Description:

E2906 Registration Worksheet (step 1) 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=85FA2555-1EC1-F884-E040-BB89AD432656

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=85FA2555-1EC1-F884-E040-BB89AD432656
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Versions (2)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
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January 9, 2015

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Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT01041703 Eligibility - E2906 Registration Worksheet (step 1) - 3082845v1.0

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1 forms  
  1. StudyEvent: E2906 Registration Worksheet (step 1)
    1. No Instruction available.
Eligibility
Has the eligibility checklist been completed
In the opinion of the investigator, is the patient eligible?
Has written informed consent been obtained
Has HIPAA authorization been obtained
Cytogenetic results
Therapy-related AML
Antecedent hematologic disorders
Patient has consented to take part in the Quality of Life Study
I agree to participate in the laboratory research studies that are being done as part of this clinical trial.
I agree to provide additional blood for research.
May your coded samples and related coded information be kept for use in research to learn about, prevent, find or treat cancer? This may also include research on inherited traits (genes passed on in families).
May your coded samples and related coded information be kept for use in research to learn about, prevent, find or treat other health problems (for example: diabetes, Alzheimer's disease, or heart disease)? This may also include research on inherited traits (genes passed on in families).
Someone from this institution may contact me in the future to ask me to take part in more research.
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