Description:

E1900 Long-Term Follow-up Form Combination Chemotherapy With or Without Monoclonal Antibody Therapy Followed by Stem Cell Transplant in Treating Patients With Acute Myeloid Leukemia NCT00049517 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A7294868-3C8F-2FCA-E034-0003BA0B1A09

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A7294868-3C8F-2FCA-E034-0003BA0B1A09

Keywords:
Versions (2) ▾
  1. 5/25/12
  2. 1/10/15
Uploaded on:

January 10, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Long-Term Follow-up Form Leukemia (NCT00049517)

No Instruction available.

  1. StudyEvent: E1900 Long-Term Follow-up Form
    1. No Instruction available.
Header
Are data amended?
M D Y
M D Y
Vital Status
Patient's Vital Status
M D Y
Primary Cause of Death
Disease Follow-up Status
Has the patient had a documented clinical assessment for this cancer (since submission of the previous follow-up form)?
Notice Of Relapse
Has the patient developed a first relapse that has not been previously reported?
Did a physician make a formal diagnosis of relapse? (If no or unknown, specify basis of PD in Comments)
Notice Of New Primary
Has a new primary cancer or MDS been diagnosed that has not been previously reported?
Toxicity
Has the patient experienced any severe (Grade >= 3) long term toxicity that has not been previously reported?
Non-protocol Therapy
Has the patient received any non-protocol cancer therapy prior to first relapse (not previously reported)?
Transfusions