2158: Thalassemia Post-Infusion

The Thalassemia Post-Infusion (2158) Form is one of the Comprehensive Report Forms. This form captures thalassemia-specific post-infusion data such as the recipient’s thalassemia diagnosis, donor related information, transfusion, hepatic, cardiac, renal, iron overload assessment prior to the start of the preparative regimen, hematologic labs, organ impairment, and pre-infusion therapy.

This form must be completed for all transplant and gene therapy recipients, randomized to the Comprehensive Report Form (CRF) track whose primary disease is reported as Hemoglobinopathies – Transfusion dependent thalassemia: Transfusion beta dependent thalassemia or Other transfusion dependent thalassemia on the Disease Classification (2402) Form.

Links to Sections of Form:
Q1 – 15: Post-Infusion Disease Testing
Q16 – 17: Transfusion Therapy
Q18 – 29: Treatment
Q30 – 31: Splenic Assessments
Q32 – 55: Hepatic Assessments
Q56 – 68: Cardiac Assessments
Q67 – 73: Renal Assessments
Q74 – 76: Avascular Necrosis
Q77: Other Symptoms
Q78 – 92: Additional Iron Overload Assessments
Q93 – 101: Additional Hematologic Labs
Q102 – 113: Specify Existing Other Organ Impairments
Q114 – 121: Disease Modifying Therapies
Q122: Marrow Evaluation

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
4/24/2026	2158: Thalassemia Post-Infusion	Add	CIBMTR Study CS22-24 blue note box added above Q122: CIBMTR Study CS22-24: The Laboratory Studies (3502) and Marrow Surveillance (3506) forms will only come due for Zyntelgo® infusions enrolled in CIBMTR study CS22-24.
4/24/2026	2158: Thalassemia Post-Infusion	Modify	Corrected time point for reporting GFR in Q72 – 73: The glomerular filtration rate (GFR) estimates how much blood passes through the glomeruli each minute and is used to check how well the kidneys are working. Indicate whether the GFR was measured prior to the start of the preparative regimen / infusion in the current reporting period. If measured, select Known and report the laboratory value and unit of measure documented on the laboratory report. If testing was performed multiple times, report the most recent laboratory value obtained. If the GFR was not measured or if no information is available to determine if the GFR was assessed, report Unknown.
3/27/2026	2158: Thalassemia Post-Infusion	Add	Version 3 of the 2158: Thalassemia Post-Infusion section of the Forms Instructions Manual released. Version 3 corresponds to revision 3 of the Form 2158.

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CIBMTR® (Center for International Blood and Marrow Transplant Research) is a research collaboration between the Medical College of Wisconsin and NMDP.