CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Treatment/Intervention Data
CRF: Hematopoiesis Form

24 results.
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
C58981 Granulocyte colony stimulating factor receive indicate code GCSFReceiveIndicateCode Code indicating whether the patient received G-CSF (granulocyte colony stimulating factor). Code indicating whether the patient received G-CSF (granulocyte colony stimulating factor). Did the patient receive G-CSF during this assessment period? 1;2;1;2 Yes;No;Yes;No Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 11:47:16.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) GCSFREC
C58992 Chimerism assay evaluation method code other text ChmrsmAssyEvalMethodCodeOTH The free-text field related to 'Chimerism assay evaluation method code' specifying other text. The free-text field related to 'Chimerism assay evaluation method code' specifying other text. Specify other method of evaluation Alphanumeric Adult;Pediatric Proposed 1.00 2019-01-07 12:39:06.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant 100

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BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) MRWMTHSP
C58982 Granulocyte colony stimulating factor initiate assess period indicate code GCSFInitAsesPerIndCode Code indicating whether G-CSF (granulocyte colony stimulating factor) was initiated during the assessment period. Code indicating whether G-CSF (granulocyte colony stimulating factor) was initiated during the assessment period. Was G-CSF initated during this assessment period? 1;2;1;2 Yes;No;Yes;No Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 11:50:13.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) GCSFIN
C58993 Chimerism cell type code ChimerismCellTypeCode Code denoting the chimerism cell type Code denoting the chimerism cell type Record chimerism cell type 1;2 Unmanipulated;Manipulated/sorted Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 12:42:44.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) MRWTYPE
C58983 Granulocyte colony stimulating factor initiate date GCSFInitiateDate Date on which G-CSF (granulocyte colony stimulating factor) was initiated. Date on which G-CSF (granulocyte colony stimulating factor) was initiated. Date G-CSF was initiated Date or Date & Time Adult;Pediatric Proposed 1.00 2019-01-07 11:52:40.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

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BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) GCFSDT
C58994 Chimerism assay sample sort text ChimerismAssaySampleSortTxt Text describing how the chimerism assay sample was sorted. Text describing how the chimerism assay sample was sorted. Record how the sample was sorted Alphanumeric Adult;Pediatric Proposed 1.00 2019-01-07 12:45:10.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant 100

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BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) MRWSORT
C58984 Absolute neutrophil count drop below 500 per microliter after condition regimen initiate indicate code ANCDpBl500PrULAfCnRgInIndCode Code indicating whether the patient's ANC (absolute neutrophil count) dropped below 500 per microliter after initiation of conditioning regimen. Code indicating whether the patient's ANC (absolute neutrophil count) dropped below 500 per microliter after initiation of conditioning regimen. Did the patient's ANC drop below 500/L after the initiation of the conditioning regimen? 1;2;1;2 Yes;No;Yes;No Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 12:03:22.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) ANCDRP
C58995 Chimerism assay result code ChimerismAssayResultCode Code denoting the results of the chimerism assay being documented. Code denoting the results of the chimerism assay being documented. Record assay results 1;2;3;88 All host cells;All donor cells;Host and donor;Not evaluable/not enough cells Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 13:46:49.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) MRWRSLT
C58985 Absolute neutrophil count greater equal 500 per microliter 3 consecutive measurement different day indicate code ANCGrEq500PrUL3CsMrDfDyIndCode Code indicating whether the patient achieved ANC (absolute neutrophil count) greater than or equal to 500 per microliter for three consecutive measurements on different days. Code indicating whether the patient achieved ANC (absolute neutrophil count) greater than or equal to 500 per microliter for three consecutive measurements on different days. Did the patient achieve ANC >= 500/L for three consecutive measurements obtained on different days? 1;2;3 Yes;No;Previously reported Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 12:07:09.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) ANCREC
C58996 Chimerism assay result donor percent value ChmrsmAssyRsltDonrPctVal Value in percent of the proportion of donor cells in the chimerism assay being recorded. Value in percent of the proportion of donor cells in the chimerism assay being recorded. % donor Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 13:51:22.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

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0 99 percent BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) MRWPCTD
C58986 Absolute neutrophil count measurement ANCMeasr Measurement of ANC (absolute neutrophil count) per microliter. Measurement of ANC (absolute neutrophil count) per microliter. Record absolute neutrophil count Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 12:13:05.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

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0 99999 Count per microliter BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) D1ANC
C58997 Chimerism assay blood sample indicate code ChmrsmAssyBloodSmplIndCode Code indicating whether a chimerism assay was performed on a blood sample. Code indicating whether a chimerism assay was performed on a blood sample. Was a chimerism assay performed on a blood sample during this assessment period? 1;2;1;2 Yes;No;Yes;No Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 12:27:22.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) MRWCHIM
C58987 Absolute neutrophil count measurement date ANCMeasrDate Date on which ANC (absolute neutrophil count) was measured. Date on which ANC (absolute neutrophil count) was measured. Record date absolute neutrophil count obtained Date or Date & Time Adult;Pediatric Proposed 1.00 2019-01-07 12:15:34.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

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BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) D1ANCDT
C58998 Chimerism assay T cell sample indicate code ChmrsmAssyTCellSmplIndCode Code indicating whether a chimerism assay was performed on a T cell sample. Code indicating whether a chimerism assay was performed on a T cell sample. Was a chimerism assay performed on a T cell sample during this assessment period? 1;2;1;2 Yes;No;Yes;No Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 12:27:22.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) MRWCHIM
C58988 Absolute neutrophil count most recent measurement ANCMostRecentMeasr Measurement of the most recent ANC (absolute neutrophil count) per microliter. Measurement of the most recent ANC (absolute neutrophil count) per microliter. Record the most recent absolute neutrophil count Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 12:20:14.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

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0 99999 Count per microliter BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) RECNTANC
C58999 Chimerism assay T cell sample type code ChmrsmAssyTCellSamplTypCode Code denoting the type of T cell sample on which a chimerism assay was performed. Code denoting the type of T cell sample on which a chimerism assay was performed. Record the type of T cell sample 1;2 Blood;Marrow Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 13:59:59.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) TCLTYPE
C58989 Absolute neutrophil count most recent measurement date ANCMstRctMeasrDate Date of the most recent measurement of the patient's ANC (absolute neutrophil count). Date of the most recent measurement of the patient's ANC (absolute neutrophil count). Date most recent absolute neutrophil count obtained Date or Date & Time Adult;Pediatric Proposed 1.00 2019-01-07 12:22:22.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

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BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) RCTANCDT
C59000 Chimerism assay myeloid cell sample indicate code ChmrsmAssyMyldClSmplIndCode Code indicating whether a chimerism assay was performed on a myeloid cell sample. Code indicating whether a chimerism assay was performed on a myeloid cell sample. Was a chimerism assay performed on a myeloid cell sample during this assessment period? 1;2;1;2 Yes;No;Yes;No Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 12:27:22.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) MRWCHIM
C01701 Lab specimen collection date and time LabSpecmnCollDateTime Date (and time if applicable and known) when the specimen was collected Date (and time if applicable and known) when the specimen was collected Record date specimen collected Date or Date & Time Adult;Pediatric Proposed 3.00 2013-07-25 08:54:08.2 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

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DeBaun Forms
C58990 Chimerism assay marrow sample indicate code ChmrsmAssyMrrwSmplIndCode Code indicating whether a chimerism assay was performed on a marrow sample. Code indicating whether a chimerism assay was performed on a marrow sample. Was a chimerism assay performed on a marrow sample during this assessment period? 1;2;1;2 Yes;No;Yes;No Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 12:27:22.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) MRWCHIM
C59001 Chimerism sort myeloid cell type code ChmrsmSrtMyldClTypCode Code denoting the type of myeloid cell by which the chimerism was sorted. Code denoting the type of myeloid cell by which the chimerism was sorted. Record the cell type by which the chimerism was sorted 1;2 CD15+;CD33+ Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 14:04:22.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) MYELCELL
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 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant 4000

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DeBaun Forms
C58991 Chimerism assay evaluation method code ChmrsmAssyEvalMethodCode Code denoting the method of evaluation used in the chimerism assay being recorded. Code denoting the method of evaluation used in the chimerism assay being recorded. Record method of evaluation 1;2;3;4;5;9 Standard cytogenetics;Fluorescent in situ hybridization (FISH);Restriction fragment length polymorphisms (RFLP);Polymerase chain reaction (PCR) [VNTR, STR, micro or mini satellite];HLA serotyping;Other, specify Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 12:32:08.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) MRWMTHD
C59002 Chimerism assay myeloid cell sample type code ChmrsmAssyMyldCellSamplTypCode Code denoting the type of myeloid cell sample on which a chimerism assay was performed. Code denoting the type of myeloid cell sample on which a chimerism assay was performed. Record the type of myeloid cell sample 1;2 Blood;Marrow Numeric Values Adult;Pediatric Proposed 1.00 2019-01-07 13:59:59.0 Hematopoiesis Form Treatment/Intervention Data Transplantation/Stem Cell Transplant

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Hematopoiesis Form (HF6) TCLTYPE
24 results.
CSV