1. HemOnc A New Standard Vocabulary for Chemotherapy Regimen Representation in the OMOP Common Data Model
Jeremy Warner MD, MS, FAMIA
Associate Professor of Medicine and Biomedical Informatics
Vanderbilt University
September 12th, 2019

2. Disclosures Consulting: Westat
Stock ownership: HemOnc.org LLC (no monetary value)
Funding: NIH, AACR

3. Outline Motivation & overview of HemOnc.org
Why another chemotherapy regimen ontology?
The HemOnc regimen model
OMOP CDM and extension
Current status and use cases
Outline

4. Motivation & overview of HemOnc.org

5. Chemotherapeutics are given in complex combination regimens and protocols
Regimen details have traditionally been underspecified or recorded in a non-computable manner
Regimens are not well-represented in current IT systems, leading to an unmet need in data representation
Motivation

6. State of the art, 2001

7. State of the art, 2005

8. State of the art, 2005
Huge range of optionality (dosing, days, cycle length)
References are not specific to the condition being treated

9. “State of the art”, 2019

10. Better, but not machine readable or computable
Both references are to the metastatic or advanced stage setting
Is this the only dosing? (hold that thought)

11. Electronic ≠ Knowledge Base
vs.

12. Knowledge Base (KB) Dimensions
Machine-readable, or not
Internal or External to an Organization
Open vs. Restricted Access ($$, credentials)
Contributors
Users
Curated vs. Collaborative
Breadth vs. Depth
Complete vs. “Under Construction”

13. Example of a Broad, Open, Collaborative KB

14. Example of a Broad, Open, Curated KB

15. Example of a Deep, Open, Curated, Expert-Driven KB

16. Example of a Deep, Restricted-Access KB

17. Multiple Stakeholders
Physicians and Physician Extenders
Choose and order chemotherapy
Nurses
Interpret and carry out orders
Pharmacists
Check order accuracy and compound drugs
Other
Cost and resource decision-makers (e.g. CMO)
Insurance companies (e.g. coverage decisions)
EMR vendors (e.g. standard protocols for CPOE)
Researchers
Registrars!!!!
Physicians and Physician Extenders
Responsible for ordering the “best” chemotherapy regimen for their patients, without introducing errors
Nurses
Responsible for carrying out order sets with toxic drugs, complex timing, and complicated dose calculations
Pharmacists
Responsible for checking order accuracy and preparing drugs with high toxicity and limited shelf-life
Other
Cost and resource decision-makers (e.g. CMO)
Insurance companies (e.g. coverage decisions)
EMR vendors (e.g. standard protocols for CPOE)

18. Yang et al. ASCO Quality Symposium 2013

19. Dosage, including lack of weight-based or BSA-based dosing information
What types of errors or inconsistencies, if any, have you noticed in any of the references you used in the past year?
Error/inconsistency
# respon. %
Dosage, including lack of weight-based or BSA-based dosing information
32/139
23%
Drug name 1
0.7%
Lack of precision or necessary information needed to properly give the regimen (such as missing information about the exact days on which to administer drugs) 76
55%
Route of administration 7 5%
Schedule of administration 35
25%
Spelling/typographical errors that would not affect patient safety 13 9%
Yang et al. ASCO Quality Symposium 2013

20. Our Formative Questions
Can an open collaborative chemotherapy regimen knowledge base, using a wiki platform, be created which is more comprehensive and accurate than existing resources?
What will be the response from users? Will they show support by returning to use it?
What potential do wikis have for being a model of information sharing in medicine?
Slide courtesy of Peter Yang

21. HemOnc.org priorities (2019)
Creating a database of all approved systemic antineoplastic therapy agents and supportive medications used in the field of hematology/oncology.
Creating a database of all standard-of-care systemic antineoplastic therapy regimens and references to primary literature (PubMed and direct links to the abstracts/full articles).
Sample order sets and examples of supportive medications used with treatment regimens
Aggregating useful links to existing resources by disease, such as guidelines, information about prognosis, clinical calculators, staging, and patient resources.

23. LIVE DEMO #1
_Page

24. HemOnc.org – a growing resource
By the numbers
938 content pages
>476k lines of content
>52.6M characters of content
~5800 primary references
>3000 context-specific regimens
~1500 registered users
36 members of editorial board
2018 page views: 1,030,355

26. Semi-structured regimens

29. Why another chemotherapy regimen ontology?

30. First – what is an ontology?

31. From SlideShare
(S. Santhiappan, 2007)

32. From SlideShare
(S. Santhiappan, 2007)

33. Concepts and Relationships

34. SNOMED-CT
6 regimens

35. SEER*Rx
513 regimens, but:
Many are outdated
No concept codes

36. NCI Thesaurus
451 regimens

37. The HemOnc regimen model

38. Supportive medications HemOnc Regimen Model (simplified)
Was studied in
Has study group
Study
Study Group
Was studied in
Has context
Context
Was studied in
Has modality
Has reference
PMID
Has…component
Modality
Has…
Reference
Has accepted use
URL
Component
Condition
Antineoplastics
First author
Middle author
Last author
Title
Was published…
Has…Rx
Supportive medications
NCIT
SNOMED
Journal
Year
RxNorm
Local therapy
Internal relationships
Included in first OHDSI releases
Future OHDSI releases
External relationships
Third OHDSI release (planned)
HemOnc Regimen Model (simplified)

39. Comparison of the terminologies
Terminology
Maps to Drugs
Disease Context
Treatment Context
Modality
Link to Evidence
Number of regimens
SNOMED-CT
Yes* No 6
SEER*Rx
513
NCI Thesaurus
Yes
No**
735
HemOnc
2940***
*Antineoplastics; HemOnc also maps to supportive medications
**In some cases, modality can be inferred
***Includes 1310 regimen “stubs” which are not yet fully specified

40. What do I mean by treatment context?
Cancer is a complicated, often chronic, illness
When a treatment is given can be as important (or more important) than what the treatment is
Rule of thumb #1: curative therapies are more toxic but of shorter duration
Rule of thumb #2: non-curative therapies are usually given until they stop working
Rule of thumb #3: non-curative therapies should be less toxic and focus on improving symptoms

41. The Cancer Care Continuum
Resolution
Sequelae
Late effects
Risk Assessment
Early Diagnosis
Surveillance
Treatment
Early stage, curable (<50%)
Prevention & Diagnosis
Palliative Care
Hospice/EOL..
Treatment
Advanced or relapsed, incurable (>50%)

42. HemOnc treatment contexts (N=33)
All lines of therapy
Curative therapy
Non-curative therapy
Upfront therapy
Salvage therapy
1st line
2nd line
3rd line
Subseq line
See below
Induction
Consolidation
Maintenance
Upfront/Salvage therapy
Pre-definitive therapy
Definitive therapy
Post-definitive therapy
Induction
Adjuvant
Neoadjuvant
Consolidation
Maintenance

43. What do I mean by modality?

44. HemOnc modalities (N=18)
Hormonotherapy
Immunotherapy
Chemotherapy
Radiotherapy
Chemohormonotherapy
Chemoimmunotherapy
Chemoradiotherapy
Chemoradioimmunotherapy
Etc.
Null therapy
Supportive therapy
We are defining surgery as a procedure, not a modality

45. OMOP CDM and extension

46. IMAGE: FINE ART IMAGES/HERITAGE IMAGES/GETTY IMAGE

49. Episodes Disease and treatment abstractions are modeled as episodes
Disease abstractions include: first occurrence, remissions, relapses, and end of life event.
Treatment abstractions include: treatment course, treatment regimen, and treatment cycle.
These abstractions may be derived algorithmically pre- or post-ETL or extracted from the source data directly.
In addition to the regular OMOP type_concept_ID, we propose to store references to the derivation algorithms in the vocabulary.

50. Advantages of Using Episodes
Supports levels of abstraction that are clinically and analytically relevant
Supports explicit connection between a disease/treatment abstraction and lower level events (conditions, procedures, drugs) that are linked to this abstraction
Persists provenance of episode derivation (e.g. directly from source data, algorithmically)
Is generalisable to:
abstraction of other chronic diseases
Representation of episode of care (Gowtham, to be continued)

51. Current status and use cases

52. Concepts Concept class Count Author 29,680 Sig Stub 771 Reference
5,872
Component
575
ReferenceTitle
5,785
Component Class
341
PubMedURL
5,777
Journal
199
ReferenceURL
5,708
Condition
120
Sig*
5,654
Year 82
Study
5,038
Procedure 52
Brand Name
4,050
Condition Class 49
Study name short
2,385
Context (S) 33
Regimen (S)
1,630
BioCondition 24
Regimen Stub
1,310
Modality 18
Study Group
1,008
Route 13
Total unique concepts
76,174
*Includes med, radiation, and cycle sigs

53. Relationships (partial list) Total unique relationships: 186,259
Count
Has middle author
70,628
Has antineopl Rx
4,216
Was studied in
18,719
Has been compared to
3,972
Has URL
5,928
Is current in
2,334
Has last author
5,641
Is historical in
382
Has antineoplastic
4,397
Has FDA indication
320
Total unique relationships: 186,259

54. Example: CapeOx
Concept 1
Relationship Type
Concept 2
Vocab. 1
Vocab. 2
CapeOx
Has modality
Chemotherapy
HemOnc
Has antineoplastic
Capecitabine
Oxaliplatin
Has antineopl Rx
(RxCUI)
RxNorm
(RxCUI) 32592
Has context
Adjuvant_therapy
Non-curative_first- line_therapy
Non-curative_second- line_therapy
Non-curative_third- line_therapy
Non-curative_therapy
Neoadjuvant_therapy
Concept 1
Relationship Type
Concept 2
Vocab. 1
Vocab. 2
CapeOx
Has accepted use
Colon_cancer
HemOnc
Esophageal_cancer
Gastric_cancer
Hepatocellular_carcinoma
Pancreatic_cancer
Rectal_cancer
Is current in
Can be preceded by
Colon_cancer_surgery
CAPIRI
Irinotecan_monotherapy
Gastrectomy
Capecitabine_monotherapy
Capecitabine_and_RT
Not shown are bibliometric relationships, including direct comparison of regimens

55. Supportive medications HemOnc Regimen Model (1st OHDSI release)
Has context
Context
Has…component
Component
Has…Rx
Antineoplastics
Supportive medications
RxNorm
Local therapy
Internal relationships
Included in first OHDSI release
External relationships
HemOnc Regimen Model (1st OHDSI release)

56. Example for regimen FOLFOX in Athena

57. http://athena.ohdsi.org/search- terms/terms/35804755
LIVE DEMO #2
terms/terms/

58. HemOnc Regimen Browser (beta)
Was studied in
Study
Was studied in
Has context
Context
Was studied in
Has accepted use
Has reference
PMID
Condition
Reference
URL
Internal relationships
Included in first OHDSI release
Future OHDSI releases
External relationships
Second OHDSI release (planned)
HemOnc Regimen Browser (beta)

60. https://smartpcm-dev.app.vumc.org/#
LIVE DEMO #3

61. Mapping Components to Regimens
Has accepted use
Condition
Has…Rx
RxNorm
Internal relationships
Included in first OHDSI release
External relationships
Mapping Components to Regimens

62. Project: match drugs to HemOnc regimens
Small (N=36) breast cancer cohort
Data had been curated and stored in REDCap by line of therapy
N=195 treatment exposures

63. Results, cont.
178 (91%) of the lines of therapy matched to a HemOnc regimen
Of these, all but 6 (3.4%) were determined automatically
49 mapped regimens (84.5%) had an accepted use in breast cancer
Reason for no match
# of instances
Example
No drug or regimen names 3
N/A
Regimen name only, with only experimental drugs
PI3K inhibitor GDC-0032
Regimens modeled differently in HemOnc 1
EC-T
Regimen not present in HemOnc; no data to support combination found 10
Gemcitabine, Vinorelbine, Bevacizumab
Total 17

64. Other

65. Supportive medications Finding treatment exposures in free text
Regimen
Has…component
Component
Antineoplastics
Supportive medications
Local therapy
Internal relationships
Included in first OHDSI release
External relationships
Finding treatment exposures in free text

66. Doxorubicin Brand names Adriablastina Cadria Doxorrubicina Lipodox
Adriacept
Carcinocin
Doxorrubicina Colhidrol
Lyphidox
Adriacin
Cloridrato DE
Doxoruben
Nagun
Adriamycin
Daxotel
Doxorubicina
Neoxane
Adriamycine
Deldoxin
Doxorubicine
Nuaze
Adriblastin
Dicladox
Doxorubicinum
Oncodria
Adriblastina
Dobicin
Doxorubin
Onkodox
Adriblastine
Dobixin
Doxotec
Onkostatil
Adricept
Doxo
Doxtie
Pallagicin
Adricin
Doxo Cell
Duxocin
Ranxas
Adrim
Doxobin
Evacet
Rastocin
Adrimedac
Doxocris
Farmiblastina
Ribodoxo
Adrosal
Doxokebir
Fauldoxo
Roxorin
Antraciclin
Doxolem
Flavicina
Rubex
Biorrub
Doxonolver
Ifadox
Varidoxo
Biorubina
Doxor
Kemodoxa
Zodox
Synonyms
FI-106
ADM
hydroxydaunorubicin

67. Rd synonym_name synonym_concept_code synonym_vocabulary_id
language_concept_id Ld
24196
HemOnc
Lenalidomide and Dexamethasone
Lenalidomide and low-dose dexamethasone
LenDex Rd
RevDex
Revlimid (Lenalidomide) and Dexamethasone
Revlimid (Lenalidomide) and low-dose dexamethasone Rd

68. Multiple myeloma regimen acronyms
Cyclophosphamide_.26_Prednisone
Velcade-MP.2C_then_LenDex
Dexamethasone.2C_Cyclophosphamide.2C_Etoposide.2C_Cisplatin
Bendamustine.2C_Lenalidomide.2C_Dexamethasone
M-DEX
Dara-RD
Carfilzomib.2C_Cyclophosphamide.2C_Dexamethasone
Darzalex.2C_Pomalyst.2C_Dexamethasone
IFN-a
Cytoxan.2C_Kyprolis.2C_Thalomid.2C_Dexamethasone
Interferon_alfa_.26_Dex
Kyprolis_,26_Farydak
Velcade-MP
Elotuzumab-Ld
Ixazomib-LenDex
ZLD
Cyclophosphamide.2C_Prednisone
VMP.2C_then_RevDex
Dexamethasone.2C_Cyclophosphamide.2C_Etoposide.2C_Platinol
Bendamustine.2C_Lenalidomide.2C_Dex
M-Dex
Dara-Rd
Carfilzomib.2C_Cyclophosphamide.2C_Dex
Daratumumab.2C_Pomalidomide.2C_Dex
IFN-a_monotherapy
Cyclophosphamide.2C_Carfilzomib.2C_Thalidomide.2C_Dex
IFN-a_.26_Dexamethasone
Panobinostat_.26_Carfilzomib
VMP
Empliciti-RD
Ixazomib-RevDex
ZLd
Cytoxan.2C_Prednisone
VMP.2C_then_LenDex
DCEP
Bendamustine.2C_Revlimid.2C_Dexamethasone
Melphalan_.26_Dexamethasone
Dara-LD
Cyclophosphamide.2C_Carfilzomib.2C_Dex
Daratumumab.2C_Pomalyst.2C_Dex
Interferon
Cyroxan.2C_Kyprolis.2C_Thalomid.2C_Dex
IFN-a_.26_Dex
Farydak_.26_Carfilzomib
MVP
Empliciti-Rd
Ixa-RevDex
ABCM
Cytoxan_Pred
MVP.2C_then_RevDex
Vincristine.2C_Doxorubicin.2C_Dexamethasone
Bendamustine.2C_Revlimid.2C_Dex
Melph_Dex
Dara-Ld
Cyclophosphamide.2C_Carfilzomib.2C_Dexamethasone
Darzalex.2C_Pomalidomide.2C_Dex
Interferon_monotherapy
Cyclophosphamide.2C_Carfilzomib.2C_ThalDex
Interferon_.26_Dexamethasone
Panobinostat_.26_Kyprolis
MPV
Empliciti-RevDex
Ixa-LenDex
mCOP/MP
Cytoxan_.26_Prednisone
MVP.2C_then_LenDex
Oncovin.2C_Adriamycin.2C_Dexamethasone
Bendamustine_RevDex
Melphalan_Dex
Dara-RevDex
Cyclophosphamide.2C_Kyprolis.2C_Dex
Darzalex.2C_Pomalyst.2C_Dex
IFN
Cytoxan.2C_Kyprolis.2C_ThalDex
Interferon_.26_Dex
Farydak_.26_Kyprolis
Bortezomib.2C_Thalidomide.2C_Dexamethasone
Empliciti-LenDex
LenDex-Ixa
Cyclophosphamide.2C_Vincristine.2C_Adriamycin.2C_Melphalan.2C_Prednisone CP
MPV.2C_then_RevDex
Vincristine.2C_Doxorubicin.2C_Dex
Bendamustine_LenDex
Alkeran_Dex
Daratumumab-RD
Cyclophosphamide.2C_Kyprolis.2C_Dexamethasone
Darzalex-PD
IFN_monotherapy
CyKTD
IFN_.26_Dexamethasone
Carfilzomib.2C_Pomalidomide.2C_Dexamethasone
Velcade.2C_Thalidomide.2C_Dexamethasone
Empliciti-LD
RevDex-Ixa
C-VAMP
CyPred
MPV.2C_then_LenDex
Oncovin.2C_Adriamycin.2C_Dex
Bendamustine.2C_RD
Alkeran_Decadron
Daratumumab-LenDex
Cytoxan.2C_Carfilzomib.2C_Dexamethasone
Darzalex-Pd
Alfa_interferon
CyKTd
IFN_.26_Dex
Carfilzomib.2C_Pomalidomide.2C_Dex
Bortezomib.2C_Thalidomide.2C_Dex
Empliciti-Ld
IRd
DEX-IFN
Prednisone_monotherapy
VMP.2C_then_Rd
VAD
Bendamustine.2C_Rd
Alkeran_Deamethasone
Dara-LenDex
Cytoxan.2C_Carfilzomib.2C_Dex
Darzalex-PomDex
Alfa_interferon_monotherapy
CyTKD
Alfa_interferon_.26_Dexamethasone
Carfilzomib.2C_Pomalyst.2C_Dexamethaonse
Bortezomib.2C_ThalDex
Elo-RD
IRD
Interferon_alfa_.26_Dexamethasone
Pred_monotherapy
VMP.2FRd
VAd
Bendamustine.2C_LD MD
Daratumumab-LD
Cytoxan.2C_Kyprolis.2C_Dexamethasone
Darzalex-LD
Intron_A
CyTKd
Alfa_interferon_.26_Dex
Carfilzomib.2C_Pomalyst.2C_Dex
Velcade.2C_Thalidomide.2C_Dex
Elo-Rd
ILD
Pred
VMP/Rd
Carfilzomib.2C_Thalidomide.2C_Dexamethasone
Bendamustine.2C_Ld MP
Daratumumab-Ld
Cytoxan.2C_Kyprolis.2C_Dex
Darzalex-Ld
Intron_A_monotherapy
Cy-KTD
Intron_A_.26_Dex
Kyprolis.2C_Pomalidomide.2C_Dexamethasone
Velcade.2C_ThalDex
Elo-RevDex
Ild
Prednisone
Bortezomib.2C_Melphalan.2C_Prednisone.2C_alternating_with_Lenalidomide_.26_Dexamethasone
Kyprolis.2C_Thalomid.2C_Dexamethasone
Benda-RD
M-Pred
Daratumumab-Rd
CCyd
Dara-PD
VAMP
Cy-KTd
Intron_A_.26_Dexamethasone
Kyprolis.2C_Pomalidomide.2C_Dex
VTD
Elo-LenDex
CPR
Prednisolone_monotherapy
Velcade.2C_Melphalan.2C_Prednisone.2C_alternating_with_Revlimid_.26_Dexamethasone
Carfilzomib.2C_Thalidomide.2C_Dex
Benda-Rd
Melphalan_.26_Prednisone
DRd
KCyd
Dara-Pd
Bortezomib_.26_Dexamethasone
Cy-TKD
Thalidomide_monotherapy
Kyprolis.2C_Pomalyst.2C_Dexamethaonse
vTD
Elo-LD
CyPR
Prednisolone
Bortezomib-MP.2C_alternating_with_RevDex
Kyprolis.2C_Thalomid.2C_Dex
Benda-LD
Melph_Pred
DRD
CyKD BD
Cy-TKd
Thalidomide
Kyprolis.2C_Pomalyst.2C_Dex
VTd
Elo-Ld
Cyclophosphamide.2C_Lenalidomide.2C_Prednisone
Alfa-interferon_.26_Dexamethasone
Observation
Bortezomib-MP.2C_alternating_with_LenDex
Carfilzomib.2C_ThalDex
Benda-Ld
Melphalan_Pred
DLD
CyKd
Daratumumab-PD Bd
CYKLONE
Thal
Carfilzomib-PomDex
TVd
ELd
Cyclophosphamide.2C_Revlimid.2C_Prednisone
Monitoring
Velcade-MP.2C_alternating_with_RevDex
Kyprolis.2C_ThalDex
BRD
Alkeran_Pred
DLd
Daratumumab-PomDex
Bort-Dex
Total_Therapy T
Kyprolis-PomDex
TVD
ERd
Cytoxan.2C_Lenalidomide.2C_Prednisone
Active surveillance
Velcade-MP.2C_alternating_with_LenDex
KTD
Benda-Revlimid-Dex
Alkeran_Prednisone
Daratumumab.2C_Bortezomib.2C_Dexamethasone
CyCarfD
Dara-PomDex Vd
VDT-PACE
Thalomid
Carf-PomDex
Bortezomib.2C_Lenalidomide.2C_Dexamethasone
ELD
Cytoxan.2C_Revlimid.2C_Prednisone
Placebo
VMP.2C_alternating_with_RevDex
KTd
Benda-Lenalidomide-Dex
Cyclophosphamide.2C_Bortezomib.2C_Dexamethasone
Daratumumab.2C_Velcade.2C_Dexamethasone
CyCarfd
Daratumumab-Pd VD
VTD-PACE
Bortezomib_.26_Thalidomide
CarfPomDex
Velcade.2C_Revlimid.2C_Dexamethasone
CyRevPred
Pbo
VMP.2C_alternating_with_LenDex
TKD
Bortezomib-HyperCAD
Cytoxan.2C_Velcade.2C_Dex
Darzalex.2C_Velcade.2C_Dexamethasone
CarfCyD
DPD
Velcade_.26_Dexamethasone
Bortezomib.2C_Dexamethasone.2C_Panobinostat
Velcade_.26_Thalidomide
CPd
Lenalidomide.2C_Bortezomib.2C_Dexamethasone
Elotuzumab.2C_Pomalidomide.2C_Dexamethasone
CyLenPred
Alfa-interferon_.26_Dex
Lenalidomide_monotherapy
MVP.2C_alternating_with_RevDex
TKd
Bortezomib.2C_Thalidomide.2C_Dexamethasone.2C_Panobinostat
Cytoxan.2C_Velcade.2C_Decadron
Dara-Velcade-Dex
CarfCyd
DPd
Velcade-Dex
Panobinostat.2C_Bortezomib.2C_Dexamethasone
Velcade_.26_Thalomid
KPd
Revlimid.2C_Velcade.2C_Dexamethasone
Elotuzumab.2C_Pomalidomide.2C_Dex
CyRP
Lenalidomide
MVP.2C_alternating_with_LenDex
Lenalidomide_.26_Prednisone
Panobinostat.2C_Bortezomib.2C_Thalidomide.2C_Dexamethasone
VDC
Darzalex-Velcade-Dex
Pomalidomide.2C_Dexamethasone.2C_Daratumumab
Bortezomib_.26_Melphalan.2C_then_auto_HSCT
Panobinostat-Bort-Dex VT
CPD
Bortezomib.2C_Lenalidomide.2C_Dex
Elotuzumab.2C_Pomalyst.2C_Dexamethasone
REP
VBMCP
Len
MPV.2C_alternating_with_RevDex
Revlimid_.26_Prednisone
Panobinostat.2C_Velcade.2C_Thalidomide.2C_Dexamethasone
CyBorD
Dara-VD
Carfilzomib.2C_Lenalidomide.2C_Dexamethasone
PVD
Bor-HDM
Panobinostat-Vd TV
KPD
Velcade.2C_Revlimid.2C_Dex
Elotuzumab.2C_Pomalyst.2C_Dex
MPT
VBMC
Rev
MPV.2C_alternating_with_LenDex
LenPred
Panobinostat.2C_Bortezomib.2C_Thalidomide.2C_Dex
VDC-mod
Dara-Vd
Kyprolis.2C_Revlimid.2C_Dexamethasone
Bortezomib.2C_Pomalidomide.2C_Dexamethasone
Velcade_.26_Melphalan.2C_then_auto_HSCT
Panobinostat-VD
Melphalan.2C_Lenalidomide.2C_Prednisone
CRD_.28Cyclophosphamide.29
Lenalidomide.2C_Bortezomib.2C_Dex
Empliciti.2C_Pomalidomide.2C_Dexamethasone
Melphalan.2C_Prednisone.2C_Thalidomide
VMCP
Revlimid
Bortezomib.2C_Melphalan.2C_Prednisone.2C/Lenalidomide_.26_Dexamethasone
RevPred
Panobinostat.2C_Bortezomib.2C_ThalDex
VCD
Daratumumab-VD
Lenalidomide.2C_Carfilzomib.2C_Dexamethasone
Velcade.2C_Pomalyst.2C_Dexamethasone
Velcade-HDM
Panobinostat.2C_Velcade.2C_Dexamethasone
Melphalan.2C_Revlimid.2C_Prednisone
CRD
Revlimid.2C_Velcade.2C_Dex
Empliciti.2C_Pomalidomide.2C_Dex
Melphalan.2C_Thalidomide.2C_Prednisone
VCMP R
Velcade.2C_Melphalan.2C_Prednisone.2C/Revlimid_.26_Dexamethasone RP
Panobinostat.2C_Velcade.2C_Thalidomide.2C_Dex
CVD
Daratumumab-Vd
Revlimid.2C_Kyprolis.2C_Dexamethasone
Pomalidomide.2C_Bortezomib.2C_Dexamethasone
Bort-HDM
Panobinostat-Velcade-Dex
Lenalidomide.2C_MP
DTPACE
Velcade-LenDex
Empliciti.2C_Pomalyst.2C_Dexamethasone
MTP
VMCP.2FVBAP
Rev_monotherapy
Bortezomib-MP.2C/RevDex
Tandem_melphalan.2C_then_auto_HSCT
Panobinostat.2C_Velcade.2C_ThalDex
CyVD
Darzalex-VD
Carfilzomib.2C_Lenalidomide.2C_Dex
Pomalyst.2C_Velcade.2C_Dexamethasone
Melphalan.2C_then_auto_HSCT
Pano.2C_Bortezomib.2C_Dexamethasone
Revlimid.2C_MP
DT-PACE
Velcade-RevDex
Empliciti.2C_Pomalyst.2C_Dex
Thalidomide_.26_Prednisolone
VMCP/VBAP
Cyclophosphamide_monotherapy
Bortezomib-MP.2C/LenDex
Tandem_auto
Panobinostat-VTD
Daratumumab_monotherapy
Darzalex-Vd
Kyprolis.2C_Revlimid.2C_Dex
Bortezomib.2C_Pomalidomide.2C_Dex
CRd_.28Cyclophosphamide.29
Pano-Bort-Dex
MPR
Panobinostat.2C_Lenalidomide.2C_Dexamethasone
Lenalidomide-VD
Elotuzumab-PomDex
Thalidomide_.26_Prednisone
VMCP.2FVCAP
Cyclophosphamide
Velcade-MP.2C/RevDex
Tandem_ASCT
Panobinostat-vTD
Darzalex_Monotherapy
Lenalidomide.2C_Carfilzomib.2C_Dex
Velcade.2C_Pomalyst.2C_Dex
Cyclophosphamide.2C_Lenalidomide.2C_Dexamethasone
Pano-Vd
RMP
Panobinostat-Rd
Lenalidomide-Vd
Empliciti-PomDex
Thalomid_.26_Prednisone
VMCP/VCAP
Cy_monotherapy
Velcade-MP.2C/LenDex
Tandem_Auto_HSCT
Panobinostat-VTd
Daratumumab
Revlimid.2C_Kyprolis.2C_Dex
Pomalidomide.2C_Bortezomib.2C_Dex
Cyclophosphamide.2C_Revlimid.2C_Dexamethasone
Pano-VD
LMP
Panobinostat-RD
Revlimid-VD
Elotuzumab-PD
ThalPred
Melphalan.2C_then_auto_HSCT.2C_then_Melphalan_.26_Busulfan.2C_then_auto_HSCT Cy
VMP.2C/RevDex
Tandem_AHCT
Panobinostat-TVd
Darzalex
DVD
Kyprolis.2C_LenDex
Pomalyst.2C_Velcade.2C_Dex
Cyclophosphamide.2C_Revlimid.2C_Dex
Pano.2C_Velcade.2C_Dexamethasone
MPL
Panobinostat-LD
Revlimid-Vd
Empliciti-PD
Bortezomib.2C_Thalidomide.2C_Prednisone
MEL200.2C_then_auto_HSCT.2C_then_MEL220_.26_Dexamethasone.2C_then_auto_HSCT
Cytoxan_monotherapy
VMP.2C/LenDex
Vincristine.2C_Carmustine.2C_Melphalan.2C_Cyclophosphamide.2C_Prednisone_alternating_with_Vincristine2C_Carmustine.2C_Doxorubicin.2C_Dexamethasone
Panobinostat-TVD
Dara_monotherapy
DVd
RKd
Velcade-PomDex
Cyclophosphamide.2C_Lenalidomide.2C_Dex
Pano-Velcade-Dex
Bortezomib.2C_liposomal_Doxorubicin.2C_Dexamethasone
Panobinostat.2C_Revlimid.2C_Dexamethasone
RVD
Elo-Pom-Dex
Bortezomib.2C_Thalomid.2C_Prednisone
Melphalan.2C_then_auto_HSCT.2C_then_Melphalan_.26_TBI.2C_then_auto_HSCT
Cytoxan
MVP.2C/RevDex
Vincristine.2C_BCNU.2C_Melphalan.2C_Cyclophosphamide.2C_Prednisone_alternating_with_Vincristine2C_BCNU.2C_Adriamycin.2C_Dexamethasone
Pano-VTD
Dara
Elotuzumab.2C_Bortezomib.2C_Dexamethasone
KDR
Pomalidomide-VD
Cyclophosphamide.2C_LenDex
Farydak.2C_Bortezomib.2C_Dexamethasone
Bortezomib.2C_liposomal_Adriamycin.2C_Dexamethasone
Panobinostat-RevDex
RVd
Elo-PomDex
Velcade.2C_Thalidomide.2C_Prednisone
Melphalan.2C_then_auto_HSCT.2C_then_RIC_allo_HSCT
Melphalan_monotherapy
MVP.2C/LenDex
Vincristine.2C_BiCNU.2C_Melphalan.2C_Cyclophosphamide.2C_Prednisone_alternating_with_Vincristine2C_BiCNU.2C_Doxorubicin.2C_Dexamethasone
Pano-vTD
Ixazomib_monotherapy
Elotuzumab.2C_Velcade.2C_Dexamethasone
KRD
Pomalidomide-Vd
Cyclophosphamide_RevDex
Farydak-Bort-Dex
Bortezomib.2C_Doxil.2C_Dexamethasone
Panobinostat-Ld
VDR
Elo-PD
Velcade.2C_Thalomid.2C_Prednisone
Melphalan_.26_Methylprednisolone.2C_then_auto_HSCT
Melph
MPV.2C/RevDex
VBMCP.2FVBAD
Pano-VTd
Ninlaro_monotherapy
Empliciti.2C_Velcade.2C_Dexamethasone
CRd_.28Carfilzomib.29
Pomalyst-VD
RevCyDex
Farydak-Vd
Velcade.2C_liposomal_Adriamycin.2C_Dexamethasone
Panobinostat-LenDex
VRD
Elo-Pd
Velcade.2C_ThalPred
Interferon_alfa_.26_Prednisone
Melphalan
MPV.2C/LenDex
VBMCP/VBAD
Pano-TVd
Ixazomib
Elotuzumab.2C_Velcade.2C_Dex
CRd
Pomalyst-Vd
CyRevDex
Farydak-VD
Velcade.2C_Doxil.2C_Dexamethasone
Farydak.2C_Lenalidomide.2C_Dexamethasone
VRd
EPD
VTP
IFN-a_.26_Prednisone
Alkeran_monotherapy
Zoledronic_acid_therapy
Cyclophosphamide.2C_Vincristine.2C_Doxorubicin.2C_Dexamethasone
Pano-TVD
Ninlaro
Empliciti.2C_Velcade.2C_Dex
KRd
PVd
CyRevD
Farydak.2C_Velcade.2C_Dexamethasone
PS-341.2C_liposomal_Adriamycin.2C_Dexamethasone
Farydak-Rd
Lenalidomide.2C_Bortezomib.2C_Cyclophosphamide.2C_Dexamethasone
Epd
Bortezomib.2C_Melphalan.2C_Prednisone.2C_Thalidomide
IFN_.26_Prednisone
Alkeran
Zoledronic_acid
Cyclophosphamide.2C_Vincristine.2C_Adriamycin.2C_Dexamethasone
Farydak.2C_Bortezomib.2C_Thalidomide.2C_Dexamethasone
Ixa
Elotuzumab-VD
Daratumumab.2C_Bortezomib.2C_Melphalan.2C_Prednisone
VDP
CyLenDex
Farydak-Velcade-Dex
PAD_doxil
Farydak-RD
Revlimid.2C_Velcade.2C_Cytoxan.2C_Dexamethasone
Pomalidomide_monotherapy
Velcade.2C_Melphalan.2C_Prednisone.2C_Thalidomide
Interferon_.26_Prednisone P
Zometa
CVAD
Farydak.2C_Velcade.2C_Thalidomide.2C_Dexamethasone
Ixa_monotherapy
Elotuzumab-Vd
Daratumumab.2C_Velcade.2C_Melphalan.2C_Prednisone
VPD
LenCyDex
Bortezomib_.26_Doxorubicin_liposomal
PAD doxil
Farydak-LD
Lenalidomide.2C_Bortezomib.2C_Cyclophosphamide.2C_Dex
Pomalidomide
Bortezomib.2C_Melphalan.2C_Thalidomide.2C_Prednisone.2C
Alfa-interferon_.26_Prednisone
Vemurafenib_monotherapy
Biaxin.2C_Lenalidomide.2C_Dexamethasone
Thalidomide_.26_Dexamethasone
Farydak.2C_Bortezomib.2C_Thalidomide.2C_Dex
Ixazomib_.26_Dexamethasone
Empliciti-VD
Darzalex.2C_Velcade.2C_Melphalan.2C_Prednisone
VPd
CyLenD
Bortezomib_.26_liposomal_Doxorubicin
Farydak.2C_Revlimid.2C_Dexamethasone
Revlimid.2C_Velcade.2C_Cytoxan.2C_Dex
Pomalyst
Velcade.2C_Melphalan.2C_Thalidomide.2C_Prednisone.2C
Intron_A_.26_Prednisone
Vemurafenib
Biaxin.2C_Lenalidomide.2C_Dex
Thalidomide_.26_Dex
Farydak.2C_Bortezomib.2C_ThalDex
Ninlaro_.26_Dexamethasone
Empliciti-Vd
Daratumumab.2C_Velcade-MP
Vorinostat.2C_Lenalidomide.2C_Dexamethasone
RCyD
Bortezomib_.26_Doxil
VDD
Farydak-RevDex
Cyclophosphamide_.26_RVD
Velcade-MPT
Interferon_alfa_.26_Thalidomide
Zelboraf
Biaxin.2C_Revlimid.2C_Dexamethasone
Thalomid_.26_Dexamethasone
Farydak.2C_Velcade.2C_Thalidomide.2C_Dex
Ixazomib_Dex
Elo-Velcade-Dex
Daratumumab.2C_Bortezomib-MP
Vorinostat.2C_Lenalidomide.2C_Dex
LCyD
Velcade_.26_Doxil
Etoposide.2C_Dexamethasone.2C_Cytarabine.2C_Prednisone
Farydak-Ld
Cyclophosphamide_.26_VRD
PomCyDex
Velcade-MTP
IFN-a_.26_Thalidomide
Zelboraf_monotherapy
Biaxin.2C_Revlimid.2C_Dex
ThalDex
Farydak.2C_Velcade.2C_ThalDex
Ninlaro_Dex
Elo-VD
Dara-VMP
Vorinostat-Rd
Cytoxan_LenDex
Bortezomib_.26_Vorinostat
Etoposide.2C_Dexamethasone.2C_Ara-C.2C_Prednisone
Farydak-LenDex
Cyclophosphamide_.26_VRd
Cyclophosphamide.2C_Pomalidomide.2C_Dexamethasone
Bortezomib-MPT
IFN_.26_Thalidomide
Dexamethasone_monotherapy
Biaxin.2C_LD
Thal-Dex
Farydak-VTD
Ixa_Dex
Elo-Vd
Dara-MVP
Vorinostat-RD
Cytoxan_RevDex
Bortezomib_.26_Zorinza
EDAP
Pano-Rd
Cyclophosphamide_.26_RVd
Cyclophosphamide.2C_Pomalidomide.2C_Dex
Bortezomib-MTP
Interferon_.26_Thalidomide
Dexamethasone
Biaxin.2C_Ld TD
Farydak-vTD ID
EVD
Dara-MPV
Vorinostat-LD
Cytoxan.2C_Revlimid.2C_Dexamethasone
Velcade_.26_Vorinostat
Bortezomib_.26_Prednisone
Pano-RD
CyVRD
Cyclophosphamide.2C_Pomalyst.2C_Dexamethasone
VMTP
Alfa-interferon_.26_Thalidomide
Dex
Biaxin.2C_RD Td
Farydak-VTd Id
Evd
Daratumumab-VMP
Vorinostat-Revlimid_.26_Dexamethasone
Velcade_.26_Zorinza
Bortezomib_.26_Pred
Pano-LD
CyVRd
Cyclophosphamide.2C_Pomalyst.2C_Dex
VMPT
Intron_A_.26_Thalidomide
Pulsed_Dex
Biaxin.2C_Rd
Bortezomib.2C_Doxorubicin.2C_Dexamethasone
Farydak-TVd
Pomalidomide_.26_Dexamethasone
EBd
Daratumumab-MVP
Vorinostat-Revlimid_.26_Dex
Carfilzomib_.26_Dexamethasone
Velcade_.26_Prednisone
Pano-RevDex
CyRVD
Cyclophosphamide-PomDex
Thalidomide.2C_Doxorubicin.2C_Dexamethasone
Thalidomide_.26_Interferon_alfa
Dex_monotherapy
BiRD
Bortezomib.2C_Adriamycin.2C_Dexamethasone
Farydak-TVD
Pomalyst_.26_Dexamethasone
EBD
Daratumumab-MPV
Vorinostat-RevDex
LDC
Carfilzomib_.26_Dex
Velcade_.26_Pred
Pano-Ld
CyRVd
CyPomDex
Thalidomide.2C_Adriamycin.2C_Dexamethasone
Thalidomide_.26_IFN-a
Pulsed_Dexamethasone
BiRd
Velcade.2C_Doxorubicin.2C_Dexamethasone
Bendamustine.2C_Thalidomide.2C_Dexamethasone
Pomalidomide_.26_Dex
Elotuzumab.2C_Lenalidomide.2C_Dexamethasone
Darzalex-VMP
Vorinostat-Ld
RdC
Kyprolis_.26_Dexamethasone VP
Pano-LenDex
R-CyBorD
CyPomD
Thalomid.2C_Doxorubicin.2C_Dexamethasone
Thalidomide_.26_IFN
Pulsed_Decadron
BiLd
Velcade.2C_Adriamycin.2C_Dexamethasone
Bendamustine.2C_Thalidomide.2C_Dex
Pomalyst_.26_Dex
Elotuzumab.2C_Revlimid.2C_Dexamethasone
Darzalex-MVP
Vorinostat-LenDex
CLD
Kyprolis_.26_Dex
Bendamustine.2C_Bortezomib.2C_Dexamethasone
FRD
R-VCD
PomCyD
Thalomid.2C_Adriamycin.2C_Dexamethasone
Thalidomide_.26_Interferon
Decadron
BiLD
Bortezomib.2C_Doxorubicin.2C_Dex
Bendamustine.2C_Thalomid.2C_Dexamethasone Pd
Darzalex-MPV
Zorinza.2C_Lenalidomide.2C_Dexamethasone
CLd KD
Bendamustine.2C_Bortezomib.2C_Dex
FRd
R-CVD
Cytoxan-PomDex
Thalomid.2C_Doxorubicin.2C_Dex
Thalidomide_.26_Alfa-interferon
Decadron_monotherapy
CMP
Bortezomib.2C_Adriamycin.2C_Dex
BendaThalDex PD
Empliciti.2C_Lenalidomide.2C_Dexamethasone
D-VMP
Zorinza.2C_Lenalidomide.2C_Dex Rd
Carf-Dex
Bendamustine.2C_Velcade.2C_Dexamethasone
FLD
RVDC
Cytoxan.2C_Pomalyst.2C_Dexamethasone
Thalidomide.2C_Adriamycin.2C_Dex
Thalidomide_.26_Intron_A
Bortezomib_monotherapy
Carfilzomib.2C_Melphalan.2C_Prednisone
Velcade.2C_Doxorubicin.2C_Dex
Benda-ThalDex
PomDex
Empliciti.2C_Revlimid.2C_Dexamethasone
Ixazomib.2C_Lenalidomide.2C_Dexamethasone
Zorinza-Rd RD
CarfDex
Bendamustine.2C_Velcade.2C_Dex
FLd
RVCD
Cytoxan.2C_Pomalyst.2C_Dex
Carmustine_.26_Doxorubicin
Bortezomib
Kyprolis.2C_Melphalan.2C_Prednisone
Velcade.2C_Adriamycin.2C_Dex
Benda-Thal-Dex
Pom + LoDEX
Elotuzumab.2C_Lenalidomide.2C_Dex
Ixazomib.2C_Lenalidomide.2C_Dex
Zorinza-RD LD Kd
Bendamustine.2C_VD
Hyper-CVAD
RVCd
CyPD
Thalomid.2C_Adriamycin.2C_Dex
Doxorubicin_.26_Carmustine
Bort
Carfilzomib-MP
PS-341.2C_Adriamycin.2C_Dexamethasone
BendaTD
Elotuzumab.2C_Revlimid.2C_Dex
Ixazomib-RD
Zorinza-LD
Revlimid_.26_Dexamethasone
Cyclophosphamide_.26_Dexamethasone
Bendamustine.2C_Vd
PCP
RCVD
CyPd
TAd
Carmustine_.26_Adriamycin
Bort_monotherapy
Kyprolis-MP
PAD
BendaTd
Melphalan_.26_TBI.2C_then_auto_HSCT
Empliciti.2C_Lenalidomide.2C_Dex
Ixazomib-Rd
Zorinza-Revlimid_.26_Dexamethasone
RevDex
Cytoxan-Dex
Benda-VD
Cyclophosphamide.2C_Pomalidomide.2C_Prednisone
RCVd
TDD
Adriamycin_.26_Carmustine
Velcade
KMP
PAd
Benda-TD
Melphalan_.26_Total_Body_Irradiation
Empliciti.2C_Revlimid.2C_Dex
Ixazomib.2C_Revlimid.2C_Dexamethasone
Zorinza-Revlimid_.26_Dex Ld
CyDex
Benda-Vd
Cyclophosphamide.2C_Pomalyst.2C_Prednisone
CRVD
TAD
BCNU_.26_Doxorubicin
Velcade_monotherapy
MKP
Benda-Td
Melphalan_.26_TBI
Elotuzumab-RD
Ixazomib.2C_Revlimid.2C_Dex
Zorinza-RevDex
LenDex
Daratumumab.2C_Lenalidomide.2C_Dexamethasone
BVD
Cyclophosphamide-PomP
CRVd
PdC
Vincristine.2C_Liposomal_Doxorubicin.2C_Dexamethasone
Doxorubicin_.26_BCNU V
MPK
BDD
BTD
TBI
Elotuzumab-Rd
Ninlaro.2C_Revlimid.2C_Dexamethasone
Zorinza-Ld
Lenalidomide_.26_Dexamethasone
Daratumumab.2C_Revlimid.2C_Dexamethasone
CyPomP
CVRD
PCD
Oncovin.2C_Doxil.2C_Dexamethasone
BCNU_.26_Adriamycin
V_monotherapy
Cyclophosphamide.2C_Carfilzomib.2C_Thalidomide.2C_Dexamethasone
BAD
Carfilzomib_.26_Panobinostat
Bortezomib.2C_Melphalan.2C_Prednisone
Elotuzumab-RevDex
Ninlaro.2C_Revlimid.2C_Dex
Zorinza-LenDex
CTD
Darzalex.2C_Lenalidomide.2C_Dexamethasone
Benda-Velcade-Dex
PomCyP
CVRd
PCd
Vincristine.2C_Liposomal_Doxorubicin.2C_Dex
Adriamycin_.26_BCNU
Interferon_alfa_monotherapy
Cyclophosphamide.2C_Kyprolis.2C_Thalidomide.2C_Dexamethasone
BAd
Carfilzomib_.26_Farydak
Velcade.2C_Melphalan.2C_Prednisone
Elotuzumab-LenDex
Ninlaro-RevDex
ZRd
ThalCyDex
Darzalex.2C_Revlimid.2C_Dexamethasone
BBD
Cytoxan-PomP
VRCD
Bortezomib_.26_Cyclophosphamide
Oncovin.2C_Doxil.2C_Dex
Pomalidomide.2C_Dexamethasone.2C_Pembrolizumab
Interferon_alfa
Kyprolis_.26_Panobinostat
Bortezomib-MP
Elotuzumab-LD
Ninlaro-LenDex
ZRD
CyThalDex
Darzalex-RD
Carfilzomib_monotherapy
Cytoxan.2C_Pomalyst.2C_Prednisone
VRCd
Cyclophosphamide_.26_Bortezomib
Vad_doxil
Pembrolizumab.2C_Pomalidomide.2C_Dexamethasone
Multiple myeloma regimen acronyms

69. Vocabulary Availability
Retrospective research (any user)
Non-commercial user (any use)
Available now!
Commercial user (any use other than retrospective)
Available now!

70. Acknowledgements HemOnc.org Peter C. Yang (founder) Others
Zachary H. Moldwin (intern)
Harry Hochheiser
The Editorial Board
Georgia Tech team FHIR Hose
OHDSI Oncology Subgroup
Donna Rivera
Dmitry Dymshyts
Andrew Grothen
Christian G. Reich
Catherine Wang
Michael J. Gurley
Funding
Rimma Belenkaya
NCI U01 CA231840
Andrew E. Williams
NCI U24 CA184407
Timur Vakhitov
NCI U24 CA194215
Vanderbilt University Medical Center (VUMC)
NCI P30 CA (VUMC CCSG)
Andrew Malty
Li Wen
Kristin Wuichet

71. Appendix

72. Next step #1: Normalizing Drug Sigsid
step
sig
doseNum
doseUnit
divided
doseCap
route
time
duration
frequency
days+misc
comment
corollary
39486
1/1
1.3 mg/m^2 (or previously tolerated dose) IV once per day on days 1_and_8
1.3
mg/m^2
NOS IV
once per day
on day 1_and_8
(or previously tolerated dose)
39488
1.3 mg/m^2 IV bolus once on day 1
bolus once
once
on day 1
39489
1.3 mg/m^2 IV bolus once per day on days 1_4_15_22
bolus once per day
on day 1_4_15_22
39490
1.3 mg/m^2 IV bolus once per day on days 1_4_8_11
on day 1_4_8_11
39491
1.3 mg/m^2 IV bolus once per day on days 1_4_8_11_22_25_29_32
on day 1_4_8_11_22_25_29_32
39492
1.3 mg/m^2 IV bolus once per day on days 1_8_15_22
on day 1_8_15_22
39493
1.3 mg/m^2 IV bolus once per day on days 1_8_22_29
on day 1_8_22_29
39494
1.3 mg/m^2 IV once on day 1
39495
1.3 mg/m^2 IV once per day on days 1_and_4
on day 1_and_4
39496
1.3 mg/m^2 IV once per day on days 1_and_4, given first on day 1
on day 1_and_4, given first
given first
39497
1.3 mg/m^2 IV once per day on days 1_4_8_11
39498
1.3 mg/m^2 IV once per day on days 1_4_8_11, given first
on day 1_4_8_11, given first
39499
1.3 mg/m^2 IV once per day on days 1_4_8_11_22_25_29_32
39500
1.3 mg/m^2 IV once per day on days 1_8_15
on day 1_8_15
39501
1.3 mg/m^2 IV once per day on days 1_8_15_22
39502
1.3 mg/m^2 IV once per day on days 1_8_22_29
39503
1.3 mg/m^2 IV once per week for two weeks
once per week for two weeks
once per week
39508
1.3 mg/m^2 IV over 3_to_5 seconds once per day on days 1_4_8_11
over 3_to_5 seconds once per day
over 3_to_5 second
45123
1.3 mg/m^2 (maximum dose of 2 mg) IV once per day on days 1_and_15
of 2 mg
on day 1_and_15
(maximum dose of 2 mg)
40468
1.3_to_1.8 mg/m^2 IV once on day 3
1.3_to_1.8
on day 3

73. Next step #2: Protocols

74. Next step #3: Modeling complex roles in the ontology
HiDAC  is a historical regimen in the upfront treatment of AML
HiDAC  is an active regimen in the consolidation treatment of AML
HiDAC
historical
upfront
AML
HiDAC
active
consolidation
AML
Consolidation
Has Role Context
Active
Has Context
Has Role
Has Role Disease
AML
HiDAC
Has Role Disease
Has Role
Historical
Has Context
Has Role Context
Upfront
Regimen
Context
Disease
Status

75. A. Disease, treatment, biomarker contexts
Regimen Component
Example
Disease context
Diffuse large B-cell lymphoma
Encoded disease context
SNOMED-CT
SCTID:
OncoTree
DLBCLNOS
NCIT
C8851
Biomarker context
NRAS-mutated melanoma
Treatment context
Untreated; Adjuvant therapy; etc.
A. Disease, treatment, biomarker contexts

76. B. Regimen-level concepts
Regimen Component
Example
Preferred regimen name
R-CHOP
Regimen name expansion if acronym
Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisone
Regimen synonym(s)
CHOP-R; R-CHOP-21; etc.
Regimen coded concepts
NCIT
C9760
Regimen type
Chemotherapy; Immunotherapy
Regimen schedule
21-day cycle
Regimen duration
8 cycles
If randomized – type
Control; Experimental
If experimental – type
Escalation; De-escalation; Substitution
Regimen variant #, if applicable
Variant #2
Regimen variant short description, if applicable
prednisolone 40 mg/m2
B. Regimen-level concepts

77. C. Component-level concepts
Regimen Component
Example
Component* preferred name
rituximab
Drug generic name(s)
Drug brand name(s)
Ikgdar, Mabtas, MabThera, Reditux, Ristova, Rituxan, Rituxim, Transera-Kit
Drug synonym(s)
BI , CT-P10, IDEC-102, IDEC-C2B8, PF , RTXM83
Drug approval status
FDA approved
If FDA approved, year of approval
1997
Encoded drug concepts
RxNorm
RXCUI:
ATC code etc.
Drug sig (whole)
375 mg/m2 IV once over 30 minutes on day 1, given first
Drug dose
375
Drug units
mg/m2
Drug route IV
Drug frequency
once
Drug infusion time
over 30 minutes
Drug sequencing
given first
Drug schedule
day 1
Drug special instructions
Maximum of 2 mg per cycle
Drug category
Antineoplastic chemotherapy; Supportive medications, etc.
*Mostly drugs, but other interventions are allowed (radiation, surgery)

78. D. Study-level concepts
Regimen Component
Example
Study unique identifier
AGMT NHL-14
Study short name
Fridrik et al. 2016
Study coded concept
NCT
Study design
Phase III
Study collaborative
AGMT
Study start year
2007
Study end year
2010
D. Study-level concepts

79. E. Publication-level concepts
Regimen Component
Example
Reference
AGMT NHL-14::00
Reference URL
PubMed URL
PubMed Central URL
NONE
Reference meta-data
Title
Cardiotoxicity with rituximab, cyclophosphamide, non-pegylated liposomal doxorubicin, vincristine and prednisolone compared to rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone in frontline treatment of patients with diffuse large B-cell lymphoma: A randomised phase-III study from the Austrian Cancer Drug Therapy Working Group [Arbeitsgemeinschaft Medikamentöse Tumortherapie AGMT](NHL-14)
Journal
European Journal of Cancer
Journal impact factor
7.191
Year of publication
2016
Reference order
00 = first publication; 01 = second, and so on
E. Publication-level concepts

80. F. Author-level concepts
Regimen Component
Example
Author name
Fridrik_Michael A
Author metadata
Author position
First author
Author institutional affiliation
Kepler University Hospital, Johannes Kepler University, Linz, Austria
F. Author-level concepts

81. Cardinality (in progress)
Regimen Attribute
Concept Class
Example
Preferred regimen name [1]
Regimen
R-CHOP
Regimen name expansion if acronym [0..n]
Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Predniso(lo)ne
Regimen synonym(s) [0..n]
N/A
CHOP-R; R-CHOP-21; CHOP-R; RCHOP; CHOPR
Regimen coded concept(s), if available [0..n]
NCIT ID: C9760
Regimen type [1..n]
Regimen_type
Chemotherapy
Regimen schedule [1..2]
21-day cycle
Regimen duration [1..2]
6 cycles
If randomized – type [0..1]
Experimental
If experimental – type [0..1]
Escalation
Regimen variant #, if applicable [0..n]
Variant #5
Regimen variant short description, if applicable [0..n]
prednisone 100 mg, IV rituximab, flat- dose vincristine
Cardinality (in progress)

82. Regimen Binary Relationships (N = 17)
Plain English Description
Concept 1 Class
Relationship Type
Concept 2 Class
Biomarker-specific regimen
Regimen
Has BioIndication
BioDisease
Antineoplastic interventions
Has Antineoplastic
Component
Supportive interventions
Has Supportive Med
Immune suppressing interventions
Has Immunosuppressor
Local interventions, including CNS therapy
Has Local Therapy
Episode context of treatment
Has Context
Context
Disease context of treatment
Has Indication
Disease
Current Regimen
Is Current In
Historical Regimen
Is Historical In
Link to preceding treatment(s)
Can Be Preceded By
Link to subsequent treatment(s)
Can Be Followed By
Direct comparison within an RCT*
Has Been Compared To
Regimen or Regimen Stub
Regimen type
Has Regimen Type
Regimen_type
Antineoplastic interventions (RxNorm)
Has Antineopl Rx
RxNorm Ingredient
Supportive interventions (RxNorm)
Has Support Med Rx
Immune suppressing interventions (RxNorm)
Has Immunosuppr Rx
Local interventions, including CNS therapy (RxNorm)
Has Local Therap Rx
*This relationship will not be included in the first public release

83. Non-Regimen Binary Relationships (N = 18)
Plain English Description
Concept 1 Class
Relationship Type
Concept 2 Class
Generic class hierarchy
(Multiple)
Is a
Generic external mapping*
Maps to
Evidence to support use
Was Studied In
Study
Biomarker-specific disease subtype*
BioDisease
Is Bio SubClass
Disease
Brand name(s)*
Component
Has Brand Name
Brand_Name
Drug prescription signetur
Has Sig
Sig or Sig Stub
Year of FDA approval
Was FDA Approved Yr
Year
Middle author
Reference
Has Middle Author
Author
First author
Has First Author
Last author
Has Last Author
Journal of publication
Was Published In
Journal
PubMed URL
Has PMID
PubMedURL
Reference title
Has Title
ReferenceTitle
Reference URL
Has URL
ReferenceURL
Year of Publication
Was Published Year
Has Reference
Study group
Has Study Group
Study Group
Study's short name
Has Study Short Name
Study_name_short
*These relationships are to be included in the first public release