Q140 – 142: GVHD Prophylaxis

!The following GVHD prophylaxis questions are to be completed for allogeneic HCTs only. Autologous HCTs continue with the Post-HCT Therapy Planned as of Day 0 section.

*If ATG or Campath were ordered for GVHD prophylaxis prior to or after Day 0, report these drugs in the Additional Drugs Given in the Peri-Transplant Period section of the Pre-TED. Do not report these drugs in the GVHD Prophylaxis section.

Question 140: Was GVHD prophylaxis planned?

After allogeneic HCT, specific immunosuppressive therapy may be administered to prevent GVHD or to immunosuppress the host marrow, thereby promoting engraftment of the donor stem cells. Most transplant centers have specific GVHD prophylaxis protocols and graft rejection protocols. Planned agents a recipient receives as a result of these protocols should be included in this section. This answer does not have to match what is reported on the Post-Infusion Follow-Up (2100) Form.

Indicate if GVHD prophylaxis was planned at the time of transplant. If GVHD prophylaxis was not planned at the time of transplant, check No.

Questions 141 – 142: Specify drugs / intervention (check all that apply)

The prophylactic drug options listed on the form are intended to be administered in a systemic or oral form. If the recipient received one of the listed drugs in a topical form, select the “other agent” option and specify the drug.

!Product Manipulation for GVHD Prophylaxis
In Specify drugs / intervention questions, be sure to report any product manipulation done for GVHD Prophylaxis. Product manipulation is not captured anywhere else on this revision of the Pre-TED (2400) Form and any manipulation done for GVHD Prophylaxis should be reported here. An example of product manipulation for GVHD prophylaxis is T-cell depletion.

The Pre-TED Form lists the generic chemotherapy drug names. The following website provides the trade names under which generic drugs are manufactured: http://www.rxlist.com/script/main/hp.asp

If GVHD prophylaxis is used for a syngeneic (monozygotic or identical twin) or autologous HCT, attach a copy of the source document using the attachment feature in FormsNet3^SM.

Section Updates:

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