Sub-Domain: Treatment%2FIntervention Data
CRF:
CDE ID | CDE Name | Variable Name | Definition | Short Description | Additional Notes (Question Text) | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guideline) | Sub Domain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | Source | Form Set | Form | Field | Domain | CDASH Variable | CDASH Definition | CDASH Label | Controlled Terminology | Prompt | Essentiality | Question Text | CDASH imp guidance | SDTM IG target | csDSR | PhenX | Data Type | CRF Completion Inst | SDTMIG Target Var | SDTMIG Target Map | Codelist Name | PVs | Pre Pop Value | Query Display | List Style |
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C58827 | Acute GVHD diagnosis date | AcuteGVHDDiagnosisDate | Date of diagnosis of acute GVHD (Graft Versus Host Disease) | Date of diagnosis of acute GVHD (Graft Versus Host Disease) | Date of diagnosis of acute GVHD | Date or Date & Time | Adult;Pediatric | Proposed | 1.00 | 2018-12-12 15:18:08.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGAGDGDT | |||||||||||||||||||||||||||||
C58875 | Nausea vomit GVHD status code | NauseaVomitGVHDStatusCode | Code denoting the nausea/vomiting status of the subject/participant with GVHD (Graft Versus Host Disease) | Code denoting the nausea/vomiting status of the subject/participant with GVHD (Graft Versus Host Disease) | Nausea and vomiting | 1;0 | Persistent nausea, vomiting or anorexia;No protracted nausea and vomiting | Numeric Values |
Indicate the maximum severity of involvment during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-14 14:35:32.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGNAUSVM | ||||||||||||||||||||||||||
C58907 | ECP therapy chronic GVHD indicate code | ECPThpyChrnGVHDIndCode | Code indicating whether ECP (Extra-corporeal photopheresis) therapy was used to treat chronic GVHD (graft-versus-host disease) | Code indicating whether ECP (Extra-corporeal photopheresis) therapy was used to treat chronic GVHD (graft-versus-host disease) | ECP (Extra-corporeal Photopheresis) | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
Indicate whether the agent listed was used to treat chronic GVHD during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-17 12:03:21.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGTHECP | ||||||||||||||||||||||||||
C58843 | MMF use GVHD prophylaxis indicate code | MMFUseGVHDProphylaxisIndCode | Code indicating whether MMF was used for GVHD (Graft Versus Host Disease) prophylaxis. | Code indicating whether MMF was used for GVHD (Graft Versus Host Disease) prophylaxis. | MMF | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
If given or discontinued during assessment period, specify all immunosuppressants used for GVHD prophylaxis |
Adult;Pediatric | Proposed | 1.00 | 2018-12-14 11:06:16.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGPRMMF | ||||||||||||||||||||||||||
C58854 | Chronic GVHD diagnosis onset initial date | ChronGVHDDxOnsetInitlDate | Date of initial diagnosis or onset of chronic GVHD (Graft Versus Host Disease). | Date of initial diagnosis or onset of chronic GVHD (Graft Versus Host Disease). | Date of initial diagnosis/onset of chronic GVHD | Date or Date & Time |
Only initial diagnosis or onset of chronic GVHD should be reported |
Adult;Pediatric | Proposed | 1.00 | 2018-12-14 11:46:11.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGCGDGDT | ||||||||||||||||||||||||||||
C58886 | Eosinophilia present indicate code | EosinphiliaPresntIndicatCode | Code indicating whether eosinophilia is present in the subject/participant. | Code indicating whether eosinophilia is present in the subject/participant. | Eosinophilia | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-17 11:11:17.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGEOSINP | |||||||||||||||||||||||||||
C58921 | Other agent therapy chronic GVHD indicate code | OthAgntThpyChrnGVHDIndCode | Code indicating whether therapy using another agent was used to treat chronic GVHD (graft-versus-host disease) | Code indicating whether therapy using another agent was used to treat chronic GVHD (graft-versus-host disease) | Was another agent used to treat chronic GVHD? | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
Indicate whether the agent listed was used to treat chronic GVHD during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-17 12:03:21.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGTHOTHR | ||||||||||||||||||||||||||
C58865 | Rash other type present indicate code | RashOthrTypPresentIndCode | Code indicating whether another type of skin rash is present | Code indicating whether another type of skin rash is present | Other type of rash | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-14 12:47:02.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGRSMACU | |||||||||||||||||||||||||||
C58897 | Chronic GVHD treatment initiate date | ChronGVHDTreatinitiatDate | Date on which therapy for treatment of chronic GVHD (Graft Versus Host Disease) was initiated. | Date on which therapy for treatment of chronic GVHD (Graft Versus Host Disease) was initiated. | Date chronic GVHD treatment initiated | Date or Date & Time |
If the date is out of range because the therapy was initiated during a previous assessment period, it should be entered on the previous form. |
Adult;Pediatric | Proposed | 1.00 | 2018-12-17 12:00:36.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGCTRDT | ||||||||||||||||||||||||||||
C58828 | Skin abnormality severity at acute GVHD maximum overall grade code | SknAbnSvrAtActGVHDMaxOvlGrdCod | Code for the highest severity of skin abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Code for the highest severity of skin abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Skin abnormalities | 0;1;2;3;4 | No rash;Maculopapular rash, <25% of body surface;Maculopapular rash, 25–50% of body surface;Generalized erythrodema;Generalized erythrodema with bullus formation and desquamation | Numeric Values |
Record the highest severity for the organ system at the time of maximum overall grade of acute GVHD |
Adult;Pediatric | Proposed | 1.00 | 2018-12-12 15:24:41.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGASKNAB | ||||||||||||||||||||||||||
C58876 | Diarrhea persistence GVHD code | DiarrheaPersistenceGVHDCode | Code denoting the persistence of diarrhea for the subject/participant with GVHD (Graft Versus Host Disease) | Code denoting the persistence of diarrhea for the subject/participant with GVHD (Graft Versus Host Disease) | Diarrhea | 0;1;2 | None;Persisting less than 2 weeks;Persisting more than 2 weeks | Numeric Values |
Indicate the maximum severity of involvment during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-14 14:40:11.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGDIARH | ||||||||||||||||||||||||||
C58908 | Sirolimus therapy chronic GVHD indicate code | SirolimusThpyChrnGVHDIndCode | Code indicating whether Sirolimus (Rapamycin) therapy was used to treat chronic GVHD (graft-versus-host disease) | Code indicating whether Sirolimus (Rapamycin) therapy was used to treat chronic GVHD (graft-versus-host disease) | Sirolimus (Rapamycin) | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
Indicate whether the agent listed was used to treat chronic GVHD during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-17 12:03:21.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGTHSIR | ||||||||||||||||||||||||||
C58844 | Maraviroc use GVHD prophylaxis indicate code | MarUseGVHDProphylaxisIndCode | Code indicating whether Maraviroc was used for GVHD (Graft Versus Host Disease) prophylaxis. | Code indicating whether Maraviroc was used for GVHD (Graft Versus Host Disease) prophylaxis. | Maraviroc | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
If given or discontinued during assessment period, specify all immunosuppressants used for GVHD prophylaxis |
Adult;Pediatric | Proposed | 1.00 | 2018-12-14 11:06:16.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGPRMRVR | ||||||||||||||||||||||||||
C58855 | Karnofsky Lansky minimum score code | KarnLanMinScorCode | Code denoting the minimum score on the Karnofsky or Lansky scale. | Code denoting the minimum score on the Karnofsky or Lansky scale. | Minimum Karnofsky/Lansky Score at time of diagnosis | 02;03;04;05;06;07;08;09;10;01 | 90 (Normal Activity/Minor Restriction in Strenuous Play);80 (Normal Activity with Effort/Restricted in Strenuous Play);70 (Unable to Carry On Normal Activity/Less Time Spent in Play);60 (Requires Occasional Assistance/Minimal Active Play);50 (Requires Considerable Assistance/No Active Play);40 (Disabled/Able to Initiate Quiet Activities);30 (Severely Disabled/Needs Assistance for Quiet Play);20 (Very Sick/Limited to Very Passive Activity);10 (Moribund, Completely Disabled);100 (Normal, No Complaints/Fully Active) | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-14 11:50:05.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGDGKNLN | |||||||||||||||||||||||||||
C58887 | Serositis present indicate code | SerositisPresentIndicatCode | Code indicating whether serositis is present in the subject/participant. | Code indicating whether serositis is present in the subject/participant. | Serositis | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-17 11:14:02.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGSEROS | |||||||||||||||||||||||||||
C58922 | Other agent use treat GVHD specify text | OthAgntUseTrtGVHDSpcfyTxt | The free-text related to 'Other agent therapy chronic GVHD indicate code' for specifying the other agent that was used to treat chronic GVHD (graft-versus-host disease) | The free-text related to 'Other agent therapy chronic GVHD indicate code' for specifying the other agent that was used to treat chronic GVHD (graft-versus-host disease) | Specify other agent used to treat chronic GVHD | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2018-12-17 15:38:57.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy | 100 |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGTHOTSP | ||||||||||||||||||||||||||||
C58866 | Rash other type present specify text | RashOthrTypPresentSpcfyTxt | Free-text field related to 'Rash other type present indicate code' for specifying the type of rash present. | Free-text field related to 'Rash other type present indicate code' for specifying the type of rash present. | Specify other rash | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2018-12-14 13:11:51.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy | 100 |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGRSOTSP | ||||||||||||||||||||||||||||
C58898 | ALS ALG ATS ATG therapy chronic GVHD indicate code | ALSALGATSATGThpyChrnGVHDIndCod | Code indicating whether any of the following therapies were used to treat chronic GVHD (graft-versus-host disease): anti-lymphocytic serum (ALS), anti-lymphocyte globulin (ALG), anti-thymocyte serum (ATS), anti-thymocyte globulin (ATG) | Code indicating whether any of the following therapies were used to treat chronic GVHD (graft-versus-host disease): anti-lymphocytic serum (ALS), anti-lymphocyte globulin (ALG), anti-thymocyte serum (ATS), anti-thymocyte globulin (ATG) | ALS, ALG, ATS, ATG | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
Indicate whether the agent listed was used to treat chronic GVHD during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-17 12:03:21.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGTHATG | ||||||||||||||||||||||||||
C58829 | Upper GI abnormality severity at acute GVHD maximum overall grade code | UGIAbnSvrAtActGVHDMaxOvlGrdCod | Code for the highest severity of upper GI (gastrointestinal tract) abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Code for the highest severity of upper GI (gastrointestinal tract) abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Upper GI abnormalities | 1;0 | Persistent nausea, vomiting or anorexia;No protracted nausea and vomiting | Numeric Values |
Record the highest severity for the organ system at the time of maximum overall grade of acute GVHD |
Adult;Pediatric | Proposed | 1.00 | 2018-12-12 15:24:41.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGAUGIAB | ||||||||||||||||||||||||||
C58877 | Bilirubin high measurement | BilirubinHighMeasr | Highest measurement of bilirubin (method unspecified), in milligrams per deciliter | Highest measurement of bilirubin (method unspecified), in milligrams per deciliter | Highest bilirubin value | Numeric Values |
Record the highest value during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-17 10:35:20.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Free-Form Entry |
0 | 99.9 | milligram per deciliter | BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGBILI | |||||||||||||||||||||||||
C58909 | Etretinate therapy chronic GVHD indicate code | EtretinateThpyChrnGVHDIndCode | Code indicating whether Etretinate therapy was used to treat chronic GVHD (graft-versus-host disease) | Code indicating whether Etretinate therapy was used to treat chronic GVHD (graft-versus-host disease) | Etretinate | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
Indicate whether the agent listed was used to treat chronic GVHD during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-17 12:03:21.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGTHETR | ||||||||||||||||||||||||||
C58845 | Methotrexate use GVHD prophylaxis indicate code | MethUseGVHDProphylaxisIndCode | Code indicating whether Methotrexate was used for GVHD (Graft Versus Host Disease) prophylaxis. | Code indicating whether Methotrexate was used for GVHD (Graft Versus Host Disease) prophylaxis. | Methotrexate | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
If given or discontinued during assessment period, specify all immunosuppressants used for GVHD prophylaxis |
Adult;Pediatric | Proposed | 1.00 | 2018-12-14 11:06:16.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGPRMTRX | ||||||||||||||||||||||||||
C58856 | Platelet minimum time diagnosis count | PlateletMinTimDxCt | Minimum count of platelets per cubic millimeter at the time of diagnosis. | Minimum count of platelets per cubic millimeter at the time of diagnosis. | Minimum platelet count at time of diagnosis | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-14 12:23:41.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Free-Form Entry |
0 | 999999 | cubic millimeter | BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGDGPLT | ||||||||||||||||||||||||||
C58888 | Fascitis present indicate code | FascitisPresentIndicateCode | Code indicating whether fascitis is present in the subject/participant. | Code indicating whether fascitis is present in the subject/participant. | Fascitis | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-17 11:15:19.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGFASCIT | |||||||||||||||||||||||||||
C01541 | Weight measurement | WgtMeasr | Measurement of participant's/subject's weight | Measurement of participant's/subject's weight | Weight at time of diagnosis | Numeric Values | Adult;Pediatric | Proposed | 3.00 | 2013-07-25 08:54:08.2 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Free-Form Entry |
0 | 500 | kilogram | 2179689 | DeBaun Forms | ||||||||||||||||||||||||||||
C58867 | Xerophthalmia status code | XerophthalmiaStatusCode | Code denoting the degree of xerophthalmia exhibited by the subject/participant. | Code denoting the degree of xerophthalmia exhibited by the subject/participant. | Xerophthalmia | 0;1;2 | No symptoms;Dry eyes but not requiring therapy;Dryness of eyes or inflammation requiring therapy | Numeric Values |
Indicate the maximum severity of involvment during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-14 13:22:37.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGXEROPH | ||||||||||||||||||||||||||
C58899 | Azathiapine therapy chronic GVHD indicate code | AzathiapinThpyChrnGVHDIndCode | Code indicating whether Azathiapine therapy was used to treat chronic GVHD (graft-versus-host disease) | Code indicating whether Azathiapine therapy was used to treat chronic GVHD (graft-versus-host disease) | Azathioprine | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
Indicate whether the agent listed was used to treat chronic GVHD during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-17 12:03:21.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGTHAZAT | ||||||||||||||||||||||||||
C58830 | Lower GI abnormality severity at acute GVHD maximum overall grade code | LGIAbnSvrAtActGVHDMaxOvlGrdCod | Code for the highest severity of lower GI (gastrointestinal tract) abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Code for the highest severity of lower GI (gastrointestinal tract) abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Lower GI abnormalities | 0;1;2;3;4;5 | No diarrhea;Diarrhea less than or equal to 500 mL/day or <280 mL/m^2;Diarrhea >500 but less than or equal to 1000 mL/day or 280–555 mL/m^2;Diarrhea >1000 but less than or equal to 1500 mL/day or 556–833 mL/m^2;Diarrhea >1500 mL/day or >833 mL/m^2;Severe abdominal pain with or without ileus, or stool with frank blood or melena | Numeric Values |
Record the highest severity for the organ system at the time of maximum overall grade of acute GVHD |
Adult;Pediatric | Proposed | 1.00 | 2018-12-12 15:24:41.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGALGIAB | ||||||||||||||||||||||||||
C58878 | Bilirubin measurement sample date | BilirubinMeasrSampleDate | Date bilirubin sample was collected for testing. | Date bilirubin sample was collected for testing. | Date bilirubin sample obtained | Date or Date & Time | Adult;Pediatric | Proposed | 1.00 | 2018-12-17 10:41:01.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGBILIDT | |||||||||||||||||||||||||||||
C58910 | Lamprene therapy chronic GVHD indicate code | LampreneThpyChrnGVHDIndCode | Code indicating whether Lamprene therapy was used to treat chronic GVHD (graft-versus-host disease) | Code indicating whether Lamprene therapy was used to treat chronic GVHD (graft-versus-host disease) | Lamprene | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
Indicate whether the agent listed was used to treat chronic GVHD during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-17 12:03:21.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGTHLAMP | ||||||||||||||||||||||||||
C58846 | Prednisone use GVHD prophylaxis indicate code | PredUseGVHDProphylaxisIndCode | Code indicating whether Prednisone was used for GVHD (Graft Versus Host Disease) prophylaxis. | Code indicating whether Prednisone was used for GVHD (Graft Versus Host Disease) prophylaxis. | Prednisone | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
If given or discontinued during assessment period, specify all immunosuppressants used for GVHD prophylaxis |
Adult;Pediatric | Proposed | 1.00 | 2018-12-14 11:06:16.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGPRPRED | ||||||||||||||||||||||||||
C58857 | Alkaline phosphatase time diagnosis measurement | AlkPhosphtaseTimDxMeasr | Measurement in units per liter of alkaline phosphatase at the time of diagnosis | Measurement in units per liter of alkaline phosphatase at the time of diagnosis | Alkaline phosphatase at time of diagnosis | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-14 12:27:04.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Free-Form Entry |
0 | 9999 | unit per liter | BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGDGALKP | ||||||||||||||||||||||||||
C58889 | Other organ involve GVHD indicate code | OthOrganInvolvGVHDIndicatCode | Code indicating whether other organs not specified were involved with the subject/participant's GVHD (Graft Versus Host Disease). | Code indicating whether other organs not specified were involved with the subject/participant's GVHD (Graft Versus Host Disease). | Was there any other organ involvement in chronic GVHD? | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-17 11:17:43.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGOTORGN | |||||||||||||||||||||||||||
C18027 | Comment text | CmmntTxt | Provide any additional information that pertains to the question. | Provide any additional information that pertains to the question. | Comments | Alphanumeric | Adult;Pediatric | Proposed | 3.00 | 2013-07-16 14:01:43.01 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy | 4000 |
Free-Form Entry |
DeBaun Forms | |||||||||||||||||||||||||||||||
C58868 | Mucositis oral ulcer functional status code | MucostsOralUlcrFunclStatCode | Code denoting the functional status of the subject/participant's mucositis or oral ulcers. | Code denoting the functional status of the subject/participant's mucositis or oral ulcers. | Mucositis/ulcers (functional) | 0;1;2;3 | No symptoms;Minimal symptoms, normal diet;Symptomatic but can eat and swallow modified diet;Symptomatic and unable to adequately aliment or hydrate orally | Numeric Values |
Indicate the maximum severity of involvment during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-14 13:32:52.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGMUCOS | ||||||||||||||||||||||||||
C58900 | Cyclosporine therapy chronic GVHD indicate code | CyclosporinThpyChrnGVHDIndCode | Code indicating whether Cyclosporine therapy was used to treat chronic GVHD (graft-versus-host disease) | Code indicating whether Cyclosporine therapy was used to treat chronic GVHD (graft-versus-host disease) | Cyclosporine | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
Indicate whether the agent listed was used to treat chronic GVHD during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-17 12:03:21.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGTHCYCL | ||||||||||||||||||||||||||
C58834 | Liver abnormality severity at acute GVHD maximum overall grade code | LvrAbnSvrAtActGVHDMaxOvlGrdCod | Code for the highest severity of liver abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Code for the highest severity of liver abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Liver abnormalities | 0;1;2;3;4 | Bilirubin <2.0 mg/dL;Bilirubin 2.0–3.0 mg/dL;Bilirubin 3.1–6.0 mg/dL;Bilirubin 6.1–15.0 mg/dL;Bilirubin >15.0 mg/dL | Numeric Values |
Record the highest severity for the organ system at the time of maximum overall grade of acute GVHD |
Adult;Pediatric | Proposed | 1.00 | 2018-12-12 15:24:41.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGALVRAB | ||||||||||||||||||||||||||
C58879 | Alanine aminotransferase high measurement | ALTHighMeasr | Highest measurement of ALT (alanine aminotransferase). | Highest measurement of ALT (alanine aminotransferase). | Highest ALT value | Numeric Values |
Record the highest value during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-17 10:46:11.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Free-Form Entry |
0 | 9999 | unit per liter | BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGALT | |||||||||||||||||||||||||
C58911 | Etanercept therapy chronic GVHD indicate code | EtanerceptThpyChrnGVHDIndCode | Code indicating whether Etanercept therapy was used to treat chronic GVHD (graft-versus-host disease) | Code indicating whether Etanercept therapy was used to treat chronic GVHD (graft-versus-host disease) | Etanercept | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
Indicate whether the agent listed was used to treat chronic GVHD during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-17 12:03:21.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGTHETAN | ||||||||||||||||||||||||||
C58847 | Sirolimus use GVHD prophylaxis indicate code | SiroUseGVHDProphylaxisIndCode | Code indicating whether Sirolimus was used for GVHD (Graft Versus Host Disease) prophylaxis. | Code indicating whether Sirolimus was used for GVHD (Graft Versus Host Disease) prophylaxis. | Sirolimus | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
If given or discontinued during assessment period, specify all immunosuppressants used for GVHD prophylaxis |
Adult;Pediatric | Proposed | 1.00 | 2018-12-14 11:06:16.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGPRSIR | ||||||||||||||||||||||||||
C58858 | Bilirubin total measurement | BilirubinTotalMeasr | Measurement in milligrams per deciliter of total bilirubin | Measurement in milligrams per deciliter of total bilirubin | Total bilirubin at time of diagnosis | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-14 12:31:12.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Free-Form Entry |
0 | 99.9 | milligram per deciliter | BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGDGBILI | ||||||||||||||||||||||||||
C58890 | Other organ involve GVHD specify text | OthrOrgnInvolvGVHDSpcfyTxt | The free-text field related to 'Other organ involve GVHD indicate code' for specifying other organs involved. | The free-text field related to 'Other organ involve GVHD indicate code' for specifying other organs involved. | Specify other organ involvement in chronic GVHD | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2018-12-17 11:30:10.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy | 100 |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGOTORSP | ||||||||||||||||||||||||||||
C58746 | Alanine aminotransferase sample date | ALTSampleDate | Date on which the alanine aminotransferase (ALT) sample was collected. | Date on which the alanine aminotransferase (ALT) sample was collected. | Date ALT sample obtained | Date or Date & Time | Adult;Pediatric | Proposed | 1.00 | 2018-12-10 09:11:55.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | 1507A (ENR) | HSCALTDT | |||||||||||||||||||||||||||||
C58869 | Bronchiolitis obliterans status code | BronchioltsObliternsStatusCode | Code denoting the status of the subject/participant's bronchiolitis obliterans | Code denoting the status of the subject/participant's bronchiolitis obliterans | Bronchiolitis obliterans | 1;2;3;4 | Yes, histologic diagnosis;Yes, clinical diagnosis;No;Unknown | Numeric Values |
Indicate the maximum severity of involvment during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-14 13:37:50.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGBRNCH | ||||||||||||||||||||||||||
C58901 | Systemic corticosteroid therapy chronic GVHD indicate code | SysCrtcstrdThpyChrnGVHDIndCode | Code indicating whether systemic corticosteroid therapy was used to treat chronic GVHD (graft-versus-host disease) | Code indicating whether systemic corticosteroid therapy was used to treat chronic GVHD (graft-versus-host disease) | Systemic Corticosteroids | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
Indicate whether the agent listed was used to treat chronic GVHD during this assessment period |
Adult;Pediatric | Proposed | 1.00 | 2018-12-17 12:03:21.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGTHSYCO | ||||||||||||||||||||||||||
C58837 | Prophylaxis GVHD given during assessment period code | PrphylxGVHDGivDurAssessPrdCode | Code for whether prophylaxis for GVHD (Graft Versus Host Disease) was given to the subject/participant during the assessment period. | Code for whether prophylaxis for GVHD (Graft Versus Host Disease) was given to the subject/participant during the assessment period. |
Was prophylaxis for GVHD given during this assessment period? |
1;2;3 | Yes;No;Discontinued during this assessment period | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-12 15:44:33.0 | Follow Up/Chronic GVHD Form | Treatment%2FIntervention Data | cookie-policy |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGPROPIM |