Sub-Domain: Additional Proposed Instruments
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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C58585 | Blood marrow transplant donor type code | BloodMarowTrnsplntDonorTypCode | Code for the type of donor being considered for blood or marrow transplant. | Code for the type of donor being considered for blood or marrow transplant. | Donor type | 1;2 | Unrelated Cord Blood;Related Haploidentical | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-10-23 12:07:12.0 | HLA Form - 1507 | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 15070 Release 5.10 | HLA Form - 1507 (H05) | HXXDNTYP | |||||||||||||||||||||||||||
C59125 | Match score calculated recipient to donor HLA locus A text | MtchScrCalcRecipDonrHLALocATxt | Text field for recording the recipient-to-donor calculated match score for HLA (Human Leukocyte Antigen) locus A. | Text field for recording the recipient-to-donor calculated match score for HLA (Human Leukocyte Antigen) locus A. | Recipient-to-Donor Locus A calculated HLA Match Score | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-22 11:42:41.0 | HLA Form - 1507 | Additional Proposed Instruments | Other | 5 |
Free-Form Entry |
BMTCTN | 15070 Release 5.10 | HLA Form - 1507 (H05) | HXXSCRA | ||||||||||||||||||||||||||||
C59126 | Match score calculated recipient to donor HLA locus B text | MtchScrCalcRecipDonrHLALocBTxt | Text field for recording the recipient-to-donor calculated match score for HLA (Human Leukocyte Antigen) locus B. | Text field for recording the recipient-to-donor calculated match score for HLA (Human Leukocyte Antigen) locus B. | Recipient-to-Donor Locus B calculated HLA Match Score | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-22 11:42:41.0 | HLA Form - 1507 | Additional Proposed Instruments | Other | 5 |
Free-Form Entry |
BMTCTN | 15070 Release 5.10 | HLA Form - 1507 (H05) | HXXSCRB | ||||||||||||||||||||||||||||
C59127 | Match score calculated recipient to donor HLA locus C text | MtchScrCalcRecipDonrHLALocCTxt | Text field for recording the recipient-to-donor calculated match score for HLA (Human Leukocyte Antigen) locus C. | Text field for recording the recipient-to-donor calculated match score for HLA (Human Leukocyte Antigen) locus C. | Recipient-to-Donor Locus C calculated HLA Match Score | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-22 11:42:41.0 | HLA Form - 1507 | Additional Proposed Instruments | Other | 5 |
Free-Form Entry |
BMTCTN | 15070 Release 5.10 | HLA Form - 1507 (H05) | HXXSCRC | ||||||||||||||||||||||||||||
C59128 | Match score calculated recipient to donor HLA locus DRB1 text | MtchScrCalRecDonrHLALocDRB1Txt | Text field for recording the recipient-to-donor calculated match score for HLA (Human Leukocyte Antigen) locus DRB1. | Text field for recording the recipient-to-donor calculated match score for HLA (Human Leukocyte Antigen) locus DRB1. | Recipient-to-Donor Locus DRB1 calculated HLA Match Score | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-22 11:42:41.0 | HLA Form - 1507 | Additional Proposed Instruments | Other | 5 |
Free-Form Entry |
BMTCTN | 15070 Release 5.10 | HLA Form - 1507 (H05) | HXXSCRD | ||||||||||||||||||||||||||||
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 | HLA Form - 1507 | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
DeBaun Forms | |||||||||||||||||||||||||||||||
C59129 | Match score calculated recipient to donor HLA locus DQB1 text | MtchScrCalRecDonrHLALocDQB1Txt | Text field for recording the recipient-to-donor calculated match score for HLA (Human Leukocyte Antigen) locus DQB1. | Text field for recording the recipient-to-donor calculated match score for HLA (Human Leukocyte Antigen) locus DQB1. | Recipient-to-Donor Locus DQB1 calculated HLA Match Score | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-22 11:42:41.0 | HLA Form - 1507 | Additional Proposed Instruments | Other | 5 |
Free-Form Entry |
BMTCTN | 15070 Release 5.10 | HLA Form - 1507 (H05) | HXXSCRQ | ||||||||||||||||||||||||||||
C58580 | Transplant role type | TransplantRoleTyp | Type of role in the transplant that is occupied by the person for whom data are being recorded. | Type of role in the transplant that is occupied by the person for whom data are being recorded. | Recipient or Donor? | Recipient;Donor | Recipient;Donor | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2018-10-23 11:12:47.0 | HLA Form - 1507 | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 15070 Release 5.10 | HLA Form - 1507 (H05) | n/a | |||||||||||||||||||||||||||
C59130 | Match score total calculated recipient to donor HLA text | MtchScrTotlCalRecDonrHLATxt | Text field for recording the recipient-to-donor total calculated match score for HLA (Human Leukocyte Antigen). | Text field for recording the recipient-to-donor total calculated match score for HLA (Human Leukocyte Antigen). | Recipient-to-Donor total calculated HLA Match Score | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-22 11:42:41.0 | HLA Form - 1507 | Additional Proposed Instruments | Other | 7 |
Free-Form Entry |
BMTCTN | 15070 Release 5.10 | HLA Form - 1507 (H05) | HXXHLA | ||||||||||||||||||||||||||||
C58581 | Human leukocyte antigen typing gene locus code | HLATypngGeneLocusCode | Code identifying the gene locus for the human leukocyte antigen (HLA) being typed. | Code identifying the gene locus for the human leukocyte antigen (HLA) being typed. | HLA locus | HLA-A;HLA-B;HLA-C;HLA-DQB1;HLA-DRB1 | HLA-A;HLA-B;HLA-C;HLA-DQB1;HLA-DRB1 | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2018-10-23 11:25:56.0 | HLA Form - 1507 | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 15070 Release 5.10 | HLA Form - 1507 (H05) | n/a | |||||||||||||||||||||||||||
C59131 | Institutional HLA match score recipient to donor category | InstlHLAMtchScrRecipToDonrCat | Category of institution's HLA (Human Leukocyte Antigen) match score for recipient to donor. | Category of institution's HLA (Human Leukocyte Antigen) match score for recipient to donor. | Indicate your institution's HLA Match Score for Recipient-to-Donor | 0/6;1/6;2/6;3/6;4/6;5/6;6/6;0/8;1/8;2/8;3/8;4/8;5/8;6/8;7/8;8/8 | 0/6;1/6;2/6;3/6;4/6;5/6;6/6;0/8;1/8;2/8;3/8;4/8;5/8;6/8;7/8;8/8 | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-22 11:55:41.0 | HLA Form - 1507 | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 15070 Release 5.10 | HLA Form - 1507 (H05) | HXXSISC | |||||||||||||||||||||||||||
C58582 | Genetic typing method code | GeneticTypingMethodCode | Code for the type of method used for genetic typing. | Code for the type of method used for genetic typing. | Typing method | 1;2 | DNA Technology;Serology | Numeric Values |
DNA based typing: DNA typing is allele level typing and determines HLA alleles by looking at the sequence of the DNA. Serologic typing: Serologic typing is antigen level typing and determines an HLA group of alleles by looking at the proteins expressed on the cell surface. If you are unsure whether the typing method used is DNA based or Serologic, follow up with your HLA lab. |
Adult;Pediatric | Proposed | 1.00 | 2018-10-23 11:52:51.0 | HLA Form - 1507 | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 15070 Release 5.10 | HLA Form - 1507 (H05) | HXXRAMET | ||||||||||||||||||||||||||
C58583 | Human leukocyte antigen typing allele 1 code | HLATypingAllele1Code | Code for the first allele reported for the specified gene locus using the specified human leukocyte antigen (HLA) typing method. | Code for the first allele reported for the specified gene locus using the specified human leukocyte antigen (HLA) typing method. | 1st allele | Alphanumeric |
DNA based typing: Laboratories may use '/', '-' or a combination of numbers and letters on the typing report as a shorthand notation for the results. The letters, called allele codes, will be 1 or more characters in length and represent a combination of possible alleles at a locus. The same allele combination may be reported several different ways (e.g., DRB*01:01 or 01:02, DRB1*01:01/01:02, DRB1*01:01/02, or DRB1*01:AB). Transcribe the information onto the form as directly as possible. If 2 digits are reported for DNA based typing (e.g., HLA-A*02), enter the two digits followed by 'xx' (e.g., 02:xx). Serologic typing: Serologic typing is antigen level typing and determines an HLA group of alleles by looking at the proteins expressed on the cell surface. Serologic typing is reported as either 1 or 2 digits (e.g., 18 or 2). Leading zeros should not be entered for serologic typing; otherwise serologic typing results should be entered exactly as they appear on the report. |
Adult;Pediatric | Proposed | 1.00 | 2018-10-23 12:00:40.0 | HLA Form - 1507 | Additional Proposed Instruments | Other | 100 |
Free-Form Entry |
BMTCTN | 15070 Release 5.10 | HLA Form - 1507 (H05) | HXXA1REC | |||||||||||||||||||||||||||
C58584 | Human leukocyte antigen typing allele 2 code | HLATypingAllele2Code | Code for the second allele reported for the specified gene locus using the specified human leukocyte antigen (HLA) typing method. | Code for the second allele reported for the specified gene locus using the specified human leukocyte antigen (HLA) typing method. | 2nd allele | Alphanumeric |
If only one allele is reported for a locus (homozygous), the value should be entered for both the 1st and 2nd alleles. |
Adult;Pediatric | Proposed | 1.00 | 2018-10-23 12:00:40.0 | HLA Form - 1507 | Additional Proposed Instruments | Other | 100 |
Free-Form Entry |
BMTCTN | 15070 Release 5.10 | HLA Form - 1507 (H05) | HXXA2REC |