI Thesaurus Property-3)
C0333828 (UMLS 2011AA Property-3)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
BoneMarrowAspirateDate
Item
Date of most recent bone marrow aspirate
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C12431 (NCI Thesaurus ObjectClass)
C0005953 (UMLS 2011AA ObjectClass)
C13347 (NCI Thesaurus Property)
C0370199 (UMLS 2011AA Property)
Blasts, Bone Marrow
Item
If yes, record the percentage of blasts in most recent biopsy
float
C25294 (NCI Thesaurus ObjectClass)
C1982687 (UMLS CUI-1)
C12431 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C12918 (NCI Thesaurus Property-3)
C25613 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
Blasts, Bone Marrow
Item
If yes, record the percentage of blasts in most recent biopsy
float
C25294 (NCI Thesaurus ObjectClass)
C1982687 (UMLS CUI-1)
C12431 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C12918 (NCI Thesaurus Property-3)
C25613 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
BoneMarrowBiopsyDate
Item
Date of bone marrow biopsy
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C15189 (NCI Thesaurus Property)
C0005558 (UMLS 2011AA Property)
C12431 (NCI Thesaurus ObjectClass)
C0005953 (UMLS 2011AA ObjectClass)
Item
Record the patients Karnofsky performance status
text
C25367 (NCI Thesaurus Property)
C20641 (NCI Thesaurus ObjectClass)
C1518965 (UMLS 2011AA ObjectClass)
C25338 (NCI Thesaurus ValueDomain)
C0449820 (UMLS 2011AA ValueDomain)
CL.12
Code List
Record the patients Karnofsky performance status
CL Item
Normal, No Complaints, No Evidence Of Disease (100 (Normal; no complaints/fully active_)
CL Item
Able To Carry On Normal Activity; Minor Signs Or Symptoms Of Disease (90 (Normal activity/minor restrictions in strenuous play))
CL Item
Normal Activity With Effort; Some Signs Or Symptoms Of Disease (80 (Normal activity with effort/restricted to strenuous play))
CL Item
Cares For Self, Unable To Carry On Normal Activity Or To Do Active Work (70 (Unable to carry on normal activity/less time spent at play))
CL Item
Requires Occasional Assistance, But Is Able To Care For Most Of His/her Needs (60 (Requires occasional assistance/minimal active play))
CL Item
Requires Considerable Assistance And Frequent Medical Care (50 (Requires considerable assistance/no active play))
CL Item
Disabled, Requires Special Care And Assistance (40 (Disabled/needs assistance for quiet play))
CL Item
Severely Disabled, Hospitalization Indicated. Death Not Imminent (30 (severely disabled/needs assistance for quiet play))
CL Item
Very Sick, Hospitalization Indicated. Death Not Imminent (20 (Very sick/limited to very passive activity))
CL Item
Moribund, Fatal Processes Progressing Rapidly (10 (Moribund; completely disabled))
DoesthepatientmeettheWorldHealthOrganizations(WHO)criteriafordonovoAML
Item
Does the patient meet the World Health Organizations (WHO) criteria for do novo AML
boolean
Item
Record the patients most recent complete remission stage
text
CL.2
Code List
Record the patients most recent complete remission stage
CL Item
First morphologic CR (First morphologic CR)
CL Item
Second morphologic CR (Second morphologic CR)
Recordthedatethemostrecentcompleteremission
Item
Record the date the most recent complete remission
text
Wasanadequatebonemarrowaspirateperformedwithin4weekspriortotheproposedconditioningdate
Item
Was an adequate bone marrow aspirate performed within 4 weeks prior to the proposed conditioning date
boolean
Ifanadequatebonemarrowaspiratewasnotperforned,wasabonemarrowbiopsyperformedwithin4weekspriortotheproposedconditioningdate
Item
If an adequate bone marrow aspirate was not perforned, was a bone marrow biopsy performed within 4 weeks prior to the proposed conditioning date
boolean
Isthereanyevidenceofapersistentlyabnormalleaukemiapopulationbyflowcytometry
Item
Is there any evidence of a persistently abnormal leaukemia population by flow cytometry
boolean
Isthereanyevidenceofextramedullaryleukemia
Item
Is there any evidence of extramedullary leukemia
boolean
DoesthepatienthaveahistoryofCNSinvolvement
Item
Does the patient have a history of CNS involvement
boolean
Ifyes,isthereanyevidenceofleukemiablastsintheCSF
Item
If yes, is there any evidence of leukemia blasts in the CSF
boolean
Item
Indicate the number of cycles of infuction chemotherapy (or in0induction for patients in 2nd CR) the patient received to achieve first or second complete remission
text
CL.10
Code List
Indicate the number of cycles of infuction chemotherapy (or in0induction for patients in 2nd CR) the patient received to achieve first or second complete remission
CL Item
One prior cycle (One prior cycle)
CL Item
Two prior cycles (Two prior cycles)
Item
Indicate the number of consolidation therapies the patient received prior to transplant (any consolidation regimen that does not require transplantation for hematopoetic recovery can be used)
text
CL.11
Code List
Indicate the number of consolidation therapies the patient received prior to transplant (any consolidation regimen that does not require transplantation for hematopoetic recovery can be used)
CL Item
One cycle (One cycle)
CL Item
More than one cycle (More than one cycle)
Item Group
Left Ventricular Ejection Fraction
HeartLVEFTestPercentageValue
Item
Most recent value
float
C12727 (NCI Thesaurus ObjectClass)
C0018787 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C37946 (NCI Thesaurus Property-2)
C2700377 (UMLS 2011AA Property-2)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
HeartLVEFTestDate
Item
Date of assessment
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C12727 (NCI Thesaurus ObjectClass)
C0018787 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property)
C0022885 (UMLS 2011AA Property)
C37946 (NCI Thesaurus Property-2)
C2700377 (UMLS 2011AA Property-2)
ULNforyourinstitution
Item
ULN for your institution
text
Item Group
Bilirubin
HepaticBilirubinLabValue
Item
Most recent value
float
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C305 (NCI Thesaurus Property-2)
C0005437 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
HepaticBilirubinLabUpperLimitNormalValue
Item
ULN for your institution
float
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C305 (NCI Thesaurus Property-2)
C0005437 (UMLS 2011AA Property-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C1519815 (UMLS 2011AA ValueDomain-2)
LaboratoryProcedureBilirubinOutcomeDate
Item
Date of assessment
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C305 (NCI Thesaurus Property-2)
C0005437 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
Item Group
Alt
ALTValue
Item
Most recent value
float
SpecimenLaboratoryProcedureCollectionDate
Item
Date of assessment
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25453 (NCI Thesaurus Property)
C1516698 (UMLS 2011AA Property)
C25294 (NCI Thesaurus Property-2)
C0022885 (UMLS 2011AA Property-2)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
ULNforyourinstitution
Item
ULN for your institution
text
Item Group
Ast
HepaticSGOT(AST)LabUnspecifiedValue
Item
Most recent value
float
C13308 (NCI Thesaurus ObjectClass)
C0205054 (UMLS 2011AA ObjectClass)
C25202 (NCI Thesaurus Property)
C0242192 (UMLS 2011AA Property)
C37984 (NCI Thesaurus Property-2)
C0022877 (UMLS 2011AA Property-2)
C38046 (NCI Thesaurus ValueDomain)
C0205370 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
LaboratoryProcedureSerumGlutamicOxaloaceticTransferaseResultUnspecifiedUpperLimitofNormalValue
Item
ULN for your institution
float
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C25202 (NCI Thesaurus Property)
C0242192 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C1519815 (UMLS 2011AA ValueDomain-2)
SpecimenLaboratoryProcedureCollectionDate
Item
Date of assessment
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25453 (NCI Thesaurus Property)
C1516698 (UMLS 2011AA Property)
C25294 (NCI Thesaurus Property-2)
C0022885 (UMLS 2011AA Property-2)
C19157 (NCI Thesaurus ObjectClass)
C0370003 (UMLS 2011AA ObjectClass)
Item Group
Serum Creatinine
RenalCreatinineLabSpecifiedValue
Item
Most recent value
float
C25225 (NCI Thesaurus ObjectClass)
C0022646 (UMLS 2011AA ObjectClass)
C399 (NCI Thesaurus Property)
C0010294 (UMLS 2011AA Property)
C25294 (NCI Thesaurus Property-2)
C0022885 (UMLS 2011AA Property-2)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
Creatinine, serum ULN
Item
ULN for your institution
float
C25294 (NCI Thesaurus ObjectClass)
C0201976 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C1519815 (UMLS CUI-2)
C399 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
Laboratory Procedure Date
Item
Date of assessment
date
C25164 (NCI Thesaurus ValueDomain)
C0022885 (UMLS CUI-1)
C25214 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C38000 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
Item Group
Dlco (corrected For Hemoglobin)
LungCarbonMonoxideDiffusingCapabilityTestAssessmentPredictiveValuePercentageValue
Item
Most recent value
float
C12468 (NCI Thesaurus ObjectClass)
C0024109 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C38083 (NCI Thesaurus Property-2)
C1516251 (UMLS 2011AA Property-2)
C25613 (NCI Thesaurus ValueDomain)
C0439165 (UMLS 2011AA ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C1522609 (UMLS 2011AA ValueDomain-2)
C16238 (NCI Thesaurus ValueDomain-3)
C1514307 (UMLS 2011AA ValueDomain-3)
Laboratory Procedure Date
Item
Date of assessment
date
C25164 (NCI Thesaurus ValueDomain)
C0022885 (UMLS CUI-1)
C25214 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C38000 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
ULNforyourinstitution
Item
ULN for your institution
text
Item Group
Patient Exclusion Criteria
CriteriaApprovalDate
Item
Date approved by medical monitor
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
AntibodyHIVTestStatus
Item
Is the patient HIV seropositive
boolean
C14219 (NCI Thesaurus Property)
C0019682 (UMLS 2011AA Property)
C16295 (NCI Thesaurus ObjectClass)
C0003241 (UMLS 2011AA ObjectClass)
C25294 (NCI Thesaurus Property-2)
C0022885 (UMLS 2011AA Property-2)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Doesthepatienthaveuncontrolleddiabetes?
Item
Does the patient have uncontrolled diabetes mellitus
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
Item
Is the patient diagnosed with an uncontrolled viral, bacterial, or fungal infection
text
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C26726 (NCI Thesaurus Property)
C0009450 (UMLS 2011AA Property)
CL.22
Code List
Is the patient diagnosed with an uncontrolled viral, bacterial, or fungal infection
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Is the donor pregant (positive serum or unie B-HCG) or breastfeeding
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
CL.35
Code List
Is the donor pregant (positive serum or unie B-HCG) or breastfeeding
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No, And Not Nursing (No)
CL Item
Not applicable (Not applicable)
IsthepatientdoagnosedwithM3-AML(acutepromyelocyticleukemiaandinfirstcompleteremission)
Item
Is the patient doagnosed with M3-AML (acute promyelocytic leukemia and in first complete remission)
boolean
Isthepatientdiagnosedwithacuteleukemiafollowingblasttransformationofpriorchronicmyelogenousleukemia(CML)orothermyeloproliferativedisease
Item
Is the patient diagnosed with acute leukemia following blast transformation of prior chronic myelogenous leukemia (CML) or other myeloproliferative disease
boolean
IsthepatientdiagnosedwithM4Eo-AMLwithinv16andinfirstcompleteremission
Item
Is the patient diagnosed with M4Eo-AML with inv 16 and in first complete remission
boolean
IsthepatientdiagnosedwithAMLwitht(8;21)andinfirstcompleteremission
Item
Is the patient diagnosed with AML with t(8;21) and in first complete remission
boolean
Item
Is the patient participating in other clinical trails that involve investigational drugs or devices
text
CL.17
Code List
Is the patient participating in other clinical trails that involve investigational drugs or devices
CL Item
Yes (Yes)
CL Item
Yes, approved by medical monitor (Yes, approved by medical monitor)
CL Item
No (No)
Doesthepatienthaveahistoryofcytopeniaconsistentwithdiagnosesofmyelodysplasticsyndrome(MDS)formorethen3monthspriortothediagnosisofAmlordoesthepatienthavereatments-relatedAML
Item
Does the patient have a history of cytopenia consistent with diagnoses of myelodysplastic syndrome (MDS) for more then 3 months prior to the diagnosis of Aml or does the patient have reatments-related AML
boolean
DoesthepatientshaveevidenceofactiveHepatitisBorCinfectionorevidenceofcirrhosis
Item
Does the patients have evidence of active Hepatitis B or C infection or evidence of cirrhosis
boolean
No
Item
No
text
Doesthepatienthaveadocumentedallergytoirondextranormurineproteinsandrabbitantithymocyteglobulin
Item
Does the patient have a documented allergy to iron dextran or murine proteins and rabbit antithymocyte globulin
boolean
Hasthepatienthadapriorallogeneicorautologoustransplant
Item
Has the patient had a prior allogeneic or autologous transplant
boolean
Item Group
Donor Inclusion Criteria
InformedConsentFormSignedDate
Item
Record date donor centent was signed
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C16468 (NCI Thesaurus ObjectClass)
C0009797 (UMLS 2011AA ObjectClass)
C25679 (NCI Thesaurus Property)
Birth Date
Item
Record donor's birthdate
date
C25164 (NCI Thesaurus ValueDomain)
C0421451 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain-2)
C25155 (NCI Thesaurus Property)
Patient Weight
Item
Record donor's weight
float
C25209 (NCI Thesaurus ValueDomain)
C0005910 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25208 (NCI Thesaurus Property)
HumanImmunodeficiencyVirusDiagnosisInd-3
Item
Is the donor HIV seronegative within 30 days of apheresis collection
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C14219 (NCI Thesaurus ObjectClass)
C0019682 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
TransplantDonorHepatitisBSurfaceAntigenInd-3
Item
Is the donor seronegative for hepatitis B surface antigen within 30 days of apheresis collection
boolean
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25168 (NCI Thesaurus ObjectClass)
C0040288 (UMLS 2011AA ObjectClass)
C12981 (NCI Thesaurus ObjectClass-2)
C0332835 (UMLS 2011AA ObjectClass-2)
C0019168 (NCI Metathesaurus Property)
TransplantDonorHepatitisCVirusAntibodyInd-3
Item
Is the donor seronegative for hepatitis C within 30 days of apheresis collection
boolean
C25168 (NCI Thesaurus ObjectClass)
C0040288 (UMLS 2011AA ObjectClass)
C12981 (NCI Thesaurus ObjectClass-2)
C0332835 (UMLS 2011AA ObjectClass-2)
C14312 (NCI Thesaurus Property)
C0220847 (UMLS 2011AA Property)
C16295 (NCI Thesaurus Property-2)
C0003241 (UMLS 2011AA Property-2)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
Item
Is the donor pregant (positive serum or unie B-HCG) or breastfeeding
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
CL.35
Code List
Is the donor pregant (positive serum or unie B-HCG) or breastfeeding
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No, And Not Nursing (No)
CL Item
Not applicable (Not applicable)
Isthedonorseronegativeforsyphiliswithin30daysfoapheresiscollection
Item
Is the donor seronegative for syphilis within 30 days fo apheresis collection
boolean
IsthedonoragreeabletoseconddonationofPBSCintheeventofgraftfailureofEBV-relatedlymphopropliferativediesase,ifnecessary
Item
Is the donor agreeable to second donation of PBSC in the event of graft failure of EBV-related lymphopropliferative diesase, if necessary
boolean
Isthedonoragreeabletoundergogeneralanesthesiaandbonemarrowdonation,ifnecessary
Item
Is the donor agreeable to undergo general anesthesia and bone marrow donation, if necessary
boolean
Doesthedonorhaveadequateveinsforleukapheresisoragresstoplacementfoacentralcatheter
Item
Does the donor have adequate veins for leukapheresis or agress to placement fo a central catheter
boolean
Doesthedonorhaveevidenceofactiveinfection(includingurinarytractinfectionorrespiratorytractinfection)orviralhepatitisexposure(onscreeninig),unlessonlyHBs,AB+andHBVDNAnegative
Item
Does the donor have evidence of active infection (including urinary tract infection or respiratory tract infection) or viral hepatitis exposure (on screeninig), unless only HBs, AB+ and HBV DNA negative
boolean
Doesthedonoehaveanyfactorswhichplacehim-heratincreaserickforcomplicationsfromleukopharesisofG-CSFtherapy(e.g.,autoimmunedisease,sicklecelltrait,symptomaticcoronaryarterydiseaserequiringtherapy)
Item
Does the donoe have any factors which place him-her at increase rick for complications from leukopharesis of G-CSF therapy (e.g., autoimmune disease, sickle cell trait, symptomatic coronary artery disease requiring therapy)
boolean
Item Group
Hla Typing
Item
Type of HLA Match required by this protocol
text
CL.36
Code List
Type of HLA Match required by this protocol
CL Item
High level DNA (High level DNA)
CL Item
Low level DNA (Low level DNA)
CL Item
Serologic (Serologic)
CL Item
Loci A, B: serologic, locus DRB1, low level DNA (Loci A, B: serologic, locus DRB1, low level DNA)
CL Item
Loci A, B: low level DNA, locus DRB1: high level DNA (Loci A, B: low level DNA, locus DRB1: high level DNA)
CL Item
Loci A, B: serologic; locus DRB1: high level DNA (Loci A, B: serologic; locus DRB1: high level DNA)
Item Group
Recipient Hla Typing
Item Group
Hla-a
Item
Typing method
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C0150103 (NCI Metathesaurus Property)
CL.47
Code List
Typing method
CL Item
Dna (DNA technology)
C0012854 (NCI Metathesaurus)
CL Item
Serology (Serology)
Item
Antigens/alleles provided
text
CL.38
Code List
Antigens/alleles provided
CL Item
One (One)
CL Item
Two (Two)
1st
Item
1st
text
2nd
Item
2nd
text
Item Group
Hla-b
Item
Typing method
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C0150103 (NCI Metathesaurus Property)
CL.47
Code List
Typing method
CL Item
Dna (DNA technology)
C0012854 (NCI Metathesaurus)
CL Item
Serology (Serology)
Item
Antigens/alleles provided
text
CL.40
Code List
Antigens/alleles provided
CL Item
One (One)
CL Item
Two (Two)
1st
Item
1st
text
2nd
Item
2nd
text
Item Group
Hla-c
1st
Item
1st
text
2nd
Item
2nd
text
Item Group
Hla-drb1
Item
Typing method
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C0150103 (NCI Metathesaurus Property)
CL.47
Code List
Typing method
CL Item
Dna (DNA technology)
C0012854 (NCI Metathesaurus)
CL Item
Serology (Serology)
Item
Antigens/alleles provided
text
CL.42
Code List
Antigens/alleles provided
CL Item
One (One)
CL Item
Two (Two)
1st
Item
1st
text
2nd
Item
2nd
text
Item Group
Donor Hla Typing
Item Group
Hla-a
Item
Typing method
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C0150103 (NCI Metathesaurus Property)
CL.47
Code List
Typing method
CL Item
Dna (DNA technology)
C0012854 (NCI Metathesaurus)
CL Item
Serology (Serology)
Item
Antigens/alleles provided
text
CL.44
Code List
Antigens/alleles provided
CL Item
One (One)
CL Item
Two (Two)
1st
Item
1st
text
2nd
Item
2nd
text
Item Group
Hla-b
Item
Typing method
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C0150103 (NCI Metathesaurus Property)
CL.47
Code List
Typing method
CL Item
Dna (DNA technology)
C0012854 (NCI Metathesaurus)
CL Item
Serology (Serology)
Item
Antigens/alleles provided
text
CL.46
Code List
Antigens/alleles provided
CL Item
One (One)
CL Item
Two (Two)
1st
Item
1st
text
2nd
Item
2nd
text
Item Group
Hla-c
1st
Item
1st
text
2nd
Item
2nd
text
Item Group
Hla-drb1
Item
Typing method
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C16847 (NCI Thesaurus Property)
C0449851 (UMLS 2011AA Property)
C12981 (NCI Thesaurus ObjectClass)
C0332835 (UMLS 2011AA ObjectClass)
C0150103 (NCI Metathesaurus Property)
CL.47
Code List
Typing method
CL Item
Dna (DNA technology)
C0012854 (NCI Metathesaurus)
CL Item
Serology (Serology)
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
Item
Antigens/alleles provided
text
CL.48
Code List
Antigens/alleles provided
CL Item
One (One)
CL Item
Two (Two)
1st
Item
1st
text
2nd
Item
2nd
text
HLAMatchscorerequiredbythisprotocol
Item
HLA Match score required by this protocol
text
Locus-AcalculatedHLAMatchscore
Item
Locus-A calculated HLA Match score
text
Locus-BcalculatedHLAMatchscore
Item
Locus-B calculated HLA Match score
text
Locus-DRB1calculatedHLAMatchscore
Item
Locus-DRB1 calculated HLA Match score
text
TotalcalculatedHLAMatchscore
Item
Total calculated HLA Match score
text
DoyouagreewiththecalculatedHLAMatchscore
Item
Do you agree with the calculated HLA Match score
boolean
Item
Indicate your institution's HLA Match score for this participant
text
CL.50
Code List
Indicate your institution's HLA Match score for this participant
CL Item
0/6 (0/6)
CL Item
1/6 (1/6)
CL Item
2/6 (2/6)
CL Item
3/6 (3/6)
CL Item
4/6 (4/6)
CL Item
5/6 (5/6)
CL Item
6/6 (6/6)
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