Question 13: Was PTLD confirmed by biopsy?

Indicate Yes or No if PTLD was confirmed by a biopsy. If No, continue with question 16.

Questions 14 – 15: Was the pathology of the tumor EBV positive?

Using the pathology report, indicate Yes or No if the tumor was EBV positive. Additionally, indicate if documentation was submitted to the CIBMTR. CIBMTR recommends attaching the pathology report in FormsNet3SM.

For further instructions on how to attach documents in FormsNet3SM, refer to the Training Guide.

Question 16: Was there EBV reactivation in the blood?

Indicate Yes or No if there was EBV reactivation in the blood. If the EBV reactivation (in the blood) was not assessed, select Not done and continue with question 22.

Questions 17 – 19: How was EBV reactivation diagnosed?

EBV reactivation may be diagnosed by polymerase chain reaction (PCR) methods (qualitative or quantitative) where a blood sample is taken and manipulated using PCR techniques to determine the presence and classification of an organism by identifying DNA sequences unique to the specific organism.

Indicate how EBV reactivation was diagnosed.

  • Qualitative PCR of blood: Indicates if EBV was detected (provides “positive” or “negative” results).
  • Quantitative PCR of blood: Provides the number of copies of EBV detected. If selected, specify the viral load of blood (at diagnosis of EBV) in question 19 in copies / mL.

If EBV reactivation was diagnosed by a method other than qualitative or quantitative PCR of blood, select Other method and specify in question 18.

Questions 20 – 21: Was a quantitative PCR of blood performed again after diagnosis?

If EBV reactivation was diagnosed by quantitative PCR of blood, as reported above, indicate Yes or No if a quantitative PCR of blood was performed again after diagnosis. If Yes, report the highest EBV viral load of blood in the current reporting period.

If No, continue with question 22.

Questions 22 – 24: Was there lymphomatous involvement? (e.g. a mass)

Indicate Yes or No if there was lymphomatous involvement of PTLD. If Yes, specify the sites of involvement. Check all that apply.

If No, continue with the signature lines.

Section Updates:

Question Number Date of Change Add/Remove/Modify Description Reasoning (If applicable)
. . . . .
Last modified: Jul 23, 2021

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