Keywords
Treatment Form ×
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Table of contents
  1. 1. Clinical Trial
  2. 2. Routine Documentation
  3. 3. Registry/Cohort Study
  4. 4. Quality Assurance
  5. 5. Data Standard
  6. 6. Patient-Reported Outcome
  7. 7. Medical Specialty
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- 9/17/21 - 1 form, 19 itemgroups, 107 items, 1 language
Itemgroups: Registry Use Only, Center Identification, Recipient Identification, 100 Day Report Only, Initial ANC Recovery, Initial Platelet Recovery, Graft versus Host Disease, New Malignancy, Lymphoproliferative or Myeloproliferative Disorder - Part 1 of 2, New Malignancy, Lymphoproliferative or Myeloproliferative Disorder - Part 2 of 2, Survival (Part 1 of 2), Survival (Part 2 of 2), Post - HSCT Therapy, HSCT for Non-Malignant Disease ONLY, Malignant Disease Evaluation for This HSCT, First Relapse or Progression After HSCT, Additional Treatment, Method of Latest Disease Assessment, Donor Cellular Infusion (DCI) (Part 1 of 2), Donor Cellular Infusion (DCI) (Part 2 of 2)
- 9/17/21 - 1 form, 19 itemgroups, 107 items, 1 language
Itemgroups: Registry Use Only, Center Identification, Recipient Identification, 100 Day Report Only, Initial ANC Recovery, Initial Platelet Recovery, Graft versus Host Disease, New Malignancy, Lymphoproliferative or Myeloproliferative Disorder - Part 1 of 2, New Malignancy, Lymphoproliferative or Myeloproliferative Disorder - Part 2 of 2, Survival (Part 1 of 2), Survival (Part 2 of 2), Post - HSCT Therapy, HSCT for Non-Malignant Disease ONLY, Malignant Disease Evaluation for This HSCT, First Relapse or Progression After HSCT, Additional Treatment, Method of Latest Disease Assessment, Donor Cellular Infusion (DCI) (Part 1 of 2), Donor Cellular Infusion (DCI) (Part 2 of 2)
- 9/17/21 - 1 form, 20 itemgroups, 109 items, 1 language
Itemgroups: Registry Use Only, Center Identification, Recipient Identification, 100 Day Report Only, Initial ANC Recovery, Initial Platelet Recovery, Graft versus Host Disease, New Malignancy, Lymphoproliferative or Myeloproliferative Disorder - Part 1 of 3, New Malignancy, Lymphoproliferative or Myeloproliferative Disorder - Part 2 of 3, New Malignancy, Lymphoproliferative or Myeloproliferative Disorder Part 3 of 3, Survival (Part 1 of 2), Survival (Part 2 of 2), Post - HSCT Therapy, HSCT for Non-Malignant Disease ONLY, Malignant Disease Evaluation for This HSCT, First Relapse or Progression After HSCT, Additional Treatment, Method of Latest Disease Assessment, Donor Cellular Infusion (DCI) (Part 1 of 2), Donor Cellular Infusion (DCI) (Part 2 of 2)
- 9/17/21 - 1 form, 69 itemgroups, 315 items, 1 language
Itemgroups: CIBMTR Use Only, Center Identification, Recipient Identification: Part 1 of 2, Study ID Number, Recipient Identification: Part 2 of 2, Recipient Race, Disease Classification, Hematopoietic Stem Cell Transplant (HSCT) : Part 1 of 4, Cell Source, Hematopoietic Stem Cell Transplant (HSCT) : Part 2 of 4, Donor Information, Hematopoietic Stem Cell Transplant (HSCT) : Part 3 of 4, Ex Vivo Graft Manipulation Type, Hematopoietic Stem Cell Transplant (HSCT) : Part 4 of 4, Preparative Regimen - Part 1 / 7, Preparative Regimen - Part 2 / 7, Preparative Regimen - Part 3 / 7 (Anthracyclines), Preparative Regimen - Part 4 / 7 (Monoclonal Antibodies), Preparative Regimen - Part 5 / 7 (Radiolabeled MAb), Preparative Regimen - Part 6 / 7 (Intent of Preparative Regimen), Preparative Regimen - Part 7 / 7 (Reason for NST / RIC), Comorbid Conditions, Type of Comorbid Condition, GVHD Prophylaxis, Post-HSCT Disease Therapy Planned as of Day 0, Type of Additional Post-HSCT Therapy, Other Toxicity Modifying Regimen, Pre-Transplant Essential Data Disease Classification Sheet, Acute Myelogenous Leukemia (AML) or Acute Nonlymphocytic Leukemia (ANLL): Part 1 of 2, Type of Therapy Related AML, Acute Myelogenous Leukemia (AML) or Acute Nonlymphocytic Leukemia (ANLL): Part 2 of 2, Acute Lymphoblastic Leukemia (ALL), Other Acute Leukemia, Chronic Myelogenous Leukemia (CML): Part 1 of 2, CML Prior HSCT Treatment, Chronic Myelogenous Leukemia (CML): Part 2 of 2, Myelodysplastic or Myeloproliferative Disease Classification, Myelodysplastic or Myeloproliferative Diseases: Part 1 of 2, Type of Therapy Related MDS / MPS, Myelodysplastic or Myeloproliferative Diseases: Part 2 of 2, Other Leukemias, Hodgkin Lymphoma, Non-Hodgkin's Lymphoma, Plasma Cell Disorders, Breast Cancer, Other Disease, Other Malignancies, Anemia/Hemoglobinopathy, Platelet Disorders, Histiocytic Disorders, Inherited Disorders of Metabolism/Osteopetrosis, Immune Deficiencies, Autoimmune Disorders, Systemic Sclerosis Involvement, Systemic Sclerosis Laboratory Procedures, Systemic Lupus Erythematosus (SLE) Involvement, Systemic Lupus Erythematosus (SLE) Laboratory Procedures, Sjogren Syndrome Involvement, Polymyositis / Dermatomyositis Involvement, Polymyositis / Dermatomyositis Laboratory Procedure, Antiphospholipid Syndrome Involvement, Antiphospholipid Syndrome Laboratory Procedures, Wegener Granulomatosis Involvement, Wegener Granulomatosis Laboratory Procedures, Polyarteritis Nodosa Involvement, Polyarteritis Nodosa Laboratory Procedures, Rheumatoid Arthritis Involvement, Psoriatic Arthritis / Psoriasis Involvement, Multiple Sclerosis (MS) Involvement
- 9/17/21 - 1 form, 71 itemgroups, 316 items, 1 language
Itemgroups: CIBMTR Use Only, Center Identification, Recipient Identification: Part 1 of 2, Study ID Number, Recipient Identification: Part 2 of 2, Recipient Race, Disease Classification, Hematopoietic Stem Cell Transplant (HSCT) : Part 1 of 4, Cell Source, Autologous HSCT, Hematopoietic Stem Cell Transplant (HSCT) : Part 2 of 4, Donor Information, Hematopoietic Stem Cell Transplant (HSCT) : Part 3 of 4, Ex Vivo Graft Manipulation Type, Hematopoietic Stem Cell Transplant (HSCT) : Part 4 of 4, Preparative Regimen - Part 1 / 7, Preparative Regimen - Part 2 / 7, Preparative Regimen - Part 3 / 7 (Anthracyclines), Preparative Regimen - Part 4 / 7 (Monoclonal Antibodies), Preparative Regimen - Part 5 / 7 (Radiolabeled MAb), Preparative Regimen - Part 6 / 7 (Intent of Preparative Regimen), Preparative Regimen - Part 7 / 7 (Reason for NST / RIC), Comorbid Conditions, Type of Comorbid Condition, GVHD Prophylaxis, Post-HSCT Disease Therapy Planned as of Day 0, Type of Additional Post-HSCT Therapy, Other Toxicity Modifying Regimen, Pre-Transplant Essential Data Disease Classification Sheet, Acute Myelogenous Leukemia (AML) or Acute Nonlymphocytic Leukemia (ANLL): Part 1 of 2, Type of Therapy Related AML, Acute Myelogenous Leukemia (AML) or Acute Nonlymphocytic Leukemia (ANLL): Part 2 of 2, Acute Lymphoblastic Leukemia (ALL), Other Acute Leukemia, Chronic Myelogenous Leukemia (CML): Part 1 of 2, CML Prior HSCT Treatment, Chronic Myelogenous Leukemia (CML): Part 2 of 2, Myelodysplastic or Myeloproliferative Disease Classification at Diagnosis, Myelodysplastic or Myeloproliferative Disease Status at Transplantation, Myelodysplastic or Myeloproliferative Diseases: Part 1 of 2, Type of Therapy Related MDS / MPS, Myelodysplastic or Myeloproliferative Diseases: Part 2 of 2, Other Leukemias, Hodgkin Lymphoma, Non-Hodgkin's Lymphoma, Plasma Cell Disorders, Breast Cancer, Other Disease, Other Malignancies, Anemia/Hemoglobinopathy, Platelet Disorders, Histiocytic Disorders, Inherited Disorders of Metabolism/Osteopetrosis, Immune Deficiencies, Autoimmune Disorders, Systemic Sclerosis Involvement, Systemic Sclerosis Laboratory Procedures, Systemic Lupus Erythematosus (SLE) Involvement, Systemic Lupus Erythematosus (SLE) Laboratory Procedures, Sjogren Syndrome Involvement, Polymyositis / Dermatomyositis Involvement, Polymyositis / Dermatomyositis Laboratory Procedure, Antiphospholipid Syndrome Involvement, Antiphospholipid Syndrome Laboratory Procedures, Wegener Granulomatosis Involvement, Wegener Granulomatosis Laboratory Procedures, Polyarteritis Nodosa Involvement, Polyarteritis Nodosa Laboratory Procedures, Rheumatoid Arthritis Involvement, Psoriatic Arthritis / Psoriasis Involvement, Multiple Sclerosis (MS) Involvement
- 9/17/21 - 1 form, 69 itemgroups, 315 items, 1 language
Itemgroups: CIBMTR Use Only, Center Identification, Recipient Identification: Part 1 of 2, Study ID Number, Recipient Identification: Part 2 of 2, Recipient Race, Disease Classification, Hematopoietic Stem Cell Transplant (HSCT) : Part 1 of 4, Cell Source, Hematopoietic Stem Cell Transplant (HSCT) : Part 2 of 4, Donor Information, Hematopoietic Stem Cell Transplant (HSCT) : Part 3 of 4, Ex Vivo Graft Manipulation Type, Hematopoietic Stem Cell Transplant (HSCT) : Part 4 of 4, Preparative Regimen - Part 1 / 7, Preparative Regimen - Part 2 / 7, Preparative Regimen - Part 3 / 7 (Anthracyclines), Preparative Regimen - Part 4 / 7 (Monoclonal Antibodies), Preparative Regimen - Part 5 / 7 (Radiolabeled MAb), Preparative Regimen - Part 6 / 7 (Intent of Preparative Regimen), Preparative Regimen - Part 7 / 7 (Reason for NST / RIC), Comorbid Conditions, Type of Comorbid Condition, GVHD Prophylaxis, Post-HSCT Disease Therapy Planned as of Day 0, Type of Additional Post-HSCT Therapy, Other Toxicity Modifying Regimen, Pre-Transplant Essential Data Disease Classification Sheet, Acute Myelogenous Leukemia (AML) or Acute Nonlymphocytic Leukemia (ANLL): Part 1 of 2, Type of Therapy Related AML, Acute Myelogenous Leukemia (AML) or Acute Nonlymphocytic Leukemia (ANLL): Part 2 of 2, Acute Lymphoblastic Leukemia (ALL), Other Acute Leukemia, Chronic Myelogenous Leukemia (CML): Part 1 of 2, CML Prior HSCT Treatment, Chronic Myelogenous Leukemia (CML): Part 2 of 2, Myelodysplastic or Myeloproliferative Disease Classification, Myelodysplastic or Myeloproliferative Diseases: Part 1 of 2, Type of Therapy Related MDS / MPS, Myelodysplastic or Myeloproliferative Diseases: Part 2 of 2, Other Leukemias, Hodgkin Lymphoma, Non-Hodgkin's Lymphoma, Plasma Cell Disorders, Breast Cancer, Other Disease, Other Malignancies, Anemia/Hemoglobinopathy, Platelet Disorders, Histiocytic Disorders, Inherited Disorders of Metabolism/Osteopetrosis, Immune Deficiencies, Autoimmune Disorders, Systemic Sclerosis Involvement, Systemic Sclerosis Laboratory Procedures, Systemic Lupus Erythematosus (SLE) Involvement, Systemic Lupus Erythematosus (SLE) Laboratory Procedures, Sjogren Syndrome Involvement, Polymyositis / Dermatomyositis Involvement, Polymyositis / Dermatomyositis Laboratory Procedure, Antiphospholipid Syndrome Involvement, Antiphospholipid Syndrome Laboratory Procedures, Wegener Granulomatosis Involvement, Wegener Granulomatosis Laboratory Procedures, Polyarteritis Nodosa Involvement, Polyarteritis Nodosa Laboratory Procedures, Rheumatoid Arthritis Involvement, Psoriatic Arthritis / Psoriasis Involvement, Multiple Sclerosis (MS) Involvement
- 9/17/21 - 1 form, 6 itemgroups, 74 items, 1 language
Itemgroups: CRF Header, Myeloma: Form Administration, Myeloma Transplant: Treatment Plan, Myeloma Transplant: Donor Lymphocyte Infusions, Myeloma Transplant: Allogeneic - Donor Information, Comments