E1900 Long-Term Follow-up Form Combination Chemotherapy With or Without Monoclonal Antibody Therapy Followed by Stem Cell Transplant in Treating Patients With Acute Myeloid Leukemia Source Form: NCI FormBuilder:

  1. 5/25/12 5/25/12 -
  2. 1/10/15 1/10/15 - Martin Dugas
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May 25, 2012

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Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT00049517 Follow-Up - E1900 Long-Term Follow-up Form - 2054137v3.0

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  1. StudyEvent: E1900 Long-Term Follow-up Form
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Are data amended? (If yes, please circle amended items in red)
Vital Status
Patient's Vital Status
Primary Cause of Death
Disease Follow-up Status
Has the patient had a documented clinical assessment for this cancer (since submission of the previous follow-up form)?
Notice Of Relapse
Has the patient developed a first relapse that has not been previously reported?
Did a physician make a formal diagnosis of relapse? (If no or unknown, specify basis of PD in Comments)
Notice Of New Primary
Has a new primary cancer or MDS been diagnosed that has not been previously reported?
Has the patient experienced any severe (Grade >= 3) long term toxicity that has not been previously reported?
Non-protocol Therapy
Has the patient received any non-protocol cancer therapy prior to first relapse (not previously reported)?
Ccrr Module For E1900 Long-term Follow-up Form

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