Question 15: Is this the first application of cellular therapy (non-HCT)?

Indicate if this is the recipient’s first non-HCT cellular therapy application. This is defined as the first application the recipient ever receives, not the first application the recipient receives at your facility. The intent is to capture the full picture of the recipient’s treatment history.

If “yes” or “unknown”, continue with question 24. If “no”, continue with question 16.

Question 16: Were all prior cellular therapies (non-HCT) reported to the CIBMTR?

This should include any/all infusions not performed at your center. If the recipient is a transfer patient, you will be able to see all past infusion dates in the Recipient Information Grid in FormsNet3SM. Contact the CIBMTR Customer Service Center if there are questions.

If “yes” or “unknown”, continue to question 24. If “no”, continue with question 17.

Question 17: Specify the number of prior cellular therapies:

Enter the number of prior cellular therapies for the recipient. A “cellular therapy event” is defined as the infusion or administration of a cellular therapy product for treatment of a specific indication(s). Each infusion or administration of a cellular product should be counted separately. Include all infusions the recipient received, even if they were not performed at your center. The intent is to capture the full picture of the recipient’s treatment history.

Question 18: Date of the prior cellular therapy:

Report the date (YYYY-MM-DD) of the prior cellular therapy being reported in this instance. If the exact date is unknown and must be estimated, check the “date estimated” box.

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

Question 19: Was the cellular therapy performed at a different institution?

Indicate if the prior cellular therapy being reported in this instance was performed at another institution. If “yes”, report the name and address of the institution in question 20. If “no”, continue with question 21.

Question 20: Specify the institution that performed the prior cellular therapy:

Report the name, city, state, and country of the institution where the recipient’s prior cellular therapy being reported in this instance was performed. These data are used to identify and link the recipient’s existence in the database and, if necessary, obtain data from the other institution where the previous treatment was administered.

Question 21 – 22: Specify the indication for the prior cellular therapy:

Select the indication for the prior cellular therapy being reported in this instance. Any indication that is followed by “(post-HCT)” or “(with HCT)” requires that a prior HCT also be reported to CIBMTR.

If the indication for the prior cellular therapy is not listed, select “other indication” and specify the indication in question 22. If the indication for the prior cellular therapy is not documented, select “unknown”.

Question 23: What was the cell source for the prior cellular therapy? (check all that apply)

Indicate the cell source(s) for the prior cellular therapy being reported in this instance. If the product is “off the shelf” or a “third party donor” product obtained from pharmaceutical companies or other corporate entities, donor type should still be identified.

An autologous product has cells collected from the recipient for his/her own use.

An unrelated donor (allogeneic, unrelated) is a donor who shares no known ancestry with the recipient. Include adoptive parents/children or step-parents/children.

A related donor (allogeneic or syngeneic, related) is a blood-related relative. This includes monozygotic (identical twins), non-monozygotic (dizygotic, fraternal, non-identical) twins, siblings, parents, aunts, uncles, children, cousins, half-siblings, etc.

Question 24: Has the recipient ever had a prior HCT?

Include all HCTs in the recipient’s history, even if the transplants were not performed at your center. The intent is to capture the full picture of the recipient’s treatment history.

If “yes” continue with question 25. If “no” or “unknown”, continue with question 30.

Question 25: Were all prior HCTs reported to the CIBMTR?

This should include any/all HCTs not performed at your center. If the recipient is a transfer patient, you will be able to see all past infusion dates in the Recipient Information Grid in FormsNet3SM. Please submit any questions via Center Support in the ServiceNow application.

If “yes” or “unknown”, continue with question 30. If “no”, continue with question 26.

Question 26: Date of the prior HCT:

Report the date (YYYY-MM-DD) of the prior HCT being reported in this instance.

If the exact date is unknown, please view General Instructions, General Guidelines for Completing Forms for more information on reporting partial and unknown dates.

Question 27: Was the HCT performed at a different institution?

Indicate if the prior HCT being reported in this instance was performed at another institution. If “yes” report the name and address of the institution in question 28. If “no” continue with question 29.

Question 28: Specify the institution that performed the prior HCT:

Report the name, city, state, and country of the institution where the recipient’s prior HCT being reported in this instance was performed. These data are used to identify and link the recipient’s existence in the database and, if necessary, obtain data from the previous transplant center.

Question 29: Specify the HSC source(s) for the prior HCT: (check all that apply)

Indicate the applicable cell source(s) for the prior HCT being reported in this instance.

An autologous product has cells collected from the recipient for his/her own use.

An unrelated donor (allogeneic, unrelated) is a donor who shares no known ancestry with the recipient. Include adoptive parents/children or step-parents/children.

A related donor (allogeneic, related) is a blood-related relative. This includes monozygotic (identical twins), non-monozygotic (dizygotic, fraternal, non-identical) twins, siblings, parents, aunts, uncles, children, cousins, half-siblings, etc.

Section Updates:

Question Number Date of Change Add/Remove/Modify Description Reasoning (If applicable)
. . . . .
Last modified: Dec 22, 2020

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