This form is to be updated at each response assessment time point defined in the protocol. Please see protocol for guidelines for response evaluation

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
C1320722 (UMLS CUI-1)
Cancer Follow-Up Status Date
Item
Date of Last Clinical Assessment
date
C9305 (NCI Thesaurus ObjectClass)
C16033 (NCI Thesaurus Property)
C25365 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C3694716 (UMLS CUI [1])
Research Comments Text
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI [1])
Item Group
Complete Response
C1275810 (UMLS CUI-1)
Complete Response Observed
Item
Complete response first observed (CR)
boolean
C25755 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus ObjectClass-2)
C25509 (NCI Thesaurus Property)
C25599 (NCI Thesaurus Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1275810 (UMLS CUI [1])
Complete Response Date
Item
Complete Response (CR) First Observed Date
date
C25755 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus ObjectClass-2)
C25509 (NCI Thesaurus Property)
C25599 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C0677874 (UMLS CUI [1,1])
C1115465 (UMLS CUI [1,2])
Complete Response Confirmed
Item
Complete response confirmed (CR)
boolean
C38148 (NCI Thesaurus ValueDomain)
C25755 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus ObjectClass-2)
C25458 (NCI Thesaurus Property)
C1275810 (UMLS CUI [1,1])
C0750484 (UMLS CUI [1,2])
Complete Response Confirmed Date
Item
Complete Response Confirmed Date (CR)
date
C25164 (NCI Thesaurus ValueDomain)
C25755 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus ObjectClass-2)
C25458 (NCI Thesaurus Property)
C1275810 (UMLS CUI [1,1])
C0750484 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item
Method of Evaluation
integer
C25284 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C2911685 (UMLS CUI [1])
CL.18
Code List
Method of Evaluation
CL Item
Palpation (1)
C0030247 (UMLS CUI-1)
CL Item
X-ray (2)
C0043309 (UMLS CUI-1)
CL Item
CT scan (3)
C0040405 (UMLS CUI-1)
CL Item
MRI scan (4)
C0917711 (UMLS CUI-1)
CL Item
Ultrasound (5)
C1456803 (UMLS CUI-1)
CL Item
Intravenous Pyelogram (6)
C0203108 (UMLS CUI-1)
CL Item
Gallium Scan (7)
C0521316 (UMLS CUI-1)
CL Item
Lymphangiogram (8)
C0024219 (UMLS CUI-1)
CL Item
Bone Scan (9)
C0203668 (UMLS CUI-1)
CL Item
Biopsy (10)
C0005558 (UMLS CUI-1)
CL Item
PET scan (11)
C0032743 (UMLS CUI-1)
CL Item
PET/CT scan (12)
C1699633 (UMLS CUI-1)
CL Item
Peripheral Blood Counts (13)
C0005771 (UMLS CUI-1)
CL Item
Bone Marrow Aspirate (14)
C1271729 (UMLS CUI-1)
CL Item
Bone Marrow Biopsy (15)
C0005954 (UMLS CUI-1)
CL Item
Other (16)
C0205394 (UMLS CUI-1)
Assessment Method, specify
Item
Other Specify
text
C25685 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C2911685 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
Item Group
Morphologic Complete Remission
C0332437 (UMLS CUI-1)
C0677874 (UMLS CUI-2)
Cellular Morphology Complete Remission First Observed
Item
Morphologic Complete Remission (CR) First Observed
boolean
C4870 (NCI Thesaurus ObjectClass)
C17768 (NCI Thesaurus ObjectClass-2)
C25509 (NCI Thesaurus Property)
C25599 (NCI Thesaurus Property-2)
C38147 (NCI Thesaurus ValueDomain)
C0677874 (UMLS CUI [1,1])
C2700385 (UMLS CUI [1,2])
C1441672 (UMLS CUI [1,3])
Cellular Morphology Complete Remission First Observed Date
Item
Morphologic Complete Remission (CR) First Observed Date
date
C4870 (NCI Thesaurus ObjectClass)
C17768 (NCI Thesaurus ObjectClass-2)
C25509 (NCI Thesaurus Property)
C25599 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0677874 (UMLS CUI [1,1])
C2700385 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Cellular Morphology Complete Remission Confirmed
Item
Morphologic Complete Remission (CR) Confirmed
boolean
C38147 (NCI Thesaurus ValueDomain)
C25458 (NCI Thesaurus Property)
C4870 (NCI Thesaurus ObjectClass)
C17768 (NCI Thesaurus ObjectClass-2)
C0677874 (UMLS CUI [1,1])
C2700385 (UMLS CUI [1,2])
C0750484 (UMLS CUI [1,3])
Cellular Morphology Complete Remission Confirmed Date
Item
Morphologic Complete Remission (CR) Confirmed Date
date
C25164 (NCI Thesaurus ValueDomain)
C25458 (NCI Thesaurus Property)
C4870 (NCI Thesaurus ObjectClass)
C17768 (NCI Thesaurus ObjectClass-2)
C0677874 (UMLS CUI [1,1])
C2700385 (UMLS CUI [1,2])
C0750484 (UMLS CUI [1,3])
C0011008 (UMLS CUI [1,4])
Item
Method of Evaluation
integer
C25284 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C2911685 (UMLS CUI [1])
CL.18
Code List
Method of Evaluation
CL Item
Palpation (1)
C0030247 (UMLS CUI-1)
CL Item
X-ray (2)
C0043309 (UMLS CUI-1)
CL Item
CT scan (3)
C0040405 (UMLS CUI-1)
CL Item
MRI scan (4)
C0917711 (UMLS CUI-1)
CL Item
Ultrasound (5)
C1456803 (UMLS CUI-1)
CL Item
Intravenous Pyelogram (6)
C0203108 (UMLS CUI-1)
CL Item
Gallium Scan (7)
C0521316 (UMLS CUI-1)
CL Item
Lymphangiogram (8)
C0024219 (UMLS CUI-1)
CL Item
Bone Scan (9)
C0203668 (UMLS CUI-1)
CL Item
Biopsy (10)
C0005558 (UMLS CUI-1)
CL Item
PET scan (11)
C0032743 (UMLS CUI-1)
CL Item
PET/CT scan (12)
C1699633 (UMLS CUI-1)
CL Item
Peripheral Blood Counts (13)
C0005771 (UMLS CUI-1)
CL Item
Bone Marrow Aspirate (14)
C1271729 (UMLS CUI-1)
CL Item
Bone Marrow Biopsy (15)
C0005954 (UMLS CUI-1)
CL Item
Other (16)
C0205394 (UMLS CUI-1)
Assessment Method, specify
Item
Other Specify
text
C25685 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C2911685 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
Item Group
Complete Response, Unconfirmed
C1275810 (UMLS CUI-1)
C1547326 (UMLS CUI-2)
Complete Response unconfirmed
Item
Complete Response, Unconfirmed (CRu) First Observed
boolean
C25755 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus ObjectClass-2)
C25458 (NCI Thesaurus ObjectClass-3)
C25594 (NCI Thesaurus ObjectClass-4)
C25509 (NCI Thesaurus Property)
C25599 (NCI Thesaurus Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1275810 (UMLS CUI [1,1])
C1547326 (UMLS CUI [1,2])
Complete Response unconfirmed Date
Item
Complete Response, unconfirmed (CRu) First Observed Date
date
C25755 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus ObjectClass-2)
C25458 (NCI Thesaurus ObjectClass-3)
C25594 (NCI Thesaurus ObjectClass-4)
C25509 (NCI Thesaurus Property)
C25599 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C1275810 (UMLS CUI [1,1])
C1547326 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Complete Response unconfirmed confirmed
Item
Complete Response, unconfirmed (CRu) confirmed
boolean
C25755 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus ObjectClass-2)
C25458 (NCI Thesaurus ObjectClass-3)
C25594 (NCI Thesaurus ObjectClass-4)
C25458 (NCI Thesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1275810 (UMLS CUI [1,1])
C1547326 (UMLS CUI [1,2])
C0750484 (UMLS CUI [1,3])
Complete Response unconfirmed confirmation date
Item
Complete Response, Unconfirmed (CRu) Confirmed Date
date
C25755 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus ObjectClass-2)
C25458 (NCI Thesaurus ObjectClass-3)
C25594 (NCI Thesaurus ObjectClass-4)
C25458 (NCI Thesaurus Property)
C25164 (NCI Thesaurus ValueDomain)
C1275810 (UMLS CUI [1,1])
C1547326 (UMLS CUI [1,2])
C0750484 (UMLS CUI [1,3])
C0011008 (UMLS CUI [1,4])
Item
Method of Evaluation
integer
C25284 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C2911685 (UMLS CUI [1])
CL.18
Code List
Method of Evaluation
CL Item
Palpation (1)
C0030247 (UMLS CUI-1)
CL Item
X-ray (2)
C0043309 (UMLS CUI-1)
CL Item
CT scan (3)
C0040405 (UMLS CUI-1)
CL Item
MRI scan (4)
C0917711 (UMLS CUI-1)
CL Item
Ultrasound (5)
C1456803 (UMLS CUI-1)
CL Item
Intravenous Pyelogram (6)
C0203108 (UMLS CUI-1)
CL Item
Gallium Scan (7)
C0521316 (UMLS CUI-1)
CL Item
Lymphangiogram (8)
C0024219 (UMLS CUI-1)
CL Item
Bone Scan (9)
C0203668 (UMLS CUI-1)
CL Item
Biopsy (10)
C0005558 (UMLS CUI-1)
CL Item
PET scan (11)
C0032743 (UMLS CUI-1)
CL Item
PET/CT scan (12)
C1699633 (UMLS CUI-1)
CL Item
Peripheral Blood Counts (13)
C0005771 (UMLS CUI-1)
CL Item
Bone Marrow Aspirate (14)
C1271729 (UMLS CUI-1)
CL Item
Bone Marrow Biopsy (15)
C0005954 (UMLS CUI-1)
CL Item
Other (16)
C0205394 (UMLS CUI-1)
Assessment Method, specify
Item
Other Specify
text
C25685 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C2911685 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
Item Group
Morphologic Complete Remission With Incomplete Blood Count Recovery
C3538993 (UMLS CUI-1)
Incomplete Blood Cell Count Recovery Complete Remission Observed
Item
Morphologic Complete Remission With Incomplete Blood Count Recovery (CRi) First Observed
boolean
C49160 (NCI Thesaurus ObjectClass)
C4870 (NCI Thesaurus ObjectClass-2)
C17768 (NCI Thesaurus ObjectClass-3)
C70827 (NCI Thesaurus ObjectClass-4)
C28133 (NCI Thesaurus ObjectClass-5)
C25509 (NCI Thesaurus Property)
C25599 (NCI Thesaurus Property-2)
C38147 (NCI Thesaurus ValueDomain)
C3538993 (UMLS CUI [1])
Incomplete Blood Cell Count Recovery Complete Remission Observed Date
Item
Morphologic Complete Remission With Incomplete Blood Count Recovery (CRi) First Observed Date
date
C49160 (NCI Thesaurus ObjectClass)
C4870 (NCI Thesaurus ObjectClass-2)
C17768 (NCI Thesaurus ObjectClass-3)
C70827 (NCI Thesaurus ObjectClass-4)
C28133 (NCI Thesaurus ObjectClass-5)
C25509 (NCI Thesaurus Property)
C25599 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C3538993 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Incomplete Blood Cell Count Recovery Complete Remission Confirmed
Item
Morphologic Complete Remission With Incomplete Blood Count Recovery (CRi) Confirmed
boolean
C49160 (NCI Thesaurus ObjectClass)
C4870 (NCI Thesaurus ObjectClass-2)
C17768 (NCI Thesaurus ObjectClass-3)
C70827 (NCI Thesaurus ObjectClass-4)
C28133 (NCI Thesaurus ObjectClass-5)
C25458 (NCI Thesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C3538993 (UMLS CUI [1,1])
C0750484 (UMLS CUI [1,2])
Incomplete Blood Cell Count Recovery Complete Remission Confirmed Date
Item
Morphologic Complete Remission With Incomplete Blood Count Recovery (CRi) Confirmed Date
date
C49160 (NCI Thesaurus ObjectClass)
C4870 (NCI Thesaurus ObjectClass-2)
C17768 (NCI Thesaurus ObjectClass-3)
C70827 (NCI Thesaurus ObjectClass-4)
C28133 (NCI Thesaurus ObjectClass-5)
C25458 (NCI Thesaurus Property)
C25164 (NCI Thesaurus ValueDomain)
C3538993 (UMLS CUI [1,1])
C0750484 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item
Method of Evaluation
integer
C25284 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C2911685 (UMLS CUI [1])
CL.18
Code List
Method of Evaluation
CL Item
Palpation (1)
C0030247 (UMLS CUI-1)
CL Item
X-ray (2)
C0043309 (UMLS CUI-1)
CL Item
CT scan (3)
C0040405 (UMLS CUI-1)
CL Item
MRI scan (4)
C0917711 (UMLS CUI-1)
CL Item
Ultrasound (5)
C1456803 (UMLS CUI-1)
CL Item
Intravenous Pyelogram (6)
C0203108 (UMLS CUI-1)
CL Item
Gallium Scan (7)
C0521316 (UMLS CUI-1)
CL Item
Lymphangiogram (8)
C0024219 (UMLS CUI-1)
CL Item
Bone Scan (9)
C0203668 (UMLS CUI-1)
CL Item
Biopsy (10)
C0005558 (UMLS CUI-1)
CL Item
PET scan (11)
C0032743 (UMLS CUI-1)
CL Item
PET/CT scan (12)
C1699633 (UMLS CUI-1)
CL Item
Peripheral Blood Counts (13)
C0005771 (UMLS CUI-1)
CL Item
Bone Marrow Aspirate (14)
C1271729 (UMLS CUI-1)
CL Item
Bone Marrow Biopsy (15)
C0005954 (UMLS CUI-1)
CL Item
Other (16)
C0205394 (UMLS CUI-1)
Assessment Method, specify
Item
Other Specify
text
C25685 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C2911685 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
Item Group
Partial Response
C1521726 (UMLS CUI-1)
Partial Response Observed
Item
Partial response first observed (PR)
boolean
C25755 (NCI Thesaurus ObjectClass)
C25378 (NCI Thesaurus ObjectClass-2)
C25509 (NCI Thesaurus Property)
C25599 (NCI Thesaurus Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1521726 (UMLS CUI [1])
PR date
Item
Partial Response (PR) First Observed Date
date
C25755 (NCI Thesaurus ObjectClass)
C25378 (NCI Thesaurus ObjectClass-2)
C25509 (NCI Thesaurus Property)
C25599 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C1521726 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
PR confirmed
Item
Partial response confirmed
boolean
C25755 (NCI Thesaurus ObjectClass)
C25378 (NCI Thesaurus ObjectClass-2)
C25458 (NCI Thesaurus Property)
C38148 (NCI Thesaurus ValueDomain)
C25755 (NCI Thesaurus ValueDomain-2)
C1521726 (UMLS CUI [1,1])
C0750484 (UMLS CUI [1,2])
PR confirmation date
Item
Partial Response Confirmed Date
date
C25164 (NCI Thesaurus ValueDomain)
C25755 (NCI Thesaurus ObjectClass)
C25458 (NCI Thesaurus Property)
C25378 (NCI Thesaurus ObjectClass-2)
C1521726 (UMLS CUI [1,1])
C0750484 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item
Method of Evaluation
integer
C25284 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C2911685 (UMLS CUI [1])
CL.18
Code List
Method of Evaluation
CL Item
Palpation (1)
C0030247 (UMLS CUI-1)
CL Item
X-ray (2)
C0043309 (UMLS CUI-1)
CL Item
CT scan (3)
C0040405 (UMLS CUI-1)
CL Item
MRI scan (4)
C0917711 (UMLS CUI-1)
CL Item
Ultrasound (5)
C1456803 (UMLS CUI-1)
CL Item
Intravenous Pyelogram (6)
C0203108 (UMLS CUI-1)
CL Item
Gallium Scan (7)
C0521316 (UMLS CUI-1)
CL Item
Lymphangiogram (8)
C0024219 (UMLS CUI-1)
CL Item
Bone Scan (9)
C0203668 (UMLS CUI-1)
CL Item
Biopsy (10)
C0005558 (UMLS CUI-1)
CL Item
PET scan (11)
C0032743 (UMLS CUI-1)
CL Item
PET/CT scan (12)
C1699633 (UMLS CUI-1)
CL Item
Peripheral Blood Counts (13)
C0005771 (UMLS CUI-1)
CL Item
Bone Marrow Aspirate (14)
C1271729 (UMLS CUI-1)
CL Item
Bone Marrow Biopsy (15)
C0005954 (UMLS CUI-1)
CL Item
Other (16)
C0205394 (UMLS CUI-1)
Assessment Method, specify
Item
Other Specify
text
C25685 (NCI Thesaurus ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C16847 (NCI Thesaurus Property)
C2911685 (UMLS CUI [1,1])
C1521902 (UMLS CUI [1,2])
Item Group
Progressive Disease
C1335499 (UMLS CUI-1)
Disease Relapse Progression
Item
Has the patient been diagnosed with relapsed/recurrent or progressive disease (If Yes, continue. Otherwise, stop)
boolean
C2991 (NCI Thesaurus ObjectClass)
C38155 (NCI Thesaurus Property)
C15220 (NCI Thesaurus Property-2)
C19987 (NCI Thesaurus Property-3)
C38148 (NCI Thesaurus ValueDomain)
C1335499 (UMLS CUI [1])
Progression Neoplasm Date
Item
Progression/relapsed disease first observed date
date
C3262 (NCI Thesaurus ObjectClass)
C18265 (NCI Thesaurus ObjectClass-2)
C25331 (NCI Thesaurus ObjectClass-3)
C25599 (NCI Thesaurus Property)
C25164 (NCI Thesaurus ValueDomain)
C1335499 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Please indicate site of progression/relapse
integer
C13717 (NCI Thesaurus ValueDomain)
C25331 (NCI Thesaurus Property)
C2991 (NCI Thesaurus ObjectClass)
C0242656 (UMLS CUI [1,1])
C1515974 (UMLS CUI [1,2])
CL.20
Code List
Please indicate site of progression/relapse
CL Item
Original Site Only (1)
C0475447 (UMLS CUI-1)
CL Item
New Site Only (2)
C1302430 (UMLS CUI-1)
CL Item
New Site plus Original Site (3)
C0475447 (UMLS CUI-1)
C1302430 (UMLS CUI-2)
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