2013: CLL Pre-Infusion

The CLL Pre-Infusion (2013) Form is a Comprehensive Report Forms. This form captures CLL-specific pre-infusion data such as disease assessments and laboratory studies at diagnosis, pre-infusion treatment for CLL, and most recent disease assessments prior to the start of the preparative regimen / infusion.

This form must be completed for all recipients assigned to the CRF track whose disease, reported on Disease Classification (2402) Form, is chronic lymphocytic leukemia (CLL), B-cell/small lymphocytic leukemia (SLL), or prolymphocytic leukemia (PLL). Both the CLL Pre-Infusion (2013) and Lymphoma Pre-Infusion (2018) Forms must be completed if the recipient had Richter’s transformation from CLL to diffuse large B-cell lymphoma prior to transplant or cellular therapy.

Links to Sections of Form
Q1: Subsequent Infusion
Q2 – 8: Disease Assessments at Diagnosis
Q9 – 47: Laboratory Studies at Diagnosis
Q48 – 104: Pre-Infusion Therapy
Q105 – 154: Disease Assessment at Last Evaluation Prior to the Start of the Preparative Regimen / Infusion

Manual Updates
Sections of the Forms Instruction Manual are frequently updated. The most recent updates to the manual can be found below. For additional information, select the manual section and review the updated text.

To reference the historical Manual Change History for this form, please see the retired manual section on the Retired Forms Manuals webpage.

Date	Manual Section	Add/Remove/Modify	Description
4/19/2025	2013: CLL Pre-Infusion	Add	Disease Assessment at the Last Evaluation and CLL to NHL Transformations blue note box added to Q105: Disease Assessments at the Last Evaluation and CLL to NHL Transformations: When CLL has transformed to NHL, the disease assessment at the last evaluation section will be disabled.
4/19/2025	2013: CLL Pre-Infusion	Modify	Clarification: Systemic symptoms or B symptoms (also known as constitutional symptoms) include unexplained fever > 38˚ C (100.4˚ F), night sweats, and / or unexplained weight loss of >10% of body weight in six months before treatment diagnosis. Specify if the recipient had B symptoms within six months prior to the diagnosis. If it is unclear if symptoms were present within six months prior to the diagnosis, seek physician clarification.
10/25/2024	2013: CLL Pre-Infusion	Modify	Version 4 of the 2013: CLL Pre-Infusion section of the Forms Instructions Manual released. Version 4 corresponds to revision 4 of the Form 2013.

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