Q10 – 16: Granulopoiesis / Neutrophil Recovery

!This section can only be completed on the 100-day, 6 month, 1 year, and 2 year follow-up forms. These questions will be skipped for all subsequent reporting periods.

*Combined Follow-Up
In scenarios where a cellular therapy was given after an HCT and this form is now being completed based on the subsequent cellular therapy date, these questions do not apply and are disabled.

Absolute neutrophil recovery (ANC) recovery is defined as an ANC of ≥ 500/mm³ (or ≥ 0.5 × 10⁹/L) for three consecutive laboratory values obtained on different days. Date of ANC recovery is the date of the first of three consecutive laboratory values where the ANC is ≥ 500/mm³. At some institutions, the laboratory reports display the ANC value once there are sufficient white blood cells to perform a differential count. At other institutions, the laboratory reports do not display the ANC, and it must be calculated from the white blood cell count (WBC) and the percent of segmented and band neutrophils (if the differential was performed on a machine, the percent neutrophils will include both segmented and band neutrophils). If the laboratory report displays an automated ANC value of exactly 500/mm³, the actual ANC value should be calculated from the manual differential if available. The calculated value from the manual differential will determine ANC recovery. If your institution’s laboratory reports do not display the ANC value, use the following calculation to determine the ANC:

Example 1. Calculating Absolute Neutrophil Count (ANC)

Traditionally, the definition of ANC recovery required selecting the first date of three consecutive days in which the recipient’s ANC was ≥ 0.5×10⁹/L (500/mm³). For various reasons it may not be possible to obtain daily laboratory values. Under those circumstances, report ANC recovery based upon three consecutive laboratory values (drawn more than a day apart) as long as the ANC remains ≥ 0.5×10⁹/L (500/mm³).

Tracking the date of ANC recovery may not always be straightforward. In some cases, the ANC may fluctuate for a period of time before the recipient fully recovers. In other cases, the ANC may remain above ≥ 500/mm³ for several days immediately post-HCT and then fall below ≥ 500/mm³. Do not begin counting ANC values of ≥ 500/mm³ towards recovery until the ANC has dropped to the lowest level (nadir) post-HCT. If the recipient was transplanted using a non-myeloablative (NST) or reduced intensity (RIC) regimen, or was transplanted for an immunodeficiency (e.g., SCID, WAS), the recipient’s ANC may never drop below ≥ 500/mm³. If this is the case, an ANC recovery date will not be reported, and the “not applicable” option should be chosen. However, if the recipient’s ANC drops below ≥ 500/mm³ for even one day, this should be considered the nadir and “not applicable” should not be chosen. See the following example for more information regarding tracking the date of ANC recovery.

To report dates in this section, use the first of 3 consecutive laboratory values obtained on different days.

Example 2: Tracking ANC Recovery

Transplant Date = May 6
Contact Date = August 15

Date	WBC	%Neutrophils	ANC
May 7	900	0.6	540
May 8	850	0.59	502
May 9	720	0.7	504
May 10	300	0.45	135
May 11	15	No differential	—
May 12	30	No differential	—
May 13	50	No differential	—
May 14	250	0.4	100
May 15	800	0.7	560	Date of initial recovery: ANC ≥ 500/mm3 (report this date in question 7)
May 16	1050	0.8	840
May 17	1000	0.7	700
May 18	1800	0.6	1080
May 19	2000	0.55	1100
May 20	2500	0.53	1325
May 21-August 14	—	—	—	ANC ≥ 500/mm3) for timeframe
August 15 (contact date)	2250	0.43	968

Example 3: Initial Recovery with Subsequent Decline and Recovery

Transplant Date = May 6
Contact Date = August 15

Date	WBC	%Neutrophils	ANC
May 7	900	0.6	540
May 8	850	0.59	502
May 9	720	0.7	504
May 10	300	0.45	135
May 11	15	No differential	—
May 12	30	No differential	—
May 13	50	No differential	—
May 14	250	0.4	100
May 15	800	0.7	560	Date of initial recovery: ANC ≥ 500/mm3 (report this date in question 7)
May 16	1050	0.8	840
May 17	1000	0.7	700
May 18	1800	0.6	1080
May 19	2000	0.55	1100
May 20	2500	0.53	1325
May 21	2250	0.43	968
May 22	1500	0.45	675
May 23	800	0.6	480	Date of first decline: ANC ≤ 500/mm3 (report this date in question 9)
May 24	850	0.41	349
May 25	720	0.53	382
May 26	500	0.45	225
May 27	490	0.3	147
May 28	650	0.7	455
May 29	800	0.8	640	Date of recovery: ANC ≥ 500/mm3 (report this date in question 12)
May 30-August 14	—	—	—	ANC ≥ 500/mm3 for timeframe
August 15 (contact date)	2245	0.72	1616

Question 10: Was there evidence of initial hematopoietic recovery?

Indicate whether or not there was evidence of initial ANC recovery following this HCT.
Check only one response:

• Select Yes if ANC ≥ 500/mm³ (or ≥ 0.5 × 10⁹/L) was achieved and sustained for 3 laboratory values.
• Select No if ANC ≥ 500/mm³ (or ≥ 0.5 × 10⁹/L) was not achieved.
• Select Not applicable if the recipient’s ANC never dropped below 500/mm³ (or ≥ 0.5 × 10⁹/L) at any time after the start of the preparative regimen.
• Select Previously reported if the recipient’s initial hematopoietic recovery was recorded on a previous report.

*When Not applicable is reported for 100-day reporting period, for all future reporting periods, select Previously reported.

Question 11: Date ANC ≥ 500/mm3 (first of 3 lab values)

Enter the first date of the three consecutive laboratory values obtained on different days where the ANC was ≥ 500/mm³ (or ≥ 0.5 × 10⁹/L). For an example of tracking ANC, see Example 2 and Example 3 above.

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

Question 12: Following the initial hematopoietic recovery, was there subsequent decline in ANC to < 500/mm³ for ≥ 3 days?

Indicate Yes or No if there was subsequent decline in ANC < 500/mm³ (or < 0.5 × 10⁹/L) (three consecutive laboratory values obtained on different days where the ANC declined to < 500/mm³.

*Multiple Recoveries and Declines
The form does not allow for multiple recoveries and declines in the same reporting period. If the recipient’s ANC initially recovers and then declines, followed by another recovery and another decline, report the date of the first (initial) recovery, the first decline, and the last recovery.

Question 13: Date of decline in ANC < 500/mm³ for ≥ 3 days (first of 3 days that the ANC declined)

Enter the first date of the three consecutive laboratory values obtained on different days where the ANC declined to < 500/mm³ (or < 0.5 × 10⁹/L).

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

Question 14: Did recipient recover and maintain ANC ≥ 500/mm³ following the decline?

Indicate Yes or No if there was evidence of ANC recovery following the decline (three consecutive laboratory values obtained on different days where the ANC was ≥ 500/mm³ (or ≥ 0.5 × 10⁹/L).

Question 15 – 16: Date of ANC recovery

Report if the date of ANC recovery following the decline is Known or Unknown. If the date of recovery is Known, enter the first date of the three consecutive laboratory values obtained on different days where the ANC recovered to ≥ 500/mm³ (or ≥ 0.5 × 10⁹/L) following the decline. See Example 3 above.

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

Section Updates:

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