This form must be completed for all infusions for recipients of non-HCT cellular therapy (including post-HCT “DCI / DLI” infusions). For recipients of hematopoietic cellular transplants (HCT), complete the Hematopoietic Stem Cell Transplant (HCT) Infusion (2006) form.

The Cellular Therapy Infusion (4006) form is designed to capture infusion-specific information for all infusions given to a recipient as part of a course of cellular therapy. In addition to use in research, this information is used for quality assurance measures, both by the NMDP and the Cord Blood Banks.

Product specific information is collected on Cellular Therapy Product (4003) form. A Cellular Therapy Product (4003) form is required for each product and a Cellular Therapy Infusion (4006) form is required for each infusion of that product. For example, a single product may be infused three times per course of cellular therapy. In this scenario, one Cellular Therapy Product (4003) form and three Cellular Therapy Infusion (4006) forms would be completed.

If more than one infusion occurs, as defined by event date, each infusion must be analyzed and reported on a separate Cellular Therapy Product (4006) form. This is true even if the same product is being infused on a later date.

For more information see Appendix D–How to Distinguish Infusion Types and Appendix E–Definition of a Product.

Links to sections of form:
Q1-31: Product Infusion
Q32-35: Concomitant Therapy

Date Manual Section Add/Remove/Modify Description
10/27/2022 Q1-31: Product Identification Modify Added CarvyktiTM to the blue note box above below14: If the cellular therapy product infused is the commercially available product Kymriah® ,or BreyanziTM, Abecma®, or CarvyktiTM this question will be disabled.
9/29/2021 Q1-31: Product Identification Modify Added CarvyktiTM to the blue note box above question 14: Product specific reporting guides for reporting cells administered can be requested for Kymriah®, BreyanziTM, Abecma®, and CarvyktiTM by contacting CIBMTR Center Support.
9/23/2022 4006: Cellular Therapy Infusion Modify Updated for new DLI reporting process: This form must be completed for all products for recipients of non-HCT cellular therapy (including post-HCT DCI /DLI” infusions). For recipients of hematopoietic cellular transplants (HCT), complete the Hematopoietic Stem Cell Transplant (HCT) Infusion (2006) form. For recipients of Donor Lymphocyte Infusions (DLI), complete the Donor Lymphocyte Infusion (2199) form.
9/23/2022 4006: Cellular Therapy Infusion Remove Removed blue note box below question 1: If your center considers this to be a Donor Lymphocyte Infusions (DLI), as reported on the Pre-CTED (4000) form, product name will not be auto-populated. Select Other product for the product name
9/23/2022 4006: Cellular Therapy Infusion Modify Added commercially available CAR-T product CarvyktiTM to the blue note box below Batch number in question 2-5: If the cellular therapy product infused is the commercially available product Kymriah® or CarvyktiTM, the batch number must be reported and is available with the information that comes with the product.
9/23/2022 4006: Cellular Therapy Infusion Modify Removed the reference to DLI: If the product being infused as a cellular therapy is a portion from a prior HCT (e.g., DLI/ DCI), the portion becomes the “entire” product for the purposes of this form.
9/23/2022 4006: Cellular Therapy Infusion Modify Added commercially available CAR-T product CarvyktiTM to the blue note box below question 10-13: If the cellular therapy product infused is the commercially available product Kymriah®, Yescarta®, TecartusTM, BreyanziTM, or Abecma®, or CarvyktiTM report the route of infusion as Intravenous.
5/10/2022 4006: Cellular Therapy Infusion Modify Removed Breyanzi from the blue note box below question 14: If the cellular therapy product infused is the commercially available product Kymriah® , BreyanziTM, or Abemca®, this question will be disabled.
1/28/2022 4006: Cellular Therapy Infusion Modify Version 6 of the 4006: Cellular Therapy Infusion section of the Forms Instruction Manual released. Version 6 corresponds to revision 6 of the Form 4006.
Last modified: Oct 27, 2022

Need more help with this?
Don’t hesitate to contact us here.

Was this helpful?

Yes No
You indicated this topic was not helpful to you ...
Could you please leave a comment telling us why? Thank you!
Thanks for your feedback.