Long-Term Follow-up Form Leukemia (NCT00049517)

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 NCT00049517 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A7294868-3C8F-2FCA-E034-0003BA0B1A09

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  1. StudyEvent: E1900 Long-Term Follow-up Form
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Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
Protocol ID ECOG
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)
Protocol ID Participating Group
Item
Participating Group Protocol No.
text
C3274381 (UMLS CUI-1)
C2347449 (UMLS CUI-2)
Patient ID Participating Group
Item
Participating Group Patient ID
text
C2348585 (UMLS CUI-1)
C2347449 (UMLS CUI-2)
Institution
Item
Institution/Affiliate
text
C1301943 (UMLS CUI-1)
Data amended
Item
Are data amended?
boolean
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C1511726 (UMLS CUI-1)
C1691222 (UMLS CUI-2)
Reporting Period Start Date
Item
Reporting Period Start Date
date
C2361257 (UMLS CUI-1)
Reporting Period End Date
Item
Reporting Period End Date
date
C2361259 (UMLS CUI-1)
Comments
Item
Comments
text
C0947611 (UMLS CUI-1)
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)
Item Group
Vital Status
C1148433 (UMLS CUI-1)
Item
Patient's Vital Status
text
C1148433 (UMLS CUI-1)
Code List
Patient's Vital Status
CL Item
Alive (Alive)
CL Item
Dead (Dead)
Date of Last Contact or Death
Item
Date of Last Contact or Death
date
C0805839 (UMLS CUI-1)
C1148348 (UMLS CUI-2)
Item
Primary Cause of Death
text
C0007465 (UMLS CUI-1)
Code List
Primary Cause of Death
CL Item
Due To Protocol Treatment (Due to protocol treatment)
CL Item
Due To This Disease (Due to this disease)
CL Item
Due To Other Cause, Specify (Due to other cause)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Death Reason, Specify
Item
Describe cause of death
text
C0007465 (UMLS CUI-1)
C1521902 (UMLS CUI-2)
Item Group
Disease Follow-up Status
C0589120 (UMLS CUI-1)
Follow-Up Cancer
Item
Has the patient had a documented clinical assessment for this cancer (since submission of the previous follow-up form)?
boolean
C1522577 (UMLS CUI-1)
C0006826 (UMLS CUI-2)
Follow-up Date Cancer
Item
Date of last clinical cancer assessment (If yes)
date
C2991 (NCI Thesaurus ObjectClass)
C25365 (NCI Thesaurus Property)
C3694716 (UMLS CUI-1)
C0006826 (UMLS CUI-2)
Item Group
Notice Of Relapse
C0277556 (UMLS CUI-1)
Tumor Progression
Item
Has the patient developed a first relapse that has not been previously reported?
boolean
C0178874 (UMLS CUI-1)
Date of Relapse
Item
Date of relapse
date
C0035020 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
Relapse certain
Item
Did a physician make a formal diagnosis of relapse? (If no or unknown, specify basis of PD in Comments)
boolean
C38148 (NCI Thesaurus ValueDomain)
C25741 (NCI Thesaurus ObjectClass)
C25254 (NCI Thesaurus Property)
C15220 (NCI Thesaurus Property-2)
C0035020 (UMLS CUI-1)
C0205423 (UMLS CUI-2)
Item Group
Notice Of New Primary
C0751623 (UMLS CUI-1)
New Primary Cancer
Item
Has a new primary cancer or MDS been diagnosed that has not been previously reported?
boolean
C0751623 (UMLS CUI-1)
New Primary Cancer Site
Item
Site(s) of new primary
text
C0751623 (UMLS CUI-1)
C1515974 (UMLS CUI-2)
Item Group
Toxicity
C0040539 (UMLS CUI-1)
Toxicity, long-term
Item
Has the patient experienced any severe (Grade >= 3) long term toxicity that has not been previously reported?
boolean
C0040539 (UMLS CUI-1)
C0443252 (UMLS CUI-2)
Item Group
Non-protocol Therapy
C1518384 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
Non-protocol Therapy
Item
Has the patient received any non-protocol cancer therapy prior to first relapse (not previously reported)?
boolean
C38148 (NCI Thesaurus ValueDomain)
C1518384 (UMLS CUI-1)
C0087111 (UMLS CUI-2)
Item Group
Transfusions
C1879316 (UMLS CUI-1)
Platelet Transfusion
Item
Number of platlet transfusions (this reporting period)
integer
C44278 (NCI Thesaurus ValueDomain)
C25639 (NCI Thesaurus Property)
C25463 (NCI Thesaurus ValueDomain-2)
C15366 (NCI Thesaurus ObjectClass)
C0086818 (UMLS CUI-1)
Platelet Transfusion, recent date
Item
Date of most recent platelet transfusion
date
C25164 (NCI Thesaurus ValueDomain)
C25639 (NCI Thesaurus Property)
C15366 (NCI Thesaurus ObjectClass)
C25577 (NCI Thesaurus ValueDomain-2)
C0086818 (UMLS CUI-1)
C0332185 (UMLS CUI-2)
Red Blood Cell Transfusion
Item
Number of RBC transfusions (this reporting period)
integer
C44278 (NCI Thesaurus ValueDomain)
C25639 (NCI Thesaurus Property)
C25463 (NCI Thesaurus ValueDomain-2)
C15409 (NCI Thesaurus ObjectClass)
C0086252 (UMLS CUI-1)
Red Blood Cell Transfusion, recent date
Item
Date of most recent RBC transfusion
date
C25164 (NCI Thesaurus ValueDomain)
C25639 (NCI Thesaurus Property)
C15409 (NCI Thesaurus ObjectClass)
C25577 (NCI Thesaurus ValueDomain-2)
C0086252 (UMLS CUI-1)
C0332185 (UMLS CUI-2)

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