02062024 - Current SCTOD Information Collections to HRSA

02062024 - Current SCTOD Information Collections to HRSA - 020620245001.xlsx

Stem Cell Therapeutic Outcomes Database

02062024 - Current SCTOD Information Collections to HRSA

OMB: 0915-0310

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Overview

Header Definitions
Change Summary
Pre-Transplant Information Coll
Transplant Procedure&Product
Post-Transplant Periodic Inform
pull down menus

Sheet 1: Header Definitions


Information Collection Domains Indicates the category of information collection by time period that corresponds to the burden table. For each of the following Domains, there is a corresponding Tab.
1- Pre-Transplant Information Collection
2- Transplant Procedure and Product Information
3- Post-Transplant Periodic Information Collection
Below are the defintions for each column heading.


Column Header Title Column Header Title Definitions
Information Collection Domain Sub-Type Identifies a grouping of information collection within an Information Collection Domain. These information collection domain sub types roughly correspond to section/domain headers currently found on CIBMTR data collection instruments.
Information Collection Domain Additional Sub Domain Additional Sub Domain set recipeint, donor, infusion type or product criteria that must be met for an information collection element to be required
Response required if Additional Sub Domain applies Response options are "yes" or "no".
If the criteria noted in Additional sub domain applies, the information collection data element will be applicable and information collection data element responses supplied. Always "yes" when an additional sub domain is present.
Information Collection may be requested at multiple times Response options are "yes" or "no".
Some information may be collected at "multiple" time points or in multiple iterations. A multiple request may occur with a new or duplicate event, new infusion, changes in treatment or outcomes follow up. For example: product analyses at multple timepoints, chimerism analyses on multple dates, subsequent neoplasms, co-morbidities, covid infection, Disease Status, Post Transplant Therapy, GVHD, labs and pathology (collected at diagnosis, between diagnosis and infusion, at infusion and during followup)
Current Information Collection Data Element (if applicable) Depicts the information collection data element currently being requested.
Current Information Collection Data Element Response Option(s) Depicts the information collection data element response options currently being requested.
Information Collection update: Notes the type of update. If Blank, there was no change.

options:

Addition of Information Requested

Deletion of Information Requested

Deletion of Information: Merged to Check all that Apply

Change/Clarification of Information Requested

Change/Clarification of Response Options

Change/Clarification of Information Requested and Response Options

Data will be captured on Lab Module
Proposed Information Collection Data Element (if applicable) Depicts the changes to the information collection data element requested in red line format. Rows containing changes are highlighted in Yellow
Proposed Information Collection Data Element Response Option(s) Depicts the changes to the information collection data element response options in red line format. Rows containing changes are highlighted in yellow.
Rationale for Information Collection Update The following options identify the change summary:

options:

Reduce burden: expanded response options to include responses previously reported manually or created a "check all that apply"

Be consistent with current clinical landscape, improve transplant outcome data

Capture data accurately

Examples added or typographical errors corrected for clarification

Covid-19 Impact

Capture additional relevent disease information

Sheet 2: Change Summary
Item ID Time Point Information Collection Domain Sub-Type Information Collection Domain Additional Sub Domain Response required if Additional Sub Domain applies Information Collection may be requested multiple times Current Information Collection Data Element (if applicable) Current Information Collection Data Element Response Option(s) Information Collection update: Proposed Information Collection Data Element (if applicable) Proposed Information Collection Data Element Response Option(s) Rationale for Information Collection Update
PRE665 Pre-Transplant Pre-Transplant Essential Data


Has the patient been infected with COVID-19 (SARS-CoV-2) based on a positive test result at any time prior to the start of the preparative regimen / infusion? No,Yes Question will be disabled Has the patient been infected with COVID-19 (SARS-CoV-2) based on a positive test result at any time prior to the start of the preparative regimen / infusion? No,Yes Reduce burden: data no longer relevant
PRE666 Pre-Transplant Pre-Transplant Essential Data


Did the patient require hospitalization for management of COVID-19 (SARS-CoV-2) infection? No,Yes Question will be disabled Did the patient require hospitalization for management of COVID-19 (SARS-CoV-2) infection? No,Yes Reduce burden: data no longer relevant
PRE667 Pre-Transplant Pre-Transplant Essential Data


Was mechanical ventilation given for COVID-19 (SARS-CoV-2) infection? No,Yes Question will be disabled Was mechanical ventilation given for COVID-19 (SARS-CoV-2) infection? No,Yes Reduce burden: data no longer relevant
PRE668 Pre-Transplant Pre-Transplant Essential Data
no yes Was a vaccine for COVID-19 (SARS-CoV-2) received? No,Unknown,Yes Question will be disabled Was a vaccine for COVID-19 (SARS-CoV-2) received? No,Unknown,Yes Reduce burden: data no longer relevant
PRE669 Pre-Transplant Pre-Transplant Essential Data COVID-19 Vaccine yes yes Specify vaccine brand AstraZeneca,Johnson & Johnson/Janssen,Moderna,Novavax,Other (specify),Pfizer-BioNTech Question will be disabled Specify vaccine brand AstraZeneca,Johnson & Johnson/Janssen,Moderna,Novavax,Other (specify),Pfizer-BioNTech Reduce burden: data no longer relevant
PRE670 Pre-Transplant Pre-Transplant Essential Data COVID-19 Vaccine yes yes Specify other type: open text Question will be disabled Specify other type: open text Reduce burden: data no longer relevant
PRE671 Pre-Transplant Pre-Transplant Essential Data COVID-19 Vaccine yes yes Select dose(s) received Booster dose,First dose (with planned second dose) ,One dose (without planned second dose) ,Second dose,Third dose Question will be disabled Select dose(s) received Booster dose,First dose (with planned second dose) ,One dose (without planned second dose) ,Second dose,Third dose Reduce burden: data no longer relevant
PRE672 Pre-Transplant Pre-Transplant Essential Data COVID-19 Vaccine yes yes Date received: YYYY/MM/DD Question will be disabled Date received: YYYY/MM/DD Reduce burden: data no longer relevant
PRE673 Pre-Transplant Pre-Transplant Essential Data COVID-19 Vaccine yes yes Date estimated checked Question will be disabled Date estimated checked Reduce burden: data no longer relevant
PRE674 Pre-Transplant Pre-Transplant Essential Data
no no Is there a history of mechanical ventilation? (excluding COVID-19 (SARS-CoV-2))? no,yes Change/Clarification of Information Requested and Response Option Is there a history of mechanical ventilation? (excluding COVID-19 (SARS-CoV-2))? no,yes Instruction text change to remove instructions
POST056 Post-Transplant Post-Transplant Essential Data
no yes Did the recipient develop COVID-19 (SARS-CoV-2)? No,Yes Question will be disabled Did the recipient develop COVID-19 (SARS-CoV-2)? No,Yes Reduce burden: data no longer relevant
POST057 Post-Transplant Post-Transplant Essential Data
no yes Date of diagnosis: YYYY/MM/DD Question will be disabled Date of diagnosis: YYYY/MM/DD Reduce burden: data no longer relevant
POST058 Post-Transplant Post-Transplant Essential Data
no yes Was a vaccine for COVID-19 (SARS-CoV-2) received? No,Unknown,Yes Question will be disabled Was a vaccine for COVID-19 (SARS-CoV-2) received? No,Unknown,Yes Reduce burden: data no longer relevant
POST059 Post-Transplant Post-Transplant Essential Data Covid-19 Vaccine yes yes Specify vaccine brand AstraZeneca,Johnson & Johnson,Moderna,Novavax,Other (specify),Pfizer-BioNTech Question will be disabled Specify vaccine brand AstraZeneca,Johnson & Johnson,Moderna,Novavax,Other (specify),Pfizer-BioNTech Reduce burden: data no longer relevant
POST060 Post-Transplant Post-Transplant Essential Data Covid-19 Vaccine yes yes Specify other type: open text Question will be disabled Specify other type: open text Reduce burden: data no longer relevant
POST061 Post-Transplant Post-Transplant Essential Data Covid-19 Vaccine yes yes Select dose(s) received Booster dose,First dose(with planned second dose) ,One dose(without planned second dose) ,Second dose,Third dose Question will be disabled Select dose(s) received Booster dose,First dose(with planned second dose) ,One dose(without planned second dose) ,Second dose,Third dose Reduce burden: data no longer relevant
POST062 Post-Transplant Post-Transplant Essential Data Covid-19 Vaccine yes yes Date received: YYYY/MM/DD Question will be disabled Date received: YYYY/MM/DD Reduce burden: data no longer relevant
POST063 Post-Transplant Post-Transplant Essential Data Covid-19 Vaccine yes yes Date estimated checked question will be disabled Date estimated checked reduce burden: data no longer relevant
PRE042 Pre-Transplant Disease Classification
no no What was the primary disease for which the HCT / cellular therapy was performed? Autoimmune diseases,Acute lymphoblastic leukemia (ALL),Acute myeloid leukemia (AML or ANLL),Chronic myeloid leukemia (CML),Hemoglobinopathies,Histiocytic disorders,Hodgkin lymphoma,Inherited Bone Marrow Failure Syndromes(If the recipient developed MDS or AML, indicate MDS or AML as the primary disease.)– ,Disorders of the immune system,Inherited disorders of metabolism,Inherited abnormalities of platelets,Myelodysplastic syndrome (MDS) (If recipient has transformed to AML, indicate AML as the primary disease.),Myeloproliferative neoplasms (MPN)(If recipient has transformed to AML, indicate AML as the primary disease.),Non-Hodgkin lymphoma,Acute leukemia of ambiguous lineage and other myeloid neoplasms,Other disease,Other leukemia (includes CLL),Multiple myeloma / plasma cell disorder (PCD),Paroxysmal nocturnal hemoglobinuria (PNH),Recessive dystrophic epidermolysis bullosa,Aplastic Anemia(If the recipient developed MDS or AML, indicate MDS or AML as the primary disease.) ,Solid tumors,Tolerance induction associated with solid organ transplant Change/Clarification of Information Requested What was the primary disease for which the HCT / cellular therapy was performed? Autoimmune diseases,Acute lymphoblastic leukemia (ALL),Acute myeloid leukemia (AML or ANLL),Chronic myeloid leukemia (CML),Hemoglobinopathies,Histiocytic disorders,Hodgkin lymphoma,Inherited Bone Marrow Failure Syndromes(If the recipient developed MDS or AML, indicate MDS or AML as the primary disease.)– ,Disorders of the immune system,Inherited disorders of metabolism,Inherited abnormalities of platelets,Myelodysplastic syndrome (MDS) (If recipient has transformed to AML, indicate AML as the primary disease.),Myeloproliferative neoplasms (MPN)(If recipient has transformed to AML, indicate AML as the primary disease.),Non-Hodgkin lymphoma,Acute leukemia of ambiguous lineage and other myeloid neoplasms,Other disease,Other leukemia (includes CLL),Multiple myeloma / plasma cell disorder (PCD),Paroxysmal nocturnal hemoglobinuria (PNH),Recessive dystrophic epidermolysis bullosa,Aplastic Anemia(If the recipient developed MDS or AML, indicate MDS or AML as the primary disease.) ,Solid tumors,Tolerance induction associated with solid organ transplant Capture data accurately
PRE043 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Specify the AML classification AML with recurrent genetic abnormalities:
AML with t(9;11) (p22.3;q23.3); MLLT3-KMT2A (5),
AML with t(6;9) (p23;q34.1); DEK-NUP214 (6),
AML with inv(3) (q21.3;q26.2) or t(3;3) (q21.3;q26.2); GATA2, MECOM (7),
AML (megakaryoblastic) with t(1;22) (p13.3;q13.3); RBM15-MKL1 (8),
AML with t(8;21); (q22; q22.1); RUNX1-RUNX1T1 (281),
AML with inv(16) (p13.1;1q22) or t(16;16)(p13.1; q22); CBFB-MYH11 (282),
APL with PML-RARA (283),
AML with BCR-ABL1 (provisional entity) (3),
AML with mutated NPM1 (4),
AML with biallelic mutations of CEBPA (297),
AML with mutated RUNX1 (provisional entity) (298),
AML with 11q23 (MLL) abnormalities (i.e., t(4;11), t(6;11), t(9;11), t(11;19)) (284),
AML with myelodysplasia – related changes (285),
Therapy related AML (t-AML) (9),
AML, not otherwise specified:
AML, not otherwise specified (280),
AML, minimally differentiated (286),
AML without maturation (287) ,
AML with maturation (288) ,
Acute myelomonocytic leukemia (289),
Acute monoblastic / acute monocytic leukemia (290),
Acute erythroid leukemia (erythroid / myeloid and pure erythroleukemia) (291),
Acute megakaryoblastic leukemia (292),
Acute basophilic leukemia (293),
Acute panmyelosis with myelofibrosis (294),
Myeloid sarcoma (295),
Myeloid leukemia associated with Down syndrome (299),		 Change/Clarification of Information Requested and Response Option Specify the AML classification AML with recurrent genetic abnormalities: AML with defining genetic abnormalities
AML with t(9;11) (p22.3;q23.3); MLLT3-KMT2A (5), Acute myeloid leukemia with MLLT3::KMT2A fusion (5)
AML with t(6;9) (p23;q34.1); DEK-NUP214 (6), Acute myeloid leukemia with DEK::NUP214 fusion (6)
AML with inv(3) (q21.3;q26.2) or t(3;3) (q21.3;q26.2); GATA2, MECOM (7), Acute myeloid leukemia with MECOM (EVI1), GATA2 rearrangement (7)
Acute myeloid leukemia with Other MECOM rearrangements
AML (megakaryoblastic) with t(1;22) (p13.3;q13.3); RBM15-MKL1 (8), Acute myeloid leukemia with RBM15::MRTFA fusion (8)
AML with t(8;21); (q22; q22.1); RUNX1-RUNX1T1 (281), Acute myeloid leukemia with RUNX1::RUNX1T1 fusion (281)
AML with inv(16) (p13.1;1q22) or t(16;16)(p13.1; q22); CBFB-MYH11 (282), Acute myeloid leukemia with CBFB::MYH11 fusion (282)
APL with PML-RARA (283), Acute promyelocytic leukemia with PML::RARA fusion (283)
Acute promyelocytic leukemia with other RARA fusions
AML with BCR-ABL1 (provisional entity) (3), Acute myeloid leukemia with BCR::ABL1 fusion (3)
AML with mutated NPM1 (4), Acute myeloid leukemia with NPM1 mutation (4)
AML with biallelic mutations of CEBPA (297), Acute myeloid leukemia with CEBPA mutation (297)
AML with mutated RUNX1 (provisional entity) (298),
AML with 11q23 (MLL) abnormalities (i.e., t(4;11), t(6;11), t(9;11), t(11;19)) (284), Acute myeloid leukemia with other KMT2A rearrangements (284)
AML with myelodysplasia – related changes (285), Acute myeloid leukemia with myelodysplasia – related (285)
Therapy related AML (t-AML) (9),
Acute myeloid leukemia with NUP98 rearrangement
Acute myeloid leukemia with mutated TP53
Acute myeloid leukemia with other defined genetic alterations
AML, not otherwise specified: Acute myeloid leukemia, defined by differentiation
AML, Acute myeloid leukemia not otherwise specified (280),
AML, minimally differentiated (286), Acute myeloid leukemia with minimal differentiation (286)
AML Acute myeloid leukemia without maturation (287) ,
AML Acute myeloid leukemia with maturation (288) ,
Acute myelomonocytic leukemia (289),
Acute monoblastic / Acute monocytic leukemia (290),
Acute erythroid leukemia (erythroid / myeloid and pure erythroleukemia) (291),
Acute megakaryoblastic leukemia (292),
Acute basophilic leukemia (293),
Acute panmyelosis with myelofibrosis (294),
Myeloid sarcoma (295),
Myeloid leukemia associated with Down syndrome (299),		 Capture data accurately
PRE135 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Specify ALL classification B-lymphoblastic leukemia / lymphoma:
B-lymphoblastic leukemia / lymphoma, NOS (B-cell ALL, NOS) (191),
B-lymphoblastic leukemia / lymphoma with t(9;22)(q34.1;q11.2); BCR-ABL1 (192),
B-lymphoblastic leukemia / lymphoma with t(v;11q23.3); KMT2A rearranged (193),
B-lymphoblastic leukemia / lymphoma with t(1;19)(q23;p13.3); TCF3-PBX1 (194),
B-lymphoblastic leukemia / lymphoma with t(12;21) (p13.2;q22.1); ETV6-RUNX1 (195),
B-lymphoblastic leukemia / lymphoma with t(5;14) (q31.1;q32.3); IL3-IGH (81),
B-lymphoblastic leukemia / lymphoma with Hyperdiploidy (51-65 chromosomes) (82),
B-lymphoblastic leukemia / lymphoma with Hypodiploidy (<46 chromosomes) (83),
B-lymphoblastic leukemia / lymphoma, BCR-ABL1-like (provisional entity) (94),
B-lymphoblastic leukemia / lymphoma, with iAMP21 (95),
T-cell lymphoblastic leukemia / lymphoma:
T-cell lymphoblastic leukemia / lymphoma (Precursor T-cell ALL) (196),
Early T-cell precursor lymphoblastic leukemia (96)
,NK cell lymphoblastic leukemia / lymphoma:
Natural killer (NK)- cell lymphoblastic leukemia / lymphoma (97)		 Change/Clarification of Information Requested and Response Option Specify ALL classification B-lymphoblastic leukemia / lymphoma:
B-lymphoblastic leukemia / lymphoma, NOS (B-cell ALL, NOS) (191), B-lymphoblastic leukemia / lymphoma, NOS (191)
B-lymphoblastic leukemia / lymphoma with t(9;22)(q34.1;q11.2); BCR-ABL1 (192), B-lymphoblastic leukemia / lymphoma with BCR::ABL1 fusion (192)
B-lymphoblastic leukemia / lymphoma with t(v;11q23.3); KMT2A rearranged (193), B-lymphoblastic leukemia / lymphoma with KMT2A rearrangement (193)
B-lymphoblastic leukemia / lymphoma with t(1;19)(q23;p13.3); TCF3-PBX1 (194), B-lymphoblastic leukemia / lymphoma with TCF3::PBX1 fusion (194)
B-lymphoblastic leukemia / lymphoma with t(12;21) (p13.2;q22.1); ETV6-RUNX1 (195), B-lymphoblastic leukemia / lymphoma with ETV6::RUNX1 fusion (195)
B-lymphoblastic leukemia / lymphoma with ETV6::RUNX1-like features
B-lymphoblastic leukemia / lymphoma with t(5;14) (q31.1;q32.3); IL3-IGH (81), B-lymphoblastic leukemia / lymphoma with IGH::IL3 fusion (81)
B-lymphoblastic leukemia / lymphoma with Hyperdiploidy (51-65 chromosomes) (82), B-lymphoblastic leukemia / lymphoma with high hyperdiploidy (82)
B-lymphoblastic leukemia / lymphoma with Hypodiploidy (<46 chromosomes) (83), B-lymphoblastic leukemia / lymphoma with hypodiploidy (83)
B-lymphoblastic leukemia / lymphoma, BCR-ABL1-like (provisional entity) (94), B-lymphoblastic leukemia / lymphoma, BCR::ABL1-like features (94)
B-lymphoblastic leukemia / lymphoma, with iAMP21 (95),
B-lymphoblastic leukemia / lymphoma with TCF3::HLF fusion
B-lymphoblastic leukemia / lymphoma with other defined genetic abnormalities
B-lymphoblastic leukemia / lymphoma with DUX4 rearrangement
B-lymphoblastic leukemia / lymphoma with IG::MYC fusion
B-lymphoblastic leukemia / lymphoma with MEF2D rearrangement
B-lymphoblastic leukemia / lymphoma with ZNF384 rearrangement
B-lymphoblastic leukemia / lymphoma with NUTM1 rearrangement
B-lymphoblastic leukemia / lymphoma with PAX5alt abnormalities
B-lymphoblastic leukemia / lymphoma with PAX5 p.P80R abnormalities
T-cell lymphoblastic leukemia / lymphoma:
T-cell lymphoblastic leukemia / lymphoma, NOS (Precursor T-cell ALL) (196),
T-lymphoblastic leukemia / lymphoma, HOXA dysregulated
T-lymphoblastic leukemia / lymphoma, SPI1 rearrangement
T-lymphoblastic leukemia / lymphoma, TLX1 rearrangement
T-lymphoblastic leukemia / lymphoma, TLX3 rearrangement
T-lymphoblastic leukemia / lymphoma, NKX3 rearrangement
T-lymphoblastic leukemia / lymphoma, TAL1-2 rearrangement
T-lymphoblastic leukemia / lymphoma, LMO1-2 rearrangement
T-lymphoblastic leukemia / lymphoma, BHLH, other
Early T-cell precursor lymphoblastic leukemia / lymphoma (96),
Early T-precursor lymphoblastic leukemia / lymphoma, with BCL11B
NK cell lymphoblastic leukemia / lymphoma:
Natural killer (NK)- cell lymphoblastic leukemia / lymphoma (97)		 Capture data accurately
PRE202 Pre-Transplant Disease Classification Acute Leukemias of Ambiguous Lineage and Other Myeloid Neoplasms yes no Specify acute leukemias of ambiguous lineage and other myeloid neoplasm classification Acute undifferentiated leukemia,
Blastic plasmacytoid dendritic cell neoplasm ,
Mixed phenotype acute leukemia,
B/myeloid, NOS,
Mixed phenotype acute leukemia (MPAL) with t(9;22)(q34.1;q11.2);
BCR-ABL1,Mixed phenotype acute leukemia with t(v; 11q23.3);
KMT2A rearranged,
Mixed phenotype acute leukemia,
T/myeloid, NOS,
Other acute leukemia of ambiguous lineage or myeloid neoplasm		 Change/Clarification of Information Requested and Response Option Specify acute leukemias of ambiguous lineage and other myeloid neoplasm classification Acute undifferentiated leukemia (31),
Blastic plasmacytoid dendritic cell neoplasm (296) ,
Mixed-phenotype acute leukemia, B/myeloid, NOS, (86)
Mixed phenotype acute leukemia (MPAL) with t(9;22)(q34.1;q11.2); BCR-ABL1 fusion, Mixed phenotype acute leukemia (MPAL) with BCR::ABL1 fusion (84)
Mixed phenotype acute leukemia with t(v; 11q23.3); KMT2A rearranged, Mixed phenotype acute leukemia with KMT2A rearrangement (85)
Mixed-phenotype acute leukemia with ZNF384 rearrangement
Acute leukemia of ambiguous lineage with BCL11B rearrangement
Mixed-phenotype acute leukemia, T/myeloid, NOS, (87)
Mixed-phenotype acute leukemia, rare types
Other acute leukemia of ambiguous lineage or myeloid neoplasm Acute leukemia of ambiguous lineage, NOS (88) 		Capture data accurately
PRE217 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes no What was the MDS subtype at diagnosis? - If transformed to AML, indicate AML as primary disease; also complete AML Disease Classification questions Atypical chronic myeloid leukemia (aCML), BCR-ABL1-,
Chronic myelomonocytic leukemia (CMMoL),
Juvenile myelomonocytic leukemia (JMML/JCML),
Myelodysplastic syndrome with isolated del(5q),
Myelodysplastic syndrome with multilineage dysplasia (MDS-MLD),
MDS / MPN with ring sideroblasts and thrombocytosis (MDS / MPN-RS-T),
Myelodysplastic syndrome / myeloproliferative neoplasm, unclassifiable, syndrome with single lineage dysplasia (MDS-SLD),
Myelodysplastic syndrome (MDS), unclassifiable,
Refractory cytopenia of childhood.
Myelodysplatic Syndrome with excess blasts (MDS-EB):
MDS with excess blasts-1 (MDS-EB-1),
MDS with excess blasts-2 (MDS-EB-2).
Myelodysplatic Syndrome with ring sideroblasts:
MDS-RS with multilineage dysplasia (MDS-RS-MLD),
MDS-RS with single lineage dysplasia (MDS-RS-SLD),		 Change/Clarification of Information Requested and Response Option What was the MDS subtype at diagnosis? - If transformed to AML, indicate AML as primary disease; also complete AML Disease Classification questions MDS with defining genetic abnormalities
Myelodysplastic syndrome with isolated del(5q), Myelodysplastic syndrome with low blasts and isolated 5q deletion (MDS-5q) (66)
Myelodysplastic syndrome with low blasts and SF3B1 mutation (MDS-SF3B1)
Myelodysplastic syndrome with low blasts and ring sideroblasts (>=15% ring sideroblasts and wild type SF3B1)
Myelodysplastic syndrome with biallelic TP53 inactivation (MDS-biTP53)
MDS, morphically defined
Myelodysplastic syndrome with low blasts (MDS-LB; <5% BM, <2%PB)
Myelodysplastic syndrome, hypoplastic (MDS-h) <=25% cellularity by age
Myelodysplatic Syndrome with ring sideroblasts: MDS-RS with multilineage dysplasia (MDS-RS-MLD),MDS-RS with single lineage dysplasia (MDS-RS-SLD),
MDS with excess blasts-1, Myelodysplastic syndrome with increased blasts (MDS-IB1) (61)
MDS with excess blasts-2, Myelodysplastic syndrome with increased blasts (MDS-IB2) (62)
Myelodysplastic syndrome with fibrosis (MDS-f)
Childhood myelodysplastic neoplasms (MDS)
Refractory cytopenia of childhood. Childhood MDS with low blasts, hypocellular (68)
Childhood MDS with increased blasts
Childhood MDS with low blasts, not otherwise specified
Myelodysplastic / myeloproliferative neoplasms
Chronic myelomonocytic leukemia (CMMoL), Chronic myelomonocytic leukemia (CMML), Myelodysplastic (54)
Chronic myelomonocytic leukemia (CMML), Myeloproliferative
MDS / MPN with ring sideroblasts and thrombocytosis (MDS / MPN-RS-T), Myelodysplastic/myeloproliferative neoplasm with SF3B1 mutation and thrombocytosis (1452)
MDS/MPN with ring siderobloasts (>=15% ring sideroblasts and wild type SF3B1) and thrombocytosis
Juvenile myelomonocytic leukemia (JMML/JCML) (36),
Atypical chronic myeloid leukemia (aCML) BCR-ABL1-,Myelodysplastic/myeloproliferative neoplasm with neutrophilia (1440)
Myelodysplastic syndrome / myeloproliferative neoplasm, unclassifiable, Myelodysplastic syndrome / myeloproliferative neoplasm, NOS (69)
Myelodysplastic syndrome with multilineage dysplasia (MDS-MLD),
Myelodysplastic syndrome (MDS), unclassifiable,		 Capture data accurately
Capture data accurately
PRE218 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes no Specify Myelodysplastic syndrome, unclassifiable (MDS-U) MDS-U with 1% blood blasts,MDS-U based on defining cytogenetic abnormality,MDS-U with single lineage dysplasia and pancytopenia Question will be disabled Specify Myelodysplastic syndrome, unclassifiable (MDS-U) MDS-U with 1% blood blasts,MDS-U based on defining cytogenetic abnormality,MDS-U with single lineage dysplasia and pancytopenia Reduce burden: data no longer relevant
PRE245 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify the MDS subtype or AML after transformation Transformed to AML,Chronic myelomonocytic leukemia (CMMoL),Myelodysplastic syndrome with isolated del(5q),Myelodysplastic syndrome with multilineage dysplasia (MDS-MLD),MDS / MPN with ring sideroblasts and thrombocytosis (MDS / MPN-RS-T),Myelodysplastic syndrome / myeloproliferative neoplasm, unclassifiable,Myelodysplastic syndrome with single lineage dysplasia (MDS-SLD),Myelodysplastic syndrome (MDS), unclassifiable,Refractory cytopenia of childhood. Myelodysplatic Syndrome with excess blasts (MDS-EB): MDS with excess blasts-1 (MDS-EB-1),MDS with excess blasts-2 (MDS-EB-2). Myelodysplatic syndrome with ring sideroblasts: MDS-RS with multilineage dysplasia (MDS-RS-MLD),MDS-RS with single lineage dysplasia (MDS-RS-SLD). Change/Clarification of Information Requested and Response Option Specify the MDS subtype or AML after transformation MDS with defining genetic abnormalities
Myelodysplastic syndrome with isolated del(5q), Myelodysplastic syndrome with low blasts and isolated 5q deletion (MDS-5q) (66)
Myelodysplastic syndrome with low blasts and SF3B1 mutation (MDS-SF3B1)
Myelodysplastic syndrome with low blasts and ring sideroblasts (>=15% ring sideroblasts and wild type SF3B1)
Myelodysplastic syndrome with biallelic TP53 inactivation (MDS-biTP53)
MDS, morphically defined
MDS, with low blasts (MDS-LB; <5% BM, <2%PB)
MDS, hypoplastic (MDS-h) <=25% cellularity by age
Myelodysplatic Syndrome with excess blasts (MDS-EB):
MDS with excess blasts-1 (MDS-EB-1), MDS with increased blasts (MDS-IB1) (61)
MDS with excess blasts-2 (MDS-EB-2). MDS with increased blasts (MDS-IB2) (62)
MDS with fibrosis (MDS-f)
Childhood myelodysplastic neoplasms (MDS)
Refractory cytopenia of childhood. Childhood MDS with low blasts, hypocellular (68)
Childhood MDS with low blasts, not otherwise specified
Childhood MDS with increased blasts
Myelodysplastic/myeloproliferative neoplasms
Chronic myelomonocytic leukemia (CMMoL),Chronic myelomonocytic leukemia (CMML), Myelodysplastic (54)
Chronic myelomonocytic leukemia (CMML), Myeloproliferative
Myelodysplastic/myeloproliferative neoplasm with neutrophilia (1440)
MDS / MPN with ring sideroblasts and thrombocytosis (MDS / MPN-RS-T), Myelodysplastic/myeloproliferative neoplasm with SF3B1 mutation and thrombocytosis (1452)
MDS/MPN with ring siderobloasts (>=15% ring sideroblasts and wild type SF3B1) and thrombocytosis
Myelodysplastic syndrome / myeloproliferative neoplasm, unclassifiable, Myelodysplastic syndrome / myeloproliferative neoplasm, NOS (69)
Transformed to AML,Myelodysplastic syndrome with multilineage dysplasia (MDS-MLD), Myelodysplastic syndrome with single lineage dysplasia (MDS-SLD),Myelodysplastic syndrome (MDS), unclassifiable, Myelodysplatic syndrome with ring sideroblasts: MDS-RS with multilineage dysplasia (MDS-RS-MLD),MDS-RS with single lineage dysplasia (MDS-RS-SLD)		 Capture data accurately
PRE246 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify Myelodysplastic syndrome, unclassifiable (MDS-U) MDS-U with 1% blood blasts,MDS-U based on defining cytogenetic abnormality,MDS-U with single lineage dysplasia and pancytopenia Question will be disabled Specify Myelodysplastic syndrome, unclassifiable (MDS-U) MDS-U with 1% blood blasts,MDS-U based on defining cytogenetic abnormality,MDS-U with single lineage dysplasia and pancytopenia Reduce burden: data no longer relevant
PRE273 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no What was the MPN subtype at diagnosis? Chronic eosinophilic leukemia, not otherwise specified (NOS),
Primary myelofibrosis (PMF),
Chronic neutrophilic leukemia,
Essential thrombocythemia,
Myeloproliferative neoplasm (MPN), unclassifiable,
Myeloid / lymphoid neoplasms with FGFR1 rearrangement,
Myeloid / lymphoid neoplasms with PCM1-JAK2,
Myeloid / lymphoid neoplasms with PDGFRA rearrangement,
Myeloid / lymphoid neoplasms with PDGFRB rearrangement,
Polycythemia vera (PCV),
Mastocytosis: Cutaneous mastocytosis (CM),
Systemic mastocytosis,
Mast cell sarcoma (MCS)		 Change/Clarification of Information Requested and Response Option What was the MPN subtype at diagnosis? Myeloproliferative neoplasms
Chronic neutrophilic leukemia
Chronic eosinophilic leukemia, not otherwise specified (NOS),
Essential thrombocythemia,
Myeloproliferative neoplasm (MPN), unclassifiable,
Myeloproliferative neoplasm, not otherwise specified
Myeloid / lymphoid neoplasms with FGFR1 rearrangement,
Myeloid / lymphoid neoplasms with PCM1-JAK2,Myeloid / lymphoid neoplasms with PDGFRA rearrangement,Myeloid / lymphoid neoplasms with PDGFRB rearrangement,
Polycythemia vera (PCV),
Primary myelofibrosis (PMF),
Mastocytosis
Cutaneous mastocytosis (CM),
Systemic mastocytosis,
Mast cell sarcoma (MCS)		 Capture data accurately
PRE274 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Specify systemic mastocytosis Aggressive systemic mastocytosis (ASM),Indolent systemic mastocytosis (ISM),Mast cell leukemia (MCL),Systemic mastocytosis with an associated hematological neoplasm (SM-AHN),Smoldering systemic mastocytosis (SSM) Change/Clarification of Information Requested and Response Option Specify systemic mastocytosis Aggressive systemic mastocytosis (ASM),Indolent systemic mastocytosis (ISM),Mast cell leukemia (MCL),Systemic mastocytosis with an associated hematological neoplasm (SM-AHN),Smoldering systemic mastocytosis (SSM), Bone marrow mastocytosis Capture data accurately
PRE358 Pre-Transplant Disease Classification Other Leukemia (OL) yes no Specify the other leukemia classification Chronic lymphocytic leukemia (CLL), NOS,
Chronic lymphocytic leukemia (CLL),
B-cell / small lymphocytic lymphoma (SLL),
Hairy cell leukemia,
Hairy cell leukemia variant,
Monoclonal B-cell lymphocytosis,
Other leukemia,
Other leukemia, NOS,
PLL, B-cell,
Prolymphocytic leukemia (PLL), NOS,
PLL, T-cell		 Change/Clarification of Information Requested and Response Option Specify the other leukemia classification Mature B-cell neoplasms
Chronic lymphocytic leukemia (CLL), NOS,
Chronic lymphocytic leukemia (CLL), B-cell / small lymphocytic lymphoma (SLL), Chronic lymphocytic leukemia/small lymphocytic lymphoma
Splenic B-cell lymphomas and leukemias
Hairy cell leukemia,
Hairy cell leukemia variant, Splenic B-cell lymphoma/leukemia with prominent nucleoli
Monoclonal B-cell lymphocytosis
Other leukemia,
Other leukemia, NOS,
PLL, B-cell,Prolymphocytic leukemia (PLL), NOS ,PLL, T-cell		 Capture data accurately
PRE365 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Specify the lymphoma histology Hodgkin Lymphoma
Hodgkin lymphoma, not otherwise specified (150)
Lymphocyte depleted (154)
Lymphocyte-rich (151)
Mixed cellularity (153)
Nodular lymphocyte predominant Hodgkin lymphoma (155)
Nodular sclerosis (152)
Non-Hodgkin Lymphoma
B-cell Neoplasms
ALK+ large B-cell lymphoma (1833)
B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and classical Hodgkin lymphoma (149)
Burkitt lymphoma (111)
Burkitt-like lymphoma with 11q aberration (1834)
Diffuse, large B-cell lymphoma- Activated B-cell type (non-GCB) (1821)
Diffuse, large B-cell lymphoma- Germinal center B-cell type (1820)
Diffuse large B-cell Lymphoma (cell of origin unknown) (107)
DLBCL associated with chronic inflammation (1825)
Duodenal-type follicular lymphoma (1815)
EBV+ DLBCL, NOS (1823)
EBV+ mucocutaneous ulcer (1824)
Extranodal marginal zone B-cell lymphoma of mucosal associated lymphoid tissue type (MALT) (122)
Follicular, mixed, small cleaved and large cell (Grade II follicle center lymphoma) (103)
Follicular, predominantly large cell (Grade IIIA follicle center lymphoma) (162)
Follicular, predominantly large cell (Grade IIIB follicle center lymphoma) (163)
Follicular, predominantly large cell (Grade IIIA vs IIIB not specified) (1814)
Follicular, predominantly small cleaved cell (Grade I follicle center lymphoma) (102)
Follicular (grade unknown) (164)
HHV8+ DLBCL, NOS (1826)
High-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements (1831)
High-grade B-cell lymphoma, NOS (1830)
Intravascular large B-cell lymphoma (136)
Large B-cell lymphoma with IRF4 rearrangement (1832)
Lymphomatoid granulomatosis (1835)
Mantle cell lymphoma (115)
Nodal marginal zone B-cell lymphoma (± monocytoid B-cells) (123)
Pediatric nodal marginal zone lymphoma (1813)
Pediatric-type follicular lymphoma (1816)
Plasmablastic lymphoma (1836)
Primary cutaneous DLBCL, leg type (1822)
Primary cutaneous follicle center lymphoma (1817)
Primary diffuse, large B-cell lymphoma of the CNS (118)
Primary effusion lymphoma (138)
Primary mediastinal (thymic) large B-cell lymphoma (125)
Splenic B-cell lymphoma/leukemia, unclassifiable (1811)
Splenic diffuse red pulp small B-cell lymphoma (1812)
Splenic marginal zone B-cell lymphoma (124)
T-cell / histiocytic rich large B-cell lymphoma (120)
Waldenstrom macroglobulinemia / Lymphoplasmacytic lymphoma (173)
Other B-cell lymphoma (129) – Go to question 380

T-cell and NK-cell Neoplasms
Adult T-cell lymphoma / leukemia (HTLV1 associated) (134)
Aggressive NK-cell leukemia (27)
Anaplastic large-cell lymphoma (ALCL), ALK positive (143)
Anaplastic large-cell lymphoma (ALCL), ALK negative (144)
Angioimmunoblastic T-cell lymphoma (131)
Breast implant–associated anaplastic large-cell lymphoma (1861)
Chronic lymphoproliferative disorder of NK cells (1856)
Enteropathy-type T-cell lymphoma (133)
Extranodal NK / T-cell lymphoma, nasal type (137)
Follicular T-cell lymphoma (1859)
Hepatosplenic T-cell lymphoma (145)
Indolent T-cell lymphoproliferative disorder of the GI tract (1858)
Monomorphic epitheliotropic intestinal T-cell lymphoma (1857)
Mycosis fungoides (141)
Nodal peripheral T-cell lymphoma with TFH phenotype (1860)
Peripheral T-cell lymphoma (PTCL), NOS (130)
Primary cutaneous acral CD8+ T-cell lymphoma (1853)
Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder (1854)
Primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma (1852)
Primary cutaneous CD30+ T-cell lymphoproliferative disorders [Primary cutaneous anaplastic large-cell lymphoma (C-ALCL), lymphoid papulosis] (147)
Primary cutaneous γδ T-cell lymphoma (1851)
Sézary syndrome (142)
Subcutaneous panniculitis-like T-cell lymphoma (146)
Systemic EBV+ T-cell lymphoma of childhood (1855)
T-cell large granular lymphocytic leukemia (126)
Other T-cell / NK-cell lymphoma (139)

Posttransplant lymphoproliferative disorders (PTLD)
Classical Hodgkin lymphoma PTLD (1876)
Florid follicular hyperplasia PTLD (1873)
Infectious mononucleosis PTLD (1872)
Monomorphic PTLD (B- and T-/NK-cell types) (1875)
Plasmacytic hyperplasia PTLD (1871)
Polymorphic PTLD (1874)		 Change/Clarification of Information Requested and Response Option Specify the lymphoma histology Hodgkin Lymphoma
Hodgkin lymphoma, not otherwise specified Classic Hodgkin lymphoma (150)
Lymphocyte depleted (154)
Lymphocyte-rich (151)
Mixed cellularity (153)
Nodular lymphocyte predominant Hodgkin lymphoma (155)
Nodular sclerosis (152)
Burkitt lymphoma
Burkitt lymphoma (111)
Large B-cell lymphomas
Diffuse large B-cell Lymphoma (cell of origin unknown) Diffuse large B-cell lymphoma, NOS (107)
Diffuse, large B-cell lymphoma, Germinal center B-cell subtype (1820)
Diffuse, large B-cell lymphoma- Activated B-cell type (non-GCB) Diffuse large B-cell lymphoma, Activated B-cell subtype (1821)
T-cell / histiocytic-rich large B-cell lymphoma (120)
High-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements Diffuse large B-cell lymphoma/ high grade B-cell lymphoma with MYC and BCL2 rearrangements (1831)
Diffuse large B-cell lymphoma/ high grade B-cell lymphoma with MYC and BCL6 rearrangements
Diffuse large B-cell lymphoma/ high grade B-cell lymphoma with MYC, BCL2, and BCL6 rearrangements
ALK-positive large B-cell lymphoma (1833)
Large B-cell lymphoma with IRF4 rearrangement (1832)
Burkitt-like lymphoma with 11q aberration High-grade B-cell lymphoma with 11q aberrations (1834)
Lymphomatoid granulomatosis (1835)
EBV+ DLBCL, NOS EBV-positive diffuse large B-cell lymphoma (1823)
DLBCL Diffuse, large B-cell lymphoma associated with chronic inflammation (1825)
Fibrin-associated large B-cell lymphoma
Fluid overload-associated large B-cell lymphoma
Plasmablastic lymphoma (1836)
Primary cutaneous DLBCL diffuse, large B-cell lymphoma, leg type (1822)
Intravascular large B-cell lymphoma (136)
Primary mediastinal (thymic) large B-cell lymphoma (125)
B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and classical Hodgkin lymphoma Mediastinal grey zone lymphoma (149)
High-grade B-cell lymphoma, NOS (1830)
Primary large B-cell lymphoma of immune-privileged sites
Primary diffuse, large B-cell lymphoma of the CNS (118)
Primary large B-cell lymphoma of the vitreoretina
Primary large B-cell lymphoma of the testis
KSHV/HHV8-associated B-cell lymphoid proliferations and lymphomas
Primary effusion lymphoma (138)
HHV8+ DLBCL, NOS KSHV/HHV8-positive diffuse large B-cell lymphoma (1826)
Lymphoplasmacytic lymphoma
Waldenstrom macroglobulinemia / Lymphoplasmacytic lymphoma (173)
IgM-LPL/Waldenstron macroglobulinemia
non-IgM-LPL/Waldenstron macroglobulinemia
Marginal zone lymphoma
Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type (MALT) (122)
Primary cutaneous marginal zone lymphoma
Nodal marginal zone B-cell lymphoma (± monocytoid B-cells) (123)
Pediatric nodal marginal zone lymphoma (1813)
Splenic B-cell lymphomas
Splenic B-cell lymphoma/leukemia, unclassifiable with prominent nucleoli (1811)
Splenic diffuse red pulp small B-cell lymphoma (1812)
Splenic marginal zone B-cell lymphoma (124)
Follicular lymphoma
Duodenal-type follicular lymphoma (1815)
Follicular, mixed, small cleaved and large cell (Grade II follicle center lymphoma) (103)
Follicular, predominantly large cell (Grade IIIA follicle center lymphoma) (162)
Follicular, predominantly large cell (Grade IIIB follicle center lymphoma) (163)
Follicular, predominantly large cell (Grade IIIA vs IIIB not specified) (1814)
Follicular, predominantly small cleaved cell (Grade I follicle center lymphoma) (102)
Follicular (grade unknown) (164)
Pediatric-type follicular lymphoma (1816)
Cutaneous follicle center lymphoma
Primary cutaneous follicle center lymphoma (1817)
Mantle cell lymphoma
Mantle cell lymphoma (115)
Leukaemic non-nodal mantle cell lymphoma
Transformations of indolent B-cell lymphomas
Transformations of indolent B-cell lymphomas
Lymphomas associated with immune deficiency and dysregulation
Classical Hodgkin lymphoma PTLD (1876)
Infectious mononucleosis PTLD (1872)
EBV-positive mucocutaneous ulcer (1824)
Monomorphic PTLD (B- and T-/NK-cell types) (1875)
Plasmacytic hyperplasia PTLD Hyperplasia arising in immune deficiencies (e.g. PTLD) (1871)
Polymorphic PTLD Polymorphic lymphoproliferative disorders arising in immune deficiency/dysregulation (1874)
Mature T-cell and NK-cell leukemias
T-cell large granular lymphocytic leukemia (126)
Chronic lymphoproliferative disorder of NK cells NK-large granular lymphocytic leukemia (1856)
Adult T-cell lymphoma / leukemia (HTLV1 associated) (134)
Sézary syndrome (142)
Aggressive NK-cell leukemia (27)
Primary cutaneous T-cell lymphomas
Primary cutaneous acral CD8-positive T-cell lymphoma lymphoproliferative disorder(1853)
Primary cutaneous CD4-positive small or medium T-cell lymphoproliferative disorder (1854)
Mycosis fungoides (141)
Primary cutaneous CD30+ T-cell lymphoproliferative disorders [Primary cutaneous anaplastic large-cell lymphoma (C-ALCL), lymphoid papulosis] Primary cutaneous CD30-positive T-cell lymphoproliferative disorder: Lymphomatoid papulosis (147)
Primary cutaneous CD30-positive T-cell lymphoproliferative disorder: Primary cutaneous anaplastic large cell lymphoma
Subcutaneous panniculitis-like T-cell lymphoma (146)
Primary cutaneous γδ gamma/delta T-cell lymphoma (1851)
Primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma (1852)
Primary cutaneous peripheral T-cell lymphoma, NOS
Intestinal T-cell and NK-cell lymphoid proliferations and lymphomas
Indolent T-cell lymphoproliferative disorder of the GI tract lymphoma of the gastrointestinal tract (1858)
Indolent NK-cell lymphoproliferative disorder of the gastrointestinal tract
Enteropathy-type associated T-cell lymphoma (133)
Monomorphic epitheliotropic intestinal T-cell lymphoma (1857)
Intestinal T-cell lymphoma, NOS
Hepatosplenic T-cell lymphoma
Hepatosplenic T-cell lymphoma (145)
Anaplastic large cell lymphoma
Anaplastic large-cell lymphoma (ALCL), ALK positive ALK-positive anaplastic large cell lymphoma (143)
Anaplastic large-cell lymphoma (ALCL), ALK negative ALK-negative anaplastic large cell lymphoma (144)
Breast implant–associated anaplastic large-cell lymphoma (1861)
Nodal T-follicular helper (TFH) cell lymphoma
Angioimmunoblastic T-cell lymphoma Nodal TFH cell lymphoma, angioimmunoblastic-type (131)
Follicular T-cell lymphoma Nodal TFH cell lymphoma, follicular-type (1859)
Nodal peripheral T-cell lymphoma with TFH phenotype Nodal TFH cell lymphoma, NOS (1860)
Other peripheral T-cell lymphomas
Peripheral T-cell lymphoma (PTCL), NOS (130)
EBV-positive NK/T-cell lymphomas
EBV-positive nodal T- and NK-cell lymphoma
Extranodal NK / T-cell lymphoma, nasal type (137)
EBV-positive T- and NK-cell lymphoid proliferations and lymphomas of childhood
Systemic EBV+ -positiveT-cell lymphoma of childhood (1855)
Other B-cell lymphoma (129)
Other T-cell / NK-cell lymphoma (139)
Non-Hodgkin Lymphoma
B-cell Neoplasms
T-cell and NK-cell Neoplasms
Posttransplant lymphoproliferative disorders (PTLD)
Florid follicular hyperplasia PTLD (1873)		 Capture data accurately
PRE382 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Specify the multiple myeloma/plasma cell disorder (PCD) classification Amyloidosis,
Monoclonal gammopathy of renal significance (MGRS),
Multiple myeloma,
Multiple myeloma-light chain only,
Multiple myeloma-non-secretory,
Osteosclerotic myeloma / POEMS syndrome,
Other plasma cell disorder (PCD),
Plasma cell leukemia (PCL),
Smoldering myeloma,
Solitary plasmacytoma		 Change/Clarification of Information Requested and Response Option Specify the multiple myeloma/plasma cell disorder (PCD) classification Immuno-globulin-related (AL) Aamyloidosis,
Multiple myeloma,
Multiple myeloma-light chain only,
Multiple myeloma-non-secretory,
Plasma cell leukemia (PCL),
Solitary pPlasmacytoma
Smoldering myeloma,
Plasma cell neoplasm with associated paraneoplastic syndrome
Monoclonal gammopathy of renal significance (MGRS),
Osteosclerotic myeloma / POEMS syndrome,
Other plasma cell disorder (PCD)		 Capture data accurately
PRE387 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Select monoclonal immunoglobulin deposition disease (MIDD) subtype Heavy chain deposition disease (HCDD)
Light chain deposition disease (LCDD),
Monoclonal immunoglobulin deposition disease 		Change/Clarification of Information Requested and Response Option Select monoclonal immunoglobulin deposition disease (MIDD) subtype Heavy chain deposition disease (HCDD)
Light chain deposition disease (LCDD),
Light and heavy chain deposition disease (LHCDD) Monoclonal immunoglobulin deposition disease 		Capture data accurately
PRE389 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Solitary plasmacytoma was Solitary plasmacytoma of bone
Extraosseous plasmacytoma		 Change/Clarification of Information Requested and Response Option Solitary plasmacytoma was Bone derived, Solitary plasmacytoma of bone
Extramedullary Extraosseous plasmacytoma		 Capture data accurately
PRE393 Pre-Transplant Disease Classification Preceding or Concurrent Plasma Cell Disorder yes yes Specify preceding / concurrent disorder Amyloidosis,
Monoclonal gammopathy of renal significance,
Monoclonal gammopathy of unknown significance,
Multiple myeloma,
Multiple myeloma - light chain only,
Multiple myeloma - non-secretory,
Osteosclerotic myeloma / POEMS syndrome,
Other disease,
Plasma cell leukemia,
Smoldering myeloma,
Solitary plasmacytoma		 Change/Clarification of Information Requested and Response Option Specify preceding / concurrent disorder Immuno-globulin-related (AL) Aamyloidosis,
Monoclonal gammopathy of renal significance,
Monoclonal gammopathy of unknown significance,
Multiple myeloma,
Multiple myeloma - light chain only,
Multiple myeloma - non-secretory,
Osteosclerotic myeloma / POEMS syndrome,
Other disease,
Plasma cell leukemia,
Smoldering myeloma,
Solitary pPlasmacytoma		 Capture data accurately
PRE424 Pre-Transplant Disease Classification Solid Tumors yes no Specify the solid tumor classification Breast cancer,
Bone sarcoma (excluding Ewing family tumors),
Cervical,
Central nervous system tumor, including CNS PNET,
Colorectal,
Ovarian (epithelial),
Ewing family tumors, extraosseous (including PNET),
Ewing family tumors of bone (including PNET),
External genitalia,
Fibrosarcoma,
Gastric,
Germ cell tumor, extragonadal,
Hepatobiliary,
Head / neck,
Hemangiosarcoma,
Lung, not otherwise specified,
Leiomyosarcoma,
Lymphangio sarcoma,
Liposarcoma,
Medulloblastoma,
Mediastinal neoplasm,
Melanoma,
Neuroblastoma,
Neurogenic sarcoma,
Lung, non-small cell,
Other solid tumor,
Prostate,
Renal cell,
Retinoblastoma,
Rhabdomyosarcoma,
Lung, small cell,
Synovial sarcoma,
Solid tumor, not otherwise specified,
Pancreatic,
Soft tissue sarcoma (excluding Ewing family tumors),
Testicular,
Thymoma,
Vaginal,
Wilms Tumor		 Change/Clarification of Information Requested and Response Option Specify the solid tumor classification Breast cancer
Breast cancer,
Tumors of the head / neck
Tumors of the Hhead / neck,
Digestive system tumors
Colorectal,
Pancreatic,
Tumor of the esophagus and gastro-esophageal (GE) junction
Gastric, Tumors of the stomach
Hepatobiliary, Tumors of liver and intrahepatic bile ducts
Central nervous system tumors
Atypical teratoid rhabdoid tumor (ATRT)
Central nervous system tumor, including CNS PNET
Diffuse intrinsic pontine glioma (DIPG)
Ependymoma
Glioblastoma multiforme (GBM)
Medulloblastoma
Soft tissue or bone tumors
Bone sarcoma (excluding Ewing family tumors),
Desmoplastic small round cell tumors
Ewing family tumors of bone (including PNET)
Ewing family tumors, extraosseous (including PNET)
Neurogenic sarcoma, Malignant Peripheral Nerve Sheath Tumor
Myxoid round cell sarcoma
Rhabdomyosarcoma,
Synovial sarcoma,
Soft tissue sarcoma (excluding Ewing family tumors), Other soft tissue sarcoma (excluding Ewing family tumors)
Tumors of endocrine organs
Germ cell tumors, gonadal
Germ cell tumor, extragonadal
Neuroblastoma
Thoracic tumors
Lung, non-small cell,
Lung, small cell,
Lung, not otherwise specified,
Adenocarcinoma,
Squamous carcinoma
Tumor of the pleura (Mesothelioma)
Skin tumors
Melanoma,
Genitourinary tumors
Ovarian (epithelial),
Prostate,
Renal cell,
Testicular
Vaginal,
Pediatric-focused tumor
Malignant Rhabdoid Tumor of the Kidney
Retinoblastoma,
Wilms Tumor
Other solid tumors
Other solid tumor,
Solid tumor, not otherwise specified,
Cervical,
External genitalia,
Fibrosarcoma,
Hemangiosarcoma,
Leiomyosarcoma,
Lymphangio sarcoma,
Liposarcoma,
Thymoma,
Mediastinal neoplasm,		 Capture data accurately
PRE429 Pre-Transplant Disease Classification Inherited Bone Marrow Failure Syndromes yes no Specify the inherited bone marrow failure syndrome classification Dyskeratosis congenita,
Fanconi anemia,
Severe congenital neutropenia,
Diamond-Blackfan anemia,
Shwachman-Diamond		 Change/Clarification of Information Requested and Response Option Specify the inherited bone marrow failure syndrome classification Dyskeratosis congenita, Telomere Biology Disorders including Dyskeratosis congenita (DKC1, TERT, TERC, and other mutations)
Fanconi anemia,
Severe congenital neutropenia (Elastase deficiency/ELANE or HAX1 mutations)
Diamond-Blackfan anemia,
Shwachman-Diamond (DNAJC21, EFL1, or SBDS mutations)
Germline SAMD9 variant (MIRAGE Syndrome)
Germline SAMD9L variant (SAMD9L-related Ataxia Pancytopenia Syndrome)
Other inherited bone failure syndromes		 Capture data accurately
PRE464 Pre-Transplant Disease Classification Disorders of the Immune System yes no Specify disorder of immune system classification Ataxia telangiectasia,
Bare lymphocyte syndrome,
Cartilage hair hypoplasia,
CD40 ligand deficiency,
Chronic granulomatous disease,
DiGeorge anomaly,
Griscelli syndrome type 2,
HIV infection,
Hermansky-Pudlak syndrome type 2,
Leukocyte adhesion deficiencies, including GP180, CD-18, LFA and WBC adhesion deficiencies,
Neutrophil actin deficiency,
Chediak-Higashi syndrome,
Other immunodeficiencies,
Omenn syndrome,
Other pigmentary dilution disorder,
Other SCID,
Reticular dysgenesis,
Adenosine deaminase (ADA) deficiency / severe combined immunodeficiency (SCID),
SCID, not otherwise specified,
Absence of T and B cells SCID,
Absence of T, normal B cell SCID,
Immune deficiency, not otherwise specified,
Common variable immunodeficiency,
Wiskott-Aldrich syndrome,
X-linked lymphoproliferative syndrome		 Change/Clarification of Information Requested and Response Option Specify disorder of immune system classification Severe Combined Immunodeficiencies
Adenosine deaminase (ADA) deficiency / severe combined immunodeficiency (SCID), SCID, T- B- NK-, Adenosine deaminase (ADA) deficiency
SCID, T- B- NK-, reticular dysgenesis,
SCID, T- B- NK+, RAG 1/2 deficiency
SCID, T- B- NK+, DCLRE1C (Artemis) deficiency
Absence of T, normal B cell SCID, SCID, T-, normal B and NK cells, ILR alpha deficiency
SCID, T- B- NK-, NOS
SCID, not otherwise specified,
Other SCID,
Combined Immunodeficiencies
CD40 ligand deficiency,
DOCK8 Deficiency
MHC Class II Deficiency (Bare lymphocyte syndrome)
Omenn syndrome,
ZAP-70 deficiency
Combined Immunodeficiencies with Associated or Syndromic Features
Ataxia telangiectasia,
Cartilage-hair hypoplasia,
DiGeorge anomaly,
NEMO Deficiency Syndrome
Wiskott-Aldrich syndrome,
Predominately Antibody deficiencies
Common variable immunodeficiency,
Activated PI3 Kinase Delta Deficiency Syndrome (APDS1 or PIK3CD)
Diseases of immune dysregulation, hemophagocytic lymphohistiocytosis
Chediak-Higashi syndrome,
Griscelli syndrome type 2,
Hermansky-Pudlak syndrome type 2,
Other pigmentary dilution disorder,
Diseases of immune dysregulation, EBV susceptibility
X-linked lymphoproliferative syndrome SAP deficiency (XIAP-1)
XIAP-2 deficiency
ITK deficiency
Diseases of immune dysregulation, syndromes with Autoimmunity and Others, NOS
Autoimmune Lymphoproliferative Syndrome (ALPS)
CTLA4 deficiency
IPEX, Immune Dysregulation Polyendocrinopathy, enteropathy X-linked (FOXP3 deficiency)
LRBA Deficiency
STAT3 Gain of Function
Congenital defects of phagocyte
Chronic granulomatous disease,
GATA2 deficiency
Leukocyte adhesion deficiencies, including GP180, CD-18, LFA and WBC adhesion deficiencies,
Neutrophil actin deficiency, Neutropenia with combined immune deficiency (MKL1 deficiency, Actin deficiency)
Other Immunodeficiencies
STAT1 Gain of Function
Other immunodeficiencies,
HIV infection,
Immune deficiency, not otherwise specified,
Absence of T and B cells SCID,		 Capture data accurately
PRE477 Pre-Transplant Disease Classification Histiocytic Disorders yes no Specify histiocytic disorder classification Histiocytic disorder, not otherwise specified (570),
Langerhans cell histiocytosis (histiocytosis-X) (572),
Hemophagocytic lymphohistiocytosis (HLH) (571),
Hemophagocytosis (reactive or viral associated) (573),
Malignant histiocytosis (574),
Other histiocytic disorder (579)		 Change/Clarification of Information Requested and Response Option Specify histiocytic disorder classification Diseases of immune dysregulation, Familial Hemophagocytic Lymphohistiocytosis (FHL)
Familial Hemophagocytic Lymphohistiocytosis, Perforin deficiency (FHL2)
Familial Hemophagocytic Lymphohistiocytosis, UNC13D (FHL3)
Familial Hemophagocytic Lymphohistiocytosis, STX11 (FHL4)
Familial Hemophagocytic Lymphohistiocytosis, STXBP2 (FHL5)
Familial Hemophagocytic Lymphohistiocytosis, no mutation identified
Familial Hemophagocytic Lymphohistiocytosis, other mutations
Histiocytic disorder, not otherwise specified (570),
Langerhans cell histiocytosis (histiocytosis-X) (572),
Hemophagocytic lymphohistiocytosis (HLH) (571),
Hemophagocytosis (reactive or viral associated) (573),
Malignant histiocytosis (574),Other histiocytic disorder (579)		 Capture data accurately
PRE655 Pre-Transplant Pre-Transplant Essential Data Autologous Transplant yes yes What agents were used to mobilize the autologous recipient for this HCT? (check all that apply) G-CSF (TBO-filgrastim, filgrastim, Granix, Neupogen) ,GM-CSF (sargramostim, Leukine), Pegylated G-CSF (pegfilgrastim, Neulasta), Plerixafor (Mozobil), Combined with chemotherapy, Anti-CD20 (rituximab, Rituxan), Other agent Change/Clarification of Information Requested and Response Option What agents were used to mobilize the autologous recipient for this HCT? (check all that apply) G-CSF (TBO-filgrastim, filgrastim, Granix, Neupogen) ,GM-CSF (sargramostim, Leukine), Pegylated G-CSF (pegfilgrastim, Neulasta), Plerixafor (Mozobil), Combined with chemotherapy, Anti-CD20 (rituximab, Rituxan), Motixafortide (Aphexda), Other agent
PRO113 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product Allogeneic Donors yes no Specify growth and mobilizing factor(s) (check all that apply) G-CSF (filgrastim, Neupogen),Pegylated G-CSF(pegfilgrastim, Neulasta) , Plerixafor (Mozobil) Other growth or mobilizing factor(s) Change/Clarification of Information Requested and Response Option Specify growth and mobilizing factor(s) (check all that apply) G-CSF (filgrastim, Neupogen),Pegylated G-CSF(pegfilgrastim, Neulasta) , Plerixafor (Mozobil), Motixafortide (Aphexda), Other growth or mobilizing factor(s) Capture data accurately

Sheet 3: Pre-Transplant Information Coll




Information Collection Domain: Pre-Transplant Information Collection






Item ID Time Point Information Collection Domain Sub-Type Information Collection Domain Additional Sub Domain Response required if Additional Sub Domain applies Information Collection may be requested multiple times Current Information Collection Data Element (if applicable) Current Information Collection Data Element Response Option(s) Information Collection update: Proposed Information Collection Data Element (if applicable) Proposed Information Collection Data Element Response Option(s) Rationale for Information Collection Update
PRE665 Pre-Transplant Pre-Transplant Essential Data


Has the patient been infected with COVID-19 (SARS-CoV-2) based on a positive test result at any time prior to the start of the preparative regimen / infusion? No,Yes Question will be disabled Has the patient been infected with COVID-19 (SARS-CoV-2) based on a positive test result at any time prior to the start of the preparative regimen / infusion? No,Yes Reduce burden: data no longer relevant
PRE666 Pre-Transplant Pre-Transplant Essential Data


Did the patient require hospitalization for management of COVID-19 (SARS-CoV-2) infection? No,Yes Question will be disabled Did the patient require hospitalization for management of COVID-19 (SARS-CoV-2) infection? No,Yes Reduce burden: data no longer relevant
PRE667 Pre-Transplant Pre-Transplant Essential Data


Was mechanical ventilation given for COVID-19 (SARS-CoV-2) infection? No,Yes Question will be disabled Was mechanical ventilation given for COVID-19 (SARS-CoV-2) infection? No,Yes Reduce burden: data no longer relevant
PRE668 Pre-Transplant Pre-Transplant Essential Data
no yes Was a vaccine for COVID-19 (SARS-CoV-2) received? No,Unknown,Yes Question will be disabled Was a vaccine for COVID-19 (SARS-CoV-2) received? No,Unknown,Yes Reduce burden: data no longer relevant
PRE669 Pre-Transplant Pre-Transplant Essential Data COVID-19 Vaccine yes yes Specify vaccine brand AstraZeneca,Johnson & Johnson/Janssen,Moderna,Novavax,Other (specify),Pfizer-BioNTech Question will be disabled Specify vaccine brand AstraZeneca,Johnson & Johnson/Janssen,Moderna,Novavax,Other (specify),Pfizer-BioNTech Reduce burden: data no longer relevant
PRE670 Pre-Transplant Pre-Transplant Essential Data COVID-19 Vaccine yes yes Specify other type: open text Question will be disabled Specify other type: open text Reduce burden: data no longer relevant
PRE671 Pre-Transplant Pre-Transplant Essential Data COVID-19 Vaccine yes yes Select dose(s) received Booster dose,First dose (with planned second dose) ,One dose (without planned second dose) ,Second dose,Third dose Question will be disabled Select dose(s) received Booster dose,First dose (with planned second dose) ,One dose (without planned second dose) ,Second dose,Third dose Reduce burden: data no longer relevant
PRE672 Pre-Transplant Pre-Transplant Essential Data COVID-19 Vaccine yes yes Date received: YYYY/MM/DD Question will be disabled Date received: YYYY/MM/DD Reduce burden: data no longer relevant
PRE673 Pre-Transplant Pre-Transplant Essential Data COVID-19 Vaccine yes yes Date estimated checked Question will be disabled Date estimated checked Reduce burden: data no longer relevant
PRE674 Pre-Transplant Pre-Transplant Essential Data
no no Is there a history of mechanical ventilation? (excluding COVID-19 (SARS-CoV-2))? no,yes Change/Clarification of Information Requested and Response Option Is there a history of mechanical ventilation? (excluding COVID-19 (SARS-CoV-2))? no,yes Instruction text change to remove instructions
PRE042 Pre-Transplant Disease Classification
no no What was the primary disease for which the HCT / cellular therapy was performed? Autoimmune diseases,Acute lymphoblastic leukemia (ALL),Acute myeloid leukemia (AML or ANLL),Chronic myeloid leukemia (CML),Hemoglobinopathies,Histiocytic disorders,Hodgkin lymphoma,Inherited Bone Marrow Failure Syndromes(If the recipient developed MDS or AML, indicate MDS or AML as the primary disease.)– ,Disorders of the immune system,Inherited disorders of metabolism,Inherited abnormalities of platelets,Myelodysplastic syndrome (MDS) (If recipient has transformed to AML, indicate AML as the primary disease.),Myeloproliferative neoplasms (MPN)(If recipient has transformed to AML, indicate AML as the primary disease.),Non-Hodgkin lymphoma,Acute leukemia of ambiguous lineage and other myeloid neoplasms,Other disease,Other leukemia (includes CLL),Multiple myeloma / plasma cell disorder (PCD),Paroxysmal nocturnal hemoglobinuria (PNH),Recessive dystrophic epidermolysis bullosa,Aplastic Anemia(If the recipient developed MDS or AML, indicate MDS or AML as the primary disease.) ,Solid tumors,Tolerance induction associated with solid organ transplant
What was the primary disease for which the HCT / cellular therapy was performed? Autoimmune diseases,Acute lymphoblastic leukemia (ALL),Acute myeloid leukemia (AML or ANLL),Chronic myeloid leukemia (CML),Hemoglobinopathies,Histiocytic disorders,Hodgkin lymphoma,Inherited Bone Marrow Failure Syndromes(If the recipient developed MDS or AML, indicate MDS or AML as the primary disease.)– ,Disorders of the immune system,Inherited disorders of metabolism,Inherited abnormalities of platelets,Myelodysplastic syndrome (MDS) (If recipient has transformed to AML, indicate AML as the primary disease.),Myeloproliferative neoplasms (MPN)(If recipient has transformed to AML, indicate AML as the primary disease.),Non-Hodgkin lymphoma,Acute leukemia of ambiguous lineage and other myeloid neoplasms,Other disease,Other leukemia (includes CLL),Multiple myeloma / plasma cell disorder (PCD),Paroxysmal nocturnal hemoglobinuria (PNH),Recessive dystrophic epidermolysis bullosa,Aplastic Anemia(If the recipient developed MDS or AML, indicate MDS or AML as the primary disease.) ,Solid tumors,Tolerance induction associated with solid organ transplant
PRE043 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Specify the AML classification AML with recurrent genetic abnormalities:
AML with t(9;11) (p22.3;q23.3); MLLT3-KMT2A (5),
AML with t(6;9) (p23;q34.1); DEK-NUP214 (6),
AML with inv(3) (q21.3;q26.2) or t(3;3) (q21.3;q26.2); GATA2, MECOM (7),
AML (megakaryoblastic) with t(1;22) (p13.3;q13.3); RBM15-MKL1 (8),
AML with t(8;21); (q22; q22.1); RUNX1-RUNX1T1 (281),
AML with inv(16) (p13.1;1q22) or t(16;16)(p13.1; q22); CBFB-MYH11 (282),
APL with PML-RARA (283),
AML with BCR-ABL1 (provisional entity) (3),
AML with mutated NPM1 (4),
AML with biallelic mutations of CEBPA (297),
AML with mutated RUNX1 (provisional entity) (298),
AML with 11q23 (MLL) abnormalities (i.e., t(4;11), t(6;11), t(9;11), t(11;19)) (284),
AML with myelodysplasia – related changes (285),
Therapy related AML (t-AML) (9),
AML, not otherwise specified:
AML, not otherwise specified (280),
AML, minimally differentiated (286),
AML without maturation (287) ,
AML with maturation (288) ,
Acute myelomonocytic leukemia (289),
Acute monoblastic / acute monocytic leukemia (290),
Acute erythroid leukemia (erythroid / myeloid and pure erythroleukemia) (291),
Acute megakaryoblastic leukemia (292),
Acute basophilic leukemia (293),
Acute panmyelosis with myelofibrosis (294),
Myeloid sarcoma (295),
Myeloid leukemia associated with Down syndrome (299),		 Change/Clarification of Information Requested and Response Option Specify the AML classification AML with recurrent genetic abnormalities: AML with defining genetic abnormalities
AML with t(9;11) (p22.3;q23.3); MLLT3-KMT2A (5), Acute myeloid leukemia with MLLT3::KMT2A fusion (5)
AML with t(6;9) (p23;q34.1); DEK-NUP214 (6), Acute myeloid leukemia with DEK::NUP214 fusion (6)
AML with inv(3) (q21.3;q26.2) or t(3;3) (q21.3;q26.2); GATA2, MECOM (7), Acute myeloid leukemia with MECOM (EVI1), GATA2 rearrangement (7)
Acute myeloid leukemia with Other MECOM rearrangements
AML (megakaryoblastic) with t(1;22) (p13.3;q13.3); RBM15-MKL1 (8), Acute myeloid leukemia with RBM15::MRTFA fusion (8)
AML with t(8;21); (q22; q22.1); RUNX1-RUNX1T1 (281), Acute myeloid leukemia with RUNX1::RUNX1T1 fusion (281)
AML with inv(16) (p13.1;1q22) or t(16;16)(p13.1; q22); CBFB-MYH11 (282), Acute myeloid leukemia with CBFB::MYH11 fusion (282)
APL with PML-RARA (283), Acute promyelocytic leukemia with PML::RARA fusion (283)
Acute promyelocytic leukemia with other RARA fusions
AML with BCR-ABL1 (provisional entity) (3), Acute myeloid leukemia with BCR::ABL1 fusion (3)
AML with mutated NPM1 (4), Acute myeloid leukemia with NPM1 mutation (4)
AML with biallelic mutations of CEBPA (297), Acute myeloid leukemia with CEBPA mutation (297)
AML with mutated RUNX1 (provisional entity) (298),
AML with 11q23 (MLL) abnormalities (i.e., t(4;11), t(6;11), t(9;11), t(11;19)) (284), Acute myeloid leukemia with other KMT2A rearrangements (284)
AML with myelodysplasia – related changes (285), Acute myeloid leukemia with myelodysplasia – related (285)
Therapy related AML (t-AML) (9),
Acute myeloid leukemia with NUP98 rearrangement
Acute myeloid leukemia with mutated TP53
Acute myeloid leukemia with other defined genetic alterations
AML, not otherwise specified: Acute myeloid leukemia, defined by differentiation
AML, Acute myeloid leukemia not otherwise specified (280),
AML, minimally differentiated (286), Acute myeloid leukemia with minimal differentiation (286)
AML Acute myeloid leukemia without maturation (287) ,
AML Acute myeloid leukemia with maturation (288) ,
Acute myelomonocytic leukemia (289),
Acute monoblastic / Acute monocytic leukemia (290),
Acute erythroid leukemia (erythroid / myeloid and pure erythroleukemia) (291),
Acute megakaryoblastic leukemia (292),
Acute basophilic leukemia (293),
Acute panmyelosis with myelofibrosis (294),
Myeloid sarcoma (295),
Myeloid leukemia associated with Down syndrome (299),		 Capture data accurately
PRE135 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Specify ALL classification B-lymphoblastic leukemia / lymphoma:
B-lymphoblastic leukemia / lymphoma, NOS (B-cell ALL, NOS) (191),
B-lymphoblastic leukemia / lymphoma with t(9;22)(q34.1;q11.2); BCR-ABL1 (192),
B-lymphoblastic leukemia / lymphoma with t(v;11q23.3); KMT2A rearranged (193),
B-lymphoblastic leukemia / lymphoma with t(1;19)(q23;p13.3); TCF3-PBX1 (194),
B-lymphoblastic leukemia / lymphoma with t(12;21) (p13.2;q22.1); ETV6-RUNX1 (195),
B-lymphoblastic leukemia / lymphoma with t(5;14) (q31.1;q32.3); IL3-IGH (81),
B-lymphoblastic leukemia / lymphoma with Hyperdiploidy (51-65 chromosomes) (82),
B-lymphoblastic leukemia / lymphoma with Hypodiploidy (<46 chromosomes) (83),
B-lymphoblastic leukemia / lymphoma, BCR-ABL1-like (provisional entity) (94),
B-lymphoblastic leukemia / lymphoma, with iAMP21 (95),
T-cell lymphoblastic leukemia / lymphoma:
T-cell lymphoblastic leukemia / lymphoma (Precursor T-cell ALL) (196),
Early T-cell precursor lymphoblastic leukemia (96)
,NK cell lymphoblastic leukemia / lymphoma:
Natural killer (NK)- cell lymphoblastic leukemia / lymphoma (97)		 Change/Clarification of Information Requested and Response Option Specify ALL classification B-lymphoblastic leukemia / lymphoma:
B-lymphoblastic leukemia / lymphoma, NOS (B-cell ALL, NOS) (191), B-lymphoblastic leukemia / lymphoma, NOS (191)
B-lymphoblastic leukemia / lymphoma with t(9;22)(q34.1;q11.2); BCR-ABL1 (192), B-lymphoblastic leukemia / lymphoma with BCR::ABL1 fusion (192)
B-lymphoblastic leukemia / lymphoma with t(v;11q23.3); KMT2A rearranged (193), B-lymphoblastic leukemia / lymphoma with KMT2A rearrangement (193)
B-lymphoblastic leukemia / lymphoma with t(1;19)(q23;p13.3); TCF3-PBX1 (194), B-lymphoblastic leukemia / lymphoma with TCF3::PBX1 fusion (194)
B-lymphoblastic leukemia / lymphoma with t(12;21) (p13.2;q22.1); ETV6-RUNX1 (195), B-lymphoblastic leukemia / lymphoma with ETV6::RUNX1 fusion (195)
B-lymphoblastic leukemia / lymphoma with ETV6::RUNX1-like features
B-lymphoblastic leukemia / lymphoma with t(5;14) (q31.1;q32.3); IL3-IGH (81), B-lymphoblastic leukemia / lymphoma with IGH::IL3 fusion (81)
B-lymphoblastic leukemia / lymphoma with Hyperdiploidy (51-65 chromosomes) (82), B-lymphoblastic leukemia / lymphoma with high hyperdiploidy (82)
B-lymphoblastic leukemia / lymphoma with Hypodiploidy (<46 chromosomes) (83), B-lymphoblastic leukemia / lymphoma with hypodiploidy (83)
B-lymphoblastic leukemia / lymphoma, BCR-ABL1-like (provisional entity) (94), B-lymphoblastic leukemia / lymphoma, BCR::ABL1-like features (94)
B-lymphoblastic leukemia / lymphoma, with iAMP21 (95),
B-lymphoblastic leukemia / lymphoma with TCF3::HLF fusion
B-lymphoblastic leukemia / lymphoma with other defined genetic abnormalities
B-lymphoblastic leukemia / lymphoma with DUX4 rearrangement
B-lymphoblastic leukemia / lymphoma with IG::MYC fusion
B-lymphoblastic leukemia / lymphoma with MEF2D rearrangement
B-lymphoblastic leukemia / lymphoma with ZNF384 rearrangement
B-lymphoblastic leukemia / lymphoma with NUTM1 rearrangement
B-lymphoblastic leukemia / lymphoma with PAX5alt abnormalities
B-lymphoblastic leukemia / lymphoma with PAX5 p.P80R abnormalities
T-cell lymphoblastic leukemia / lymphoma:
T-cell lymphoblastic leukemia / lymphoma, NOS (Precursor T-cell ALL) (196),
T-lymphoblastic leukemia / lymphoma, HOXA dysregulated
T-lymphoblastic leukemia / lymphoma, SPI1 rearrangement
T-lymphoblastic leukemia / lymphoma, TLX1 rearrangement
T-lymphoblastic leukemia / lymphoma, TLX3 rearrangement
T-lymphoblastic leukemia / lymphoma, NKX3 rearrangement
T-lymphoblastic leukemia / lymphoma, TAL1-2 rearrangement
T-lymphoblastic leukemia / lymphoma, LMO1-2 rearrangement
T-lymphoblastic leukemia / lymphoma, BHLH, other
Early T-cell precursor lymphoblastic leukemia / lymphoma (96),
Early T-precursor lymphoblastic leukemia / lymphoma, with BCL11B
NK cell lymphoblastic leukemia / lymphoma:
Natural killer (NK)- cell lymphoblastic leukemia / lymphoma (97)		 Capture data accurately
PRE202 Pre-Transplant Disease Classification Acute Leukemias of Ambiguous Lineage and Other Myeloid Neoplasms yes no Specify acute leukemias of ambiguous lineage and other myeloid neoplasm classification Acute undifferentiated leukemia,
Blastic plasmacytoid dendritic cell neoplasm ,
Mixed phenotype acute leukemia,
B/myeloid, NOS,
Mixed phenotype acute leukemia (MPAL) with t(9;22)(q34.1;q11.2);
BCR-ABL1,Mixed phenotype acute leukemia with t(v; 11q23.3);
KMT2A rearranged,
Mixed phenotype acute leukemia,
T/myeloid, NOS,
Other acute leukemia of ambiguous lineage or myeloid neoplasm		 Change/Clarification of Information Requested and Response Option Specify acute leukemias of ambiguous lineage and other myeloid neoplasm classification Acute undifferentiated leukemia (31),
Blastic plasmacytoid dendritic cell neoplasm (296) ,
Mixed-phenotype acute leukemia, B/myeloid, NOS, (86)
Mixed phenotype acute leukemia (MPAL) with t(9;22)(q34.1;q11.2); BCR-ABL1 fusion, Mixed phenotype acute leukemia (MPAL) with BCR::ABL1 fusion (84)
Mixed phenotype acute leukemia with t(v; 11q23.3); KMT2A rearranged, Mixed phenotype acute leukemia with KMT2A rearrangement (85)
Mixed-phenotype acute leukemia with ZNF384 rearrangement
Acute leukemia of ambiguous lineage with BCL11B rearrangement
Mixed-phenotype acute leukemia, T/myeloid, NOS, (87)
Mixed-phenotype acute leukemia, rare types
Other acute leukemia of ambiguous lineage or myeloid neoplasm Acute leukemia of ambiguous lineage, NOS (88) 		Capture data accurately
PRE217 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes no What was the MDS subtype at diagnosis? - If transformed to AML, indicate AML as primary disease; also complete AML Disease Classification questions Atypical chronic myeloid leukemia (aCML), BCR-ABL1-,
Chronic myelomonocytic leukemia (CMMoL),
Juvenile myelomonocytic leukemia (JMML/JCML),
Myelodysplastic syndrome with isolated del(5q),
Myelodysplastic syndrome with multilineage dysplasia (MDS-MLD),
MDS / MPN with ring sideroblasts and thrombocytosis (MDS / MPN-RS-T),
Myelodysplastic syndrome / myeloproliferative neoplasm, unclassifiable, syndrome with single lineage dysplasia (MDS-SLD),
Myelodysplastic syndrome (MDS), unclassifiable,
Refractory cytopenia of childhood.
Myelodysplatic Syndrome with excess blasts (MDS-EB):
MDS with excess blasts-1 (MDS-EB-1),
MDS with excess blasts-2 (MDS-EB-2).
Myelodysplatic Syndrome with ring sideroblasts:
MDS-RS with multilineage dysplasia (MDS-RS-MLD),
MDS-RS with single lineage dysplasia (MDS-RS-SLD),		 Change/Clarification of Information Requested and Response Option What was the MDS subtype at diagnosis? - If transformed to AML, indicate AML as primary disease; also complete AML Disease Classification questions MDS with defining genetic abnormalities
Myelodysplastic syndrome with isolated del(5q), Myelodysplastic syndrome with low blasts and isolated 5q deletion (MDS-5q) (66)
Myelodysplastic syndrome with low blasts and SF3B1 mutation (MDS-SF3B1)
Myelodysplastic syndrome with low blasts and ring sideroblasts (>=15% ring sideroblasts and wild type SF3B1)
Myelodysplastic syndrome with biallelic TP53 inactivation (MDS-biTP53)
MDS, morphically defined
Myelodysplastic syndrome with low blasts (MDS-LB; <5% BM, <2%PB)
Myelodysplastic syndrome, hypoplastic (MDS-h) <=25% cellularity by age
Myelodysplatic Syndrome with ring sideroblasts: MDS-RS with multilineage dysplasia (MDS-RS-MLD),MDS-RS with single lineage dysplasia (MDS-RS-SLD),
MDS with excess blasts-1, Myelodysplastic syndrome with increased blasts (MDS-IB1) (61)
MDS with excess blasts-2, Myelodysplastic syndrome with increased blasts (MDS-IB2) (62)
Myelodysplastic syndrome with fibrosis (MDS-f)
Childhood myelodysplastic neoplasms (MDS)
Refractory cytopenia of childhood. Childhood MDS with low blasts, hypocellular (68)
Childhood MDS with increased blasts
Childhood MDS with low blasts, not otherwise specified
Myelodysplastic / myeloproliferative neoplasms
Chronic myelomonocytic leukemia (CMMoL), Chronic myelomonocytic leukemia (CMML), Myelodysplastic (54)
Chronic myelomonocytic leukemia (CMML), Myeloproliferative
MDS / MPN with ring sideroblasts and thrombocytosis (MDS / MPN-RS-T), Myelodysplastic/myeloproliferative neoplasm with SF3B1 mutation and thrombocytosis (1452)
MDS/MPN with ring siderobloasts (>=15% ring sideroblasts and wild type SF3B1) and thrombocytosis
Juvenile myelomonocytic leukemia (JMML/JCML) (36),
Atypical chronic myeloid leukemia (aCML) BCR-ABL1-,Myelodysplastic/myeloproliferative neoplasm with neutrophilia (1440)
Myelodysplastic syndrome / myeloproliferative neoplasm, unclassifiable, Myelodysplastic syndrome / myeloproliferative neoplasm, NOS (69)
Myelodysplastic syndrome with multilineage dysplasia (MDS-MLD),
Myelodysplastic syndrome (MDS), unclassifiable,		 Capture data accurately
PRE218 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes no Specify Myelodysplastic syndrome, unclassifiable (MDS-U) MDS-U with 1% blood blasts,MDS-U based on defining cytogenetic abnormality,MDS-U with single lineage dysplasia and pancytopenia Question will be disabled Specify Myelodysplastic syndrome, unclassifiable (MDS-U) MDS-U with 1% blood blasts,MDS-U based on defining cytogenetic abnormality,MDS-U with single lineage dysplasia and pancytopenia Reduce burden: data no longer relevant
PRE245 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify the MDS subtype or AML after transformation Transformed to AML,Chronic myelomonocytic leukemia (CMMoL),Myelodysplastic syndrome with isolated del(5q),Myelodysplastic syndrome with multilineage dysplasia (MDS-MLD),MDS / MPN with ring sideroblasts and thrombocytosis (MDS / MPN-RS-T),Myelodysplastic syndrome / myeloproliferative neoplasm, unclassifiable,Myelodysplastic syndrome with single lineage dysplasia (MDS-SLD),Myelodysplastic syndrome (MDS), unclassifiable,Refractory cytopenia of childhood. Myelodysplatic Syndrome with excess blasts (MDS-EB): MDS with excess blasts-1 (MDS-EB-1),MDS with excess blasts-2 (MDS-EB-2). Myelodysplatic syndrome with ring sideroblasts: MDS-RS with multilineage dysplasia (MDS-RS-MLD),MDS-RS with single lineage dysplasia (MDS-RS-SLD). Change/Clarification of Information Requested and Response Option Specify the MDS subtype or AML after transformation MDS with defining genetic abnormalities
Myelodysplastic syndrome with isolated del(5q), Myelodysplastic syndrome with low blasts and isolated 5q deletion (MDS-5q) (66)
Myelodysplastic syndrome with low blasts and SF3B1 mutation (MDS-SF3B1)
Myelodysplastic syndrome with low blasts and ring sideroblasts (>=15% ring sideroblasts and wild type SF3B1)
Myelodysplastic syndrome with biallelic TP53 inactivation (MDS-biTP53)
MDS, morphically defined
MDS, with low blasts (MDS-LB; <5% BM, <2%PB)
MDS, hypoplastic (MDS-h) <=25% cellularity by age
Myelodysplatic Syndrome with excess blasts (MDS-EB):
MDS with excess blasts-1 (MDS-EB-1), MDS with increased blasts (MDS-IB1) (61)
MDS with excess blasts-2 (MDS-EB-2). MDS with increased blasts (MDS-IB2) (62)
MDS with fibrosis (MDS-f)
Childhood myelodysplastic neoplasms (MDS)
Refractory cytopenia of childhood. Childhood MDS with low blasts, hypocellular (68)
Childhood MDS with low blasts, not otherwise specified
Childhood MDS with increased blasts
Myelodysplastic/myeloproliferative neoplasms
Chronic myelomonocytic leukemia (CMMoL),Chronic myelomonocytic leukemia (CMML), Myelodysplastic (54)
Chronic myelomonocytic leukemia (CMML), Myeloproliferative
Myelodysplastic/myeloproliferative neoplasm with neutrophilia (1440)
MDS / MPN with ring sideroblasts and thrombocytosis (MDS / MPN-RS-T), Myelodysplastic/myeloproliferative neoplasm with SF3B1 mutation and thrombocytosis (1452)
MDS/MPN with ring siderobloasts (>=15% ring sideroblasts and wild type SF3B1) and thrombocytosis
Myelodysplastic syndrome / myeloproliferative neoplasm, unclassifiable, Myelodysplastic syndrome / myeloproliferative neoplasm, NOS (69)
Transformed to AML,Myelodysplastic syndrome with multilineage dysplasia (MDS-MLD), Myelodysplastic syndrome with single lineage dysplasia (MDS-SLD),Myelodysplastic syndrome (MDS), unclassifiable, Myelodysplatic syndrome with ring sideroblasts: MDS-RS with multilineage dysplasia (MDS-RS-MLD),MDS-RS with single lineage dysplasia (MDS-RS-SLD)
PRE246 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify Myelodysplastic syndrome, unclassifiable (MDS-U) MDS-U with 1% blood blasts,MDS-U based on defining cytogenetic abnormality,MDS-U with single lineage dysplasia and pancytopenia Question will be disabled Specify Myelodysplastic syndrome, unclassifiable (MDS-U) MDS-U with 1% blood blasts,MDS-U based on defining cytogenetic abnormality,MDS-U with single lineage dysplasia and pancytopenia Reduce burden: data no longer relevant
PRE273 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no What was the MPN subtype at diagnosis? Chronic eosinophilic leukemia, not otherwise specified (NOS),
Primary myelofibrosis (PMF),
Chronic neutrophilic leukemia,
Essential thrombocythemia,
Myeloproliferative neoplasm (MPN), unclassifiable,
Myeloid / lymphoid neoplasms with FGFR1 rearrangement,
Myeloid / lymphoid neoplasms with PCM1-JAK2,
Myeloid / lymphoid neoplasms with PDGFRA rearrangement,
Myeloid / lymphoid neoplasms with PDGFRB rearrangement,
Polycythemia vera (PCV),
Mastocytosis: Cutaneous mastocytosis (CM),
Systemic mastocytosis,
Mast cell sarcoma (MCS)		 Change/Clarification of Information Requested and Response Option What was the MPN subtype at diagnosis? Myeloproliferative neoplasms
Chronic neutrophilic leukemia
Chronic eosinophilic leukemia, not otherwise specified (NOS),
Essential thrombocythemia,
Myeloproliferative neoplasm (MPN), unclassifiable,
Myeloproliferative neoplasm, not otherwise specified
Myeloid / lymphoid neoplasms with FGFR1 rearrangement,
Myeloid / lymphoid neoplasms with PCM1-JAK2,Myeloid / lymphoid neoplasms with PDGFRA rearrangement,Myeloid / lymphoid neoplasms with PDGFRB rearrangement,
Polycythemia vera (PCV),
Primary myelofibrosis (PMF),
Mastocytosis
Cutaneous mastocytosis (CM),
Systemic mastocytosis,
Mast cell sarcoma (MCS)		 Capture data accurately
PRE274 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Specify systemic mastocytosis Aggressive systemic mastocytosis (ASM),Indolent systemic mastocytosis (ISM),Mast cell leukemia (MCL),Systemic mastocytosis with an associated hematological neoplasm (SM-AHN),Smoldering systemic mastocytosis (SSM) Change/Clarification of Information Requested and Response Option Specify systemic mastocytosis Aggressive systemic mastocytosis (ASM),Indolent systemic mastocytosis (ISM),Mast cell leukemia (MCL),Systemic mastocytosis with an associated hematological neoplasm (SM-AHN),Smoldering systemic mastocytosis (SSM), Bone marrow mastocytosis Reduce burden: data no longer relevant
PRE358 Pre-Transplant Disease Classification Other Leukemia (OL) yes no Specify the other leukemia classification Chronic lymphocytic leukemia (CLL), NOS,
Chronic lymphocytic leukemia (CLL),
B-cell / small lymphocytic lymphoma (SLL),
Hairy cell leukemia,
Hairy cell leukemia variant,
Monoclonal B-cell lymphocytosis,
Other leukemia,
Other leukemia, NOS,
PLL, B-cell,
Prolymphocytic leukemia (PLL), NOS,
PLL, T-cell		 Change/Clarification of Information Requested and Response Option Specify the other leukemia classification Mature B-cell neoplasms
Chronic lymphocytic leukemia (CLL), NOS,
Chronic lymphocytic leukemia (CLL), B-cell / small lymphocytic lymphoma (SLL), Chronic lymphocytic leukemia/small lymphocytic lymphoma
Splenic B-cell lymphomas and leukemias
Hairy cell leukemia,
Hairy cell leukemia variant, Splenic B-cell lymphoma/leukemia with prominent nucleoli
Monoclonal B-cell lymphocytosis
Other leukemia,
Other leukemia, NOS,
PLL, B-cell,Prolymphocytic leukemia (PLL), NOS ,PLL, T-cell		 Capture data accurately
PRE365 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Specify the lymphoma histology Hodgkin Lymphoma
Hodgkin lymphoma, not otherwise specified (150)
Lymphocyte depleted (154)
Lymphocyte-rich (151)
Mixed cellularity (153)
Nodular lymphocyte predominant Hodgkin lymphoma (155)
Nodular sclerosis (152)
Non-Hodgkin Lymphoma
B-cell Neoplasms
ALK+ large B-cell lymphoma (1833)
B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and classical Hodgkin lymphoma (149)
Burkitt lymphoma (111)
Burkitt-like lymphoma with 11q aberration (1834)
Diffuse, large B-cell lymphoma- Activated B-cell type (non-GCB) (1821)
Diffuse, large B-cell lymphoma- Germinal center B-cell type (1820)
Diffuse large B-cell Lymphoma (cell of origin unknown) (107)
DLBCL associated with chronic inflammation (1825)
Duodenal-type follicular lymphoma (1815)
EBV+ DLBCL, NOS (1823)
EBV+ mucocutaneous ulcer (1824)
Extranodal marginal zone B-cell lymphoma of mucosal associated lymphoid tissue type (MALT) (122)
Follicular, mixed, small cleaved and large cell (Grade II follicle center lymphoma) (103)
Follicular, predominantly large cell (Grade IIIA follicle center lymphoma) (162)
Follicular, predominantly large cell (Grade IIIB follicle center lymphoma) (163)
Follicular, predominantly large cell (Grade IIIA vs IIIB not specified) (1814)
Follicular, predominantly small cleaved cell (Grade I follicle center lymphoma) (102)
Follicular (grade unknown) (164)
HHV8+ DLBCL, NOS (1826)
High-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements (1831)
High-grade B-cell lymphoma, NOS (1830)
Intravascular large B-cell lymphoma (136)
Large B-cell lymphoma with IRF4 rearrangement (1832)
Lymphomatoid granulomatosis (1835)
Mantle cell lymphoma (115)
Nodal marginal zone B-cell lymphoma (± monocytoid B-cells) (123)
Pediatric nodal marginal zone lymphoma (1813)
Pediatric-type follicular lymphoma (1816)
Plasmablastic lymphoma (1836)
Primary cutaneous DLBCL, leg type (1822)
Primary cutaneous follicle center lymphoma (1817)
Primary diffuse, large B-cell lymphoma of the CNS (118)
Primary effusion lymphoma (138)
Primary mediastinal (thymic) large B-cell lymphoma (125)
Splenic B-cell lymphoma/leukemia, unclassifiable (1811)
Splenic diffuse red pulp small B-cell lymphoma (1812)
Splenic marginal zone B-cell lymphoma (124)
T-cell / histiocytic rich large B-cell lymphoma (120)
Waldenstrom macroglobulinemia / Lymphoplasmacytic lymphoma (173)
Other B-cell lymphoma (129) – Go to question 380

T-cell and NK-cell Neoplasms
Adult T-cell lymphoma / leukemia (HTLV1 associated) (134)
Aggressive NK-cell leukemia (27)
Anaplastic large-cell lymphoma (ALCL), ALK positive (143)
Anaplastic large-cell lymphoma (ALCL), ALK negative (144)
Angioimmunoblastic T-cell lymphoma (131)
Breast implant–associated anaplastic large-cell lymphoma (1861)
Chronic lymphoproliferative disorder of NK cells (1856)
Enteropathy-type T-cell lymphoma (133)
Extranodal NK / T-cell lymphoma, nasal type (137)
Follicular T-cell lymphoma (1859)
Hepatosplenic T-cell lymphoma (145)
Indolent T-cell lymphoproliferative disorder of the GI tract (1858)
Monomorphic epitheliotropic intestinal T-cell lymphoma (1857)
Mycosis fungoides (141)
Nodal peripheral T-cell lymphoma with TFH phenotype (1860)
Peripheral T-cell lymphoma (PTCL), NOS (130)
Primary cutaneous acral CD8+ T-cell lymphoma (1853)
Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder (1854)
Primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma (1852)
Primary cutaneous CD30+ T-cell lymphoproliferative disorders [Primary cutaneous anaplastic large-cell lymphoma (C-ALCL), lymphoid papulosis] (147)
Primary cutaneous γδ T-cell lymphoma (1851)
Sézary syndrome (142)
Subcutaneous panniculitis-like T-cell lymphoma (146)
Systemic EBV+ T-cell lymphoma of childhood (1855)
T-cell large granular lymphocytic leukemia (126)
Other T-cell / NK-cell lymphoma (139)

Posttransplant lymphoproliferative disorders (PTLD)
Classical Hodgkin lymphoma PTLD (1876)
Florid follicular hyperplasia PTLD (1873)
Infectious mononucleosis PTLD (1872)
Monomorphic PTLD (B- and T-/NK-cell types) (1875)
Plasmacytic hyperplasia PTLD (1871)
Polymorphic PTLD (1874)		 Change/Clarification of Information Requested and Response Option Specify the lymphoma histology Hodgkin Lymphoma
Hodgkin lymphoma, not otherwise specified Classic Hodgkin lymphoma (150)
Lymphocyte depleted (154)
Lymphocyte-rich (151)
Mixed cellularity (153)
Nodular lymphocyte predominant Hodgkin lymphoma (155)
Nodular sclerosis (152)
Burkitt lymphoma
Burkitt lymphoma (111)
Large B-cell lymphomas
Diffuse large B-cell Lymphoma (cell of origin unknown) Diffuse large B-cell lymphoma, NOS (107)
Diffuse, large B-cell lymphoma, Germinal center B-cell subtype (1820)
Diffuse, large B-cell lymphoma- Activated B-cell type (non-GCB) Diffuse large B-cell lymphoma, Activated B-cell subtype (1821)
T-cell / histiocytic-rich large B-cell lymphoma (120)
High-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements Diffuse large B-cell lymphoma/ high grade B-cell lymphoma with MYC and BCL2 rearrangements (1831)
Diffuse large B-cell lymphoma/ high grade B-cell lymphoma with MYC and BCL6 rearrangements
Diffuse large B-cell lymphoma/ high grade B-cell lymphoma with MYC, BCL2, and BCL6 rearrangements
ALK-positive large B-cell lymphoma (1833)
Large B-cell lymphoma with IRF4 rearrangement (1832)
Burkitt-like lymphoma with 11q aberration High-grade B-cell lymphoma with 11q aberrations (1834)
Lymphomatoid granulomatosis (1835)
EBV+ DLBCL, NOS EBV-positive diffuse large B-cell lymphoma (1823)
DLBCL Diffuse, large B-cell lymphoma associated with chronic inflammation (1825)
Fibrin-associated large B-cell lymphoma
Fluid overload-associated large B-cell lymphoma
Plasmablastic lymphoma (1836)
Primary cutaneous DLBCL diffuse, large B-cell lymphoma, leg type (1822)
Intravascular large B-cell lymphoma (136)
Primary mediastinal (thymic) large B-cell lymphoma (125)
B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and classical Hodgkin lymphoma Mediastinal grey zone lymphoma (149)
High-grade B-cell lymphoma, NOS (1830)
Primary large B-cell lymphoma of immune-privileged sites
Primary diffuse, large B-cell lymphoma of the CNS (118)
Primary large B-cell lymphoma of the vitreoretina
Primary large B-cell lymphoma of the testis
KSHV/HHV8-associated B-cell lymphoid proliferations and lymphomas
Primary effusion lymphoma (138)
HHV8+ DLBCL, NOS KSHV/HHV8-positive diffuse large B-cell lymphoma (1826)
Lymphoplasmacytic lymphoma
Waldenstrom macroglobulinemia / Lymphoplasmacytic lymphoma (173)
IgM-LPL/Waldenstron macroglobulinemia
non-IgM-LPL/Waldenstron macroglobulinemia
Marginal zone lymphoma
Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type (MALT) (122)
Primary cutaneous marginal zone lymphoma
Nodal marginal zone B-cell lymphoma (± monocytoid B-cells) (123)
Pediatric nodal marginal zone lymphoma (1813)
Splenic B-cell lymphomas
Splenic B-cell lymphoma/leukemia, unclassifiable with prominent nucleoli (1811)
Splenic diffuse red pulp small B-cell lymphoma (1812)
Splenic marginal zone B-cell lymphoma (124)
Follicular lymphoma
Duodenal-type follicular lymphoma (1815)
Follicular, mixed, small cleaved and large cell (Grade II follicle center lymphoma) (103)
Follicular, predominantly large cell (Grade IIIA follicle center lymphoma) (162)
Follicular, predominantly large cell (Grade IIIB follicle center lymphoma) (163)
Follicular, predominantly large cell (Grade IIIA vs IIIB not specified) (1814)
Follicular, predominantly small cleaved cell (Grade I follicle center lymphoma) (102)
Follicular (grade unknown) (164)
Pediatric-type follicular lymphoma (1816)
Cutaneous follicle center lymphoma
Primary cutaneous follicle center lymphoma (1817)
Mantle cell lymphoma
Mantle cell lymphoma (115)
Leukaemic non-nodal mantle cell lymphoma
Transformations of indolent B-cell lymphomas
Transformations of indolent B-cell lymphomas
Lymphomas associated with immune deficiency and dysregulation
Classical Hodgkin lymphoma PTLD (1876)
Infectious mononucleosis PTLD (1872)
EBV-positive mucocutaneous ulcer (1824)
Monomorphic PTLD (B- and T-/NK-cell types) (1875)
Plasmacytic hyperplasia PTLD Hyperplasia arising in immune deficiencies (e.g. PTLD) (1871)
Polymorphic PTLD Polymorphic lymphoproliferative disorders arising in immune deficiency/dysregulation (1874)
Mature T-cell and NK-cell leukemias
T-cell large granular lymphocytic leukemia (126)
Chronic lymphoproliferative disorder of NK cells NK-large granular lymphocytic leukemia (1856)
Adult T-cell lymphoma / leukemia (HTLV1 associated) (134)
Sézary syndrome (142)
Aggressive NK-cell leukemia (27)
Primary cutaneous T-cell lymphomas
Primary cutaneous acral CD8-positive T-cell lymphoma lymphoproliferative disorder(1853)
Primary cutaneous CD4-positive small or medium T-cell lymphoproliferative disorder (1854)
Mycosis fungoides (141)
Primary cutaneous CD30+ T-cell lymphoproliferative disorders [Primary cutaneous anaplastic large-cell lymphoma (C-ALCL), lymphoid papulosis] Primary cutaneous CD30-positive T-cell lymphoproliferative disorder: Lymphomatoid papulosis (147)
Primary cutaneous CD30-positive T-cell lymphoproliferative disorder: Primary cutaneous anaplastic large cell lymphoma
Subcutaneous panniculitis-like T-cell lymphoma (146)
Primary cutaneous γδ gamma/delta T-cell lymphoma (1851)
Primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma (1852)
Primary cutaneous peripheral T-cell lymphoma, NOS
Intestinal T-cell and NK-cell lymphoid proliferations and lymphomas
Indolent T-cell lymphoproliferative disorder of the GI tract lymphoma of the gastrointestinal tract (1858)
Indolent NK-cell lymphoproliferative disorder of the gastrointestinal tract
Enteropathy-type associated T-cell lymphoma (133)
Monomorphic epitheliotropic intestinal T-cell lymphoma (1857)
Intestinal T-cell lymphoma, NOS
Hepatosplenic T-cell lymphoma
Hepatosplenic T-cell lymphoma (145)
Anaplastic large cell lymphoma
Anaplastic large-cell lymphoma (ALCL), ALK positive ALK-positive anaplastic large cell lymphoma (143)
Anaplastic large-cell lymphoma (ALCL), ALK negative ALK-negative anaplastic large cell lymphoma (144)
Breast implant–associated anaplastic large-cell lymphoma (1861)
Nodal T-follicular helper (TFH) cell lymphoma
Angioimmunoblastic T-cell lymphoma Nodal TFH cell lymphoma, angioimmunoblastic-type (131)
Follicular T-cell lymphoma Nodal TFH cell lymphoma, follicular-type (1859)
Nodal peripheral T-cell lymphoma with TFH phenotype Nodal TFH cell lymphoma, NOS (1860)
Other peripheral T-cell lymphomas
Peripheral T-cell lymphoma (PTCL), NOS (130)
EBV-positive NK/T-cell lymphomas
EBV-positive nodal T- and NK-cell lymphoma
Extranodal NK / T-cell lymphoma, nasal type (137)
EBV-positive T- and NK-cell lymphoid proliferations and lymphomas of childhood
Systemic EBV+ -positiveT-cell lymphoma of childhood (1855)
Other B-cell lymphoma (129)
Other T-cell / NK-cell lymphoma (139)
Non-Hodgkin Lymphoma
B-cell Neoplasms
T-cell and NK-cell Neoplasms
Posttransplant lymphoproliferative disorders (PTLD)
Florid follicular hyperplasia PTLD (1873)		 Capture data accurately
PRE382 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Specify the multiple myeloma/plasma cell disorder (PCD) classification Amyloidosis,
Monoclonal gammopathy of renal significance (MGRS),
Multiple myeloma,
Multiple myeloma-light chain only,
Multiple myeloma-non-secretory,
Osteosclerotic myeloma / POEMS syndrome,
Other plasma cell disorder (PCD),
Plasma cell leukemia (PCL),
Smoldering myeloma,
Solitary plasmacytoma		 Change/Clarification of Information Requested and Response Option Specify the multiple myeloma/plasma cell disorder (PCD) classification Immuno-globulin-related (AL) Aamyloidosis,
Multiple myeloma,
Multiple myeloma-light chain only,
Multiple myeloma-non-secretory,
Plasma cell leukemia (PCL),
Solitary pPlasmacytoma
Smoldering myeloma,
Plasma cell neoplasm with associated paraneoplastic syndrome
Monoclonal gammopathy of renal significance (MGRS),
Osteosclerotic myeloma / POEMS syndrome,
Other plasma cell disorder (PCD)		 Capture data accurately
PRE387 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Select monoclonal immunoglobulin deposition disease (MIDD) subtype Heavy chain deposition disease (HCDD)
Light chain deposition disease (LCDD),
Monoclonal immunoglobulin deposition disease 		Change/Clarification of Information Requested and Response Option Select monoclonal immunoglobulin deposition disease (MIDD) subtype Heavy chain deposition disease (HCDD)
Light chain deposition disease (LCDD),
Light and heavy chain deposition disease (LHCDD) Monoclonal immunoglobulin deposition disease 		Capture data accurately
PRE389 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Solitary plasmacytoma was Solitary plasmacytoma of bone
Extraosseous plasmacytoma		 Change/Clarification of Information Requested and Response Option Solitary plasmacytoma was Bone derived, Solitary plasmacytoma of bone
Extramedullary Extraosseous plasmacytoma		 Capture data accurately
PRE393 Pre-Transplant Disease Classification Preceding or Concurrent Plasma Cell Disorder yes yes Specify preceding / concurrent disorder Amyloidosis,
Monoclonal gammopathy of renal significance,
Monoclonal gammopathy of unknown significance,
Multiple myeloma,
Multiple myeloma - light chain only,
Multiple myeloma - non-secretory,
Osteosclerotic myeloma / POEMS syndrome,
Other disease,
Plasma cell leukemia,
Smoldering myeloma,
Solitary plasmacytoma
Specify preceding / concurrent disorder Immuno-globulin-related (AL) Aamyloidosis,
Monoclonal gammopathy of renal significance,
Monoclonal gammopathy of unknown significance,
Multiple myeloma,
Multiple myeloma - light chain only,
Multiple myeloma - non-secretory,
Osteosclerotic myeloma / POEMS syndrome,
Other disease,
Plasma cell leukemia,
Smoldering myeloma,
Solitary pPlasmacytoma
PRE424 Pre-Transplant Disease Classification Solid Tumors yes no Specify the solid tumor classification Breast cancer,
Bone sarcoma (excluding Ewing family tumors),
Cervical,
Central nervous system tumor, including CNS PNET,
Colorectal,
Ovarian (epithelial),
Ewing family tumors, extraosseous (including PNET),
Ewing family tumors of bone (including PNET),
External genitalia,
Fibrosarcoma,
Gastric,
Germ cell tumor, extragonadal,
Hepatobiliary,
Head / neck,
Hemangiosarcoma,
Lung, not otherwise specified,
Leiomyosarcoma,
Lymphangio sarcoma,
Liposarcoma,
Medulloblastoma,
Mediastinal neoplasm,
Melanoma,
Neuroblastoma,
Neurogenic sarcoma,
Lung, non-small cell,
Other solid tumor,
Prostate,
Renal cell,
Retinoblastoma,
Rhabdomyosarcoma,
Lung, small cell,
Synovial sarcoma,
Solid tumor, not otherwise specified,
Pancreatic,
Soft tissue sarcoma (excluding Ewing family tumors),
Testicular,
Thymoma,
Vaginal,
Wilms Tumor		 Change/Clarification of Information Requested and Response Option Specify the solid tumor classification Breast cancer
Breast cancer,
Tumors of the head / neck
Tumors of the Hhead / neck,
Digestive system tumors
Colorectal,
Pancreatic,
Tumor of the esophagus and gastro-esophageal (GE) junction
Gastric, Tumors of the stomach
Hepatobiliary, Tumors of liver and intrahepatic bile ducts
Central nervous system tumors
Atypical teratoid rhabdoid tumor (ATRT)
Central nervous system tumor, including CNS PNET
Diffuse intrinsic pontine glioma (DIPG)
Ependymoma
Glioblastoma multiforme (GBM)
Medulloblastoma
Soft tissue or bone tumors
Bone sarcoma (excluding Ewing family tumors),
Desmoplastic small round cell tumors
Ewing family tumors of bone (including PNET)
Ewing family tumors, extraosseous (including PNET)
Neurogenic sarcoma, Malignant Peripheral Nerve Sheath Tumor
Myxoid round cell sarcoma
Rhabdomyosarcoma,
Synovial sarcoma,
Soft tissue sarcoma (excluding Ewing family tumors), Other soft tissue sarcoma (excluding Ewing family tumors)
Tumors of endocrine organs
Germ cell tumors, gonadal
Germ cell tumor, extragonadal
Neuroblastoma
Thoracic tumors
Lung, non-small cell,
Lung, small cell,
Lung, not otherwise specified,
Adenocarcinoma,
Squamous carcinoma
Tumor of the pleura (Mesothelioma)
Skin tumors
Melanoma,
Genitourinary tumors
Ovarian (epithelial),
Prostate,
Renal cell,
Testicular
Vaginal,
Pediatric-focused tumor
Malignant Rhabdoid Tumor of the Kidney
Retinoblastoma,
Wilms Tumor
Other solid tumors
Other solid tumor,
Solid tumor, not otherwise specified,
Cervical,
External genitalia,
Fibrosarcoma,
Hemangiosarcoma,
Leiomyosarcoma,
Lymphangio sarcoma,
Liposarcoma,
Thmoma,
Mediastinal neoplasm,		 Capture data accurately
PRE429 Pre-Transplant Disease Classification Inherited Bone Marrow Failure Syndromes yes no Specify the inherited bone marrow failure syndrome classification Dyskeratosis congenita,
Fanconi anemia,
Severe congenital neutropenia,
Diamond-Blackfan anemia,
Shwachman-Diamond		 Change/Clarification of Information Requested and Response Option Specify the inherited bone marrow failure syndrome classification Dyskeratosis congenita, Telomere Biology Disorders including Dyskeratosis congenita (DKC1, TERT, TERC, and other mutations)
Fanconi anemia,
Severe congenital neutropenia (Elastase deficiency/ELANE or HAX1 mutations)
Diamond-Blackfan anemia,
Shwachman-Diamond (DNAJC21, EFL1, or SBDS mutations)
Germline SAMD9 variant (MIRAGE Syndrome)
Germline SAMD9L variant (SAMD9L-related Ataxia Pancytopenia Syndrome)
Other inherited bone failure syndromes		 Capture data accurately
PRE464 Pre-Transplant Disease Classification Disorders of the Immune System yes no Specify disorder of immune system classification Ataxia telangiectasia,
Bare lymphocyte syndrome,
Cartilage hair hypoplasia,
CD40 ligand deficiency,
Chronic granulomatous disease,
DiGeorge anomaly,
Griscelli syndrome type 2,
HIV infection,
Hermansky-Pudlak syndrome type 2,
Leukocyte adhesion deficiencies, including GP180, CD-18, LFA and WBC adhesion deficiencies,
Neutrophil actin deficiency,
Chediak-Higashi syndrome,
Other immunodeficiencies,
Omenn syndrome,
Other pigmentary dilution disorder,
Other SCID,
Reticular dysgenesis,
Adenosine deaminase (ADA) deficiency / severe combined immunodeficiency (SCID),
SCID, not otherwise specified,
Absence of T and B cells SCID,
Absence of T, normal B cell SCID,
Immune deficiency, not otherwise specified,
Common variable immunodeficiency,
Wiskott-Aldrich syndrome,
X-linked lymphoproliferative syndrome		 Change/Clarification of Information Requested and Response Option Specify disorder of immune system classification Severe Combined Immunodeficiencies
Adenosine deaminase (ADA) deficiency / severe combined immunodeficiency (SCID), SCID, T- B- NK-, Adenosine deaminase (ADA) deficiency
SCID, T- B- NK-, reticular dysgenesis,
SCID, T- B- NK+, RAG 1/2 deficiency
SCID, T- B- NK+, DCLRE1C (Artemis) deficiency
Absence of T, normal B cell SCID, SCID, T-, normal B and NK cells, ILR alpha deficiency
SCID, T- B- NK-, NOS
SCID, not otherwise specified,
Other SCID,
Combined Immunodeficiencies
CD40 ligand deficiency,
DOCK8 Deficiency
MHC Class II Deficiency (Bare lymphocyte syndrome)
Omenn syndrome,
ZAP-70 deficiency
Combined Immunodeficiencies with Associated or Syndromic Features
Ataxia telangiectasia,
Cartilage-hair hypoplasia,
DiGeorge anomaly,
NEMO Deficiency Syndrome
Wiskott-Aldrich syndrome,
Predominately Antibody deficiencies
Common variable immunodeficiency,
Activated PI3 Kinase Delta Deficiency Syndrome (APDS1 or PIK3CD)
Diseases of immune dysregulation, hemophagocytic lymphohistiocytosis
Chediak-Higashi syndrome,
Griscelli syndrome type 2,
Hermansky-Pudlak syndrome type 2,
Other pigmentary dilution disorder,
Diseases of immune dysregulation, EBV susceptibility
X-linked lymphoproliferative syndrome SAP deficiency (XIAP-1)
XIAP-2 deficiency
ITK deficiency
Diseases of immune dysregulation, syndromes with Autoimmunity and Others, NOS
Autoimmune Lymphoproliferative Syndrome (ALPS)
CTLA4 deficiency
IPEX, Immune Dysregulation Polyendocrinopathy, enteropathy X-linked (FOXP3 deficiency)
LRBA Deficiency
STAT3 Gain of Function
Congenital defects of phagocyte
Chronic granulomatous disease,
GATA2 deficiency
Leukocyte adhesion deficiencies, including GP180, CD-18, LFA and WBC adhesion deficiencies,
Neutrophil actin deficiency, Neutropenia with combined immune deficiency (MKL1 deficiency, Actin deficiency)
Other Immunodeficiencies
STAT1 Gain of Function
Other immunodeficiencies,
HIV infection,
Immune deficiency, not otherwise specified,
Absence of T and B cells SCID,		 Capture data accurately
PRE477 Pre-Transplant Disease Classification Histiocytic Disorders yes no Specify histiocytic disorder classification Histiocytic disorder, not otherwise specified (570),
Langerhans cell histiocytosis (histiocytosis-X) (572),
Hemophagocytic lymphohistiocytosis (HLH) (571),
Hemophagocytosis (reactive or viral associated) (573),
Malignant histiocytosis (574),
Other histiocytic disorder (579)		 Change/Clarification of Information Requested and Response Option Specify histiocytic disorder classification Diseases of immune dysregulation, Familial Hemophagocytic Lymphohistiocytosis (FHL)
Familial Hemophagocytic Lymphohistiocytosis, Perforin deficiency (FHL2)
Familial Hemophagocytic Lymphohistiocytosis, UNC13D (FHL3)
Familial Hemophagocytic Lymphohistiocytosis, STX11 (FHL4)
Familial Hemophagocytic Lymphohistiocytosis, STXBP2 (FHL5)
Familial Hemophagocytic Lymphohistiocytosis, no mutation identified
Familial Hemophagocytic Lymphohistiocytosis, other mutations
Histiocytic disorder, not otherwise specified (570),
Langerhans cell histiocytosis (histiocytosis-X) (572),
Hemophagocytic lymphohistiocytosis (HLH) (571),
Hemophagocytosis (reactive or viral associated) (573),
Malignant histiocytosis (574),Other histiocytic disorder (579)		 Capture data accurately
PRE655 Pre-Transplant Pre-Transplant Essential Data Autologous Transplant yes yes What agents were used to mobilize the autologous recipient for this HCT? (check all that apply) G-CSF (TBO-filgrastim, filgrastim, Granix, Neupogen) ,GM-CSF (sargramostim, Leukine), Pegylated G-CSF (pegfilgrastim, Neulasta), Plerixafor (Mozobil), Combined with chemotherapy, Anti-CD20 (rituximab, Rituxan), Motixafortide (Aphexda), Other agent Change/Clarification of Information Requested and Response Option What agents were used to mobilize the autologous recipient for this HCT? (check all that apply) G-CSF (TBO-filgrastim, filgrastim, Granix, Neupogen) ,GM-CSF (sargramostim, Leukine), Pegylated G-CSF (pegfilgrastim, Neulasta), Plerixafor (Mozobil), Combined with chemotherapy, Anti-CD20 (rituximab, Rituxan), Motixafortide (Aphexda), Other agent
PRE001 Pre-Transplant Additional Drugs Given In the Peri-Transplant Period
no no ALG, ALS, ATG, ATS, Alemtuzumab, Defibrotide, KGF, Ursodiol, None (check all that apply)
ALG, ALS, ATG, ATS, Alemtuzumab, Defibrotide, KGF, Ursodiol, None (check all that apply)
PRE002 Pre-Transplant Additional Drugs Given In the Peri-Transplant Period
no no Total prescribed dose: __ __ __ __ __ mg/kg
Total prescribed dose: __ __ __ __ __ mg/kg
PRE003 Pre-Transplant Additional Drugs Given In the Peri-Transplant Period
no no Specify source ATGAM (horse),ATG - Fresenius (rabbit),Other,Thymoglobulin (rabbit)
Specify source ATGAM (horse),ATG - Fresenius (rabbit),Other,Thymoglobulin (rabbit)
PRE004 Pre-Transplant Additional Drugs Given In the Peri-Transplant Period
no no Specify other source: open text
Specify other source: open text
PRE005 Pre-Transplant Additional Drugs Given In the Peri-Transplant Period
no no Total prescribed dose: __ __ __ __ . _ mg/m2
__ __ __ __ __ . __mg/kg
__ __ __ __ __ . __mg/kg
Total prescribed dose: __ __ __ __ . _ mg/m2
__ __ __ __ __ . __mg/kg
__ __ __ __ __ . __mg/kg
PRE006 Pre-Transplant Covid-19 Impact
no no

Question will be disabled Was the HCT impacted for a reason related to the COVID-19 (SARS-CoV-2) pandemic? no,yes Reduce burden: data no longer relevant
PRE007 Pre-Transplant Covid-19 Impact
no no

Question will be disabled Is the HCT date different than the originally intended HCT date? no,yes Reduce burden: data no longer relevant
PRE008 Pre-Transplant Covid-19 Impact
no no

Question will be disabled Original Date of HCT YYYY/MM/DD Reduce burden: data no longer relevant
PRE009 Pre-Transplant Covid-19 Impact
no no


Date estimated checked
PRE010 Pre-Transplant Covid-19 Impact
no no


Is the donor different than the originally intended donor? no,yes
PRE011 Pre-Transplant Covid-19 Impact
no no


Specify the originally intended donor unrelated donor, syngeneic (monozygotic twin) , HLA-idential sibling (may include non-monozygotic twin) , HLA-matched other relative (does NOT include a haplo-identical donor), HLA-mismatched relative
PRE012 Pre-Transplant Covid-19 Impact
no no


Is the product type (bone marrow, PBSC, cord blood unit) different than the originally intended product type? no,yes
PRE013 Pre-Transplant Covid-19 Impact
no no


Specify the originally intended product type bone marrow,Other product,PBSC, cord blood unit
PRE014 Pre-Transplant Covid-19 Impact
no no


Specify other product type open text
PRE015 Pre-Transplant Covid-19 Impact
no no


Was the current product thawed from a cryopreserved state prior to infusion? no,yes
PRE016 Pre-Transplant Covid-19 Impact
no no


Did the preparative regimen change from the original plan? no, yes
PRE017 Pre-Transplant Covid-19 Impact
no no


Did the GVHD prophylaxis change from the original plan? no,yes
PRE018 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Specify method(s) that was used to assess measurable residual disease status (check all that apply) FISH, Karyotyping, Flow Cytometry, PCR, NGS, Not assessed Question will be enabled Specify method(s) that was used to assess measurable residual disease status (check all that apply) FISH, Karyotyping, Flow Cytometry, PCR, NGS, Not assessed Capture additional relevent disease information
PRE019 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Was measurable residual disease detected by FISH? no,yes Question will be enabled Was measurable residual disease detected by FISH? no,yes Capture additional relevent disease information
PRE020 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Was measurable residual disease detected by karyotyping assay? no,yes Question will be enabled Was measurable residual disease detected by karyotyping assay? no,yes Capture additional relevent disease information
PRE021 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Which leukemia phenotype was used for detection (check all the apply) original leukemia immunophenotype, aberrant phenotype
Which leukemia phenotype was used for detection (check all the apply) original leukemia immunophenotype, aberrant phenotype
PRE022 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no What is the lower limit of detection (for the original leukemia immunophenotype) open text
What is the lower limit of detection (for the original leukemia immunophenotype) open text
PRE023 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no What is the lower limit of detection (for the aberrant phenotype) open text
What is the lower limit of detection (for the aberrant phenotype) open text
PRE024 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Was measurable residual disease detected by flow cytometry? no,yes Question will be enabled Was measurable residual disease detected by flow cytometry? no,yes Capture additional relevent disease information
PRE025 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Was measurable residual disease detected by PCR? no,yes Question will be enabled Was measurable residual disease detected by PCR? no,yes Capture additional relevent disease information
PRE026 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Was measurable residual disease detected by NGS? no,yes Question will be enabled Was measurable residual disease detected by NGS? no,yes Capture additional relevent disease information
PRE027 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Specify method(s) that was used to assess measurable residual disease status (check all that apply) FISH, Karyotyping, Flow Cytometry, PCR, NGS, Not assessed Question will be enabled Specify method(s) that was used to assess measurable residual disease status (check all that apply) FISH, Karyotyping, Flow Cytometry, PCR, NGS, Not assessed Capture additional relevent disease information
PRE028 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Was measurable residual disease detected by FISH? no,yes Question will be enabled Was measurable residual disease detected by FISH? no,yes Capture additional relevent disease information
PRE029 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Was measurable residual disease detected by karyotyping assay? no,yes Question will be enabled Was measurable residual disease detected by karyotyping assay? no,yes Capture additional relevent disease information
PRE030 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Which leukemia phenotype was used for detection (check all the apply) original leukemia immunophenotype, aberrant phenotype
Which leukemia phenotype was used for detection (check all the apply) original leukemia immunophenotype, aberrant phenotype
PRE031 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no What is the lower limit of detection (for the original leukemia immunophenotype) open text
What is the lower limit of detection (for the original leukemia immunophenotype) open text
PRE032 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no What is the lower limit of detection (for the aberrant phenotype) open text
What is the lower limit of detection (for the aberrant phenotype) open text
PRE033 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Was measurable residual disease detected by flow cytometry? no,yes Question will be enabled Was measurable residual disease detected by flow cytometry? no,yes Capture additional relevent disease information
PRE034 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Was measurable residual disease detected by PCR? no,yes Question will be enabled Was measurable residual disease detected by PCR? no,yes Capture additional relevent disease information
PRE035 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Was measurable residual disease detected by NGS? no,yes Question will be enabled Was measurable residual disease detected by NGS? no,yes Capture additional relevent disease information
PRE036 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Specify the liver size: : ___ ___ centimeters
Specify the liver size: : ___ ___ centimeters
PRE037 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes JAK2 Exon 12 Negative,Not done,Positive
JAK2 Exon 12 Negative,Not done,Positive
PRE038 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(5q) / 5q-,del(7q) / 7q-,del(13q) / 13q-,dup(1),i17q,inv(3),-5,-7,-Y,Other abnormality,t(1;any),t(11q23;any),t(12p11.2;any),t(3q21;any),t(6;9),+8,+9
Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(5q) / 5q-,del(7q) / 7q-,del(13q) / 13q-,dup(1),i17q,inv(3),-5,-7,-Y,Other abnormality,t(1;any),t(11q23;any),t(12p11.2;any),t(3q21;any),t(6;9),+8,+9
PRE039 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Was documentation submitted to the CIBMTR? (e.g. FISH report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. FISH report) No,Yes
PRE040 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Assignment of DLBCL (germinal center B-cell type vs. activated B-cell type) subtype was based on Gene expression profile,Immunohistochemistry (e.g. Han’s algorithm),Unknown
Assignment of DLBCL (germinal center B-cell type vs. activated B-cell type) subtype was based on Gene expression profile,Immunohistochemistry (e.g. Han’s algorithm),Unknown
PRE041 Pre-Transplant Disease Classification
no yes Date of diagnosis of primary disease for HCT / cellular therapy: YYYY/MM/DD
Date of diagnosis of primary disease for HCT / cellular therapy: YYYY/MM/DD












PRE044 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Did AML transform from MDS or MPN? no,yes-Also complete MDS or MPN Disease Classification questions
Did AML transform from MDS or MPN? no,yes-Also complete MDS or MPN Disease Classification questions
PRE045 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Is the disease (AML) therapy related? no,Unknown,yes
Is the disease (AML) therapy related? no,Unknown,yes
PRE046 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Did the recipient have a predisposing condition? no,Unknown,yes
Did the recipient have a predisposing condition? no,Unknown,yes
PRE047 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Specify condition Bloom syndrome,Dyskeratosis congenita,Down Syndrome,Fanconi anemia,Other condition
Specify condition Bloom syndrome,Dyskeratosis congenita,Down Syndrome,Fanconi anemia,Other condition
PRE048 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Specify other condition: open text
Specify other condition: open text
PRE049 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Were cytogenetics tested (karyotyping or FISH)? (at diagnosis) no,Unknown,yes
Were cytogenetics tested (karyotyping or FISH)? (at diagnosis or relapse) no,Unknown,yes
PRE050 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Were cytogenetics tested via FISH? No,Yes
Were cytogenetics tested via FISH? No,Yes
PRE051 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Results of tests Abnormalities identified,No abnormalities
Results of tests Abnormalities identified,No abnormalities
PRE052 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE053 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE054 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,del(11q) / 11q-,del(16q) / 16q-,del(17q) / 17q-,del(20q) / 20q-,del(21q) / 21q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,inv(16),inv(3),-17,-18,-5,-7,-X,-Y,Other abnormality,t(15;17) and variants,t(16;16),t(3;3),t(6;9),t(8;21),t(9;11),t(9;22),+11,+13,+14,+21,+22,+4,+8
Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,del(11q) / 11q-,del(16q) / 16q-,del(17q) / 17q-,del(20q) / 20q-,del(21q) / 21q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,inv(16),inv(3),-17,-18,-5,-7,-X,-Y,Other abnormality,t(15;17) and variants,t(16;16),t(3;3),t(6;9),t(8;21),t(9;11),t(9;22),+11,+13,+14,+21,+22,+4,+8
PRE055 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE056 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Were cytogenetics tested via karyotyping? No,Yes
Were cytogenetics tested via karyotyping? No,Yes
PRE057 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
PRE058 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE059 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE060 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,del(11q) / 11q-,del(16q) / 16q-,del(17q) / 17q-,del(20q) / 20q-,del(21q) / 21q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,inv(16),inv(3),-17,-18,-5,-7,-X,-Y,Other abnormality,t(15;17) and variants,t(16;16),t(3;3),t(6;9),t(8;21),t(9;11),t(9;22),+11,+13,+14,+21,+22,+4,+8
Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,del(11q) / 11q-,del(16q) / 16q-,del(17q) / 17q-,del(20q) / 20q-,del(21q) / 21q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,inv(16),inv(3),-17,-18,-5,-7,-X,-Y,Other abnormality,t(15;17) and variants,t(16;16),t(3;3),t(6;9),t(8;21),t(9;11),t(9;22),+11,+13,+14,+21,+22,+4,+8
PRE061 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE062 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
PRE063 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Were tests for molecular markers performed? (at diagnosis or relapse) no,Unknown,yes
Were tests for molecular markers performed? (at diagnosis or relapse) no,Unknown,yes
PRE064 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes CEBPA Negative,Not Done,Positive
CEBPA Negative,Not Done,Positive
PRE065 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify CEBPA mutation Biallelic (homozygous),Monoallelic (heterozygous),Unknown
Specify CEBPA mutation Biallelic (double mutant),Monoallelic (single mutant),Unknown
PRE066 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes FLT3 - TKD (point mutations in D835 or deletions of codon I836) Negative,Not done,Positive
FLT3 - TKD (point mutations in D835 or deletions of codon I836) Negative,Not done,Positive
PRE067 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes FLT3 – ITD mutation Negative,Not Done,Positive
FLT3 – ITD mutation Negative,Not Done,Positive
PRE068 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes FLT3 - ITD allelic ratio Known,Unknown
FLT3 - ITD allelic ratio Known,Unknown
PRE069 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify FLT3 - ITD allelic ratio: __ __ . __ __
Specify FLT3 - ITD allelic ratio: __ __ . __ __
PRE070 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes IDH1 Negative,Not Done,Positive
IDH1 Negative,Not Done,Positive
PRE071 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes IDH2 Negative,Not Done,Positive
IDH2 Negative,Not Done,Positive
PRE072 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes KIT Negative,Not Done,Positive
KIT Negative,Not Done,Positive
PRE073 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes NPM1 Negative,Not Done,Positive
NPM1 Negative,Not Done,Positive
PRE074 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Other molecular marker Negative,Not Done,Positive
Other molecular marker Negative,Not Done,Positive
PRE075 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify other molecular marker: open text
Specify other molecular marker: open text
PRE076 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Were cytogenetics tested (karyotyping or FISH)? (between diagnosis and last evaluation) no,Unknown,yes
Were cytogenetics tested (karyotyping or FISH)? (between diagnosis or relapse and last evaluation) no,Unknown,yes
PRE077 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Were cytogenetics tested via FISH? No,Yes
Were cytogenetics tested via FISH? No,Yes
PRE078 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Results of tests Abnormalities identified,No abnormalities
Results of tests Abnormalities identified,No abnormalities
PRE079 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE080 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE081 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,del(11q) / 11q-,del(16q) / 16q-,del(17q) / 17q-,del(20q) / 20q-,del(21q) / 21q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,inv(16),inv(3),-17,-18,-5,-7,-X,-Y,Other abnormality,t(15;17) and variants,t(16;16),t(3;3),t(6;9),t(8;21),t(9;11),t(9;22),+11,+13,+14,+21,+22,+4,+8
Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,del(11q) / 11q-,del(16q) / 16q-,del(17q) / 17q-,del(20q) / 20q-,del(21q) / 21q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,inv(16),inv(3),-17,-18,-5,-7,-X,-Y,Other abnormality,t(15;17) and variants,t(16;16),t(3;3),t(6;9),t(8;21),t(9;11),t(9;22),+11,+13,+14,+21,+22,+4,+8
PRE082 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE083 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Were cytogenetics tested via karyotyping? No,Yes
Were cytogenetics tested via karyotyping? No,Yes
PRE084 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
PRE085 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE086 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE087 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,del(11q) / 11q-,del(16q) / 16q-,del(17q) / 17q-,del(20q) / 20q-,del(21q) / 21q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,inv(16),inv(3),-17,-18,-5,-7,-X,-Y,Other abnormality,t(15;17) and variants,t(16;16),t(3;3),t(6;9),t(8;21),t(9;11),t(9;22),+11,+13,+14,+21,+22,+4,+8
Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,del(11q) / 11q-,del(16q) / 16q-,del(17q) / 17q-,del(20q) / 20q-,del(21q) / 21q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,inv(16),inv(3),-17,-18,-5,-7,-X,-Y,Other abnormality,t(15;17) and variants,t(16;16),t(3;3),t(6;9),t(8;21),t(9;11),t(9;22),+11,+13,+14,+21,+22,+4,+8
PRE088 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE089 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
PRE090 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Were tests for molecular markers performed? (e.g. PCR, NGS) (between diagnosis and last evaluation) no,Unknown,yes
Were tests for molecular markers performed? (e.g. PCR, NGS) (between diagnosis or relapse and last evaluation) no,Unknown,yes
PRE091 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes CEBPA Negative,Not Done,Positive
CEBPA Negative,Not Done,Positive
PRE092 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify CEBPA mutation Biallelic (homozygous),Monoallelic (heterozygous),Unknown
Specify CEBPA mutation Biallelic (double mutant),Monoallelic (single mutant),Unknown
PRE093 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes FLT3 - TKD (point mutations in D835 or deletions of codon I836) Negative,Not done,Positive
FLT3 - TKD (point mutations in D835 or deletions of codon I836) Negative,Not done,Positive
PRE094 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes FLT3 – ITD mutation Negative,Not Done,Positive
FLT3 – ITD mutation Negative,Not Done,Positive
PRE095 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes FLT3 - ITD allelic ratio Known,Unknown
FLT3 - ITD allelic ratio Known,Unknown
PRE096 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify FLT3 - ITD allelic ratio: __ __ . __ __
Specify FLT3 - ITD allelic ratio: __ __ . __ __
PRE097 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes IDH1 Negative,Not Done,Positive
IDH1 Negative,Not Done,Positive
PRE098 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes IDH2 Negative,Not Done,Positive
IDH2 Negative,Not Done,Positive
PRE099 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes KIT Negative,Not Done,Positive
KIT Negative,Not Done,Positive
PRE100 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes NPM1 Negative,Not Done,Positive
NPM1 Negative,Not Done,Positive
PRE101 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Other molecular marker Negative,Not Done,Positive
Other molecular marker Negative,Not Done,Positive
PRE102 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify other molecular marker: open text
Specify other molecular marker: open text
PRE103 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Were cytogenetics tested (karyotyping or FISH)? (at last evaluation) no,Unknown,yes
Were cytogenetics tested (karyotyping or FISH)? (at last evaluation) no,Unknown,yes
PRE104 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Were cytogenetics tested via FISH? No,Yes
Were cytogenetics tested via FISH? No,Yes
PRE105 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Results of tests Abnormalities identified,No abnormalities
Results of tests Abnormalities identified,No abnormalities
PRE106 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE107 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE108 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,del(11q) / 11q-,del(16q) / 16q-,del(17q) / 17q-,del(20q) / 20q-,del(21q) / 21q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,inv(16),inv(3),-17,-18,-5,-7,-X,-Y,Other abnormality,t(15;17) and variants,t(16;16),t(3;3),t(6;9),t(8;21),t(9;11),t(9;22),+11,+13,+14,+21,+22,+4,+8
Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,del(11q) / 11q-,del(16q) / 16q-,del(17q) / 17q-,del(20q) / 20q-,del(21q) / 21q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,inv(16),inv(3),-17,-18,-5,-7,-X,-Y,Other abnormality,t(15;17) and variants,t(16;16),t(3;3),t(6;9),t(8;21),t(9;11),t(9;22),+11,+13,+14,+21,+22,+4,+8
PRE109 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE110 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Were cytogenetics tested via karyotyping? No,Yes
Were cytogenetics tested via karyotyping? No,Yes
PRE111 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
PRE112 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE113 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE114 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,del(11q) / 11q-,del(16q) / 16q-,del(17q) / 17q-,del(20q) / 20q-,del(21q) / 21q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,inv(16),inv(3),-17,-18,-5,-7,-X,-Y,Other abnormality,t(15;17) and variants,t(16;16),t(3;3),t(6;9),t(8;21),t(9;11),t(9;22),+11,+13,+14,+21,+22,+4,+8
Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,del(11q) / 11q-,del(16q) / 16q-,del(17q) / 17q-,del(20q) / 20q-,del(21q) / 21q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,inv(16),inv(3),-17,-18,-5,-7,-X,-Y,Other abnormality,t(15;17) and variants,t(16;16),t(3;3),t(6;9),t(8;21),t(9;11),t(9;22),+11,+13,+14,+21,+22,+4,+8
PRE115 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE116 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
PRE117 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Were tests for molecular markers performed?(e.g. PCR, NGS) (at last evaluation) no,Unknown,yes
Were tests for molecular markers performed?(e.g. PCR, NGS) (at last evaluation) no,Unknown,yes
PRE118 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes CEBPA Negative,Not Done,Positive
CEBPA Negative,Not Done,Positive
PRE119 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify CEBPA mutation Biallelic (homozygous),Monoallelic (heterozygous),Unknown
Specify CEBPA mutation Biallelic (double mutant),Monoallelic (single mutant),Unknown
PRE120 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes FLT3 - TKD (point mutations in D835 or deletions of codon I836) Negative,Not done,Positive
FLT3 - TKD (point mutations in D835 or deletions of codon I836) Negative,Not done,Positive
PRE121 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes FLT3 – ITD mutation Negative,Not Done,Positive
FLT3 – ITD mutation Negative,Not Done,Positive
PRE122 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes FLT3 - ITD allelic ratio Known,Unknown
FLT3 - ITD allelic ratio Known,Unknown
PRE123 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify FLT3 - ITD allelic ratio: __ __ . __ __
Specify FLT3 - ITD allelic ratio: __ __ . __ __
PRE124 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes IDH1 Negative,Not Done,Positive
IDH1 Negative,Not Done,Positive
PRE125 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes IDH2 Negative,Not Done,Positive
IDH2 Negative,Not Done,Positive
PRE126 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes KIT Negative,Not Done,Positive
KIT Negative,Not Done,Positive
PRE127 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes NPM1 Negative,Not Done,Positive
NPM1 Negative,Not Done,Positive
PRE128 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Other molecular marker Negative,Not Done,Positive
Other molecular marker Negative,Not Done,Positive
PRE129 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes yes Specify other molecular marker: open text
Specify other molecular marker: open text
PRE130 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Did the recipient have central nervous system leukemia at any time prior to the start of the preparative regimen / infusion? no,Unknown,yes
Did the recipient have central nervous system leukemia at any time prior to the start of the preparative regimen / infusion? no,Unknown,yes
PRE131 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no What was the disease status? 1st complete remission,1st relapse,2nd complete remission,2nd relapse,≥ 3rd complete remission, ≥3rd relapse,No treatment,Primary induction failure
What was the disease status? 1st complete remission,1st relapse,2nd complete remission,2nd relapse,≥ 3rd complete remission, ≥3rd relapse,No treatment,Primary induction failure
PRE132 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no How many cycles of induction therapy were required to achieve 1st complete remission? (includes CRi) 1,2, ≥ 3
How many cycles of induction therapy were required to achieve 1st complete remission? (includes CRi) 1,2, ≥ 3
PRE133 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Date of most recent relapse: YYYY/MM/DD
Date of most recent relapse: YYYY/MM/DD
PRE134 Pre-Transplant Disease Classification Acute Myelogenous Leukemia (AML) yes no Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD












PRE136 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Did the recipient have a predisposing condition? no,Unknown,yes
Did the recipient have a predisposing condition? no,Unknown,yes
PRE137 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Specify condition Aplastic anemia,Bloom syndrome,Down Syndrome,Fanconi anemia,Other condition
Specify condition Aplastic anemia,Bloom syndrome,Down Syndrome,Fanconi anemia,Other condition
PRE138 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Specify other condition: open text
Specify other condition: open text
PRE139 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Were tyrosine kinase inhibitors given for therapy at any time prior to the start of the preparative regimen / infusion? (e.g. imatinib mesylate, dasatinib, etc.) no,yes
Were tyrosine kinase inhibitors given for therapy at any time prior to the start of the preparative regimen / infusion? (e.g. imatinib mesylate, dasatinib, etc.) no,yes
PRE140 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Were cytogenetics tested (karyotyping or FISH)? (at diagnosis) no,Unknown,yes
Were cytogenetics tested (karyotyping or FISH)? (at diagnosis or relapse) no,Unknown,yes
PRE141 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Were cytogenetics tested via FISH? No,Yes
Were cytogenetics tested via FISH? No,Yes
PRE142 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Results of tests Abnormalities identified,No abnormalities
Results of tests Abnormalities identified,No abnormalities
PRE143 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE144 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE145 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,9p any abnormality,add(14q),del(12p) / 12p-,del(6q) / 6q-,del(9p) / 9p-,Hyperdiploid (> 50),Hypodiploid (< 46),iAMP21,-7,Other abnormality,t(1;19),t(10;14),t(11;14),t(12;21),t(2;8),t(4;11),t(5;14),t(8;14),t(8;22),t(9;22),+17,+21,+4,+8
Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,9p any abnormality,add(14q),del(12p) / 12p-,del(6q) / 6q-,del(9p) / 9p-,Hyperdiploid (> 50),Hypodiploid (< 46),iAMP21,-7,Other abnormality,t(1;19),t(10;14),t(11;14),t(12;21),t(2;8),t(4;11),t(5;14),t(8;14),t(8;22),t(9;22),+17,+21,+4,+8
PRE146 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE147 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Were cytogenetics tested via karyotyping? No,Yes
Were cytogenetics tested via karyotyping? No,Yes
PRE148 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
PRE149 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE150 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE151 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,9p any abnormality,add(14q),del(12p) / 12p-,del(6q) / 6q-,del(9p) / 9p-,Hyperdiploid (> 50),Hypodiploid (< 46),iAMP21,-7,Other abnormality,t(1;19),t(10;14),t(11;14),t(12;21),t(2;8),t(4;11),t(5;14),t(8;14),t(8;22),t(9;22),+17,+21,+4,+8
Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,9p any abnormality,add(14q),del(12p) / 12p-,del(6q) / 6q-,del(9p) / 9p-,Hyperdiploid (> 50),Hypodiploid (< 46),iAMP21,-7,Other abnormality,t(1;19),t(10;14),t(11;14),t(12;21),t(2;8),t(4;11),t(5;14),t(8;14),t(8;22),t(9;22),+17,+21,+4,+8
PRE152 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE153 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
PRE154 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Were tests for molecular markers performed? (at diagnosis) no,Unknown,yes
Were tests for molecular markers performed? (at diagnosis or relapse) no,Unknown,yes
PRE155 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes BCR / ABL Negative,Not Done,Positive
BCR / ABL Negative,Not Done,Positive
PRE156 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes TEL-AML / AML1 Negative,Not Done,Positive
TEL-AML / AML1 Negative,Not Done,Positive
PRE157 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Other molecular marker Negative,Not Done,Positive
Other molecular marker Negative,Not Done,Positive
PRE158 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify other molecular marker: open text
Specify other molecular marker: open text
PRE159 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Were cytogenetics tested (karyotyping or FISH)? (between diagnosis and last evaluation) no,Unknown,yes
Were cytogenetics tested (karyotyping or FISH)? (between diagnosis or at relapse and last evaluation) no,Unknown,yes
PRE160 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Were cytogenetics tested via FISH? No,Yes
Were cytogenetics tested via FISH? No,Yes
PRE161 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Results of tests Abnormalities identified,No abnormalities
Results of tests Abnormalities identified,No abnormalities
PRE162 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE163 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE164 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,9p any abnormality,add(14q),del(12p) / 12p-,del(6q) / 6q-,del(9p) / 9p-,Hyperdiploid (> 50),Hypodiploid (< 46),iAMP21,-7,Other abnormality,t(1;19),t(10;14),t(11;14),t(12;21),t(2;8),t(4;11),t(5;14),t(8;14),t(8;22),t(9;22),+17,+21,+4,+8
Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,9p any abnormality,add(14q),del(12p) / 12p-,del(6q) / 6q-,del(9p) / 9p-,Hyperdiploid (> 50),Hypodiploid (< 46),iAMP21,-7,Other abnormality,t(1;19),t(10;14),t(11;14),t(12;21),t(2;8),t(4;11),t(5;14),t(8;14),t(8;22),t(9;22),+17,+21,+4,+8
PRE165 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE166 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Were cytogenetics tested via karyotyping? No,Yes
Were cytogenetics tested via karyotyping? No,Yes
PRE167 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
PRE168 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE169 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE170 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,9p any abnormality,add(14q),del(12p) / 12p-,del(6q) / 6q-,del(9p) / 9p-,Hyperdiploid (> 50),Hypodiploid (< 46),iAMP21,-7,Other abnormality,t(1;19),t(10;14),t(11;14),t(12;21),t(2;8),t(4;11),t(5;14),t(8;14),t(8;22),t(9;22),+17,+21,+4,+8
Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,9p any abnormality,add(14q),del(12p) / 12p-,del(6q) / 6q-,del(9p) / 9p-,Hyperdiploid (> 50),Hypodiploid (< 46),iAMP21,-7,Other abnormality,t(1;19),t(10;14),t(11;14),t(12;21),t(2;8),t(4;11),t(5;14),t(8;14),t(8;22),t(9;22),+17,+21,+4,+8
PRE171 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE172 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
PRE173 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Were tests for molecular markers performed? (e.g. PCR, NGS) (between diagnosis and last evaluation) no,Unknown,yes
Were tests for molecular markers performed? (e.g. PCR, NGS) (between diagnosis or relapse and last evaluation) no,Unknown,yes
PRE174 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes BCR / ABL Negative,Not Done,Positive
BCR / ABL Negative,Not Done,Positive
PRE175 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes TEL-AML / AML1 Negative,Not Done,Positive
TEL-AML / AML1 Negative,Not Done,Positive
PRE176 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Other molecular marker Negative,Not Done,Positive
Other molecular marker Negative,Not Done,Positive
PRE177 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify other molecular marker: open text
Specify other molecular marker: open text
PRE178 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Were cytogenetics tested (karyotyping or FISH)? (at last evaluation) no,Unknown,yes
Were cytogenetics tested (karyotyping or FISH)? (at last evaluation) no,Unknown,yes
PRE179 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Were cytogenetics tested via FISH? No,Yes
Were cytogenetics tested via FISH? No,Yes
PRE180 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Results of tests Abnormalities identified,No abnormalities
Results of tests Abnormalities identified,No abnormalities
PRE181 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE182 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE183 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,9p any abnormality,add(14q),del(12p) / 12p-,del(6q) / 6q-,del(9p) / 9p-,Hyperdiploid (> 50),Hypodiploid (< 46),iAMP21,-7,Other abnormality,t(1;19),t(10;14),t(11;14),t(12;21),t(2;8),t(4;11),t(5;14),t(8;14),t(8;22),t(9;22),+17,+21,+4,+8
Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,9p any abnormality,add(14q),del(12p) / 12p-,del(6q) / 6q-,del(9p) / 9p-,Hyperdiploid (> 50),Hypodiploid (< 46),iAMP21,-7,Other abnormality,t(1;19),t(10;14),t(11;14),t(12;21),t(2;8),t(4;11),t(5;14),t(8;14),t(8;22),t(9;22),+17,+21,+4,+8
PRE184 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE185 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Were cytogenetics tested via karyotyping? (at last evaluation) No,Yes
Were cytogenetics tested via karyotyping? (at last evaluation) No,Yes
PRE186 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
PRE187 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE188 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE189 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,9p any abnormality,add(14q),del(12p) / 12p-,del(6q) / 6q-,del(9p) / 9p-,Hyperdiploid (> 50),Hypodiploid (< 46),iAMP21,-7,Other abnormality,t(1;19),t(10;14),t(11;14),t(12;21),t(2;8),t(4;11),t(5;14),t(8;14),t(8;22),t(9;22),+17,+21,+4,+8
Specify abnormalities (check all that apply) (11q23) any abnormality,12p any abnormality,9p any abnormality,add(14q),del(12p) / 12p-,del(6q) / 6q-,del(9p) / 9p-,Hyperdiploid (> 50),Hypodiploid (< 46),iAMP21,-7,Other abnormality,t(1;19),t(10;14),t(11;14),t(12;21),t(2;8),t(4;11),t(5;14),t(8;14),t(8;22),t(9;22),+17,+21,+4,+8
PRE190 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE191 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
PRE192 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Were tests for molecular markers performed? (e.g. PCR, NGS) (at last evaluation) no,Unknown,yes
Were tests for molecular markers performed? (e.g. PCR, NGS) (at last evaluation) no,Unknown,yes
PRE193 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes BCR / ABL Negative,Not Done,Positive
BCR / ABL Negative,Not Done,Positive
PRE194 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes TEL-AML / AML1 Negative,Not Done,Positive
TEL-AML / AML1 Negative,Not Done,Positive
PRE195 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Other molecular marker Negative,Not Done,Positive
Other molecular marker Negative,Not Done,Positive
PRE196 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes yes Specify other molecular marker: open text
Specify other molecular marker: open text
PRE197 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Did the recipient have central nervous system leukemia at any time prior to the start of the preparative regimen / infusion? no,Unknown,yes
Did the recipient have central nervous system leukemia at any time prior to the start of the preparative regimen / infusion? no,Unknown,yes
PRE198 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no What was the disease status? 1st complete remission (include CRi),1st relapse,2nd complete remission,2nd relapse, ≥ 3rd complete remission, ≥3rd relapse,No treatment,Primary induction failure
What was the disease status? 1st complete remission (include CRi),1st relapse,2nd complete remission,2nd relapse, ≥ 3rd complete remission, ≥3rd relapse,No treatment,Primary induction failure
PRE199 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no How many cycles of induction therapy were required to achieve 1st complete remission? 1,2, ≥ 3
How many cycles of induction therapy were required to achieve 1st complete remission? 1,2, ≥ 3
PRE200 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Date of most recent relapse: YYYY/MM/DD
Date of most recent relapse: YYYY/MM/DD
PRE201 Pre-Transplant Disease Classification Acute Lymphoblastic Leukemia (ALL) yes no Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD












PRE203 Pre-Transplant Disease Classification Acute Leukemias of Ambiguous Lineage and Other Myeloid Neoplasms yes no Specify other acute leukemia of ambiguous lineage or myeloid neoplasm: open text
Specify other acute leukemia of ambiguous lineage or myeloid neoplasm: open text
PRE204 Pre-Transplant Disease Classification Acute Leukemias of Ambiguous Lineage and Other Myeloid Neoplasms yes no What was the disease status? (based on hematological test results) 1st complete remission (no previous marrow or extramedullary relapse),1st relapse,2nd complete remission,2nd relapse, ≥ 3rd complete remission, ≥ 3rd relapse,No treatment,Primary induction failure
What was the disease status? (based on hematological test results) 1st complete remission (no previous marrow or extramedullary relapse),1st relapse,2nd complete remission,2nd relapse, ≥ 3rd complete remission, ≥ 3rd relapse,No treatment,Primary induction failure
PRE205 Pre-Transplant Disease Classification Acute Leukemias of Ambiguous Lineage and Other Myeloid Neoplasms yes no Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD
PRE206 Pre-Transplant Disease Classification Chronic Myelogenous Leukemia (CML) yes no Was therapy given prior to this HCT? no,yes
Was therapy given prior to this HCT? no,yes
PRE207 Pre-Transplant Disease Classification Chronic Myelogenous Leukemia (CML) yes no Combination chemotherapy no,yes
Combination chemotherapy no,yes
PRE208 Pre-Transplant Disease Classification Chronic Myelogenous Leukemia (CML) yes no Hydroxyurea (Droxia, Hydrea) no,yes
Hydroxyurea (Droxia, Hydrea) no,yes
PRE209 Pre-Transplant Disease Classification Chronic Myelogenous Leukemia (CML) yes no Tyrosine kinase inhibitor (e.g.imatinib mesylate, dasatinib, nilotinib) no,yes
Tyrosine kinase inhibitor (e.g.imatinib mesylate, dasatinib, nilotinib) no,yes
PRE210 Pre-Transplant Disease Classification Chronic Myelogenous Leukemia (CML) yes no Interferon-&alpha; (Intron, Roferon) (includes PEG) no,yes
Interferon-&alpha; (Intron, Roferon) (includes PEG) no,yes
PRE211 Pre-Transplant Disease Classification Chronic Myelogenous Leukemia (CML) yes no Other therapy no,yes
Other therapy no,yes
PRE212 Pre-Transplant Disease Classification Chronic Myelogenous Leukemia (CML) yes no Specify other therapy: open text
Specify other therapy: open text
PRE213 Pre-Transplant Disease Classification Chronic Myelogenous Leukemia (CML) yes no What was the disease status? Accelerated phase,Blast phase,Complete hematologic response (CHR) preceded by accelerated phase and/or blast phase,Complete hematologic response (CHR) preceded only by chronic phase,Chronic phase
What was the disease status? Accelerated phase,Blast phase,Complete hematologic response (CHR) preceded by accelerated phase and/or blast phase,Complete hematologic response (CHR) preceded only by chronic phase,Chronic phase
PRE214 Pre-Transplant Disease Classification Chronic Myelogenous Leukemia (CML) yes no Specify level of response Complete cytogenetic response (CCyR),Complete molecular remission (CMR),Minimal cytogenetic response,Minor cytogenetic response,Major molecular remission (MMR),No cytogenetic response (No CyR),Partial cytogenetic response (PCyR)
Specify level of response Complete cytogenetic response (CCyR),Complete molecular remission (CMR),Minimal cytogenetic response,Minor cytogenetic response,Major molecular remission (MMR),No cytogenetic response (No CyR),Partial cytogenetic response (PCyR)
PRE215 Pre-Transplant Disease Classification Chronic Myelogenous Leukemia (CML) yes no Number 1st,2nd,3rd or higher
Number 1st,2nd,3rd or higher
PRE216 Pre-Transplant Disease Classification Chronic Myelogenous Leukemia (CML) yes no Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD
PRE217 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes no What was the MDS subtype at diagnosis? - If transformed to AML, indicate AML as primary disease; also complete AML Disease Classification questions Atypical chronic myeloid leukemia (aCML), BCR-ABL1-,Chronic myelomonocytic leukemia (CMMoL),Juvenile myelomonocytic leukemia (JMML/JCML),Myelodysplastic syndrome with isolated del(5q),Myelodysplastic syndrome with multilineage dysplasia (MDS-MLD),MDS / MPN with ring sideroblasts and thrombocytosis (MDS / MPN-RS-T),Myelodysplastic syndrome / myeloproliferative neoplasm, unclassifiable, syndrome with single lineage dysplasia (MDS-SLD),Myelodysplastic syndrome (MDS), unclassifiable,Refractory cytopenia of childhood. Myelodysplatic Syndrome with excess blasts (MDS-EB): MDS with excess blasts-1 (MDS-EB-1),MDS with excess blasts-2 (MDS-EB-2). Myelodysplatic Syndrome with ring sideroblasts: MDS-RS with multilineage dysplasia (MDS-RS-MLD),MDS-RS with single lineage dysplasia (MDS-RS-SLD),Myelodysplastic
What was the MDS subtype at diagnosis? - If transformed to AML, indicate AML as primary disease; also complete AML Disease Classification questions Atypical chronic myeloid leukemia (aCML), BCR-ABL1-,Chronic myelomonocytic leukemia (CMMoL),Juvenile myelomonocytic leukemia (JMML/JCML),Myelodysplastic syndrome with isolated del(5q),Myelodysplastic syndrome with multilineage dysplasia (MDS-MLD),MDS / MPN with ring sideroblasts and thrombocytosis (MDS / MPN-RS-T),Myelodysplastic syndrome / myeloproliferative neoplasm, unclassifiable, syndrome with single lineage dysplasia (MDS-SLD),Myelodysplastic syndrome (MDS), unclassifiable,Refractory cytopenia of childhood. Myelodysplatic Syndrome with excess blasts (MDS-EB): MDS with excess blasts-1 (MDS-EB-1),MDS with excess blasts-2 (MDS-EB-2). Myelodysplatic Syndrome with ring sideroblasts: MDS-RS with multilineage dysplasia (MDS-RS-MLD),MDS-RS with single lineage dysplasia (MDS-RS-SLD),Myelodysplastic












PRE219 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes no Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
PRE220 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes no Was the disease MDS therapy related? no,Unknown,yes
Was the disease MDS therapy related? no,Unknown,yes
PRE221 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes no Did the recipient have a predisposing condition? no,Unknown,yes
Did the recipient have a predisposing condition? no,Unknown,yes
PRE222 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes no Specify condition Aplastic anemia,DDX41-associated familial MDS,Fanconi anemia,GATA2 deficiency (including Emberger syndrome, MonoMac syndrome, DCML deficiency) ,Li-Fraumeni Syndrome,Other condition,Paroxysmal nocturnal hemoglobinuria,Diamond-Blackfan Anemia,RUNX1 deficiency (previously “familial platelet disorder with propensity to myeloid malignancies”) ,SAMD9- or SAMD9L-associated familial MDS,Shwachman-Diamond Syndrome,Telomere biology disorder (including dyskeratosis congenita)
Specify condition Aplastic anemia,DDX41-associated familial MDS,Fanconi anemia,GATA2 deficiency (including Emberger syndrome, MonoMac syndrome, DCML deficiency) ,Li-Fraumeni Syndrome,Other condition,Paroxysmal nocturnal hemoglobinuria,Diamond-Blackfan Anemia,RUNX1 deficiency (previously “familial platelet disorder with propensity to myeloid malignancies”) ,SAMD9- or SAMD9L-associated familial MDS,Shwachman-Diamond Syndrome,Telomere biology disorder (including dyskeratosis congenita)
PRE223 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes no Specify other condition: open text
Specify other condition: open text
PRE224 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Date CBC drawn: YYYY/MM/DD
Date CBC drawn: YYYY/MM/DD
PRE225 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Blasts in bone marrow Known,Unknown
Blasts in bone marrow Known,Unknown
PRE226 Pre-Transplant Disease Classification
yes yes Blasts in bone marrow __ ___ ___%
Blasts in bone marrow __ ___ ___%
PRE227 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Were cytogenetics tested (karyotyping or FISH)? no,Unknown,yes
Were cytogenetics tested (karyotyping or FISH)? no,Unknown,yes
PRE228 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Were cytogenetics tested via FISH? No,Yes
Were cytogenetics tested via FISH? No,Yes
PRE229 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Sample source Peripheral blood,Bone marrow
Sample source Peripheral blood,Bone marrow
PRE230 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Results of tests Abnormalities identified,No abnormalities
Results of tests Abnormalities identified,No abnormalities
PRE231 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE232 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE233 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,del(13q) / 13q-,i17q,inv(3),-13,-20,-5,-7,-Y,Other abnormality,t(1;3),t(11;16),t(2;11),t(3;21),t(3;3),t(6;9),+19,+8
Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,del(13q) / 13q-,i17q,inv(3),-13,-20,-5,-7,-Y,Other abnormality,t(1;3),t(11;16),t(2;11),t(3;21),t(3;3),t(6;9),+19,+8
PRE234 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE235 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
PRE236 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Were cytogenetics tested via karyotyping? No,Yes
Were cytogenetics tested via karyotyping? No,Yes
PRE237 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Sample source Peripheral blood,Bone marrow
Sample source Peripheral blood,Bone marrow
PRE238 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
PRE239 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE240 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE241 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,del(13q) / 13q-,i17q,inv(3),-13,-20,-5,-7,-Y,Other abnormality,t(1;3),t(11;16),t(2;11),t(3;21),t(3;3),t(6;9),+19,+8
Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,del(13q) / 13q-,i17q,inv(3),-13,-20,-5,-7,-Y,Other abnormality,t(1;3),t(11;16),t(2;11),t(3;21),t(3;3),t(6;9),+19,+8
PRE242 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE243 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
PRE244 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Did the recipient progress or transform to a different MDS subtype or AML between diagnosis and the start of the preparative regimen/ infusion? No,Yes
Did the recipient progress or transform to a different MDS subtype or AML between diagnosis and the start of the preparative regimen/ infusion? No,Yes
























PRE247 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify the date of the most recent transformation: YYYY/MM/DD
Specify the date of the most recent transformation: YYYY/MM/DD
PRE248 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Date of MDS diagnosis: YYYY/MM/DD
Date of MDS diagnosis: YYYY/MM/DD
PRE249 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Date CBC drawn: YYYY/MM/DD
Date CBC drawn: YYYY/MM/DD
PRE250 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Blasts in bone marrow Known,Unknown
Blasts in bone marrow Known,Unknown
PRE251 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Blasts in bone marrow __ ___ ___%
Blasts in bone marrow __ ___ ___%
PRE252 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Were cytogenetics tested (karyotyping or FISH)? no,Unknown,yes
Were cytogenetics tested (karyotyping or FISH)? no,Unknown,yes
PRE253 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Were cytogenetics tested via FISH? No,Yes
Were cytogenetics tested via FISH? No,Yes
PRE254 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Sample source Peripheral blood,Bone marrow
Sample source Peripheral blood,Bone marrow
PRE255 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Results of tests Abnormalities identified,No abnormalities
Results of tests Abnormalities identified,No abnormalities
PRE256 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE257 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE258 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,del(13q) / 13q-,i17q,inv(3),-13,-20,-5,-7,-Y,Other abnormality,t(1;3),t(11;16),t(2;11),t(3;21),t(3;3),t(6;9),+19,+8
Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,del(13q) / 13q-,i17q,inv(3),-13,-20,-5,-7,-Y,Other abnormality,t(1;3),t(11;16),t(2;11),t(3;21),t(3;3),t(6;9),+19,+8
PRE259 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE260 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
PRE261 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Were cytogenetics tested via karyotyping? No,Yes
Were cytogenetics tested via karyotyping? No,Yes
PRE262 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Sample source Peripheral blood,Bone marrow
Sample source Peripheral blood,Bone marrow
PRE263 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
PRE264 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE265 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE266 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,del(13q) / 13q-,i17q,inv(3),-13,-20,-5,-7,-Y,Other abnormality,t(1;3),t(11;16),t(2;11),t(3;21),t(3;3),t(6;9),+19,+8
Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(3q) / 3q-,del(5q) / 5q-,del(7q) / 7q-,del(9q) / 9q-,del(13q) / 13q-,i17q,inv(3),-13,-20,-5,-7,-Y,Other abnormality,t(1;3),t(11;16),t(2;11),t(3;21),t(3;3),t(6;9),+19,+8
PRE267 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE268 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. cytogenetic or FISH report) No,Yes
PRE269 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes no What was the disease status? Complete remission (CR),Hematologic improvement (HI),Not assessed,No response (NR) / stable disease (SD),Progression from hematologic improvement (Prog from HI),Relapse from complete remission (Rel from CR)
What was the disease status? Complete remission (CR),Hematologic improvement (HI),Not assessed,No response (NR) / stable disease (SD),Progression from hematologic improvement (Prog from HI),Relapse from complete remission (Rel from CR)
PRE270 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes no Specify the cell line examined to determine HI status HI-E,HI-N,HI-P
Specify the cell lines examined to determine HI status HI-E,HI-N,HI-P
PRE271 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes no Specify transfusion dependence Low-transfusion burden (LTB),Non-transfused (NTD)
Specify transfusion dependence Low-transfusion burden (LTB),Non-transfused (NTD)
PRE272 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes no Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD
























PRE275 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Was documentation submitted to the CIBMTR? (e.g. pathology report used for diagnosis) No,Yes
Was documentation submitted to the CIBMTR? (e.g. pathology report used for diagnosis) No,Yes
PRE276 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Did the recipient have constitutional symptoms in six months before diagnosis? (symptoms are >10% weight loss in 6 months, night sweats, or unexplained fever higher than 37.5 °C) No,Unknown,Yes
Did the recipient have constitutional symptoms in six months before diagnosis? (symptoms are >10% weight loss in 6 months, night sweats, or unexplained fever higher than 37.5 °C) No,Unknown,Yes
PRE277 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Date CBC drawn: YYYY/MM/DD
Date CBC drawn: YYYY/MM/DD
PRE278 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Blasts in bone marrow Known,Unknown
Blasts in bone marrow Known,Unknown
PRE279 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Blasts in bone marrow __ ___ ___%
Blasts in bone marrow __ ___ ___%
PRE280 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Were tests for driver mutations performed? No,Unknown,Yes
Were tests for driver mutations performed? No,Unknown,Yes
PRE281 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes JAK2 Negative,Not done,Positive
JAK2 Negative,Not done,Positive
PRE282 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes JAK2 V617F Negative,Not done,Positive
JAK2 V617F Negative,Not done,Positive
PRE283 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes JAK2 Exon 12 Negative,Not done,Positive
JAK2 Exon 12 Negative,Not done,Positive
PRE284 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes CALR Negative,Not done,Positive
CALR Negative,Not done,Positive
PRE285 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes CALR type 1 Negative,Not done,Positive
CALR type 1 Negative,Not done,Positive
PRE286 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes CALR type 2 Negative,Not done,Positive
CALR type 2 Negative,Not done,Positive
PRE287 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Not defined Negative,Not done,Positive
Not defined Negative,Not done,Positive
PRE288 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes MPL Negative,Not done,Positive
MPL Negative,Not done,Positive
PRE289 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes CSF3R Negative,Not done,Positive
CSF3R Negative,Not done,Positive
PRE290 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Was documentation submitted to the CIBMTR? No,Yes
Was documentation submitted to the CIBMTR? No,Yes
PRE291 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Were cytogenetics tested (karyotyping or FISH)? no,Unknown,yes
Were cytogenetics tested (karyotyping or FISH)? no,Unknown,yes
PRE292 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Were cytogenetics tested via FISH? No,Yes
Were cytogenetics tested via FISH? No,Yes
PRE293 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Sample source Peripheral blood,Bone marrow
Sample source Peripheral blood,Bone marrow
PRE294 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Results of tests Abnormalities identified,No abnormalities
Results of tests Abnormalities identified,No abnormalities
PRE295 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE296 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE297 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(5q) / 5q-,del(7q) / 7q-,del(13q) / 13q-,dup(1),i17q,inv(3),-5,-7,-Y,Other abnormality,t(1;any),t(11q23;any),t(12p11.2;any),t(3q21;any),t(6;9),+8,+9
Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(5q) / 5q-,del(7q) / 7q-,del(13q) / 13q-,dup(1),i17q,inv(3),-5,-7,-Y,Other abnormality,t(1;any),t(11q23;any),t(12p11.2;any),t(3q21;any),t(6;9),+8,+9
PRE298 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE299 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Was documentation submitted to the CIBMTR? (e.g. FISH report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. FISH report) No,Yes
PRE300 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Were cytogenetics tested via karyotyping? No,Yes
Were cytogenetics tested via karyotyping? No,Yes
PRE301 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Sample source Peripheral blood,Bone marrow
Sample source Peripheral blood,Bone marrow
PRE302 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
PRE303 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE304 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE305 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(5q) / 5q-,del(7q) / 7q-,del(13q) / 13q-,dup(1),i17q,inv(3),-5,-7,-Y,Other abnormality,t(1;any),t(11q23;any),t(12p11.2;any),t(3q21;any),t(6;9),+8,+9
Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(5q) / 5q-,del(7q) / 7q-,del(13q) / 13q-,dup(1),i17q,inv(3),-5,-7,-Y,Other abnormality,t(1;any),t(11q23;any),t(12p11.2;any),t(3q21;any),t(6;9),+8,+9
PRE306 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE307 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Was documentation submitted to the CIBMTR? (e.g. karyotyping report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. karyotyping report) No,Yes
PRE308 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Did the recipient progress or transform to a different MPN subtype or AML between diagnosis and the start of the preparative regimen / infusion? No,Yes
Did the recipient progress or transform to a different MPN subtype or AML between diagnosis and the start of the preparative regimen / infusion? No,Yes
PRE309 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Specify the MPN subtype or AML after transformation Transformed to AML,Post-essential thrombocythemic myelofibrosis,Post-polycythemic myelofibrosis
Specify the MPN subtype or AML after transformation Transformed to AML,Post-essential thrombocythemic myelofibrosis,Post-polycythemic myelofibrosis
PRE310 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Specify the date of the most recent transformation: YYYY/MM/DD
Specify the date of the most recent transformation: YYYY/MM/DD
PRE311 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Date of MPN diagnosis: YYYY/MM/DD
Date of MPN diagnosis: YYYY/MM/DD
PRE312 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Specify transfusion dependence at last evaluation prior to the start of the preparative regimen / infusion High-transfusion burden (HTB)- (≥ 8 RBCs in 16weeks; ≥ 4 in 8 weeks),Low-transfusion burden (LTB)-(3-7 RBCs in 16 weeks in at least 2 transfusion episodes; maximum of 3 in 8 weeks),Non-transfused (NTD) –(0 RBCs in 16 weeks)
Specify transfusion dependence at last evaluation prior to the start of the preparative regimen / infusion High-transfusion burden (HTB)- (≥ 8 RBCs in 16weeks; ≥ 4 in 8 weeks),Low-transfusion burden (LTB)-(3-7 RBCs in 16 weeks in at least 2 transfusion episodes; maximum of 3 in 8 weeks),Non-transfused (NTD) –(0 RBCs in 16 weeks)
PRE313 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Did the recipient have constitutional symptoms in six months before last evaluation prior to the start of the preparative regimen / infusion? (symptoms are >10% weight loss in 6 months, night sweats, or unexplained fever higher than 37.5 °C) No,Unknown,Yes
Did the recipient have constitutional symptoms in six months before last evaluation prior to the start of the preparative regimen / infusion? (symptoms are >10% weight loss in 6 months, night sweats, or unexplained fever higher than 37.5 °C) No,Unknown,Yes
PRE314 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Did the recipient have splenomegaly at last evaluation prior to the start of the preparative regimen / infusion? No,Not applicable(splenectomy) ,Unknown,Yes
Did the recipient have splenomegaly at last evaluation prior to the start of the preparative regimen / infusion? No,Not applicable(splenectomy) ,Unknown,Yes
PRE315 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Specify the method used to measure spleen size CT/MRI scan,Physical exam,Ultrasound
Specify the method used to measure spleen size CT/MRI scan,Physical exam,Ultrasound
PRE316 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Specify the spleen size: : ___ ___ centimeters below left costal margin
Specify the spleen size: : ___ ___ centimeters below left costal margin
PRE317 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Specify the spleen size: :___ ___ centimeters
Specify the spleen size: :___ ___ centimeters
PRE318 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Did the recipient have hepatomegaly at last evaluation prior to the start of the preparative regimen / infusion? no,Unknown,yes
Did the recipient have hepatomegaly at last evaluation prior to the start of the preparative regimen / infusion? no,Unknown,yes
PRE319 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Specify the method used to measure liver size CT/MRI scan,Physical exam,Ultrasound
Specify the method used to measure liver size CT/MRI scan,Physical exam,Ultrasound
PRE320 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Specify the liver size: : ___ ___ centimeters below right costal margin
Specify the liver size: : ___ ___ centimeters below right costal margin
PRE321 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Date CBC drawn: YYYY/MM/DD
Date CBC drawn: YYYY/MM/DD
PRE322 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Blasts in bone marrow Known,Unknown
Blasts in bone marrow Known,Unknown
PRE323 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Blasts in bone marrow __ ___ ___%
Blasts in bone marrow __ ___ ___%
PRE324 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Were tests for driver mutations performed? No,Unknown,Yes
Were tests for driver mutations performed? No,Unknown,Yes
PRE325 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes JAK2 Negative,Not done,Positive
JAK2 Negative,Not done,Positive
PRE326 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes JAK2 V617F Negative,Not done,Positive
JAK2 V617F Negative,Not done,Positive
PRE327 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes CALR Negative,Not done,Positive
CALR Negative,Not done,Positive
PRE328 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes CALR type 1 Negative,Not done,Positive
CALR type 1 Negative,Not done,Positive
PRE329 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes CALR type 2 Negative,Not done,Positive
CALR type 2 Negative,Not done,Positive
PRE330 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Not defined Negative,Not done,Positive
Not defined Negative,Not done,Positive
PRE331 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes MPL Negative,Not done,Positive
MPL Negative,Not done,Positive
PRE332 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes CSF3R Negative,Not done,Positive
CSF3R Negative,Not done,Positive
PRE333 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Was documentation submitted to the CIBMTR? No,Yes
Was documentation submitted to the CIBMTR? No,Yes
PRE334 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Were cytogenetics tested (karyotyping or FISH)? no,Unknown,yes
Were cytogenetics tested (karyotyping or FISH)? no,Unknown,yes
PRE335 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Were cytogenetics tested via FISH? No,Yes
Were cytogenetics tested via FISH? No,Yes
PRE336 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Sample source Peripheral blood,Bone marrow
Sample source Peripheral blood,Bone marrow
PRE337 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Results of tests Abnormalities identified,No abnormalities
Results of tests Abnormalities identified,No abnormalities
PRE338 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE339 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE340 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE341 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Were cytogenetics tested via karyotyping? No,Yes
Were cytogenetics tested via karyotyping? No,Yes
PRE342 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Sample source Peripheral blood,Bone marrow
Sample source Peripheral blood,Bone marrow
PRE343 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
PRE344 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE345 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
Specify number of distinct cytogenetic abnormalities Four or more (4 or more),One (1),Three (3),Two (2)
PRE346 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(5q) / 5q-,del(7q) / 7q-,del(13q) / 13q-,dup(1),i17q,inv(3),-5,-7,-Y,Other abnormality,t(1;any),t(11q23;any),t(12p11.2;any),t(3q21;any),t(6;9),+8,+9
Specify abnormalities (check all that apply) del(11q) / 11q-,del(12p) / 12p-,del(20q) / 20q-,del(5q) / 5q-,del(7q) / 7q-,del(13q) / 13q-,dup(1),i17q,inv(3),-5,-7,-Y,Other abnormality,t(1;any),t(11q23;any),t(12p11.2;any),t(3q21;any),t(6;9),+8,+9
PRE347 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Specify other abnormality: open text
Specify other abnormality: open text
PRE348 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Was documentation submitted to the CIBMTR? (e.g. karyotyping report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. karyotyping report) No,Yes
PRE349 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no What was the disease status? Clinical improvement (CI),Complete clinical remission (CR),Not assessed,Partial clinical remission (PR),Progressive disease,Relapse,Stable disease (SD)
What was the disease status? Clinical improvement (CI),Complete clinical remission (CR),Not assessed,Partial clinical remission (PR),Progressive disease,Relapse,Stable disease (SD)
PRE350 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Was an anemia response achieved? No,Yes
Was an anemia response achieved? No,Yes
PRE351 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Was a spleen response achieved? No,Yes
Was a spleen response achieved? No,Yes
PRE352 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Was a symptom response achieved? No,Yes
Was a symptom response achieved? No,Yes
PRE353 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD
PRE354 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Specify the cytogenetic response Complete response (CR Eradication of pre-existing abnormality,Not assessed,Not applicable,None of the above: Does not meet the CR or PR criteria, Partial response (PR) ≥ 50% reduction in abnormal metaphases ,Re-emergence of pre-existing cytogenetic abnormality
Specify the cytogenetic response Complete response (CR Eradication of pre-existing abnormality,Not assessed,Not applicable,None of the above: Does not meet the CR or PR criteria, Partial response (PR) ≥ 50% reduction in abnormal metaphases ,Re-emergence of pre-existing cytogenetic abnormality
PRE355 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD
PRE356 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Specify the molecular response Complete response (CR): Eradication of pre-existing abnormality ,Not assessed,Not applicable,None of the above: Does not meet the CR or PR criteria ,Partial response (PR): ≥50% decrease in allele burden ,Re-emergence of a pre-existing molecular abnormality
Specify the molecular response Complete response (CR): Eradication of pre-existing abnormality ,Not assessed,Not applicable,None of the above: Does not meet the CR or PR criteria ,Partial response (PR): ≥50% decrease in allele burden ,Re-emergence of a pre-existing molecular abnormality
PRE357 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes no Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD












PRE359 Pre-Transplant Disease Classification Other Leukemia (OL) yes no Specify other leukemia: open text
Specify other leukemia: open text
PRE360 Pre-Transplant Disease Classification Other Leukemia (OL) yes no Was any 17p abnormality detected? no,yes
Was any 17p abnormality detected? no,yes
PRE361 Pre-Transplant Disease Classification Other Leukemia (OL) yes no Did a histologic transformation to diffuse large B-cell lymphoma (Richter syndrome) occur at any time after CLL diagnosis? no,yes
Did a histologic transformation to diffuse large B-cell lymphoma (Richter syndrome) occur at any time after CLL diagnosis? no,yes
PRE362 Pre-Transplant Disease Classification Other Leukemia (OL) yes no What was the disease status? (Atypical CML) 1st complete remission (no previous bone marrow or extramedullary relapse),1st relapse,2nd complete remission,2nd relapse,&ge;3rd complete remission,&ge;3rd relapse,No treatment,Primary induction failure
What was the disease status? (Atypical CML) 1st complete remission (no previous bone marrow or extramedullary relapse),1st relapse,2nd complete remission,2nd relapse,&ge;3rd complete remission,&ge;3rd relapse,No treatment,Primary induction failure
PRE363 Pre-Transplant Disease Classification Other Leukemia (OL) yes no What was the disease status? (CLL, PLL, Hairy cell leukemia, Other leukemia) Complete remission (CR),Not assessed,Untreated,Partial remission (PR),Progressive disease (Prog),Stable disease (SD)
What was the disease status? (CLL, PLL, Hairy cell leukemia, Other leukemia) Complete remission (CR),Not assessed,Untreated,Partial remission (PR),Progressive disease (Prog),Stable disease (SD)
PRE364 Pre-Transplant Disease Classification Other Leukemia (OL) yes no Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD
PRE366 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Specify other lymphoma histology: open text
Specify other lymphoma histology: open text
PRE367 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Is the lymphoma histology reported at transplant a transformation from CLL? no,yes
Is the lymphoma histology reported at transplant a transformation from CLL? no,yes (Also complete Chronic Lymphocytic Leukemia (CLL) )
PRE368 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Was any 17p abnormality detected? no,yes
Was any 17p abnormality detected? no,yes
PRE369 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Is the lymphoma histology reported at transplant a transformation from a different lymphoma histology? (Not CLL) No,Yes
Is the lymphoma histology reported at transplant a transformation from a different lymphoma histology? (Not CLL) No,Yes
PRE370 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Specify the original lymphoma histology (prior to transformation) Aggressive NK-cell leukemia,Anaplastic large-cell lymphoma (ALCL), ALK negative,Anaplastic large-cell lymphoma (ALCL), ALK positive,Angioimmunoblastic T-cell lymphoma,Adult T-cell lymphoma / leukemia (HTLV1 associated),Breast implant-associated anaplastic large-cell lymphoma,Burkitt-like lymphoma with 11q aberration,Chronic lymphoproliferative disorder of NK cells,Diffuse, Large B-cell Lymphoma (cell of origin unknown),B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and classical Hodgkin Lymphoma,DLBCL associated with chronic inflammation,EBV+ DLBCL, NOS,Diffuse, large B-cell lymphoma- Germinal center B-cell type,HHV8+ DLBCL, NOS,Diffuse, large B-cell lymphoma- Activated B-cell type (non-GCB),EBV+ mucocutaneous ulcer,Enteropathy-type T-cell lymphoma,Extranodal NK / T-cell lymphoma, nasal type,Duodenal-type follicular lymphoma,Pediatric-type follicular lymphoma,Follicular T-cell lymphoma,Follicular (grade unknown),Follicular, predominantly large cell (Grade IIIA follicle center lymphoma),Follicular, predominantly large cell (Grade IIIB follicle center lymphoma),Follicular, predominantly large cell (Grade IIIA vs IIIB not specified),Follicular, predominantly small cleaved cell (Grade I follicle center lymphoma),Follicular, mixed, small cleaved and large cell (Grade II follicle center lymphoma),Hepatosplenic T-cell lymphoma,High-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements,High-grade B-cell lymphoma, NOS,Hodgkin lymphoma, not otherwise specified,Infectious mononucleosis PTLD,Intravascular large B-cell lymphoma,Indolent T-cell lymphoproliferative disorder of the GI tract,ALK+ large B-cell lymphoma,Large B-cell lymphoma with IRF4 rearrangement,Lymphocyte depleted,Lymphocyte-rich,Lymphomatoid granulomatosis,Extranodal marginal zone B-cell lymphoma of mucosal associated lymphoid tissue type (MALT),Mixed cellularity,Primary mediastinal (thymic) large B-cell lymphoma,Monomorphic epitheliotropic intestinal T-cell lymphoma,Mycosis fungoides,Mantle cell lymphoma,Nodular lymphocyte predominant Hodgkin lymphoma,Nodal marginal zone B-cell lymphoma (&plusmn; monocytoid B-cells),Nodal peripheral T-cell lymphoma with TFH phenotype,Nodular sclerosis,Other T-cell / NK-cell lymphoma,Other B-cell lymphoma,Primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma,Primary cutaneous CD30+ T-cell lymphoproliferative disorders [Primary cutaneous anaplastic large-cell lymphoma (C-ALCL), lymphoid papulosis],Primary cutaneous acral CD8+ T-cell lymphoma,Primary cutaneous CD4+ small / medium T-cell lymphoproliferative disorder,Primary cutaneous follicle center lymphoma,Primary cutaneous gamma-delta T-cell lymphoma,Primary diffuse, large B-cell lymphoma of the CNS,Primary cutaneous DLBCL, leg type,Pediatric nodal marginal zone lymphoma,Plasmacytic hyperplasia PTLD,Plasmablastic lymphoma,Primary effusion lymphoma,Peripheral T-cell lymphoma (PTCL), NOS,Florid follicular hyperplasia PTLD,Classical Hodgkin lymphoma PTLD,Monomorphic PTLD (B- and T-/NK-cell types),Polymorphic PTLD,Splenic B-cell lymphoma / leukemia, unclassifiable,Splenic diffuse red pulp small B-cell lymphoma,Splenic marginal zone B-cell lymphoma,Burkitt lymphoma,Subcutaneous panniculitis-like T-cell lymphoma,Systemic EBV+ T-cell lymphoma of childhood,Sézary syndrome,T-cell / histiocytic rich large B-cell lymphoma,T-cell large granular lymphocytic leukemia,Waldenstrom macroglobulinemia / Lymphoplasmacytic lymphoma
Specify the original lymphoma histology (prior to transformation) Aggressive NK-cell leukemia,Anaplastic large-cell lymphoma (ALCL), ALK negative,Anaplastic large-cell lymphoma (ALCL), ALK positive,Angioimmunoblastic T-cell lymphoma,Adult T-cell lymphoma / leukemia (HTLV1 associated),Breast implant-associated anaplastic large-cell lymphoma,Burkitt-like lymphoma with 11q aberration,Chronic lymphoproliferative disorder of NK cells,Diffuse, Large B-cell Lymphoma (cell of origin unknown),B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and classical Hodgkin Lymphoma,DLBCL associated with chronic inflammation,EBV+ DLBCL, NOS,Diffuse, large B-cell lymphoma- Germinal center B-cell type,HHV8+ DLBCL, NOS,Diffuse, large B-cell lymphoma- Activated B-cell type (non-GCB),EBV+ mucocutaneous ulcer,Enteropathy-type T-cell lymphoma,Extranodal NK / T-cell lymphoma, nasal type,Duodenal-type follicular lymphoma,Pediatric-type follicular lymphoma,Follicular T-cell lymphoma,Follicular (grade unknown),Follicular, predominantly large cell (Grade IIIA follicle center lymphoma),Follicular, predominantly large cell (Grade IIIB follicle center lymphoma),Follicular, predominantly large cell (Grade IIIA vs IIIB not specified),Follicular, predominantly small cleaved cell (Grade I follicle center lymphoma),Follicular, mixed, small cleaved and large cell (Grade II follicle center lymphoma),Hepatosplenic T-cell lymphoma,High-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements,High-grade B-cell lymphoma, NOS,Hodgkin lymphoma, not otherwise specified,Infectious mononucleosis PTLD,Intravascular large B-cell lymphoma,Indolent T-cell lymphoproliferative disorder of the GI tract,ALK+ large B-cell lymphoma,Large B-cell lymphoma with IRF4 rearrangement,Lymphocyte depleted,Lymphocyte-rich,Lymphomatoid granulomatosis,Extranodal marginal zone B-cell lymphoma of mucosal associated lymphoid tissue type (MALT),Mixed cellularity,Primary mediastinal (thymic) large B-cell lymphoma,Monomorphic epitheliotropic intestinal T-cell lymphoma,Mycosis fungoides,Mantle cell lymphoma,Nodular lymphocyte predominant Hodgkin lymphoma,Nodal marginal zone B-cell lymphoma (&plusmn; monocytoid B-cells),Nodal peripheral T-cell lymphoma with TFH phenotype,Nodular sclerosis,Other T-cell / NK-cell lymphoma,Other B-cell lymphoma,Primary cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma,Primary cutaneous CD30+ T-cell lymphoproliferative disorders [Primary cutaneous anaplastic large-cell lymphoma (C-ALCL), lymphoid papulosis],Primary cutaneous acral CD8+ T-cell lymphoma,Primary cutaneous CD4+ small / medium T-cell lymphoproliferative disorder,Primary cutaneous follicle center lymphoma,Primary cutaneous gamma-delta T-cell lymphoma,Primary diffuse, large B-cell lymphoma of the CNS,Primary cutaneous DLBCL, leg type,Pediatric nodal marginal zone lymphoma,Plasmacytic hyperplasia PTLD,Plasmablastic lymphoma,Primary effusion lymphoma,Peripheral T-cell lymphoma (PTCL), NOS,Florid follicular hyperplasia PTLD,Classical Hodgkin lymphoma PTLD,Monomorphic PTLD (B- and T-/NK-cell types),Polymorphic PTLD,Splenic B-cell lymphoma / leukemia, unclassifiable,Splenic diffuse red pulp small B-cell lymphoma,Splenic marginal zone B-cell lymphoma,Burkitt lymphoma,Subcutaneous panniculitis-like T-cell lymphoma,Systemic EBV+ T-cell lymphoma of childhood,Sézary syndrome,T-cell / histiocytic rich large B-cell lymphoma,T-cell large granular lymphocytic leukemia,Waldenstrom macroglobulinemia / Lymphoplasmacytic lymphoma
PRE371 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Specify other lymphoma histology: open text
Specify other lymphoma histology: open text
PRE372 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Date of original lymphoma diagnosis: (report the date of diagnosis of original lymphoma subtype) YYYY/MM/DD
Date of original lymphoma diagnosis: (report the date of diagnosis of original lymphoma subtype) YYYY/MM/DD
PRE373 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Was a PET (or PET/CT) scan performed? (at last evaluation prior to the start of the preparative regimen / infusion) no,yes
Was a PET (or PET/CT) scan performed? (at last evaluation prior to the start of the preparative regimen / infusion) no,yes
PRE374 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Was the PET (or PET/CT) scan positive for lymphoma involvement at any disease site? no,yes
Was the PET (or PET/CT) scan positive for lymphoma involvement at any disease site? no,yes
PRE375 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Date of PET scan Known,Unknown
Date of PET scan Known,Unknown
PRE376 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Date of PET (or PET/CT) scan: YYYY/MM/DD
Date of PET (or PET/CT) scan: YYYY/MM/DD
PRE377 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Deauville (five-point) score of the PET (or PET/CT) scan Known,Unknown
Deauville (five-point) score of the PET (or PET/CT) scan Known,Unknown
PRE378 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Scale 1- no uptake or no residual uptake
2- slight uptake, but below blood pool (mediastinum)
3- uptake above mediastinal, but below or equal to uptake in the liver
4- uptake slightly to moderately higher than liver
5- markedly increased uptake or any new lesion
Scale 1- no uptake or no residual uptake
2- slight uptake, but below blood pool (mediastinum)
3- uptake above mediastinal, but below or equal to uptake in the liver
4- uptake slightly to moderately higher than liver
5- markedly increased uptake or any new lesion
PRE379 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no What was the disease status? CR1 - 1st complete remission: no bone marrow or extramedullary relapse prior to transplant,CR2 - 2nd complete remission,CR3+ - 3rd or subsequent complete remission,PIF res - Primary induction failure – resistant: NEVER in COMPLETE remission but with stable or progressive disease on treatment.,PIF sen / PR1 - Primary induction failure – sensitive: NEVER in COMPLETE remission but with partial remission on treatment.,PIF unk - Primary induction failure – sensitivity unknown,REL1 res - 1st relapse – resistant: stable or progressive disease with treatment,REL1 sen - 1st relapse – sensitive: partial remission (if complete remission was achieved, classify as CR2),REL1 unk - 1st relapse – sensitivity unknown,REL1 unt - 1st relapse – untreated; includes either bone marrow or extramedullary relapse,REL2 res - 2nd relapse – resistant: stable or progressive disease with treatment,REL2 sen - 2nd relapse – sensitive: partial remission (if complete remission achieved, classify as CR3+),REL2 unk - 2nd relapse – sensitivity unknown,REL2 unt - 2nd relapse – untreated: includes either bone marrow or extramedullary relapse,REL3+ res - 3rd or subsequent relapse – resistant: stable or progressive disease with treatment,REL3+ sen - 3rd or subsequent relapse – sensitive: partial remission (if complete remission achieved, classify as CR3+),REL3+ unk - 3rd relapse or greater – sensitivity unknown,REL3+ unt - 3rd or subsequent relapse – untreated; includes either bone marrow or extramedullary relapse,Disease untreated
What was the disease status? CR1 - 1st complete remission: no bone marrow or extramedullary relapse prior to transplant,CR2 - 2nd complete remission,CR3+ - 3rd or subsequent complete remission,PIF res - Primary induction failure – resistant: NEVER in COMPLETE remission but with stable or progressive disease on treatment.,PIF sen / PR1 - Primary induction failure – sensitive: NEVER in COMPLETE remission but with partial remission on treatment.,PIF unk - Primary induction failure – sensitivity unknown,REL1 res - 1st relapse – resistant: stable or progressive disease with treatment,REL1 sen - 1st relapse – sensitive: partial remission (if complete remission was achieved, classify as CR2),REL1 unk - 1st relapse – sensitivity unknown,REL1 unt - 1st relapse – untreated; includes either bone marrow or extramedullary relapse,REL2 res - 2nd relapse – resistant: stable or progressive disease with treatment,REL2 sen - 2nd relapse – sensitive: partial remission (if complete remission achieved, classify as CR3+),REL2 unk - 2nd relapse – sensitivity unknown,REL2 unt - 2nd relapse – untreated: includes either bone marrow or extramedullary relapse,REL3+ res - 3rd or subsequent relapse – resistant: stable or progressive disease with treatment,REL3+ sen - 3rd or subsequent relapse – sensitive: partial remission (if complete remission achieved, classify as CR3+),REL3+ unk - 3rd relapse or greater – sensitivity unknown,REL3+ unt - 3rd or subsequent relapse – untreated; includes either bone marrow or extramedullary relapse,Disease untreated
PRE380 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Total number of lines of therapy received (between diagnosis and HCT / infusion) 1 line,2 lines,3+ lines
Total number of lines of therapy received (between diagnosis and HCT / infusion) 1 line,2 lines,3+ lines
PRE381 Pre-Transplant Disease Classification Hodgkin and Non-Hodgkin Lymphoma yes no Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD












PRE383 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Specify other plasma cell disorder: open text
Specify other plasma cell disorder: open text
PRE384 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Specify heavy and/or light chain type (check all that apply) IgA (heavy chain only),IgA kappa,IgA lambda,IgD (heavy chain only),IgD kappa,IgD lambda,IgE (heavy chain only),IgE kappa,IgE lambda,IgG (heavy chain only),IgG kappa,IgG lambda,IgM (heavy chain only),IgM kappa,IgM lambda,Kappa (light chain only),Lambda (light chain only)
Specify heavy and/or light chain type (check all that apply) IgA (heavy chain only),IgA kappa,IgA lambda,IgD (heavy chain only),IgD kappa,IgD lambda,IgE (heavy chain only),IgE kappa,IgE lambda,IgG (heavy chain only),IgG kappa,IgG lambda,IgM (heavy chain only),IgM kappa,IgM lambda,Kappa (light chain only),Lambda (light chain only)
PRE385 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Specify Amyloidosis classification AH amyloidosis,AHL amyloidosis,AL amyloidosis
Specify Amyloidosis classification AH amyloidosis,AHL amyloidosis,AL amyloidosis
PRE386 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Select monoclonal gammopathy of renal significance (MGRS) classification C3 glomerulopathy with monoclonal gammopathy,Crystal-storing histiocytosis,Immunotactoid glomerulopathy (ITGN)/ Glomerulonephritis with organized monoclonal microtubular immunoglobulin deposits (GOMMID),Light chain fanconi syndrome,Monoclonal immunoglobulin deposition disease (MIDD),Non-amyloid fibrillary glomerulonephritis,Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits (PGNMID),Proximal tubulopathy without crystals,Type 1 cryoglobulinemic glomerulonephritis,Unknown
Select monoclonal gammopathy of renal significance (MGRS) classification C3 glomerulopathy with monoclonal gammopathy,Crystal-storing histiocytosis,Immunotactoid glomerulopathy (ITGN)/ Glomerulonephritis with organized monoclonal microtubular immunoglobulin deposits (GOMMID),Light chain fanconi syndrome,Monoclonal immunoglobulin deposition disease (MIDD),Non-amyloid fibrillary glomerulonephritis,Proliferative glomerulonephritis with monoclonal immunoglobulin G deposits (PGNMID),Proximal tubulopathy without crystals,Type 1 cryoglobulinemic glomerulonephritis,Unknown












PRE388 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Was documentation submitted to the CIBMTR? (e.g. pathology report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. pathology report) No,Yes












PRE390 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no What was the Durie-Salmon staging? (at diagnosis) Stage I (All of the following: Hgb > 10g/dL; serum calcium normal or <10.5 mg/dL; bone x-ray normal bone structure (scale 0), or solitary bone plasmacytoma only; low M-component production rates IgG < 5g/dL, IgA < 3g/dL; urine light chain M-component on electrophoresis <4g/24h) – ,Stage II (Fitting neither Stage I or Stage III) ,Stage III (One of more of the following: Hgb < 8.5 g/dL; serum calcium > 12 mg/dL; advanced lytic bone lesions (scale 3); high M-component production rates IgG >7g/dL, IgA > 5g/dL; Bence Jones protein >12g/24h) ,Unknown
What was the Durie-Salmon staging? (at diagnosis) Stage I (All of the following: Hgb > 10g/dL; serum calcium normal or <10.5 mg/dL; bone x-ray normal bone structure (scale 0), or solitary bone plasmacytoma only; low M-component production rates IgG < 5g/dL, IgA < 3g/dL; urine light chain M-component on electrophoresis <4g/24h) – ,Stage II (Fitting neither Stage I or Stage III) ,Stage III (One of more of the following: Hgb < 8.5 g/dL; serum calcium > 12 mg/dL; advanced lytic bone lesions (scale 3); high M-component production rates IgG >7g/dL, IgA > 5g/dL; Bence Jones protein >12g/24h) ,Unknown
PRE391 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no What was the Durie-Salmon sub classification? (at diagnosis) A - relatively normal renal function (serum creatinine < 2.0 mg/dL,B - abnormal renal function (serum creatinine ≥ 2.0 mg/dL)
What was the Durie-Salmon sub classification? (at diagnosis) A - relatively normal renal function (serum creatinine < 2.0 mg/dL,B - abnormal renal function (serum creatinine ≥ 2.0 mg/dL)
PRE392 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Did the recipient have a preceding or concurrent plasma cell disorder? No,Yes
Did the recipient have a preceding or concurrent plasma cell disorder? No,Yes
PRE394 Pre-Transplant Disease Classification Preceding or Concurrent Plasma Cell Disorder yes yes Specify other preceding/concurrent disorder: open text
Specify other preceding/concurrent disorder: open text
PRE395 Pre-Transplant Disease Classification Preceding or Concurrent Plasma Cell Disorder yes yes Date of diagnosis of preceding / concurrent disorder: YYYY/MM/DD
Date of diagnosis of preceding / concurrent disorder: YYYY/MM/DD
PRE396 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Serum beta2 - microglobulin Known,Unknown
Serum beta2 - microglobulin Known,Unknown
PRE397 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Serum beta2-microglobulin: : ___ ___ ___ ● ___ ___ ___ μg/dL
: ___ ___ ___ ● ___ ___ ___ mg/L
: ___ ___ ___ ● ___ ___ ___ nmol/L
Serum beta2-microglobulin: : ___ ___ ___ ● ___ ___ ___ μg/dL
: ___ ___ ___ ● ___ ___ ___ mg/L
: ___ ___ ___ ● ___ ___ ___ nmol/L
PRE398 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no I.S.S Stage Known,Unknown
I.S.S Stage Known,Unknown
PRE399 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no I.S.S Stage 1 (Serum β2-microglobulin < 3.5 mg/L, Serum albumin ≥ 3.5 g/dL), 2(Not fitting stage 1 or 3) ,3 (Serum β2-microglobulin ≥ 5.5 mg/L; Serum albumin —)
I.S.S Stage 1 (Serum β2-microglobulin < 3.5 mg/L, Serum albumin ≥ 3.5 g/dL), 2(Not fitting stage 1 or 3) ,3 (Serum β2-microglobulin ≥ 5.5 mg/L; Serum albumin —)
PRE400 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no R-I.S.S Stage Known,Unknown
R-I.S.S Stage Known,Unknown
PRE401 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no R-I.S.S Stage 1 (ISS stage I and no high-risk cytogenetic abnormalities by FISH [deletion 17p / 17p-, t(4;14), t(14;16)] and normal LDH levels),2(Not R-ISS stage I or III),3(ISS stage III and either high-risk cytogenetic abnormalities by FISH [deletion 17p / 17p-, t(4;14), t(14;16)] or high LDH levels)
R-I.S.S Stage 1 (ISS stage I and no high-risk cytogenetic abnormalities by FISH [deletion 17p / 17p-, t(4;14), t(14;16)] and normal LDH levels),2(Not R-ISS stage I or III),3(ISS stage III and either high-risk cytogenetic abnormalities by FISH [deletion 17p / 17p-, t(4;14), t(14;16)] or high LDH levels)
PRE402 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Plasma cells in blood by flow cytometry Known,Unknown
Plasma cells in peripheral blood by flow cytometry Known,Unknown
PRE403 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Plasma cells in blood by flow cytometry ___ ___• ___ ___   %
Plasma cells in blood by flow cytometry ___ ___• ___ ___   %
PRE404 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Plasma cells in blood by morphologic assessment Known,Unknown
Plasma cells in peripheral blood by morphologic assessment Known,Unknown
PRE405 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Plasma cells in blood by morphologic assessment ___ ___• ___ ___   %
Plasma cells in blood by morphologic assessment ___ ___• ___ ___   %
PRE406 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Plasma cells in blood by morphologic assessment ___ ___ ___ ___ ___ • ___ ___ □ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ • ___ ___ □ x 106/L
Plasma cells in blood by morphologic assessment ___ ___ ___ ___ ___ • ___ ___ □ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ • ___ ___ □ x 106/L
PRE407 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Were cytogenetics tested (karyotyping or FISH)? (at diagnosis) no,Unknown,yes
Were cytogenetics tested (karyotyping or FISH)? (at diagnosis) no,Unknown,yes
PRE408 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Were cytogenetics tested via FISH? No,Yes
Were cytogenetics tested via FISH? No,Yes
PRE409 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Results of tests Abnormalities identified,No abnormalities
Results of tests Abnormalities identified,No abnormalities
PRE410 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE411 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Specify abnormalities (check all that apply) Any abnormality at 1p,Any abnormality at 1q,del(13q) / 13q-,del(17p) / 17p-,Hyperdiploid (> 50),Hypodiploid (< 46),-13,-17,MYC rearrangement,Other abnormality,t(11;14),t(14;16),t(14;20),t(4;14),t(6;14),+11,+15,+19,+3,+5,+7,+9
Specify abnormalities (check all that apply) Any abnormality at 1p,Any abnormality at 1q,del(13q) / 13q-,del(17p) / 17p-,Hyperdiploid (> 50),Hypodiploid (< 46),-13,-17,MYC rearrangement,Other abnormality,t(11;14),t(14;16),t(14;20),t(4;14),t(6;14),+11,+15,+19,+3,+5,+7,+9
PRE412 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Specify other abnormality: open text
Specify other abnormality: open text
PRE413 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Was documentation submitted to the CIBMTR? (e.g. FISH report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. FISH report) No,Yes
PRE414 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Were cytogenetics tested via karyotyping? No,Yes
Were cytogenetics tested via karyotyping? No,Yes
PRE415 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
Results of tests Abnormalities identified,No abnormalities,No evaluable metaphases
PRE416 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
International System for Human Cytogenetic Nomenclature (ISCN) compatible string: open text
PRE417 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Specify abnormalities (check all that apply) Any abnormality at 1p,Any abnormality at 1q,del(13q) / 13q-,del(17p) / 17p-,Hyperdiploid (> 50),Hypodiploid (< 46),-13,-17,MYC rearrangement,Other abnormality,t(11;14),t(14;16),t(14;20),t(4;14),t(6;14),+11,+15,+19,+3,+5,+7,+9
Specify abnormalities (check all that apply) Any abnormality at 1p,Any abnormality at 1q,del(13q) / 13q-,del(17p) / 17p-,Hyperdiploid (> 50),Hypodiploid (< 46),-13,-17,MYC rearrangement,Other abnormality,t(11;14),t(14;16),t(14;20),t(4;14),t(6;14),+11,+15,+19,+3,+5,+7,+9
PRE418 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Specify other abnormality: open text
Specify other abnormality: open text
PRE419 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Was documentation submitted to the CIBMTR? (e.g. karyotyping report) No,Yes
Was documentation submitted to the CIBMTR? (e.g. karyotyping report) No,Yes
PRE420 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no What is the hematologic disease status? Complete remission (CR),Progressive disease (PD),Partial remission (PR),Relapse from CR (Rel) (untreated),Stringent complete remission (sCR),Stable disease (SD),Unknown,Very good partial remission (VGPR)
What is the hematologic disease status? Complete remission (CR),Progressive disease (PD),Partial remission (PR),Relapse from CR (Rel) (untreated),Stringent complete remission (sCR),Stable disease (SD),Unknown,Very good partial remission (VGPR)
PRE421 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD
PRE422 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Specify amyloidosis hematologic response (for Amyloid patients only) Complete response (CR),No response (NR) / stable disease (SD),Progressive disease (PD),Partial response (PR),Relapse from CR (Rel) (untreated),Unknown,Very good partial response (VGPR)
Specify amyloidosis hematologic response (for Amyloid patients only) Complete response (CR),No response (NR) / stable disease (SD),Progressive disease (PD),Partial response (PR),Relapse from CR (Rel) (untreated),Unknown,Very good partial response (VGPR)
PRE423 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD












PRE425 Pre-Transplant Disease Classification Solid Tumors yes no Specify other solid tumor: open text
Specify other solid tumor: open text
PRE426 Pre-Transplant Disease Classification Aplastic Anemia yes no Specify the aplastic anemia classification – If the recipient developed MDS or AML, indicate MDS or AML as the primary disease. Acquired amegakaryocytosis (not congenital),Acquired pure red cell aplasia (not congenital),Acquired AA, not otherwise specified,Other acquired cytopenic syndrome,Acquried AA secondary to chemotherapy,Acquired AA, secondary to hepatitis,Acquired AA secondary to immunotherapy or immune effector cell therapy,Acquired AA, secondary to toxin / other drug
Specify the aplastic anemia classification – If the recipient developed MDS or AML, indicate MDS or AML as the primary disease. Acquired amegakaryocytosis (not congenital),Acquired pure red cell aplasia (not congenital),Acquired AA, not otherwise specified,Other acquired cytopenic syndrome,Acquried AA secondary to chemotherapy,Acquired AA, secondary to hepatitis,Acquired AA secondary to immunotherapy or immune effector cell therapy,Acquired AA, secondary to toxin / other drug
PRE427 Pre-Transplant Disease Classification Aplastic Anemia yes no Specify severity Not severe,Severe / very severe
Specify severity Not severe,Severe / very severe
PRE428 Pre-Transplant Disease Classification Aplastic Anemia yes no Specify other acquired cytopenic syndrome: open text
Specify other acquired cytopenic syndrome: open text












PRE430 Pre-Transplant Disease Classification Hemoglobinopathies yes no Specify the hemoglobinopathy classification Other hemoglobinopathy,Sickle cell disease,Transfusion dependent thalassemia
Specify the hemoglobinopathy classification Other hemoglobinopathy,Sickle cell disease,Transfusion dependent thalassemia
PRE431 Pre-Transplant Disease Classification Hemoglobinopathies yes no Specify transfusion dependent thalassemia Transfusion dependent beta thalassemia,Other transfusion dependent thalassemia
Specify transfusion dependent thalassemia Transfusion dependent beta thalassemia,Other transfusion dependent thalassemia
PRE432 Pre-Transplant Disease Classification Hemoglobinopathies yes no Specify other hemoglobinopathy: open text
Specify other hemoglobinopathy: open text
PRE433 Pre-Transplant Disease Classification Hemoglobinopathies yes no Was tricuspid regurgitant jet velocity (TRJV) measured by echocardiography? No,Unknown,Yes
Was tricuspid regurgitant jet velocity (TRJV) measured by echocardiography? No,Unknown,Yes
PRE434 Pre-Transplant Disease Classification Hemoglobinopathies yes no TRJV measurement Known,Unknown
TRJV measurement Known,Unknown
PRE435 Pre-Transplant Disease Classification Hemoglobinopathies yes no TRJV measurement: __ __● ___ m/sec
TRJV measurement: __ __● ___ m/sec
PRE436 Pre-Transplant Disease Classification Hemoglobinopathies yes no Was liver iron content (LIC) tested within 6 months prior to infusion? No,Yes
Was liver iron content (LIC) tested within 6 months prior to infusion? No,Yes
PRE437 Pre-Transplant Disease Classification Hemoglobinopathies yes no Liver iron content:
___ ___ ___ ● ___mg Fe/g liver dry weight
___ ___ ___ ● ___g Fe/kg liver dry weight
___ ___ ___ ● ___µmol Fe / g liver dry weight
Liver iron content:
___ ___ ___ ● ___mg Fe/g liver dry weight
___ ___ ___ ● ___g Fe/kg liver dry weight
___ ___ ___ ● ___µmol Fe / g liver dry weight
PRE438 Pre-Transplant Disease Classification Hemoglobinopathies yes no Method used to estimate LIC? FerriScan,Liver Biopsy,Other,SQUID MRI,T2 MRI
Method used to estimate LIC? FerriScan,Liver Biopsy,Other,SQUID MRI,T2 MRI
PRE439 Pre-Transplant Disease Classification Hemoglobinopathies yes no Is the recipient red blood cell transfusion dependent? (requiring transfusion to maintain HGB 9-10 g/dL) No,Yes
Is the recipient red blood cell transfusion dependent? (requiring transfusion to maintain HGB 9-10 g/dL) No,Yes
PRE440 Pre-Transplant Disease Classification Hemoglobinopathies yes no Year of first transfusion: (since diagnosis): YYYY
Year of first transfusion: (since diagnosis): YYYY
PRE441 Pre-Transplant Disease Classification Hemoglobinopathies yes no Was iron chelation therapy given at any time since diagnosis? No,Unknown,Yes
Was iron chelation therapy given at any time since diagnosis? No,Unknown,Yes
PRE442 Pre-Transplant Disease Classification Hemoglobinopathies yes no Did iron chelation therapy meet the following criteria: initiated within 18 months of the first transfusion and administered for at least 5 days / week (either oral or parenteral iron chelation medication)? No, iron chelation therapy given, but not meeting criteria,Iron chelation therapy given, but details of administration unknown,Yes, iron chelation therapy given as specified
Did iron chelation therapy meet the following criteria: initiated within 18 months of the first transfusion and administered for at least 5 days / week (either oral or parenteral iron chelation medication)? No, iron chelation therapy given, but not meeting criteria,Iron chelation therapy given, but details of administration unknown,Yes, iron chelation therapy given as specified
PRE443 Pre-Transplant Disease Classification Hemoglobinopathies yes no Specify reason criteria not met Non-adherence,Other,Toxicity due to iron chelation therapy
Specify reason criteria not met Non-adherence,Other,Toxicity due to iron chelation therapy
PRE444 Pre-Transplant Disease Classification Hemoglobinopathies yes no Specify other reason criteria not met: open text
Specify other reason criteria not met: open text
PRE445 Pre-Transplant Disease Classification Hemoglobinopathies yes no Year iron chelation therapy started Known,Unknown
Year iron chelation therapy started Known,Unknown
PRE446 Pre-Transplant Disease Classification Hemoglobinopathies yes no Year started: YYYY
Year started: YYYY
PRE447 Pre-Transplant Disease Classification Hemoglobinopathies yes no Did the recipient have hepatomegaly? (≥ 2 cm below costal margin) no,Unknown,yes
Did the recipient have hepatomegaly? (≥ 2 cm below costal margin) no,Unknown,yes
PRE448 Pre-Transplant Disease Classification Hemoglobinopathies yes no Liver size as measured below the costal margin at most recent evaluation: __ __ cm
Liver size as measured below the costal margin at most recent evaluation: __ __ cm
PRE449 Pre-Transplant Disease Classification Hemoglobinopathies yes no Was a liver biopsy performed at any time since diagnosis? no,yes
Was a liver biopsy performed at any time since diagnosis? no,yes
PRE450 Pre-Transplant Disease Classification Hemoglobinopathies yes no Date functional status assessed Known,Unknown
Date functional status assessed Known,Unknown
PRE451 Pre-Transplant Disease Classification Hemoglobinopathies yes no Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD
PRE452 Pre-Transplant Disease Classification Hemoglobinopathies yes no Date estimated checked
Date estimated checked
PRE453 Pre-Transplant Disease Classification Hemoglobinopathies yes no Was there evidence of liver cirrhosis? No,Unknown,Yes
Was there evidence of liver cirrhosis? No,Unknown,Yes
PRE454 Pre-Transplant Disease Classification Hemoglobinopathies yes no Was there evidence of liver fibrosis? No,Unknown,Yes
Was there evidence of liver fibrosis? No,Unknown,Yes
PRE455 Pre-Transplant Disease Classification Hemoglobinopathies yes no Type of fibrosis Bridging,Other,Periportal,Unknown
Type of fibrosis Bridging,Other,Periportal,Unknown
PRE456 Pre-Transplant Disease Classification Hemoglobinopathies yes no Was there evidence of chronic hepatitis? No,Unknown,Yes
Was there evidence of chronic hepatitis? No,Unknown,Yes
PRE457 Pre-Transplant Disease Classification Hemoglobinopathies yes no Was documentation submitted to the CIBMTR? (e.g. liver biopsy) No,Yes
Was documentation submitted to the CIBMTR? (e.g. liver biopsy) No,Yes
PRE458 Pre-Transplant Disease Classification Hemoglobinopathies yes no Is there evidence of abnormal cardiac iron deposition based on MRI of the heart at time of infusion? No,Yes
Is there evidence of abnormal cardiac iron deposition based on MRI of the heart at time of infusion? No,Yes
PRE459 Pre-Transplant Disease Classification Hemoglobinopathies yes no Did the recipient have a splenectomy? no,Unknown,yes
Did the recipient have a splenectomy? no,Unknown,yes
PRE460 Pre-Transplant Disease Classification Hemoglobinopathies yes no TIBC: : ___ ___ ___● ___ ___ µg / dL
: ___ ___ ___● ___ ___µmol / L
TIBC: : ___ ___ ___● ___ ___ µg / dL
: ___ ___ ___● ___ ___µmol / L
PRE461 Pre-Transplant Disease Classification Hemoglobinopathies yes no Total serum bilirubin Known,Unknown
Total serum bilirubin Known,Unknown
PRE462 Pre-Transplant Disease Classification Hemoglobinopathies yes no Total serum bilirubin: : ___ ___ ___● ___ ___ mg/dL
: ___ ___ ___● ___ ___µmol / L
Total serum bilirubin: : ___ ___ ___● ___ ___ mg/dL
: ___ ___ ___● ___ ___µmol / L
PRE463 Pre-Transplant Disease Classification Hemoglobinopathies yes no Upper limit of normal for total serum bilirubin: __ __ __ ● __
Upper limit of normal for total serum bilirubin: __ __ __ ● __












PRE465 Pre-Transplant Disease Classification Disorders of the Immune System yes no Specify other SCID: open text
Specify other SCID: open text
PRE466 Pre-Transplant Disease Classification Disorders of the Immune System yes no Specify other immunodeficiency: open text
Specify other immunodeficiency: open text
PRE467 Pre-Transplant Disease Classification Disorders of the Immune System yes no Specify other pigmentary dilution disorder: open text
Specify other pigmentary dilution disorder: open text
PRE468 Pre-Transplant Disease Classification Disorders of the Immune System yes no Did the recipient have an active or recent infection with a viral pathogen within 60 days of HCT? No,Yes
Did the recipient have an active or recent infection with a viral pathogen within 60 days of HCT? No,Yes
PRE469 Pre-Transplant Disease Classification Disorders of the Immune System yes no Specify viral pathogen (check all that apply) Adenovirus,BK Virus,Chikaugunya Virus,Cytomegalovirus (CMV),Coronavirus,Dengue Virus,Epstein-Barr Virus (EBV),Enterovirus D68 (EV-D68),Enterovirus (ECHO, Coxsackie),Enterovirus, NOS,Enterovirus (polio),Hepatitis A Virus,Hepatitis B Virus,Hepatitis C Virus,Hepatitis E,Human herpesvirus 6 (HHV-6),Human Immunodeficiency Virus 1 or 2,Human metapneumovirus,Human Papillomavirus (HPV),Herpes Simplex Virus (HSV),Human T-lymphotropic Virus 1 or 2,Influenza A Virus,Influenza B Virus,Influenza, NOS,JC Virus (Progressive Multifocal Leukoencephalopathy (PML)),Measles Virus (Rubeola),Mumps Virus,Norovirus,Human Parainfluenza Virus (all species),Rhinovirus (all species),Rotavirus (all species),Respiratory Syncytial Virus (RSV),Rubella Virus,Varicella Virus,West Nile Virus (WNV)
Specify viral pathogen (check all that apply) Adenovirus,BK Virus,Chikaugunya Virus,Cytomegalovirus (CMV),Coronavirus,Dengue Virus,Epstein-Barr Virus (EBV),Enterovirus D68 (EV-D68),Enterovirus (ECHO, Coxsackie),Enterovirus, NOS,Enterovirus (polio),Hepatitis A Virus,Hepatitis B Virus,Hepatitis C Virus,Hepatitis E,Human herpesvirus 6 (HHV-6),Human Immunodeficiency Virus 1 or 2,Human metapneumovirus,Human Papillomavirus (HPV),Herpes Simplex Virus (HSV),Human T-lymphotropic Virus 1 or 2,Influenza A Virus,Influenza B Virus,Influenza, NOS,JC Virus (Progressive Multifocal Leukoencephalopathy (PML)),Measles Virus (Rubeola),Mumps Virus,Norovirus,Human Parainfluenza Virus (all species),Rhinovirus (all species),Rotavirus (all species),Respiratory Syncytial Virus (RSV),Rubella Virus,Varicella Virus,West Nile Virus (WNV)
PRE470 Pre-Transplant Disease Classification Disorders of the Immune System yes no Has the recipient ever been infected with PCP / PJP? No,Yes
Has the recipient ever been infected with PCP / PJP? No,Yes
PRE471 Pre-Transplant Disease Classification Disorders of the Immune System yes no Does the recipient have GVHD due to maternal cell engraftment pre-HCT? (SCID only) No,Yes
Does the recipient have GVHD due to maternal cell engraftment pre-HCT? (SCID only) No,Yes
PRE472 Pre-Transplant Disease Classification Inherited Abnormalities of Platelets yes no Specify inherited abnormalities of platelets classification Congenital amegakaryocytosis / congenital thrombocytopenia (501),Glanzmann thrombasthenia (502),Other inherited platelet abnormality (509)
Specify inherited abnormalities of platelets classification Congenital amegakaryocytosis / congenital thrombocytopenia (501),Glanzmann thrombasthenia (502),Other inherited platelet abnormality (509)
PRE473 Pre-Transplant Disease Classification Inherited Abnormalities of Platelets yes no Specify other inherited platelet abnormality: open text
Specify other inherited platelet abnormality: open text
PRE474 Pre-Transplant Disease Classification Inherited Disorders of Metabolism yes no Specify inherited disorders of metabolism classification Adrenoleukodystrophy (ALD) (543),Aspartyl glucosaminidase (561),ß-glucuronidase deficiency (VII) (537),Fucosidosis (562),Gaucher disease (541),Glucose storage disease (548),Hunter syndrome (II) (533),Hurler syndrome (IH) (531),I-cell disease (546),Krabbe disease (globoid leukodystrophy) (544),Lesch-Nyhan (HGPRT deficiency) (522),Mannosidosis (563),Maroteaux-Lamy (VI) (536),Metachromatic leukodystrophy (MLD) (542),Mucolipidoses, not otherwise specified (540),Morquio (IV) (535),Mucopolysaccharidosis (V) (538),Mucopolysaccharidosis, not otherwise specified (530),Niemann-Pick disease (545),Neuronal ceroid lipofuscinosis (Batten disease) (523),Other inherited metabolic disorder (529),Osteopetrosis (malignant infantile osteopetrosis) (521),Polysaccharide hydrolase abnormality, not otherwise specified (560),Sanfilippo (III) (534),Scheie syndrome (IS) (532),Inherited metabolic disorder, not otherwise specified (520),Wolman disease (547)
Specify inherited disorders of metabolism classification Hereditary diffuse leukoencephalopathy with spheroids, Adrenoleukodystrophy (ALD) (543),Aspartyl glucosaminidase (561),ß-glucuronidase deficiency (VII) (537),Fucosidosis (562),Gaucher disease (541),Glucose storage disease (548),Hunter syndrome (II) (533),Hurler syndrome (IH) (531),I-cell disease (546),Krabbe disease (globoid leukodystrophy) (544),Lesch-Nyhan (HGPRT deficiency) (522),Mannosidosis (563),Maroteaux-Lamy (VI) (536),Metachromatic leukodystrophy (MLD) (542),Mucolipidoses, not otherwise specified (540),Morquio (IV) (535),Mucopolysaccharidosis (V) (538),Mucopolysaccharidosis, not otherwise specified (530),Niemann-Pick disease (545),Neuronal ceroid lipofuscinosis (Batten disease) (523),Other inherited metabolic disorder (529),Osteopetrosis (malignant infantile osteopetrosis) (521),Polysaccharide hydrolase abnormality, not otherwise specified (560),Sanfilippo (III) (534),Scheie syndrome (IS) (532),Inherited metabolic disorder, not otherwise specified (520),Wolman disease (547)
PRE475 Pre-Transplant Disease Classification Inherited Disorders of Metabolism yes no Specify other inherited metabolic disorder: open text
Specify other inherited metabolic disorder: open text
PRE476 Pre-Transplant Disease Classification Inherited Disorders of Metabolism yes no Loes composite score __ __ Adrenoleukodystrophy (ALD) only
Loes composite score __ __ Adrenoleukodystrophy (ALD) only












PRE478 Pre-Transplant Disease Classification Histiocytic Disorders yes no Specify other histiocytic disorder: open text
Specify other histiocytic disorder: open text
PRE479 Pre-Transplant Disease Classification Histiocytic Disorders yes no Did the recipient have an active or recent infection with a viral pathogen within 60 days of HCT? Hemophagocytic lymphohistiocytosis (HLH) only No,Yes
Did the recipient have an active or recent infection with a viral pathogen within 60 days of HCT? Hemophagocytic lymphohistiocytosis (HLH) only No,Yes
PRE480 Pre-Transplant Disease Classification Histiocytic Disorders yes no Specify viral pathogen (check all that apply) Adenovirus,BK Virus,Chikaugunya Virus,Cytomegalovirus (CMV),Coronavirus,Dengue Virus,Epstein-Barr Virus (EBV),Enterovirus D68 (EV-D68),Enterovirus (ECHO, Coxsackie),Enterovirus, NOS,Enterovirus (polio),Hepatitis A Virus,Hepatitis B Virus,Hepatitis C Virus,Hepatitis E,Human herpesvirus 6 (HHV-6),Human Immunodeficiency Virus 1 or 2,Human metapneumovirus,Human Papillomavirus (HPV),Herpes Simplex Virus (HSV),Human T-lymphotropic Virus 1 or 2,Influenza A Virus,Influenza B Virus,Influenza, NOS,JC Virus (Progressive Multifocal Leukoencephalopathy (PML)),Measles Virus (Rubeola),Mumps Virus,Norovirus,Human Parainfluenza Virus (all species),Rhinovirus (all species),Rotavirus (all species),Respiratory Syncytial Virus (RSV),Rubella Virus,Varicella Virus,West Nile Virus (WNV)
Specify viral pathogen (check all that apply) Adenovirus,BK Virus,Chikaugunya Virus,Cytomegalovirus (CMV),Coronavirus,Dengue Virus,Epstein-Barr Virus (EBV),Enterovirus D68 (EV-D68),Enterovirus (ECHO, Coxsackie),Enterovirus, NOS,Enterovirus (polio),Hepatitis A Virus,Hepatitis B Virus,Hepatitis C Virus,Hepatitis E,Human herpesvirus 6 (HHV-6),Human Immunodeficiency Virus 1 or 2,Human metapneumovirus,Human Papillomavirus (HPV),Herpes Simplex Virus (HSV),Human T-lymphotropic Virus 1 or 2,Influenza A Virus,Influenza B Virus,Influenza, NOS,JC Virus (Progressive Multifocal Leukoencephalopathy (PML)),Measles Virus (Rubeola),Mumps Virus,Norovirus,Human Parainfluenza Virus (all species),Rhinovirus (all species),Rotavirus (all species),Respiratory Syncytial Virus (RSV),Rubella Virus,Varicella Virus,West Nile Virus (WNV)
PRE481 Pre-Transplant Disease Classification Histiocytic Disorders yes no Has the recipient ever been infected with PCP / PJP? No,Yes
Has the recipient ever been infected with PCP / PJP? No,Yes
PRE482 Pre-Transplant Disease Classification Autoimmune Diseases yes no Specify autoimmune disease classification Antiphospholipid syndrome,Behcet syndrome,Churg-Strauss,Classical polyarteritis nodosa,Crohn's disease,Diabetes mellitus type I,Evans syndrome,Giant cell arteritis,Hemolytic anemia,Idiopathic thrombocytopenic purpura (ITP),Juvenile idiopathic arthritis (JIA): oligoarticular,Juvenile idiopathic arthritis (JIA): other,Juvenile idiopathic arthritis (JIA): polyarticular,Juvenile idiopathic arthritis (JIA): systemic (Still's disease),Microscopic polyarteritis nodosa,Multiple sclerosis,Myasthenia gravis,Other autoimmune disorder,Overlap necrotizing arteritis,Other arthritis,Other autoimmune bowel disorder,Other autoimmune cytopenia,Other autoimmune neurological disorder,Other connective tissue disease,Other vasculitis,Psoriatic arthritis / psoriasis,Polymyositis / dermatomyositis,Rheumatoid arthritis,Sjogren syndrome,Systemic lupus erythematosius (SLE),Systemic sclerosis,Takayasu,Ulcerative colitis,Wegener granulomatosis
Specify autoimmune disease classification Antiphospholipid syndrome,Behcet syndrome,Churg-Strauss,Classical polyarteritis nodosa,Crohn's disease,Diabetes mellitus type I,Evans syndrome,Giant cell arteritis,Hemolytic anemia,Idiopathic thrombocytopenic purpura (ITP),Juvenile idiopathic arthritis (JIA): oligoarticular,Juvenile idiopathic arthritis (JIA): other,Juvenile idiopathic arthritis (JIA): polyarticular,Juvenile idiopathic arthritis (JIA): systemic (Still's disease),Microscopic polyarteritis nodosa,Multiple sclerosis,Myasthenia gravis,Other autoimmune disorder,Overlap necrotizing arteritis,Other arthritis,Other autoimmune bowel disorder,Other autoimmune cytopenia,Other autoimmune neurological disorder,Other connective tissue disease,Other vasculitis,Psoriatic arthritis / psoriasis,Polymyositis / dermatomyositis,Rheumatoid arthritis,Sjogren syndrome,Systemic lupus erythematosius (SLE),Systemic sclerosis,Takayasu,Ulcerative colitis,Wegener granulomatosis
PRE483 Pre-Transplant Disease Classification Autoimmune Diseases yes no Specify other autoimmune cytopenia: open text
Specify other autoimmune cytopenia: open text
PRE484 Pre-Transplant Disease Classification Autoimmune Diseases yes no Specify other autoimmune bowel disorder: open text
Specify other autoimmune bowel disorder: open text
PRE485 Pre-Transplant Disease Classification Autoimmune Diseases yes no Specify other autoimmune disease: open text
Specify other autoimmune disease: open text
PRE486 Pre-Transplant Disease Classification Tolerance Induction Associated with Solid Organ Transplant yes no Specify solid organ transplanted (check all that apply) Kidney,Liver,Other organ,Pancreas
Specify solid organ transplanted (check all that apply) Kidney,Liver,Other organ,Pancreas
PRE487 Pre-Transplant Disease Classification Tolerance Induction Associated with Solid Organ Transplant yes no Specify other organ: open text
Specify other organ: open text
PRE488 Pre-Transplant Disease Classification Tolerance Induction Associated with Solid Organ Transplant yes no Specify other disease: open text
Specify other disease: open text
PRE489 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes WBC Known,Unknown
WBC Known,Unknown
PRE490 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes WBC ___ ___ ___ ___ ___ ___ ● ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ● ___ x 106/L
WBC ___ ___ ___ ___ ___ ___ ● ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ● ___ x 106/L
PRE491 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Neutrophils Known,Unknown
Neutrophils Known,Unknown
PRE492 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Neutrophils ___ ___%
Neutrophils ___ ___%
PRE493 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Blasts in blood Known,Unknown
Blasts in blood Known,Unknown
PRE494 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Blasts in blood ___ ___%
Blasts in blood ___ ___%
PRE495 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Hemoglobin Known,Unknown
Hemoglobin Known,Unknown
PRE496 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes At Diagnosis: Hemoglobin ___ ___ ___ ___ ● ___ ___ g/dL
___ ___ ___ ___ ● ___ ___ g/L
___ ___ ___ ___ ● ___ ___ mmol/L
At Diagnosis: Hemoglobin ___ ___ ___ ___ ● ___ ___ g/dL
___ ___ ___ ___ ● ___ ___ g/L
___ ___ ___ ___ ● ___ ___ mmol/L
PRE497 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Were RBCs transfused ≤ 30 days before date of test? No,Yes
Were RBCs transfused ≤ 30 days before date of test? No,Yes
PRE498 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Platelets Known,Unknown
Platelets Known,Unknown
PRE499 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Platelets ___ ___ ___ ___ ___ ___ ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ___ ___ x 106/L
Platelets ___ ___ ___ ___ ___ ___ ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ___ ___ x 106/L
PRE500 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Were platelets transfused ≤ 7 days before date of test? No,Yes
Were platelets transfused ≤ 7 days before date of test? No,Yes
PRE501 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes WBC Known,Unknown
WBC Known,Unknown
PRE502 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Neutrophils Known,Unknown
Neutrophils Known,Unknown
PRE503 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Neutrophils ___ ___%
Neutrophils ___ ___%
PRE504 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Blasts in blood Known,Unknown
Blasts in blood Known,Unknown
PRE505 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Blasts in blood ___ ___%
Blasts in blood ___ ___%
PRE506 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Hemoglobin Known,Unknown
Hemoglobin Known,Unknown
PRE507 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Prior to Infusion: Hemoglobin ___ ___ ___ ___ ● ___ ___ g/dL
___ ___ ___ ___ ● ___ ___ g/L
___ ___ ___ ___ ● ___ ___ mmol/L
Prior to Infusion: Hemoglobin ___ ___ ___ ___ ● ___ ___ g/dL
___ ___ ___ ___ ● ___ ___ g/L
___ ___ ___ ___ ● ___ ___ mmol/L
PRE508 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Were RBCs transfused ≤ 30 days before date of test? No,Yes
Were RBCs transfused ≤ 30 days before date of test? No,Yes
PRE509 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Platelets Known,Unknown
Platelets Known,Unknown
PRE510 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Platelets ___ ___ ___ ___ ___ ___ ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ___ ___ x 106/L
Platelets ___ ___ ___ ___ ___ ___ ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ___ ___ x 106/L
PRE511 Pre-Transplant Disease Classification Myelodysplastic Syndrome (MDS) yes yes Were platelets transfused ≤ 7 days before date of test? No,Yes
Were platelets transfused ≤ 7 days before date of test? No,Yes
PRE512 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes WBC Known,Unknown
WBC Known,Unknown
PRE513 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes WBC ___ ___ ___ ___ ___ ___ ● ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ● ___ x 106/L
WBC ___ ___ ___ ___ ___ ___ ● ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ● ___ x 106/L
PRE514 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Neutrophils Known,Unknown
Neutrophils Known,Unknown
PRE515 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Neutrophils ___ ___%
Neutrophils ___ ___%
PRE516 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Blasts in blood Known,Unknown
Blasts in blood Known,Unknown
PRE517 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Blasts in blood ___ ___%
Blasts in blood ___ ___%
PRE518 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Hemoglobin Known,Unknown
Hemoglobin Known,Unknown
PRE519 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Hemoglobin ___ ___ ___ ___ ● ___ ___ g/dL
___ ___ ___ ___ ● ___ ___ g/L
___ ___ ___ ___ ● ___ ___ mmol/L
Hemoglobin ___ ___ ___ ___ ● ___ ___ g/dL
___ ___ ___ ___ ● ___ ___ g/L
___ ___ ___ ___ ● ___ ___ mmol/L
PRE520 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Were RBCs transfused ≤ 30 days before date of test? No,Yes
Were RBCs transfused ≤ 30 days before date of test? No,Yes
PRE521 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Platelets Known,Unknown
Platelets Known,Unknown
PRE522 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Platelets ___ ___ ___ ___ ___ ___ ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ___ ___ x 106/L
Platelets ___ ___ ___ ___ ___ ___ ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ___ ___ x 106/L
PRE523 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Were platelets transfused ≤ 7 days before date of test? No,Yes
Were platelets transfused ≤ 7 days before date of test? No,Yes
PRE524 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes WBC Known,Unknown
WBC Known,Unknown
PRE525 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes WBC ___ ___ ___ ___ ___ ___ ● ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ● ___ x 106/L
WBC ___ ___ ___ ___ ___ ___ ● ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ● ___ x 106/L
PRE526 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Neutrophils Known,Unknown
Neutrophils Known,Unknown
PRE527 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Neutrophils ___ ___%
Neutrophils ___ ___%
PRE528 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Blasts in blood Known,Unknown
Blasts in blood Known,Unknown
PRE529 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Blasts in blood ___ ___%
Blasts in blood ___ ___%
PRE530 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Hemoglobin Known,Unknown
Hemoglobin Known,Unknown
PRE531 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Hemoglobin ___ ___ ___ ___ ● ___ ___ g/dL
___ ___ ___ ___ ● ___ ___ g/L
___ ___ ___ ___ ● ___ ___ mmol/L
Hemoglobin ___ ___ ___ ___ ● ___ ___ g/dL
___ ___ ___ ___ ● ___ ___ g/L
___ ___ ___ ___ ● ___ ___ mmol/L
PRE532 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Were RBCs transfused ≤ 30 days before date of test? No,Yes
Were RBCs transfused ≤ 30 days before date of test? No,Yes
PRE533 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Platelets Known,Unknown
Platelets Known,Unknown
PRE534 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Platelets ___ ___ ___ ___ ___ ___ ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ___ ___ x 106/L
Platelets ___ ___ ___ ___ ___ ___ ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ___ ___ x 106/L
PRE535 Pre-Transplant Disease Classification Myeloproliferative Neoplasms (MPN) yes yes Were platelets transfused ≤ 7 days before date of test? No,Yes
Were platelets transfused ≤ 7 days before date of test? No,Yes
PRE536 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Serum albumin Known,Unknown
Serum albumin Known,Unknown
PRE537 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Serum albumin: : ___ ___ ● ___ g/dL
: ___ ___ ● ___ g/L
Serum albumin: : ___ ___ ● ___ g/dL
: ___ ___ ● ___ g/L
PRE538 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no LDH Known,Unknown
LDH Known,Unknown
PRE539 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no LDH ___ ___ ___ ___ ___ ● ___ ___ o U/L
___ ___ ___ ___ ___ ● ___ ___ o μkat/L
LDH ___ ___ ___ ___ ___ ● ___ ___ o U/L
___ ___ ___ ___ ___ ● ___ ___ o μkat/L
PRE540 Pre-Transplant Disease Classification Multiple Myeloma / Plasma Cell Disorder (PCD) yes no Upper limit of normal for LDH: ___ ___ ___ ___ ___ • ___ ___
Upper limit of normal for LDH: ___ ___ ___ ___ ___ • ___ ___
PRE541 Pre-Transplant Disease Classification Hemoglobinopathies yes no Serum iron Known,Unknown
Serum iron Known,Unknown
PRE542 Pre-Transplant Disease Classification Hemoglobinopathies yes no Serum iron : ___ ___ ___● ___ ___ µg / dL
: ___ ___ ___● ___ ___µmol / L
Serum iron : ___ ___ ___● ___ ___ µg / dL
: ___ ___ ___● ___ ___µmol / L
PRE543 Pre-Transplant Disease Classification Hemoglobinopathies yes no Total iron binding capacity (TIBC) Known,Unknown
Total iron binding capacity (TIBC) Known,Unknown
PRE544 Pre-Transplant GVHD Prophylaxis Allogeneic Recipient yes no Was GVHD prophylaxis planned? No,Yes
Was GVHD prophylaxis planned? No,Yes
PRE545 Pre-Transplant GVHD Prophylaxis Allogeneic Recipient yes no Specify drugs / intervention (check all that apply) Abatacept,Anti CD 25(Zenapax, Daclizumab, AntiTAC),Blinded randomized trial,Bortezomib,CD34 enriched(CD34+ selection),Corticosteriods (systemic),Cyclophosphamide (Cytoxan),Cyclosporine (CSA, Neoral, Sandimmune),Extra-corporeal photopheresis (ECP),Ex-vivo T-cell depletion,Filgotinib,Maraviroc,Mycophenolate mofetil (MMF) (Cellcept),Methotrexate (MTX) (Amethopterin),Other agent,Ruxolitinib,Sirolimus (Rapamycin, Rapamune),Tacrolimus(FK 506),Tocilizumab
Specify drugs / intervention (check all that apply) Abatacept,Anti CD 25(Zenapax, Daclizumab, AntiTAC),Blinded randomized trial,Bortezomib,CD34 enriched(CD34+ selection),Corticosteriods (systemic),Cyclophosphamide (Cytoxan),Cyclosporine (CSA, Neoral, Sandimmune),Extra-corporeal photopheresis (ECP),Ex-vivo T-cell depletion,Filgotinib,Maraviroc,Mycophenolate mofetil (MMF) (Cellcept),Methotrexate (MTX) (Amethopterin),Other agent,Ruxolitinib,Sirolimus (Rapamycin, Rapamune),Tacrolimus(FK 506),Tocilizumab
PRE546 Pre-Transplant GVHD Prophylaxis Allogeneic Recipient yes no Specify other agent: open text (do not report ATG, campath)
Specify other agent: open text (do not report ATG, campath)
PRE547 Pre-Transplant Post-HCT Disease Therapy Planned as of Day 0
no no Is additional post-HCT therapy planned? no,yes
Is additional post-HCT therapy planned? no,yes
PRE548 Pre-Transplant Post-HCT Disease Therapy Planned as of Day 0
no no Specify post-HCT therapy planned Azacitidine(Vidaza),Blinatumomab,Bortezomib (Velcade),Bosutinib,Brentuximab,Carfilzomib,Cellular therapy (e.g. DCI, DLI),Crenolanib,Daratumumab,Dasatinib,Decitabine,Elotuzumab,Enasidenib,Gilteritinib,Ibrutinib,Imanitib mesylate (Gleevec, Glivec),Intrathecal chemotherapy,Ivosidenib,Ixazomib,Lenalidomide (Revlimid),Lestaurtinib,Local radiotherapy,Midostaurin,Nilotinib,Obinutuzumab,Other,Pacritinib,Ponatinib,Quizartinib,Rituximab (Rituxan, Mabthera),Sorafenib,Sunitinib,Thalidomide (Thalomid),Unknown
Specify post-HCT therapy planned Azacitidine(Vidaza),Blinatumomab,Bortezomib (Velcade),Bosutinib,Brentuximab,Carfilzomib,Cellular therapy (e.g. DCI, DLI),Crenolanib,Daratumumab,Dasatinib,Decitabine,Elotuzumab,Enasidenib,Gilteritinib,Ibrutinib,Imanitib mesylate (Gleevec, Glivec),Intrathecal chemotherapy,Ivosidenib,Ixazomib,Lenalidomide (Revlimid),Lestaurtinib,Local radiotherapy,Midostaurin,Nilotinib,Obinutuzumab,Other,Pacritinib,Ponatinib,Quizartinib,Rituximab (Rituxan, Mabthera),Sorafenib,Sunitinib,Thalidomide (Thalomid),Unknown
PRE549 Pre-Transplant Post-HCT Disease Therapy Planned as of Day 0
no no Specify other therapy: open text
Specify other therapy: open text
PRE550 Pre-Transplant Pre-HCT Preparative Regimen
no no Drug (drop down list) Bendamustine,Busulfan,Carboplatin,Carmustine,Clofarabine,Cyclophosphamide,Cytarabine,Etoposide,Fludarabine,Gemcitabine,Ibritumomab tiuxetan,Ifosfamide,Lomustine,Melphalan,Methylprednisolone,Other,Pentostatin,Propylene glycol-free melphalan,Rituximab,Thiotepa,Tositumomab,Treosulfan
Drug (drop down list) Bendamustine,Busulfan,Carboplatin,Carmustine,Clofarabine,Cyclophosphamide,Cytarabine,Etoposide,Fludarabine,Gemcitabine,Ibritumomab tiuxetan,Ifosfamide,Lomustine,Melphalan,Methylprednisolone,Other,Pentostatin,Propylene glycol-free melphalan,Rituximab,Thiotepa,Tositumomab,Treosulfan, Azathioprine, Bortezomib, Cisplatin, Hydroxyurea, and Vincristine.
PRE551 Pre-Transplant Pre-HCT Preparative Regimen
no no Actual weight at initiation of pre-HCT preparative regimen: ___ ___ ___ . ___pounds
___ ___ ___ . ___kilograms
Actual weight at initiation of pre-HCT preparative regimen: ___ ___ ___ . ___pounds
___ ___ ___ . ___kilograms
PRE552 Pre-Transplant Pre-HCT Preparative Regimen
no no Was a pre-HCT preparative regimen prescribed? no,yes
Was a pre-HCT preparative regimen prescribed? no,yes
PRE553 Pre-Transplant Pre-HCT Preparative Regimen Allogeneic Recipient yes no Classify the recipient’s prescribed preparative regimen (Allogeneic HCTs only) Myeloablative,Non-myeloablative (NST),Reduced intensity (RIC)
Classify the recipient’s prescribed preparative regimen (Allogeneic HCTs only) Myeloablative,Non-myeloablative (NST),Reduced intensity (RIC)
PRE554 Pre-Transplant Pre-HCT Preparative Regimen
no no Was irradiation planned as part of the pre-HCT preparative regimen? no,yes
Was irradiation planned as part of the pre-HCT preparative regimen? no,yes
PRE555 Pre-Transplant Pre-HCT Preparative Regimen
no no What was the prescribed radiation field? Total body by intensity-modulated radiation therapy (IMRT),Thoracoabdominal region,Total body,Total lymphoid or nodal regions
What was the prescribed radiation field? Total body by intensity-modulated radiation therapy (IMRT),Thoracoabdominal region,Total body,Total lymphoid or nodal regions
PRE556 Pre-Transplant Pre-HCT Preparative Regimen
no no Total prescribed dose: (dose per fraction x total number of fractions) ___ ___ ___ ___ . ___ Gy
___ ___ ___ ___ . ___ cGy
Total prescribed dose: (dose per fraction x total number of fractions) ___ ___ ___ ___ . ___ Gy
___ ___ ___ ___ . ___ cGy
PRE557 Pre-Transplant Pre-HCT Preparative Regimen
no no Date started: YYYY/MM/DD
Date started: YYYY/MM/DD
PRE558 Pre-Transplant Pre-HCT Preparative Regimen
no no Was the radiation fractionated? no,yes
Was the radiation fractionated? no,yes
PRE559 Pre-Transplant Pre-HCT Preparative Regimen
no no Total number of fractions: open text
Total number of fractions: open text
PRE560 Pre-Transplant Pre-HCT Preparative Regimen
no yes Specify other drug: open text
Specify other drug: open text
PRE561 Pre-Transplant Pre-HCT Preparative Regimen
no yes Total prescribed dose: __ __ __ __ __. __ mg/m2
__ __ __ __ __. __mg/kg
__ __ __ __ __. __AUC (mg x h/L)
__ __ __ __ __. __AUC (µmol x min/L)
__ __ __ __ __. __CSS (ng/mL)
Total prescribed dose: __ __ __ __ __. __ mg/m2
__ __ __ __ __. __mg/kg
__ __ __ __ __. __AUC (mg x h/L)
__ __ __ __ __. __AUC (µmol x min/L)
__ __ __ __ __. __CSS (ng/mL)
PRE562 Pre-Transplant Pre-HCT Preparative Regimen
no yes Date started: YYYY/MM/DD
Date started: YYYY/MM/DD
PRE563 Pre-Transplant Pre-HCT Preparative Regimen
no yes Specify administration (busulfan only) Both,IV,Oral
Specify administration (busulfan only) Both,IV,Oral
PRE564 Pre-Transplant Pre-Transplant Essential Data


Is the recipient participating in a clinical trial? no,yes
Is the recipient participating in a clinical trial? no,yes
PRE565 Pre-Transplant Pre-Transplant Essential Data
no no Height at initiation of pre-HCT preparative regimen: ___ ___ ___ inches
___ ___ ___ cms
Height at initiation of pre-HCT preparative regimen: ___ ___ ___.___ inches
___ ___ ___ .___cms
PRE566 Pre-Transplant Pre-Transplant Essential Data

yes Date: YYYY/MM/DD
Date: YYYY/MM/DD
PRE567 Pre-Transplant Pre-Transplant Essential Data
no no Sequence Number: Auto Filled Field
Sequence Number: Auto Filled Field
PRE568 Pre-Transplant Pre-Transplant Essential Data
no no Date Received: Auto Filled Field
Date Received: Auto Filled Field
PRE569 Pre-Transplant Pre-Transplant Essential Data
no no CIBMTR Center Number: Auto Filled Field
CIBMTR Center Number: Auto Filled Field
PRE570 Pre-Transplant Pre-Transplant Essential Data
no no EBMT Code (CIC): Auto Filled Field
EBMT Code (CIC): Auto Filled Field
PRE571 Pre-Transplant Pre-Transplant Essential Data
no no CIBMTR Research ID: Auto Filled Field
CIBMTR Research ID: Auto Filled Field
PRE572 Pre-Transplant Pre-Transplant Essential Data
no no Event date: Auto Filled Field created with CRID
Event date: Auto Filled Field created with CRID
PRE573 Pre-Transplant Pre-Transplant Essential Data
no no Date of birth: YYYY/MM/DD
Date of birth: YYYY/MM/DD
PRE574 Pre-Transplant Pre-Transplant Essential Data
no no Sex female,male
Sex female,male
PRE575 Pre-Transplant Pre-Transplant Essential Data
no no Ethnicity Hispanic or Latino,Not applicable (not a resident of the USA),Not Hispanic or Latino,Unknown
Ethnicity Hispanic or Latino,Not applicable (not a resident of the USA),Not Hispanic or Latino,Unknown
PRE576 Pre-Transplant Pre-Transplant Essential Data
no no Race (check all that apply) American Indian or Alaska Native,Asian,Black or African American,Not reported,Native Hawaiian or Other Pacific Islander,Unknown,White
Race (check all that apply) American Indian or Alaska Native,Asian,Black or African American,Not reported,Native Hawaiian or Other Pacific Islander,Unknown,White
PRE577 Pre-Transplant Pre-Transplant Essential Data
no no Race detail (check all that apply) African American,African (both parents born in Africa),South Asian,American Indian, South or Central America,Alaskan Native or Aleut,North American Indian,Black Caribbean,Caribbean Indian,Other White,Eastern European,Filipino (Pilipino),Guamanian,Hawaiian,Japanese,Korean,Mediterranean,Middle Eastern,North American,North Coast of Africa,Chinese,Northern European,Other Pacific Islander,Other Black,Samoan,Black South or Central American,Other Southeast Asian,Unknown,Vietnamese,White Caribbean,Western European,White South or Central American
Race detail (check all that apply) African American,African (both parents born in Africa),South Asian,American Indian, South or Central America,Alaskan Native or Aleut,North American Indian,Black Caribbean,Caribbean Indian,Other White,Eastern European,Filipino (Pilipino),Guamanian,Hawaiian,Japanese,Korean,Mediterranean,Middle Eastern,North American,North Coast of Africa,Chinese,Northern European,Other Pacific Islander,Other Black,Samoan,Black South or Central American,Other Southeast Asian,Unknown,Vietnamese,White Caribbean,Western European,White South or Central American
PRE578 Pre-Transplant Pre-Transplant Essential Data
no no Country of primary residence Andorra,United Arab Emirates,Afghanistan,Antigua and Barbuda,Anguilla,Albania,Armenia,Netherlands Antilles,Angola,Antarctica,Argentina,American Samoa,Austria,Australia,Aruba,Aland Islands,Azerbaijan,Bosnia and Herzegovina,Barbados,Bangladesh,Belgium,Burkina Faso,Bulgaria,Bahrain,Burundi,Benin,Saint Barthelemy,Bermuda,Brunei Darussalam,Bolivia,Bonaire, Sint Eustatius and Saba,Brazil,Bahamas,Bhutan,Bouvet Island,Botswana,Belarus,Belize,Canada,Cocos (Keeling) Islands,Congo, Democratic Republic of the,Central African Republic,Congo, Republic of the,Switzerland,Cote d'Ivoire,Cook Islands,Chile,Cameroon,China,Colombia,Costa Rica,Cuba,Cape Verde,Curacao,Christmas Island,Cyprus,Czech Republic,Germany,Djibouti,Denmark,Dominica,Dominican Republic,Algeria,Ecuador,Estonia,Egypt,Western Sahara,Eritrea,Spain,Ethiopia,Finland,Fiji,Falkland Islands,Micronesia,Faroe Islands,France,Gabon,United Kingdom (England, Wales, Scotland, Northern Ireland),Grenada,Georgia,French Guiana,Guernsey,Ghana,Gibraltar,Greenland,Gambia,Guinea,Guadeloupe,Equatorial Guinea,Greece,South Georgia and the South Sandwich Islands,Guatemala,Guam,Guinea-Bissau,Guyana,Hong Kong,Heard Island and McDonald Islands,Honduras,Croatia,Haiti,Hungary,Indonesia,Ireland,Israel,Isle of Man,India,British Indian Ocean Territory,Iraq,Iran,Iceland,Italy,Jersey,Jamaica,Jordan,Japan,Kenya,Kyrgyzstan,Cambodia,Kiribati,Comoros,Saint Kitts and Nevis,North Korea,South Korea,Kuwait,Cayman Islands,Kazakhstan,Laos,Lebanon,Saint Lucia,Liechtenstein,Sri Lanka,Liberia,Lesotho,Lithuania,Luxembourg,Latvia,Libya,Morocco,Monaco,Moldova,Montenegro,Saint Martin, French,Madagascar,Marshall Islands,Macedonia,Mali,Myanmar,Mongolia,Macau,Northern Mariana Islands,Martinique,Mauritania,Montserrat,Malta,Mauritius,Maldives,Malawi,Mexico,Malaysia,Mozambique,Namibia,New Caledonia,Niger,Norfolk Island,Nigeria,Nicaragua,Netherlands,Norway,Nepal,Nauru,Niue,New Zealand,Oman,Panama,Peru,French Polynesia,Papua New Guinea,Philippines,Pakistan,Poland,Saint Pierre and Miquelon,Pitcairn Islands,Puerto Rico,Palestine, State of,Portugal,Palau,Paraguay,Qatar,Reunion,Romania,Serbia,Russia,Rwanda,Saudi Arabia,Solomon Islands,Seychelles,Sudan,Sweden,Singapore,Saint Helena,Slovenia,Svalbard and Jan Mayen,Slovak Republic,Sierra Leone,San Marino,Senegal,Somalia,Suriname,South Sudan,Sao Tome and Principe,El Salvador,Sint Maarten, Dutch,Syria,Swaziland,Turks and Caicos Islands,Chad,French Southern Territories,Togo,Thailand,Tajikistan,Tokelau,Timor-Leste,Turkmenistan,Tunisia,Tonga,Turkey,Trinidad and Tobago,Tuvalu,Taiwan,Tanzania,Ukraine,Uganda,United States Minor Outlying Islands,United States,Uruguay,Uzbekistan,Holy See,Saint Vincent and the Grenadines,Venezuela,British Virgin Islands,United States Virgin Islands,Vietnam,Vanuatu,Wallis and Futuna Islands,Samoa,Yemen,Mayotte,South Africa,Zambia,Zimbabwe
Country of primary residence Andorra,United Arab Emirates,Afghanistan,Antigua and Barbuda,Anguilla,Albania,Armenia,Netherlands Antilles,Angola,Antarctica,Argentina,American Samoa,Austria,Australia,Aruba,Aland Islands,Azerbaijan,Bosnia and Herzegovina,Barbados,Bangladesh,Belgium,Burkina Faso,Bulgaria,Bahrain,Burundi,Benin,Saint Barthelemy,Bermuda,Brunei Darussalam,Bolivia,Bonaire, Sint Eustatius and Saba,Brazil,Bahamas,Bhutan,Bouvet Island,Botswana,Belarus,Belize,Canada,Cocos (Keeling) Islands,Congo, Democratic Republic of the,Central African Republic,Congo, Republic of the,Switzerland,Cote d'Ivoire,Cook Islands,Chile,Cameroon,China,Colombia,Costa Rica,Cuba,Cape Verde,Curacao,Christmas Island,Cyprus,Czech Republic,Germany,Djibouti,Denmark,Dominica,Dominican Republic,Algeria,Ecuador,Estonia,Egypt,Western Sahara,Eritrea,Spain,Ethiopia,Finland,Fiji,Falkland Islands,Micronesia,Faroe Islands,France,Gabon,United Kingdom (England, Wales, Scotland, Northern Ireland),Grenada,Georgia,French Guiana,Guernsey,Ghana,Gibraltar,Greenland,Gambia,Guinea,Guadeloupe,Equatorial Guinea,Greece,South Georgia and the South Sandwich Islands,Guatemala,Guam,Guinea-Bissau,Guyana,Hong Kong,Heard Island and McDonald Islands,Honduras,Croatia,Haiti,Hungary,Indonesia,Ireland,Israel,Isle of Man,India,British Indian Ocean Territory,Iraq,Iran,Iceland,Italy,Jersey,Jamaica,Jordan,Japan,Kenya,Kyrgyzstan,Cambodia,Kiribati,Comoros,Saint Kitts and Nevis,North Korea,South Korea,Kuwait,Cayman Islands,Kazakhstan,Laos,Lebanon,Saint Lucia,Liechtenstein,Sri Lanka,Liberia,Lesotho,Lithuania,Luxembourg,Latvia,Libya,Morocco,Monaco,Moldova,Montenegro,Saint Martin, French,Madagascar,Marshall Islands,Macedonia,Mali,Myanmar,Mongolia,Macau,Northern Mariana Islands,Martinique,Mauritania,Montserrat,Malta,Mauritius,Maldives,Malawi,Mexico,Malaysia,Mozambique,Namibia,New Caledonia,Niger,Norfolk Island,Nigeria,Nicaragua,Netherlands,Norway,Nepal,Nauru,Niue,New Zealand,Oman,Panama,Peru,French Polynesia,Papua New Guinea,Philippines,Pakistan,Poland,Saint Pierre and Miquelon,Pitcairn Islands,Puerto Rico,Palestine, State of,Portugal,Palau,Paraguay,Qatar,Reunion,Romania,Serbia,Russia,Rwanda,Saudi Arabia,Solomon Islands,Seychelles,Sudan,Sweden,Singapore,Saint Helena,Slovenia,Svalbard and Jan Mayen,Slovak Republic,Sierra Leone,San Marino,Senegal,Somalia,Suriname,South Sudan,Sao Tome and Principe,El Salvador,Sint Maarten, Dutch,Syria,Swaziland,Turks and Caicos Islands,Chad,French Southern Territories,Togo,Thailand,Tajikistan,Tokelau,Timor-Leste,Turkmenistan,Tunisia,Tonga,Turkey,Trinidad and Tobago,Tuvalu,Taiwan,Tanzania,Ukraine,Uganda,United States Minor Outlying Islands,United States,Uruguay,Uzbekistan,Holy See,Saint Vincent and the Grenadines,Venezuela,British Virgin Islands,United States Virgin Islands,Vietnam,Vanuatu,Wallis and Futuna Islands,Samoa,Yemen,Mayotte,South Africa,Zambia,Zimbabwe
PRE579 Pre-Transplant Pre-Transplant Essential Data
no no State of residence of recipient Acre,Alagoas,Amapa,Amazonas,Bahia,Ceara,Distrito Federal,Espirito Santo,Goias,Maranhao,Mato Grosso,Mato Grosso do Sul,Minas Gerais,Para,Paraiba,Parana,Pernambuco,Piaui,Rio Grande do Norte,Rio Grande do Sul,Rio de Janeiro,Rondonia,Roraima,Santa Catarina,Sao Paulo,Sergipe,Tocantins
State of residence of recipient Acre,Alagoas,Amapa,Amazonas,Bahia,Ceara,Distrito Federal,Espirito Santo,Goias,Maranhao,Mato Grosso,Mato Grosso do Sul,Minas Gerais,Para,Paraiba,Parana,Pernambuco,Piaui,Rio Grande do Norte,Rio Grande do Sul,Rio de Janeiro,Rondonia,Roraima,Santa Catarina,Sao Paulo,Sergipe,Tocantins
PRE580 Pre-Transplant Pre-Transplant Essential Data
no no Province or territory of residence of recipient Alberta,British Columbia,Manitoba,New Brunswick,Newfoundland and Labrador,Nova Scotia,Nunavut,Northwest Territories,Ontario,Prince Edward Island,Quebec,Saskatchewan,Yukon
Province or territory of residence of recipient Alberta,British Columbia,Manitoba,New Brunswick,Newfoundland and Labrador,Nova Scotia,Nunavut,Northwest Territories,Ontario,Prince Edward Island,Quebec,Saskatchewan,Yukon
PRE581 Pre-Transplant Pre-Transplant Essential Data
no no State of residence of recipient Alaska,Alabama,Arkansas,Arizona,California,Colorado,Connecticut,District of Columbia,Delaware,Florida,Georgia,Hawaii,Iowa,Idaho,Illinois,Indiana,Kansas,Kentucky,Louisiana,Massachusetts,Maryland,Maine,Michigan,Minnesota,Missouri,Mississippi,Montana,North Carolina,North Dakota,Nebraska,New Hampshire,New Jersey,New Mexico,Nevada,New York,Ohio,Oklahoma,Oregon,Pennsylvania,Rhode Island,South Carolina,South Dakota,Tennessee,Texas,Utah,Virginia,Vermont,Washington,Wisconsin,West Virginia,Wyoming
State of residence of recipient Alaska,Alabama,Arkansas,Arizona,California,Colorado,Connecticut,District of Columbia,Delaware,Florida,Georgia,Hawaii,Iowa,Idaho,Illinois,Indiana,Kansas,Kentucky,Louisiana,Massachusetts,Maryland,Maine,Michigan,Minnesota,Missouri,Mississippi,Montana,North Carolina,North Dakota,Nebraska,New Hampshire,New Jersey,New Mexico,Nevada,New York,Ohio,Oklahoma,Oregon,Pennsylvania,Rhode Island,South Carolina,South Dakota,Tennessee,Texas,Utah,Virginia,Vermont,Washington,Wisconsin,West Virginia,Wyoming
PRE582 Pre-Transplant Pre-Transplant Essential Data
no no NMDP Recipient ID (RID): open text
NMDP Recipient ID (RID): open text
PRE583 Pre-Transplant Pre-Transplant Essential Data
no no Zip or postal code for place of recipient's residence (USA and Canada residents only): open text
Zip or postal code for place of recipient's residence (USA and Canada residents only): open text
PRE584 Pre-Transplant Pre-Transplant Essential Data Allogeneic Recipient yes no Has the recipient signed an IRB / ethics committee (or similar body) approved consent form to donate research blood samples to the NMDP / CIBMTR (For allogeneic HCTs only)? No (recipient declined),Not applicable (center not participating), Not approached,Yes (recipient consented)
Has the recipient signed an IRB / ethics committee (or similar body) approved consent form to donate research blood samples to the NMDP / CIBMTR (For allogeneic HCTs only)? No (recipient declined),Not applicable (center not participating), Not approached,Yes (recipient consented)
PRE585 Pre-Transplant Pre-Transplant Essential Data Allogeneic Recipient yes no Date form was signed: YYYY/MM/DD
Date form was signed: YYYY/MM/DD
PRE586 Pre-Transplant Pre-Transplant Essential Data Related Donors yes no Did the recipient submit a research sample to the NMDP/CIBMTR repository? (Related donors only) no,yes
Did the recipient submit a research sample to the NMDP/CIBMTR repository? (Related donors only) no,yes
PRE587 Pre-Transplant Pre-Transplant Essential Data Related Donors yes no Research sample recipient ID: open text
Research sample recipient ID: open text
PRE588 Pre-Transplant Pre-Transplant Essential Data Clinical Trial Participants yes no Study Sponsor BMT CTN, CIBMTR CRO Services, PIDTC, USIDNET, COG, PedAL, Other sponsor
Study Sponsor BMT CTN, CIBMTR CRO Services, PIDTC, USIDNET, COG, PedAL, Other sponsor
PRE589 Pre-Transplant Pre-Transplant Essential Data Clinical Trial Participants yes no Specify other sponsor: open text
Specify other sponsor: open text
PRE590 Pre-Transplant Pre-Transplant Essential Data Clinical Trial Participants yes no Study ID Number A Representative list of current response options is shown here. This list will change on a frequent basis to accommodate updates – changes in the response options do not affect burden of completing this question.BMT CTN 0301 - Aplastic Anemia,BMT CTN 0601 - Sickle Cell Anemia,BMT CTN 0701 - Follicular Lymphoma,BMT CTN 0702 - Myeloma,BMT CTN 0801 - Chronic GVHD Treatment,BMT CTN 0803 - Auto HCT in HIV + Patients,RCI BMT 09 - MRD,RCI BMT 09 - Plex,BMT CTN 0901 - Myeloablative vs. RIC,BMT CTN 0902 - Peri-TX Stress Mgmt,BMT CTN 0903 - Allo HCT in HIV + Patients,RCI BMT 10 - CBA,RCI BMT 10-CMSMDS-1,RCI BMT 11 - Treo,BMT CTN 1101 - Haplo vs. Double UCB with RIC,BMT CTN 1102 - MDS in older patients,RCI BMT 12 - Moxe,BMT CTN 1202 - Biomarker,BMT CTN 1203 - GVHD Prophylaxis,BMT CTN 1204 - HLH,BMT CTN 1205 - Easy-to-read Consent Form (ETRIC),RCI BMT 13 - TLEC,BMT CTN 1301 - CNI-Free,BMT CTN 1302 - Allo MM,BMT CTN 1401 - Myeloma Vaccine,RCI BMT 145-ADS-202,RCI BMT 15 - MMUD,BMT CTN 1501 - Standard Risk GVHD,BMT CTN 1502 - CHAMP Aplastic Anemia,BMT CTN 1503 - STRIDE2,BMT CTN 1506 - AML Maintenance Therapy,BMT CTN 1507 - Haplo Sickle Cell,RCI BMT 16-CMS-MF,RCI BMT 16 - NTCD,RCI BMT 17- CD33,RCI BMT 17-CMS-MM,RCI BMT 17-CMS-SCD,RCI BMT 17 - CSIDE,BMT CTN 1703 - PROGRESS III,BMT CTN 1704 - CHARM,BMT CTN 1803 - Haplo NK Cell,BMT CTN 1903 - HIV T Cell,BMT CTN 1904 - Treo BM Failure Syndromes,BMT CTN 1905 - BEAT-MS (ITN077AI),PIDTC 6901 - Disorders of the immune system (SCID),PIDTC 6903 - Disorders of the immune system (CGD),PIDTC 6904 - Disorders of the immune system (WAS),RCI BMT ACCESS,RCI BMT KIR - DS,RCI BMT SQOL, COG APAL2020SC (PedAL), COG ASCT2031, COG AALL1732, COG AAML1831
Study ID Number A Representative list of current response options is shown here. This list will change on a frequent basis to accommodate updates – changes in the response options do not affect burden of completing this question.BMT CTN 0301 - Aplastic Anemia,BMT CTN 0601 - Sickle Cell Anemia,BMT CTN 0701 - Follicular Lymphoma,BMT CTN 0702 - Myeloma,BMT CTN 0801 - Chronic GVHD Treatment,BMT CTN 0803 - Auto HCT in HIV + Patients,RCI BMT 09 - MRD,RCI BMT 09 - Plex,BMT CTN 0901 - Myeloablative vs. RIC,BMT CTN 0902 - Peri-TX Stress Mgmt,BMT CTN 0903 - Allo HCT in HIV + Patients,RCI BMT 10 - CBA,RCI BMT 10-CMSMDS-1,RCI BMT 11 - Treo,BMT CTN 1101 - Haplo vs. Double UCB with RIC,BMT CTN 1102 - MDS in older patients,RCI BMT 12 - Moxe,BMT CTN 1202 - Biomarker,BMT CTN 1203 - GVHD Prophylaxis,BMT CTN 1204 - HLH,BMT CTN 1205 - Easy-to-read Consent Form (ETRIC),RCI BMT 13 - TLEC,BMT CTN 1301 - CNI-Free,BMT CTN 1302 - Allo MM,BMT CTN 1401 - Myeloma Vaccine,RCI BMT 145-ADS-202,RCI BMT 15 - MMUD,BMT CTN 1501 - Standard Risk GVHD,BMT CTN 1502 - CHAMP Aplastic Anemia,BMT CTN 1503 - STRIDE2,BMT CTN 1506 - AML Maintenance Therapy,BMT CTN 1507 - Haplo Sickle Cell,RCI BMT 16-CMS-MF,RCI BMT 16 - NTCD,RCI BMT 17- CD33,RCI BMT 17-CMS-MM,RCI BMT 17-CMS-SCD,RCI BMT 17 - CSIDE,BMT CTN 1703 - PROGRESS III,BMT CTN 1704 - CHARM,BMT CTN 1803 - Haplo NK Cell,BMT CTN 1903 - HIV T Cell,BMT CTN 1904 - Treo BM Failure Syndromes,BMT CTN 1905 - BEAT-MS (ITN077AI),PIDTC 6901 - Disorders of the immune system (SCID),PIDTC 6903 - Disorders of the immune system (CGD),PIDTC 6904 - Disorders of the immune system (WAS),RCI BMT ACCESS,RCI BMT KIR - DS,RCI BMT SQOL, COG APAL2020SC (PedAL), COG ASCT2031, COG AALL1732, COG AAML1831
PRE591 Pre-Transplant Pre-Transplant Essential Data Clinical Trial Participants yes no Subject ID: open text
Subject ID: open text
PRE592 Pre-Transplant Pre-Transplant Essential Data Clinical Trial Participants yes no Specify the ClinicalTrials.gov identification number: open text
Specify the ClinicalTrials.gov identification number: open text
PRE593 Pre-Transplant Pre-Transplant Essential Data Autologous Transplant yes no Is a subsequent HCT planned as part of the overall treatment protocol? (not as a reaction to post-HCT disease assessment) (For autologous HCTs only) no,yes
Is a subsequent HCT planned as part of the overall treatment protocol? (not as a reaction to post-HCT disease assessment) (For autologous HCTs only) no,yes
PRE594 Pre-Transplant Pre-Transplant Essential Data Autologous Transplant yes no Specify subsequent HCT planned Allogeneic,Autologous
Specify subsequent HCT planned Allogeneic,Autologous
PRE595 Pre-Transplant Pre-Transplant Essential Data


Has the recipient ever had a prior HCT? No,Yes
Has the recipient ever had a prior HCT? No,Yes
PRE596 Pre-Transplant Pre-Transplant Essential Data


Specify the number of prior HCTs: open text
Specify the number of prior HCTs: open text
PRE597 Pre-Transplant Pre-Transplant Essential Data


Were all prior HCTs reported to the CIBMTR? No,Unknown,Yes
Were all prior HCTs reported to the CIBMTR? No,Unknown,Yes
PRE598 Pre-Transplant Pre-Transplant Essential Data Prior Transplant yes yes Date of the prior HCT: YYYY/MM/DD
Date of the prior HCT: YYYY/MM/DD
PRE599 Pre-Transplant Pre-Transplant Essential Data Prior Transplant yes yes Date estimated checked
Date estimated checked
PRE600 Pre-Transplant Pre-Transplant Essential Data Prior Transplant yes yes Was the prior HCT performed at a different institution? No,Yes
Was the prior HCT performed at a different institution? No,Yes
PRE601 Pre-Transplant Pre-Transplant Essential Data Prior Transplant yes yes Name: open text
Name: open text
PRE602 Pre-Transplant Pre-Transplant Essential Data Prior Transplant yes yes City: open text
City: open text
PRE603 Pre-Transplant Pre-Transplant Essential Data Prior Transplant yes yes State: open text
State: open text
PRE604 Pre-Transplant Pre-Transplant Essential Data Prior Transplant yes yes Country: open text
Country: open text
PRE605 Pre-Transplant Pre-Transplant Essential Data Prior Transplant yes yes What was the HPC source for the prior HCT? (check all that apply) Allogeneic - related, Allogeneic -unrelated, Autologous
What was the HPC source for the prior HCT? (check all that apply) Allogeneic - related, Allogeneic -unrelated, Autologous
PRE606 Pre-Transplant Pre-Transplant Essential Data
no no Reason for current HCT Graft failure / insufficient hematopoietic recovery,Insufficient chimerism,New malignancy (including PTLD and EBV lymphoma),Other,Persistent primary disease,Planned subsequent HCT, per protocol,Recurrent primary disease
Reason for current HCT Graft failure / insufficient hematopoietic recovery,Insufficient chimerism,New malignancy (including PTLD and EBV lymphoma),Other,Persistent primary disease,Planned subsequent HCT, per protocol,Recurrent primary disease
PRE607 Pre-Transplant Pre-Transplant Essential Data
no no Date of graft failure / rejection: YYYY/MM/DD
Date of graft failure / rejection: YYYY/MM/DD
PRE608 Pre-Transplant Pre-Transplant Essential Data
no no Date of relapse: YYYY/MM/DD
Date of relapse: YYYY/MM/DD
PRE609 Pre-Transplant Pre-Transplant Essential Data
no no Date of secondary malignancy: YYYY/MM/DD
Date of secondary malignancy: YYYY/MM/DD
PRE610 Pre-Transplant Pre-Transplant Essential Data
no no Specify other reason: open text
Specify other reason: open text
PRE611 Pre-Transplant Pre-Transplant Essential Data
no no Has the recipient ever had a prior cellular therapy? (do not include DLIs) No,Unknown,Yes
Has the recipient ever had a prior cellular therapy? (do not include DLIs) No,Unknown,Yes
PRE612 Pre-Transplant Pre-Transplant Essential Data Prior Cellular Therapies yes no Were all prior cellular therapies reported to the CIBMTR? No,Unknown,Yes
Were all prior cellular therapies reported to the CIBMTR? No,Unknown,Yes
PRE613 Pre-Transplant Pre-Transplant Essential Data Prior Cellular Therapies yes no Date of the prior cellular therapy: YYYY/MM/DD
Date of the prior cellular therapy: YYYY/MM/DD
PRE614 Pre-Transplant Pre-Transplant Essential Data Prior Cellular Therapies yes no Was the cellular therapy performed at a different institution? No,Yes
Was the cellular therapy performed at a different institution? No,Yes
PRE615 Pre-Transplant Pre-Transplant Essential Data Prior Cellular Therapies yes no Name: open text
Name: open text
PRE616 Pre-Transplant Pre-Transplant Essential Data Prior Cellular Therapies yes no City: open text
City: open text
PRE617 Pre-Transplant Pre-Transplant Essential Data Prior Cellular Therapies yes no State: open text
State: open text
PRE618 Pre-Transplant Pre-Transplant Essential Data Prior Cellular Therapies yes no Country: open text
Country: open text
PRE619 Pre-Transplant Pre-Transplant Essential Data Prior Cellular Therapies yes no Specify the source(s) for the prior cellular therapy (check all that apply) Allogeneic-related,Allogeneic-unrelated,Autologous
Specify the source(s) for the prior cellular therapy (check all that apply) Allogeneic-related,Allogeneic-unrelated,Autologous
PRE620 Pre-Transplant Pre-Transplant Essential Data
no no Multiple donors? no,yes
Multiple donors? no,yes
PRE621 Pre-Transplant Pre-Transplant Essential Data
no no Specify number of donors: open text
Specify number of donors: open text
PRE622 Pre-Transplant Pre-Transplant Essential Data
no yes Specify donor Allogeneic-related donor,Allogeneic-unrelated donor,Autologous
Specify donor Allogeneic-related donor,Allogeneic-unrelated donor,Autologous
PRE623 Pre-Transplant Pre-Transplant Essential Data
no yes Specify product type (check all that apply) Bone marrow,Other product,PBSC,Single cord blood unit
Specify product type (check all that apply) Bone marrow,Other product,PBSC,Single cord blood unit
PRE624 Pre-Transplant Pre-Transplant Essential Data
no yes Specify other product: open text
Specify other product: open text
PRE625 Pre-Transplant Pre-Transplant Essential Data
yes yes Is the product genetically modified? No,Yes
Is the product genetically modified? No,Yes
PRE626 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Specify the related donor type HLA-matched other relative,HLA-mismatched relative,HLA-identical sibling (may include non-monozygotic twin),Syngeneic (monozygotic twin)
Specify the related donor type HLA-matched other relative,HLA-mismatched relative,HLA-identical sibling (may include non-monozygotic twin),Syngeneic (monozygotic twin)
PRE627 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Specify the biological relationship of the donor to the recipient Fraternal twin,Father,Grandchild,Grandparent,Mother,Maternal aunt,Maternal cousin,Maternal uncle,Other biological relative,Paternal aunt,Paternal cousin,Paternal uncle,Recipient's child,Sibling
Specify the biological relationship of the donor to the recipient Fraternal twin,Father,Grandchild,Grandparent,Mother,Maternal aunt,Maternal cousin,Maternal uncle,Other biological relative,Paternal aunt,Paternal cousin,Paternal uncle,Recipient's child,Sibling
PRE628 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Specify other biological relative: open text
Specify other biological relative: open text
PRE629 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Degree of mismatch (related donors only) 1 HLA antigen mismatch, greater than or equal to 2 HLA antigen mismatch (does include haploidentical donor)
Degree of mismatch (related donors only) 1 HLA antigen mismatch, greater than or equal to 2 HLA antigen mismatch (does include haploidentical donor)
PRE630 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Specify unrelated donor type HLA matched unrelated,HLA mismatched unrelated
Specify unrelated donor type HLA matched unrelated,HLA mismatched unrelated
PRE631 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Did NMDP / Be the Match facilitate the procurement, collection, or transportation of the product? No,Yes
Did NMDP / Be the Match facilitate the procurement, collection, or transportation of the product? No,Yes
PRE632 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Was this donor used for any prior HCTs? (for this recipient) no,yes
Was this donor used for any prior HCTs? (for this recipient) no,yes
PRE633 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Global Registration Identifier for Donors (GRID) open text
Global Registration Identifier for Donors (GRID) open text
PRE634 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes NMDP cord blood unit ID: open text
NMDP cord blood unit ID: open text
PRE635 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Registry donor ID: open text
Registry donor ID: open text
PRE636 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Non-NMDP cord blood unit ID: open text
Non-NMDP cord blood unit ID: open text
PRE637 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Is the CBU ID also the ISBT DIN number? No,Unknown,Yes
Is the CBU ID also the ISBT DIN number? No,Unknown,Yes
PRE638 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Specify the ISBT DIN number: open text
Specify the ISBT DIN number: open text
PRE639 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Registry or UCB Bank ID (A) Austrian Bone Marrow Donors,(ACB) Austrian Cord Blood Registry,(ACCB) StemCyte, Inc,(AE) Emirates Bone Marrow Donor Registry,(AM) Armenian Bone Marrow Donor Registry Charitable Trust,(AOCB) University of Colorado Cord Blood Bank,(AR) Argentine CPH Donors Registry,(ARCB) BANCEL - Argentina Cord Blood Bank,(AUCB) Australian Cord Blood Registry,(AUS) Australian / New Zealand Bone Marrow Donor Registry,(B) Marrow Donor Program Belgium,(BCB) Belgium Cord Blood Registry,(BG) Bulgarian Bone Marrow Donor Registry,(BR) INCA/REDOMO,(BSCB) British Bone Marrow Registry - Cord Blood,(CB) Cord Blood Registry,(CH) Swiss BloodStem Cells - Adult Donors,(CHCB) Swiss Blood Stem Cells - Cord Blood,(CKCB) Celgene Cord Blood Bank,(CN) China Marrow Donor Program (CMDP),(CNCB) Shan Dong Cord Blood Bank,(CND) Canadian Blood Services Bone Marrow Donor Registry,(CS2) Czech National Marrow Donor Registry,(CSCR) Czech Stem Cells Registry,(CY) Cyprus Paraskevaidio Bone Marrow Donor Registry,(CY2) The Cyprus Bone Marrow Donor Registry,(D) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Adult Donors,(DCB) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Cord Blood,(DK) The Danish Bone Marrow Donor Registry,(DK2) Bone Marrow Donors Copenhagen (BMDC),(DUCB) German Branch of the European Cord Blood Bank,(E) REDMO,(ECB) Spanish Cord Blood Registry,(F) France Greffe de Moelle - Adult Donors,(FCB) France Greffe de Moelle - Cord Blood,(FI) Finnish Bone Marrow Donor Registry,(FICB) Finnish Cord Blood Registry,(GB) The Anthony Nolan Trust,(GB3) Welsh Bone Marrow Donor Registry,(GB4) British Bone Marrow Registry,(GR) Unrelated Hematopoietic Stem Cell Donor Registry Greece,(GRCB) Michigan Community Blood Centers Cord Blood Bank,(H) Hungarian Bone Marrow Donor Registry,(HEM) Hema-Quebec,(HK) Hong Kong Bone Marrow Donor Registry,(HR) Croatian Bone Marrow Donor Registry,(I) Italian Bone Marrow Donor Registry,(I3CB) Sheba Medical Centre Cord Blood Registry,(ICB) Italian Cord Blood Bank Network,(IL) Hadassah BMDR,(IL2) Ezer Mizion Bone Marrow Donor Registry,(IL3) Sheba Medical Center Donor Registry,(ILCB) Isreal Cord Blood Bank,(IN) Asian Indian Donor Marrow Registry,(IN2) Dept. of Transfusion Medicine,(IRL) The Irish Unrelated Bone Marrow Panel,(JP) Japan Marrow Donor Program,(KR) Korea Marrow Donor Program,(LT) Lithuanian National Bone Marrow Donor Registry,(LVCB) Leuven Cord Blood Bank,(MACB) Victoria Angel Registry of Hope,(MX) Mexican Bone Marrow Donor Registry,(N) The Norwegian Bone Marrow Donor Registry,(NL) Europdonor Foundation- Adult Donors,(NLCB) Europdonor Foundation - Cord Blood,(NYCB) National Cord Blood Program, New York Blood Center,(OTH) Other Registry,(P) Portuguese Bone Marrow Donors Registry,(PL) National Polish Bone Marrow Registry,(PL2) Unrelated Bone Marrow Donor Registry -Adult Donors,(PL3) Against Leukemia Foundation Marrow Donor Registry,(PL4) Ursula Jaworska Foundation - Bone Marrow Donor Registry,(PL5) Polish Central Bone Marrow Donor Registry - Adult Donors,(PMCB) Elie Katz Umbilical Cord Blood Program,(R) Russian Bone Marrow Donor Registry,(R2) Karelian Registry of Unrelated Donors of Hematopoietic Stem Cells,(S) Tobias Registry of Swedish Bone Marrow Donors,(SG) Singapore Bone Marrow Donor Programme (BMDP),(SK) Slovak National Bone Marrow Donor Registry,(SKCB) Eurocord Slovakia / Slovak Pacental Stem Cell Registry,(SLCBB) St Louis Cord Blood Bank,(SLO) Slovenia Donor,(SM) San Marino Bone Marrow Donor Registry,(T1CB) TRAN - Cord Blood,(TACB) StemCyte, Inc. Taiwan,(TECB) Healthbanks Biotech, Co., Ltd,(TH) Thai Stem Cell Donor Registry (TSCDR),(TOCB) Tokyo Cord Blood Bank,(TPCB) BIONET / BabyBanks,(TRAN) TRAN - Adult Donors,(TRIS) Bone Marrow Bank of Istanbul Medical Faculty,(TW) Buddhist Tzu Chi Stem Cells Center - Adult Donors,(TWCB) Buddhist Tzu Chi Stem Cells Center - Cord Blood,(U1CB) National Marrow Donor Program - Cord Blood,(USA1) National Marrow Donor Program - Adult Donors,(USA2) America Bone Marrow Donor Registry,(UY) SINDOME,(VIAC) Viacord,(W3CB) Polish Central Bone Marrow Donor Registry - Cord Blood,(WACB) Unrelated Bone Marrow Donor Registry - Cord Blood,(ZA) South African Bone Marrow Registry
Registry or UCB Bank ID (A) Austrian Bone Marrow Donors,(ACB) Austrian Cord Blood Registry,(ACCB) StemCyte, Inc,(AE) Emirates Bone Marrow Donor Registry,(AM) Armenian Bone Marrow Donor Registry Charitable Trust,(AOCB) University of Colorado Cord Blood Bank,(AR) Argentine CPH Donors Registry,(ARCB) BANCEL - Argentina Cord Blood Bank,(AUCB) Australian Cord Blood Registry,(AUS) Australian / New Zealand Bone Marrow Donor Registry,(B) Marrow Donor Program Belgium,(BCB) Belgium Cord Blood Registry,(BG) Bulgarian Bone Marrow Donor Registry,(BR) INCA/REDOMO,(BSCB) British Bone Marrow Registry - Cord Blood,(CB) Cord Blood Registry,(CH) Swiss BloodStem Cells - Adult Donors,(CHCB) Swiss Blood Stem Cells - Cord Blood,(CKCB) Celgene Cord Blood Bank,(CN) China Marrow Donor Program (CMDP),(CNCB) Shan Dong Cord Blood Bank,(CND) Canadian Blood Services Bone Marrow Donor Registry,(CS2) Czech National Marrow Donor Registry,(CSCR) Czech Stem Cells Registry,(CY) Cyprus Paraskevaidio Bone Marrow Donor Registry,(CY2) The Cyprus Bone Marrow Donor Registry,(D) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Adult Donors,(DCB) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Cord Blood,(DK) The Danish Bone Marrow Donor Registry,(DK2) Bone Marrow Donors Copenhagen (BMDC),(DUCB) German Branch of the European Cord Blood Bank,(E) REDMO,(ECB) Spanish Cord Blood Registry,(F) France Greffe de Moelle - Adult Donors,(FCB) France Greffe de Moelle - Cord Blood,(FI) Finnish Bone Marrow Donor Registry,(FICB) Finnish Cord Blood Registry,(GB) The Anthony Nolan Trust,(GB3) Welsh Bone Marrow Donor Registry,(GB4) British Bone Marrow Registry,(GR) Unrelated Hematopoietic Stem Cell Donor Registry Greece,(GRCB) Michigan Community Blood Centers Cord Blood Bank,(H) Hungarian Bone Marrow Donor Registry,(HEM) Hema-Quebec,(HK) Hong Kong Bone Marrow Donor Registry,(HR) Croatian Bone Marrow Donor Registry,(I) Italian Bone Marrow Donor Registry,(I3CB) Sheba Medical Centre Cord Blood Registry,(ICB) Italian Cord Blood Bank Network,(IL) Hadassah BMDR,(IL2) Ezer Mizion Bone Marrow Donor Registry,(IL3) Sheba Medical Center Donor Registry,(ILCB) Isreal Cord Blood Bank,(IN) Asian Indian Donor Marrow Registry,(IN2) Dept. of Transfusion Medicine,(IRL) The Irish Unrelated Bone Marrow Panel,(JP) Japan Marrow Donor Program,(KR) Korea Marrow Donor Program,(LT) Lithuanian National Bone Marrow Donor Registry,(LVCB) Leuven Cord Blood Bank,(MACB) Victoria Angel Registry of Hope,(MX) Mexican Bone Marrow Donor Registry,(N) The Norwegian Bone Marrow Donor Registry,(NL) Europdonor Foundation- Adult Donors,(NLCB) Europdonor Foundation - Cord Blood,(NYCB) National Cord Blood Program, New York Blood Center,(OTH) Other Registry,(P) Portuguese Bone Marrow Donors Registry,(PL) National Polish Bone Marrow Registry,(PL2) Unrelated Bone Marrow Donor Registry -Adult Donors,(PL3) Against Leukemia Foundation Marrow Donor Registry,(PL4) Ursula Jaworska Foundation - Bone Marrow Donor Registry,(PL5) Polish Central Bone Marrow Donor Registry - Adult Donors,(PMCB) Elie Katz Umbilical Cord Blood Program,(R) Russian Bone Marrow Donor Registry,(R2) Karelian Registry of Unrelated Donors of Hematopoietic Stem Cells,(S) Tobias Registry of Swedish Bone Marrow Donors,(SG) Singapore Bone Marrow Donor Programme (BMDP),(SK) Slovak National Bone Marrow Donor Registry,(SKCB) Eurocord Slovakia / Slovak Pacental Stem Cell Registry,(SLCBB) St Louis Cord Blood Bank,(SLO) Slovenia Donor,(SM) San Marino Bone Marrow Donor Registry,(T1CB) TRAN - Cord Blood,(TACB) StemCyte, Inc. Taiwan,(TECB) Healthbanks Biotech, Co., Ltd,(TH) Thai Stem Cell Donor Registry (TSCDR),(TOCB) Tokyo Cord Blood Bank,(TPCB) BIONET / BabyBanks,(TRAN) TRAN - Adult Donors,(TRIS) Bone Marrow Bank of Istanbul Medical Faculty,(TW) Buddhist Tzu Chi Stem Cells Center - Adult Donors,(TWCB) Buddhist Tzu Chi Stem Cells Center - Cord Blood,(U1CB) National Marrow Donor Program - Cord Blood,(USA1) National Marrow Donor Program - Adult Donors,(USA2) America Bone Marrow Donor Registry,(UY) SINDOME,(VIAC) Viacord,(W3CB) Polish Central Bone Marrow Donor Registry - Cord Blood,(WACB) Unrelated Bone Marrow Donor Registry - Cord Blood,(ZA) South African Bone Marrow Registry
PRE640 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Specify other Registry or UCB Bank: open text
Specify other Registry or UCB Bank: open text
PRE641 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Donor date of birth Known,Unknown
Donor date of birth Known,Unknown
PRE642 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Donor date of birth: YYYY/MM/DD
Donor date of birth: YYYY/MM/DD
PRE643 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Donor age Known,Unknown
Donor age Known,Unknown
PRE644 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Donor age: Months (use only if less than 1 years old), Years open text
Donor age: Months (use only if less than 1 years old), Years open text
PRE645 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Donor sex female,male
Donor sex female,male
PRE646 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Specify blood type (donor) (non-NMDP allogeneic donors only) A,AB,B,O
Specify blood type (donor) (non-NMDP allogeneic donors only) A,AB,B,O
PRE647 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Specify Rh factor (donor) (non-NMDP allogeneic donors only) Negative,Positive
Specify Rh factor (donor) (non-NMDP allogeneic donors only) Negative,Positive
PRE648 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Donor CMV-antibodies (IgG or Total) (Allogeneic HCTs only) Indeterminate, Not applicable (cord blood unit), Non-reactive, Not done, Reactive
Donor CMV-antibodies (IgG or Total) (Allogeneic HCTs only) Indeterminate, Not applicable (cord blood unit), Non-reactive, Not done, Reactive
PRE649 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Has the donor signed an IRB / ethics committee (or similar body) approved consent form to donate research blood samples to the NMDP / CIBMTR? (Related donors only) No (donor declined), Not applicable (center not participating), Not approached, Yes (donor consented)
Has the donor signed an IRB / ethics committee (or similar body) approved consent form to donate research blood samples to the NMDP / CIBMTR? (Related donors only) No (donor declined), Not applicable (center not participating), Not approached, Yes (donor consented)
PRE650 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Date form was signed: YYYY/MM/DD
Date form was signed: YYYY/MM/DD
PRE651 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Did the donor submit a research sample to the NMDP/CIBMTR repository? (Related donors only) no,yes
Did the donor submit a research sample to the NMDP/CIBMTR repository? (related donors only) no,yes
PRE652 Pre-Transplant Pre-Transplant Essential Data Allogeneic Donors yes yes Research sample donor ID: open text
Research sample donor ID: open text
PRE653 Pre-Transplant Pre-Transplant Essential Data Autologous Transplant yes yes Specify number of products infused from this donor: open text
Specify number of products infused from this donor: open text
PRE654 Pre-Transplant Pre-Transplant Essential Data Autologous Transplant yes yes Specify the number of these products intended to achieve hematopoietic engraftment: open text
Specify the number of these products intended to achieve hematopoietic engraftment: open text
PRE656 Pre-Transplant Pre-Transplant Essential Data Autologous Transplant yes yes Specify other agent: open text
Specify other agent: open text
PRE657 Pre-Transplant Pre-Transplant Essential Data Autologous Transplant yes yes Name of product (gene therapy recipients) Betibeglogene autotemcel (Zyntelgo®), Elivaldogene autotemcel (Skysona®), Exagamglogene autotemcel, Other name
Name of product (gene therapy recipients) Betibeglogene autotemcel (Zyntelgo®), Elivaldogene autotemcel (Skysona®), Exagamglogene autotemcel, Other name
PRE658 Pre-Transplant Pre-Transplant Essential Data Autologous Transplant yes yes Specify other name: open text
Specify other name: open text
PRE659 Pre-Transplant Pre-Transplant Essential Data
no no What scale was used to determine the recipient’s functional status? Karnofsky,Lansky
What scale was used to determine the recipient’s functional status? Karnofsky,Lansky
PRE660 Pre-Transplant Pre-Transplant Essential Data
no no Karnofsky Scale (recipient age ≥ 16 years) 100 Normal; no complaints; no evidence of disease,10 Moribund; fatal process progressing rapidly,20 Very sick; hospitalization necessary,30 Severely disabled; hospitalization indicated, although death not imminent,40 Disabled; requires special care and assistance,50 Requires considerable assistance and frequent medical care,60 Requires occasional assistance but is able to care for most needs,70 Cares for self; unable to carry on normal activity or to do active work,80 Normal activity with effort,90 Able to carry on normal activity
Karnofsky Scale (recipient age ≥ 16 years) 100 Normal; no complaints; no evidence of disease,10 Moribund; fatal process progressing rapidly,20 Very sick; hospitalization necessary,30 Severely disabled; hospitalization indicated, although death not imminent,40 Disabled; requires special care and assistance,50 Requires considerable assistance and frequent medical care,60 Requires occasional assistance but is able to care for most needs,70 Cares for self; unable to carry on normal activity or to do active work,80 Normal activity with effort,90 Able to carry on normal activity
PRE661 Pre-Transplant Pre-Transplant Essential Data
no no Lansky Scale (recipient age ≥ 1 year and < 16 years) 100 Fully active,10 Completely disabled, not even passive play,20 Limited to very passive activity initiated by others (e.g., TV),30 Needs considerable assistance for quiet activity,40 Able to initiate quiet activities,50 Considerable assistance required for any active play; fully able to engage in quiet play,60 Ambulatory up to 50% of time, limited active play with assistance / supervision,70 Both greater restrictions of, and less time spent in, active play,80 Restricted in strenuous play, tires more easily, otherwise active,90 Minor restriction in physically strenuous play
Lansky Scale (recipient age ≥ 1 year and < 16 years) 100 Fully active,10 Completely disabled, not even passive play,20 Limited to very passive activity initiated by others (e.g., TV),30 Needs considerable assistance for quiet activity,40 Able to initiate quiet activities,50 Considerable assistance required for any active play; fully able to engage in quiet play,60 Ambulatory up to 50% of time, limited active play with assistance / supervision,70 Both greater restrictions of, and less time spent in, active play,80 Restricted in strenuous play, tires more easily, otherwise active,90 Minor restriction in physically strenuous play
PRE662 Pre-Transplant Pre-Transplant Essential Data Allogeneic Recipient yes no Specify blood type (of recipient) (For allogeneic HCTs only) A,AB,B,O
Specify blood type (of recipient) (For allogeneic HCTs only) A,AB,B,O
PRE663 Pre-Transplant Pre-Transplant Essential Data Allogeneic Recipient yes no Specify Rh factor (of recipient) (For allogeneic HCTs only) Negative,Positive
Specify Rh factor (of recipient) (For allogeneic HCTs only) Negative,Positive
PRE664 Pre-Transplant Pre-Transplant Essential Data
no no Recipient CMV-antibodies (IgG or Total) Indeterminate,Non-reactive,Not done,Reactive
Recipient CMV-antibodies (IgG or Total) Indeterminate,Non-reactive,Not done,Reactive
PRE675 Pre-Transplant Pre-Transplant Essential Data
no no Is there a history of invasive fungal infection? No,Yes
Is there a history of invasive fungal infection? No,Yes
PRE676 Pre-Transplant Pre-Transplant Essential Data
no no Does the recipient have known complex congenital heart disease? (corrected or uncorrected) (excluding simple ASD, VSD, or PDA repair) (pediatric only) No,Yes
Does the recipient have known complex congenital heart disease? (corrected or uncorrected) (excluding simple ASD, VSD, or PDA repair) (pediatric only) No,Yes
PRE677 Pre-Transplant Pre-Transplant Essential Data
no no Were there any co-existing diseases or organ impairment present according to the HCT comorbidity index (HCT-CI)? (Source: Sorror, M. L. (2013). How I assess comorbidities before hematopoietic cell transplantation. Blood, 121(15), 2854-2863.) No,Yes
Were there any co-existing diseases or organ impairment present according to the HCT comorbidity index (HCT-CI)? (Source: Sorror, M. L. (2013). How I assess comorbidities before hematopoietic cell transplantation. Blood, 121(15), 2854-2863.) No,Yes
PRE678 Pre-Transplant Pre-Transplant Essential Data Comorbid Conditions Yes no Specify co-existing diseases or organ impairment (check all that apply) Arrhythmia - Any history of atrial fibrillation or flutter, sick sinus syndrome, or ventricular arrhythmias requiring treatment
Cardiac -Any history of coronary artery disease (one or more vessel-coronary artery stenosis requiring medical treatment, stent, or bypass graft), congestive heart failure, myocardial infarction, OR ejection fraction ≤ 50% on the most recent test
Cerebrovascular disease -Any history of transient ischemic attack, subarachnoid hemorrhage or cerebral thrombosis, embolism, or hemorrhage
Diabetes -Requiring treatment with insulin or oral hypoglycemic drugs in the last 4 weeks but not diet alone
Heart valve disease -At least a moderate to severe degree of valve stenosis or insufficiency as determined by Echo; prosthetic mitral or aortic valve; or symptomatic mitral valve prolapse
Hepatic, mild - Bilirubin > upper limit of normal to 1.5 × upper limit of normal, or AST/ALT > upper limit of normal to 2.5 × upper limit of normal at the time of transplant OR any history of hepatitis B or hepatitis C infection
Hepatic, moderate/severe -Liver cirrhosis, bilirubin > 1.5 × upper limit of normal, or AST/ALT > 2.5 × upper limit of normal
Infection -Includes a documented infection, fever of unknown origin, or pulmonary nodules suspicious for fungal pneumonia or a positive PPD test requiring prophylaxis against tuberculosis. Patients must have started antimicrobial treatment before Day 0 with continuation of antimicrobial treatment after Day 0
Inflammatory bowel disease -Any history of Crohn’s disease or ulcerative colitis requiring treatment
Obesity -Patients older than 18 years with a body mass index (BMI) > 35 kg/m2 prior to the start of conditioning or a BMI of the 95th percentile of higher for patients aged 18 years or younger
Peptic ulcer -Any history of peptic (gastric or duodenal) ulcer confirmed by endoscopy or radiologic diagnosis requiring treatment
Psychiatric disturbance -Presence of any mood (e.g., depression), anxiety, or other psychiatric disorder (e.g. bipolar disorder or schizophrenia) requiring continuous treatment in the last 4 weeks
Pulmonary, moderate -Corrected diffusion capacity of carbon monoxide and/or FEV1 of 66-80% or dyspnea on slight activity attributed to pulmonary disease at transplant
Pulmonary, severe -Corrected diffusion capacity of carbon monoxide and/or FEV1 of ≤ 65% or dyspnea at rest attributed to pulmonary disease or the need for intermittent or continuous oxygen during the 4 weeks prior to transplant
Renal, moderate / severe -Serum creatinine > 2 mg/dL or > 177 μmol/L; on dialysis during the 4 weeks prior to transplant; OR prior renal transplantation -go to question 102
Rheumatologic -Any history of a rheumatologic disease (e.g., systemic lupus erythematosis, rheumatoid arthritis, polymyositis, mixed connective tissue disease, or polymyalgia rheumatica, etc.) requiring treatment. (Do NOT include degenerative joint disease, osteoarthritis)
Prior malignancy-Treated at any time point in the patient’s past history, other than the primary disease for which this infusion is being performed -go to question 103
Specify co-existing diseases or organ impairment (check all that apply) Arrhythmia - Any history of atrial fibrillation or flutter, sick sinus syndrome, or ventricular arrhythmias requiring treatment
Cardiac -Any history of coronary artery disease (one or more vessel-coronary artery stenosis requiring medical treatment, stent, or bypass graft), congestive heart failure, myocardial infarction, OR ejection fraction ≤ 50% on the most recent test
Cerebrovascular disease -Any history of transient ischemic attack, subarachnoid hemorrhage or cerebral thrombosis, embolism, or hemorrhage
Diabetes -Requiring treatment with insulin or oral hypoglycemic drugs in the last 4 weeks but not diet alone
Heart valve disease -At least a moderate to severe degree of valve stenosis or insufficiency as determined by Echo; prosthetic mitral or aortic valve; or symptomatic mitral valve prolapse
Hepatic, mild - Bilirubin > upper limit of normal to 1.5 × upper limit of normal, or AST/ALT > upper limit of normal to 2.5 × upper limit of normal at the time of transplant OR any history of hepatitis B or hepatitis C infection
Hepatic, moderate/severe -Liver cirrhosis, bilirubin > 1.5 × upper limit of normal, or AST/ALT > 2.5 × upper limit of normal
Infection -Includes a documented infection, fever of unknown origin, or pulmonary nodules suspicious for fungal pneumonia or a positive PPD test requiring prophylaxis against tuberculosis. Patients must have started antimicrobial treatment before Day 0 with continuation of antimicrobial treatment after Day 0
Inflammatory bowel disease -Any history of Crohn’s disease or ulcerative colitis requiring treatment
Obesity -Patients older than 18 years with a body mass index (BMI) > 35 kg/m2 prior to the start of conditioning or a BMI of the 95th percentile of higher for patients aged 18 years or younger
Peptic ulcer -Any history of peptic (gastric or duodenal) ulcer confirmed by endoscopy or radiologic diagnosis requiring treatment
Psychiatric disturbance -Presence of any mood (e.g., depression), anxiety, or other psychiatric disorder (e.g. bipolar disorder or schizophrenia) requiring continuous treatment in the last 4 weeks
Pulmonary, moderate -Corrected diffusion capacity of carbon monoxide and/or FEV1 of 66-80% or dyspnea on slight activity attributed to pulmonary disease at transplant
Pulmonary, severe -Corrected diffusion capacity of carbon monoxide and/or FEV1 of ≤ 65% or dyspnea at rest attributed to pulmonary disease or the need for intermittent or continuous oxygen during the 4 weeks prior to transplant
Renal, moderate / severe -Serum creatinine > 2 mg/dL or > 177 μmol/L; on dialysis during the 4 weeks prior to transplant; OR prior renal transplantation -go to question 102
Rheumatologic -Any history of a rheumatologic disease (e.g., systemic lupus erythematosis, rheumatoid arthritis, polymyositis, mixed connective tissue disease, or polymyalgia rheumatica, etc.) requiring treatment. (Do NOT include degenerative joint disease, osteoarthritis)
Prior malignancy-Treated at any time point in the patient’s past history, other than the primary disease for which this infusion is being performed -go to question 103
PRE679 Pre-Transplant Pre-Transplant Essential Data Comorbid Conditions Yes no Was the recipient on dialysis immediately prior to start of preparative regimen? No,Unknown,Yes
Was the recipient on dialysis immediately prior to start of preparative regimen? No,Unknown,Yes
PRE680 Pre-Transplant Pre-Transplant Essential Data Comorbid Conditions Yes no Specify prior malignancy (check all that apply) Breast cancer
Central nervous system (CNS) malignancy (e.g., glioblastoma, astrocytoma)
Gastrointestinal malignancy (e.g., colon, rectum, stomach, pancreas, intestine, esophageal)
Genitourinary malignancy (e.g., kidney, bladder, ovary, testicle, genitalia, uterus, cervix, prostate) Acute myeloid leukemia
Chronic myeloid leukemia
Acute lymphoblastic leukemia
Chronic lymphoblastic leukemia
Leukemia
Lung cancer
Lymphoma (includes Hodgkin & non-Hodgkin lymphoma)
MDS / MPN
Melanoma
Multiple myeloma / plasma cell disorder (PCD)
Oropharyngeal cancer (e.g., tongue, buccal mucosa)
Sarcoma
Thyroid cancer
Other skin malignancy (basal cell, squamous cell)
Other hematologic malignancy
Other solid tumor
Specify prior malignancy (check all that apply) Breast cancer
Central nervous system (CNS) malignancy (e.g., glioblastoma, astrocytoma)
Gastrointestinal malignancy (e.g., colon, rectum, stomach, pancreas, intestine, esophageal)
Genitourinary malignancy (e.g., kidney, bladder, ovary, testicle, genitalia, uterus, cervix, prostate)
Acute myeloid leukemia
Chronic myeloid leukemia
Acute lymphoblastic leukemia
Chronic lymphoblastic leukemia
Lung cancer
Lymphoma (includes Hodgkin & non-Hodgkin lymphoma)
MDS / MPN
Melanoma
Multiple myeloma / plasma cell disorder (PCD)
Oropharyngeal cancer (e.g., tongue, buccal mucosa)
Sarcoma
Thyroid cancer
Other skin malignancy (basal cell, squamous cell)
Other hematologic malignancy
Other solid tumor
PRE681 Pre-Transplant Pre-Transplant Essential Data Comorbid Conditions Yes no Specify other hematologic malignancy: (prior) open text
Specify other hematologic malignancy: (prior) open text
PRE682 Pre-Transplant Pre-Transplant Essential Data
no no Specify other solid tumor: (prior) open text
Specify other solid tumor: (prior) open text
PRE683 Pre-Transplant Pre-Transplant Essential Data
no no Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
PRE684 Pre-Transplant Pre-Transplant Essential Data
no no Upper limit of normal for your institution: open text
Upper limit of normal for your institution: open text
PRE685 Pre-Transplant Pre-Transplant Essential Data
no no Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
PRE686 Pre-Transplant Pre-Transplant Essential Data
no no Did the recipient have a prior solid organ transplant? No,Yes
Did the recipient have a prior solid organ transplant? No,Yes
PRE687 Pre-Transplant Pre-Transplant Essential Data Prior Solid Organ Transplant yes yes Specify organ Bowel,Heart,Kidney(s),Liver,Lung,Other organ,Pancreas
Specify organ Bowel,Heart,Kidney(s),Liver,Lung,Other organ,Pancreas
PRE688 Pre-Transplant Pre-Transplant Essential Data Prior Solid Organ Transplant yes yes Specify other organ: open text
Specify other organ: open text
PRE689 Pre-Transplant Pre-Transplant Essential Data Prior Solid Organ Transplant yes yes Year of prior solid organ transplant: YYYY
Year of prior solid organ transplant: YYYY
PRE690 Pre-Transplant Pre-Transplant Essential Data

yes First Name (person completing form): open text
First Name (person completing form): open text
PRE691 Pre-Transplant Pre-Transplant Essential Data

yes Last Name: open text
Last Name: open text
PRE692 Pre-Transplant Pre-Transplant Essential Data

yes E-mail address: open text
E-mail address: open text
PRE693 Pre-Transplant Pre-Transplant Essential Data
no no Glomerular filtration rate (GFR) before start of preparative regimen (pediatric only) Known,Unknown
Glomerular filtration rate (GFR) before start of preparative regimen (pediatric only) Known,Unknown
PRE694 Pre-Transplant Pre-Transplant Essential Data
no no Glomerular filtration rate (GFR): __ __ __ mL/min/1.73m2
Glomerular filtration rate (GFR): __ __ __ mL/min/1.73m2
PRE695 Pre-Transplant Pre-Transplant Essential Data
no no Serum ferritin (within 4 weeks prior to the start of the preparative regimen, use result closest to the start date) Known,Unknown
Serum ferritin (within 4 weeks prior to the start of the preparative regimen, use result closest to the start date) Known,Unknown
PRE696 Pre-Transplant Pre-Transplant Essential Data
no no Serum ferritin (within 4 weeks prior to the start of the preparative regimen, use result closest to the start date)   ___ ___ ___ ___ ___ ng/mL (μg/L)
Serum ferritin (within 4 weeks prior to the start of the preparative regimen, use result closest to the start date)   ___ ___ ___ ___ ___ ng/mL (μg/L)
PRE697 Pre-Transplant Pre-Transplant Essential Data
no no Serum albumin (within 4 weeks prior to the start of the preparative regimen, use result closest to the start date) Known,Unknown
Serum albumin (within 4 weeks prior to the start of the preparative regimen, use result closest to the start date) Known,Unknown
PRE698 Pre-Transplant Pre-Transplant Essential Data
no no Serum albumin (within 4 weeks prior to the start of the preparative regimen, use result closest to the start date) ___ ___ ● __g/dL
___ ___ ● __ g/L
Serum albumin (within 4 weeks prior to the start of the preparative regimen, use result closest to the start date) ___ ___ ● __g/dL
___ ___ ● __ g/L
PRE699 Pre-Transplant Pre-Transplant Essential Data
no no Platelets (within 4 weeks prior to the start of the preparative regimen, use result closest to the start date) Known,Unknown
Platelets (within 4 weeks prior to the start of the preparative regimen, use result closest to the start date) Known,Unknown
PRE700 Pre-Transplant Pre-Transplant Essential Data
no no Platelets (within 4 weeks prior to the start of the preparative regimen, use result closest to the start date) ___ ___ ___ ___ ___ ___ ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ___ x 106/L
Platelets (within 4 weeks prior to the start of the preparative regimen, use result closest to the start date) ___ ___ ___ ___ ___ ___ ___ x 109/L (x 103/mm3)
___ ___ ___ ___ ___ ___ ___ x 106/L
PRE701 Pre-Transplant Pre-Transplant Essential Data
no no Were platelets transfused ≤ 7 days before date of test? No,Unknown,Yes
Were platelets transfused < 7 days before date of test? No,Unknown,Yes
PRE702 Pre-Transplant Prior Exposure: Potential Study Eligibility
no no Specify if the recipient received any of the following (at any time prior to HCT / infusion) (check all that apply) Blinatumomab(Blincyto),Gemtuzumab ozogamicin (Mylotarg),Inotuzumab ozogamicin (Besponsa) ,Mogamulizumab (Poteligeo) ,None,Thiotepa
Specify if the recipient received any of the following (at any time prior to HCT / infusion) (check all that apply) Blinatumomab(Blincyto),Gemtuzumab ozogamicin (Mylotarg),Inotuzumab ozogamicin (Besponsa) ,Mogamulizumab (Poteligeo) ,None,Thiotepa

Sheet 4: Transplant Procedure&Product




Information Collection Domain: Transplant Procedure and Product Information






Item ID Time Point Information Collection Domain Additional Sub Domain Response required if Additional Sub Domain applies Information Collection may be requested multiple times Current Information Collection Data Element (if applicable) Current Information Collection Data Element Response Option(s) Information Collection update: Proposed Information Collection Data Element (if applicable) Proposed Information Collection Data Element Response Option(s) Rationale for Information Collection Update
PRO113 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product Allogeneic Donors yes no Specify growth and mobilizing factor(s) (check all that apply) G-CSF (filgrastim, Neupogen),Pegylated G-CSF(pegfilgrastim, Neulasta) , Plerixafor (Mozobil) Other growth or mobilizing factor(s) Change/Clarification of Information Requested and Response Option Specify growth and mobilizing factor(s) (check all that apply) G-CSF (filgrastim, Neupogen),Pegylated G-CSF(pegfilgrastim, Neulasta) , Plerixafor (Mozobil), Motixafortide (Aphexda), Other growth or mobilizing factor(s) Capture data accurately
PRO001 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Registry donor ID: open text
Registry donor ID: open text
PRO002 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Non-NMDP cord blood unit ID: open text
Non-NMDP cord blood unit ID: open text
PRO003 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Global Registration Identifier for Donors (GRID) open text
Global Registration Identifier for Donors (GRID) open text
PRO004 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no ISBT DIN: open text
ISBT DIN: open text
PRO005 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Registry or UCB Bank ID (A) Austrian Bone Marrow Donors,(ACB) Austrian Cord Blood Registry,(ACCB) StemCyte, Inc,(AE) Emirates Bone Marrow Donor Registry,(AM) Armenian Bone Marrow Donor Registry Charitable Trust,(AOCB) University of Colorado Cord Blood Bank,(AR) Argentine CPH Donors Registry,(ARCB) BANCEL - Argentina Cord Blood Bank,(AUCB) Australian Cord Blood Registry,(AUS) Australian / New Zealand Bone Marrow Donor Registry,(B) Marrow Donor Program Belgium,(BCB) Belgium Cord Blood Registry,(BG) Bulgarian Bone Marrow Donor Registry,(BR) INCA/REDOMO,(BSCB) British Bone Marrow Registry - Cord Blood,(CB) Cord Blood Registry,(CH) Swiss BloodStem Cells - Adult Donors,(CHCB) Swiss Blood Stem Cells - Cord Blood,(CKCB) Celgene Cord Blood Bank,(CN) China Marrow Donor Program (CMDP),(CNCB) Shan Dong Cord Blood Bank,(CND) Canadian Blood Services Bone Marrow Donor Registry,(CS2) Czech National Marrow Donor Registry,(CSCR) Czech Stem Cells Registry,(CY) Cyprus Paraskevaidio Bone Marrow Donor Registry,(CY2) The Cyprus Bone Marrow Donor Registry,(D) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Adult Donors,(DCB) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Cord Blood,(DK) The Danish Bone Marrow Donor Registry,(DK2) Bone Marrow Donors Copenhagen (BMDC),(DUCB) German Branch of the European Cord Blood Bank,(E) REDMO,(ECB) Spanish Cord Blood Registry,(F) France Greffe de Moelle - Adult Donors,(FCB) France Greffe de Moelle - Cord Blood,(FI) Finnish Bone Marrow Donor Registry,(FICB) Finnish Cord Blood Registry,(GB) The Anthony Nolan Trust,(GB3) Welsh Bone Marrow Donor Registry,(GB4) British Bone Marrow Registry,(GR) Unrelated Hematopoietic Stem Cell Donor Registry Greece,(GRCB) Michigan Community Blood Centers Cord Blood Bank,(H) Hungarian Bone Marrow Donor Registry,(HEM) Hema-Quebec,(HK) Hong Kong Bone Marrow Donor Registry,(HR) Croatian Bone Marrow Donor Registry,(I) Italian Bone Marrow Donor Registry,(I3CB) Sheba Medical Centre Cord Blood Registry,(ICB) Italian Cord Blood Bank Network,(IL) Hadassah BMDR,(IL2) Ezer Mizion Bone Marrow Donor Registry,(IL3) Sheba Medical Center Donor Registry,(ILCB) Isreal Cord Blood Bank,(IN) Asian Indian Donor Marrow Registry,(IN2) Dept. of Transfusion Medicine,(IRL) The Irish Unrelated Bone Marrow Panel,(JP) Japan Marrow Donor Program,(KR) Korea Marrow Donor Program,(LT) Lithuanian National Bone Marrow Donor Registry,(LVCB) Leuven Cord Blood Bank,(MACB) Victoria Angel Registry of Hope,(MX) Mexican Bone Marrow Donor Registry,(N) The Norwegian Bone Marrow Donor Registry,(NL) Europdonor Foundation- Adult Donors,(NLCB) Europdonor Foundation - Cord Blood,(NYCB) National Cord Blood Program, New York Blood Center,(OTH) Other Registry,(P) Portuguese Bone Marrow Donors Registry,(PL) National Polish Bone Marrow Registry,(PL2) Unrelated Bone Marrow Donor Registry -Adult Donors,(PL3) Against Leukemia Foundation Marrow Donor Registry,(PL4) Ursula Jaworska Foundation - Bone Marrow Donor Registry,(PL5) Polish Central Bone Marrow Donor Registry - Adult Donors,(PMCB) Elie Katz Umbilical Cord Blood Program,(R) Russian Bone Marrow Donor Registry,(R2) Karelian Registry of Unrelated Donors of Hematopoietic Stem Cells,(S) Tobias Registry of Swedish Bone Marrow Donors,(SG) Singapore Bone Marrow Donor Programme (BMDP),(SK) Slovak National Bone Marrow Donor Registry,(SKCB) Eurocord Slovakia / Slovak Pacental Stem Cell Registry,(SLCBB) St Louis Cord Blood Bank,(SLO) Slovenia Donor,(SM) San Marino Bone Marrow Donor Registry,(T1CB) TRAN - Cord Blood,(TACB) StemCyte, Inc. Taiwan,(TECB) Healthbanks Biotech, Co., Ltd,(TH) Thai Stem Cell Donor Registry (TSCDR),(TOCB) Tokyo Cord Blood Bank,(TPCB) BIONET / BabyBanks,(TRAN) TRAN - Adult Donors,(TRIS) Bone Marrow Bank of Istanbul Medical Faculty,(TW) Buddhist Tzu Chi Stem Cells Center - Adult Donors,(TWCB) Buddhist Tzu Chi Stem Cells Center - Cord Blood,(U1CB) National Marrow Donor Program - Cord Blood,(USA1) National Marrow Donor Program - Adult Donors,(USA2) America Bone Marrow Donor Registry,(UY) SINDOME,(VIAC) Viacord,(W3CB) Polish Central Bone Marrow Donor Registry - Cord Blood,(WACB) Unrelated Bone Marrow Donor Registry - Cord Blood,(ZA) South African Bone Marrow Registry
Registry or UCB Bank ID (A) Austrian Bone Marrow Donors,(ACB) Austrian Cord Blood Registry,(ACCB) StemCyte, Inc,(AE) Emirates Bone Marrow Donor Registry,(AM) Armenian Bone Marrow Donor Registry Charitable Trust,(AOCB) University of Colorado Cord Blood Bank,(AR) Argentine CPH Donors Registry,(ARCB) BANCEL - Argentina Cord Blood Bank,(AUCB) Australian Cord Blood Registry,(AUS) Australian / New Zealand Bone Marrow Donor Registry,(B) Marrow Donor Program Belgium,(BCB) Belgium Cord Blood Registry,(BG) Bulgarian Bone Marrow Donor Registry,(BR) INCA/REDOMO,(BSCB) British Bone Marrow Registry - Cord Blood,(CB) Cord Blood Registry,(CH) Swiss BloodStem Cells - Adult Donors,(CHCB) Swiss Blood Stem Cells - Cord Blood,(CKCB) Celgene Cord Blood Bank,(CN) China Marrow Donor Program (CMDP),(CNCB) Shan Dong Cord Blood Bank,(CND) Canadian Blood Services Bone Marrow Donor Registry,(CS2) Czech National Marrow Donor Registry,(CSCR) Czech Stem Cells Registry,(CY) Cyprus Paraskevaidio Bone Marrow Donor Registry,(CY2) The Cyprus Bone Marrow Donor Registry,(D) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Adult Donors,(DCB) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Cord Blood,(DK) The Danish Bone Marrow Donor Registry,(DK2) Bone Marrow Donors Copenhagen (BMDC),(DUCB) German Branch of the European Cord Blood Bank,(E) REDMO,(ECB) Spanish Cord Blood Registry,(F) France Greffe de Moelle - Adult Donors,(FCB) France Greffe de Moelle - Cord Blood,(FI) Finnish Bone Marrow Donor Registry,(FICB) Finnish Cord Blood Registry,(GB) The Anthony Nolan Trust,(GB3) Welsh Bone Marrow Donor Registry,(GB4) British Bone Marrow Registry,(GR) Unrelated Hematopoietic Stem Cell Donor Registry Greece,(GRCB) Michigan Community Blood Centers Cord Blood Bank,(H) Hungarian Bone Marrow Donor Registry,(HEM) Hema-Quebec,(HK) Hong Kong Bone Marrow Donor Registry,(HR) Croatian Bone Marrow Donor Registry,(I) Italian Bone Marrow Donor Registry,(I3CB) Sheba Medical Centre Cord Blood Registry,(ICB) Italian Cord Blood Bank Network,(IL) Hadassah BMDR,(IL2) Ezer Mizion Bone Marrow Donor Registry,(IL3) Sheba Medical Center Donor Registry,(ILCB) Isreal Cord Blood Bank,(IN) Asian Indian Donor Marrow Registry,(IN2) Dept. of Transfusion Medicine,(IRL) The Irish Unrelated Bone Marrow Panel,(JP) Japan Marrow Donor Program,(KR) Korea Marrow Donor Program,(LT) Lithuanian National Bone Marrow Donor Registry,(LVCB) Leuven Cord Blood Bank,(MACB) Victoria Angel Registry of Hope,(MX) Mexican Bone Marrow Donor Registry,(N) The Norwegian Bone Marrow Donor Registry,(NL) Europdonor Foundation- Adult Donors,(NLCB) Europdonor Foundation - Cord Blood,(NYCB) National Cord Blood Program, New York Blood Center,(OTH) Other Registry,(P) Portuguese Bone Marrow Donors Registry,(PL) National Polish Bone Marrow Registry,(PL2) Unrelated Bone Marrow Donor Registry -Adult Donors,(PL3) Against Leukemia Foundation Marrow Donor Registry,(PL4) Ursula Jaworska Foundation - Bone Marrow Donor Registry,(PL5) Polish Central Bone Marrow Donor Registry - Adult Donors,(PMCB) Elie Katz Umbilical Cord Blood Program,(R) Russian Bone Marrow Donor Registry,(R2) Karelian Registry of Unrelated Donors of Hematopoietic Stem Cells,(S) Tobias Registry of Swedish Bone Marrow Donors,(SG) Singapore Bone Marrow Donor Programme (BMDP),(SK) Slovak National Bone Marrow Donor Registry,(SKCB) Eurocord Slovakia / Slovak Pacental Stem Cell Registry,(SLCBB) St Louis Cord Blood Bank,(SLO) Slovenia Donor,(SM) San Marino Bone Marrow Donor Registry,(T1CB) TRAN - Cord Blood,(TACB) StemCyte, Inc. Taiwan,(TECB) Healthbanks Biotech, Co., Ltd,(TH) Thai Stem Cell Donor Registry (TSCDR),(TOCB) Tokyo Cord Blood Bank,(TPCB) BIONET / BabyBanks,(TRAN) TRAN - Adult Donors,(TRIS) Bone Marrow Bank of Istanbul Medical Faculty,(TW) Buddhist Tzu Chi Stem Cells Center - Adult Donors,(TWCB) Buddhist Tzu Chi Stem Cells Center - Cord Blood,(U1CB) National Marrow Donor Program - Cord Blood,(USA1) National Marrow Donor Program - Adult Donors,(USA2) America Bone Marrow Donor Registry,(UY) SINDOME,(VIAC) Viacord,(W3CB) Polish Central Bone Marrow Donor Registry - Cord Blood,(WACB) Unrelated Bone Marrow Donor Registry - Cord Blood,(ZA) South African Bone Marrow Registry
PRO006 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Donor DOB: YYYY/MM/DD
Donor DOB: YYYY/MM/DD
PRO007 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Donor age: open text, check "Months" or check "Years"
Donor age: open text, check "Months" or check "Years"
PRO008 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Donor sex female,male
Donor sex female,male
PRO009 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specify the person for whom this typing is being done Donor,Recipient-final typing
Specify the person for whom this typing is being done Donor,Recipient-final typing
PRO010 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Was documentation submitted to the CIBMTR (e.g. lab report) No,Yes
Was documentation submitted to the CIBMTR (e.g. lab report) No,Yes
PRO011 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Locus A Known,Unknown
Locus A Known,Unknown
PRO012 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no First A* allele designations: open text
First A* allele designations: open text
PRO013 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Second A* allele designations: open text
Second A* allele designations: open text
PRO014 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Locus B Known,Unknown
Locus B Known,Unknown
PRO015 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no First B* allele designations: open text
First B* allele designations: open text
PRO016 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Second B* allele designations: open text
Second B* allele designations: open text
PRO017 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Locus C Known,Unknown
Locus C Known,Unknown
PRO018 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no First C* allele designations: open text
First C* allele designations: open text
PRO019 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Second C* allele designations: open text
Second C* allele designations: open text
PRO020 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Locus DRB1 Known,Unknown
Locus DRB1 Known,Unknown
PRO021 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no First DRB1* allele designations: open text
First DRB1* allele designations: open text
PRO022 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Second DRB1* allele designations: open text
Second DRB1* allele designations: open text
PRO023 Transplant Procedure and Product Information Confirmation of HLA Typing
no no Locus DRB3 Known,Unknown
Locus DRB3 Known,Unknown
PRO024 Transplant Procedure and Product Information Confirmation of HLA Typing
no no First DRB3* allele designations: open text
First DRB3* allele designations: open text
PRO025 Transplant Procedure and Product Information Confirmation of HLA Typing
no no Second DRB3* allele designations: open text
Second DRB3* allele designations: open text
PRO026 Transplant Procedure and Product Information Confirmation of HLA Typing
no no Locus DRB4 Known,Unknown
Locus DRB4 Known,Unknown
PRO027 Transplant Procedure and Product Information Confirmation of HLA Typing
no no First DRB4* allele designations: open text
First DRB4* allele designations: open text
PRO028 Transplant Procedure and Product Information Confirmation of HLA Typing
no no Second DRB4* allele designations: open text
Second DRB4* allele designations: open text
PRO029 Transplant Procedure and Product Information Confirmation of HLA Typing
no no Locus DRB5 Known,Unknown
Locus DRB5 Known,Unknown
PRO030 Transplant Procedure and Product Information Confirmation of HLA Typing
no no First DRB5* allele designations: open text
First DRB5* allele designations: open text
PRO031 Transplant Procedure and Product Information Confirmation of HLA Typing
no no Second DRB5* allele designations: open text
Second DRB5* allele designations: open text
PRO032 Transplant Procedure and Product Information Confirmation of HLA Typing
no no Locus DQB1 Known,Unknown
Locus DQB1 Known,Unknown
PRO033 Transplant Procedure and Product Information Confirmation of HLA Typing
no no First DQB1* allele designations: open text
First DQB1* allele designations: open text
PRO034 Transplant Procedure and Product Information Confirmation of HLA Typing
no no Second DQB1* allele designations: open text
Second DQB1* allele designations: open text
PRO035 Transplant Procedure and Product Information Confirmation of HLA Typing
no no Locus DPB1 Known,Unknown
Locus DPB1 Known,Unknown
PRO036 Transplant Procedure and Product Information Confirmation of HLA Typing
no no First DPB1* allele designations: open text
First DPB1* allele designations: open text
PRO037 Transplant Procedure and Product Information Confirmation of HLA Typing
no no Second DPB1* allele designations: open text
Second DPB1* allele designations: open text
PRO038 Transplant Procedure and Product Information Confirmation of HLA Typing
no no Locus DQA1 Known,Unknown
Locus DQA1 Known,Unknown
PRO039 Transplant Procedure and Product Information Confirmation of HLA Typing
no no First DQA1* allele designations: open text
First DQA1* allele designations: open text
PRO040 Transplant Procedure and Product Information Confirmation of HLA Typing
no no Second DQA1* allele designations: open text
Second DQA1* allele designations: open text
PRO041 Transplant Procedure and Product Information Confirmation of HLA Typing
no no Locus DPA1 Known,Unknown
Locus DPA1 Known,Unknown
PRO042 Transplant Procedure and Product Information Confirmation of HLA Typing
no no First DPA1* allele designations: open text
First DPA1* allele designations: open text
PRO043 Transplant Procedure and Product Information Confirmation of HLA Typing
no no Second DPA1* allele designations: open text
Second DPA1* allele designations: open text
PRO044 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no A Antigens. Number of antigens provided one,two
A Antigens. Number of antigens provided one,two
PRO045 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity – 1st antigen A1,A10,A11,A19,A2,A203,A210,A23(9),A24(9),A2403,A25(10),A26(10),A28,A29(19),A3,A30(19),A31(19),A32(19),A33(19),A34(10),A36,A43,A66(10),A68(28),A69(28),A74(19),A80,A9,AX
Specificity – 1st antigen A1,A10,A11,A19,A2,A203,A210,A23(9),A24(9),A2403,A25(10),A26(10),A28,A29(19),A3,A30(19),A31(19),A32(19),A33(19),A34(10),A36,A43,A66(10),A68(28),A69(28),A74(19),A80,A9,AX
PRO046 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity – 2nd antigen A1,A10,A11,A19,A2,A203,A210,A23(9),A24(9),A2403,A25(10),A26(10),A28,A29(19),A3,A30(19),A31(19),A32(19),A33(19),A34(10),A36,A43,A66(10),A68(28),A69(28),A74(19),A80,A9,AX
Specificity – 2nd antigen A1,A10,A11,A19,A2,A203,A210,A23(9),A24(9),A2403,A25(10),A26(10),A28,A29(19),A3,A30(19),A31(19),A32(19),A33(19),A34(10),A36,A43,A66(10),A68(28),A69(28),A74(19),A80,A9,AX
PRO047 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no B Antigens. Number of antigens provided one,two
B Antigens. Number of antigens provided one,two
PRO048 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity – 1st antigen B12,B13,B14,B15,B16,B17,B18,B21,B22,B27,B2708,B35,B37,B38(16),B39(16),B3901,B3902,B40,B4005,B41,B42,B44(12),B45(12),B46,B47,B48,B49(21),B5,B50(21),B51(5),B5102,B5103,B52(5),B53,B54(22),B55(22),B56(22),B57(17),B58(17),B59,B60(40),B61(40),B62(15),B63(15),B64(14),B65(14),B67,B7,B70,B703,B71(70),B72(70),B73,B75(15),B76(15),B77(15),B78,B8,B81,B82,BX
Specificity – 1st antigen B12,B13,B14,B15,B16,B17,B18,B21,B22,B27,B2708,B35,B37,B38(16),B39(16),B3901,B3902,B40,B4005,B41,B42,B44(12),B45(12),B46,B47,B48,B49(21),B5,B50(21),B51(5),B5102,B5103,B52(5),B53,B54(22),B55(22),B56(22),B57(17),B58(17),B59,B60(40),B61(40),B62(15),B63(15),B64(14),B65(14),B67,B7,B70,B703,B71(70),B72(70),B73,B75(15),B76(15),B77(15),B78,B8,B81,B82,BX
PRO049 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity – 2nd antigen B12,B13,B14,B15,B16,B17,B18,B21,B22,B27,B2708,B35,B37,B38(16),B39(16),B3901,B3902,B40,B4005,B41,B42,B44(12),B45(12),B46,B47,B48,B49(21),B5,B50(21),B51(5),B5102,B5103,B52(5),B53,B54(22),B55(22),B56(22),B57(17),B58(17),B59,B60(40),B61(40),B62(15),B63(15),B64(14),B65(14),B67,B7,B70,B703,B71(70),B72(70),B73,B75(15),B76(15),B77(15),B78,B8,B81,B82,BX
Specificity – 2nd antigen B12,B13,B14,B15,B16,B17,B18,B21,B22,B27,B2708,B35,B37,B38(16),B39(16),B3901,B3902,B40,B4005,B41,B42,B44(12),B45(12),B46,B47,B48,B49(21),B5,B50(21),B51(5),B5102,B5103,B52(5),B53,B54(22),B55(22),B56(22),B57(17),B58(17),B59,B60(40),B61(40),B62(15),B63(15),B64(14),B65(14),B67,B7,B70,B703,B71(70),B72(70),B73,B75(15),B76(15),B77(15),B78,B8,B81,B82,BX
PRO050 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no C Antigens. Number of antigens provided one,two
C Antigens. Number of antigens provided one,two
PRO051 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity – 1st antigen Cw1,Cw10(W3),Cw2,Cw3,Cw4,Cw5,Cw6,Cw7,Cw8,Cw9(W3),CX
Specificity – 1st antigen Cw1,Cw10(W3),Cw2,Cw3,Cw4,Cw5,Cw6,Cw7,Cw8,Cw9(W3),CX
PRO052 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity – 2nd antigen Cw1,Cw10(W3),Cw2,Cw3,Cw4,Cw5,Cw6,Cw7,Cw8,Cw9(W3),CX
Specificity – 2nd antigen Cw1,Cw10(W3),Cw2,Cw3,Cw4,Cw5,Cw6,Cw7,Cw8,Cw9(W3),CX
PRO053 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity Bw4 present? no,yes
Specificity Bw4 present? no,yes
PRO054 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity Bw6 present? no,yes
Specificity Bw6 present? no,yes
PRO055 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no DR Antigens. Number of antigens provided one,two
DR Antigens. Number of antigens provided one,two
PRO056 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity – 1st antigen DR1,DR10,DR103,DR11(5),DR12(5),DR13(6),DR14(6),DR1403,DR1404,DR15(2),DR16(2),DR17(3),DR18(3),DR2,DR3,DR4,DR5,DR6,DR7,DR8,DR9,DRX
Specificity – 1st antigen DR1,DR10,DR103,DR11(5),DR12(5),DR13(6),DR14(6),DR1403,DR1404,DR15(2),DR16(2),DR17(3),DR18(3),DR2,DR3,DR4,DR5,DR6,DR7,DR8,DR9,DRX
PRO057 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity – 2nd antigen DR1,DR10,DR103,DR11(5),DR12(5),DR13(6),DR14(6),DR1403,DR1404,DR15(2),DR16(2),DR17(3),DR18(3),DR2,DR3,DR4,DR5,DR6,DR7,DR8,DR9,DRX
Specificity – 2nd antigen DR1,DR10,DR103,DR11(5),DR12(5),DR13(6),DR14(6),DR1403,DR1404,DR15(2),DR16(2),DR17(3),DR18(3),DR2,DR3,DR4,DR5,DR6,DR7,DR8,DR9,DRX
PRO058 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity DR51 present? no,yes
Specificity DR51 present? no,yes
PRO059 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity DR52 present? no,yes
Specificity DR52 present? no,yes
PRO060 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity DR53 present? no,yes
Specificity DR53 present? no,yes
PRO061 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no DQ Antigens. Number of antigens provided one,two
DQ Antigens. Number of antigens provided one,two
PRO062 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity – 1st antigen DQ1,DQ2,DQ3,DQ4,DQ5(1),DQ6(1),DQ7(3),DQ8(3),DQ9(3),DQX
Specificity – 1st antigen DQ1,DQ2,DQ3,DQ4,DQ5(1),DQ6(1),DQ7(3),DQ8(3),DQ9(3),DQX
PRO063 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity – 2nd antigen DQ1,DQ2,DQ3,DQ4,DQ5(1),DQ6(1),DQ7(3),DQ8(3),DQ9(3),DQX
Specificity – 2nd antigen DQ1,DQ2,DQ3,DQ4,DQ5(1),DQ6(1),DQ7(3),DQ8(3),DQ9(3),DQX
PRO064 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no DP Antigens. Number of antigens provided one,two
DP Antigens. Number of antigens provided one,two
PRO065 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity – 1st antigen DPw1,DPw2,DPw3,DPw4,DPw5,DPw6,DPX
Specificity – 1st antigen DPw1,DPw2,DPw3,DPw4,DPw5,DPw6,DPX
PRO066 Transplant Procedure and Product Information Confirmation of HLA Typing Non NMDP Allogeneic or syngeneic Donor / Recipient or Non NMDP Cord Blood Unit Information yes no Specificity – 2nd antigen DPw1,DPw2,DPw3,DPw4,DPw5,DPw6,DPX
Specificity – 2nd antigen DPw1,DPw2,DPw3,DPw4,DPw5,DPw6,DPX
PRO067 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion
no no HCT type (check only one) Allogeneic, related,Allogeneic, unrelated,Autologous
HCT type (check only one) Allogeneic, related,Allogeneic, unrelated,Autologous
PRO068 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Non NMDP Allogeneic Donor / Infant Demographic Information yes no Was the donor ever pregnant? Not applicable (male donor or cord blood unit) ,No,Unknown,Yes
Was the donor ever pregnant? Not applicable (male donor or cord blood unit) ,No,Unknown,Yes
PRO069 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Non NMDP Allogeneic Donor / Infant Demographic Information yes no Number of pregnancies Known,Unknown
Number of pregnancies Known,Unknown
PRO070 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Non NMDP Allogeneic Donor / Infant Demographic Information yes no Specify number of pregnancies: open text
Specify number of pregnancies: open text
PRO071 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Non NMDP Allogeneic Donor / Infant Demographic Information yes no Ethnicity (donor) Hispanic or Latino,Not applicable (not a resident of the USA),Not Hispanic or Latino,Unknown
Ethnicity (donor) Hispanic or Latino,Not applicable (not a resident of the USA),Not Hispanic or Latino,Unknown
PRO072 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Non NMDP Allogeneic Donor / Infant Demographic Information yes no Race (donor) (check all that apply) American Indian or Alaska Native,Asian,Black or African American,Not reported,Native Hawaiian or Other Pacific Islander,Unknown,White
Race (donor) (check all that apply) American Indian or Alaska Native,Asian,Black or African American,Not reported,Native Hawaiian or Other Pacific Islander,Unknown,White
PRO073 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Non NMDP Allogeneic Donor / Infant Demographic Information yes no Race detail (donor) (check all that apply) African American,African (both parents born in Africa),South Asian,American Indian, South or Central America,Alaskan Native or Aleut,North American Indian,Black Caribbean,Caribbean Indian,Other White,Eastern European,Filipino (Pilipino),Guamanian,Hawaiian,Japanese,Korean,Mediterranean,Middle Eastern,North American,North Coast of Africa,Chinese,Northern European,Other Pacific Islander,Other Black,Samoan,Black South or Central American,Other Southeast Asian,Unknown,Vietnamese,White Caribbean,Western European,White South or Central American
Race detail (donor) (check all that apply) African American,African (both parents born in Africa),South Asian,American Indian, South or Central America,Alaskan Native or Aleut,North American Indian,Black Caribbean,Caribbean Indian,Other White,Eastern European,Filipino (Pilipino),Guamanian,Hawaiian,Japanese,Korean,Mediterranean,Middle Eastern,North American,North Coast of Africa,Chinese,Northern European,Other Pacific Islander,Other Black,Samoan,Black South or Central American,Other Southeast Asian,Unknown,Vietnamese,White Caribbean,Western European,White South or Central American
PRO074 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Non NMDP Allogeneic Donor / Infant Demographic Information yes no Was the donor a carrier for potentially transferable genetic diseases? No,Yes
Was the donor a carrier for potentially transferable genetic diseases? No,Yes
PRO075 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Non NMDP Allogeneic Donor / Infant Demographic Information yes no Specify potentially transferable genetic disease (check all that apply) Other hemoglobinopathy,Other disease,Sickle cell anemia,Thalassemia
Specify potentially transferable genetic disease (check all that apply) Other hemoglobinopathy,Other disease,Sickle cell anemia,Thalassemia
PRO076 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Non NMDP Allogeneic Donor / Infant Demographic Information yes no Specify other disease: open text
Specify other disease: open text
PRO077 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Non NMDP Allogeneic Donor / Infant Demographic Information yes no Was the donor / product tested for other transferable genetic or clonal abnormalities? No,Unknown,Yes
Was the donor / product tested for other transferable genetic or clonal abnormalities? No,Unknown,Yes
PRO078 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Non NMDP Allogeneic Donor / Infant Demographic Information yes no Clonal hematopoiesis of indeterminate potential (CHIP) No,Yes
Clonal hematopoiesis of indeterminate potential (CHIP) No,Yes
PRO079 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Non NMDP Allogeneic Donor / Infant Demographic Information yes no What was the method of testing used? open text
What was the method of testing used? open text
PRO080 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Non NMDP Allogeneic Donor / Infant Demographic Information yes no Monoclonal B-cell lymphocytosis No,Yes
Monoclonal B-cell lymphocytosis No,Yes
PRO081 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Non NMDP Allogeneic Donor / Infant Demographic Information yes no Other transferable genetic or clonal abnormality No,Yes
Other transferable genetic or clonal abnormality No,Yes
PRO082 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Non NMDP Allogeneic Donor / Infant Demographic Information yes no Specify other transferable genetic or clonal abnormality: open text
Specify other transferable genetic or clonal abnormality: open text
PRO083 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Allo Related Donor / Infant Demographic Information yes no Did this donor have a central line placed? no,yes
Did this donor have a central line placed? no,yes
PRO084 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Allo Related Donor / Infant Demographic Information yes no Was the donor hospitalized (inpatient) during or after the collection? no,yes
Was the donor hospitalized (inpatient) during or after the collection? no,yes
PRO085 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Allo Related Donor / Infant Demographic Information yes no Did the donor experience any life-threatening complications during or after the collection? no,yes
Did the donor experience any life-threatening complications during or after the collection? no,yes
PRO086 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Allo Related Donor / Infant Demographic Information yes no Specify: open text
Specify: open text
PRO087 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Allo Related Donor / Infant Demographic Information yes no Did the allogeneic donor give one or more autologous transfusion units? No,Yes
Did the allogeneic donor give one or more autologous transfusion units? No,Yes
PRO088 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Allo Related Donor / Infant Demographic Information yes no Date of collection: YYYY/MM/DD
Date of collection: YYYY/MM/DD
PRO089 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Allo Related Donor / Infant Demographic Information yes no Number of units: open text
Number of units: open text
PRO090 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Allo Related Donor / Infant Demographic Information yes no Did the donor receive blood transfusions as a result of the collection? Allogeneic transfusions,Autologous transfusions,No
Did the donor receive blood transfusions as a result of the collection? Allogeneic transfusions,Autologous transfusions,No
PRO091 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Allo Related Donor / Infant Demographic Information yes no Specify number of autologous units: open text
Specify number of autologous units: open text
PRO092 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Allo Related Donor / Infant Demographic Information yes no Specify number of allogeneic units: open text
Specify number of allogeneic units: open text
PRO093 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Allo Related Donor / Infant Demographic Information yes no Did the donor die as a result of the collection? no,yes
Did the donor die as a result of the collection? no,yes
PRO094 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Allo Related Donor / Infant Demographic Information yes no Specify cause of death: open text
Specify cause of death: open text
PRO095 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion
no yes First Name (person completing form): open text
First Name (person completing form): open text
PRO096 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion
no yes Last Name: open text
Last Name: open text
PRO097 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion
no yes E-mail address: open text
E-mail address: open text
PRO098 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion
no yes Date: YYYY/MM/DD
Date: YYYY/MM/DD
PRO099 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Product type (check only one) Bone marrow,Other product,PBSC,Single cord blood unit
Product type Bone marrow,Other product,PBSC,Single cord blood unit
PRO100 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Specify: open text
Specify: open text
PRO101 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no NMDP Product No,Yes
NMDP Product No,Yes
PRO102 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no NMDP cord blood unit ID: open text
NMDP cord blood unit ID: open text
PRO103 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no NMDP donor ID: open text
NMDP donor ID: open text
PRO104 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Registry donor ID: open text
Registry donor ID: open text
PRO105 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Non-NMDP cord blood unit ID: open text
Non-NMDP cord blood unit ID: open text
PRO106 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Global Registration Identifier for Donors (GRID) open text
Global Registration Identifier for Donors (GRID) open text
PRO107 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no ISBT DIN: open text
ISBT DIN: open text
PRO108 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Registry or UCB Bank ID (A) Austrian Bone Marrow Donors,(ACB) Austrian Cord Blood Registry,(ACCB) StemCyte, Inc,(AE) Emirates Bone Marrow Donor Registry,(AM) Armenian Bone Marrow Donor Registry Charitable Trust,(AOCB) University of Colorado Cord Blood Bank,(AR) Argentine CPH Donors Registry,(ARCB) BANCEL - Argentina Cord Blood Bank,(AUCB) Australian Cord Blood Registry,(AUS) Australian / New Zealand Bone Marrow Donor Registry,(B) Marrow Donor Program Belgium,(BCB) Belgium Cord Blood Registry,(BG) Bulgarian Bone Marrow Donor Registry,(BR) INCA/REDOMO,(BSCB) British Bone Marrow Registry - Cord Blood,(CB) Cord Blood Registry,(CH) Swiss BloodStem Cells - Adult Donors,(CHCB) Swiss Blood Stem Cells - Cord Blood,(CKCB) Celgene Cord Blood Bank,(CN) China Marrow Donor Program (CMDP),(CNCB) Shan Dong Cord Blood Bank,(CND) Canadian Blood Services Bone Marrow Donor Registry,(CS2) Czech National Marrow Donor Registry,(CSCR) Czech Stem Cells Registry,(CY) Cyprus Paraskevaidio Bone Marrow Donor Registry,(CY2) The Cyprus Bone Marrow Donor Registry,(D) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Adult Donors,(DCB) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Cord Blood,(DK) The Danish Bone Marrow Donor Registry,(DK2) Bone Marrow Donors Copenhagen (BMDC),(DUCB) German Branch of the European Cord Blood Bank,(E) REDMO,(ECB) Spanish Cord Blood Registry,(F) France Greffe de Moelle - Adult Donors,(FCB) France Greffe de Moelle - Cord Blood,(FI) Finnish Bone Marrow Donor Registry,(FICB) Finnish Cord Blood Registry,(GB) The Anthony Nolan Trust,(GB3) Welsh Bone Marrow Donor Registry,(GB4) British Bone Marrow Registry,(GR) Unrelated Hematopoietic Stem Cell Donor Registry Greece,(GRCB) Michigan Community Blood Centers Cord Blood Bank,(H) Hungarian Bone Marrow Donor Registry,(HEM) Hema-Quebec,(HK) Hong Kong Bone Marrow Donor Registry,(HR) Croatian Bone Marrow Donor Registry,(I) Italian Bone Marrow Donor Registry,(I3CB) Sheba Medical Centre Cord Blood Registry,(ICB) Italian Cord Blood Bank Network,(IL) Hadassah BMDR,(IL2) Ezer Mizion Bone Marrow Donor Registry,(IL3) Sheba Medical Center Donor Registry,(ILCB) Isreal Cord Blood Bank,(IN) Asian Indian Donor Marrow Registry,(IN2) Dept. of Transfusion Medicine,(IRL) The Irish Unrelated Bone Marrow Panel,(JP) Japan Marrow Donor Program,(KR) Korea Marrow Donor Program,(LT) Lithuanian National Bone Marrow Donor Registry,(LVCB) Leuven Cord Blood Bank,(MACB) Victoria Angel Registry of Hope,(MX) Mexican Bone Marrow Donor Registry,(N) The Norwegian Bone Marrow Donor Registry,(NL) Europdonor Foundation- Adult Donors,(NLCB) Europdonor Foundation - Cord Blood,(NYCB) National Cord Blood Program, New York Blood Center,(OTH) Other Registry,(P) Portuguese Bone Marrow Donors Registry,(PL) National Polish Bone Marrow Registry,(PL2) Unrelated Bone Marrow Donor Registry -Adult Donors,(PL3) Against Leukemia Foundation Marrow Donor Registry,(PL4) Ursula Jaworska Foundation - Bone Marrow Donor Registry,(PL5) Polish Central Bone Marrow Donor Registry - Adult Donors,(PMCB) Elie Katz Umbilical Cord Blood Program,(R) Russian Bone Marrow Donor Registry,(R2) Karelian Registry of Unrelated Donors of Hematopoietic Stem Cells,(S) Tobias Registry of Swedish Bone Marrow Donors,(SG) Singapore Bone Marrow Donor Programme (BMDP),(SK) Slovak National Bone Marrow Donor Registry,(SKCB) Eurocord Slovakia / Slovak Pacental Stem Cell Registry,(SLCBB) St Louis Cord Blood Bank,(SLO) Slovenia Donor,(SM) San Marino Bone Marrow Donor Registry,(T1CB) TRAN - Cord Blood,(TACB) StemCyte, Inc. Taiwan,(TECB) Healthbanks Biotech, Co., Ltd,(TH) Thai Stem Cell Donor Registry (TSCDR),(TOCB) Tokyo Cord Blood Bank,(TPCB) BIONET / BabyBanks,(TRAN) TRAN - Adult Donors,(TRIS) Bone Marrow Bank of Istanbul Medical Faculty,(TW) Buddhist Tzu Chi Stem Cells Center - Adult Donors,(TWCB) Buddhist Tzu Chi Stem Cells Center - Cord Blood,(U1CB) National Marrow Donor Program - Cord Blood,(USA1) National Marrow Donor Program - Adult Donors,(USA2) America Bone Marrow Donor Registry,(UY) SINDOME,(VIAC) Viacord,(W3CB) Polish Central Bone Marrow Donor Registry - Cord Blood,(WACB) Unrelated Bone Marrow Donor Registry - Cord Blood,(ZA) South African Bone Marrow Registry
Registry or UCB Bank ID (A) Austrian Bone Marrow Donors,(ACB) Austrian Cord Blood Registry,(ACCB) StemCyte, Inc,(AE) Emirates Bone Marrow Donor Registry,(AM) Armenian Bone Marrow Donor Registry Charitable Trust,(AOCB) University of Colorado Cord Blood Bank,(AR) Argentine CPH Donors Registry,(ARCB) BANCEL - Argentina Cord Blood Bank,(AUCB) Australian Cord Blood Registry,(AUS) Australian / New Zealand Bone Marrow Donor Registry,(B) Marrow Donor Program Belgium,(BCB) Belgium Cord Blood Registry,(BG) Bulgarian Bone Marrow Donor Registry,(BR) INCA/REDOMO,(BSCB) British Bone Marrow Registry - Cord Blood,(CB) Cord Blood Registry,(CH) Swiss BloodStem Cells - Adult Donors,(CHCB) Swiss Blood Stem Cells - Cord Blood,(CKCB) Celgene Cord Blood Bank,(CN) China Marrow Donor Program (CMDP),(CNCB) Shan Dong Cord Blood Bank,(CND) Canadian Blood Services Bone Marrow Donor Registry,(CS2) Czech National Marrow Donor Registry,(CSCR) Czech Stem Cells Registry,(CY) Cyprus Paraskevaidio Bone Marrow Donor Registry,(CY2) The Cyprus Bone Marrow Donor Registry,(D) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Adult Donors,(DCB) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Cord Blood,(DK) The Danish Bone Marrow Donor Registry,(DK2) Bone Marrow Donors Copenhagen (BMDC),(DUCB) German Branch of the European Cord Blood Bank,(E) REDMO,(ECB) Spanish Cord Blood Registry,(F) France Greffe de Moelle - Adult Donors,(FCB) France Greffe de Moelle - Cord Blood,(FI) Finnish Bone Marrow Donor Registry,(FICB) Finnish Cord Blood Registry,(GB) The Anthony Nolan Trust,(GB3) Welsh Bone Marrow Donor Registry,(GB4) British Bone Marrow Registry,(GR) Unrelated Hematopoietic Stem Cell Donor Registry Greece,(GRCB) Michigan Community Blood Centers Cord Blood Bank,(H) Hungarian Bone Marrow Donor Registry,(HEM) Hema-Quebec,(HK) Hong Kong Bone Marrow Donor Registry,(HR) Croatian Bone Marrow Donor Registry,(I) Italian Bone Marrow Donor Registry,(I3CB) Sheba Medical Centre Cord Blood Registry,(ICB) Italian Cord Blood Bank Network,(IL) Hadassah BMDR,(IL2) Ezer Mizion Bone Marrow Donor Registry,(IL3) Sheba Medical Center Donor Registry,(ILCB) Isreal Cord Blood Bank,(IN) Asian Indian Donor Marrow Registry,(IN2) Dept. of Transfusion Medicine,(IRL) The Irish Unrelated Bone Marrow Panel,(JP) Japan Marrow Donor Program,(KR) Korea Marrow Donor Program,(LT) Lithuanian National Bone Marrow Donor Registry,(LVCB) Leuven Cord Blood Bank,(MACB) Victoria Angel Registry of Hope,(MX) Mexican Bone Marrow Donor Registry,(N) The Norwegian Bone Marrow Donor Registry,(NL) Europdonor Foundation- Adult Donors,(NLCB) Europdonor Foundation - Cord Blood,(NYCB) National Cord Blood Program, New York Blood Center,(OTH) Other Registry,(P) Portuguese Bone Marrow Donors Registry,(PL) National Polish Bone Marrow Registry,(PL2) Unrelated Bone Marrow Donor Registry -Adult Donors,(PL3) Against Leukemia Foundation Marrow Donor Registry,(PL4) Ursula Jaworska Foundation - Bone Marrow Donor Registry,(PL5) Polish Central Bone Marrow Donor Registry - Adult Donors,(PMCB) Elie Katz Umbilical Cord Blood Program,(R) Russian Bone Marrow Donor Registry,(R2) Karelian Registry of Unrelated Donors of Hematopoietic Stem Cells,(S) Tobias Registry of Swedish Bone Marrow Donors,(SG) Singapore Bone Marrow Donor Programme (BMDP),(SK) Slovak National Bone Marrow Donor Registry,(SKCB) Eurocord Slovakia / Slovak Pacental Stem Cell Registry,(SLCBB) St Louis Cord Blood Bank,(SLO) Slovenia Donor,(SM) San Marino Bone Marrow Donor Registry,(T1CB) TRAN - Cord Blood,(TACB) StemCyte, Inc. Taiwan,(TECB) Healthbanks Biotech, Co., Ltd,(TH) Thai Stem Cell Donor Registry (TSCDR),(TOCB) Tokyo Cord Blood Bank,(TPCB) BIONET / BabyBanks,(TRAN) TRAN - Adult Donors,(TRIS) Bone Marrow Bank of Istanbul Medical Faculty,(TW) Buddhist Tzu Chi Stem Cells Center - Adult Donors,(TWCB) Buddhist Tzu Chi Stem Cells Center - Cord Blood,(U1CB) National Marrow Donor Program - Cord Blood,(USA1) National Marrow Donor Program - Adult Donors,(USA2) America Bone Marrow Donor Registry,(UY) SINDOME,(VIAC) Viacord,(W3CB) Polish Central Bone Marrow Donor Registry - Cord Blood,(WACB) Unrelated Bone Marrow Donor Registry - Cord Blood,(ZA) South African Bone Marrow Registry
PRO109 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Donor DOB: YYYY/MM/DD
Donor DOB: YYYY/MM/DD
PRO110 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Donor age: open text, check "Months" or check "Years"
Donor age: open text, check "Months" or check "Years"
PRO111 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Donor sex open text, check "Months" or check "Years"
Donor sex open text, check "Months" or check "Years"
PRO112 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product Allogeneic Donors yes no Did the donor receive growth and mobilizing factors, prior to any stem cell harvest, to enhance the product collection for this HCT? No,Yes
Did the donor receive growth and mobilizing factors, prior to any stem cell harvest, to enhance the product collection for this HCT? No,Yes












PRO114 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product Allogeneic Donors yes no Specify other growth or mobilizing factor(s): open text
Specify other growth or mobilizing factor(s): open text
PRO115 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Date of first collection for this mobilization: YYYY/MM/DD
Date of first collection for this mobilization: YYYY/MM/DD
PRO116 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Were anticoagulants or other agents added to the product between collection and infusion? No,Yes
Were anticoagulants or other agents added to the product between collection and infusion? No,Yes
PRO117 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Specify anticoagulant(s) or other agents (check all that apply) Acid citrate dextrose (ACD, ACD-A), Citrate phosphate dextrose (CPD, CPD-A), Ethylenediaminetetraacetic acid (EDTA), Heparin, Other agent
Specify anticoagulant(s) or other agents (check all that apply) Acid citrate dextrose (ACD, ACD-A), Citrate phosphate dextrose (CPD, CPD-A), Ethylenediaminetetraacetic acid (EDTA), Heparin, Other agent
PRO118 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Specify other agent: open text
Specify other agent: open text
PRO119 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Was this product collected off-site and shipped to your facility? no,yes
Was this product collected off-site and shipped to your facility? no,yes
PRO120 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Date of receipt of product at your facility: YYYY/MM/DD
Date of receipt of product at your facility: YYYY/MM/DD
PRO121 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Time of receipt of product (24-hour clock): Hour:Minute Check standard time or check daylight savings
Time of receipt of product (24-hour clock): Hour:Minute Check standard time or check daylight savings
PRO122 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Specify the shipping environment of the product(s) Room temperature, Cooled (refrigerator temperature, not frozen), Frozen (cyropreserved), Other shipping enfivronment
Specify the shipping environment of the product(s) Room temperature, Cooled (refrigerated gel pack, refrigerator temperature, not frozen), Frozen (cyropreserved), Other shipping enfivronment
PRO123 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Specify other shipping environment: open text
Specify other shipping environment: open text
PRO124 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Was there any indication that the environment within the shipper was outside the expected temperature range for this product at any time during shipment? no,yes
Was there any indication that the environment within the shipper was outside the expected temperature range for this product at any time during shipment? no,yes
PRO125 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Were the secondary containers (e.g., insulated shipping containers and unit cassette) intact when they arrived at your center? no,yes
Were the secondary containers (e.g., insulated shipping containers and unit cassette) intact when they arrived at your center? no,yes
PRO126 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product Cord Blood Product Infusion yes no Was the cord blood unit stored at your center prior to thawing? no,yes
Was the cord blood unit stored at your center prior to thawing? no,yes
PRO127 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product Cord Blood Product Infusion yes no Specify the storage method used for the cord blood unit Electric freezer,Liquid nitrogen,Vapor phase
Specify the storage method used for the cord blood unit Electric freezer,Liquid nitrogen,Vapor phase
PRO128 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product Cord Blood Product Infusion yes no Temperature during storage < -150 0C , > -150 0C to < -135 0C , > -135 0C to < -80 0C, > -80 0C
Temperature during storage < -150 0C , > -150 0C to < -135 0C , > -135 0C to < -80 0C, > -80 0C
PRO129 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Date storage started: YYYY/MM/DD
Date storage started: YYYY/MM/DD
PRO130 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product Cord Blood Product Infusion yes no Total nucleated cells: (Includes nucleated red and nucleated white cells) _ _ _ _ . __ __ x 10 __ __ (Includes nucleated red and nucleated white cells) (Cord blood units only)
Total nucleated cells: (Includes nucleated red and nucleated white cells) _ _ _ _ . __ __ x 10 __ __ (Includes nucleated red and nucleated white cells) (Cord blood units only)
PRO131 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product Cord Blood Product Infusion yes no CD34+ cells Done,Not done
CD34+ cells Done,Not done
PRO132 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product Cord Blood Product Infusion yes no Total number of CD34+ cells: _ _ _ _ . __ __ x 10 __ __
Total number of CD34+ cells: _ _ _ _ . __ __ x 10 __ __
PRO133 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Was the product thawed from a cryopreserved state prior to infusion? no,yes
Was the product thawed from a cryopreserved state prior to infusion? no,yes
PRO134 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Was the entire product thawed? no,yes
Was the entire product thawed? no,yes
PRO135 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product Cord Blood Product Infusion yes no Specify the percent of the product that was thawed? (Cord Blood units only) 20%,80%,Other percent
Specify the percent of the product that was thawed? (Cord Blood units only) 20%,80%,Other percent
PRO136 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product Cord Blood Product Infusion yes no Specify other percent: _ _%
Specify other percent: _ _%
PRO137 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Date thawing process initiated: YYYY/MM/DD
Date thawing process initiated: YYYY/MM/DD
PRO138 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Time at initiation of thaw (24-hour clock): Hour:Minute Check "standard time" or "check daylight savings time"
Time at initiation of thaw (24-hour clock): Hour:Minute Check "standard time" or "check daylight savings time"
PRO139 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Time of thaw completion: Hour:Minute Check "standard time" or "check daylight savings time"
Time of thaw completion: Hour:Minute Check "standard time" or "check daylight savings time"
PRO140 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no What method was used to thaw the product? Electric warmer,Other method,Waterbath
What method was used to thaw the product? Electric warmer,Other method,Waterbath
PRO141 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Specify other method: open text
Specify other method: open text
PRO142 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Did any incidents or product complaints occur while preparing or thawing the product? No,Yes
Did any incidents or product complaints occur while preparing or thawing the product? No,Yes
PRO143 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Was the product processed prior to infusion? No,Yes
Was the product processed prior to infusion? No,Yes
PRO144 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Specify processing (check all that apply) Buffy coat enriched (buffy coat preparation) ,Diluted,Plasma reduced,RBC reduced,Washed
Specify processing (check all that apply) Buffy coat enriched (buffy coat preparation) ,Diluted,Plasma reduced,RBC reduced,Washed
PRO145 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Was the product manipulated prior to infusion? no,yes
Was the product manipulated prior to infusion? no,yes
PRO146 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Specify manipulations performed (check all that apply) CD34 enriched (CD34+ selection), Ex-vivo expansion, Ex-vivo T-cell depetion, Genetic manipulation (gene transfer / transuction), Other cell manipulation
Specify manipulations performed (check all that apply) CD34 enriched (CD34+ selection), Ex-vivo expansion, Ex-vivo T-cell depetion, Genetic manipulation (gene transfer / transuction), Other cell manipulation
PRO147 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Specify antibodies used (check all that apply) Alpha/beta antibody,Anti CD19,Anti CD3,Anti CD4,Anti CD45RA,Anti CD52,Anti CD8,Other antibody
Specify antibodies used (check all that apply) Alpha/beta antibody,Anti CD19,Anti CD3,Anti CD4,Anti CD45RA,Anti CD52,Anti CD8,Other antibody
PRO148 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Specify other antibody: open text
Specify other antibody: open text
PRO149 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Specify T-cell depletion method Antibody affinity column,Immunomagnetic beads,Other Method
Specify T-cell depletion method Antibody affinity column,Immunomagnetic beads,Other Method
PRO150 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Specify other method: open text
Specify other method: open text
PRO151 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no no Specify other cell manipulation: open text
Specify other cell manipulation: open text
PRO152 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Specify the timepoint in the product preparation phase that the product was analyzed Product arrival (cord blood only) , At infusion (final quantity infused)
Specify the timepoint in the product preparation phase that the product was analyzed Product arrival (cord blood only) , At infusion (final quantity infused)
PRO153 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Date of product analysis: YYYY/MM/DD
Date of product analysis: YYYY/MM/DD
PRO154 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Total volume of product plus additives: _ _ _ _ _ . _ ml
Total volume of product plus additives: _ _ _ _ _ . _ ml
PRO155 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Total nucleated cells (TNC) Done,Not done
Total nucleated cells (TNC) Done,Not done
PRO156 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Total nucleated cells: _ _ _ _ . __ __ x 10 __ __
Total nucleated cells: _ _ _ _ . __ __ x 10 __ __
PRO157 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Viability of TNC Done,Not done,Unknown
Viability of TNC Done,Not done,Unknown
PRO158 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Viability of TNC: _ _ _ %
Viability of TNC: _ _ _ %
PRO159 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Method of testing TNC viability Flow cytometry based,Other method,Trypan blue
Method of testing TNC viability Flow cytometry based (7AAD, AOPI, AOEB),Other method,Trypan blue
PRO160 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Specify other method: open text
Specify other method: open text
PRO161 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Nucleated white blood cells Done,Not done
Nucleated white blood cells Done,Not done
PRO162 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Total number of nucleated white blood cells: _ _ _ _ . __ __ x 10 __ __
Total number of nucleated white blood cells: _ _ _ _ . __ __ x 10 __ __
PRO163 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Mononuclear cells Done,Not done
Mononuclear cells Done,Not done
PRO164 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Total number of mononuclear cells: _ _ _ _ . __ __ x 10 __ __
Total number of mononuclear cells: _ _ _ _ . __ __ x 10 __ __
PRO165 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Nucleated red blood cells Done,Not done
Nucleated red blood cells Done,Not done
PRO166 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Total number of nucleated red blood cells: _ _ _ _ . __ __ x 10 __ __
Total number of nucleated red blood cells: _ _ _ _ . __ __ x 10 __ __
PRO167 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes CD34+ cells Done,Not done
CD34+ cells Done,Not done
PRO168 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Total number of CD34+ cells: _ _ _ _ . __ __ x 10 __ __
Total number of CD34+ cells: _ _ _ _ . __ __ x 10 __ __
PRO169 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Viability of CD34+ cells Done,Not done,Unknown
Viability of CD34+ cells Done,Not done,Unknown
PRO170 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Viability of CD34+ cells: _ _ _%
Viability of CD34+ cells: _ _ _%
PRO171 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Method of testing CD34+ cell viability Flow cytometry based,Other method,Trypan blue
Method of testing CD34+ cell viability Flow cytometry based (7AAD, AOPI, AOEB), Other method,Trypan blue
PRO172 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Specify other method: open text
Specify other method: open text
PRO173 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes CD3+ cells Done,Not done
CD3+ cells Done,Not done
PRO174 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Viability of CD3+ cells Done,Not done,Unknown
Viability of CD3+ cells Done,Not done,Unknown
PRO175 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Total number of CD3+ cells: _ _ _ _ . __ __ x 10 __ __
Total number of CD3+ cells: _ _ _ _ . __ __ x 10 __ __
PRO176 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Viability of CD3+ cells: _ _ _%
Viability of CD3+ cells: _ _ _%
PRO177 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Method of testing CD3+ cell viability Flow cytometry based,Other method,Trypan blue
Method of testing CD3+ cell viability Flow cytometry based (7AAD, AOPI, AOEB), Other method,Trypan blue
PRO178 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Specify other method: open text
Specify other method: open text
PRO179 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes CD3+CD4+ cells Done,Not done
CD3+CD4+ cells Done,Not done
PRO180 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Total number of CD3+CD4+ cells: _ _ _ _ . __ __ x 10 __ __
Total number of CD3+CD4+ cells: _ _ _ _ . __ __ x 10 __ __
PRO181 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Viability of CD3+CD4+ cells Done,Not done,Unknown
Viability of CD3+CD4+ cells Done,Not done,Unknown
PRO182 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Viability of CD3+CD4+ cells: _ _ _%
Viability of CD3+CD4+ cells: _ _ _%
PRO183 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Method of testing CD3+CD4+ cell viability Flow cytometry based,Other method,Trypan blue
Method of testing CD3+CD4+ cell viability Flow cytometry based (7AAD, AOPI, AOEB), Other method,Trypan blue
PRO184 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Specify other method: open text
Specify other method: open text
PRO185 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes CD3+CD8+ cells Done,Not done
CD3+CD8+ cells Done,Not done
PRO186 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Total number of CD3+CD8+ cells: _ _ _ _ *_ _ x 10 _ _
Total number of CD3+CD8+ cells: _ _ _ _ *_ _ x 10 _ _
PRO187 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Viability of CD3+CD8+ cells Done,Not done,Unknown
Viability of CD3+CD8+ cells Done,Not done,Unknown
PRO188 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Viability of CD3+CD8+ cells: _ _ _%
Viability of CD3+CD8+ cells: _ _ _%
PRO189 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Method of testing CD3+CD8+ cell viability Flow cytometry based,Other method,Trypan blue
Method of testing CD3+CD8+ cell viability Flow cytometry based (7AAD, AOPI, AOEB), Other method,Trypan blue
PRO190 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Infusion Product
no yes Specify other method: open text
Specify other method: open text
PRO191 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes yes Were the colony-forming units (CFU) assessed after thawing? (cord blood units only) no,yes
Were the colony-forming units (CFU) assessed after thawing? (cord blood units only) no,yes
PRO192 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes yes Was there growth? no,yes
Was there growth? no,yes
PRO193 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes yes Total CFU-GM Done,Not done
Indicate which Assessments were Carried out (Check all that apply) Total CFU-GM, Total CFU-GEMM, Total BFU-E
PRO194 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes yes Total CFU-GM: _ _ _ _ _.__x10__ __
Total CFU-GM: _ _ _ _ _.__x10__ __
PRO195 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes yes Total CFU-GEMM: _ _ _ _ _.__x10__ __
Total CFU-GEMM: _ _ _ _ _.__x10__ __
PRO196 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes yes Total BFU-E: _ _ _ _ _.__x10__ __
Total BFU-E: _ _ _ _ _.__x10__ __
PRO197 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion
no yes Were any positive cultures (for bacterial or fungal infections) obtained from the product at the transplant center? (complete for all cell products) No,Pending,Unknown,Yes
Were any positive cultures (for bacterial or fungal infections) obtained from the product at the transplant center? (complete for all cell products) No,Pending,Unknown,Yes
PRO198 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Product Analysis yes yes Specify Organism Code(s): Bacterial Infections: 121 inetobacter (all species), 125 Bordetella pertussis (whooping cough), 128 Campylobacter (all species), 129 Capnocytophaga (all species), 171 Chlamydia (pneumoniae), 130 Citrobacter (freundii, other species), 131 Clostridium (all species except difficile), 132 Clostridium difficile, 173 Corynebacterium jeikeium, 134 Enterobacter (all species), 135 Enterococcus (all species), 177 Enterococcus, vancomycin resistant (VRE), 136 Escherichia (also E. coli), 139 Fusobacterium (all species), 187 Haemophilus influenzae, 188 Haemophilus non-influenzae, 146 Klebsiella (all species), 147 Lactobacillus (bulgaricus, acidophilus, other species), 189 Legionella pneumophila, 190 Legionella non-pneumophila, 103 Leptospira (all species), 148 Leptotrichia buccalis, 149 Leuconostoc (all species), 104 Listeria monocytogenes, 151 Micrococcus, NOS, 118 Mycobacterium abscessus, 112 Mycobacterium avium - intracellulare (MAC, MAI), 108 Mycobacterium cheloneae, 109 Mycobacterium fortuitum, 114 Mycobacterium haemophilum, 115 Mycobacterium kansasii, 116 Mycobacterium marinum, 117 Mycobacterium mucogenicum, 110 Mycobacterium tuberculosis (tuberculosis, Koch bacillus), 105 Mycoplasma (all species), 183 Neisseria gonorrhoeae, 184 Neisseria meningitidis, 106 Nocardia (all species), 153 Pasteurella multocida, 155 Proteus (all species), 157 Pseudomonas or Burkholderia cepacia, 185 Pseudomonas aeruginosa, 186 Pseudomonas non-aeruginosa, 159 Rhodococcus (all species), 107 Rickettsia (all species), 160 Salmonella (all species), 161 Serratia marcescens,162 Shigella (all species), 180 Staphylococcus aureus (Methacillin Resistant), 179 Staphylococcus aureus (Methacillin Sensitive), 158 Stenotrophomonas maltophilia, 166 Stomatococcus mucilaginosis, 181 Streptococcus, alpha-hemolytic, 182 Streptococcus, Group B, 178 Streptococcus pneumoniae, 168 Treponema (syphilis), 169 Vibrio (all species) Fungal Infections: 210 Aspergillus, NOS, 211 Aspergillus flavus, 212 Aspergillus fumigatus, 213 Aspergillus niger, 215 Aspergillus terreus, 214 Aspergillus ustus, 270 Blastomyces (dermatitidis), 201 Candida albicans, 208 Candida non-albicans, 271 Coccidioides (all species), 222 Cryptococcus gattii, 221 Cryptococcus neoformans, 230 Fusarium (all species), 261 Histoplasma (capsulatum), 241 Mucorales (all species), 260 Pneumocystis (PCP / PJP), 242 Rhizopus (all species), 272 Scedosporium (all species), 240 Zygomycetes, NOS, 503 Suspected fungal infection, 777 Other organism
Specify Organism Code(s): Bacterial Infections: 121 inetobacter (all species), 125 Bordetella pertussis (whooping cough), 128 Campylobacter (all species), 129 Capnocytophaga (all species), 171 Chlamydia (pneumoniae), 130 Citrobacter (freundii, other species), 131 Clostridium (all species except difficile), 132 Clostridium difficile, 173 Corynebacterium jeikeium, 134 Enterobacter (all species), 135 Enterococcus (all species), 177 Enterococcus, vancomycin resistant (VRE), 136 Escherichia (also E. coli), 139 Fusobacterium (all species), 187 Haemophilus influenzae, 188 Haemophilus non-influenzae, 146 Klebsiella (all species), 147 Lactobacillus (bulgaricus, acidophilus, other species), 189 Legionella pneumophila, 190 Legionella non-pneumophila, 103 Leptospira (all species), 148 Leptotrichia buccalis, 149 Leuconostoc (all species), 104 Listeria monocytogenes, 151 Micrococcus, NOS, 118 Mycobacterium abscessus, 112 Mycobacterium avium - intracellulare (MAC, MAI), 108 Mycobacterium cheloneae, 109 Mycobacterium fortuitum, 114 Mycobacterium haemophilum, 115 Mycobacterium kansasii, 116 Mycobacterium marinum, 117 Mycobacterium mucogenicum, 110 Mycobacterium tuberculosis (tuberculosis, Koch bacillus), 105 Mycoplasma (all species), 183 Neisseria gonorrhoeae, 184 Neisseria meningitidis, 106 Nocardia (all species), 153 Pasteurella multocida, 155 Proteus (all species), 157 Pseudomonas or Burkholderia cepacia, 185 Pseudomonas aeruginosa, 186 Pseudomonas non-aeruginosa, 159 Rhodococcus (all species), 107 Rickettsia (all species), 160 Salmonella (all species), 161 Serratia marcescens,162 Shigella (all species), 180 Staphylococcus aureus (Methicillin Resistant), 179 Staphylococcus aureus (Methicillin Sensitive), 158 Stenotrophomonas maltophilia, 166 Stomatococcus mucilaginosis, 181 Streptococcus, alpha-hemolytic, 182 Streptococcus, Group B, 178 Streptococcus pneumoniae, 168 Treponema (syphilis), 169 Vibrio (all species) Fungal Infections: 210 Aspergillus, NOS, 211 Aspergillus flavus, 212 Aspergillus fumigatus, 213 Aspergillus niger, 215 Aspergillus terreus, 214 Aspergillus ustus, 270 Blastomyces (dermatitidis), 201 Candida albicans, 208 Candida non-albicans, 271 Coccidioides (all species), 222 Cryptococcus gattii, 221 Cryptococcus neoformans, 230 Fusarium (all species), 261 Histoplasma (capsulatum), 241 Mucorales (all species), 260 Pneumocystis (PCP / PJP), 242 Rhizopus (all species), 272 Scedosporium (all species), 240 Zygomycetes, NOS, 503 Suspected fungal infection, 777 Other organism
PRO199 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Product Analysis yes yes Specify Organism Code(s): Bacterial Infections: 121 inetobacter (all species), 125 Bordetella pertussis (whooping cough), 128 Campylobacter (all species), 129 Capnocytophaga (all species), 171 Chlamydia (pneumoniae), 130 Citrobacter (freundii, other species), 131 Clostridium (all species except difficile), 132 Clostridium difficile, 173 Corynebacterium jeikeium, 134 Enterobacter (all species), 135 Enterococcus (all species), 177 Enterococcus, vancomycin resistant (VRE), 136 Escherichia (also E. coli), 139 Fusobacterium (all species), 187 Haemophilus influenzae, 188 Haemophilus non-influenzae, 146 Klebsiella (all species), 147 Lactobacillus (bulgaricus, acidophilus, other species), 189 Legionella pneumophila, 190 Legionella non-pneumophila, 103 Leptospira (all species), 148 Leptotrichia buccalis, 149 Leuconostoc (all species), 104 Listeria monocytogenes, 151 Micrococcus, NOS, 118 Mycobacterium abscessus, 112 Mycobacterium avium - intracellulare (MAC, MAI), 108 Mycobacterium cheloneae, 109 Mycobacterium fortuitum, 114 Mycobacterium haemophilum, 115 Mycobacterium kansasii, 116 Mycobacterium marinum, 117 Mycobacterium mucogenicum, 110 Mycobacterium tuberculosis (tuberculosis, Koch bacillus), 105 Mycoplasma (all species), 183 Neisseria gonorrhoeae, 184 Neisseria meningitidis, 106 Nocardia (all species), 153 Pasteurella multocida, 155 Proteus (all species), 157 Pseudomonas or Burkholderia cepacia, 185 Pseudomonas aeruginosa, 186 Pseudomonas non-aeruginosa, 159 Rhodococcus (all species), 107 Rickettsia (all species), 160 Salmonella (all species), 161 Serratia marcescens,162 Shigella (all species), 180 Staphylococcus aureus (Methacillin Resistant), 179 Staphylococcus aureus (Methacillin Sensitive), 158 Stenotrophomonas maltophilia, 166 Stomatococcus mucilaginosis, 181 Streptococcus, alpha-hemolytic, 182 Streptococcus, Group B, 178 Streptococcus pneumoniae, 168 Treponema (syphilis), 169 Vibrio (all species) Fungal Infections: 210 Aspergillus, NOS, 211 Aspergillus flavus, 212 Aspergillus fumigatus, 213 Aspergillus niger, 215 Aspergillus terreus, 214 Aspergillus ustus, 270 Blastomyces (dermatitidis), 201 Candida albicans, 208 Candida non-albicans, 271 Coccidioides (all species), 222 Cryptococcus gattii, 221 Cryptococcus neoformans, 230 Fusarium (all species), 261 Histoplasma (capsulatum), 241 Mucorales (all species), 260 Pneumocystis (PCP / PJP), 242 Rhizopus (all species), 272 Scedosporium (all species), 240 Zygomycetes, NOS, 503 Suspected fungal infection, 777 Other organism
Specify Organism Code(s): Bacterial Infections: 121 inetobacter (all species), 125 Bordetella pertussis (whooping cough), 128 Campylobacter (all species), 129 Capnocytophaga (all species), 171 Chlamydia (pneumoniae), 130 Citrobacter (freundii, other species), 131 Clostridium (all species except difficile), 132 Clostridium difficile, 173 Corynebacterium jeikeium, 134 Enterobacter (all species), 135 Enterococcus (all species), 177 Enterococcus, vancomycin resistant (VRE), 136 Escherichia (also E. coli), 139 Fusobacterium (all species), 187 Haemophilus influenzae, 188 Haemophilus non-influenzae, 146 Klebsiella (all species), 147 Lactobacillus (bulgaricus, acidophilus, other species), 189 Legionella pneumophila, 190 Legionella non-pneumophila, 103 Leptospira (all species), 148 Leptotrichia buccalis, 149 Leuconostoc (all species), 104 Listeria monocytogenes, 151 Micrococcus, NOS, 118 Mycobacterium abscessus, 112 Mycobacterium avium - intracellulare (MAC, MAI), 108 Mycobacterium cheloneae, 109 Mycobacterium fortuitum, 114 Mycobacterium haemophilum, 115 Mycobacterium kansasii, 116 Mycobacterium marinum, 117 Mycobacterium mucogenicum, 110 Mycobacterium tuberculosis (tuberculosis, Koch bacillus), 105 Mycoplasma (all species), 183 Neisseria gonorrhoeae, 184 Neisseria meningitidis, 106 Nocardia (all species), 153 Pasteurella multocida, 155 Proteus (all species), 157 Pseudomonas or Burkholderia cepacia, 185 Pseudomonas aeruginosa, 186 Pseudomonas non-aeruginosa, 159 Rhodococcus (all species), 107 Rickettsia (all species), 160 Salmonella (all species), 161 Serratia marcescens,162 Shigella (all species), 180 Staphylococcus aureus (Methicillin Resistant), 179 Staphylococcus aureus (Methicillin Sensitive), 158 Stenotrophomonas maltophilia, 166 Stomatococcus mucilaginosis, 181 Streptococcus, alpha-hemolytic, 182 Streptococcus, Group B, 178 Streptococcus pneumoniae, 168 Treponema (syphilis), 169 Vibrio (all species) Fungal Infections: 210 Aspergillus, NOS, 211 Aspergillus flavus, 212 Aspergillus fumigatus, 213 Aspergillus niger, 215 Aspergillus terreus, 214 Aspergillus ustus, 270 Blastomyces (dermatitidis), 201 Candida albicans, 208 Candida non-albicans, 271 Coccidioides (all species), 222 Cryptococcus gattii, 221 Cryptococcus neoformans, 230 Fusarium (all species), 261 Histoplasma (capsulatum), 241 Mucorales (all species), 260 Pneumocystis (PCP / PJP), 242 Rhizopus (all species), 272 Scedosporium (all species), 240 Zygomycetes, NOS, 503 Suspected fungal infection, 777 Other organism
PRO200 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Product Analysis yes yes Specify Organism Code(s): Bacterial Infections: 121 inetobacter (all species), 125 Bordetella pertussis (whooping cough), 128 Campylobacter (all species), 129 Capnocytophaga (all species), 171 Chlamydia (pneumoniae), 130 Citrobacter (freundii, other species), 131 Clostridium (all species except difficile), 132 Clostridium difficile, 173 Corynebacterium jeikeium, 134 Enterobacter (all species), 135 Enterococcus (all species), 177 Enterococcus, vancomycin resistant (VRE), 136 Escherichia (also E. coli), 139 Fusobacterium (all species), 187 Haemophilus influenzae, 188 Haemophilus non-influenzae, 146 Klebsiella (all species), 147 Lactobacillus (bulgaricus, acidophilus, other species), 189 Legionella pneumophila, 190 Legionella non-pneumophila, 103 Leptospira (all species), 148 Leptotrichia buccalis, 149 Leuconostoc (all species), 104 Listeria monocytogenes, 151 Micrococcus, NOS, 118 Mycobacterium abscessus, 112 Mycobacterium avium - intracellulare (MAC, MAI), 108 Mycobacterium cheloneae, 109 Mycobacterium fortuitum, 114 Mycobacterium haemophilum, 115 Mycobacterium kansasii, 116 Mycobacterium marinum, 117 Mycobacterium mucogenicum, 110 Mycobacterium tuberculosis (tuberculosis, Koch bacillus), 105 Mycoplasma (all species), 183 Neisseria gonorrhoeae, 184 Neisseria meningitidis, 106 Nocardia (all species), 153 Pasteurella multocida, 155 Proteus (all species), 157 Pseudomonas or Burkholderia cepacia, 185 Pseudomonas aeruginosa, 186 Pseudomonas non-aeruginosa, 159 Rhodococcus (all species), 107 Rickettsia (all species), 160 Salmonella (all species), 161 Serratia marcescens,162 Shigella (all species), 180 Staphylococcus aureus (Methacillin Resistant), 179 Staphylococcus aureus (Methacillin Sensitive), 158 Stenotrophomonas maltophilia, 166 Stomatococcus mucilaginosis, 181 Streptococcus, alpha-hemolytic, 182 Streptococcus, Group B, 178 Streptococcus pneumoniae, 168 Treponema (syphilis), 169 Vibrio (all species) Fungal Infections: 210 Aspergillus, NOS, 211 Aspergillus flavus, 212 Aspergillus fumigatus, 213 Aspergillus niger, 215 Aspergillus terreus, 214 Aspergillus ustus, 270 Blastomyces (dermatitidis), 201 Candida albicans, 208 Candida non-albicans, 271 Coccidioides (all species), 222 Cryptococcus gattii, 221 Cryptococcus neoformans, 230 Fusarium (all species), 261 Histoplasma (capsulatum), 241 Mucorales (all species), 260 Pneumocystis (PCP / PJP), 242 Rhizopus (all species), 272 Scedosporium (all species), 240 Zygomycetes, NOS, 503 Suspected fungal infection, 777 Other organism
Specify Organism Code(s): Bacterial Infections: 121 inetobacter (all species), 125 Bordetella pertussis (whooping cough), 128 Campylobacter (all species), 129 Capnocytophaga (all species), 171 Chlamydia (pneumoniae), 130 Citrobacter (freundii, other species), 131 Clostridium (all species except difficile), 132 Clostridium difficile, 173 Corynebacterium jeikeium, 134 Enterobacter (all species), 135 Enterococcus (all species), 177 Enterococcus, vancomycin resistant (VRE), 136 Escherichia (also E. coli), 139 Fusobacterium (all species), 187 Haemophilus influenzae, 188 Haemophilus non-influenzae, 146 Klebsiella (all species), 147 Lactobacillus (bulgaricus, acidophilus, other species), 189 Legionella pneumophila, 190 Legionella non-pneumophila, 103 Leptospira (all species), 148 Leptotrichia buccalis, 149 Leuconostoc (all species), 104 Listeria monocytogenes, 151 Micrococcus, NOS, 118 Mycobacterium abscessus, 112 Mycobacterium avium - intracellulare (MAC, MAI), 108 Mycobacterium cheloneae, 109 Mycobacterium fortuitum, 114 Mycobacterium haemophilum, 115 Mycobacterium kansasii, 116 Mycobacterium marinum, 117 Mycobacterium mucogenicum, 110 Mycobacterium tuberculosis (tuberculosis, Koch bacillus), 105 Mycoplasma (all species), 183 Neisseria gonorrhoeae, 184 Neisseria meningitidis, 106 Nocardia (all species), 153 Pasteurella multocida, 155 Proteus (all species), 157 Pseudomonas or Burkholderia cepacia, 185 Pseudomonas aeruginosa, 186 Pseudomonas non-aeruginosa, 159 Rhodococcus (all species), 107 Rickettsia (all species), 160 Salmonella (all species), 161 Serratia marcescens,162 Shigella (all species), 180 Staphylococcus aureus (Methicillin Resistant), 179 Staphylococcus aureus (Methicillin Sensitive), 158 Stenotrophomonas maltophilia, 166 Stomatococcus mucilaginosis, 181 Streptococcus, alpha-hemolytic, 182 Streptococcus, Group B, 178 Streptococcus pneumoniae, 168 Treponema (syphilis), 169 Vibrio (all species) Fungal Infections: 210 Aspergillus, NOS, 211 Aspergillus flavus, 212 Aspergillus fumigatus, 213 Aspergillus niger, 215 Aspergillus terreus, 214 Aspergillus ustus, 270 Blastomyces (dermatitidis), 201 Candida albicans, 208 Candida non-albicans, 271 Coccidioides (all species), 222 Cryptococcus gattii, 221 Cryptococcus neoformans, 230 Fusarium (all species), 261 Histoplasma (capsulatum), 241 Mucorales (all species), 260 Pneumocystis (PCP / PJP), 242 Rhizopus (all species), 272 Scedosporium (all species), 240 Zygomycetes, NOS, 503 Suspected fungal infection, 777 Other organism
PRO201 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Product Analysis yes yes Specify Organism Code(s): Bacterial Infections: 121 inetobacter (all species), 125 Bordetella pertussis (whooping cough), 128 Campylobacter (all species), 129 Capnocytophaga (all species), 171 Chlamydia (pneumoniae), 130 Citrobacter (freundii, other species), 131 Clostridium (all species except difficile), 132 Clostridium difficile, 173 Corynebacterium jeikeium, 134 Enterobacter (all species), 135 Enterococcus (all species), 177 Enterococcus, vancomycin resistant (VRE), 136 Escherichia (also E. coli), 139 Fusobacterium (all species), 187 Haemophilus influenzae, 188 Haemophilus non-influenzae, 146 Klebsiella (all species), 147 Lactobacillus (bulgaricus, acidophilus, other species), 189 Legionella pneumophila, 190 Legionella non-pneumophila, 103 Leptospira (all species), 148 Leptotrichia buccalis, 149 Leuconostoc (all species), 104 Listeria monocytogenes, 151 Micrococcus, NOS, 118 Mycobacterium abscessus, 112 Mycobacterium avium - intracellulare (MAC, MAI), 108 Mycobacterium cheloneae, 109 Mycobacterium fortuitum, 114 Mycobacterium haemophilum, 115 Mycobacterium kansasii, 116 Mycobacterium marinum, 117 Mycobacterium mucogenicum, 110 Mycobacterium tuberculosis (tuberculosis, Koch bacillus), 105 Mycoplasma (all species), 183 Neisseria gonorrhoeae, 184 Neisseria meningitidis, 106 Nocardia (all species), 153 Pasteurella multocida, 155 Proteus (all species), 157 Pseudomonas or Burkholderia cepacia, 185 Pseudomonas aeruginosa, 186 Pseudomonas non-aeruginosa, 159 Rhodococcus (all species), 107 Rickettsia (all species), 160 Salmonella (all species), 161 Serratia marcescens,162 Shigella (all species), 180 Staphylococcus aureus (Methacillin Resistant), 179 Staphylococcus aureus (Methacillin Sensitive), 158 Stenotrophomonas maltophilia, 166 Stomatococcus mucilaginosis, 181 Streptococcus, alpha-hemolytic, 182 Streptococcus, Group B, 178 Streptococcus pneumoniae, 168 Treponema (syphilis), 169 Vibrio (all species) Fungal Infections: 210 Aspergillus, NOS, 211 Aspergillus flavus, 212 Aspergillus fumigatus, 213 Aspergillus niger, 215 Aspergillus terreus, 214 Aspergillus ustus, 270 Blastomyces (dermatitidis), 201 Candida albicans, 208 Candida non-albicans, 271 Coccidioides (all species), 222 Cryptococcus gattii, 221 Cryptococcus neoformans, 230 Fusarium (all species), 261 Histoplasma (capsulatum), 241 Mucorales (all species), 260 Pneumocystis (PCP / PJP), 242 Rhizopus (all species), 272 Scedosporium (all species), 240 Zygomycetes, NOS, 503 Suspected fungal infection, 777 Other organism
Specify Organism Code(s): Bacterial Infections: 121 inetobacter (all species), 125 Bordetella pertussis (whooping cough), 128 Campylobacter (all species), 129 Capnocytophaga (all species), 171 Chlamydia (pneumoniae), 130 Citrobacter (freundii, other species), 131 Clostridium (all species except difficile), 132 Clostridium difficile, 173 Corynebacterium jeikeium, 134 Enterobacter (all species), 135 Enterococcus (all species), 177 Enterococcus, vancomycin resistant (VRE), 136 Escherichia (also E. coli), 139 Fusobacterium (all species), 187 Haemophilus influenzae, 188 Haemophilus non-influenzae, 146 Klebsiella (all species), 147 Lactobacillus (bulgaricus, acidophilus, other species), 189 Legionella pneumophila, 190 Legionella non-pneumophila, 103 Leptospira (all species), 148 Leptotrichia buccalis, 149 Leuconostoc (all species), 104 Listeria monocytogenes, 151 Micrococcus, NOS, 118 Mycobacterium abscessus, 112 Mycobacterium avium - intracellulare (MAC, MAI), 108 Mycobacterium cheloneae, 109 Mycobacterium fortuitum, 114 Mycobacterium haemophilum, 115 Mycobacterium kansasii, 116 Mycobacterium marinum, 117 Mycobacterium mucogenicum, 110 Mycobacterium tuberculosis (tuberculosis, Koch bacillus), 105 Mycoplasma (all species), 183 Neisseria gonorrhoeae, 184 Neisseria meningitidis, 106 Nocardia (all species), 153 Pasteurella multocida, 155 Proteus (all species), 157 Pseudomonas or Burkholderia cepacia, 185 Pseudomonas aeruginosa, 186 Pseudomonas non-aeruginosa, 159 Rhodococcus (all species), 107 Rickettsia (all species), 160 Salmonella (all species), 161 Serratia marcescens,162 Shigella (all species), 180 Staphylococcus aureus (Methicillin Resistant), 179 Staphylococcus aureus (Methicillin Sensitive), 158 Stenotrophomonas maltophilia, 166 Stomatococcus mucilaginosis, 181 Streptococcus, alpha-hemolytic, 182 Streptococcus, Group B, 178 Streptococcus pneumoniae, 168 Treponema (syphilis), 169 Vibrio (all species) Fungal Infections: 210 Aspergillus, NOS, 211 Aspergillus flavus, 212 Aspergillus fumigatus, 213 Aspergillus niger, 215 Aspergillus terreus, 214 Aspergillus ustus, 270 Blastomyces (dermatitidis), 201 Candida albicans, 208 Candida non-albicans, 271 Coccidioides (all species), 222 Cryptococcus gattii, 221 Cryptococcus neoformans, 230 Fusarium (all species), 261 Histoplasma (capsulatum), 241 Mucorales (all species), 260 Pneumocystis (PCP / PJP), 242 Rhizopus (all species), 272 Scedosporium (all species), 240 Zygomycetes, NOS, 503 Suspected fungal infection, 777 Other organism
PRO202 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion
no yes Specify organism: open text
Specify organism: open text
PRO203 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion
no yes Date of this product infusion: YYYY/MM/DD
Date of this product infusion: YYYY/MM/DD
PRO204 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion
no yes Was the entire volume of received product infused? no,yes
Was the entire volume of received product infused? no,yes
PRO205 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion
no yes Specify what happened to the reserved portion cryopreserved for future use,discarded,other fate
Specify what happened to the reserved portion cryopreserved for future use,discarded,other fate
PRO206 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion
no yes Specify other fate: open text
Specify other fate: open text
PRO207 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion
no yes Time product infusion initiated (24-hour clock): Hour:Minute Check "standard time" or "check daylight savings time"
Time product infusion initiated (24-hour clock): Hour:Minute Check "standard time" or "check daylight savings time"
PRO208 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion
no yes Date infusion stopped: YYYY/MM/DD
Date infusion stopped: YYYY/MM/DD
PRO209 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion
no yes Time product infusion completed (24-hour clock): Hour:Minute Check "standard time" or "check daylight savings time"
Time product infusion completed (24-hour clock): Hour:Minute Check "standard time" or "check daylight savings time"
PRO210 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion
no yes Specify the route of product infusion (24-hour clock); Intramedullary,Intravenous,Other route of infusion
Specify the route of product infusion (24-hour clock); Intramedullary,Intravenous,Other route of infusion
PRO211 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion
no yes Specify other route of infusion: open text
Specify other route of infusion: open text
PRO212 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Were there any adverse events or incidents associated with the stem cell infusion? no,yes
Were there any adverse events or incidents associated with the stem cell infusion? no,yes
PRO213 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Brachycardia no,yes
Brachycardia no,yes
PRO214 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO215 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Chest tightness / pain no,yes
Chest tightness / pain no,yes
PRO216 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO217 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Chills at time of infusion no,yes
Chills at time of infusion no,yes
PRO218 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO219 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Fever ≤ 103 °F within 24 hours of infusion no,yes
Fever ≤ 103 °F within 24 hours of infusion no,yes
PRO220 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO221 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Fever > 103° F within 24 hours of infusion no,yes
Fever > 103° F within 24 hours of infusion no,yes
PRO222 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO223 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Gross hemoglobinuria no,yes
Gross hemoglobinuria no,yes
PRO224 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO225 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Headache no,yes
Headache no,yes
PRO226 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO227 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Hives no,yes
Hives no,yes
PRO228 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO229 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Hypertension no,yes
Hypertension no,yes
PRO230 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO231 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Hypotension no,yes
Hypotension no,yes
PRO232 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO233 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Hypoxia requiring oxygen (O2) support no,yes
Hypoxia requiring oxygen (O2) support no,yes
PRO234 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO235 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Nausea no,yes
Nausea no,yes
PRO236 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO237 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Rigors, mild no,yes
Rigors, mild no,yes
PRO238 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO239 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Rigors, severe no,yes
Rigors, severe no,yes
PRO240 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO241 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Shortness of breath (SOB) no,yes
Shortness of breath (SOB) no,yes
PRO242 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO243 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Tachycardia no,yes
Tachycardia no,yes
PRO244 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO245 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Vomiting no,yes
Vomiting no,yes
PRO246 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO247 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Other expected AE no,yes
Other expected AE no,yes
PRO248 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Specify other expected AE: open text
Specify other expected AE: open text
PRO249 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO250 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Other unexpected AE no,yes
Other unexpected AE no,yes
PRO251 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no Specify other unexpected AE: open text
Specify other unexpected AE: open text
PRO252 Transplant Procedure and Product Information Hematopoietic Cellular Transplant (HCT) Product Infusion Cord Blood Product Infusion yes no In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
In the Medical Director's judgment, was the adverse event a direct result of the infusion? no,yes
PRO253 Transplant Procedure and Product Information Infectious Disease Markers

yes Sequence Number: Auto Filled Field
Sequence Number: Auto Filled Field
PRO254 Transplant Procedure and Product Information Infectious Disease Markers

yes Date Received: Auto Filled Field
Date Received: Auto Filled Field
PRO255 Transplant Procedure and Product Information Infectious Disease Markers

yes CIBMTR Center Number: Auto Filled Field
CIBMTR Center Number: Auto Filled Field
PRO256 Transplant Procedure and Product Information Infectious Disease Markers

yes CIBMTR Research ID: Auto Filled Field
CIBMTR Research ID: Auto Filled Field
PRO257 Transplant Procedure and Product Information Infectious Disease Markers


Event date: Auto Filled Field created with CRID
Event date: Auto Filled Field created with CRID
PRO258 Transplant Procedure and Product Information Infectious Disease Markers
no no HCT type (check all that apply) Allogeneic, related,Allogeneic, unrelated
HCT type (check all that apply) Allogeneic, related,Allogeneic, unrelated
PRO259 Transplant Procedure and Product Information Infectious Disease Markers
no no Product type (check all that apply) Bone marrow,Other product,PBSC,Single cord blood unit
Product type (check all that apply) Bone marrow,Other product,PBSC,Single cord blood unit
PRO260 Transplant Procedure and Product Information Infectious Disease Markers
no no Other product. Specify: open text
Other product. Specify: open text
PRO261 Transplant Procedure and Product Information Infectious Disease Markers
no no Registry donor ID: open text
Registry donor ID: open text
PRO262 Transplant Procedure and Product Information Infectious Disease Markers
no no Non-NMDP cord blood unit ID: open text
Non-NMDP cord blood unit ID: open text
PRO263 Transplant Procedure and Product Information Infectious Disease Markers
no no Global Registration Identifier for Donors (GRID) open text
Global Registration Identifier for Donors (GRID) open text
PRO264 Transplant Procedure and Product Information Infectious Disease Markers
no no ISBT DIN: open text
ISBT DIN: open text
PRO265 Transplant Procedure and Product Information Infectious Disease Markers
no no Registry or UCB Bank ID (A) Austrian Bone Marrow Donors,(ACB) Austrian Cord Blood Registry,(ACCB) StemCyte, Inc,(AE) Emirates Bone Marrow Donor Registry,(AM) Armenian Bone Marrow Donor Registry Charitable Trust,(AOCB) University of Colorado Cord Blood Bank,(AR) Argentine CPH Donors Registry,(ARCB) BANCEL - Argentina Cord Blood Bank,(AUCB) Australian Cord Blood Registry,(AUS) Australian / New Zealand Bone Marrow Donor Registry,(B) Marrow Donor Program Belgium,(BCB) Belgium Cord Blood Registry,(BG) Bulgarian Bone Marrow Donor Registry,(BR) INCA/REDOMO,(BSCB) British Bone Marrow Registry - Cord Blood,(CB) Cord Blood Registry,(CH) Swiss BloodStem Cells - Adult Donors,(CHCB) Swiss Blood Stem Cells - Cord Blood,(CKCB) Celgene Cord Blood Bank,(CN) China Marrow Donor Program (CMDP),(CNCB) Shan Dong Cord Blood Bank,(CND) Canadian Blood Services Bone Marrow Donor Registry,(CS2) Czech National Marrow Donor Registry,(CSCR) Czech Stem Cells Registry,(CY) Cyprus Paraskevaidio Bone Marrow Donor Registry,(CY2) The Cyprus Bone Marrow Donor Registry,(D) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Adult Donors,(DCB) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Cord Blood,(DK) The Danish Bone Marrow Donor Registry,(DK2) Bone Marrow Donors Copenhagen (BMDC),(DUCB) German Branch of the European Cord Blood Bank,(E) REDMO,(ECB) Spanish Cord Blood Registry,(F) France Greffe de Moelle - Adult Donors,(FCB) France Greffe de Moelle - Cord Blood,(FI) Finnish Bone Marrow Donor Registry,(FICB) Finnish Cord Blood Registry,(GB) The Anthony Nolan Trust,(GB3) Welsh Bone Marrow Donor Registry,(GB4) British Bone Marrow Registry,(GR) Unrelated Hematopoietic Stem Cell Donor Registry Greece,(GRCB) Michigan Community Blood Centers Cord Blood Bank,(H) Hungarian Bone Marrow Donor Registry,(HEM) Hema-Quebec,(HK) Hong Kong Bone Marrow Donor Registry,(HR) Croatian Bone Marrow Donor Registry,(I) Italian Bone Marrow Donor Registry,(I3CB) Sheba Medical Centre Cord Blood Registry,(ICB) Italian Cord Blood Bank Network,(IL) Hadassah BMDR,(IL2) Ezer Mizion Bone Marrow Donor Registry,(IL3) Sheba Medical Center Donor Registry,(ILCB) Isreal Cord Blood Bank,(IN) Asian Indian Donor Marrow Registry,(IN2) Dept. of Transfusion Medicine,(IRL) The Irish Unrelated Bone Marrow Panel,(JP) Japan Marrow Donor Program,(KR) Korea Marrow Donor Program,(LT) Lithuanian National Bone Marrow Donor Registry,(LVCB) Leuven Cord Blood Bank,(MACB) Victoria Angel Registry of Hope,(MX) Mexican Bone Marrow Donor Registry,(N) The Norwegian Bone Marrow Donor Registry,(NL) Europdonor Foundation- Adult Donors,(NLCB) Europdonor Foundation - Cord Blood,(NYCB) National Cord Blood Program, New York Blood Center,(OTH) Other Registry,(P) Portuguese Bone Marrow Donors Registry,(PL) National Polish Bone Marrow Registry,(PL2) Unrelated Bone Marrow Donor Registry -Adult Donors,(PL3) Against Leukemia Foundation Marrow Donor Registry,(PL4) Ursula Jaworska Foundation - Bone Marrow Donor Registry,(PL5) Polish Central Bone Marrow Donor Registry - Adult Donors,(PMCB) Elie Katz Umbilical Cord Blood Program,(R) Russian Bone Marrow Donor Registry,(R2) Karelian Registry of Unrelated Donors of Hematopoietic Stem Cells,(S) Tobias Registry of Swedish Bone Marrow Donors,(SG) Singapore Bone Marrow Donor Programme (BMDP),(SK) Slovak National Bone Marrow Donor Registry,(SKCB) Eurocord Slovakia / Slovak Pacental Stem Cell Registry,(SLCBB) St Louis Cord Blood Bank,(SLO) Slovenia Donor,(SM) San Marino Bone Marrow Donor Registry,(T1CB) TRAN - Cord Blood,(TACB) StemCyte, Inc. Taiwan,(TECB) Healthbanks Biotech, Co., Ltd,(TH) Thai Stem Cell Donor Registry (TSCDR),(TOCB) Tokyo Cord Blood Bank,(TPCB) BIONET / BabyBanks,(TRAN) TRAN - Adult Donors,(TRIS) Bone Marrow Bank of Istanbul Medical Faculty,(TW) Buddhist Tzu Chi Stem Cells Center - Adult Donors,(TWCB) Buddhist Tzu Chi Stem Cells Center - Cord Blood,(U1CB) National Marrow Donor Program - Cord Blood,(USA1) National Marrow Donor Program - Adult Donors,(USA2) America Bone Marrow Donor Registry,(UY) SINDOME,(VIAC) Viacord,(W3CB) Polish Central Bone Marrow Donor Registry - Cord Blood,(WACB) Unrelated Bone Marrow Donor Registry - Cord Blood,(ZA) South African Bone Marrow Registry
Registry or UCB Bank ID (A) Austrian Bone Marrow Donors,(ACB) Austrian Cord Blood Registry,(ACCB) StemCyte, Inc,(AE) Emirates Bone Marrow Donor Registry,(AM) Armenian Bone Marrow Donor Registry Charitable Trust,(AOCB) University of Colorado Cord Blood Bank,(AR) Argentine CPH Donors Registry,(ARCB) BANCEL - Argentina Cord Blood Bank,(AUCB) Australian Cord Blood Registry,(AUS) Australian / New Zealand Bone Marrow Donor Registry,(B) Marrow Donor Program Belgium,(BCB) Belgium Cord Blood Registry,(BG) Bulgarian Bone Marrow Donor Registry,(BR) INCA/REDOMO,(BSCB) British Bone Marrow Registry - Cord Blood,(CB) Cord Blood Registry,(CH) Swiss BloodStem Cells - Adult Donors,(CHCB) Swiss Blood Stem Cells - Cord Blood,(CKCB) Celgene Cord Blood Bank,(CN) China Marrow Donor Program (CMDP),(CNCB) Shan Dong Cord Blood Bank,(CND) Canadian Blood Services Bone Marrow Donor Registry,(CS2) Czech National Marrow Donor Registry,(CSCR) Czech Stem Cells Registry,(CY) Cyprus Paraskevaidio Bone Marrow Donor Registry,(CY2) The Cyprus Bone Marrow Donor Registry,(D) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Adult Donors,(DCB) ZKRD - Zentrales Knochenmarkspender - Register Deutschland Cord Blood,(DK) The Danish Bone Marrow Donor Registry,(DK2) Bone Marrow Donors Copenhagen (BMDC),(DUCB) German Branch of the European Cord Blood Bank,(E) REDMO,(ECB) Spanish Cord Blood Registry,(F) France Greffe de Moelle - Adult Donors,(FCB) France Greffe de Moelle - Cord Blood,(FI) Finnish Bone Marrow Donor Registry,(FICB) Finnish Cord Blood Registry,(GB) The Anthony Nolan Trust,(GB3) Welsh Bone Marrow Donor Registry,(GB4) British Bone Marrow Registry,(GR) Unrelated Hematopoietic Stem Cell Donor Registry Greece,(GRCB) Michigan Community Blood Centers Cord Blood Bank,(H) Hungarian Bone Marrow Donor Registry,(HEM) Hema-Quebec,(HK) Hong Kong Bone Marrow Donor Registry,(HR) Croatian Bone Marrow Donor Registry,(I) Italian Bone Marrow Donor Registry,(I3CB) Sheba Medical Centre Cord Blood Registry,(ICB) Italian Cord Blood Bank Network,(IL) Hadassah BMDR,(IL2) Ezer Mizion Bone Marrow Donor Registry,(IL3) Sheba Medical Center Donor Registry,(ILCB) Isreal Cord Blood Bank,(IN) Asian Indian Donor Marrow Registry,(IN2) Dept. of Transfusion Medicine,(IRL) The Irish Unrelated Bone Marrow Panel,(JP) Japan Marrow Donor Program,(KR) Korea Marrow Donor Program,(LT) Lithuanian National Bone Marrow Donor Registry,(LVCB) Leuven Cord Blood Bank,(MACB) Victoria Angel Registry of Hope,(MX) Mexican Bone Marrow Donor Registry,(N) The Norwegian Bone Marrow Donor Registry,(NL) Europdonor Foundation- Adult Donors,(NLCB) Europdonor Foundation - Cord Blood,(NYCB) National Cord Blood Program, New York Blood Center,(OTH) Other Registry,(P) Portuguese Bone Marrow Donors Registry,(PL) National Polish Bone Marrow Registry,(PL2) Unrelated Bone Marrow Donor Registry -Adult Donors,(PL3) Against Leukemia Foundation Marrow Donor Registry,(PL4) Ursula Jaworska Foundation - Bone Marrow Donor Registry,(PL5) Polish Central Bone Marrow Donor Registry - Adult Donors,(PMCB) Elie Katz Umbilical Cord Blood Program,(R) Russian Bone Marrow Donor Registry,(R2) Karelian Registry of Unrelated Donors of Hematopoietic Stem Cells,(S) Tobias Registry of Swedish Bone Marrow Donors,(SG) Singapore Bone Marrow Donor Programme (BMDP),(SK) Slovak National Bone Marrow Donor Registry,(SKCB) Eurocord Slovakia / Slovak Pacental Stem Cell Registry,(SLCBB) St Louis Cord Blood Bank,(SLO) Slovenia Donor,(SM) San Marino Bone Marrow Donor Registry,(T1CB) TRAN - Cord Blood,(TACB) StemCyte, Inc. Taiwan,(TECB) Healthbanks Biotech, Co., Ltd,(TH) Thai Stem Cell Donor Registry (TSCDR),(TOCB) Tokyo Cord Blood Bank,(TPCB) BIONET / BabyBanks,(TRAN) TRAN - Adult Donors,(TRIS) Bone Marrow Bank of Istanbul Medical Faculty,(TW) Buddhist Tzu Chi Stem Cells Center - Adult Donors,(TWCB) Buddhist Tzu Chi Stem Cells Center - Cord Blood,(U1CB) National Marrow Donor Program - Cord Blood,(USA1) National Marrow Donor Program - Adult Donors,(USA2) America Bone Marrow Donor Registry,(UY) SINDOME,(VIAC) Viacord,(W3CB) Polish Central Bone Marrow Donor Registry - Cord Blood,(WACB) Unrelated Bone Marrow Donor Registry - Cord Blood,(ZA) South African Bone Marrow Registry
PRO266 Transplant Procedure and Product Information Infectious Disease Markers
no no Donor DOB: YYYY/MM/DD
Donor DOB: YYYY/MM/DD
PRO267 Transplant Procedure and Product Information Infectious Disease Markers
no no Donor age: open text, check "Months" or check "Years"
Donor age: open text, check "Months" or check "Years"
PRO268 Transplant Procedure and Product Information Infectious Disease Markers
no no Donor sex female,male
Donor sex female,male
PRO269 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Who is being tested for IDMs? donor IDM (marrow or PBSC),cord blood unit IDM,maternal IDM (cord blood)
Who is being tested for IDMs? donor IDM (marrow or PBSC),cord blood unit IDM,maternal IDM (cord blood)
PRO270 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no HBsAg: (hepatitis B surface antigen) Non-reactive,Not done,Reactive
HBsAg: (hepatitis B surface antigen) Non-reactive,Not done,Reactive
PRO271 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
PRO272 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Anti HBc: (hepatitis B core antibody) Non-reactive,Not done,Reactive
Anti HBc: (hepatitis B core antibody) Non-reactive,Not done,Reactive
PRO273 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
PRO274 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no FDA licensed NAAT testing for HBV Negative,Not done,Positive
FDA licensed NAAT testing for HBV Negative,Not done,Positive
PRO275 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
PRO276 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Anti-HCV: (hepatitis C antibody) Non-reactive,Not done,Reactive
Anti-HCV: (hepatitis C antibody) Non-reactive,Not done,Reactive
PRO277 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
PRO278 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no FDA licensed NAAT testing for HCV Negative,Not done,Positive
FDA licensed NAAT testing for HCV Negative,Not done,Positive
PRO279 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
PRO280 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no HIV-1 p24 antigen Non-reactive,Not done,Not reported,Reactive
HIV-1 p24 antigen Non-reactive,Not done,Not reported,Reactive
PRO281 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
PRO282 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no FDA licensed NAAT testing for HIV-1 Negative,Not done,Positive
FDA licensed NAAT testing for HIV-1 Negative,Not done,Positive
PRO283 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
PRO284 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Anti-HIV 1 and anti-HIV 2*: (antibodies to Human Immunodeficiency Viruses) Non-reactive,Not done,Not reported,Reactive
Anti-HIV 1 and anti-HIV 2*: (antibodies to Human Immunodeficiency Viruses) Non-reactive,Not done,Not reported,Reactive
PRO285 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
PRO286 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Chagas testing Negative,Not Done,Positive
Chagas testing Negative,Not Done,Positive
PRO287 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
PRO288 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Anti-HSV (Herpes simplex virus antibody) Negative,Not Done,Positive
Anti-HSV (Herpes simplex virus antibody) Negative,Not Done,Positive
PRO289 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
PRO290 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Anti-EBV (Epstein-Barr virus antibody) Inconclusive,Negative,Not done,Positive
Anti-EBV (Epstein-Barr virus antibody) Inconclusive,Negative,Not done,Positive
PRO291 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
PRO292 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Anti-VZV (Varicella zoster virus antibody) Negative,Not Done,Positive
Anti-VZV (Varicella zoster virus antibody) Negative,Not Done,Positive
PRO293 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
PRO294 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Other infectious disease marker, specify no,yes
Other infectious disease marker, specify no,yes
PRO295 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
PRO296 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Specify test and method: open text
Specify test and method: open text
PRO297 Transplant Procedure and Product Information Infectious Disease Markers Non NMDP Allogeneic or syngeneic Donor or Non NMDP Cord Blood Unit Information yes no Specify test results: open text
Specify test results: open text

Sheet 5: Post-Transplant Periodic Inform




Information Collection Domain: Post-Transplant Periodic Information Collection






Item ID Time Point Information Collection Domain Sub-Type Information Collection Domain Additional Sub Domain Response required if Additional Sub Domain applies Information Collection may be requested multiple times Current Information Collection Data Element (if applicable) Current Information Collection Data Element Response Option(s) Information Collection update: Proposed Information Collection Data Element (if applicable) Proposed Information Collection Data Element Response Option(s) [Threaded comment] Your version of Excel allows you to read this threaded comment; however, any edits to it will get removed if the file is opened in a newer version of Excel. Learn more: https://go.microsoft.com/fwlink/?linkid=870924 Comment: Information in this column does not match the info in the table within the OMB letter - please revise. Rationale for Information Collection Update
POST056 Post-Transplant Post-Transplant Essential Data
no yes Did the recipient develop COVID-19 (SARS-CoV-2)? No,Yes Question will be disabled Did the recipient develop COVID-19 (SARS-CoV-2)? No,Yes Reduce burden: data no longer relevant
POST057 Post-Transplant Post-Transplant Essential Data
no yes Date of diagnosis: YYYY/MM/DD Question will be disabled Date of diagnosis: YYYY/MM/DD Reduce burden: data no longer relevant
POST058 Post-Transplant Post-Transplant Essential Data
no yes Was a vaccine for COVID-19 (SARS-CoV-2) received? No,Unknown,Yes Question will be disabled Was a vaccine for COVID-19 (SARS-CoV-2) received? No,Unknown,Yes Reduce burden: data no longer relevant
POST059 Post-Transplant Post-Transplant Essential Data Covid-19 Vaccine yes yes Specify vaccine brand AstraZeneca,Johnson & Johnson,Moderna,Novavax,Other (specify),Pfizer-BioNTech Question will be disabled Specify vaccine brand AstraZeneca,Johnson & Johnson,Moderna,Novavax,Other (specify),Pfizer-BioNTech Reduce burden: data no longer relevant
POST060 Post-Transplant Post-Transplant Essential Data Covid-19 Vaccine yes yes Specify other type: open text Question will be disabled Specify other type: open text Reduce burden: data no longer relevant
POST061 Post-Transplant Post-Transplant Essential Data Covid-19 Vaccine yes yes Select dose(s) received Booster dose,First dose(with planned second dose) ,One dose(without planned second dose) ,Second dose,Third dose Question will be disabled Select dose(s) received Booster dose,First dose(with planned second dose) ,One dose(without planned second dose) ,Second dose,Third dose Reduce burden: data no longer relevant
POST062 Post-Transplant Post-Transplant Essential Data Covid-19 Vaccine yes yes Date received: YYYY/MM/DD Question will be disabled Date received: YYYY/MM/DD Reduce burden: data no longer relevant
POST063 Post-Transplant Post-Transplant Essential Data Covid-19 Vaccine yes yes Date estimated checked question will be disabled Date estimated checked reduce burden: data no longer relevant
POST001 Post-Transplant Post-Transplant Essential Data
no yes Sequence Number: Auto Filled Field
Sequence Number: Auto Filled Field
POST002 Post-Transplant Post-Transplant Essential Data
no yes Date Received: Auto Filled Field
Date Received: Auto Filled Field
POST003 Post-Transplant Post-Transplant Essential Data
no yes CIBMTR Center Number: Auto Filled Field
CIBMTR Center Number: Auto Filled Field
POST004 Post-Transplant Post-Transplant Essential Data
no yes CIBMTR Research ID: Auto Filled Field
CIBMTR Research ID: Auto Filled Field
POST005 Post-Transplant Post-Transplant Essential Data
no yes Event date: Auto Filled Field created with CRID
Event date: Auto Filled Field created with CRID
POST006 Post-Transplant Post-Transplant Essential Data
no yes Visit 100 day,1 year,2 years,> 2 years,6 months
Visit 100 day,1 year,2 years,> 2 years,6 months
POST007 Post-Transplant Post-Transplant Essential Data
no yes Specify: open text
Specify: open text
POST008 Post-Transplant Post-Transplant Essential Data
no yes Date of actual contact with the recipient to determine medical status for this follow-up report: YYYY/MM/DD
Date of actual contact with the recipient to determine medical status for this follow-up report: YYYY/MM/DD
POST009 Post-Transplant Post-Transplant Essential Data
no yes Specify the recipient's survival status at the date of last contact Alive,Dead
Specify the recipient's survival status at the date of last contact Alive,Dead (Complete recipient death data)
POST010 Post-Transplant Post-Transplant Essential Data
no yes Did the recipient receive a subsequent HCT? no,yes
Did the recipient receive a subsequent HCT? no,yes
POST011 Post-Transplant Post-Transplant Essential Data Subsequent Transplant yes yes Date of subsequent HCT: YYYY/MM/DD
Date of subsequent HCT: YYYY/MM/DD
POST012 Post-Transplant Post-Transplant Essential Data Subsequent Transplant yes yes What was the indication for subsequent HCT? Graft failure / insufficient hematopoietic recovery,Insufficient chimerism,New malignancy (including PTLD and EBV lymphoma),Other,Persistent primary disease,Planned subsequent HCT, per protocol,Recurrent primary disease
What was the indication for subsequent HCT? Graft failure / insufficient hematopoietic recovery,Insufficient chimerism,New malignancy (including PTLD and EBV lymphoma),Other,Persistent primary disease,Planned subsequent HCT, per protocol,Recurrent primary disease
POST013 Post-Transplant Post-Transplant Essential Data Subsequent Transplant yes yes Specify other indication: open text
Specify other indication: open text
POST014 Post-Transplant Post-Transplant Essential Data Subsequent Transplant yes yes Source of HSCs (check all that apply) Allogeneic, related,Allogeneic, unrelated,Autologous
Source of HSCs (check all that apply) Allogeneic, related,Allogeneic, unrelated,Autologous
POST015 Post-Transplant Post-Transplant Essential Data
no yes Has the recipient received a cellular therapy? (e.g. CAR-T, DCI) no,yes
Has the recipient received a cellular therapy? (e.g. CAR-T, DCI) no,yes
POST016 Post-Transplant Post-Transplant Essential Data Subsequent Transplant yes yes


Was this infusion a donor lymphocyte infusion (DLI)? no,yes
POST017 Post-Transplant Post-Transplant Essential Data Subsequent Transplant yes yes


Number of DLIs in this reporting period __ __
POST018 Post-Transplant Post-Transplant Essential Data Subsequent Transplant yes yes


Are any of the products, associated with this course of cellular therapy, genetically modified? no, yes
POST019 Post-Transplant Post-Transplant Essential Data Subsequent Transplant yes yes Date of cellular therapy: YYYY/MM/DD
Date of cellular therapy: YYYY/MM/DD
POST020 Post-Transplant Post-Transplant Essential Data
no yes Was there evidence of initial hematopoietic recovery? No(ANC ≥ 500/mm3 was not achieved) ,Not applicable(ANC never dropped below 500/mm3 at any time after the start of the preparative regimen,Previously reported(recipient’s initial hematopoietic recovery was recorded on a previous report) ,Yes(ANC ≥ 500/mm3 achieved and sustained for 3 lab values)
Was there evidence of initial hematopoietic recovery? No(ANC ≥ 500/mm3 was not achieved) ,Not applicable(ANC never dropped below 500/mm3 at any time after the start of the preparative regimen,Previously reported(recipient’s initial hematopoietic recovery was recorded on a previous report) ,Yes(ANC ≥ 500/mm3 achieved and sustained for 3 lab values)
POST021 Post-Transplant Post-Transplant Essential Data
no yes Date ANC ≥ 500/mm³ (first of 3 lab values): YYYY/MM/DD
Date ANC ≥ 500/mm³ (first of 3 lab values): YYYY/MM/DD
POST022 Post-Transplant Post-Transplant Essential Data
no yes Did late graft failure occur? No,Yes
Did late graft failure occur? No,Yes
POST023 Post-Transplant Post-Transplant Essential Data
no yes Was an initial platelet count ≥ 20 x 109/L achieved? No,Not applicable(Platelet count never dropped below 20 x 109/L) ,Previously reported(≥ 20 x 109/L was achieved and reported previously),Yes
Was an initial platelet count ≥ 20 x 109/L achieved? No,Not applicable(Platelet count never dropped below 20 x 109/L) ,Previously reported(≥ 20 x 109/L was achieved and reported previously),Yes
POST024 Post-Transplant Post-Transplant Essential Data
no yes Date platelets ≥ 20 x 109/L: YYYY/MM/DD
Date platelets ≥ 20 x 109/L: YYYY/MM/DD
POST025 Post-Transplant Post-Transplant Essential Data
no yes Did acute GVHD develop? No,Unknown,Yes
Did acute GVHD develop? No,Unknown,Yes
POST026 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Date of acute GVHD diagnosis: YYYY/MM/DD
Date of acute GVHD diagnosis: YYYY/MM/DD
POST027 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Did acute GVHD persist? No,Unknown,Yes
Did acute GVHD persist? No,Unknown,Yes
POST028 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Overall grade of acute GVHD at diagnosis I - Rash on ≤ 50% of skin, no liver or gut involvement
II - Rash on > 50% of skin, bilirubin 2-3 mg/dL, or diarrhea 500 – 1000 mL/day or persistent nausea or vomiting
III - Bilirubin 3-15 mg/dL, or gut stage 2-4 diarrhea > 1000 mL/day or severe abdominal pain with or without ileus
IV - Generalized erythroderma with bullous formation, or bilirubin >15 mg/dL
Not applicable (acute GVHD present but cannot be graded)
Overall grade of acute GVHD at diagnosis I - Rash on ≤ 50% of skin, no liver or gut involvement
II - Rash on > 50% of skin, bilirubin 2-3 mg/dL, or diarrhea 500 – 1000 mL/day or persistent nausea or vomiting
III - Bilirubin 3-15 mg/dL, or gut stage 2-4 diarrhea > 1000 mL/day or severe abdominal pain with or without ileus
IV - Generalized erythroderma with bullous formation, or bilirubin >15 mg/dL
Not applicable (acute GVHD present but cannot be graded)
POST029 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Skin Stage 0 – No rash, no rash attributable to acute GVHD
Stage 1 – Maculopapular rash, < 25% of body surface
Stage 2 – Maculopapular rash, 25–50% of body surface
Stage 3 – Generalized erythroderma, > 50% of body surface
Stage 4 – Generalized erythroderma with bullae formation and/or desquamation
Skin Stage 0 – No rash, no rash attributable to acute GVHD
Stage 1 – Maculopapular rash, < 25% of body surface
Stage 2 – Maculopapular rash, 25–50% of body surface
Stage 3 – Generalized erythroderma, > 50% of body surface
Stage 4 – Generalized erythroderma with bullae formation and/or desquamation
POST030 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Lower intestinal tract (use mL/day for adult recipients and mL/kg/day for pediatric recipients) Stage 0 – No diarrhea, no diarrhea attributable to acute GVHD / diarrhea < 500 mL/day (adult), or < 10 mL/kg/day (pediatric)
Stage 1 – Diarrhea 500 - 1000 mL/day (adult), or 10 - 19.9 mL/kg/day (pediatric)
Stage 2 – Diarrhea 1001 - 1500 mL/day (adult), or 20 - 30 mL/kg/day (pediatric)
Stage 3 – Diarrhea > 1500 mL/day (adult), or > 30 mL/kg/day (pediatric)
Stage 4 – Severe abdominal pain, with or without ileus, and/or grossly bloody stool
Lower intestinal tract (use mL/day for adult recipients and mL/kg/day for pediatric recipients) Stage 0 – No diarrhea, no diarrhea attributable to acute GVHD / diarrhea < 500 mL/day (adult), or < 10 mL/kg/day (pediatric)
Stage 1 – Diarrhea 500 - 1000 mL/day (adult), or 10 - 19.9 mL/kg/day (pediatric)
Stage 2 – Diarrhea 1001 - 1500 mL/day (adult), or 20 - 30 mL/kg/day (pediatric)
Stage 3 – Diarrhea > 1500 mL/day (adult), or > 30 mL/kg/day (pediatric)
Stage 4 – Severe abdominal pain, with or without ileus, and/or grossly bloody stool
POST031 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Upper intestinal tract Stage 0 – No persistent nausea or vomiting
Stage 1 – Persistent nausea or vomiting
Upper intestinal tract Stage 0 – No persistent nausea or vomiting
Stage 1 – Persistent nausea or vomiting
POST032 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Liver Stage 0 – No liver acute GVHD / bilirubin < 2.0 mg/dL (< 34 μmol/L)
Stage 1 – Bilirubin 2.0–3.0 mg/dL (34–52 μmol/L)
Stage 2 – Bilirubin 3.1–6.0 mg/dL (53–103 μmol/L)
Stage 3 – Bilirubin 6.1–15.0 mg/dL (104–256 μmol/L)
Stage 4 – Bilirubin > 15.0 mg/dL (> 256 μmol/L)
Liver Stage 0 – No liver acute GVHD / bilirubin < 2.0 mg/dL (< 34 μmol/L)
Stage 1 – Bilirubin 2.0–3.0 mg/dL (34–52 μmol/L)
Stage 2 – Bilirubin 3.1–6.0 mg/dL (53–103 μmol/L)
Stage 3 – Bilirubin 6.1–15.0 mg/dL (104–256 μmol/L)
Stage 4 – Bilirubin > 15.0 mg/dL (> 256 μmol/L)
POST033 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Other site(s) involved with acute GVHD No,Yes
Other site(s) involved with acute GVHD No,Yes
POST034 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Specify other site(s): open text
Specify other site(s): open text
POST035 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Maximum overall grade of acute GVHD I - Rash on ≤ 50% of skin, no liver or gut involvement
II - Rash on > 50% of skin, bilirubin 2-3 mg/dL, or diarrhea 500 – 1000 mL/day or persistent nausea or vomiting
III - Bilirubin 3-15 mg/dL, or gut stage 2-4 diarrhea > 1000 mL/day or severe abdominal pain with or without ileus
IV - Generalized erythroderma with bullous formation, or bilirubin >15 mg/dL
Not applicable (acute GVHD present but cannot be graded)
Maximum overall grade of acute GVHD I - Rash on ≤ 50% of skin, no liver or gut involvement
II - Rash on > 50% of skin, bilirubin 2-3 mg/dL, or diarrhea 500 – 1000 mL/day or persistent nausea or vomiting
III - Bilirubin 3-15 mg/dL, or gut stage 2-4 diarrhea > 1000 mL/day or severe abdominal pain with or without ileus
IV - Generalized erythroderma with bullous formation, or bilirubin >15 mg/dL
Not applicable (acute GVHD present but cannot be graded)
POST036 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Date maximum overall grade of acute GVHD: YYYY/MM/DD
First date maximum overall grade of acute GVHD: YYYY/MM/DD
POST037 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Skin Stage 0 – No rash, no rash attributable to acute GVHD
Stage 1 – Maculopapular rash, < 25% of body surface
Stage 2 – Maculopapular rash, 25–50% of body surface
Stage 3 – Generalized erythroderma, > 50% of body surface
Stage 4 – Generalized erythroderma with bullae formation and/or desquamation
Skin Stage 0 – No rash, no rash attributable to acute GVHD
Stage 1 – Maculopapular rash, < 25% of body surface
Stage 2 – Maculopapular rash, 25–50% of body surface
Stage 3 – Generalized erythroderma, > 50% of body surface
Stage 4 – Generalized erythroderma with bullae formation and/or desquamation
POST038 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Lower intestinal tract (use mL/day for adult recipients and mL/kg/day for pediatric recipients) Stage 0 – No diarrhea, no diarrhea attributable to acute GVHD / diarrhea < 500 mL/day (adult), or < 10 mL/kg/day (pediatric)
Stage 1 – Diarrhea 500 - 1000 mL/day (adult), or 10 - 19.9 mL/kg/day (pediatric)
Stage 2 – Diarrhea 1001 - 1500 mL/day (adult), or 20 - 30 mL/kg/day (pediatric)
Stage 3 – Diarrhea > 1500 mL/day (adult), or > 30 mL/kg/day (pediatric)
Stage 4 – Severe abdominal pain, with or without ileus, and/or grossly bloody stool
Lower intestinal tract (use mL/day for adult recipients and mL/kg/day for pediatric recipients) Stage 0 – No diarrhea, no diarrhea attributable to acute GVHD / diarrhea < 500 mL/day (adult), or < 10 mL/kg/day (pediatric)
Stage 1 – Diarrhea 500 - 1000 mL/day (adult), or 10 - 19.9 mL/kg/day (pediatric)
Stage 2 – Diarrhea 1001 - 1500 mL/day (adult), or 20 - 30 mL/kg/day (pediatric)
Stage 3 – Diarrhea > 1500 mL/day (adult), or > 30 mL/kg/day (pediatric)
Stage 4 – Severe abdominal pain, with or without ileus, and/or grossly bloody stool
POST039 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Upper intestinal tract Stage 0 – No persistent nausea or vomiting
Stage 1 – Persistent nausea or vomiting
Upper intestinal tract Stage 0 – No persistent nausea or vomiting
Stage 1 – Persistent nausea or vomiting
POST040 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Liver Stage 0 – No liver acute GVHD / bilirubin < 2.0 mg/dL (< 34 μmol/L)
Stage 1 – Bilirubin 2.0–3.0 mg/dL (34–52 μmol/L)
Stage 2 – Bilirubin 3.1–6.0 mg/dL (53–103 μmol/L)
Stage 3 – Bilirubin 6.1–15.0 mg/dL (104–256 μmol/L)
Stage 4 – Bilirubin > 15.0 mg/dL (> 256 μmol/L)
Liver Stage 0 – No liver acute GVHD / bilirubin < 2.0 mg/dL (< 34 μmol/L)
Stage 1 – Bilirubin 2.0–3.0 mg/dL (34–52 μmol/L)
Stage 2 – Bilirubin 3.1–6.0 mg/dL (53–103 μmol/L)
Stage 3 – Bilirubin 6.1–15.0 mg/dL (104–256 μmol/L)
Stage 4 – Bilirubin > 15.0 mg/dL (> 256 μmol/L)
POST041 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Other site(s) involved with acute GVHD No,Yes
Other site(s) involved with acute GVHD No,Yes
POST042 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Specify other site(s): open text
Specify other site(s): open text
POST043 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Did chronic GVHD develop? No,Unknown,Yes
Did chronic GVHD develop? No,Unknown,Yes
POST044 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Date of chronic GVHD diagnosis: YYYY/MM/DD
Date of chronic GVHD diagnosis: YYYY/MM/DD
POST045 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Did chronic GVHD persist? No,Unknown,Yes
Did chronic GVHD persist? No,Unknown,Yes
POST046 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Maximum grade of chronic GVHD (according to best clinical judgment) Mild,Moderate,Severe,Unknown
Maximum grade of chronic GVHD (according to best clinical judgment) Mild,Moderate,Severe,Unknown
POST047 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Date of maximum grade of chronic GVHD: YYYY/MM/DD
Date of maximum grade of chronic GVHD: YYYY/MM/DD
POST048 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Specify if chronic GVHD was limited or extensive Extensive – One or more of the following:
– Generalized skin involvement; or,
– Liver histology showing chronic aggressive hepatitis, bridging necrosis or cirrhosis; or,
– Involvement of eye: Schirmer’s test with < 5 mm wetting; or
– Involvement of minor salivary glands or oral mucosa demonstrated on labial biopsy; or
– Involvement of any other target organ, Limited - Localized skin involvement and/or liver dysfunction
Specify if chronic GVHD was limited or extensive Extensive – One or more of the following:
– Generalized skin involvement; or,
– Liver histology showing chronic aggressive hepatitis, bridging necrosis or cirrhosis; or,
– Involvement of eye: Schirmer’s test with < 5 mm wetting; or
– Involvement of minor salivary glands or oral mucosa demonstrated on labial biopsy; or
– Involvement of any other target organ, Limited - Localized skin involvement and/or liver dysfunction
POST049 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Is the recipient still taking systemic steroids? (Do not report steroids for adrenal insufficiency, or steroid dose ≤10 mg/day for adults, <0.1 mg/kg/day for children) No,Not Applicable,Unknown,Yes
Is the recipient still taking systemic steroids? (Do not report steroids for adrenal insufficiency, or steroid dose ≤10 mg/day for adults, <0.1 mg/kg/day for children) No,Not Applicable,Unknown,Yes
POST050 Post-Transplant Post-Transplant Essential Data Graft vs. Host Disease yes yes Is the recipient still taking (non-steroid) immunosuppressive agents (including PUVA) for GVHD? No,Not Applicable,Unknown,Yes
Is the recipient still taking (non-steroid) immunosuppressive agents (including PUVA) for GVHD? No,Not Applicable,Unknown,Yes
POST051 Post-Transplant Post-Transplant Essential Data
no yes Was specific therapy used to prevent liver toxicity? No,Yes
Was specific therapy used to prevent liver toxicity? No,Yes
POST052 Post-Transplant Post-Transplant Essential Data
no yes Specify therapy (check all that apply) Defibrotide,N-acetylcysteine,Other therapy,Tissue plasminogen activator (TPA),Ursodiol
Specify therapy (check all that apply) Defibrotide,N-acetylcysteine,Other therapy,Tissue plasminogen activator (TPA),Ursodiol, Enoxaparin (Lovenox), Heparin
POST053 Post-Transplant Post-Transplant Essential Data
no yes Specify other therapy: open text
Specify other therapy: open text
POST054 Post-Transplant Post-Transplant Essential Data
no yes Did veno-occlusive disease (VOD) / sinusoidal obstruction syndrome (SOS) develop? No,Yes
Did veno-occlusive disease (VOD) / sinusoidal obstruction syndrome (SOS) develop? No,Yes
POST055 Post-Transplant Post-Transplant Essential Data
no yes Date of diagnosis: YYYY/MM/DD
Date of diagnosis: YYYY/MM/DD
POST064 Post-Transplant Post-Transplant Essential Data
no yes Did a new malignancy, myelodysplastic, myeloproliferative, or lymphoproliferative disease / disorder occur that is different from the disease / disorder for which the HCT or cellular therapy was performed? No,Yes
Did a new malignancy, myelodysplastic, myeloproliferative, or lymphoproliferative disease / disorder occur that is different from the disease / disorder for which the HCT or cellular therapy was performed? No,Yes (Also complete Subsequent Neoplasms) , previosly reported
POST065 Post-Transplant Post-Transplant Essential Data Allogenic Recipients of Cord Blood units, Beta Thalassemia, and/or Sickle Cell Disease yes yes Were chimerism studies performed? no,yes
Were chimerism studies performed? no,yes
POST066 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Was documentation submitted to the CIBMTR? (e.g. chimerism laboratory reports) No,Yes
Was documentation submitted to the CIBMTR? (e.g. chimerism laboratory reports) No,Yes
POST067 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Were chimerism studies assessed for more than one donor / multiple donors? No,Yes
Were chimerism studies assessed for more than one donor / multiple donors? No,Yes
POST068 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Global Registration Identifier for Donors (GRID) open text
Global Registration Identifier for Donors (GRID) open text
POST069 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes NMDP cord blood unit ID: open text
NMDP cord blood unit ID: open text
POST070 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Registry donor ID: open text
Registry donor ID: open text
POST071 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Non-NMDP cord blood unit ID: open text
Non-NMDP cord blood unit ID: open text
POST072 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Date of birth: YYYY/MM/DD
Donor Date of birth: YYYY/MM/DD
POST073 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Age: MM __ __ (if less than 1 year); YY __ __ __
Age: MM __ __ (if less than 1 year); YY __ __ __
POST074 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Sex female,male
Donor Sex female,male
POST075 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Date sample collected: YYYY/MM/DD
Date sample collected: YYYY/MM/DD
POST076 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Method Single nucleotide polymorphisms (SNPS) (includes quantitative PCR, real time PCR, sequencing, other), Fluorescent in situ hybridization (FISH) for XX/XY, Karyotyping for XX/XY,vOther, Restriction fragment-length polymorphisms (RFLP), VNTR or STR, micro or mini satellite
Method Single nucleotide polymorphisms (SNPS) (includes quantitative PCR, real time PCR, sequencing, other), Fluorescent in situ hybridization (FISH) for XX/XY, Karyotyping for XX/XY,vOther, Restriction fragment-length polymorphisms (RFLP), VNTR or STR, micro or mini satellite
POST077 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Specify: open text
Specify: open text
POST078 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Cell source Bone marrow,Peripheral blood
Cell source Bone marrow,Peripheral blood
POST079 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Cell type B-cells,Granulocytes,Hematopoietic progenitor cells,NK cells,Other,Red blood cells,T-cells,Total mononuclear cells,Unsorted / whole
Cell type B-cells,Granulocytes,Hematopoietic progenitor cells,NK cells,Other,Red blood cells,T-cells,Total mononuclear cells,Unsorted / whole
POST080 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Specify: open text
Specify: open text
POST081 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Total cells examined: open text
Total cells examined: open text
POST082 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Number of donor cells: open text
Number of donor cells: open text
POST083 Post-Transplant Post-Transplant Essential Data Chimerism Study Performed yes yes Percent donor cells: __ __ __ %
Percent donor cells: __ __ __ %
POST084 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Compared to the disease status prior to the preparative regimen, what was the best response to HCT? Continued complete remission (CCR),Complete remission (CR),Not in complete remission,Not evaluated

Continued complete remission (CCR),Complete remission (CR),Not in complete remission,Not evaluated
POST085 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Specify disease status if not in complete remission Disease detected,No disease detected but incomplete evaluation to establish CR
Specify disease status if not in complete remission Disease detected,No disease detected but incomplete evaluation to establish CR
POST086 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Was the date of best response previously reported? no,yes
Was the date of best response previously reported? no,yes
POST087 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD
POST088 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Was the disease status assessed by molecular testing? No,Not Applicable,Yes
Was the disease status assessed by molecular testing? No,Not Applicable,Yes
POST089 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD
POST090 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Was disease detected? no,yes
Was disease detected? no,yes
POST091 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Was the disease status assessed via flow cytometry? No,Not Applicable,Yes
Was the disease status assessed via flow cytometry? No,Not Applicable,Yes
POST092 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD
POST093 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Was disease detected? no,yes
Was disease detected? no,yes
POST094 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Was the disease status assessed by cytogenetic testing? (karyotyping or FISH) No,Not Applicable,Yes
Was the disease status assessed by cytogenetic testing? (karyotyping or FISH) No,Not Applicable,Yes
POST095 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Was the disease status assessed via FISH? No,Not Applicable,Yes
Was the disease status assessed via FISH? No,Not Applicable,Yes
POST096 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD
POST097 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Was disease detected? no,yes
Was disease detected? no,yes
POST098 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Was the disease status assessed via karyotyping? No,Not Applicable,Yes
Was the disease status assessed via karyotyping? No,Not Applicable,Yes
POST099 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD
POST100 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Was disease detected? no,yes
Was disease detected? no,yes
POST101 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Was the disease status assessed by radiological assessment? (e.g. PET, MRI, CT) No,Not Applicable,Yes
Was the disease status assessed by radiological assessment? (e.g. PET, MRI, CT) No,Not Applicable,Yes
POST102 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD
POST103 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Was disease detected? no,yes
Was disease detected? no,yes
POST104 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Was the disease status assessed by clinical / hematologic assessment? no,yes
Was the disease status assessed by clinical / hematologic assessment? no,yes
POST105 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Date assessed: YYYY/MM/DD
Date assessed: YYYY/MM/DD
POST106 Post-Transplant Disease Assessment at the Time of Best Response to HCT
no yes Was disease detected? no,yes
Was disease detected? no,yes
POST107 Post-Transplant Post-HCT Therapy
no yes Was therapy given for reasons other than relapse, persistent, or progressive disease? (Include any maintenance and consolidation therapy.) no,yes
Was therapy given for reasons other than relapse, persistent, or progressive disease? (Include any maintenance and consolidation therapy.) no,yes
POST108 Post-Transplant Post-HCT Therapy
no yes Specify therapy (check all that apply) Blinded randomized trial,Cellular therapy,Other therapy,Radiation,Systemic therapy
Specify therapy (check all that apply) Blinded randomized trial,Cellular therapy,Other therapy,Radiation,Systemic therapy
POST109 Post-Transplant Post-HCT Therapy
no yes Specify systemic therapy (check all that apply) Alemtuzumab,Azacytidine,Blinatumomab,Bortezomib,Bosutinib,Carfilzomib,Chemotherapy,Dasatinib,Decitabine,Gemtuzumab,Gilteritinib,Ibrutinib,Imatinib mesylate,Ixazomib,Lenalidomide,Lestaurtinib,Midostaurin,Nilotinib,Nivolumab,Other systemic therapy,Pembrolizumab,Pomalidomide,Quizartinib,Rituximab,Sorafenib,Sunitinib,Thalidomide
Specify systemic therapy (check all that apply) Alemtuzumab,Azacytidine,Blinatumomab,Bortezomib,Bosutinib,Carfilzomib,Dasatinib,Decitabine,Gemtuzumab,Gilteritinib,Ibrutinib,Imatinib mesylate,Ixazomib,Lenalidomide,Lestaurtinib,Midostaurin,Nilotinib,Nivolumab,Other systemic therapy,Pembrolizumab,Pomalidomide,Quizartinib,Rituximab,Sorafenib,Sunitinib,Thalidomide, Brentuximab vendotin, Daratumumab (Darzalex)
POST110 Post-Transplant Post-HCT Therapy
no yes Specify other systemic therapy: open text
Specify other systemic therapy: open text
POST111 Post-Transplant Post-HCT Therapy
no yes Specify other therapy: open text
Specify other therapy: open text
POST112 Post-Transplant Post-HCT Therapy
no yes Did a fecal microbiota transplant (FMT) occur? No, Yes
Did a fecal microbiota transplant (FMT) occur? No, Yes
POST113 Post-Transplant Post-HCT Therapy
no yes


Date of FMT DD/MM/YY
POST114 Post-Transplant Post-HCT Therapy
no yes


Specify the indication for the FMT Graft versus host disease (GVHD), Clostridium difficle, Other
POST115 Post-Transplant Post-HCT Therapy
no yes


Specify other indication: open text
POST116 Post-Transplant Relapse or Progression Post-HCT
no yes Did the recipient experience a clinical/hematologic relapse or progression post-HCT? No,Yes
Did the recipient experience a clinical/hematologic relapse or progression post-HCT? No,Yes
POST117 Post-Transplant Relapse or Progression Post-HCT
no yes Was the date of the first clinical / hematologic relapse or progression previously reported? No,Yes (only valid >day 100)
Was the date of the first clinical / hematologic relapse or progression previously reported? No,Yes (only valid >day 100)
POST118 Post-Transplant Relapse or Progression Post-HCT
no yes Date first seen: YYYY/MM/DD
Date first seen: YYYY/MM/DD
POST119 Post-Transplant Relapse or Progression Post-HCT
no yes Was intervention given for relapsed, persistent or progressive disease? No,Yes
Was intervention given for relapsed, persistent or progressive disease? No,Yes
POST120 Post-Transplant Relapse or Progression Post-HCT
no yes Specify reason for which intervention was given Persistent disease,Relapsed / progressive disease
Specify reason for which intervention was given Persistent disease,Relapsed / progressive disease
POST121 Post-Transplant Relapse or Progression Post-HCT
no yes Specify the method(s) of detection for which intervention was given (check all that apply) Clinical and/or hematologic analysis,Cytogenetic Analysis,Disease specific molecular marker,Flow Cytometry,Radiological
Specify the method(s) of detection for which intervention was given (check all that apply) Clinical and/or hematologic analysis,Cytogenetic Analysis,Disease specific molecular marker,Flow Cytometry,Radiological
POST122 Post-Transplant Relapse or Progression Post-HCT
no yes Date intervention started: YYYY/MM/DD
Date intervention started: YYYY/MM/DD
POST123 Post-Transplant Relapse or Progression Post-HCT
no yes Specify therapy (check all that apply) Blinded randomized trial,Cellular therapy,Other therapy,Radiation,Systemic therapy
Specify therapy (check all that apply) Blinded randomized trial,Cellular therapy,Other therapy,Radiation,Systemic therapy
POST124 Post-Transplant Relapse or Progression Post-HCT
no yes Specify systemic therapy (check all that apply) Alemtuzumab,Azacytidine,Blinatumomab,Bortezomib,Bosutinib,Carfilzomib,Chemotherapy,Dasatinib,Decitabine,Gemtuzumab,Gilteritinib,Ibrutinib,Imatinib mesylate,Ixazomib,Lenalidomide,Lestaurtinib,Midostaurin,Nilotinib,Nivolumab,Other systemic therapy,Pembrolizumab,Pomalidomide,Quizartinib,Rituximab,Sorafenib,Sunitinib,Thalidomide
Specify systemic therapy (check all that apply) Alemtuzumab,Azacytidine,Blinatumomab,Bortezomib,Bosutinib,Carfilzomib,Chemotherapy,Dasatinib,Decitabine,Gemtuzumab,Gilteritinib,Ibrutinib,Imatinib mesylate,Ixazomib,Lenalidomide,Lestaurtinib,Midostaurin,Nilotinib,Nivolumab,Other systemic therapy,Pembrolizumab,Pomalidomide,Quizartinib,Rituximab,Sorafenib,Sunitinib,Thalidomide, Daratumumb (Darzalex), Venetoclax
POST125 Post-Transplant Relapse or Progression Post-HCT
no yes Specify other systemic therapy: open text
Specify other systemic therapy: open text
POST126 Post-Transplant Relapse or Progression Post-HCT
no yes Specify other therapy: open text
Specify other therapy: open text
POST127 Post-Transplant Current Disease Status
no yes What is the current disease status? Complete remission (CR),Not in complete remission,Not evaluated
What is the current disease status? Complete remission (CR),Not in complete remission,Not evaluated
POST128 Post-Transplant Current Disease Status
no yes Specify disease status if not in complete remission Disease detected,No disease detected but incomplete evaluation to establish CR
Specify disease status if not in complete remission Disease detected,No disease detected but incomplete evaluation to establish CR
POST129 Post-Transplant Current Disease Status
no yes Date of most recent disease assessment: YYYY/MM/DD
Date of assesment of current disease status YYYY/MM/DD
POST130 Post-Transplant Recipient Death Data Recipient Death yes no


Date of death: YYYY/MM/DD
POST131 Post-Transplant Recipient Death Data Recipient Death yes no


Date estimated checked
POST132 Post-Transplant Recipient Death Data Recipient Death yes no


Was cause of death confirmed by autopsy? Autopsy pending,No,Unknown,Yes
POST133 Post-Transplant Recipient Death Data Recipient Death yes no


Was documentation submitted to the CIBMTR? No,Yes
POST134 Post-Transplant Recipient Death Data Recipient Death yes no Primary cause of death Accidental death,Acute GVHD,Adult respiratory distress syndrome (ARDS) (other than IPS),Bacterial infection,Cardiac failure,Chronic GVHD,Central nervous system (CNS) failure,COVID-19 (SARS-CoV-2),Cytokine release syndrome,Diffuse alveolar damage (without hemorrhage), Disseminated intravascular coagulation (DIC),Fungal infection, Gastrointestinal (GI) failure (not liver),Graft rejection or failure, Thrombotic microangiopathy (TMA) (Thrombotic thrombocytopenic purpura (TTP)/Hemolytic Uremic Syndrome (HUS)),Idiopathic pneumonia syndrome (IPS), Liver failure (not VOD),Multiple organ failure,New malignancy,Infection, organism not identified,Other cause, Other infection,Other organ failure,Other pulmonary syndrome (excluding pulmonary hemorrhage),Other vascular,Prior malignancy,Protozoal infection, Pulmonary failure,Recurrence / persistence / progression of disease,Renal failure,Suicide,Thromboembolic, Pneumonitis due to Cytomegalovirus (CMV),Viral infection,Pneumonitis due to other virus,Veno-occlusive disease (VOD) / sinusoidal obstruction syndrome (SOS)
Primary cause of death Accidental death,Acute GVHD,Adult respiratory distress syndrome (ARDS) (other than IPS),Bacterial infection,Cardiac failure,Chronic GVHD,Central nervous system (CNS) failure,COVID-19 (SARS-CoV-2),Cytokine release syndrome,Diffuse alveolar damage (without hemorrhage),Diffuse alveolar hemorrhage (DAH),Disseminated intravascular coagulation (DIC),Fungal infection,Gastrointestinal hemorrhage,Gastrointestinal (GI) failure (not liver),Graft rejection or failure,Hemorrhagic cystitis,Thrombotic microangiopathy (TMA) (Thrombotic thrombocytopenic purpura (TTP)/Hemolytic Uremic Syndrome (HUS)),Idiopathic pneumonia syndrome (IPS),Intracranial hemorrhage,Liver failure (not VOD),Multiple organ failure,New malignancy,Infection, organism not identified,Other cause,Other hemorrhage neurotoxicity (ICANS), Other infection,Other organ failure,Other pulmonary syndrome (excluding pulmonary hemorrhage),Other vascular,Prior malignancy,Protozoal infection,Pulmonary hemorrhage,Pulmonary failure,Recurrence / persistence / progression of disease,Renal failure,Suicide,Thromboembolic, Tumor lysis syndrome, Pneumonitis due to Cytomegalovirus (CMV),Viral infection,Pneumonitis due to other virus,Veno-occlusive disease (VOD) / sinusoidal obstruction syndrome (SOS)
POST135 Post-Transplant Recipient Death Data Recipient Death yes no Specify: open text
Specify: open text
POST136 Post-Transplant Recipient Death Data Recipient Death yes no Contributing cause of death Accidental death,Acute GVHD,Adult respiratory distress syndrome (ARDS) (other than IPS),Bacterial infection,Cardiac failure,Chronic GVHD,Central nervous system (CNS) failure,COVID-19 (SARS-CoV-2),Cytokine release syndrome,Diffuse alveolar damage (without hemorrhage), Disseminated intravascular coagulation (DIC),Fungal infection, Gastrointestinal (GI) failure (not liver),Graft rejection or failure, Thrombotic microangiopathy (TMA) (Thrombotic thrombocytopenic purpura (TTP)/Hemolytic Uremic Syndrome (HUS)),Idiopathic pneumonia syndrome (IPS), Liver failure (not VOD),Multiple organ failure,New malignancy,Infection, organism not identified,Other cause, Other infection,Other organ failure,Other pulmonary syndrome (excluding pulmonary hemorrhage),Other vascular,Prior malignancy,Protozoal infection, Pulmonary failure,Recurrence / persistence / progression of disease,Renal failure,Suicide,Thromboembolic, Pneumonitis due to Cytomegalovirus (CMV),Viral infection,Pneumonitis due to other virus,Veno-occlusive disease (VOD) / sinusoidal obstruction syndrome (SOS)
Contributing cause of death Accidental death,Acute GVHD,Adult respiratory distress syndrome (ARDS) (other than IPS),Bacterial infection,Cardiac failure,Chronic GVHD,Central nervous system (CNS) failure,COVID-19 (SARS-CoV-2),Cytokine release syndrome,Diffuse alveolar damage (without hemorrhage),Diffuse alveolar hemorrhage (DAH),Disseminated intravascular coagulation (DIC),Fungal infection,Gastrointestinal hemorrhage,Gastrointestinal (GI) failure (not liver),Graft rejection or failure,Hemorrhagic cystitis,Thrombotic microangiopathy (TMA) (Thrombotic thrombocytopenic purpura (TTP)/Hemolytic Uremic Syndrome (HUS)),Idiopathic pneumonia syndrome (IPS),Intracranial hemorrhage,Liver failure (not VOD),Multiple organ failure,New malignancy,Infection, organism not identified,Other cause,Other hemorrhage neurotoxicity (ICANS), Other infection,Other organ failure,Other pulmonary syndrome (excluding pulmonary hemorrhage),Other vascular,Prior malignancy,Protozoal infection,Pulmonary hemorrhage,Pulmonary failure,Recurrence / persistence / progression of disease,Renal failure,Suicide,Thromboembolic, Tumor lysis syndrome, Pneumonitis due to Cytomegalovirus (CMV),Viral infection,Pneumonitis due to other virus,Veno-occlusive disease (VOD) / sinusoidal obstruction syndrome (SOS)
POST137 Post-Transplant Recipient Death Data Recipient Death yes no Specify: open text
Specify: open text
POST138 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes Specify the new malignancy Hematologic Malignancy: Acute myeloid leukemia (AML / ANLL), Other leukemia, Myelodysplastic syndrome (MDS), Myeloproliferative neoplasm (MPN), Overlapping myelodysplasia / myeloproliferative neoplasm (MDS / MPN), Hodgkin lymphoma, Non-Hodgkin lymphoma, Clonal cytogenetic abnormality without leukemia or MDS, Uncontrolled proliferation of donor cells without malignant transformation
Solid Tumors: Oropharyngeal cancer (e.g. tongue, mouth, throat), Gastrointestinal malignancy (e.g. esophagus, stomach, small intestine, colon, rectum, anus, liver, pancreas), Lung cancer, Melanoma, Squamous cell skin malignancy, Basal cell skin malignancy, Breast cancer, Genitourinary malignancy (e.g. kidney, bladder, cervix, uterus, ovary, prostate, testis), Central nervous system (CNS) malignancy (e.g. meningioma, glioma), Thyroid cancer
Specify the new malignancy Hematologic Malignancy: Acute myeloid leukemia (AML / ANLL), Acute lymphoblastic leukemia (ALL), Other leukemia, Myelodysplastic syndrome (MDS), Myeloproliferative neoplasm (MPN), Overlapping myelodysplasia / myeloproliferative neoplasm (MDS / MPN), Hodgkin lymphoma, Non-Hodgkin lymphoma, Multiple myeloma / plasma cell neoplasms, Clonal cytogenetic abnormality without leukemia or MDS, Uncontrolled proliferation of donor cells without malignant transformation.
Solid Tumors: Bone sarcoma (regardless of site), Soft tissue sarcoma (regardless of site), Oropharyngeal cancer (e.g. tongue, mouth, throat), Gastrointestinal malignancy (e.g. esophagus, stomach, small intestine, colon, rectum, anus, liver, pancreas), Lung cancer, Melanoma, Squamous cell skin malignancy, Basal cell skin malignancy, Breast cancer, Genitourinary malignancy (e.g. kidney, bladder, cervix, uterus, ovary, prostate, testis), Central nervous system (CNS) malignancy (e.g. meningioma, glioma), Thyroid cancer
POST139 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Was post-transplant lymphoproliferative disorder (PTLD) diagnosed? No,Yes
POST140 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Specify type of PTLD Monomorphic,Polymorphic,Unknown
POST141 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Specify oropharyngeal cancer Mouth,Throat,Tongue, Other oropharyngeal cancer
POST142 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Specify gastrointestinal malignancy Anus,Colon,Esophagus,Liver ,Pancreas,Rectum,Small intestine (DUODENUM, JEJUNUM, ILEUM),Stomach, Other gastrointestinall cancer
POST143 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Specify genitourinary malignancy Bladder,Cervix,Kidney,Ovary,Prostate,Testicle,Uterus, Other genitourary malignancy
POST144 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Specify CNS malignancy Glioma,Meningioma,Other CNS malignancy
POST145 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes Specify other new malignancy: open text
Specify other new malignancy: open text
POST146 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes Date of diagnosis: YYYY/MM/DD
Date of diagnosis: YYYY/MM/DD
POST147 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes Was documentation submitted to the CIBMTR? No,Yes
Was documentation submitted to the CIBMTR? No,Yes
POST148 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes Was the new malignancy donor / cell product derived? No,Not Done,Yes
Was the new malignancy donor / cell product derived? No,Not Done,Yes
POST149 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes Was documentation submitted to the CIBMTR? no,yes
Was documentation submitted to the CIBMTR? no,yes
POST150 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Was PTLD confirmed by biopsy? No,Yes
POST151 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes Was the pathology of the tumor EBV positive? no,yes
Was the pathology of the tumor EBV positive? no,yes
POST152 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Was documentation submitted to the CIBMTR? (e.g. pathology report) No,Yes
POST153 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Was there EBV reactivation in the blood? No,Not Done,Yes
POST154 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


How was EBV reactivation diagnosed? Other method,Qualitative PCR of blood,Quantitative PCR of blood
POST155 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Specify other method: open text
POST156 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Quantitative EBV viral load of blood: At diagnosis _____ copies/ml
POST157 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Was a quantitative PCR of blood performed again after diagnosis? No,Yes
POST158 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Highest EBV viral load of blood: ______copies/ml
POST159 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Was there lymphomatous involvement? No,Yes
POST160 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Specify sites of PTLD involvement (check all that apply) Bone marrow,Central nervous system (brain or cerebrospinal fluid),Liver,Lung,Lymph node(s),Other,Spleen
POST161 Post-Transplant Subsequent Neoplasms New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder yes yes


Specify other site: open text
POST162 Post-Transplant Subsequent Neoplasms
no yes First Name (person completing form): open text
First Name (person completing form): open text
POST163 Post-Transplant Subsequent Neoplasms
no yes Last Name: open text
Last Name: open text
POST164 Post-Transplant Subsequent Neoplasms
no yes E-mail address: open text
E-mail address: open text
POST165 Post-Transplant Subsequent Neoplasms
no yes Date: YYYY/MM/DD
Date: YYYY/MM/DD

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