Q12 – 22: Post-Transplant Lymphoproliferative Disorder

Question 12: Was PTLD confirmed by biopsy?

Indicate if PTLD was confirmed by a biopsy. If it is not known, select No.

*EBV Testing Documentation
The submission of EBV tumor testing documentation (i.e., pathology report) is strongly recommended. For instructions on how to attach documents in FormsNet3^SM, refer to the FormsNet3 Training Guide.

Question 13: Was the pathology of the tumor EBV positive?

Using the pathology report, specify if the PTLD tumor was EBV positive. Seek clinician clarification if the documentation is unclear.

Question 14: Was there EBV reactivation in the blood?

Specify if there was EBV reactivation in the blood. If EBV reactivation (in the blood) was not assessed, select Not done.

Questions 15 – 17: How was EBV reactivation diagnosed?

EBV reactivation may be diagnosed by polymerase chain reaction (PCR) methods (qualitative or quantitative) where a blood sample is taken and manipulated using PCR techniques to determine the presence and classification of an organism by identifying DNA sequences unique to the specific organism.

Indicate how EBV reactivation was diagnosed.

• Qualitative PCR of blood: Indicates if EBV was detected (provides “positive” or “negative” results).
• Quantitative PCR of blood: Provides the number of copies of EBV detected. If selected, specify the viral load of blood (at diagnosis of EBV) in copies / mL.
  

If EBV reactivation was diagnosed by a method other than qualitative or quantitative PCR of blood, select Other method and specify.

Questions 18 – 19: Was a quantitative PCR of blood performed again after diagnosis?

If EBV reactivation was diagnosed by quantitative PCR of blood, as reported above, specify if a quantitative PCR of blood was performed again after the diagnosis. If Yes, report the highest EBV viral load of blood in the current reporting period.

*Questions 20 – 22: Was there lymphomatous involvement? (e.g. a mass)

Indicate if there was lymphomatous involvement of PTLD (i.e., a mass). If Yes, specify all sites of involvement. If an involvement site is not listed as an option, select Other site and specify.

Section Updates:

Question Number	Date of Change	Add/Remove/Modify	Description	Reasoning (If applicable)
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