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18pp EBMT Amyloidosis

- 20-09-21 - 1 Formulier, 21 Itemgroepen, 284 Data-elementen, 1 Taal
Itemgroepen: GENERAL INFORMATION TEAM, GENERAL INFORMATION PATIENT, DISEASE, AL AMYLOIDOSIS INITIAL DIAGNOSIS, ORGAN INVOLVEMENT AT DIAGNOSIS, PRE-HSCT TREATMENT, HSCT, STATUS OF DISEASE AT COLLECTION (AUTOGRAFTS ONLY), STATUS OF DISEASE AT START OF CONDITIONING FOR BMT, STATUS OF DISEASE AT 100 DAYS AFTER HSCT, ORGAN-SPECIFIC RESPONSES AT 100 DAYS AFTER HSCT, FORMS TO BE FILLED IN, FOLLOW UP AL AMYLOIDOSIS, PATIENT LAST SEEN, GRAFT VERSUS HOST DISEASE (GvHD) SINCE LAST REPORT, OTHER COMPLICATIONS SINCE LAST REPORT, GRAFT ASSESSMENT AND HAEMOPOIETIC CHIMAERISM, ADDITIONAL THERAPIES SINCE LAST FOLLOW UP, FIRST EVIDENCE OF DISEASE WORSENING SINCE LAST HSCT, LAST DISEASE AND PATIENT STATUS, ADDITIONAL NOTES IF APPLICABLE
DOCUMENTED PATHOGENS (Use this table for guidance on the pathogens of interest) Bacteria: S. pneumoniae, Other gram positive (i.e.: other streptococci, staphylococci, listeria …),Haemophilus influenzae, Other gram negative (i.e.: E. coli klebsiella, proteus, serratia, pseudomonas …), Legionella sp, Mycobacteria sp, Other Fungi: Candida sp, Aspergillus sp, Pneumocystis carinii, Other Parasites: Toxoplasma gondii, Other Viruses: HSV, VZV, EBV, CMV, HHV-6, RSV. Other respiratory virus (influenza, parainfluenza, rhinovirus), Adenovirus, HBV, HCV, HIV,Papovavirus, Parvovirus, Other

Eligibility NCT00925002 ATTR-PN - Eligibility

- 17-09-21 - 1 Formulier, 2 Itemgroepen, 10 Data-elementen, 2 Talen
Itemgroepen: Inclusion Criteria, Exclusion Criteria
ODM derived from http://clinicaltrials.gov/show/NCT00925002

Primary Amyloidosis - On-Study Form

- 27-06-15 - 1 Formulier, 4 Itemgroepen, 64 Data-elementen, 1 Taal
Itemgroepen: Header, Amyloid: Form Administration, Amyloid: Disease Description, Amyloid: Prior Treatment
Primary Amyloidosis - On-Study Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D6E2AA52-99FE-5B44-E034-0003BA12F5E7

Response - Primary Amyloidosis - Baseline Disease Assessment Form - 2275065v3.0 - Primary Amyloidosis - Baseline Disease Assessment Form

- 09-01-15 - 1 Formulier, 9 Itemgroepen, 83 Data-elementen, 1 Taal
Itemgroepen: CRF Header, Amyloid: Form Administration, Amyloid: Assessment Reporting Interval, Amyloid: Protein Studies, Amyloid: Peripheral Blood Hematology/Chemistry, Amyloid: Organ Assessment, Amyloid: Bone Marrow Assessment, Amyloid: Amyloidoma, Comments
Primary Amyloidosis - Baseline Disease Assessment Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D6E369F3-B8C0-58EE-E034-0003BA12F5E7

Response - Primary Amyloidosis - Follow-Up Disease Assessment Form - 2275307v3.0 - Primary Amyloidosis - Follow-Up Disease Assessment Form

- 09-01-15 - 1 Formulier, 10 Itemgroepen, 94 Data-elementen, 1 Taal
Itemgroepen: CRF Header, Amyloid: Form Administration, Amyloid: Assessment Reporting Interval, Amyloid: Protein Studies, Amyloid: Peripheral Blood Hematology/Chemistry, Amyloid: Organ Assessment, Amyloid: Bone Marrow Assessment, Amyloid: Amyloidoma, Amyloid: Objective Response Assessment, Comments
Primary Amyloidosis - Follow-Up Disease Assessment Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D6E37EC9-1337-59D5-E034-0003BA12F5E7

Follow-Up - Primary Amyloidosis - Follow Up Form - 2273817v3.0 - Primary Amyloidosis - Follow Up Form

- 09-01-15 - 1 Formulier, 6 Itemgroepen, 32 Data-elementen, 1 Taal
Itemgroepen: CRF Header, Amyloidosis: Vital Status, Amyloidosis: Disease Follow-Up Status, Amyloidosis: Notice of Progression, Amyloidosis: Notice of New Primary, Amyloidosis: Long-Term Toxicity
Primary Amyloidosis - Follow Up Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D6794088-D3E7-0C48-E034-0003BA12F5E7

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