ID

44775

Descrição

Study documentation part: On- Treatment This is a phase III study of BMS-354825 in subjects with chronic myelogenous leukemia in accelerated phase, or in myeloid or lymphoid blast phase or with Philadelphia chromosome positive (Ph+) acute lymphoblastic leukemia who are resistant or intolerant to imatinib mesylate (Gleevec).Trial Number: NCT00123487. Drug: dasatinib. Phase 3

Palavras-chave

  1. 02/08/2015 02/08/2015 -
  2. 06/08/2015 06/08/2015 -
  3. 18/11/2021 18/11/2021 -
Titular dos direitos

Bristol-Myers Squibb

Transferido a

18 de novembro de 2021

DOI

Para um pedido faça login.

Licença

Creative Commons BY-NC 4.0

Comentários do modelo :

Aqui pode comentar o modelo. Pode comentá-lo especificamente através dos balões de texto nos grupos de itens e itens.

Comentários do grupo de itens para :

Comentários do item para :

Para descarregar formulários, precisa de ter uma sessão iniciada. Por favor faça login ou registe-se gratuitamente.

Advanced Chronic Myelogenous Leukemia (CML) NCT00123487 – On- Treatment

On-Treatment 2

VITAL SIGNS (END OF MONTH 2)
Descrição

VITAL SIGNS (END OF MONTH 2)

Alias
UMLS CUI-1
C2981594
Were vital signs taken?
Descrição

Were vital signs taken?

Tipo de dados

boolean

Alias
UMLS CUI-1
C2981594
Date:
Descrição

Date

Tipo de dados

date

Alias
UMLS CUI-1
C0011008
Position:
Descrição

Position

Tipo de dados

text

Alias
UMLS CUI-1
C0733755
Blood pressure systolic (in mm Hg):
Descrição

Blood pressure systolic

Tipo de dados

float

Unidades de medida
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
Blood pressure diastolic (in mm Hg):
Descrição

Blood pressure diastolic

Tipo de dados

float

Unidades de medida
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
Heart rate (in bpm):
Descrição

Heart rate

Tipo de dados

integer

Unidades de medida
  • bpm
Alias
UMLS CUI [1]
C0018810
bpm
PHYSICAL MEASUREMENTS (END OF MONTH 2)
Descrição

PHYSICAL MEASUREMENTS (END OF MONTH 2)

Alias
UMLS CUI-1
C0205485
UMLS CUI-2
C0242485
Were any physical measurements taken?
Descrição

Were any physical measurements taken?

Tipo de dados

boolean

Alias
UMLS CUI-1
C0205485
UMLS CUI-2
C0242485
Date of measurement:
Descrição

Date of measurement

Tipo de dados

date

Alias
UMLS CUI-1
C0011008
Weight (in Kg):
Descrição

Weight

Tipo de dados

float

Unidades de medida
  • Kg
Alias
UMLS CUI [1]
C0005910
Kg
Performance status (ECOG):
Descrição

Performance status (ECOG)

Tipo de dados

text

Alias
UMLS CUI-1
C1520224
EXTRAMEDULLARY INVOLVEMENT (END OF MONTH 2)
Descrição

EXTRAMEDULLARY INVOLVEMENT (END OF MONTH 2)

Alias
UMLS CUI-1
C1517060
UMLS CUI-2
C1314939
Date of assessment:
Descrição

Date of assessment

Tipo de dados

date

Alias
UMLS CUI-1
C0011008
Is extramedullary disease present?
Descrição

Is extramedullary disease present?

Tipo de dados

boolean

Alias
UMLS CUI-1
C1517060
UMLS CUI-2
C0012634
If yes, please provide the side code(s) from below: 1=Skin/ Soft tissue, 2=Bone, 3=Visceral (lung), 4=Visceral (liver), 5=Visceral (other), 6=Lymph node, 8=Bone marrow, 9=CNS, 10=Mediastinum, 14=Effusion, 16=Spleen, 18= Intestine, 19= Ascites, 25= Pelvis, 26=Peritoneum, 34= Ovary, 36= Pleura, 37= Gastric, 98= Other
Descrição

If yes, please provide the side code(s) from below: 1=Skin/ Soft tissue, 2=Bone, 3=Visceral (lung), 4=Visceral (liver), 5=Visceral (other), 6=Lymph node, 8=Bone marrow, 9=CNS, 10=Mediastinum, 14=Effusion, 16=Spleen, 18= Intestine, 19= Ascites, 25= Pelvis, 26=Peritoneum, 34= Ovary, 36= Pleura, 37= Gastric, 98= Other

Tipo de dados

text

Alias
UMLS CUI-1
C1517060
UMLS CUI-2
C0012634
CHEST X-RAY
Descrição

CHEST X-RAY

Alias
UMLS CUI-1
C0039985
Was a chest X-ray performed?
Descrição

Was a chest X-ray performed?

Tipo de dados

boolean

Alias
UMLS CUI-1
C0039985
Date of chest X-ray:
Descrição

Date of chest X-ray:

Tipo de dados

date

Alias
UMLS CUI-1
C0011008
Interpretation of X-ray report:
Descrição

Interpretation of X-ray report:

Tipo de dados

text

Alias
UMLS CUI-1
C0459471
If Abnormal, please specify clinically relevant abnormalities:
Descrição

If Abnormal, please specify clinically relevant abnormalities:

Tipo de dados

text

TRANSFUSIONS
Descrição

TRANSFUSIONS

Alias
UMLS CUI-1
C1879316
Did the subject recieve any transfusion(s) since the last data collection?
Descrição

Did the subject recieve any transfusion(s) since the last data collection?

Tipo de dados

boolean

Alias
UMLS CUI-1
C1879316
Date of transfusion:
Descrição

Date of transfusion

Tipo de dados

date

Alias
UMLS CUI-1
C0011008
Type of transfusion(s), provide all that apply from below: 1= Paked cells, 3= Plasma, 5=Platelets, 98= Other
Descrição

Type of transfusion(s), provide all that apply from below: 1= Paked cells, 3= Plasma, 5=Platelets, 98= Other

Tipo de dados

text

Alias
UMLS CUI-1
C1879316
UMLS CUI-2
C0332307
EXTERNAL DATA TRACKING
Descrição

EXTERNAL DATA TRACKING

Alias
UMLS CUI-1
C1516800
Were any of the following protocol specified activities performed?
Descrição

Were any of the following protocol specified activities performed?

Tipo de dados

boolean

Alias
UMLS CUI-1
C1516800
If yes, provide date and time:
Descrição

If yes, provide date and time

Tipo de dados

datetime

Alias
UMLS CUI-1
C0011008
BONE MARROW BIOPSY/ ASPIRATE
Descrição

BONE MARROW BIOPSY/ ASPIRATE

Alias
UMLS CUI-1
C0005954
Was a bone marrow procedure performed?
Descrição

Was a bone marrow procedure performed?

Tipo de dados

boolean

Alias
UMLS CUI-1
C0005954
Date of procedure:
Descrição

Date of procedure:

Tipo de dados

date

Alias
UMLS CUI-1
C0011008
Indicate procedure:
Descrição

Indicate procedure

Tipo de dados

text

Alias
UMLS CUI-1
C0184661
Was cytogenetic analysis performed?
Descrição

Was cytogenetic analysis performed?

Tipo de dados

boolean

Alias
UMLS CUI-1
C0752095
UMLS CUI-2
C0162789
UMLS CUI-3
C0022526
UMLS CUI-4
C0884358
UMLS CUI-5
C0011008
Number of metaphases examined:
Descrição

Number of metaphases examined

Tipo de dados

integer

Alias
UMLS CUI-1
C1512699
UMLS CUI-2
C0936012
UMLS CUI-3
C0025564
Number of metaphases positive for philadelphia chromosome:
Descrição

Number of metaphases positive for philadelphia chromosome

Tipo de dados

integer

Alias
UMLS CUI-1
C0031526
Was the specimen adequate for light microscopic analysis?
Descrição

Was the specimen adequate for light microscopic analysis?

Tipo de dados

boolean

Number of blasts:
Descrição

Number of blasts

Tipo de dados

float

Unidades de medida
  • %
Alias
UMLS CUI [1]
C1982687
%
Number of promyelocytes:
Descrição

Number of promyelocytes

Tipo de dados

float

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0455279
%
Number of basophils:
Descrição

Number of basophils

Tipo de dados

float

Unidades de medida
  • %
Alias
UMLS CUI [1]
C0200641
%
Cellularity form:
Descrição

Cellularity form

Tipo de dados

text

Cellularity results:
Descrição

Cellularity results

Tipo de dados

text

If "Not done", please specify:
Descrição

If "Not done", please specify

Tipo de dados

text

Alias
UMLS CUI-1
C2348235
DRUG DISPENSATION
Descrição

DRUG DISPENSATION

Was drug dispensed?
Descrição

Was drug dispensed?

Tipo de dados

boolean

Date of dispensation:
Descrição

Date of dispensation

Tipo de dados

date

Alias
UMLS CUI-1
C0011008
Container number:
Descrição

Container number

Tipo de dados

text

BMS-354825 DOSING
Descrição

BMS-354825 DOSING

Alias
UMLS CUI [1,1]
C1455147
UMLS CUI [1,2]
C0178602
Start date:
Descrição

Start date

Tipo de dados

date

Alias
UMLS CUI-1
C0011008
Stop date:
Descrição

Stop date

Tipo de dados

date

Alias
UMLS CUI-1
C0011008
Actual dose taken per day (in mg):
Descrição

Actual dose taken per day (in mg)

Tipo de dados

float

Alias
UMLS CUI-1
C0178602
UMLS CUI-2
C0205344
UMLS CUI-3
C0439423
UMLS CUI-4
C1533734
UMLS CUI-5
C0205438
Reason for dose modification:
Descrição

Reason for dose modification

Tipo de dados

text

Alias
UMLS CUI-1
C1707811
For the reasons asking for specification, please explain the cause:
Descrição

For the reasons asking for specification, please explain the cause

Tipo de dados

text

Alias
UMLS CUI-1
C2348235
CONCOMITANT MEDICATIONS
Descrição

CONCOMITANT MEDICATIONS

Alias
UMLS CUI-1
C2347852
Were any additions or changes made to concomitant medications since the last data collection?
Descrição

Were any additions or changes made to concomitant medications since the last data collection?

Tipo de dados

boolean

Alias
UMLS CUI-1
C2347852
Medication name:
Descrição

Medication name

Tipo de dados

text

Alias
UMLS CUI-1
C2360065
Date started:
Descrição

Date started

Tipo de dados

date

Alias
UMLS CUI-1
C0011008
Date stopped:
Descrição

Date stopped

Tipo de dados

date

Alias
UMLS CUI-1
C0011008
Reason:
Descrição

Reason

Tipo de dados

text

Alias
UMLS CUI-1
C0392360
NON-SERIOUS ADVERSE EVENTS
Descrição

NON-SERIOUS ADVERSE EVENTS

Did the subject experience any new or changed non- serious adverse events since the last collection?
Descrição

Did the subject experience any new or changed non- serious adverse events since the last collection?

Tipo de dados

boolean

CTC code:
Descrição

CTC code

Tipo de dados

text

Alias
UMLS CUI-1
C0805701
UMLS CUI-2
C1516728
UMLS CUI-3
C1705313
CTC grade:
Descrição

CTC grade

Tipo de dados

integer

Alias
UMLS CUI-1
C2985911
Onset date:
Descrição

Onset date

Tipo de dados

date

Alias
UMLS CUI-1
C0011008
Resolution date:
Descrição

Resolution date

Tipo de dados

date

Alias
UMLS CUI-1
C0011008
Relationship to study drug:
Descrição

Relationship to study drug

Tipo de dados

text

Alias
UMLS CUI-1
C0013227
Action taken regarding study drug:
Descrição

Action taken regarding study drug

Tipo de dados

text

Alias
UMLS CUI-1
C0013227
Treatment required?
Descrição

Treatment required?

Tipo de dados

boolean

Alias
UMLS CUI-1
C0332307
UMLS CUI-2
C0877248
UMLS CUI-3
C0087111
UMLS CUI-4
C1521801
PREGNANCY TEST (END OF MONTH 2)
Descrição

PREGNANCY TEST (END OF MONTH 2)

Alias
UMLS CUI-1
C0032976
Was a pregnancy test performed?
Descrição

Was a pregnancy test performed?

Tipo de dados

boolean

Alias
UMLS CUI-1
C0032976
Date of test:
Descrição

Date of test

Tipo de dados

date

Alias
UMLS CUI-1
C0011008
If no test was performed, specify reason:
Descrição

If no test was performed, specify reason

Tipo de dados

text

Alias
UMLS CUI-1
C0392360
If a test was performed, please specify result:
Descrição

If a test was performed, please specify result

Tipo de dados

text

Alias
UMLS CUI-1
C0392360
Specify test:
Descrição

Specify test

Tipo de dados

text

Alias
UMLS CUI-1
C0032976
EQ-5D
Descrição

EQ-5D

Alias
UMLS CUI-1
C2733251
EQ-5D evaluation:
Descrição

EQ-5D evaluation

Tipo de dados

text

Alias
UMLS CUI [1]
C2733251

Similar models

On-Treatment 2

Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
VITAL SIGNS (END OF MONTH 2)
C2981594 (UMLS CUI-1)
VITAL SIGNS
Item
Were vital signs taken?
boolean
C2981594 (UMLS CUI-1)
DATE
Item
Date:
date
C0011008 (UMLS CUI-1)
Item
Position:
text
C0733755 (UMLS CUI-1)
Code List
Position:
CL Item
Sitting (1)
CL Item
Standing (2)
CL Item
Supine (3)
BLOOD PRESSURE SYSTOLIC
Item
Blood pressure systolic (in mm Hg):
float
C0871470 (UMLS CUI [1])
BLOOD PRESSURE DIASTOLIC
Item
Blood pressure diastolic (in mm Hg):
float
C0428883 (UMLS CUI [1])
HEART RATE
Item
Heart rate (in bpm):
integer
C0018810 (UMLS CUI [1])
Item Group
PHYSICAL MEASUREMENTS (END OF MONTH 2)
C0205485 (UMLS CUI-1)
C0242485 (UMLS CUI-2)
Physical measurements
Item
Were any physical measurements taken?
boolean
C0205485 (UMLS CUI-1)
C0242485 (UMLS CUI-2)
DATE
Item
Date of measurement:
date
C0011008 (UMLS CUI-1)
Weight
Item
Weight (in Kg):
float
C0005910 (UMLS CUI [1])
ECOG
Item
Performance status (ECOG):
text
C1520224 (UMLS CUI-1)
Item Group
EXTRAMEDULLARY INVOLVEMENT (END OF MONTH 2)
C1517060 (UMLS CUI-1)
C1314939 (UMLS CUI-2)
DATE
Item
Date of assessment:
date
C0011008 (UMLS CUI-1)
EXTRAMEDULLARY DISEASE
Item
Is extramedullary disease present?
boolean
C1517060 (UMLS CUI-1)
C0012634 (UMLS CUI-2)
Extramedullary disease
Item
If yes, please provide the side code(s) from below: 1=Skin/ Soft tissue, 2=Bone, 3=Visceral (lung), 4=Visceral (liver), 5=Visceral (other), 6=Lymph node, 8=Bone marrow, 9=CNS, 10=Mediastinum, 14=Effusion, 16=Spleen, 18= Intestine, 19= Ascites, 25= Pelvis, 26=Peritoneum, 34= Ovary, 36= Pleura, 37= Gastric, 98= Other
text
C1517060 (UMLS CUI-1)
C0012634 (UMLS CUI-2)
Item Group
CHEST X-RAY
C0039985 (UMLS CUI-1)
CHEST X-RAY
Item
Was a chest X-ray performed?
boolean
C0039985 (UMLS CUI-1)
DATE
Item
Date of chest X-ray:
date
C0011008 (UMLS CUI-1)
Item
Interpretation of X-ray report:
text
C0459471 (UMLS CUI-1)
Code List
Interpretation of X-ray report:
CL Item
Normal  (1)
CL Item
Abnormal (2)
X-ray report interpretation
Item
If Abnormal, please specify clinically relevant abnormalities:
text
Item Group
TRANSFUSIONS
C1879316 (UMLS CUI-1)
Transfusion
Item
Did the subject recieve any transfusion(s) since the last data collection?
boolean
C1879316 (UMLS CUI-1)
DATE
Item
Date of transfusion:
date
C0011008 (UMLS CUI-1)
Type of transfusion
Item
Type of transfusion(s), provide all that apply from below: 1= Paked cells, 3= Plasma, 5=Platelets, 98= Other
text
C1879316 (UMLS CUI-1)
C0332307 (UMLS CUI-2)
Item Group
EXTERNAL DATA TRACKING
C1516800 (UMLS CUI-1)
EXTERNAL DATA TRACKING
Item
Were any of the following protocol specified activities performed?
boolean
C1516800 (UMLS CUI-1)
DATE AND TIME
Item
If yes, provide date and time:
datetime
C0011008 (UMLS CUI-1)
Item Group
BONE MARROW BIOPSY/ ASPIRATE
C0005954 (UMLS CUI-1)
Bone marrow biopsy
Item
Was a bone marrow procedure performed?
boolean
C0005954 (UMLS CUI-1)
DATE
Item
Date of procedure:
date
C0011008 (UMLS CUI-1)
Item
Indicate procedure:
text
C0184661 (UMLS CUI-1)
Code List
Indicate procedure:
CL Item
31 Aspirate (1)
CL Item
16 Biopsy (2)
CL Item
89 Both (Aspirate and Biopsy) (3)
CYTOGENETIC ANALYSIS
Item
Was cytogenetic analysis performed?
boolean
C0752095 (UMLS CUI-1)
C0162789 (UMLS CUI-2)
C0022526 (UMLS CUI-3)
C0884358 (UMLS CUI-4)
C0011008 (UMLS CUI-5)
Metaphase
Item
Number of metaphases examined:
integer
C1512699 (UMLS CUI-1)
C0936012 (UMLS CUI-2)
C0025564 (UMLS CUI-3)
Philadelphia chromosome
Item
Number of metaphases positive for philadelphia chromosome:
integer
C0031526 (UMLS CUI-1)
LIGHT MICROSCOPIC ANALYSIS
Item
Was the specimen adequate for light microscopic analysis?
boolean
BLASTS
Item
Number of blasts:
float
C1982687 (UMLS CUI [1])
PROMYELOCYTES
Item
Number of promyelocytes:
float
C0455279 (UMLS CUI [1])
BASOPHILS
Item
Number of basophils:
float
C0200641 (UMLS CUI [1])
Item
Cellularity form:
text
Code List
Cellularity form:
CL Item
Clot (1)
CL Item
Biopsy (2)
Item
Cellularity results:
text
Code List
Cellularity results:
CL Item
1 Absent (1)
CL Item
2 Hypocellular (less than 20%) (2)
CL Item
3 Normal (20-40%) (3)
CL Item
4 Hypercellular (41-100%) (4)
CL Item
95 Not done (specify) (5)
Specification
Item
If "Not done", please specify:
text
C2348235 (UMLS CUI-1)
Item Group
DRUG DISPENSATION
drug dispensation
Item
Was drug dispensed?
boolean
DATE
Item
Date of dispensation:
date
C0011008 (UMLS CUI-1)
Container number
Item
Container number:
text
Item Group
BMS-354825 DOSING
C1455147 (UMLS CUI [1,1])
C0178602 (UMLS CUI [1,2])
DATE
Item
Start date:
date
C0011008 (UMLS CUI-1)
DATE
Item
Stop date:
date
C0011008 (UMLS CUI-1)
DOSE
Item
Actual dose taken per day (in mg):
float
C0178602 (UMLS CUI-1)
C0205344 (UMLS CUI-2)
C0439423 (UMLS CUI-3)
C1533734 (UMLS CUI-4)
C0205438 (UMLS CUI-5)
Item
Reason for dose modification:
text
C1707811 (UMLS CUI-1)
Code List
Reason for dose modification:
CL Item
3 Hematologic toxicity (specify) (1)
CL Item
4 Non hematologic toxicity (specify) (2)
CL Item
56 Dosing error (3)
CL Item
57 Raising % blasts (4)
CL Item
59 Loss of response (5)
CL Item
66 No CHR, NEL or RTC within 6 weeks (6)
CL Item
67 NoCCyR after 6 months (7)
CL Item
68 No MCyR after 3 months (8)
CL Item
98 Other (specify) (9)
Specification
Item
For the reasons asking for specification, please explain the cause:
text
C2348235 (UMLS CUI-1)
Item Group
CONCOMITANT MEDICATIONS
C2347852 (UMLS CUI-1)
CONCOMITANT MEDICATIONS
Item
Were any additions or changes made to concomitant medications since the last data collection?
boolean
C2347852 (UMLS CUI-1)
Medication name
Item
Medication name:
text
C2360065 (UMLS CUI-1)
DATE
Item
Date started:
date
C0011008 (UMLS CUI-1)
DATE
Item
Date stopped:
date
C0011008 (UMLS CUI-1)
Item
Reason:
text
C0392360 (UMLS CUI-1)
Code List
Reason:
CL Item
3 Adverse event (1)
CL Item
98 Other (2)
Item Group
NON-SERIOUS ADVERSE EVENTS
NON-SERIOUS ADVERSE EVENTS
Item
Did the subject experience any new or changed non- serious adverse events since the last collection?
boolean
CTC CODE
Item
CTC code:
text
C0805701 (UMLS CUI-1)
C1516728 (UMLS CUI-2)
C1705313 (UMLS CUI-3)
CTC grade
Item
CTC grade:
integer
C2985911 (UMLS CUI-1)
DATE
Item
Onset date:
date
C0011008 (UMLS CUI-1)
DATE
Item
Resolution date:
date
C0011008 (UMLS CUI-1)
Item
Relationship to study drug:
text
C0013227 (UMLS CUI-1)
Code List
Relationship to study drug:
CL Item
Certain (1)
CL Item
Probable (2)
CL Item
Possible (3)
CL Item
Not likely (4)
CL Item
Not related (5)
Item
Action taken regarding study drug:
text
C0013227 (UMLS CUI-1)
Code List
Action taken regarding study drug:
CL Item
None (1)
CL Item
Reduced (2)
CL Item
Increased (3)
CL Item
Interrupted (4)
CL Item
Discontinued (5)
Treatment required
Item
Treatment required?
boolean
C0332307 (UMLS CUI-1)
C0877248 (UMLS CUI-2)
C0087111 (UMLS CUI-3)
C1521801 (UMLS CUI-4)
Item Group
PREGNANCY TEST (END OF MONTH 2)
C0032976 (UMLS CUI-1)
PREGNANCY TEST
Item
Was a pregnancy test performed?
boolean
C0032976 (UMLS CUI-1)
DATE
Item
Date of test:
date
C0011008 (UMLS CUI-1)
Item
If no test was performed, specify reason:
text
C0392360 (UMLS CUI-1)
Code List
If no test was performed, specify reason:
CL Item
1 Post-menopausal (Amenorrhea>= 12 months) (1)
CL Item
2 Surgically sterile (2)
CL Item
5 Male (3)
CL Item
6 Pre-menarche (4)
Item
If a test was performed, please specify result:
text
C0392360 (UMLS CUI-1)
Code List
If a test was performed, please specify result:
CL Item
Positive (1)
CL Item
Negative (2)
Item
Specify test:
text
C0032976 (UMLS CUI-1)
Code List
Specify test:
CL Item
Urine HCG (1)
CL Item
Serum HCG (2)
Item Group
EQ-5D
C2733251 (UMLS CUI-1)
EQ-5D
Item
EQ-5D evaluation:
text
C2733251 (UMLS CUI [1])

Use este formulário para feedback, perguntas e sugestões de aperfeiçoamento.

Campos marcados com * são obrigatórios.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial