Description:

ANHL01P1 Off Protocol Therapy Follow-Up Form Rituximab, Rasburicase, and Combination Chemotherapy in Treating Young Patients With Newly Diagnosed Advanced B-Cell Leukemia or Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B9F521CB-5F88-2558-E034-0003BA12F5E7

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B9F521CB-5F88-2558-E034-0003BA12F5E7
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  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 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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Drug/Agent Toxicity by Tissue/Organ NCT00057811 Follow-Up - ANHL01P1 Off Protocol Therapy Follow-Up Form - 2090921v3.0

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  1. StudyEvent: ANHL01P1 Off Protocol Therapy Follow-Up Form
    1. No Instruction available.
Header
Patient Status Information
Life Status (at the Date of Last Contact)
Disease Status at the end of the reporting period (Select one)
Has patient received anti-cancer therapy since the last OPTF report submission? (1. Required.)
select the type of treatment from this list (1. If 'TX' is answered 'Yes', this must be answered.)
Events Of Interest
Did the patient relapse or experience disease progression during the reporting period? (1. Required.)
Did the patient experience a second malignant neoplasm during the reporting period? (1. Required.)
Did the patient withdraw consent for follow-up at the end of the reporting period? (Note: Withdrawal of consent is to be coded only when the patient no longer wants to participate in the study and asks that data no longer be submitted.)
Was the patient confirmed lost to follow-up at the end of the reporting period? (1. Required.)
Was the patient enrolled on another COG therapeutic study at the end of the reporting period? (1. Required.)
Ccrr Module For Anhl01p1 Off Protocol Therapy Follow-up Form

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