The myelodysplastic syndromes (MDS) are a group of clonal hematopoietic stem cell diseases characterized by cytopenia(s), dysplasia (abnormal growth or development leading to an alteration in size, shape, and organization of the cell) in one or more of the major myeloid cell lines (WBC, RBC, and/or platelets), ineffective hematopoiesis, and an increased risk of developing acute myelogenous leukemia (AML). MDS occurs primarily in older adults, with a median age of 70 years. The majority of recipients present with symptoms related to cytopenias. Most recipients present with anemia requiring RBC transfusions.

Primary or de novo MDS occurs without a known history of chemotherapy or radiation exposure. Some inherited hematologic disorders, such as Fanconi anemia, dyskeratosis congenita, Shwachman-Diamond syndrome, and Diamond-Blackfan syndrome are associated with an increased risk of MDS.

Question 179: What was the MDS subtype at diagnosis?

Please indicate the MDS subtype at diagnosis. For a list of MDS subtypes and their diagnostic criteria, see Appendix H.

Question 180: Specify Myelodysplastic syndrome, unclassifiable (MDS-U)

Specify the Myelodysplastic syndrome, unclassifiable (MDS-U) and continue with question 181.

Question 181: Was documentation submitted to the CIBMTR (e.g. pathology report used for diagnosis)?

Indicate whether documentation was submitted to the CIBMTR (e.g., pathology report). For further instructions on how to attach documents in FormsNet3 SM, refer to the Training Guide.

Question 182: Was the disease (MDS) therapy-related?

Agents such as radiation or systemic therapy used to treat other diseases (e.g., Hodgkin lymphoma, non-Hodgkin lymphoma, or breast cancer) can damage the marrow and lead to a secondary malignancy, such as MDS.

If the diagnosis of MDS is therapy-related, select “yes.” If the diagnosis of MDS is not therapy-related, select “no.” If it is unknown if the MDS is therapy-related, select “unknown.”

Do not report “yes” if the recipient developed MDS after an environmental exposure (e.g., exposure to benzene).

Question 183: Did the recipient have a predisposing condition?

A predisposing condition contributes to the susceptibility of developing MDS. Therefore, diagnosis of the condition increases the likelihood that the recipient will develop MDS. If the recipient has a documented history of a predisposing condition, select “yes” and continue with question 184. If there is no history of a predisposing condition or if predisposition is unknown, indicate “no” or “unknown” and continue with question 186.

Questions 184-185: Specify condition:

Specify the recipient’s predisposing condition.

Aplastic anemia may progress to MDS and/or AML. Aplastic anemia is a broad classification referring to bone marrow failure characterized by pancytopenia and marrow hypoplasia. If aplastic anemia is selected and the recipient is on the CRF track, the Aplastic Anemia Pre-HCT (2028) Form will come due.

DDX41-associated familial MDS is a rare germline heterozygous mutation. DDX41 represents a class of tumor suppressor genes in myeloid neoplasms.

Diamond-Blackfan anemia is a rare genetic disorder that affects the ability of the marrow from producing red blood cells. These recipients may present with anemia, recipients may also exhibit physical abnormalities such as: small head size, cleft lip, webbed neck, defects of the hands and a short stature. Fanconi anemia is a rare genetic blood disorder that prevents the body from producing a sufficient number of new blood cells to function properly. Abnormal blood cells may also be produced. These recipients are short in stature, exhibit skeletal abnormalities, and have an increased risk of developing solid tumors, MDS, and leukemias. If Fanconi anemia is selected and the recipient is on the CRF track, the Fanconi Anemia Pre-HCT (2029) Form will come due.

GATA2 deficiency is a rare genetic disorder which can cause a variety of issues including viral and bacterial infections, cytopenias, myelodysplasia, myeloid leukemias, pulmonary alveolar proteinosis and lymphedema

Li-Fraumeni syndrome is a rare genetic disorder which increases the risk of developing several types of cancers, notably: breast cancer, osteosarcoma, sarcoma, brain tumors and leukemias. Li-Fraumeni syndromes are associated with mutations in the TP53 gene.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare genetic disorder of the blood cells. The disease is characterized by destruction of red blood cells. blood clots and impaired bone marrow function. PNH is very closely related and often derives from aplastic anemia. If PNH is selected and the recipient is on the CRF track, the Aplastic Anemia Pre-HCT (2028) Form will come due

RUNX1 deficiency was previously known as “familial platelet disorder with propensity to myeloid malignancies”. Recipients with RUNX1 deficiencies typically present with mild to moderate thrombocytopenia with normal-sized platelets, functional platelets defects leading to prolonged bleeding and an increased risk to develop myelodysplastic syndromes (MDS), acute myeloid leukemia (AML), or T-cell acute lymphoblastic leukemia (T-ALL).

SAMD9- or SAMD9L-associated familial MDS are germline mutations which can result in a spectrum of multisystem disorders that carry a markedly increased risk of developing myeloid malignancies.

Shwachman-Diamond syndrome (SDS) is a rare autosomal recessive disorder in which is characterized by exocrine pancreatic insufficiency, bone marrow dysfunction, and skeletal abnormalities.

Telomere biology disorder (including dyskeratosis congenita) are a complex set of inherited conditions defined by the presence of very short telomeres. Telomere biology disorder can be characterized by bone marrow failure and lung disease.

If the recipient had a predisposing condition not listed above, select “other condition” and specify the condition in question 185.

A list of entities that would fall into the “other condition” category include: ETV6-related familial thrombocytopenia, ANKRD26-related familial thrombocytopenia, SRP72-related familial aplastic anemia/MDS, MBD4-related familial leukemia, Bloom Syndrome, Noonan Syndrome, Neurofibromatosis, Downs Syndrome, ATG2B/GSKIP duplication (chromosome 14q32.2), MECOM-associated syndrome.

Report laboratory results from prior to the start of first treatment of the primary disease for which the HCT is being performed. If the recipient’s MDS transformed, report the studies from the original diagnosis.

Question 186: Date CBC drawn

These questions are intended to capture the laboratory studies performed at the diagnosis of MDS. Testing may be performed multiple times around the time of diagnosis; report the most recent laboratory results performed prior to the start of first treatment of the primary disease for HCT. If the recipient’s MDS transformed, report the studies from the original diagnosis.

Report the date the sample was drawn and continue with question 187.

Question 187-188: WBC

Indicate whether the white blood cell (WBC) count was “known” or “unknown” at diagnosis. If “known,” report the laboratory count and unit of measure documented on the laboratory report in question 188. If “unknown,” continue with question 189.

Question 189-190: Neutrophils

Indicate whether the neutrophil percentage in the blood was “known” or “unknown” at diagnosis. If “known,” report the value documented on the laboratory report in question 190. If “unknown,” continue with question 191.

Question 191-192: Blasts in the blood

Indicate whether the percent blasts in the peripheral blood is “known” or “unknown” at diagnosis. If “known,” report the laboratory value in question 192. If the percent blasts in blood at diagnosis is not known, report “unknown” and go to question 193. Note, blasts are not typically seen in the peripheral blood. If blasts are NOT reported on the differential you can still report “known” in question 191 and “0%” in question 192.

Question 193-194: Hemoglobin

Indicate whether the hemoglobin was “known” or “unknown” at diagnosis. If “known,” report the laboratory count and unit of measure documented on the laboratory report in question 194. If “unknown,” continue with question 196.

Question 195: Were RBCs transfused ≤ 30 days before the date the CBC was drawn?

Transfusions temporarily increase the red blood cell count. It is important to distinguish between a recipient whose body is creating these cells and a recipient who requires transfusions to support the counts.

Indicate if red blood cells were transfused less than or equal to 30 days prior to the date the CBC was drawn as reported in question 186.

Question 196-197: Platelets

Indicate whether the platelet count was “known” or “unknown” at diagnosis. If “known,” report the laboratory count and unit of measure documented on the laboratory report in question 197. If “unknown,” continue with question 199.

Question 198: Were platelets transfused ≤ 7 days before date the CBC was drawn?

Transfusions temporarily increase the platelet count. It is important to distinguish between a recipient whose body is creating the platelets and a recipient who requires transfusions to support the counts.

Indicate if platelets were transfused less than or equal to 7 days prior to the date the CBC was drawn as reported in question 186.

Question 199-200: Blasts in bone marrow

Indicate whether the percentage of blasts in the bone marrow was “known” or “unknown” at diagnosis. If “known,” report the percentage documented on the laboratory report in question 200. If “unknown,” continue with question 201.

If multiple methods were used to detect the percentage of blasts in the bone marrow, the aspirate differential is the most preferred method followed by flow cytometry and IHC.

Question 201: Were cytogenetics tested (karyotyping or FISH)?

Cytogenetics is the study of chromosomes. Cytogenetic assessment involves testing blood or bone marrow for the presence of known chromosomal abnormalities that reflect the recipient’s disease. Testing methods include conventional chromosome analysis (karyotyping) or fluorescence in situ hybridization (FISH). For more information about cytogenetic testing and terminology, see Appendix C, Cytogenetic Assessments.

Indicate if cytogenetic studies were obtained at diagnosis. If cytogenetic studies were obtained, select “yes” and continue with question 202.

If no cytogenetic studies were obtained or it is unknown if chromosome studies were performed, select “no” or “unknown” and continue with question 218.

Question 202: Were cytogenetics tested via FISH?

If FISH studies were performed at diagnosis, report “yes” and continue with question 203.

If FISH studies were not performed at diagnosis, report “no” and go to question 210. Examples include: no FISH study performed or FISH sample was inadequate. See Appendix C, Cytogenetic Assessments, for assistance interpreting FISH results.

Report chromosomal microarrays / chromosomal genomic arrays as FISH assessments.

Question 203: Sample source:

Indicate if the sample was from “bone marrow” or from “peripheral blood” and continue with question 204. If multiple sources were used to test FISH, the most preferred sample is the bone marrow.

Question 204: Results of tests:

If FISH assessments identified abnormalities, indicate “abnormalities identified” and continue with question 205.

If FISH assessments were unremarkable, indicate “no abnormalities” identified, continue with question 209.

Questions 205-208: Specify cytogenetic abnormalities (FISH)

Report the International System for Human Cytogenetic Nomenclature (ISCN) compatible string, if applicable, in question 205, then continue with question 206.

Report the number of abnormalities detected by FISH at diagnosis in question 206. After indicating the number of abnormalities in question 206, select all abnormalities detected in question 207. If a clonal abnormality is detected, but not listed as an option in question 207, select “other abnormality” and specify the abnormality in question 208.

If multiple “other abnormalities” were detected, report “see attachment” in question 208 and attach the final report(s) for any other abnormalities detected. For further instructions on how to attach documents in FormsNet3 SM, refer to the Training Guide.

Question 209: Was documentation submitted to the CIBMTR?

Indicate whether documentation was submitted to the CIBMTR (e.g., pathology report, FISH report). For further instructions on how to attach documents in FormsNet3 SM, refer to the Training Guide.

Question 210: Were cytogenetics tested via karyotyping?

If karyotyping was performed at diagnosis report “yes” and continue with question 211.

If karyotyping was not performed at this time point, indicate “no” and continue with question 218. Examples of this include: karyotyping was not performed, or karyotyping sample was inadequate.

Question 211: Sample source:

Indicate if the sample was from “bone marrow” or from “peripheral blood” and continue with question 212. If multiple sources were used for karyotyping assessments, the most preferred sample is the bone marrow.

Question 212: Results of tests:

If karyotyping assessments identified abnormalities, indicate “abnormalities identified” and continue with question 213.

If karyotyping assessments yielded no evaluable metaphases or there were no abnormalities identified, indicate as such and continue with question 217.

Question 213-216: Specify cytogenetic abnormalities (karyotyping)

Report the International System for Human Cytogenetic Nomenclature (ISCN) compatible string, if applicable, in question 213, then continue with question 214.

Report the number of abnormalities detected by karyotyping at diagnosis in question 214. After indicating the number of abnormalities in question 214, select all abnormalities detected in question 215. If a clonal abnormality is detected, but not listed as an option in question 215, select “other abnormality” and specify the abnormality in question 216.

If multiple “other abnormalities” were detected, report “see attachment” in question 216 and attach the final report(s) for any other abnormalities detected. For further instructions on how to attach documents in FormsNet3 SM, refer to the Training Guide.

Question 217: Was documentation submitted to the CIBMTR?

Indicate whether documentation was submitted to the CIBMTR (e.g., FISH report, karyotype report). For further instructions on how to attach documents in FormsNet3SM, refer to the Training Guide.

Question 218: Did the recipient progress or transform to a different MDS subtype or AML between diagnosis and the start of the preparative regimen / infusion?

Indicate if the recipient’s disease progressed to AML or transformed into a different MDS subtype between initial diagnosis and the start of the preparative regimen / infusion. Approximately one third of MDS cases transform into AML, signifying a poorer prognosis. Progression to AML is defined by an increase in blood or bone marrow blasts equal to or greater than 20%.

MDS subtypes may also transform / progress from one into another. A progression from one subtype of MDS to another indicates that the number of cytopenias, number of blasts, and/or morphology of marrow sufficiently qualified them for a higher grade (i.e., more severe) MDS. For example, an MDS classified as MDS-SLD at diagnosis whose blast count rises to 8% as documented on bone marrow aspirate would have progressed to MDS-EB-1.

Conversely, do not report a progression / transformation if the recipient’s assessments after diagnosis show that they qualify for a lower grade (i.e., less severe MDS). For example, a recipient who is diagnosed with MDS-EB-2, but whose assessments show that they meet the criteria for MDS-EB-1 as a response to treatment, would not qualify as a progression or transformation. In this example, the disease is lower grade (i.e., less severe), rather than a higher grade (i.e., more severe) so it should not be reported as a progression/transformation. See the table below for guidance in determining the severity of MDS progressions and transformations.

Grade of MDS Progression/Transformations

Lower Grade >>>>>> >>>>>> >>>>>> Higher Grade
MDS-SLD / MDS-RS-SLD / MDS-RS-MLD / Childhood MDS MDS-MLD MDS-EB-1 MDS-EB-2 AML
JMML/CMML AML

Indicate if the recipient’s disease progressed to AML or transformed from one MDS subtype to another. If the recipient’s disease transformed or progressed, select “yes” and continue with question 219. If there was no documented transformation or progression, select “no” and continue with question 223.

Question 219: Specify the MDS subtype after transformation:

Indicate the recipient’s current MDS subtype after transformation. If the recipient experienced more than one transformation after diagnosis, report the most recent subtype. For a list of MDS subtypes and their diagnostic criteria, see Appendix H.

If the recipient progressed or transformed to MDS unclassifiable, continue with question 220. If the disease transformed to AML, continue with question 222. If MDS progresses to AML and the recipient is on the CRF track, the Acute Myelogenous Leukemia (AML) Pre-HCT (2010) Form will also come due.

For all other progressions or transformations continue with question 221.

Question 220: Specify Myelodysplastic syndrome, unclassifiable (MDS-U)

The classification of myelodysplastic syndrome, unclassifiable (MDS-U) would be based off the bone marrow biopsy pathology report and can be reported as one of the following:

  • MDS-U with 1% blood blasts
  • MDS-U with single lineage dysplasia and pancytopenia
  • MDS-U based on defining cytogenetic abnormality

Specify the Myelodysplastic syndrome, unclassifiable (MDS-U) using the definitions listed in on the form and continue with question 221.

Question 221: Specify the date of the most recent transformation:

Report the date of assessment that determined the most recent disease transformation (i.e., if there were multiple transformations, report the most recent). Report the date of the pathological evaluation (e.g., bone marrow) or blood/serum assessment (e.g., CBC, peripheral blood smear). Enter the date the sample was collected for pathological and laboratory evaluations.

If the exact date is not known, use the process for reporting partial or unknown dates as described in General Instructions, Guidelines for Completing Forms.

Question 222: Date of MDS Diagnosis

If the recipient’s MDS transformed to AML prior to HCT, report the date of diagnosis of MDS. If the exact date is not known, use the process for reporting partial or unknown dates as described in General Instructions, Guidelines for Completing Forms.

Ensure the date of diagnosis for AML has been reported in question 1, AML is reported as the primary disease for HCT in question 2, and the AML section of the Disease Classification Form has been complete appropriately. Go to the signature line.

Question 223: Date CBC drawn:

Report the date the CBC was drawn at the last evaluation prior to the start of the preparative regimen / infusion and continue with question 224. If multiple assessments were performed, report the most recent one prior to the start of the preparative regimen / infusion.

Question 224-225: WBC

Indicate whether the white blood cell (WBC) count was “known” or “unknown” at the last evaluation prior to the start of the preparative regimen / infusion. If “known,” report the laboratory count and unit of measure documented on the laboratory report in question 225. If “unknown,” continue with question 226.

Questions 226-227: Neutrophils

Indicate whether the neutrophil percentage in the blood was “known” or “unknown” at the last evaluation prior to the start of the preparative regimen / infusion. If “known,” report the value documented on the laboratory report in question 227. If “unknown,” continue with question 228.

Question 228-229: Blasts in the blood

Indicate whether the percent blasts in the peripheral blood is “known” or “unknown” at the last evaluation prior to the start of the preparative regimen / infusion. If “known,” report the laboratory value in question 229. If the percent blasts in blood at diagnosis is not known, report “unknown” and go to question 230. Note, blasts are not typically seen in the peripheral blood. If blasts are NOT reported on the differential you can still report “known” in question 228 and “0%” in question 229.

Question 230-231: Hemoglobin

Indicate whether the hemoglobin was “known” or “unknown” at the last evaluation prior to the start of the preparative regimen / infusion. If “known,” report the laboratory count and unit of measure documented on the laboratory report in question 231. If “unknown,” continue with question 233.

Question 232: Were RBCs transfused ≤ 30 days before the date the CBC was drawn?

Transfusions temporarily increase the red blood cell count. It is important to distinguish between a recipient whose body is creating these cells and a recipient who requires transfusions to support the counts.

Indicate if red blood cells were transfused less than or equal to 30 days prior to the date the CBC was drawn as reported in question 223.

Question 233-234: Platelets

Indicate whether the platelet count was “known” or “unknown” at the last evaluation prior to the start of the preparative regimen / infusion. If “known,” report the laboratory count and unit of measure documented on the laboratory report in question 234. If “unknown,” continue with question 236.

Question 235: Were platelets transfused ≤ 7 days before the date the CBC was drawn?

Transfusions temporarily increase the platelet count. It is important to distinguish between a recipient whose body is creating the platelets and a recipient who requires transfusions to support the counts.

Indicate if platelets were transfused less than or equal to 7 days prior to the date the CBC was drawn as reported in question 223.

Questions 236-237: Blasts in bone marrow:

Indicate whether the percentage of blasts in the bone marrow was “known” or “unknown” at the last evaluation prior to the start of the preparative regimen / infusion. If “known,” report the percentage documented on the pathology report in question 237. If “unknown,” continue with question 238

If multiple assessments were performed at the last evaluation, report the most recent assessment prior to the start of the preparative regimen / infusion.

Question 238: Were cytogenetics tested (karyotyping or FISH)?

Cytogenetics is the study of chromosomes. Cytogenetic assessment involves testing blood or bone marrow for the presence of known chromosomal abnormalities that reflect the recipient’s disease. Testing methods include conventional chromosome analysis (karyotyping) or fluorescence in situ hybridization (FISH). For more information about cytogenetic testing and terminology, see Appendix C, Cytogenetic Assessments.

Indicate if cytogenetic studies were obtained at the last evaluation prior to the preparative regimen / infusion. If cytogenetic studies were obtained, select “yes” and continue with question 239.

If no cytogenetic studies were obtained or it is unknown if chromosome studies were performed, select “no” or “unknown” and continue with question 255.

Question 239: Were cytogenetics tested via FISH?

Indicate if FISH studies were performed at the last evaluation prior to the start of the preparative regimen / infusion. If “yes,” continue with question 240.

If FISH studies were not performed at the last evaluation prior to the start of the preparative regimen / infusion, report “no” and continue with question 247. Examples include: no FISH study performed, or FISH sample was inadequate. See Appendix C, Cytogenetic Assessments, for assistance interpreting FISH results.

Report chromosomal microarrays / chromosomal genomic arrays as FISH assessments.

Question 240: Sample source:

Indicate if the sample was from “bone marrow” or from “peripheral blood” and continue with question 241. If multiple sources were used to test FISH, the most preferred sample is the bone marrow.

If FISH studies were performed on multiple samples at the last evaluation prior to the start of the preparative regimen / infusion, the bone marrow results are the preferred sample source to report.

Question 241: Results of tests:

If FISH assessments identified abnormalities, indicate “abnormalities identified” and continue with question 242.

If FISH assessments were unremarkable, indicate “no abnormalities” identified, continue with question 246.

Questions 242-245: Specify cytogenetic abnormalities (FISH)

Report the International System for Human Cytogenetic Nomenclature (ISCN) compatible string, if applicable, in question 242, then continue with question 243.

Report the number of abnormalities detected by FISH at the last evaluation prior to the preparative regimen / infusion in question 243. After indicating the number of abnormalities in question 243, select all abnormalities detected in question 244.

If a clonal abnormality is detected, but not listed as an option in question 244, select “other abnormality” and specify the abnormality in question 245. If multiple “other abnormalities” were detected, report “see attachment” in question 245 and attach the final report(s) for any other abnormalities detected. For further instructions on how to attach documents in FormsNet3SM, refer to the Training Guide.

Question 246: Was documentation submitted to the CIBMTR?

Indicate whether documentation was submitted to the CIBMTR (e.g., FISH report). For further instructions on how to attach documents in FormsNet3 SM, refer to the Training Guide.

Question 247: Were cytogenetics tested via karyotyping?

Indicate if karyotyping was performed at the last evaluation prior to the preparative regimen / infusion. If “yes,” continue with question 248.

If karyotyping was not performed at the last evaluation prior to the start of the preparative regimen / infusion, indicate “no” and continue with 255. Examples of this include: karyotyping was not performed, or karyotyping sample was inadequate.

Question 248: Sample source:

Indicate if the sample was from “bone marrow” or from “peripheral blood” and continue with question 249. If karyotyping studies were performed on multiple samples at the last evaluation prior to the start of the preparative regimen / infusion, the bone marrow results are the preferred sample source to report

Question 249: Results of tests:
If karyotyping assessments identified abnormalities, indicate “abnormalities identified” and continue with question 250.

If karyotyping assessments yielded no evaluable metaphases or there were no abnormalities identified, indicate such and continue with question 254.

Question 251-253: Specify cytogenetic abnormalities (karyotyping)

Report the International System for Human Cytogenetic Nomenclature (ISCN) compatible string, if applicable, in question 250, then continue with question 251.

Report the number of abnormalities detected by karyotyping prior to the start of the preparative regimen / infusion in question 251. After indicating the number of abnormalities in question 251, select all abnormalities detected in question 252.

If a clonal abnormality is detected, but not listed as an option in question 252, select “other abnormality” and specify the abnormality in question 253. If multiple “other abnormalities” were detected, report “see attachment” in question 253 and attach the final report(s) for any other abnormalities detected. For further instructions on how to attach documents in FormsNet3 SM, refer to the Training Guide.

Question 254: Was documentation submitted to the CIBMTR?

Indicate whether documentation was submitted to the CIBMTR (e.g., karyotype report). For further instructions on how to attach documents in FormsNet3 SM, refer to the Training Guide.

Question 255: What was the disease status?

Indicate the disease status of MDS at the last evaluation prior to the start of the preparative regimen / infusion. Refer to the MDS Response Criteria section of the Forms Instructions Manual for definitions of each disease response.

Question 256: Specify the cell line examined to determine HI status:

Indicate the cell line examined to determine hematologic improvement. To determine the cell line, review the Hematologic Improvement criteria listed in the MDS Response Criteria section of the Forms Instructions Manual.

If the cell lines examined to determine hematologic improvement included “Hematologic Improvement – Erythroid (HI-E),” continue with question 257.

If the cell lines examined to determine hematologic improvement only included “Hematologic Improvement -Platelets (HI-P)” and/or “Hematologic Improvement – Neutrophils (HI-N),” continue with question 259.

Question 257: Specify transfusion dependence:

If the recipient’s pre-transplant disease status included hematologic improvement – erythroid, indicate the transfusion dependence at the time of determining disease status at last evaluation prior to start of the preparative regimen / infusion.

Select “Non-transfused (NTD)” if the recipient was without RBC transfusions as supportive care for the disease within a period of 16 weeks prior to the start of the preparative regimen / infusion and continue with question 259.

Select “Low-transfusion burden (LTB)” if the recipient had 3-7 RBC transfusions within a period of 16 weeks in at least 2 transfusion episodes with a maximum of 3 RBC transfusions in 8 weeks prior to the start of the preparative regimen / infusion and continue with question 259.

Select “High-transfusion burden (HTB)”- if the recipient had ≥8 RBCs transfusions within a period of 16 weeks or ≥4 within 8 weeks prior to the start of the preparative regimen / infusion and continue with question 258.

Question 258: Date assessed:

Enter the date of the most recent assessment of disease status prior to the start of the preparative regimen / infusion. The date reported should be that of the most disease-specific assessment within the pre-transplant work-up period (approximately 30 days). Clinical and hematologic assessments include pathological evaluation (e.g., bone marrow biopsy), radiographic examination (e.g., X-ray, CT scan, MRI scan, PET scan), and laboratory assessment (e.g., CBC, peripheral blood smear), in addition to clinician evaluation and physical examination. Enter the date the sample was collected for pathological and laboratory evaluations; enter the date the imaging took place for radiographic assessments.

If the exact date is not known, use the process for reporting partial or unknown dates as described in General Instructions, Guidelines for Completing Forms.

Last modified: Oct 23, 2020

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