Conditioning Regimen

*The timeline requirements for this form are as follows:
Assessment Time Frame: Screening through initiation of conditioning
Submission Time Frame: Within 5 days of conditioning

Height at initiation of pre-HCT conditioning regimen:
Report the subject’s documented height at the start of the conditioning regimen in centimeters or inches. Enter height in “XXX.X” format. This format allows for up to three digits prior to the decimal and up to one digit after the decimal.

Dosing body weight used for conditioning regimen:
Report the dosing body weight used for the conditioning regimen in kilograms or pounds. Enter weight in “XXX.X” format. This format allows for up to three digits prior to the decimal and up to one digit after the decimal.

Was adjusted ideal body weight (IBW) used for dosing calculation?:
Indicate if adjusted ideal body weight (IBW) was used for dosing calculation as “Yes” or “No”.

Refer to Appendix K of the protocol for IBW and AIBW calculations.

Which conditioning regimen was administered:
Select which conditioning regimen was administered. Details regarding the conditioning regimens can be found in Section 7.4 of the protocol.

• Regimen A
• Regimen B
• Regimen C
• Regimen D
• Regimen E
• Other institutional regimen that meets the CIBMTR classification for MAC or RIC/NMA conditioning intensity (requires prior written approval from sponsor)

!Other institutional regimens require protocol chair review and approval prior to use as a study conditioning regimen.

Separate forms will appear in the Conditioning Regimen folder based on answer to field.

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