Q23 – 29: Disease Modifying Therapies

Question 23: Were disease modifying therapies given? (excludes blood transfusions)

Indicate if the recipient received disease modifying therapies at any time between the diagnosis and the start of the preparative regimen, excluding blood transfusion(s) (review the question below for a list of common disease modifying therapies).

If the recipient did not receive disease modifying therapies or if no information is available to determine if the recipient received disease modifying therapies, select No or Unknown, and continue with Was enzyme activity and/or enzyme substrate tested?

*Reporting Multiple Disease Modifying Therapies
FormsNet3^SM application: Complete questions 24-29 for each disease modifying therapy administered by adding an additional instance in FormsNet3^SM application.
Paper form submission: Copy questions 24-29 and complete for each disease modifying therapy administered.

*Same Therapy Restarted
If the same therapy was started and stopped multiple times prior to the start of the preparative regimen, only one instance needs to be reported. In this case, report the therapy start date as the date therapy first began in the reporting period.

Questions 24 – 25: Specify the disease modifying therapy (check all that apply)

Select the disease modifying therapy administered as part of the line of therapy being reported.

• Leriglitazone: a novel selective peroxisome proliferator-activated receptor gamma agonist.
  If the recipient received a therapy which is not listed, select Other and specify the treatment. Report the generic name of the agent, not the brand name.

Questions 26 – 27: Date therapy started

Indicate if the therapy start date (YYYY-MM-DD) is known. If Known, report the first date the recipient began this line of therapy.

If the exact date is not known report an estimated date and check the Date estimated box. Refer to General Instructions, General Guidelines for Completing Forms for information about reporting estimated dates.

Questions 28 – 29: Date therapy stopped

Indicate if the stop date is known. If the therapy stop date is Known, report the date (YYYY-MM-DD) when the therapy end. If the therapy is being given in cycles, report the end date as the date when the recipient started the last cycle for this line of therapy. Otherwise, report the final administration date for the therapy being reported.

If the exact date is not known report an estimated date and check the Date estimated box. Refer to General Instructions, General Guidelines for Completing Forms for information about reporting estimated dates.

Report Not applicable if the recipient is still receiving therapy at the start of the preparative regimen / infusion.

Section Updates:

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

Copyright © 2004-2024 The Medical College of Wisconsin, Inc. and NMDP. All Rights Reserved.
CIBMTR® (Center for International Blood and Marrow Transplant Research) is a research collaboration between the Medical College of Wisconsin and NMDP.