409 – 412: Subsequent HCT

!Subsequent HCT
Complete this section only if the recipient received a subsequent HCT. The data reported in this section should reflect the clinical status immediately prior to the start of the preparative regimen for the subsequent HCT.
A new Pre-TED (2400), Disease Classification (2402), and Recipient Baseline (2000) form must be completed for the subsequent HCT. The exception to this is an autologous HCT performed for graft failure / insufficient hematopoietic recovery. The cells used for this subsequent autologous HCT would have been collected prior to the previous HCT.
For more information on how to distinguish infusion types (i.e., HCT vs DCI), see Appendix D.

Question 409: Date of subsequent HCT

Report the date when the recipient received the subsequent HCT.

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

Questions 410 – 411: What was the indication for subsequent HCT?

Indicate the reason for the subsequent HCT (check only one).

• Graft failure / insufficient hematopoietic recovery: Additional hematopoietic stem cells are required because there wasn’t any ANC recovery following HCT (primary graft failure), the hematopoietic recovery indefinitely declined after the initial hematopoietic recovery (secondary graft failure), or hematopoietic recovery was deemed insufficient or slow for survival following previous high-dose therapy and HCT. If autologous cells are infused for this reason, this is considered autologous rescue; in this case, reporting will continue under the prior HCT date and a new Pre-TED form is not required.
• Persistent primary disease: Additional hematopoietic stem cells are required because of the persistent presence of disease pre- and post-transplant (i.e., complete remission was never achieved following the previous transplant).
• Recurrent primary disease: Additional hematopoietic stem cells are required because of relapsed primary disease (i.e., complete remission was achieved pre- or post-transplant, but the disease relapsed following the previous transplant).
• Planned subsequent HCT, per protocol: Additional hematopoietic stem cells are given as defined by the protocol for a subsequent transplant / infusion. This transplant is not based upon recovery, disease status, or any other assessment.
• New malignancy (including PTLD and EBV lymphoma): Additional hematopoietic stem cells are required because the recipient has developed a new malignancy. This does not include a transformation or progression of the original malignancy for which the recipient was transplanted (refer to New Malignancy, Lymphoproliferative or Myeloproliferative Disease / Disorder section for more information).
• Insufficient chimerism: In the case of a stable, mixed donor chimerism, the infusion of additional cells (usually lymphocytes and not mobilized hematopoietic stem cells) is typically classified as a DCI. Verify with the transplant physician that the cells given should be reported as a subsequent transplant and that stable, mixed chimerism is the reason for the transplant. In the case of declining chimerism—when the percentage of donor cells is sequentially decreasing on several studies, indicating possible impending graft failure—additional stem cells are required. Usually the donor chimerism has fallen below 30-50%.
• Other: If additional hematopoietic stem cells are given for a reason other than the options listed, select Other and specify the other indication for the subsequent transplant.
  

Question 412: Source of HSCs (check all that apply)

Specify the hematopoietic stem cell source(s) of the recipient’s subsequent HCT. Check all that apply.

Section Updates:

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