Description:

CALGB-10403 OPEN Registration Worksheet Combination Chemotherapy in Treating Young Patients With Newly Diagnosed Acute Lymphoblastic Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=83D35A37-D0A0-FE1A-E040-BB89AD435D90

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https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=83D35A37-D0A0-FE1A-E040-BB89AD435D90
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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 NCT00558519 Registration - CALGB-10403 OPEN Registration Worksheet - 3057212v1.0

English
Details

A Intergroup Phase II Clinical Trial for Adolescents and Young Adults with Untreated Acute Lymphoblastic Leukemia (ALL)

1 forms  
Protocol Administration
Patient Demographics/pre-treatment Characteristics2
Certification Of Eligibility
In the opinion of the investigator, is the patient eligible
Certification Of Eligibility And Protocol Design
Assigned Treatment Arm
Initial Patient Consent For Specimen Use
Did the patient consent to participate in Study # 9665 (Study # 9665 CALGB Leukemia Tissue Bank If yes, register the patient to Study # 9665 during registration to Study # 10403)
Did the patient consent to participate in Study # 9862 (Study # 9862 Molecular Genetic Features of Acute Lymphoblastic Leukemia If yes, register the patient to Study # 9862 during registration to Study # 10403)
Did the patient agree to complete the Patient Survey (Questionnaire)
Initial Patient Consent For Specimen Use
Did the patient consent to participate in Study # S-9007 (Study # S-9007 Marrow and blood samples Mandatory for SWOG institutions If yes, register the patient to Study # S-9007 during registration to Study #10403)
Did the patient consent to participate in Study # S-9910 (Study # S-9910 Marrow aspirate, blood and buccal smear Strongly encouraged for SWOG institutions If yes, register the patient to Study # S-9910 during registration to Study #10403)
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