Pre-HCT Cerebrospinal Fluid (CSF) Evaluation

*The timeline requirements for this form are as follows:
Assessment Time Frame: Within 45 days prior to the anticipated start of the conditioning regimen.
Submission Time Frame: Within 5 business days of collection.

*This form will only appear in the EDC if the “Specify the disease indication at diagnosis” field on Recipient Disease form is answered ALL, AML, or Other Acute Leukemia.

Was CSF evaluation performed?:
Report whether a CSF evaluation was performed as “Yes” or “No”.

If answered Yes, complete the questions below regarding the CSF evaluation.

If answered No, no other fields are expected to be completed on this form.

Date CSF evaluation performed:
This field will only appear in the EDC if “Was CSF evaluation performed?” is answered Yes. Enter the date the test was completed. Date can either be entered directly in the data field using the DD/MMM/YYYY format, or the calendar date picker can be used.

If the date entered is a future date, a query will appear in the EDC.

Results of CSF evaluation:
Report the results of the CSF evaluation as “No evidence of disease” or “Disease detected”.

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