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  1. StudyEvent: S0100 POST- PBSCT TREATMENT FORM
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Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Physical
PatientWeight
Item
Weight (kg)
double
BodySurfaceArea
Item
BSA (M2)
double
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25157 (NCI Thesaurus Property)
C0005902 (UMLS 2011AA Property)
Item Group
Gvhd Prophylaxis
TreatmentStartDate
Item
Start Date
date
TreatmentEndDate
Item
Stop Date
date
Item
Growth Factor
text
CL.1
Code List
Growth Factor
CL Item
G-csf (G-CSF)
CL Item
Gm-csf (GM-CSF)
CL Item
Other, Specify (Other, specify)
Other,specify(growthfactor)
Item
Other, specify (growth factor)
text
Item Group
Gvhd Treatment
Item
Did the patient develop acute GVHD? (If yes)
text
CL.2
Code List
Did the patient develop acute GVHD? (If yes)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
TreatmentStartDate
Item
Start Date
date
Dateofonset
Item
Date of onset
text
TreatmentEndDate
Item
Stop Date
date
Item
Grade
text
CL.3
Code List
Grade
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item Group
Dose Modifications
Item
Were there any dose modifications or additions/omissions to protocol treatment? (check one)
text
CL.4
Code List
Were there any dose modifications or additions/omissions to protocol treatment? (check one)
CL Item
(i.e., The Treatment Was Changed According To Protocol Guidelines) (Yes, planned (i.e., the treatment was changed according to protocol guidelines))
CL Item
(i.e., The Treatment Change Was Not Part Of Protocol Guidelines) (Yes, unplanned (i.e., the treatment change was not part of protocol guidelines))
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
DoseModificationReason
Item
Yes, unplanned, specify change
text
Item Group
Chronic Gvhd
Item
Did the patient develop chronic GVHD? (If yes,)
text
CL.5
Code List
Did the patient develop chronic GVHD? (If yes,)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
dateofonset
Item
date of onset
text
Item
Extent (** Explain modifications to dose and/or course and reasons for modification)
text
CL.6
Code List
Extent (** Explain modifications to dose and/or course and reasons for modification)
CL Item
Limited (Limited)
CL110648 (NCI Metathesaurus)
CL Item
Extensive (Extensive)
C47863 (NCI Thesaurus)
C0205231 (UMLS 2011AA)
Comments
Item
Comments
text
Item Group
Ccrr Module For S0100 Post- Pbsct Treatment Form
SWOGPatientID
Item
SWOG Patient ID
text
SWOGStudyNo.
Item
SWOG Study No.
text
RegistrationStep
Item
Registration Step
text
PatientInitials
Item
Patient Initials (L, F, M)
text
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
TreatingPhysician
Item
Physician
text
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass)
C1522326 (UMLS 2011AA ObjectClass)
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