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 appropriate HCT infusion form (Form 2006).

The Form 4006 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 Form 4003. A Form 4003 is required for each product and a Form 4006 is required for each infusion of that product. For example, a single product may be infused three times per course of cellular therapy.

If more than one infusion occurs, as defined by event date, each infusion must be analyzed and reported on a separate Form 4006. This is true even if it’s the same product 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:
Q1-46: Product Infusion
Q47-50: Concomitant Therapy

Date Manual Section Add/Remove/Modify Description
1/24/2020 4006: Cellular Therapy Infusion Modify Version 4 of the 4006: Cellular Therapy Infusion section of the Forms Instruction Manual released. Version 4 corresponds to revision 4 of the Form 4006.
Last modified: Jan 30, 2020

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