The Leukodystrophies Pre-Infusion Data Form is one of the Comprehensive Report Forms. This form captures leukodystrophy specific pre-infusion data such as: disease assessments / laboratory studies at diagnosis, pre-infusion treatment and laboratory studies / clinical status prior to the start of the preparative regimen.
This form must be completed for all recipients whose primary disease is reported on the Pre-TED Disease Classification (2402) Form as a leukodystrophy and specified as one of the following:
- Krabbe Disease (globoid cell leukodystrophy)
- Metachromatic leukodystrophy (MLD)
- Adrenoleukodystrophy (ALD)
- Hereditary diffuse leukoencephalopathy with spheroids (HDLS)
Links to sections of the manual:
Q1: Subsequent Transplant or Cellular Therapy
Q2 – 22: Leukodystrophy Diagnosis
Q23 – 63: Clinical Status Prior to Preparative Regimen
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.
If you need to reference the historical Manual Change History for this form, please reference the retired manual section on the Retired Forms Manuals webpage.
| Date | Manual Section | Add/Remove/Modify | Description |
|---|---|---|---|
| 10/29/2021 | 2037: Leukodystrophies Pre-Infusion | Add | Version 1 of the Leukodystrophies Pre-Infusion Data section of the Forms Instructions Manual released. Version 1 corresponds to revision 3 of the Form 2037. |
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