Q106 – 112: Disease Modifying Therapy

Question 106: Were disease modifying therapies given? (excludes blood transfusions)

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

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, respectively and submit the form.

*Reporting Multiple Disease Modifying Therapies
FormsNet3^SM application: Complete questions 107 – 112 for each line of therapy by adding an additional instance in FormsNet3^SM application.
Paper form submission: Copy questions 107 – 112 and complete for each line of therapy.

*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 when therapy first began.

Questions 107 – 108: Specify the disease modifying therapy (check all that apply)

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

• Hydroxyurea: A type of chemotherapy. Common brand names include Droxia and Hydrea.
• Luspatercept: Treatment for anemia with recipient’s beta thalassemia. Also known as Reblozyl.

If the recipient received a therapy which is not listed, select Other and specify the treatment. Examples of the other disease modifying therapies includes drugs given as part of a clinical trial for thalassemia or future therapies not yet developed. Report the generic name of the agent, not the brand name.

Questions 109 – 110: Date therapy started

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

If the therapy start date is not known, select Unknown.

Questions 111 – 112: Date therapy stopped

Indicate if the stop date is known. If Known, specify the end date (YYYY-MM-DD). If the therapy is 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.

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:

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