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ADVL0212: On Study Worksheet (Leukemia) NCT00053963

- 7/5/15 - 1 form, 6 itemgroups, 45 items, 1 language
Itemgroups: Patient demographics, Bone Marrow, Hemogram, Chemistries, Comments, CCRR MODULE
ADVL0212: On Study Worksheet (Leukemia) NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C10238B2-42BD-142E-E034-0003BA12F5E7

ADVL0212: Eligibility Worksheet (Leukemia) NCT00053963

- 6/16/15 - 1 form, 5 itemgroups, 33 items, 1 language
Itemgroups: Header, Eligibility Assessment, Comments, Treatment Assignment, CCRR MODULE
ADVL0212: Eligibility Worksheet (Leukemia) NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C0F2D219-E599-53B9-E034-0003BA12F5E7

Brain and Central Nervous System Tumors NCT00053963 Treatment - ADVL0212: Reporting Period Worksheet (Leukemia) - 2172521v3.0 - Reporting Period Worksheet (Leukemia ADVL0212)

- 3/12/15 - 1 form, 7 itemgroups, 66 items, 1 language
Itemgroups: Header, Patient characteristics, Treatment, Concomitant Medication, New Cancer, Follow-Up, Adverse event
ADVL0212: Reporting Period Worksheet (Leukemia) FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia NCT00053963 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C0F387DC-C9D3-5664-E034-0003BA12F5E7

ADVL0212: Death Worksheet NCT00053963

- 7/8/15 - 1 form, 3 itemgroups, 14 items, 1 language
Itemgroups: Header, Death Assessment, CCRR MODULE
ADVL0212: Death Worksheet NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EAD089-F0A7-3073-E034-0003BA12F5E7

ADVL0212: Response Assessment NCT00053963

- 7/5/15 - 1 form, 5 itemgroups, 14 items, 1 language
Itemgroups: Header, Sites of Measurable Disease at the Time of Study Entry, Evaluation of lesions, Comments, CCRR MODULE
ADVL0212: Response Assessment NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EAE217-B511-30BD-E034-0003BA12F5E7

Refractory tumors in children (NCT00053963) - Eligibility Worksheet (ADVL0212 NCT00053963)

- 3/20/15 - 1 form, 2 itemgroups, 32 items, 1 language
Itemgroups: Header, Eligibility criteria
ADVL0212: Eligibility Worksheet FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia NCT00053963 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EC07E8-6588-30D1-E034-0003BA12F5E7

ADVL0212: On Study Worksheet [reload] NCT00053963

- 7/5/15 - 1 form, 7 itemgroups, 42 items, 1 language
Itemgroups: Header, Treatment related information, Diagnosis, Hemogram, Chemistries, Comments, CCRR MODULE
ADVL0212: On Study Worksheet [reload] NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B304C5F5-C7EC-0452-E034-0003BA12F5E7

ADVL0212: Prior Therapy Worksheet NCT00053963

- 7/5/15 - 1 form, 6 itemgroups, 12 items, 1 language
Itemgroups: Header, Anti-cancer therapy, Type of Prior Therapy, Comments, General Validations, CCRR MODULE
ADVL0212: Prior Therapy Worksheet NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EADAE4-318A-307A-E034-0003BA12F5E7

ADVL0212: Relapse/Progression Worksheet NCT00053963

- 7/5/15 - 1 form, 3 itemgroups, 16 items, 1 language
Itemgroups: Header, Relapse/Progression, CCRR MODULE
ADVL0212: Relapse/Progression Worksheet NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EAD72E-7E69-3077-E034-0003BA12F5E7

Recurring cancer children (ADVL0212 NCT00053963) - Reporting Period Worksheet cancer (NCT00053963)

- 3/22/15 - 1 form, 5 itemgroups, 58 items, 1 language
Itemgroups: Header, Patient characteristics, Concomitant Medication, Patient status, Adverse event
ADVL0212: Reporting Period Worksheet FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia NCT00053963 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EC15B1-1989-311F-E034-0003BA12F5E7

ADVL0212: Phase I Weekly Report NCT00053963

- 7/8/15 - 1 form, 5 itemgroups, 32 items, 1 language
Itemgroups: Header, DLT Toxicity Data, Results of test completed during this weekly reporting interval, Comments, CCRR MODULE
ADVL0212: Phase I Weekly Report NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EAF58D-ABF6-30C9-E034-0003BA12F5E7

ADVL0212: Secondary Malignancy Report Worksheet NCT00053963

- 7/5/15 - 1 form, 3 itemgroups, 12 items, 1 language
Itemgroups: Header, Secondary Malignancy, CCRR MODULE
ADVL0212: Secondary Malignancy Report Worksheet NCT00053963 FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B1EADE06-A88A-30BB-E034-0003BA12F5E7

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