Brain and Central Nervous System Tumors NCT00890747 On-Study - AMC-061 Baseline Evaluation Form (B61) - 2933416v1.0

AMC-061 Baseline Evaluation Form (B61) Sunitinib Malate in Treating HIV-Positive Patients With Cancer Undergoing Highly Active Antiretroviral Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=715BD918-9168-2975-E040-BB89AD434610

Complete this form at baseline only

  1. StudyEvent: AMC-061 Baseline Evaluation Form (B61)
    1. Complete this form at baseline only
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Visit Number
HospitalAdmissionOrdinalNumber
Item
Visit number
double
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C0019994 (UMLS 2011AA ObjectClass)
C25385 (NCI Thesaurus Property)
C0809949 (UMLS 2011AA Property)
CancerInitialDiagnosisDate
Item
Initial Diagnosis Date (mm/dd/yyyy)
date
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C25509 (NCI Thesaurus Property)
C1279901 (UMLS 2011AA Property)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
Item
Disease status
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
Code List
Disease status
CL Item
Measurable (Measurable)
C37894 (NCI Thesaurus)
C1513040 (UMLS 2011AA)
CL Item
Non-measurable (Non-Measurable)
C25589 (NCI Thesaurus)
C1518373 (UMLS 2011AA)
CL Item
Both Measurable And Non-measurable (Both Measurable and Non-Measurable)
Item
Hematopoietic Diagnosis
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C13324 (NCI Thesaurus ObjectClass)
C0229601 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
Code List
Hematopoietic Diagnosis
CL Item
Diffuse Large B-cell Lymphoma (Diffuse large B-cell lymphoma)
C8851 (NCI Thesaurus)
C0079744 (UMLS 2011AA)
CL Item
Burkitt Lymphoma/leukemia (Burkitt lymphoma/leukemia)
CL Item
Primary Effusion Lymphoma (Primary effusion lymphoma)
C6915 (NCI Thesaurus)
C1292753 (UMLS 2011AA)
CL Item
Kshv/hhv-8+ Plasmablastic Lymphoma (lymph Node) (KSHV/HHV-8+ plasmablastic lymphoma (lymph node))
CL Item
Plasma Lymphoma Of Oral Cavity (Plasma lymphoma of oral cavity)
CL Item
Polymorphic B Cell Lymphoma-ptld Type (Polymorphic B cell lymphoma-PTLD type)
CL Item
Hodgkin's Lymphoma (Hodgkin lymphoma)
C9357 (NCI Thesaurus)
C0019829 (UMLS 2011AA)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
DiseaseDiagnosisHematopoieticSpecify
Item
Other specify (If)
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C13324 (NCI Thesaurus ValueDomain)
C0229601 (UMLS 2011AA ValueDomain)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
Item
If diffuse large B-cell lymphoma, specify morphologic type
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C8851 (NCI Thesaurus ObjectClass)
C0079744 (UMLS 2011AA ObjectClass)
C17943 (NCI Thesaurus Property)
C0700619 (UMLS 2011AA Property)
Code List
If diffuse large B-cell lymphoma, specify morphologic type
CL Item
Centroblastic (Centroblastic)
CL Item
Immunoblastic (Immunoblastic)
Item
If Burkitt lymphoma/leukemia, specify morphologic type
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C2912 (NCI Thesaurus ObjectClass)
C0006413 (UMLS 2011AA ObjectClass)
C17943 (NCI Thesaurus Property)
C0700619 (UMLS 2011AA Property)
Code List
If Burkitt lymphoma/leukemia, specify morphologic type
CL Item
Classical (Classical)
CL Item
Plasmacytoid (Plasmacytoid)
CL Item
B Cell Lymphoma Unclassifiable, W/features Intermediate Between Dlbcl And Burkitt's. (atypical) (B cell lymphoma unclassifiable, w/features intermediate between DLBCL and Burkitt's. (Atypical))
Item Group
Kaposi's Sarcoma Assessment
Item
Does the patient have >=50 cutaneous lesions
text
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C9087 (NCI Thesaurus ObjectClass)
C0036220 (UMLS 2011AA ObjectClass)
C25367 (NCI Thesaurus Property)
C13316 (NCI Thesaurus Property)
C0221912 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
Code List
Does the patient have >=50 cutaneous lesions
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
KaposiSarcomaMalignantNeoplasmElevatedCount
Item
Total Number Raised Lesions
double
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C9087 (NCI Thesaurus ObjectClass)
C0036220 (UMLS 2011AA ObjectClass)
C25493 (NCI Thesaurus Property)
C0205250 (UMLS 2011AA Property)
C25256 (NCI Thesaurus Property)
C1265611 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
KaposiSarcomaMalignantNeoplasmFlatCount
Item
Total Number Flat Lesions
double
C9305 (NCI Thesaurus ObjectClass)
C0006826 (UMLS 2011AA ObjectClass)
C9087 (NCI Thesaurus ObjectClass)
C0036220 (UMLS 2011AA ObjectClass)
C25256 (NCI Thesaurus Property)
C1265611 (UMLS 2011AA Property)
C0205324 (NCI Metathesaurus Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
Item
Are there any oral cavity lesions present
text
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus Property)
C27641 (NCI Thesaurus ObjectClass)
C0026636 (UMLS 2011AA ObjectClass)
Code List
Are there any oral cavity lesions present
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Is there visceral disease
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C3262 (NCI Thesaurus ObjectClass)
C0027651 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25315 (NCI Thesaurus ObjectClass)
C0442045 (UMLS 2011AA ObjectClass)
Code List
Is there visceral disease
CL Item
No (NO)
CL Item
Yes (YES)
Item Group
Hematologic Malignancy Assessment
Item
Hematologic diagnosis
text
C62780 (NCI Thesaurus ObjectClass)
C0205488 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C3161 (NCI Thesaurus ObjectClass)
C0023418 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Hematologic diagnosis
CL Item
All (Acute Lymphoblastic Leukemia)
C3167 (NCI Thesaurus)
C0023449 (UMLS 2011AA)
CL Item
Acute Myeloid Leukemia (Acute Myeloid Leukemia)
C3171 (NCI Thesaurus)
C0023467 (UMLS 2011AA)
CL Item
Cll (Chronic Lymphoid Leukemia)
C3163 (NCI Thesaurus)
C0023434 (UMLS 2011AA)
CL Item
Chronic Myeloproliferative Disorder (Chronic Myeloproliferative Disease)
C4345 (NCI Thesaurus)
C1292778 (UMLS 2011AA)
CL Item
Leukemia (Leukemia Miscellaneous)
C3161 (NCI Thesaurus)
C0023418 (UMLS 2011AA)
C3161 (NCI Thesaurus)
C0023418 (UMLS 2011AA)
Item
Acute Lymphoblastic Leukemia
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C3167 (NCI Thesaurus ObjectClass)
C0023449 (UMLS 2011AA ObjectClass)
Code List
Acute Lymphoblastic Leukemia
CL Item
Acute Lymphoblastic Leukemia, Nos (Acute Lymphoblastic Leukemia, NOS)
CL Item
Precursor B-lymphoblastic Leukemia (Precursor B-Lymphoblastic Leukemia (B-precursor ALL))
C8644 (NCI Thesaurus)
C1292769 (UMLS 2011AA)
CL Item
Precursor T-lymphoblastic Leukemia (Precursor T-Lymphoblastic Leukemia (T-Cell ALL))
C3183 (NCI Thesaurus)
C1961099 (UMLS 2011AA)
Item
Acute Myeloid Leukemia
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C3171 (NCI Thesaurus ObjectClass)
C0023467 (UMLS 2011AA ObjectClass)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
Code List
Acute Myeloid Leukemia
CL Item
Acute Myeloid Leukemia Nos (Acute Myeloid Leukemia, NOS)
CL Item
Acute Promyelocytic Leukemia (Acute Promyelocytic Leukemia)
CL Item
Treatment-related Acute Myeloid Leukemia (Treatment-related Acute Myeloid Leukemia)
Item
Chronic Lymphoid Leukemia
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C14141 (NCI Thesaurus ObjectClass)
C0205191 (UMLS 2011AA ObjectClass)
C7539 (NCI Thesaurus ObjectClass)
C0023448 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Chronic Lymphoid Leukemia
CL Item
Adult T-cell Lymphoma/leukemia (Adult T-Cell Leukemia/Lymphoma)
C3184 (NCI Thesaurus)
C0023493 (UMLS 2011AA)
CL Item
Chronic Lymphocytic Leukemia Nos (Chronic Lymphocytic Leukemia, NOS)
CL Item
Hairy Cell Leukemia (Hairy Cell Leukemia)
C7402 (NCI Thesaurus)
C0023443 (UMLS 2011AA)
CL Item
Prolymphocytic Leukemia (Prolymphocytic Leukemia (B or T-Cell))
C3181 (NCI Thesaurus)
C0023486 (UMLS 2011AA)
CL Item
T-cell Large Granular Lymphocyte Leukemia (T-Cell Large Granular Lymphocytic Leukemia)
C4664 (NCI Thesaurus)
C1955861 (UMLS 2011AA)
Item
Chronic Myeloproliferative Disease
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C4345 (NCI Thesaurus ObjectClass)
C1292778 (UMLS 2011AA ObjectClass)
Code List
Chronic Myeloproliferative Disease
CL Item
Chronic Eosinophilic Leukemia Or Hypereosinophilic Syndrome (Chronic Eosinophilic Leukemia/Hypereosinophilic Syndrome)
C37998 (NCI Thesaurus)
C1518602 (UMLS 2011AA)
C27038 (NCI Thesaurus)
C1540912 (UMLS 2011AA)
C4563 (NCI Thesaurus)
C0346421 (UMLS 2011AA)
CL Item
Chronic Idiopathic Myelofibrosis (Chronic Idiopathic Myelofibrosis)
C2862 (NCI Thesaurus)
C0001815 (UMLS 2011AA)
CL Item
Philadelphia Chromosome Positive Chronic Myelogenous Leukemia (Chronic Myelogenous Leukemia, Philadelphia Chromosome Positive)
C9128 (NCI Thesaurus)
C0279543 (UMLS 2011AA)
CL Item
Essential Thrombocythemia (Essential Thrombocythemia)
C3407 (NCI Thesaurus)
C0040028 (UMLS 2011AA)
CL Item
Polycythemia Vera (Polycythemia Vera)
C3336 (NCI Thesaurus)
C0032463 (UMLS 2011AA)
Item
Leukemia Miscellaneous
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C3161 (NCI Thesaurus ObjectClass)
C0023418 (UMLS 2011AA ObjectClass)
C69023 (NCI Thesaurus ObjectClass)
C0205395 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Leukemia Miscellaneous
CL Item
Leukemia (Leukemia, NOS)
C3161 (NCI Thesaurus)
C0023418 (UMLS 2011AA)
C3161 (NCI Thesaurus)
C0023418 (UMLS 2011AA)
Item Group
Comments
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)

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