Question 1: Date of Birth

The date of birth is automatically populated based on the value reported in the CRID Assignment tool in FormsNet3. Verify that the date of birth is correct. If an error is noted, correct the CRID Assignment tool and verify that the date of birth has been updated on the Pre-TED Form.

Question 2: Sex

The recipient’s sex is automatically populated based on the value reported in the CRID Assignment tool in FormsNet3. Verify that the recipient’s sex is correct. If an error is noted, correct the CRID Assignment tool and verify that the recipient’s sex has been updated on the Pre-TED Form.

Question 3: Ethnicity

The recipient’s ethnicity is automatically populated based on the value reported in the CRID Assignment tool in FormsNet3. Verify that the recipient’s ethnicity is correct. If an error is noted, correct the CRID Assignment tool and verify that the recipient’s ethnicity has been updated on the Pre-TED Form.

Question 4: Race

The recipient’s race is automatically populated based on the value reported in the CRID Assignment tool in FormsNet3. Verify that the recipient’s race is correct. If an error is noted, correct the CRID Assignment tool and verify that the recipient’s race has been updated on the Pre-TED Form.

Question 5: Race Detail

The recipient’s race detail is automatically populated based on the value reported in the CRID Assignment tool in FormsNet3. Verify that the recipient’s race detail is correct. If an error is noted, correct the CRID Assignment tool and verify that the recipient’s race detail has been updated on the Pre-TED Form.

Question 6: Country of primary residence

Select the recipient’s country of residence. If the recipient’s country of primary residence is Brazil, continue with question 7. If the recipient’s country of primary residence is Canada, continue with question 8. If the recipient’s country of primary residence is the United States, continue with question 9. If the recipient’s country of primary residence is not Brazil, Canada, or the United States, continue with question 10.

Question 7: State of residence of recipient (for residents of Brazil)

If Brazil was selected as the recipient’s primary country of residence, enter the recipient’s state of permanent residence at the time of transplant.

Question 8: Providence or territory of residence of recipients (for residents of Canada)

If Canada was selected as the recipient’s primary country of residence, enter the recipient’s providence or territory of permanent residence at the time of transplant.

Question 9: State of residence of recipients (for residents of USA)

If the United States was selected as the recipient’s primary country of residence, enter the recipient’s state of permanent residence at the time of transplant.

Question 10. NMDP Recipient ID (RID):

The NMDP RID is automatically populated based on the value reported on the CRID Assignment Form (2804). Verify that the NMDP RID is correct. If an error is noted, correct Form 2804 and verify that the NMDP RID has been updated on the Pre-TED Form.

Question 11: ZIP or postal code for place of recipient’s residence (USA recipients only)

Enter the five-digit ZIP code in which the recipient resides. Only five digits are required; however, if the ZIP+4 (nine digit) code is available, please report it in this field. The zip or postal code is required for USA residents.

The postal code is optional for Canadian residents. The question can be answered or left blank without error for Canadian residents.

Question 12: Specify blood type: (for allogeneic HCTs only)

Indicate the recipient’s blood type as A. B, AB, or O. Blood type is an important characteristic in allogeneic transplant because products may require manipulation to minimize the risk of immune reaction due to incompatibility.

Question 13: Specify Rh factor: (for allogeneic HCTs only)

Indicate the recipient’s Rh (rhesus) factor. The Rh factor is an important characteristic in allogeneic transplant because product may require manipulation to minimize the risk of immune reaction due to incompatibility.

Question 14: Has the recipient signed an IRB / ethics committee (or similar body) – approved consent form to donate research blood samples to the NMDP / CIBMTR? (for allogeneic HCTs only)

The Research Sample Repository contains blood samples from unrelated recipients and/or their adult volunteer donors or cord blood units. Related allogeneic recipients and/or donors will participate at selected transplant centers.

The primary objective of the Research Repository is to make blood samples available for research studies related to histocompatibility and hematopoietic cellular transplantation.

Studies in which these data may be used include:

  • Improving the understanding of tissue matching for hematopoietic cellular donors and recipients.
  • Determining and evaluating the factors that affect transplant outcomes.
  • Studying the distribution of HLA tissue types in different populations (e.g., study tissue typing differences between different racial and ethnic populations to help develop methods to improve tissue matching between donors and recipients, including testing of rare HLA types).

Indicate if the recipient signed an IRB-approved consent form to donate research blood samples to the NMDP / CIBMTR. If Yes (recipient consented), continue with question 15. If No (recipient declined), Not approached, or Not applicable (center not participating), continue with question 18.

Blood samples are not submitted for subsequent transplants; however, this question is asked for subsequent transplants. If the recipient previously consented to submit research blood samples to NMDP / CIBMTR, select Yes (recipient consented).

Question 15: Date form was signed:

Report the date the research sample consent form was signed by the recipient. Do not report the date that the witness or health care professional signed the consent form.

Questions 16-17: Did the recipient submit a research sample to the NMDP / CIBMTR repository? (Related donors only)

There are a select number of transplant center participating in the Related Specimen Repository. If your center is one of the participating centers, and the recipient provided a research sample, select Yes and provide the recipient ID in question 17. The ID number is located on the bar code that is attached to the sample tube.

If the recipient did not provide a research sample, select No and continue with question 18.

Question 18: Is the recipient participating in a clinical trial? (Clinical trials sponsors that uses CIBMTR forms to capture outcomes data)

Indicate if the recipient is a registered participant with BMT-CTN, RCI-BMT, USIDNET, COG, and/or another clinical trial sponsor that uses CIBMTR forms to capture outcomes data. If Yes, continue with question 19. If No, continue with question 24.

BMT-CTN: Blood and Marrow Transplant Clinical Trials Network RCI-BMT: Resource for Clinical Investigation in Blood and Marrow Transplant PIDTC: Primary Immune Deficiency Treatment Consortium USIDNET: United States Immunodeficiency Network COG: Children’s Oncology Group

Questions 19-20: Study Sponsor

Select the study sponsor of the clinical trial the recipient is participating in. If the participant is enrolled in multiple studies, even if from the same sponsor, report each study separately.

If the study sponsor is reported as BMT-CTN, RCI-BMT, or PIDTC, continue with question 21.

If the study sponsor is reported as USIDNET or COG, continue with question 22.

If Other sponsor is reported, specify the study sponsor in question 20 and continue with question 22.

Question 21: Study ID Number

Select the recipient’s Study ID number.

Question 22: Subject ID

Enter the recipient’s USIDNET, COG, or other sponsor Subject ID.

If the recipient is participating in a BMT-CTN study and the EMMES ID is known, enter it here.

If the recipient is participating in an RCI-BMT study, enter the Subject ID given at the time of successful enrollment.

Question 23: Specify the ClinicalTrials.gov identification number

All clinical trials are required to be registered on the clinicaltrials.gov website and will have an associated identification number.

Report the identification number – do not include the letters “NCT,” preceding the digits.

Section Updates:

Question Number Date of Change Add/Remove/Modify Description Reasoning (If applicable)
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Last modified: Feb 12, 2021

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