Stem Cell Transplantation. Maturity Level: 2 - Ready for Review

Progressive SCT number

Progressive number of diagnosis

Progressive number of relapse/progression (after FLT)

Please Identify the institution were the procedure was performed

Institution description

Institution name

Institution address

Institution city

Institution country

Date of the reinfusion of hematopoietic stem cells. If the date is unkown or partially missed insert the year at the best of your knowledge.

Indicate if the transplant was autologous or allogeneic. 1 = Autologous 2 = Allogeneic -9922 = NK

Define the type of donor in case of allogenic transplant, 1 = matched related 2 = matched unrelated 3 = mismatch related 4 = mismatch unrelated 5 = haplo-identical -9922 = NK

1 = matched related ? sibling 2 = matched related ? parent 3 = matched related ? other (e.g. cousin) -9922 = NK

Indicate the source of cells 1 = PBSC 2 = Bone marrow 3 = Cord -9922 = NK

Please list the drugs (name) and radiotherapy used or the conditioning regimen. These drugs contribute to the calculation of cumulative doses received by the patient reported in the chemotherapy section. Here it is requested only the names of the drugs and if possible the dosage used (only for possible information in the future). No calculations are made on these data.

Graft Versus Host Disease

State if any GVHD prophylaxis was given. Details on the drug names used for GVHD prophylaxis should be listed in the chemotherapy section under 'immunotherapy'). 1 => Yes 2 => No -9922 => NK

GVHD Acute

Please State if acute GVHD occurred 1 => Yes 2 => No -9922 => NK

If yes, state the maximum grade of acute GVHD.

1 => 1 2 => 2 3 => 3 4 => 4 -9922 => NK

Define the starting date of GVHD. If the date is unkown or partially missed insert the year at the best of your knowledge.

Define the ending date of GVHD. If the date is unkown or partially missed insert the year at the best of your knowledge.

GVHD Chronic

Please State if chronic GVHD occurred 1 => Yes 2 => No -9922 => NK

If yes, state the maximum grade of chronic GVHD 1 => Limited 2 => Extensive -9922 => NK

Please Define the starting date of GVHD. If the date is unkown or partially missed insert the year at the best of your knowledge.

Please Define the ending date of GVHD. If the date is unkown or partially missed insert the year at the best of your knowledge.

Please List organs affected by GVHD

Blood before transplant

Blood type before transplant 1 => A 2 => B 3 => AB 4 => O -9922 => NK

Rh factor before transplant 1 => + 2 => - -9922 => NK

Blood after transplant

Blood type after transplant 1 => A 2 => B 3 => AB 4 => O -9922 => NK

Rh factor after transplant 1 => + 2 => - -9922 => NK

Date of end of immunosuppressive treatment. If the date is unkown or partially missed insert the year at the best of your knowledge.

Stem Cell Transplantation. Maturity Level: 2 - Ready for Review

Progressive SCT number

Progressive number of diagnosis

Progressive number of relapse/progression (after FLT)

Please Identify the institution were the procedure was performed

Institution description

Institution name

Institution address

Institution city

Institution country

Date of the reinfusion of hematopoietic stem cells. If the date is unkown or partially missed insert the year at the best of your knowledge.

Indicate if the transplant was autologous or allogeneic. 1 = Autologous 2 = Allogeneic -9922 = NK

Define the type of donor in case of allogenic transplant, 1 = matched related 2 = matched unrelated 3 = mismatch related 4 = mismatch unrelated 5 = haplo-identical -9922 = NK

1 = matched related ? sibling 2 = matched related ? parent 3 = matched related ? other (e.g. cousin) -9922 = NK

Indicate the source of cells 1 = PBSC 2 = Bone marrow 3 = Cord -9922 = NK

Please list the drugs (name) and radiotherapy used or the conditioning regimen. These drugs contribute to the calculation of cumulative doses received by the patient reported in the chemotherapy section. Here it is requested only the names of the drugs and if possible the dosage used (only for possible information in the future). No calculations are made on these data.

Graft Versus Host Disease

State if any GVHD prophylaxis was given. Details on the drug names used for GVHD prophylaxis should be listed in the chemotherapy section under 'immunotherapy'). 1 => Yes 2 => No -9922 => NK

GVHD Acute

Please State if acute GVHD occurred 1 => Yes 2 => No -9922 => NK

If yes, state the maximum grade of acute GVHD.

1 => 1 2 => 2 3 => 3 4 => 4 -9922 => NK

Define the starting date of GVHD. If the date is unkown or partially missed insert the year at the best of your knowledge.

Define the ending date of GVHD. If the date is unkown or partially missed insert the year at the best of your knowledge.

GVHD Chronic

Please State if chronic GVHD occurred 1 => Yes 2 => No -9922 => NK

If yes, state the maximum grade of chronic GVHD 1 => Limited 2 => Extensive -9922 => NK

Please Define the starting date of GVHD. If the date is unkown or partially missed insert the year at the best of your knowledge.

Please Define the ending date of GVHD. If the date is unkown or partially missed insert the year at the best of your knowledge.

Please List organs affected by GVHD

Blood before transplant

Blood type before transplant 1 => A 2 => B 3 => AB 4 => O -9922 => NK

Rh factor before transplant 1 => + 2 => - -9922 => NK

Blood after transplant

Blood type after transplant 1 => A 2 => B 3 => AB 4 => O -9922 => NK

Rh factor after transplant 1 => + 2 => - -9922 => NK

Date of end of immunosuppressive treatment. If the date is unkown or partially missed insert the year at the best of your knowledge.

Stem Cell Transplantation. Maturity Level: 2 - Ready for Review

Progressive SCT number

Progressive number of diagnosis

Progressive number of relapse/progression (after FLT)

Please Identify the institution were the procedure was performed

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Institution description

Institution name

Institution address

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Institution city

Institution country

Date of the reinfusion of hematopoietic stem cells. If the date is unkown or partially missed insert the year at the best of your knowledge.

Indicate if the transplant was autologous or allogeneic. 1 = Autologous 2 = Allogeneic -9922 = NK

Define the type of donor in case of allogenic transplant, 1 = matched related 2 = matched unrelated 3 = mismatch related 4 = mismatch unrelated 5 = haplo-identical -9922 = NK

1 = matched related ? sibling 2 = matched related ? parent 3 = matched related ? other (e.g. cousin) -9922 = NK

Indicate the source of cells 1 = PBSC 2 = Bone marrow 3 = Cord -9922 = NK

Please list the drugs (name) and radiotherapy used or the conditioning regimen. These drugs contribute to the calculation of cumulative doses received by the patient reported in the chemotherapy section. Here it is requested only the names of the drugs and if possible the dosage used (only for possible information in the future). No calculations are made on these data.

Graft Versus Host Disease

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

State if any GVHD prophylaxis was given. Details on the drug names used for GVHD prophylaxis should be listed in the chemotherapy section under 'immunotherapy'). 1 => Yes 2 => No -9922 => NK

GVHD Acute

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Please State if acute GVHD occurred 1 => Yes 2 => No -9922 => NK

If yes, state the maximum grade of acute GVHD.

1 => 1 2 => 2 3 => 3 4 => 4 -9922 => NK

Define the starting date of GVHD. If the date is unkown or partially missed insert the year at the best of your knowledge.

Define the ending date of GVHD. If the date is unkown or partially missed insert the year at the best of your knowledge.

GVHD Chronic

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Please State if chronic GVHD occurred 1 => Yes 2 => No -9922 => NK

If yes, state the maximum grade of chronic GVHD 1 => Limited 2 => Extensive -9922 => NK

Please Define the starting date of GVHD. If the date is unkown or partially missed insert the year at the best of your knowledge.

Please Define the ending date of GVHD. If the date is unkown or partially missed insert the year at the best of your knowledge.

Please List organs affected by GVHD

Blood before transplant

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Blood type before transplant 1 => A 2 => B 3 => AB 4 => O -9922 => NK

Rh factor before transplant 1 => + 2 => - -9922 => NK

Blood after transplant

Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.

May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

• value @ url

May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions.

Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).

Modifier extensions allow for extensions that cannot be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions.

There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Blood type after transplant 1 => A 2 => B 3 => AB 4 => O -9922 => NK

Rh factor after transplant 1 => + 2 => - -9922 => NK

Date of end of immunosuppressive treatment. If the date is unkown or partially missed insert the year at the best of your knowledge.