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  1. 1. Test clinico
    1. 1.1. Determinazione dell`idoneità
    1. 1.2. Storia medica
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Follow-up F1 LeMLAR-Studie Lymphoma NCT01788189 - Follow-up F1

- 29/09/16 - 1 modulo, 4 itemgroups, 44 elementi, 1 linguaggio
Itemgroups: follow- up, B symptoms, Diagnostic Neoplasm Staging, Laboratory test finding
Study part:Follow-up F1 LeMLAR-Studie. Lenalidomide in conjunction with methotrexate, leucovorin, cytarabine and rituximab for the treatment of relapsed or refractory CD20-positive aggressive lymphomas: an open-label, multicenter phase I/II trial. Publication granted by Prof. Dührsen and provided by Claudia Ose, University clinic Essen, NCT01788189, Version 1.3-28.04.2013.doc.

Follow-up F2 LeMLAR-Studie Lymphoma NCT01788189 - Follow-up F2

- 06/10/16 - 1 modulo, 2 itemgroups, 131 elementi, 1 linguaggio
Itemgroups: follow­ up, clinical examination Diagnostic Imaging Manifestation of Lymphoma
Study part: Follow-up F2 LeMLAR-Studie. Lenalidomide in conjunction with methotrexate, leucovorin, cytarabine and rituximab for the treatment of relapsed or refractory CD20-positive aggressive lymphomas: an open-label, multicenter phase I/II trial. Publication granted by Prof. Dührsen and provided by Claudia Ose, University clinic Essen, NCT01788189, Version 1.3-28.04.2013.doc.

Bogen 2 Verlaufsbogen Seite 1 von 2 TIGER Studie Version 23052012 Condition DRKS00005243 - Bogen 2 Verlaufsbogen Seite 1 von 2

- 20/09/21 - 1 modulo, 11 itemgroups, 39 elementi, 2 lingue
Itemgroups: Adiminstrative Daten I, Geburtsdatum, Adiminstrative Daten II, Therapiephase, Bisherige Therapie im Intervall, Nilotinib 2*300 mg, 1. Nilotinib Pause, PEG-IFN, 1. PEG-IFN Pause, weitere Medikation, Unterschrift
NCT01657604

Follow-Up - Melanoma-Follow-up Form - 2020198v2.31 - Melanoma-Follow-up Form

- 08/01/15 - 1 modulo, 8 itemgroups, 33 elementi, 1 linguaggio
Itemgroups: CRF Header, MELANOMA: VITAL STATUS, MELANOMA: DISEASE FOLLOW-UP STATUS, MELANOMA: NOTICE OF PROGRESSION, MELANOMA: NON-PROTOCOL THERAPY, MELANOMA: NOTICE OF NEW PRIMARY, MELANOMA: LONG-TERM TOXICITY, Comments
Melanoma-Follow-up Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A99C-3FA4-E034-080020C9C0E0

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

- 09/01/15 - 1 modulo, 6 itemgroups, 32 elementi, 1 linguaggio
Itemgroups: 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

Follow-Up - Sarcoma - Follow-Up Form - 2290562v3.0 - Sarcoma - Follow-Up Form

- 09/01/15 - 1 modulo, 7 itemgroups, 32 elementi, 1 linguaggio
Itemgroups: CRF Header, Sarcoma: Follow-up Reporting Period, Sarcoma: Vital Status, Sarcoma: Disease Follow-up Status, Sarcoma: Notice of Progression, Sarcoma: Notice of New Primary, Sarcoma: Long-Term Toxicity
Sarcoma - Follow-Up Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E405767F-8C6A-3312-E034-0003BA3F9857

Follow-Up - Gynecologic Cancer - Follow-Up Form - 2019334v3.0 - Gynecologic Cancer - Follow-Up Form

- 09/01/15 - 1 modulo, 9 itemgroups, 58 elementi, 1 linguaggio
Itemgroups: CRF Header, GYN: Form Administration, GYN: Vital Status, GYN: Disease Follow-up Status, GYN: Notice of Progression, GYN: Notice of New Primary, GYN: Long-Term Toxicity, GYN: Non-Protocol Therapy, Comments
Gynecologic Cancer - Follow-Up Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=16AA07EB-A6F0-6710-E044-0003BA3F9857

Follow-Up - SOUTHWEST ONCOLOGY GROUP FOLLOW UP FORM - 2217608v1.0 - SOUTHWEST ONCOLOGY GROUP FOLLOW UP FORM

- 09/01/15 - 1 modulo, 3 itemgroups, 25 elementi, 1 linguaggio
Itemgroups: Header, VITAL STATUS, Comments
SOUTHWEST ONCOLOGY GROUP FOLLOW UP FORM Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F4422C8B-0B8B-49D1-E034-0003BA3F9857

Follow-Up - Colorectal Cancer - Follow-Up Form - 2282337v3.0 - Colorectal Cancer - Follow-Up Form

- 09/01/15 - 1 modulo, 6 itemgroups, 19 elementi, 1 linguaggio
Itemgroups: CRF Header, Colorectal: Vital Status, Colorectal: Disease Follow-Up Status, Colorectal: Notice of Progression, Colorectal: Notice of New Primary, Comments
Colorectal Cancer - Follow-Up Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DB748B98-21DB-2FC3-E034-0003BA12F5E7

Melanoma (Skin) Follow-Up - Extended Follow-up (EFU) - 2074771v3.0 - Extended Follow-up (EFU)

- 09/01/15 - 1 modulo, 1 ItemGroup, 8 elementi, 1 linguaggio
ItemGroup: CCRR MODULE
Extended Follow-up (EFU) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B122E5B0-F30F-4DE5-E034-0003BA12F5E7

Melanoma (Skin) Follow-Up - Follow-up Assessment (FA) - 2074729v3.0 - Follow-up Assessment (FA)

- 09/01/15 - 1 modulo, 1 ItemGroup, 10 elementi, 1 linguaggio
ItemGroup: CCRR MODULE
Follow-up Assessment (FA) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B122D2BC-9A32-4DD0-E034-0003BA12F5E7

Follow-Up - Myelodysplastic Syndrome (MDS) - Follow-Up Form - 2019374v3.0 - Myelodysplastic Syndrome (MDS) - Follow-Up Form

- 20/09/21 - 1 modulo, 6 itemgroups, 25 elementi, 1 linguaggio
Itemgroups: CRF Header, MDS: Form Administration, MDS: Vital Status, MDS: Disease Follow-Up Status, MDS: Notice of Progression, Comments
Myelodysplastic Syndrome (MDS) - Follow-Up Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=1AADB4F0-41BA-1ED3-E044-0003BA3F9857

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