Question 1: Did the recipient have an eligible diagnosis?
Primary Myelofibrosis, Post-polycythemia vera myelofibrosis and post-essential thrombocythemia myelofibrosis are the three eligible sub-types for the Myelofibrosis Medicare study. Select the eligible diagnosis for the recipient.
Question 2-3: Has the recipient ever had Int-2 or high-risk disease as determined by the DIPSS?
Refer to the Myeloproliferative Neoplasm (MPN) Pre-Infusion (2057) form manual for a description of Intermediate-2 and high risk disease DIPSS scores.
Indicate Yes or No if the recipient at any time had Intermediate-2 or high-risk disease and report the date assessed (YYYY-MM-DD).
If the exact date is unknown, please view General Instructions, General Guidelines for Completing Forms for more information on reporting partial and unknown dates.
Question 4: Specify Donor:
Related donors must be a 6/6 HLA-matched donors, defined by Class I (HLA-A and -B) intermediate resolution or high-resolution DNA-based typing and Class II (HLA-DRBI) at high-resolution DNA-based typing. There is no age restriction for sibling donors. Donors that are monozygotic twins are ineligible for the study.
Unrelated donors must be an 8/8 HLA-A, -B, -C, and -DRB1 at high-resolution DNA-based typing. Donors must meet institutional or NMDP selection criteria.
Donors that are 7/8 matched are ineligible for the study.
If a matched related or unrelated donor cannot be identified, patients may proceed to allogeneic HCT with a suitable haploidentical donor (Recipient’s parents or children).
Indicate if the donor is 6/6 HLA-matched related (not monozygotic twin), 8/8 HLA-A, -B, -C, -DRB1 unrelated, or Haploidentical.
Section Updates:
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