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Leukemia NCT01041703 Treatment - E2906 Transfusion Form - Arm G - 2951660v1.0 - E2906 Transfusion Form - Arm G

- 08.01.15 - 1 Formulier, 6 Itemgroepen, 24 Data-elementen, 1 Taal
Itemgroepen: Header Module, Reporting Period, Header, Vital Status, Transfusions, Footer Module
E2906 Transfusion Form - Arm G Clofarabine or Daunorubicin Hydrochloride and Cytarabine Followed By Decitabine or Observation in Treating Older Patients With Newly Diagnosed Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=758373C9-BDBE-F79E-E040-BB89AD433D62

Leukemia NCT00492856 Treatment - SOUTHWEST ONCOLOGY GROUP Consolidation #3 and #4 Treatment Summary Form (S0521) - 2416094v1.0 - SOUTHWEST ONCOLOGY GROUP Consolidation #3 and #4 Treatment Summary Form (S0521)

- 08.01.15 - 1 Formulier, 10 Itemgroepen, 36 Data-elementen, 1 Taal
Itemgroepen: Header, Reporting Period, Status, Physical, Treatment: ATRA, Treatment: Daunorubicin, Treatment: Growth Factors, Treatment: Other Therapy, Dose Modifications, Comments
SOUTHWEST ONCOLOGY GROUP Consolidation #3 and #4 Treatment Summary Form (S0521) Combination Chemotherapy With or Without Gemtuzumab Followed By Tretinoin, Mercaptopurine, and Methotrexate or Observation in Treating Patients With Acute Promyelocytic Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=02DDF771-2EEC-49BA-E044-0003BA3F9857

Leukemia NCT00492856 Treatment - SOUTHWEST ONCOLOGY GROUP Consolidation #1 And #2 Treatment Summary Form (S0521) - 2415788v1.0 - SOUTHWEST ONCOLOGY GROUP Consolidation #1 And #2 Treatment Summary Form (S0521)

- 08.01.15 - 1 Formulier, 10 Itemgroepen, 38 Data-elementen, 1 Taal
Itemgroepen: Header, Reporting Period, Status, Physical, Treatment: Arsenic Trioxide, Treatment: Growth Factors, Treatment: Other Therapy, Dose Modifications, Plans for Consildation #3 and #4, Comments
SOUTHWEST ONCOLOGY GROUP Consolidation #1 And #2 Treatment Summary Form (S0521) Combination Chemotherapy With or Without Gemtuzumab Followed By Tretinoin, Mercaptopurine, and Methotrexate or Observation in Treating Patients With Acute Promyelocytic Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=02DB2B73-5A1C-5C81-E044-0003BA3F9857

Leukemia NCT01041703 Treatment - E2906 Arm E/F Observation/Maintenance Form - Step 3 - 3060491v1.0 - E2906 Arm E/F Observation/Maintenance Form - Step 3

- 08.01.15 - 1 Formulier, 10 Itemgroepen, 33 Data-elementen, 1 Taal
Itemgroepen: Header Module, Reporting Period - Arm E, Reporting Period - Arm F, Header, Reporting Period1, Vital Status, Patient Characteristics, Maintenance Therapy Administered, Non-Protocol Therapy, Footer Module
E2906 Arm E/F Observation/Maintenance Form - Step 3 Clofarabine or Daunorubicin Hydrochloride and Cytarabine Followed By Decitabine or Observation in Treating Older Patients With Newly Diagnosed Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=842E6463-29A6-D18F-E040-BB89AD431F47

Treatment - Leukemia/Myelodysplastic Syndrome (MDS) - Treatment Form - 2019361v3.0 - Leukemia/Myelodysplastic Syndrome (MDS) - Treatment Form

- 08.01.15 - 1 Formulier, 5 Itemgroepen, 27 Data-elementen, 1 Taal
Itemgroepen: CRF Header, Leukemia/MDS: Form Administration, Leukemia/MDS: Treatment Phase Information, Leukemia/MDS: Treatment Plan, Comments
Leukemia/Myelodysplastic Syndrome (MDS) - Treatment Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=1A9B0A01-FA23-1E8E-E044-0003BA3F9857

Follow-Up - Acute Leukemia (AML/ALL/APL) - Follow-Up Form - 2019373v3.0 - Acute Leukemia (AML/ALL/APL) - Follow-Up Form

- 08.01.15 - 1 Formulier, 6 Itemgroepen, 24 Data-elementen, 1 Taal
Itemgroepen: CRF Header, AML/ALL/APL: Form Administration, AML/ALL/APL: Vital Status, AML/ALL/APL: Disease Follow-Up Status, AML/ALL/APL: Notice of Progression, Comments
Acute Leukemia (AML/ALL/APL) - Follow-Up Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=1AB0D69C-1E03-0A07-E044-0003BA3F9857

Leukemia NCT00492856 Treatment - SOUTHWEST ONCOLOGY GROUP Post-Consolidation Treatment Summary Form: Gemtuzumab Ozogamicin (S0521) - 2466403v1.0 - SOUTHWEST ONCOLOGY GROUP Post-Consolidation Treatment Summary Form: Gemtuzumab Ozogamicin (S0521)

- 08.01.15 - 1 Formulier, 8 Itemgroepen, 45 Data-elementen, 1 Taal
Itemgroepen: Header, Status, Physical, Gemtuzumab Ozogamicin, Treatment: Growth Factors, Treatment: Other Therapy, Dose Modifications, Comments
SOUTHWEST ONCOLOGY GROUP Post-Consolidation Treatment Summary Form: Gemtuzumab Ozogamicin (S0521) Combination Chemotherapy With or Without Gemtuzumab Followed By Tretinoin, Mercaptopurine, and Methotrexate or Observation in Treating Patients With Acute Promyelocytic Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=1024CCDD-8EF2-4085-E044-0003BA3F9857

Leukemia NCT01041703 Follow-Up - E2906 Long-Term Follow-up Form - 2947429v1.0 - E2906 Long-Term Follow-up Form

- 08.01.15 - 1 Formulier, 9 Itemgroepen, 34 Data-elementen, 1 Taal
Itemgroepen: Header Module/Off-Treatment Report Period, Header, Section 1 - Vital Status, Section II - Reporting Period, Section III - Notice of New Primary, Section IV - Disease Follow-up Status, Section V - Adverse Events, Section VI - Non-Protocol Therapy Prior To Progression, Footer Module
E2906 Long-Term Follow-up Form Clofarabine or Daunorubicin Hydrochloride and Cytarabine Followed By Decitabine or Observation in Treating Older Patients With Newly Diagnosed Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=74BCE806-5598-4D7A-E040-BB89AD437934

Leukemia NCT01041703 Treatment - E2906 Treatment Form - INDUCTION - Arm A - Step 1 - 2948839v1.0 - E2906 Treatment Form - INDUCTION - Arm A - Step 1

- 08.01.15 - 1 Formulier, 11 Itemgroepen, 36 Data-elementen, 1 Taal
Itemgroepen: Header Module, Reporting Period, Header, Reporting Period1, Vital Status, Patient Characteristics, Induction Therapy Administered, Induction Therapy Administered1, Other Therapy Administered, Non-Protocol Therapy, Footer Module
E2906 Treatment Form - INDUCTION - Arm A - Step 1 Clofarabine or Daunorubicin Hydrochloride and Cytarabine Followed By Decitabine or Observation in Treating Older Patients With Newly Diagnosed Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=74CE8E4B-E13E-C2ED-E040-BB89AD436D94

Leukemia NCT00492856 Treatment - SOUTHWEST ONCOLOGY GROUP Post-Consolidation Treatment Summary Form: Maintenance Chemotherapy (S0521) - 2416411v1.0 - SOUTHWEST ONCOLOGY GROUP Post-Consolidation Treatment Summary Form: Maintenance Chemotherapy (S0521)

- 08.01.15 - 1 Formulier, 10 Itemgroepen, 39 Data-elementen, 1 Taal
Itemgroepen: Header, Status, Physical, Treatment: ATRA, Treatment: 6-MP, Treatment: Methotrexate, Treatment: Growth Factors, Treatment: Other Therapy, Dose Modifications, Comments
SOUTHWEST ONCOLOGY GROUP Post-Consolidation Treatment Summary Form:Maintenance Chemotherapy (S0521) Combination Chemotherapy With or Without Gemtuzumab Followed By Tretinoin, Mercaptopurine, and Methotrexate or Observation in Treating Patients With Acute Promyelocytic Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=02DF9FE4-284E-05F8-E044-0003BA3F9857

Leukemia NCT01041703 Treatment - E2906 Treatment Form - CONSOLIDATION - Arm C - Step 2 - 2949165v1.0 - E2906 Treatment Form - CONSOLIDATION - Arm C - Step 2

- 08.01.15 - 1 Formulier, 10 Itemgroepen, 35 Data-elementen, 1 Taal
Itemgroepen: Header Module, Reporting Period, Header, Reporting Period1, Vital Status, Patient Characteristics, Consolidation Therapy Administered, Other Therapy Administered, Non-Protocol Therapy, Footer Module
E2906 Treatment Form - CONSOLIDATION - Arm C - Step 2 Clofarabine or Daunorubicin Hydrochloride and Cytarabine Followed By Decitabine or Observation in Treating Older Patients With Newly Diagnosed Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=74CEC72C-CD53-2C0E-E040-BB89AD4367D1

Leukemia NCT01041703 Treatment - E2906 Treatment Form - INDUCTION - Arm B - Step 1 - 2949013v1.0 - E2906 Treatment Form - INDUCTION - Arm B - Step 1

- 08.01.15 - 1 Formulier, 10 Itemgroepen, 31 Data-elementen, 1 Taal
Itemgroepen: Header Module, Reporting Period, Header, Reporting Period1, Vital Status, Patient Characteristics, Induction Therapy Administered, Other Therapy Administered, Non-Protocol Therapy, Footer Module
E2906 Treatment Form - INDUCTION - Arm B - Step 1 Clofarabine or Daunorubicin Hydrochloride and Cytarabine Followed By Decitabine or Observation in Treating Older Patients With Newly Diagnosed Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=74CEC72C-CC23-2C0E-E040-BB89AD4367D1

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