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  1. StudyEvent: E1900 Material Submission Form
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Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
ECOG Protocol Number
Item
ECOG Protocol No.
text
C3274381 (UMLS CUI-1)
C1512162 (UMLS CUI-2)
ECOG Patient ID
Item
ECOG Patient ID
text
C2348585 (UMLS CUI-1)
C1512162 (UMLS CUI-2)
Registration Step
Item
Registration Step
text
C1514821 (UMLS CUI-1)
Patient name
Item
Patient's Name
text
C1299487 (UMLS CUI-1)
Participating Group Protocol Number
Item
Participating Group Protocol No.
text
C3274381 (UMLS CUI-1)
C2347449 (UMLS CUI-2)
Participating Group Patient ID
Item
Participating Group Patient ID
text
C2348585 (UMLS CUI-1)
C2347449 (UMLS CUI-2)
Institution
Item
Institution/Affiliate
text
C1301943 (UMLS CUI-1)
Blast percentage
Item
Peripheral and Marrow Blast Percentage
float
C0942416 (UMLS CUI-1)
Sample number
Item
Sample No.
text
C0237753 (UMLS CUI-1)
C0370003 (UMLS CUI-2)
Investigator signature
Item
Investigator signature
text
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C2346576 (UMLS CUI-1)
Investigator Signature Date
Item
Investigator Signature Date
date
C2346576 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
Comments
Item
Comments
text
C0947611 (UMLS CUI-1)
Item Group
Completed By Submitting Institutions
Submission date
Item
Date material(s) sent to central laboratory
date
C19157 (NCI Thesaurus ObjectClass)
C37984 (NCI Thesaurus Property)
C0205099 (NCI Metathesaurus Property)
C25694 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C1515022 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
Item
Shipped to
text
C19157 (NCI Thesaurus ObjectClass)
C25341 (NCI Thesaurus Property)
C25639 (NCI Thesaurus Property-2)
C37984 (NCI Thesaurus Property-3)
C25191 (NCI Thesaurus ValueDomain)
C0022877 (UMLS CUI-1)
Code List
Shipped to
CL Item
Leukemia Immunophenotyping Reference Library (Leukemia Immunophenotyping Reference Library)
CL Item
Ecog Cytogenetics Laboratory (ECOG Cytogenetics Laboratory)
CL Item
Other Central Laboratory (Other Central Laboratory)
Collection Date
Item
Date Materials collected
date
C1317250 (UMLS CUI-1)
Item
Tissue/material type
integer
C25284 (NCI Thesaurus ValueDomain)
C2347029 (UMLS CUI-1)
Code List
Tissue/material type
CL Item
Other (0)
CL Item
Peripheral Blood (1)
CL Item
Bone Marrow Aspirate (2)
CL Item
Bone Marrow Biopsy (3)
CL Item
Karyotype (4)
CL Item
Peripheral Blood Stem Cell Harvest (5)
Item
Type of collection/stain/process
text
Code List
Type of collection/stain/process
CL Item
Green Top (heparinized) (green top (heparinized))
CL Item
Red Top (red top)
CL Item
Slide, Unstained, Charged (slide, unstained, charged)
CL Item
Slide/air Dried Smear (slide/air dried smear)
CL Item
Karyotype (karyotype)
C25215 (NCI Thesaurus)
C1261273 (UMLS 2011AA)
CL Item
Stem Cell Harvest (stem cell harvest)
CL Item
Other (other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
Item
Timing of material collection
text
C25284 (NCI Thesaurus ValueDomain)
C25616 (NCI Thesaurus Property)
C25453 (NCI Thesaurus Property-2)
C19157 (NCI Thesaurus ObjectClass)
C2347804 (UMLS CUI-1)
Code List
Timing of material collection
CL Item
Baseline/pretreatment (baseline/pretreatment)
CL Item
Pre-transplant Remission Prior To Consolidation (pre-transplant remission prior to consolidation)
CL Item
Pre-transplant , Post-consolidation Chemotherapy (pre-transplant , post-consolidation chemotherapy)
CL Item
1 Mo. Post-transplant (1 mo. Post-transplant)
CL Item
6 Mos. Post-transplant (6 mos. Post-transplant)
CL Item
12 Mos. Post-transplant (12 mos. Post-transplant)
CL Item
Stem Cell Harvest (stem cell harvest)
CL Item
Relapse (relapse)
C18265 (NCI Thesaurus)
CL Item
Other (other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
Number of specimens submitted
Item
number of specimens submitted
integer
C0750480 (UMLS CUI-1)
C0370003 (UMLS CUI-2)
C1515023 (UMLS CUI-3)
Item
Leukemia MDS Diagnosis
text
C25372 (NCI Thesaurus ValueDomain)
C3161 (NCI Thesaurus ObjectClass)
C25161 (NCI Thesaurus Property)
C0023418 (UMLS CUI-1)
C3463824 (UMLS CUI-2)
C0008902 (UMLS CUI-3)
Code List
Leukemia MDS Diagnosis
CL Item
AML, Not Otherwise Specified (nos) (acute myeloid leukemia)
CL Item
ALL, Not Otherwise Specified (nos) (acute lymphocytic leukemia)
CL Item
Chronic Lymphocytic Leukemia (CLL) (chronic lymphocytic leukemia)
CL Item
Chronic Myelogenous Leukemia (CML), Chronic Phase (CML-chronic phase)
CL Item
Myelodysplastic Syndrome (MDS) Nos (MDS-myelodysplastic syndrome)
CL Item
Disease Classified As Specified Other Leukemia (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
CL Item
Unknown (Unknown)
CL Item
Chronic Myelogenous Leukemia, (CML), Blast Crisis (CML-blast cells)
Blast count
Item
Absolute blast count
float
C1982687 (UMLS CUI-1)
Institution contact name
Item
Institution contact name
text
C21541 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C25461 (NCI Thesaurus ObjectClass-2)
C0018704 (UMLS CUI-1)
C0337611 (UMLS CUI-2)
Principal Investigator name
Item
Principal Investigator name
text
C1521895 (UMLS CUI-1)
Phone contact person
Item
Institution contact phone number
text
C25337 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C25395 (NCI Thesaurus Property)
C25461 (NCI Thesaurus ObjectClass-2)
C0039457 (UMLS CUI-1)
C0337611 (UMLS CUI-2)
Fax number contact person
Item
Institution contact fax number
text
C25337 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ObjectClass)
C25461 (NCI Thesaurus ObjectClass-2)
C25210 (NCI Thesaurus Property)
C0337611 (UMLS CUI-1)
C0085205 (UMLS CUI-2)
Item Group
Completed By Central Lab
Date Specimen Received
Item
Date materials received at central lab
date
C0011008 (UMLS CUI-1)
C2585542 (UMLS CUI-2)
Item
Condition of material(s)
text
C1547869 (UMLS CUI-1)
Code List
Condition of material(s)
CL Item
Damaged Or Unusable (not usable as received)
CL Item
Useable (usable as received)
Aliquots
Item
Aliquots of sample made
boolean
C25180 (NCI Thesaurus ValueDomain)
C1510844 (UMLS CUI-1)
Contact name Laboratory
Item
Central Laboratory contact name
text
C25190 (NCI Thesaurus ObjectClass)
C37984 (NCI Thesaurus ObjectClass-2)
C0205099 (NCI Metathesaurus ObjectClass)
C25461 (NCI Thesaurus ObjectClass-3)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C0337611 (UMLS CUI-1)
C0022877 (UMLS CUI-2)
Phone number Central laboratory
Item
contact phone number
text
C25461 (NCI Thesaurus ObjectClass)
C64207 (NCI Thesaurus ObjectClass-2)
C25395 (NCI Thesaurus Property)
C25337 (NCI Thesaurus ValueDomain)
C25395 (NCI Thesaurus ValueDomain-2)
C0039457 (UMLS CUI-1)
C1880016 (UMLS CUI-2)
Fax number Central laboratory
Item
Contact fax number
text
C25337 (NCI Thesaurus ValueDomain)
C25461 (NCI Thesaurus ObjectClass)
C64207 (NCI Thesaurus ObjectClass-2)
C25210 (NCI Thesaurus Property)
C0085205 (UMLS CUI-1)
C1880016 (UMLS CUI-2)

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