These questions are intended to determine the status of the recipient at the last evaluation for this reporting period. Testing may have been performed multiple times during the reporting period; report the most recent laboratory values. Reported values should be within a reasonable time frame of the date of contact, or approximately one month prior to the date of contact. If the recipient received any treatment or therapy for relapse, progression, or persistent disease, leave this section of the form blank and continue with the signature section.
Questions 59-60: Absolute lymphocyte count
Indicate whether the lymphocyte count was “known” or “unknown” at the time of evaluation for the reporting period. If “known,” report the laboratory count and unit of measure documented on the laboratory report in question 60. If “unknown,” continue with question 61.
Questions 61-63: IgM
Indicate whether the IgM level was “known” or “unknown” at the time of evaluation for the reporting period. If “known,” report the laboratory value and unit of measure in question 62; report the laboratory upper limit of normal value and unit of measure in question 63. If “unknown,” continue with question 64.
Questions 64-65: Serum monoclonal protein (M-spike) (only from electrophoresis)
Indicate whether serum monoclonal protein quantification from electrophoresis was “known” or “unknown” at the time of evaluation for the reporting period. If “known,” report the laboratory value and unit of measure in question 65. If serum electrophoresis was done and did not show monoclonal protein, report “0.” If “unknown,” continue with question 66.
Questions 66-67: Urinary monoclonal protein (M-spike)
Indicate whether 24-hour urine monoclonal protein quantification from electrophoresis was “known” or “unknown” at the time of evaluation for the reporting period. If “known,” report the laboratory value and unit of measure in question 67. If urine electrophoresis was done and did not show monoclonal protein, report “0.” If “unknown,” continue with question 68.
Questions 68-69: Bone marrow aspirate (examined for histologic involvement)
Indicate whether the extent of histologic involvement in the bone marrow aspirate was “known” or “unknown” at the time of evaluation for the reporting period. If bone marrow aspirate was not examined, report “not applicable.” If “known,” report the extent of aspirate histologic involvement in question 69. If “unknown” or “not applicable,” continue with question 70.
Questions 70-71: Bone marrow biopsy (examined for histologic involvement)
Indicate whether the extent of histologic involvement in the bone marrow biopsy was “known” or “unknown” at the time of evaluation for the reporting period. If bone marrow biopsy was not examined, report “not applicable.” If “known,” report the extent of biopsy histologic involvement in question 71. If “unknown” or “not applicable,” continue with question 72.
Question 72: Specify the type of histological involvement in marrow
WM and LPL are often characterized by histologic involvement of the bone marrow. However, there are variations in type of involvement:1
- Lymphoplasmacytoid: This variant is primarily defined by small lymphocytes with some plasmacytoid lymphocytes and rare mature plasma cells. Lymphoplasmacytoid cells (plasmacytoid lymphocytes) are mononuclear cells with dark, irregular nuclei. They are slightly larger than a small lymphocyte. Additionally, mitotic and large cells are rare.
- Lymphoplasmacytic: In this variant, the involved cells are a mix of small lymphocytes, plasmacytoid lymphocytes, and mature plasma cells. Mitotic and large cells are rare.
- Polymorphous: This variant can resemble either lymphoplasmacytoid or lymphoplasmacytic variants, but mitotic and large cells are more common. Large cells are still less common than in large cell lymphomas.
Specify the type of histologic involvement as indicated by the pathology report or transplant physician. Report “unknown” if the bone marrow was not examined, there was no bone marrow involvement, or if the type of histologic involvement cannot be specified.
1 Ioachim HL, Medeiros LJ. (2009) Lymph Node Pathology, 4th edition. Philadelphia, PA: Lippincott Williams & Wilkins.
Question 73: Was there any clinical or radiological (e.g., CT, PET, PET/CT) evidence of organ involvement at the time of evaluation for this reporting period?
Indicate whether the recipient had clinical or radiological evidence of organ involvement at the time of evaluation for the reporting period. This includes clinical manifestations of WM/LPL such as palpable lymphadenopathy or hyperviscosity syndrome, and radiological evidence such as organomegaly or lymphadenopathy. Do not include biochemical markers as clinical involvement, as they are captured in other data fields in this form section.
Questions 74-77: Specify site(s)
Indicate “yes” or “no” for each site specified in questions 74-76. Do not leave any response blank. If “yes” is indicated for “other site,” specify the site in question 77. Include clinical manifestations (such as hyperviscosity syndrome or cold agglutinin disease) under “other site.” If the patient had clinical or radiological evidence of disease indicated in question 73, at least one of questions 74-76 must be answered “yes.”
Section Updates:
| Question Number | Date of Change | Add/Remove/Modify | Description | Reasoning (If applicable) |
|---|---|---|---|---|
| . | . | . | . | . |
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