Questions 78 – 80: Was a bone marrow examination performed?

Indicate Yes or No if a bone marrow examination was performed within two months prior to the start of the preparative regimen / infusion.

If a bone marrow examination was performed, select Yes, report the date of the most recent bone marrow biopsy performed prior to the start of the preparative regimen / infusion and indicate if a copy of the most recent bone marrow biopsy is attached. For instructions on how to attach documents in FormsNet3SM, refer to the Training Guide.

If a bone marrow examination was not performed or it is not known if one was performed within two months prior to the start of the preparative regimen / infusion, report No or Unknown, respectively and continue with question 94.

Question 81: Were cytogenetics tested? (FISH or Karyotype)

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.

Karyotyping is performed by culturing cells (growing cells under controlled conditions) until they reach the dividing phase. Techniques are then performed to visualize the chromosomes during cell division so that various bands and reconfigurations can be seen. Banding pattern differentiation and chromosomal reconfiguration demonstrate evidence of disease.

FISH is a sensitive technique that assesses a large number of cells. This technique uses special probes that recognize and bind to fragments of DNA. These probes are mixed with cells from the recipient’s blood or bone marrow. A fluorescent “tag” is then used to visualize the binding of the probe to the disease cells.

Indicate whether cytogenetic studies were obtained within two months prior to the start of the preparative regimen / infusion. If Yes, continue with question 82.

If cytogenetic studies were not obtained within two months prior to the start of the preparative regimen / infusion or it is not known if chromosome studies were performed, select No or Unknown, respectively and continue with question 94.

Question 82 – 83: Were cytogenetics tested via FISH?

If FISH studies were performed within two months prior to the start of the preparative regimen / infusion, report Yes and indicate whether or not abnormalities were identified.

If FISH studies were not performed, it is unknown if performed within two months prior to the start of the preparative regimen / infusion, or if the sample was inadequate (i.e., FISH failed), report No and continue with question 87.

Report chromosomal microarrays / chromosomal genomic arrays as FISH assessments.

Questions 84 – 87: Specify cytogenetic abnormalities identified via FISH

Report the ISCN compatible string, if applicable, in question 84.

Select all FISH abnormalities identified within two months prior to the start of the preparative regimen / infusion by FISH in question 85 and indicate if the FISH report(s) are attached in FormsNet3SM in question 87.

If an abnormality is detected but not listed as an option in question 85, select Other abnormality and specify the abnormality in question 86. If multiple other abnormalities were detected, report “see attached report” in question 86 and attach the final report(s) for any other abnormality detected. For instructions on how to attach documents in FormsNet3SM, refer to the Training Guide.

Questions 88 – 89: Were cytogenetics tested via karyotyping?

If karyotyping was performed within two months prior to the start of the preparative regimen / infusion, report Yes and indicate whether abnormalities were detected. If the karyotype sample was inadequate or yielded no results, select No evaluable metaphases.

If karyotyping was not performed or it is unknown if performed within two months prior to the start of the preparative regimen / infusion, report No and continue with question 94.

Questions 90 – 93: Specify cytogenetic abnormalities identified via conventional cytogenetics

Report the ISCN compatible string, if applicable, in question 90.

Select all cytogenetic abnormalities identified within two months prior to the start of the preparative regimen / infusion by conventional cytogenetics in question 91 and indicate if the karyotype report is attached in FormsNet3SM in question 93.

If an abnormality is detected but not listed as an option in question 91, select Other abnormality and specify the abnormality in question 92. If multiple other abnormalities were detected, report “see attached report” in question 24 and attach the final report(s) for any other abnormality detected. For instructions on how to attach documents in FormsNet3SM, refer to the Training Guide.

Questions 94 – 95: Was a genetic mutational panel performed? (screening for myeloid diseases)

A genetic panel is a standard panel of genes that are known to be associated with hematopoietic abnormalities. The intent of this assessment is to screen for myeloid diseases that resembles aplastic anemia (i.e., MDS). This assessment is typically a myeloid mutation panel.

Indicate whether a genetic panel was performed within two months prior to the start of the preparative regimen / infusion. If Yes, specify if a copy of the genetic panel is attached. For instructions on how to attach documents in FormsNet3SM, refer to the Training Guide.

If a genetic panel was not performed or it unknown if this assessment was performed within two months prior to the start of the preparative regimen / infusion, select No and submit the form.

Last modified: Oct 23, 2020

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