Introduction

The Transplantation and Cellular Therapy Certified Nurse (TCTCN) credential is administered by the Oncology Nursing Certification Corporation (ONCC). Formerly known as BMTCN (Blood and Marrow Transplant Certified Nurse), it was renamed in January 2026 to reflect the broader scope of modern transplant nursing, which now includes CAR-T cell therapy, gene therapy, and other cellular therapies beyond traditional bone marrow transplant. The TCTCN validates specialized knowledge in hematopoietic stem cell transplantation (HSCT) and cellular therapy.

Exam Structure

• •Questions: 165 multiple-choice questions (125 scored + 40 pretest)
• •Time Limit: 3 hours
• •Passing Score: Scaled score of 55 (25–75 scale)
• •Format: Computer-based testing at PSI testing centers
• •Cost: $300 (ONCC member) / $420 (non-member)

Eligibility Requirements

• •Current, active RN license (unencumbered)
• •2,000 hours of practice in HSCT and/or cellular therapy within the past 4 years
• •10 contact hours of continuing education in HSCT/cellular therapy within the past 3 years

Content Domains

• •Foundations of HSCT and Cellular Therapy
• •Donor and Recipient Issues
• •Conditioning Regimens
• •Infusion and Engraftment
• •Post-Transplant Complications
• •Long-Term Survivorship and Professional Issues

Pass Rate Analysis

ONCC does not publicly publish granular pass rate data for the TCTCN in the same way it does for the CPHON or OCN. Based on available data and industry sources:

• •TCTCN pass rates are estimated to be in the range of 70–75% overall, comparable to other ONCC specialty certifications
• •The exam has a smaller candidate pool than the CPHON or OCN, which makes year-to-year pass rate data less stable
• •The 2026 name change from BMTCN to TCTCN did not change the exam content, eligibility, or passing standard

Key context: The TCTCN is a highly specialized exam. Most candidates work in dedicated BMT or cellular therapy programs and have deep clinical experience in the field. The eligibility requirement of 2,000 practice hours ensures a high baseline of knowledge.

What Makes It Hard

1. Rapidly Evolving Content: Cellular therapy is one of the fastest-moving fields in oncology. New CAR-T products, gene therapies, and conditioning regimens are continually emerging. The exam reflects current practice, not historical knowledge.

1. GVHD Complexity: Graft-vs-Host Disease is the single most tested complication. Candidates must know acute vs. chronic presentations, grading systems (Glucksberg for acute, NIH for chronic), prophylaxis protocols, and multi-line treatment algorithms (steroids → ruxolitinib → ECP → other agents).

1. Pharmacology Depth: The exam tests detailed knowledge of conditioning agents (busulfan, cyclophosphamide, fludarabine, TBI), immunosuppressants (tacrolimus, cyclosporine, methotrexate, mycophenolate), and CAR-T toxicity management (tocilizumab for CRS, dexamethasone for ICANS). Drug-specific organ toxicities are heavily tested.

1. Infection Timeline Mastery: Candidates must know the pre-engraftment, early post-engraftment, and late post-transplant infection timelines, including typical pathogens, prophylaxis protocols, and treatment strategies for CMV, fungal infections, and PJP.

1. CAR-T and Cellular Therapy: The addition of CAR-T cell therapy content significantly expanded the exam scope. Candidates must understand CRS grading and management, ICANS, B-cell aplasia, and the differences between approved CAR-T products.

1. VOD/SOS and Rare Complications: Veno-occlusive disease/sinusoidal obstruction syndrome, TMA, hemorrhagic cystitis, PTLD, and idiopathic pneumonia syndrome are all tested. These are relatively rare complications that require textbook-level knowledge.

What Makes It Easier

1. Highly Specialized Candidates: The 2,000-hour eligibility requirement means most TCTCN candidates are experienced transplant nurses. Much of the exam content is familiar from daily clinical practice.

1. Focused Content Area: Unlike broad oncology exams, TCTCN focuses exclusively on HSCT and cellular therapy. The content is deep but narrow in scope.

1. ONCC Exam Format Familiarity: The 165-question, 3-hour format with scaled scoring is identical to other ONCC exams (CPHON, OCN). Candidates who have taken another ONCC exam know the structure.

1. ONCC Resources: ONCC provides a detailed test content outline, candidate handbook, and practice exams. The ASTCT also publishes clinical guidelines that align with exam content.

1. Community Support: The transplant nursing community is small but active. APHON and ASTCT offer educational resources, conferences, and networking that support exam preparation.

1. Name Change Didn’t Change Content: The BMTCN → TCTCN rename in January 2026 reflected the broader scope of cellular therapy but did not change the exam content. Study materials for BMTCN remain valid for TCTCN.

Tips for Success

1. Master GVHD: This is the highest-yield topic. Know acute vs. chronic presentations, Glucksberg grading, NIH grading, and treatment algorithms. Study the prophylaxis protocols (PTCy, tacrolimus/MTX, ATG).

1. Know the Infection Timeline: Create a visual timeline of post-transplant infections (Day 0–30: bacterial, candida; Day 30–100: CMV, aspergillus; Day 100+: VZV, encapsulated organisms). This is heavily tested.

1. Study CAR-T Toxicity Management: Know CRS grading (Lee scale), ICANS grading, and the specific treatments (tocilizumab for CRS, anakinra for refractory CRS, dexamethasone for ICANS).

1. Learn Conditioning Regimen Toxicities: Busulfan → seizures, VOD; cyclophosphamide → hemorrhagic cystitis; TBI → cataracts, growth delay; carmustine → pulmonary fibrosis.

1. Use the ONCC Practice Exam: The official practice test is the best predictor of exam readiness. Take it 2–4 weeks before your test date.

1. Read ASTCT Guidelines: The American Society for Transplantation and Cellular Therapy publishes clinical guidelines that directly inform exam content.

1. Don’t Neglect Survivorship: Late effects (endocrine dysfunction, secondary malignancies, cardiac toxicity) and long-term follow-up guidelines represent ~15% of the exam.

Sources

• •Oncology Nursing Certification Corporation (ONCC) — oncc.org
• •ONCC TCTCN Test Content Outline and Candidate Handbook
• •American Society for Transplantation and Cellular Therapy (ASTCT) — astct.org
• •Center for International Blood and Marrow Transplant Research (CIBMTR) — cibmtr.org
• •Association of Pediatric Hematology/Oncology Nurses (APHON) — aphon.org