Contents

Purpose

 

Chronic GVHD - Characteristics at Enrollment eCRF

Field Name

Description / Instructions

Format

Visit Date

The Visit Date is required.

DD-MMM-YYYY

cGVHD Original Seattle Classification

 

  • EXTENSIVE - Extensive Involvement
  • LIMITED - Limited Involvement
 Use pick list
cGVHD Revised Seattle Classification

 

  • EXTENSIVE - Extensive Involvement
  • LIMITED - Limited Involvement
 Use pick list
Organs Involved Select up to 9 organs involved from the pick list.  Use pick list
Current cGVHD Systemic Therapy?

 

  • NO
  • YES
 Use pick list
Agent Name Select up to 5 generic agents from the pick list if currently under systemic cGVHD therapy. Use pick list
Weight   Number (99.999)
% Change in Last (3) months   Number (99)
Weight Change

 

  • GAIN - Weight Gain
  • LOSS - Weight loss
  • STABLE - Stable Weight
 Use pick list
Date of Biopsy   DD-MMM-YYYY
Organ Select the organ from the picklist. Use pick list
Findings Enter the biopsy finding results. 200 characters
Autoimmune Manifestations List   200 characters 

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/OD) [E] on Jul 30, 2013