Contents

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.