Questions 2-4: Specify the planned cell source(s) for this HCT

Indicate if the recipient will be receiving cells from an autologous, related allogeneic, or unrelated allogeneic source. Indicate all that apply; if the recipient is receiving multiple products, ensure all product sources are specified. Report only the sources for the current hematopoietic cellular transplant; do not report cellular sources for previous hematopoietic cellular transplant(s), co-infusions, or planned subsequent hematopoietic cellular transplant(s).

Question 5: Planned HCT date

Report the planned date of transplant; this should be the first date of transplant reported to CIBMTR for this recipient. If the planned date of infusion changes, the electronic form should be updated in FormsNet3SM, as this data field is used to populate the date of infusion on the patient’s other case report forms. If the recipient has a previous transplant already reported to CIBMTR, review previous transplant follow-up forms and ensure the subsequent transplant is correctly reported on the follow-up forms, which will prompt appropriate follow-up forms to come due; a new or additional Form 2814 is not required. Continue with the signature section of the form.

Section Updates:

Question Number Date of Change Add/Remove/Modify Description Reasoning (If applicable)
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Last modified: Jul 28, 2021