Complete this form for recipients whose primary disease, reported on the Disease Classification Form (Form 2402), is Hodgkin Lymphoma (HL) or non-Hodgkin Lymphoma (NHL). One exception is Waldenstrom’s macroglobulinemia / lymphoplasmacytic lymphoma, for which, a Waldenstrom’s Macroglobulinemia Form (Form 2019) will be completed instead.

Is this the report of a second or subsequent transplant or cellular therapy for the same disease?

Report “No” and go to question 1 in any of the following scenarios:
• this is the first infusion reported to the CIBMTR;
• this is the first infusion given to treat the recipient’s current disease; or
• this is a second or subsequent infusion for the same disease and this baseline disease insert was not completed for the previous transplant (e.g., patient was on TED track for the prior infusion, prior infusion was autologous with no consent, etc.).

If this is a report of a second or subsequent infusion for the same disease and this baseline lymphoma disease insert was completed previously, report “Yes” and go to question 82.

Links to sections of form:
Q1-55: Disease Assessment at Diagnosis
Q56-68: Laboratory Studies at Diagnosis
Q69-81: Assessment of Nodal and Organ Involvement at Diagnosis
Q82-139: Disease Assessment at Transformation
Q140-152: Laboratory Studies at Transformation
Q153-165: Assessment of Nodal and Organ Involvement at Transformation
Q166-223: Pre-HCT or Pre-Infusion Therapy
Q224-233: Disease Assessment at the Failure of the 1st Line of Therapy
Q234-288: Disease Assessment at the Last Evaluation Prior to the Start of the Preparative Regimen / Infusion

Manual Updates:
Sections of the Forms Instruction Manual are frequently updated. The most recent updates to the manual can be found below. For additional information, select the manual section and review the updated text.

If you need to reference the historical Manual Change History for this form, please click here or reference the retired manual section on the Retired Forms Manuals webpage.

Date Manual Section Add/Remove/Modify Description
10/23/2020 2018: LYM Pre-Infusion Modify Version 5 of the 2018: Lymphoma Pre-Infusion Data section of the Forms Instruction Manual released. Version 5 corresponds to revision 6 of the Form 2018.
Last modified: Oct 23, 2020

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