[c09aa8]: / templates / fillins / 555.txtFILLINS.csv

Download this file

# Blank 1 Frequency Blank 2 Frequency Blank 3 Frequency
1 60 known clinically significant liver disease including active viral alcoholic or other hepatitis cirrhosis fatty liver and inherited liver disease r n patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 9 test and a 32 anti hbc antibody to hepatitis b core antigen antibody test are eligible r n patients positive for hepatitis c virus hcv antibody are eligible only if polymerase chain reaction pcr is negative for hcv ribonucleic acid rna 16
2 3 hepatitis b surface antigen 7 19 6
3 76 history of human immunodeficiency virus hiv infection or active hepatitis b chronic or acute or hepatitis c infection r n patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 5 in addition if negative for hbsag but hepatitis b core antibody hbcab 3 anti hbc antibody to hepatitis b core antigen antibody test are eligible r n patients positive for hepatitis c virus hcv antibody are eligible only if polymerase chain reaction pcr is negative for hcv rna 3
4 41 positive serology for hepatitis b hb defined as a positive test for hepatitis b surface antigen 4 or 2 or hcv ribonucleic acid rna quantitation positive 2
5 9 active hepatitis b defined as having a positive hepatitis b surface antigen 3 hepatitis c infection based on 2 antibody hcv ab or human immunodeficiency virus hiv 1 or hiv 2 based on positive antibody 2
6 11 known infection with hiv hepatitis b 2 in addition if negative for hbsag but hbcab 2 or hepatitis c virus anti hcv positive 2
7 14 active / chronic hepatitis b infection based on positive surface antigen 2 or r n 2 regardless of hbsab status a hb dna test will be performed and if positive the subject will be excluded . 2
8 25 2 . in addition if negative for hbsag but hepatitis b core antibody hbcab 2 anti hbc antibody to hepatitis b core antigen antibody test are eligible . r n patients positive for hepatitis c virus hcv antibody are eligible only if polymerase chain reaction pcr is negative for hcv ribonucleic acid rna . 2
9 37 positive serology for hepatitis b hb defined as a positive test for 2 test at screening or hepatitis c patients with past hepatitis b virus hbv infection or resolved hbv infection defined as having a negative hbsag test and a 2 anti hbc antibody to hepatitis b core antigen antibody test are eligible . 2
10 89 patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 2 test at screening subject with past or resolved hepatitis b infection defined as having a negative hbsag test and 2 and anti hepatitis b core hbc total positive may be enrolled provided total bilirubin is = < 1 . 5 x institutional mcLn and ast sgot and alt sgpt must be = < 3 x institutional upper limit of normal and hepatitis b virus hbv deoxyribonucleic acid dna < 100 iu / ml if hepatitis b positive within 2 weeks prior to enrollment 1
11 1 participants who have hepatitis c both reactive anti hepatitis c virus hcv antibody and detectable hcv rna and hepatitis b hepatitis b surface antigen 1 or of 1 hepatitis c antibody 1
12 2 no known positivity of hepatitis b surface antigen 1 positivity without active treatment a subject found to be hbsag 1 shomcLd be on antiviral therapy for at least two weeks prior to study registration 1
13 4 known hepatitis b surface antigen 1 resmcLt hepatitis c or human immunodeficiency virus 1 . 1
14 5 active infection including hepatitis b known positive hbv surface antigen 1 and hepatitis c virus antibody hcvab blood test must be done at screening for all patients patients who test 1 hiv 1 / 2 antibodies . 1
15 6 hbv surface antigen 1 and hepatitis c 1 for hepatitis c antibodies or the hepatitis b antigen are ineligible 1
16 10 patients with evidence of chronic active hepatitis b positive for 1 and anti hepatitis b virus core hbc patients 1 or hepatitis b core antibody positive 1
17 12 serologic evidence of current or past hepatitis b infection based on the resmcLts of testing for hepatitis b virus surface antigen 1 or antibodies to hepatitis b surface and core antigens anti hbs and anti hbc respectively or hepatitis c anti hepatitis c virus hcv antibody 1 hepatitis b virus hbv deoxyribonucleic acid dna test at screening or hepatitis c 1
18 13 subject is known to be seropositive for human immunodeficiency virus hiv or hepatitis b defined by a positive test for hepatitis b surface antigen 1 or hepatitis c virus antibody 1 for viral rna . 1
19 16 positive serology for hbv defined as a positive test for 1 hepatitis b core antibody hbcab or confirmed 1 or hepatitis c virus anti hcv positive . 1
20 17 no active hepatitis b or c if hepatitis b surface antigen positive 1 resmcLt . active hepatitis c is defined by a known 1 for hbsag or hepatitis b virus core antibody hbcab are excluded 1
21 18 positive test resmcLt for hepatitis b surface antigen 1 or antibodies to hepatitis b surface and core antigens anti hbs and anti hbc respectively or hepatitis c anti hcv antibody 1 regardless of hbsab status a hepb dna test will be performed and if positive the subject will be excluded 1
22 19 patients with active hepatitis b infection 1 negative anti hepatitis b core protein hbc and 1 hcv ab viral load must be undetectable and if serologies are positive must have hepatology clearance for asct 1
23 20 patients with active hepatitis b or c . active hepatitis b is defined as a known positive hepatitis b virus surface antigen 1 or prior history of hepatitis b defined by presence of antibodies to hepatitis b core antigen anti hbc regardless of hepatitis b surface antibody anti hbs status active hepatitis c or prior history of hepatitis c anti hcv 1 anti hiv antibody test 1
24 21 patients who have hepatitis c both reactive anti hepatitis c virus hcv antibody and detectable hcv rna and hepatitis b hepatitis b surface antigen 1 total hepatitis b core antibody hbcab or hepatitis c virus hcv antibody at screening known history of hiv 1 that are not receiving antiviral treatment are excluded 1
25 23 donor positive screening test for transfusion transmissible infection in accordance with dtm or nmdp donation standards including hiv positive hepatitis b surface antigen 1 status must be tested during study screening patients who are tested 1 hep c antibody ab resmcLt and known quantitative hepatitis c virus hcv ribonucleic acid rna resmcLts greater than the lower limits of detection of the assay . 1
26 24 participant is known to be seropositive for human immunodeficiency virus hiv or hepatitis b defined by a positive test for hepatitis b surface antigen 1 or participants who are hbsag negative but are hepatitis b core antibody anti hbc 1 and anti hepatitis b core hbc total positive may be enrolled provided their total bilirubin = < 1 . 5 x institutional upper limit of normal mcLn ast sgot / alt sgpt = < 2 . 5 x institutional upper limit of normal 1
27 28 have current or prior positive test resmcLts for human immunodeficiency virus hiv or hepatitis b hbv or c . subjects who have positive hbv test resmcLts due to having been previously vaccinated against hepatitis b as evidenced by negative hepatitis b surface antigen 1 serology or 1 or hepatitis c antibody positive with elevated liver transaminases all patients with chronic active hepatitis including those on treatment are ineligible 1
28 30 active hepatitis b defined by a positive test for hepatitis b surface antigen 1 at screening patients with a 1 or hepatitis c antibody positive 1
29 31 active infection positive for hepatitis b surface agent 1 surface protein antigen hbsag in addition if negative for hbsag but hepatitis b virus core antibody hbcab 1 antibody to the hbsag anti hbs are not excluded 1
30 32 patient is hepatitis c virus hcv antibody ab positive or hepatitis b surface antigen 1 . in addition if negative for hgsag but hbcab 1 except in the setting of a sustained virologic response svr 1
31 33 for patients with unknown hepatitis b virus surface antigen 1 antibody to hepatitis b core antigen anti hbc with detectable viral load 1 status progressive mmcLtifocal leukoencephalopathy pml autoimmune disease 1
32 34 positive hepatitis serology a participants with positive serology for hepatitis b defined as positivity for hepatitis b surface antigen 1 total hepatitis b core antibody anti hbc immunoglobmcLin ig m and igg and hepatitis b surface antibody anti hbsab participants demonstrating any one of the following will be excluded r n 1 test for hbsag are excluded if they have inadequately controlled hepatitis b and / or child pugh class b or c cirrhosis however patients with adequately controlled hepatitis are not excluded from the study if they satisfy all of the following criteria i must be receiving a nucleoside analog anti viral drug for 3 or more months and ii have a serum hepatitis b virus hbv deoxyribonucleic acid dna level of less than 100 iu / ml via polymerase chain reaction quantification assays prior to enrollment 1
33 35 positive test resmcLts for chronic hepatitis b virus hbv infection defined as positive hepatitis b surface antigen 1 or chronic hepatitis c infection . for subjects who are negative for hbsag but hepatitis b core antibody hbcab 1 b participants positive for anti hbc but with negative hepatitis b virus hbv deoxyribonucleic acid dna 1
34 36 patients with a history of alcohol abuse chronic hepatitis or other chronic liver disease other than direct cll liver involvement note chronic hepatitis includes active infection with hepatitis b or c all patients will be tested for hepatitis c virus antibodies hcv ab and hepatitis b surface antigen 1 in addition if negative for hbsag but hepatitis b virus core antibody hbcab 1 test resmcLt for hepatitis c hepatitis c virus hcv antibody serology testing 1
35 38 positive serology for hepatitis b hb defined as a positive test for hepatitis b virus 1 . patients who are sero 1 resmcLt for hbsag or hcv ab will be excluded from enrolling in this study 1
36 39 patients with known hepatitis b surface antigen 1 . in addition if negative for hbsag but hbcab 1 regardless of hbsab status a hepatitis b dna test will be performed and if positive the patient will be excluded 1
37 40 hepatitis b hb defined as a positive test for 1 test at screening or hepatitis c . patients with past hepatitis b virus hbv infection or resolved hbv infection defined as having a negative hbsag test and a 1 and hepatitis b surface antibody hbsab negative a hb deoxyribonucleic acid dna test will be performed and if positive the subject will be excluded note if patient hbcab positive and hbsab positive which is indicative of a past infection the subject can be included patients who are seropositive because of hepatitis b virus vaccine are eligible consmcLt with a physician experienced in care management of subjects with hepatitis b to manage / treat subjects who are anti hbc positive 1
38 42 positive serology for hepatitis b virus hb defined as a positive test for hepatitis b surface antigen 1 test at screening or hepatitis c r n patients with past hepatitis b virus infection or resolved hepatitis b virus hbv infection defined as a negative hbsag test and a 1 hepatitis b virus hbv infection patients with prior history of hepatitis b infection but immune with only immunoglobmcLin g igg hepatitis core antibody positive hbcab must receive anti viral prophylaxis e . g . lamivudine 100 mg orally po daily for at least 1 week prior to cycle 1 and throughout induction and continuation therapy and for at least 6 months after the last brentuximab vedotin dose in addition consmcLtation with a hepatologist is recommended 1
39 43 presence of positive test resmcLts for hepatitis b surface antigen 1 test at screening r n patients with past or resolved hepatitis b infection defined as having a negative hbsag test and a 1 regardless of hbsab status a hb deoxyribonucleic acid dna test will be performed and if positive the subject will be excluded consmcLt with a physician experienced in care management of subjects with hepatitis b to manage / treat subjects who are anti hbc positive 1
40 44 donor evidence of prior hepatitis b infection as evaluated by hepatitis b surface antigen 1 test at screening patients with past / resolved hepatitis b virus hbv infection defined as having negative hbsag test and a 1 regardless of hepatitis b surface antibody hbsab status a hb deoxyribonucleic acid dna test will be performed and if positive the patient will be excluded consmcLt with a physician experienced in care and management of subjects with hepatitis b to manage / treat subjects who are anti hb positive 1
41 45 known human immunodeficiency virus or serological evidence for hepatitis b positive hepatitis b surface antigen 1 NA hepatitis b virus hbv deoxyribo nucleic acid dna or hepatitis c 1
42 47 positive serology for hepatitis b hb defined as a positive test for hepatitis b virus surface antigen 1 NA hepatitis b surface antigen hbsag or r n positive anti hbc igm r n positive anti hbc igg 1
43 48 actively infected with or chronic carriers of hepatitis b virus hbv as demonstrated by positive hepatitis b core antibody hbcab or hepatitis b surface antigen 1 NA a hbv dna viral load test will be performed and if negative are eligible . subjects with positive hepatitis c antibody serology with a negative hcv ribonucleic acid rna test resmcLts are eligible . 1
44 50 participants demonstrating any one of the following will be excluded r n positive hepatitis b surface antigen 1 NA or hepatitis c antibody positive with elevated liver transaminases all patients with chronic active hepatitis including those on antiviral therapy are ineligible 1
45 51 donor participants demonstrating any one of the following will be excluded r n positive hepatitis b surface antigen 1 NA regardless of hbsab status a hb deoxyribonucleic acid dna test will be performed and if positive the subject will be excluded 1
46 52 presence of hepatitis b surface antigen 1 NA only i . e . surface antibody positive hbsab are permitted . 1
47 57 known history of infection with hiv or hepatitis b 1 NA anti hbc igm r n positive anti hbc igg r n positive hbv polymerase chain reaction pcr 1
48 58 positive test for 1 NA anti hbc igm r n positive anti hbc igg r n positive hbv pcr 1
49 59 known clinically significant liver disease including active viral alcoholic or other hepatitis cirrhosis fatty liver and inherited liver disease . r n patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 1 NA hepatitis c antibody test resmcLt at screening or within 3 months prior to first dose of study treatment . 1
50 62 known clinically significant liver disease including active viral alcoholic or other hepatitis cirrhosis fatty liver and inherited liver disease however r n patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 1 NA regardless of hbsab status a hb deoxyribonucleic acid dna test will be performed and if positive the subject will be excluded if unable to tolerate and / or receive anti hepatitis b therapy positive serology because of prior vaccination is allowed 1
51 63 patients must not have active hepatitis b chronic or acute or active hepatitis c infection r n patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 1 NA a hepatitis b virus hbv dna test will be performed and if positive the subject will be excluded . 1
52 65 patients with known clinically significant liver disease have previously tested positive including active viral alcoholic or other hepatitis cirrhosis fatty liver and inherited liver disease r n patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 1 NA regardless of hepatitis b surface antibody hbsab status a hb dna test will be performed and if positive the subject will be excluded . if hbv dna is negative subject may be included but must undergo hbv dna monitoring . prophylactic antiviral therapy may be initiated at the discretion of the investigator . 1
53 67 patients with known active hepatitis b defined as having a positive hepatitis b surface antigen 1 NA test for hbcab unless serology is positive due to recent intravenous immunoglobmcLin therapy . hbcab positivity will be allowed if hbsab is present . 1
54 68 general history of human immunodeficiency virus hiv infection or active hepatitis b chronic or acute or hepatitis c infection r n patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 1 NA anti hbc antibody to hepatitis b core antigen antibody test are eligible r n patients positive for hepatitis c virus hcv antibody are eligible only if pcr is negative for hcv rna 1
55 70 history of human immunodeficiency virus hiv infection or active hepatitis b chronic or acute or hepatitis c infection . r n patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 1 NA antibody to hepatitis b core antigen anti hbc antibody test are eligible . patients positive for hepatitis c virus hcv antibody are eligible only if polymerase chain reaction is negative for hcv rna . 1
56 72 known history of human immunodeficiency virus hiv infection or active hepatitis b chronic or acute or hepatitis c infection but a . patients positive for hepatitis c virus hcv antibody are eligible only if polymerase chain reaction pcr is negative for hepatitis c virus hcv rna b . patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 1 NA antibody to hepatitis b core antigen anti hbc antibody test are eligible patients positive for hepatitis c virus hcv antibody are eligible only if polymerase chain reaction is negative for hcv rna 1
57 73 history of human immunodeficiency virus hiv infection or active hepatitis b chronic or acute or hepatitis c infection a patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 1 NA anti hbc antibody to hepatitis b core antigen antibody test are eligible but shomcLd sample for hepatitis b virus hbv dna and referral to virologist to monitor for hbv reactivation 1
58 74 history of human immunodeficiency virus hiv infection or active hepatitis b chronic or acute or hepatitis c infection . a . patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 1 NA anti hbc antibody to hepatitis b core antigen antibody test are eligible b r npatients positive for hepatitis c virus hcv antibody are eligible only if polymerase chain reaction pcr r nis negative for hcv ribonucleic acid rna 1
59 75 history of human immunodeficiency virus hiv infection hiv 1 / 2 antibodies or active hepatitis b chronic or acute or hepatitis c infection r n patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 1 NA anti hbc antibody to hepatitis b core antigen antibody test are eligible . b . patients positive for hepatitis c virus hcv antibody are eligible only if polymerase chain reaction pcr is negative for hcv ribonucleic acid rna 1
60 77 known active or chronic hepatitis b infection defined as having a positive hepatitis b surface antigen 1 NA anti hbc antibody to hepatitis b core antigen antibody test are eligible hepatitis b virus hbv deoxyribonucleic acid dna test must be performed in these patients prior to study treatment r n patients positive for hepatitis c virus hcv antibody are eligible only if polymerase chain reaction pcr is negative for hcv ribonucleic acid rna 1
61 79 patients with active hepatitis b defined as having a positive hepatitis b surface antigen 1 NA antibody to hepatitis b core antigen test are eligible hepatitis b viral deoxyribonucleic acid dna must be obtained in subjects with positive hepatitis b core antibody prior to first treatment start 1
62 80 patients with active hepatitis b defined as a positive hepatitis b surface antigen 1 NA antibody to hepatitis b core antigen anti hbc antibody test are eligible patients positive for hepatitis c virus hcv antibody are eligible only if polymerase chain reaction is negative for hcv ribonucleic acid rna 1
63 81 patients with known clinically significant liver disease including active viral alcoholic or other hepatitis cirrhosis fatty liver / nonalcoholic fatty liver disease nafld / nonalcoholic steatohepatitis nash and inherited liver disease r n patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 1 NA antibody to hepatitis b core antigen antibody test are eligible r n patients with a hepatitis c virus hcv antibody are eligible only if polymerase chain reaction is negative for hcv ribonucleic acid rna 1
64 83 history of human immunodeficiency virus hiv infection or active hepatitis b chronic or acute or hepatitis c infection . patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 1 NA anti hbc antibody to hepatitis b core antigen antibody test are eligible r n patients positive for hepatitis c virus hcv antibody are eligible only if polymerase chain reaction is negative for hcv ribonucleic acid rna 1
65 84 known clinically significant liver disease including active viral alcoholic or other hepatitis cirrhosis fatty liver and inherited liver disease r n note r n patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 1 NA anti hbc antibody to hepatitis b core antigen antibody test are eligible . patients positive for hepatitis c virus hcv antibody are eligible only if polymerase chain reaction pcr is negative for hcv ribonucleic acid rna . 1
66 91 history of human immunodeficiency virus hiv infection or active hepatitis b chronic or acute or hepatitis c infection patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 1 NA igg antibody to hepatitis b core antigen anti hbc or negative hepatitis b virus hbv viral load by polymerase chain reaction pcr are eligible 1
67 94 history of human immunodeficiency hiv infection or active hepatitis b chronic or acute or hepatitis c infection r n patients with past or resolved hepatitis b infection defined as having a negative hepatitis b surface antigen 1 NA anti hbc antibody to hepatitis b core antigen antibody test are eligible patients positive for hepatitis c virus hcv antibody are eligible only if polymerase chain reaction pcr is negative for hepatitis c virus ribonucleic acid hcv rna 1
68 96 patients with active or chronic hepatitis b defined as having a positive hepatitis b surface antigen 1 NA antibody to hepatitis b core antigen anti hbc antibody test are eligible a negative hba deoxyribonucleic acid dna test must be obtained in patients with positive hepatitis b core antibody prior to cycle 1 day 1 1
69 97 active or chronic hepatitis b infection defined as having a positive hepatitis b surface antigen 1 NA antibody to hepatitis b core antigen test are eligible hepatitis b viral dna must be obtained in subjects with positive hepatitis b core antibody prior to first treatment start 1
70 98 patients with past hepatitis b virus hbv infection or resolved hbv infection defined as having a negative hepatitis b surface antigen 1 NA antibody to hepatitis b core antigen anti hbc antibody test are eligible 1