Q1-2: Primary Disease for HCT / Cellular Therapy

*Disease Classification Questions
The newest versions of the TED Forms use the World Health Organization (WHO) disease classifications. The Disease Classification questions contain all of the established WHO disease types and subtypes. The “other, specify” category should be used only if the recipient’s disease is not one of the listed options. For more information regarding disease classification, consult a transplant physician, contact the CIBMTR Customer Service Center, or visit the WHO website at: http://www.who.int/classifications/icd/en/.
Several of the Disease Classification questions ask for “Status at Transplantation.” Although there are many interpretations of disease response criteria, when reporting data to the CIBMTR, use the guidelines in this manual to determine disease status. A majority of the disease response criteria are established by an international working group. Citations of resources used to define disease responses are included where applicable.
If the recipient’s status is unclear, consult with the transplant physician for further information or contact the CIBMTR Customer Service Center.

!Subsequent HCT / Cellular Therapy for Disease Relapse:
For many diseases, the CIBMTR data collection forms capture disease assessments at multiple time points pre- and post-infusion. If the indication for this recipient’s HCT / Cellular Therapy is relapsed / progressive disease and they have had a previous infusion that was reported to the CIBMTR, only disease assessments performed after the disease relapse / progression need to be reported. In this case, the disease assessments “at diagnosis” would be the disease assessments performed at the time of relapse / progression occurred (prior to the initiation of therapy). Some pre-infusion forms on the Case Report Form (CRF) track have different reporting rules, depending on if a pre-infusion CRF had been previously complete for the recipient. Carefully review the Disease-Specific CRF manuals for additional information.

*Malignant vs. Non-Malignant
Malignant diseases involve cells dividing without control that can spread to other parts of the body through blood and lymph systems. These diseases are usually characterized by unlimited, aggressive growth, invasion of surrounding tissues, and metastasis.
Non-malignant diseases involve cell overgrowth, but lack the malignant properties of cancer.
The CIBMTR database disease codes are represented in parentheses after the disease subtype on the Disease Classification questions and can be helpful in mapping diagnosis [e.g., Myeloid Sarcoma (295)], and determining if the disease is malignant or non-malignant. Disease codes (10-299) indicate a malignant disease, with the exception of Paroxysmal Nocturnal Hemoglobinuria (PNH) (56). A disease code of (300) or above indicates a non-malignant disease, with the exception of disease code (900), which could indicate either a malignant or non-malignant disease.

If the indication for HCT is due to a combination of diseases or a transformation of one disease to another, it may be necessary to report multiple disease classifications. The tables below list how common examples of disease combinations and transformations should be reported using the Disease Classification questions.

Common Disease Combinations

Disease Combinations	Report Primary Disease as:	Report disease diagnosis date of:	Complete multiple disease sections of the Disease Classification Form?
FAN or SAA and AML	AML	AML	No
FAN or SAA and MDS	MDS	MDS	No
MYE and AMY	MYE	MYE	No

Common Disease Transformations

Disease Transformation	Report primary disease as:	Report disease diagnosis date of:	Complete multiple disease sections of the Disease Classification Form?
MDS or MPN to AML	AML	AML	Yes – AML and MDS or MPN
JMML to AML	AML	AML	Yes – AML and MDS (select questions only)
NHL to another NHL	Second NHL diagnosis	Second NHL diagnosis	No
HL to NHL*	NHL	NHL	No
CLL to NHL (i.e., Richter’s Syndrome)	NHL	NHL	No

_{AML=Acute Myelogenous Leukemia; AMY=Amyloidosis; CLL=Chronic Lymphocytic Leukemia; FAN=Fanconi Anemia; MDS=Myelodysplastic Syndrome; MPS=Myeloproliferative Disease; MYE=Multiple Myeloma; NHL=Non-Hodgkin Lymphoma; SAA=Severe Aplastic Anemia.
*Ensure that the disease process is a transformation from Hodgkin lymphoma to Non-Hodgkin lymphoma (typically diffuse large B-cell lymphoma), rather than the distinct entity “B-cell lymphoma, unclassifiable, with features indeterminate between DLBCL and classical Hodgkin Lymphoma.”}

Question 1: Date of diagnosis for primary disease for HCT:

The date of diagnosis is important because the interval between diagnosis and HCT is often a significant indicator for the recipient’s prognosis post-HCT.

Report the date of the first pathological diagnosis (e.g., bone marrow or tissue biopsy) of the disease. Enter the date the sample was collected for examination. If the diagnosis was determined at an outside center, and no documentation of a pathological or laboratory assessment is available, the dictated date of diagnosis within a physician note may be reported. Do not report the date symptoms first appeared.

If the recipient was diagnosed prenatally (in utero) or was diagnosed with a congenital immunodeficiency, report the date of birth as the date of diagnosis.

If the exact pathological diagnosis date is not known, use the process described in General Instructions, Guidelines for Completing Forms.

If this is a subsequent HCT for a new malignancy (or other new indication), report the date of diagnosis of the new malignancy.

!Erythropoietic protoporphyria (EPP): Historically, if the primary disease for transplant was erythropoietic protoporphyria, the primary disease for transplant was reported as “Other Disease.” However, the primary disease for transplant should be reported as “Inherited Abnormalities of Erythrocyte Differentiation or Function” in question 2 and specify the classification as “Other hemoglobinopathy” in question 359.

Question 2: What was the primary disease for which the HCT was performed?

Select the primary disease for which the recipient is receiving the HCT and continue with the appropriate disease classification questions.

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