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Purpose

 

Chronic GVHD - Composite Assessment Scale eCRF

Field Name

Description / Instructions

Format

Visit Date

The Visit Date is required.

DD-MMM-YYYY

Components (Skin) For each pre-defined component, select the respective score from the pick list. Pre-defined
CAS Score (Skin)
  • 0 - No GVHD
  • 1 - Mild GVHD
  • 2 - Moderate GVHD
  • 3 - Severe GVHG
  • N/A - NOT APPLICABLE
  • NOT ASSESSED - NOT ASSESSED
  • NOT ASSESSED DUE TO AGE RESTRICTION - Not Assessed due to age restriction
  • PARTIALLY ASSESSED DUE TO AGE RESTRICTION - Partially Assessed due to age restriction
Use pick list
Components (Eyes) For each pre-defined component, select the respective score from the pick list. Pre-defined 
CAS Score (Eyes)
  • 0 - No GVHD
  • 1 - Mild GVHD
  • 2 - Moderate GVHD
  • 3 - Severe GVHG
  • N/A - NOT APPLICABLE
  • NOT ASSESSED - NOT ASSESSED
  • NOT ASSESSED DUE TO AGE RESTRICTION - Not Assessed due to age restriction
  • PARTIALLY ASSESSED DUE TO AGE RESTRICTION - Partially Assessed due to age restriction
Use pick list 
Components (Mouth) For each pre-defined component, select the respective score from the pick list. Pre-defined
CAS Score (Mouth)
  • 0 - No GVHD
  • 1 - Mild GVHD
  • 2 - Moderate GVHD
  • 3 - Severe GVHG
  • N/A - NOT APPLICABLE
  • NOT ASSESSED - NOT ASSESSED
  • NOT ASSESSED DUE TO AGE RESTRICTION - Not Assessed due to age restriction
  • PARTIALLY ASSESSED DUE TO AGE RESTRICTION - Partially Assessed due to age restriction
Use pick list
CAS Score (Mouse - Schubert)

Type in the score for component "MOUTH - SCHUBERT ORAL MUCOSITIS RATING SCALE".

Number (999)
Components (Liver) For each pre-defined component, select the respective score from the pick list. Pre-defined
CAS Score (Liver)
  • 0 - No GVHD
  • 1 - Mild GVHD
  • 2 - Moderate GVHD
  • 3 - Severe GVHG
  • N/A - NOT APPLICABLE
  • NOT ASSESSED - NOT ASSESSED
  • NOT ASSESSED DUE TO AGE RESTRICTION - Not Assessed due to age restriction
  • PARTIALLY ASSESSED DUE TO AGE RESTRICTION - Partially Assessed due to age restriction
Use pick list
Components (GI) For each pre-defined component, select the respective score from the pick list. Pre-defined
CAS Score (GI)
  • 0 - No GVHD
  • 1 - Mild GVHD
  • 2 - Moderate GVHD
  • 3 - Severe GVHG
  • N/A - NOT APPLICABLE
  • NOT ASSESSED - NOT ASSESSED
  • NOT ASSESSED DUE TO AGE RESTRICTION - Not Assessed due to age restriction
  • PARTIALLY ASSESSED DUE TO AGE RESTRICTION - Partially Assessed due to age restriction
Use pick list
Components (Lungs) For each pre-defined component, select the respective score from the pick list. Pre-defined
CAS Score (Lungs)
  • 0 - No GVHD
  • 1 - Mild GVHD
  • 2 - Moderate GVHD
  • 3 - Severe GVHG
  • N/A - NOT APPLICABLE
  • NOT ASSESSED - NOT ASSESSED
  • NOT ASSESSED DUE TO AGE RESTRICTION - Not Assessed due to age restriction
  • PARTIALLY ASSESSED DUE TO AGE RESTRICTION - Partially Assessed due to age restriction
Use pick list
Components (Function) For each pre-defined component, select the respective score from the pick list. Pre-defined
CAS Score (Function)
  • 0 - No GVHD
  • 1 - Mild GVHD
  • 2 - Moderate GVHD
  • 3 - Severe GVHG
  • N/A - NOT APPLICABLE
  • NOT ASSESSED - NOT ASSESSED
  • NOT ASSESSED DUE TO AGE RESTRICTION - Not Assessed due to age restriction
  • PARTIALLY ASSESSED DUE TO AGE RESTRICTION - Partially Assessed due to age restriction
Use pick list
(HAP) Criteria For each pre-defined component, type in the the respective score. Pre-defined
(HAP) Score Type in the HAP component's score. Number (9999)
Components (PLT Count) For each pre-defined component, select the respective score from the pick list. Pre-defined
CAS Score (PLT Count)
  • 0 - No GVHD
  • 1 - Mild GVHD
  • 2 - Moderate GVHD
  • 3 - Severe GVHG
  • N/A - NOT APPLICABLE
  • NOT ASSESSED - NOT ASSESSED
  • NOT ASSESSED DUE TO AGE RESTRICTION - Not Assessed due to age restriction
  • PARTIALLY ASSESSED DUE TO AGE RESTRICTION - Partially Assessed due to age restriction
Use pick list
Components (Vulvar/Vaginal) For each pre-defined component, select the respective score from the pick list. Pre-defined
CAS Score (Vulvar/Vaginal)
  • 0 - No GVHD
  • 1 - Mild GVHD
  • 2 - Moderate GVHD
  • 3 - Severe GVHG
  • N/A - NOT APPLICABLE
  • NOT ASSESSED - NOT ASSESSED
  • NOT ASSESSED DUE TO AGE RESTRICTION - Not Assessed due to age restriction
  • PARTIALLY ASSESSED DUE TO AGE RESTRICTION - Partially Assessed due to age restriction
Use pick list
Symptoms 1-6 (Vulvar/Vaginal)

Select from 1 to 6 symptoms fro the pick list.

  • 1 - Erythema around openings of vestibular glands
  • 2 - Generalized erythema/edema of vulva including vestibule
  • 3 - Periurethral or other patchy erythema
  • 4 - Leukokeratosis
  • 5 - Erosions on flat surfaces, most notably on vulva
  • 6 - Fissures in vulvar folds (e.g. interlabial sulci, fourchette)
  • 7 - Increased friability of vulvar mucosa
  • 8 - Vulvar architectural changes such as nearly complete resorption of the labia minora and clitoral agglutination
  • 9 - Vaginal synechiae including shortened vagina
  • 10 - Hematocolpos
  • 11 - Introital stenosis
  • 12 - Myofascial pain/spasm of levator or pelvic floor muscles
Use pick list
Total CAS Score Type in the Total CAS Score. Number (999)

Legend: (d) derived field, (m) RDC mandatory, (c) for CTEP reporting only.

Validations

Code

Description

Resolutions

  There are no validations.  

Derivations

Code

Field Name

Description

  There are no derivations.  
Last updated by Fontinha, Marcelo (NIH/NCI) [C] on Jul 30, 2013