This form must be completed for all recipients randomized to the Comprehensive Report Form (CRF) track whose primary disease is reported on the Pre-TED Disease Classification Form (Form 2402) as Wiskott-Aldrich Syndrome under “disorders of the immune system.” The Wiskott-Aldrich syndrome Post-HCT Data Form (Form 2133) must be completed in conjunction with each Post-HCT follow-up form (Forms 2100, 2200, 2300) completed. The form is designed to capture specific data occurring within the timeframe of each reporting period (i.e., between day 0 and day 100 for Form 2100, between day 100 and the six-month date of contact for Form 2200, between the date of contact for the six-month follow up and the date of contact for the one-year follow up for Form 2200, etc.)
- Q1-50: Laboratory Studies Post-HCT
- Q51-105: Clinical Status of Recipient Post-HCT
- Q106-167: Post-HCT Treatment for Wiskott-Aldrich Syndrome
- Q169-174: Status of Hematologic Engraftment
Sections of the Forms Instruction Manual are frequently updated. In addition to documenting the changes within each manual section, the most recent updates to the manual can be found below. For additional information, select the manual section and review the updated text.
|2/24/17||Comprehensive Disease-Specific Manuals||Modify||Updated explanations of triggers for disease inserts to refer to the primary disease reported on the Pre-TED Disease Classification Form (Form 2402) instead of the Pre-TED Form (Form 2400)|
|2/9/16||2133: WAS Post-HCT||Add|| Added CD15+ cells to the text in question 173:
Myeloid subsets may be reported as CD15+ or CD33+ on the laboratory report.
|9/11/15||2033/2133: Wiskott Aldrich Syndrome||Add||Published new manual for 2033 & 2131 WAS Pre- and Post-HCT.|
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