May 1, 2018 Release Highlights

Forms being released:

  • 2046 R5 / 2146 R4 -Fungal Infection Pre-Infusion Forms
  • 2150 R1 - Viral Infection Diagnosis and Treatment Form*
  • 2565 R2 - Sanofi Supplemental Data Form
  • 2801 R4 –Request for Recipient Transfer Form (paper form)

*newform

General Changes:

Wording, titles, and key fields of all forms will be changing to make forms applicable for either treatment type (HCT and cellular therapy).

For more information on high level the changes to the forms, please select from the list below:

Table of Contents

Fungal Infection Forms 2046 / 2146 Change Summary

Viral Infection Diagnosis and Treatment Form 2150

Sanofi Supplemental Data Form 2565 Change Summary

Request for Recipient Transfer Form 2801 Change Summary

Fungal Infection Forms 2046 / 2146 Change Summary

Infection Episode:

Added organism type to both forms.

Viral Infection Diagnosis and Treatment Form 2150

This form will be completed when applicable viral infections are reported on the Post-HCT Follow-Up Data Form 2100.This form will not be completed for TED track recipients. The following viral infections will required a Viral Infection Diagnosis and Treatment Form 2150:

  • Adenovirus
  • BK Virus
  • Cytomegalovirus (must report a site of infection other than blood)
  • Epstein-Barr Virus
  • Human Herpes Virus 6 (must report a site of infection other than blood)

One form will come due per applicable infection. The reporting period for the viral infection form corresponds to the reporting period for the Post-HCT Follow-Up Data Form on which the infection was originally reported.

If a Post-HCT Follow-Up Data Form 2100 (revision 4) was completed prior to the spring release on May 1st, 2018, has one or more of the above applicable infections reported, and is reprocessed after the release, new viral infection forms will come due. However, centers are not expected to complete them. Noitfy your CRC when this happens so the status of the viral infection forms can be changed to NRQ.

Sanofi Supplemental Data Form 2565 Change Summary

Mobilization

Removed ‘routine’ and ‘(plerixafor used in all myeloma patients)’ from option value text in question three

Pre-collection therapy given to enhance product collection

Removed question “specify reason for admission” (was Q50)

Apheresis Collection

Removed question “Was apheresis collection performed on a weekend?” (was Q86)

Removed ‘(in place and used for transplant)’ from option value text in question 86

Added decimal place value to “Peripheral blood CD34+ cells value”

Added decimal place value to “Absolute neutrophil count (ANC) value”

Added exponent value to “Total CD34+ collected: (on this day of collection)”

Request for Recipient Transfer Form 2801 Change Summary

Key fields were updated to make this form applicable for either treatment type (HCT and cellular therapy).