TCTCN Study Plan: 7-Week Schedule
Week-by-Week Preparation Guide for the ONCC TCTCN Exam
7-Week Preparation Guide
Certifying Body: Oncology Nursing Certification Corporation (ONCC)
Exam: Transplantation and Cellular Therapy Certified Nurse (TCTCN) — formerly BMTCN
Format: Computer-based, multiple choice; 165 questions (125 scored + 40 pretest)
Time: 3 hours
Passing Score: Scaled score of 55 (25–75 scale)
Cost: $300 (ONCC member) / $420 (non-member)
Validity: 4 years
Eligibility: Active RN license + 2,000 hours in HSCT/cellular therapy in past 4 years + 10 contact hours in HSCT/cellular therapy (past 3 years)
About the Exam
The TCTCN (formerly BMTCN, renamed January 2026) validates specialized knowledge in hematopoietic stem cell transplantation and cellular therapy. Certified nurses work in bone marrow transplant units, cellular therapy programs, apheresis centers, and transplant clinics.
Exam Content Domains (per ONCC)
Week-by-Week Study Plan
Weeks 1–2: Foundations of HSCT and Donor Issues
Goal: Master transplant types, indications, and donor selection
Key Topics:
- •HSCT types: autologous (self-donor) vs. allogeneic (other donor)
- •Indications: hematologic malignancies (ALL, AML, MDS, lymphoma, myeloma), solid tumors (neuroblastoma, germ cell), non-malignant disorders (aplastic anemia, sickle cell, thalassemia, immunodeficiencies)
- •Donor selection: HLA typing (HLA-A, B, C, DRB1, DQB1), match grades (8/8, 10/10), haploidentical, cord blood
- •Unrelated donor registries: NMDP/Be The Match, international registries
- •Cord blood: advantages (tolerance of HLA mismatch), limitations (cell dose, delayed engraftment)
- •Graft sources: bone marrow, peripheral blood stem cells (PBSC), umbilical cord blood
- •Mobilization: G-CSF, plerixafor, apheresis collection process
- •Stem cell processing: cryopreservation, CD34+ selection, T-cell depletion
Daily Schedule (2 hours/day):
- •Days 1–3: HSCT types, indications, and outcomes
- •Days 4–5: HLA biology, donor selection, match grades
- •Days 6–7: Graft sources — bone marrow vs. PBSC vs. cord blood
- •Days 8–9: Mobilization, apheresis, stem cell processing
- •Days 10–11: Donor safety considerations, registry processes
- •Days 12–14: Review and practice questions
Weeks 3–4: Conditioning Regimens and Infusion
Goal: Understand preparative regimens and transplant procedures
Key Topics:
- •Conditioning types: myeloablative (MAC), reduced-intensity (RIC), non-myeloablative
- •Agents: busulfan, cyclophosphamide, fludarabine, TBI (total body irradiation), thiotepa, melphalan, treosulfan
- •TBI: total body irradiation — dosing, fractionation, acute and late effects
- •Pharmacology: mechanism of action, organ-specific toxicity (hepatic VOD/SOS, hemorrhagic cystitis, pulmonary toxicity)
- •Immunosuppression: cyclosporine, tacrolimus, methotrexate, mycophenolate, ATG, post-transplant cyclophosphamide (haplo)
- •Graft manipulation: T-cell depletion, CD34+ selection, ex vivo treatment
- •Infusion day: procedure, nursing care, DMSO toxicity (autologous), ABO incompatibility reactions (allogeneic)
- •Engraftment: neutrophil (>500 x3 days) and platelet (>20,000 x7 days without transfusion) criteria
- •Engraftment syndrome: fever, rash, pulmonary infiltrates, weight gain
- •Primary graft failure: definition, risk factors, management
Daily Schedule (2 hours/day):
- •Days 1–3: Conditioning regimen types and rationale
- •Days 4–5: Chemotherapy agents used in conditioning — toxicity profiles
- •Days 6–7: TBI — techniques, effects, nursing care
- •Days 8–9: Immunosuppression protocols and monitoring
- •Days 10–11: Infusion day nursing care, engraftment monitoring
- •Days 12–14: Engraftment complications; review
Weeks 5–6: Post-Transplant Complications
Goal: Master GVHD, infections, and organ-specific complications
Key Topics:
- •GVHD (Graft-vs-Host Disease):
- •Acute GVHD: skin (maculopapular rash), GI (diarrhea, abdominal pain), liver (elevated bilirubin); Glucksberg grading I–IV
- •Chronic GVHD: lichen planus-like skin changes, sicca syndrome, bronchiolitis obliterans, fasciitis, ocular involvement; NIH grading
- •Treatment: corticosteroids (first-line), ruxolitinib (FDA-approved), extracorporeal photopheresis, sirolimus, mycophenolate
- •Prophylaxis: post-transplant cyclophosphamide (PTCy), tacrolimus/methotrexate, ATG
- •Infections:
- •Timeline: pre-engraftment (bacterial, candida), post-engraftment (CMV, adenovirus, HHV-6), late (>100 days: VZV, encapsulated organisms)
- •CMV: monitoring (PCR), pre-emptive therapy (ganciclovir, letermovir), prophylaxis strategies
- •Fungal infections: aspergillosis, mucormycosis — prophylaxis (posaconazole, voriconazole)
- •PJP prophylaxis: TMP-SMX, pentamidine, atovaquone
- •VOD/SOS (Veno-Occlusive Disease / Sinusoidal Obsection Syndrome):
- •Pathophysiology: sinusoidal endothelial damage → hepatomegaly, ascites, jaundice
- •Risk factors: busulfan, TBI, pre-existing liver disease
- •Treatment: defibrotide (FDA-approved for severe VOD/SOS)
- •Other complications:
- •Hemorrhagic cystitis: cyclophosphamide-related, BK virus-associated
- •Pulmonary complications: DAH (diffuse alveolar hemorrhage), IPS (idiopathic pneumonia syndrome), PTLD
- •TMA (transplant-associated thrombotic microangiopathy)
- •Secondary malignancies: post-transplant lymphoproliferative disorder (PTLD)
Daily Schedule (2 hours/day):
- •Days 1–3: Acute GVHD — pathophysiology, grading, treatment
- •Days 4–5: Chronic GVHD — manifestations, grading, management
- •Days 6–7: Infection timeline, CMV monitoring and treatment
- •Days 8–9: Fungal infections, PJP, bacterial prophylaxis
- •Days 10–11: VOD/SOS, hemorrhagic cystitis, pulmonary complications
- •Days 12–14: TMA, PTLD, secondary malignancies; review
Week 7: Cellular Therapy and Final Review
Goal: CAR-T, gene therapy, survivorship, and exam readiness
Key Topics:
- •CAR-T Cell Therapy:
- •Mechanism: autologous T-cells engineered with chimeric antigen receptor
- •FDA-approved products: tisagenlecleucel (Kymriah), axicabtagene ciloleucel (Yescarta), lisocabtagene maraleucel (Breyanzi), brexucabtagene autoleucel (Tecartus), idecabtagene vicleucel (Abecma)
- •CRS (Cytokine Release Syndrome): grading (Lee scale), management (tocilizumab, anakinra)
- •ICANS (Immune Effector Cell-Associated Neurotoxicity Syndrome): grading, management (dexamethasone)
- •B-cell aplasia: hypogammaglobulinemia, IVIG replacement
- •Gene Therapy: emerging therapies for sickle cell, beta-thalassemia
- •Survivorship: late effects (endocrine, cardiac, pulmonary, secondary cancers), screening guidelines
- •End-of-life care: palliative care in transplant, when to transition goals
- •Ethics: informed consent, clinical trials, donor-recipient dynamics
Daily Schedule:
- •Days 1–2: CAR-T cell therapy — products, mechanism, toxicity management
- •Days 3–4: Gene therapy, emerging cellular therapies
- •Days 5–6: Survivorship, late effects, long-term follow-up
- •Day 7: Full-length practice exam; final review
Test-Taking Tips
- GVHD is the #1 tested topic — Know acute vs. chronic presentations, grading systems, and treatment algorithms
- Infection timeline — Pre-engraftment, early post-engraftment, late; know the typical pathogens at each phase
- CMV management — PCR monitoring, pre-emptive therapy thresholds, letermovir prophylaxis
- VOD/SOS — Know the Seattle and Baltimore diagnostic criteria, risk factors, and defibrotide treatment
- CAR-T toxicities — CRS and ICANS grading and management (tocilizumab for CRS, dexamethasone for ICANS)
- Conditioning regimens — Know which agents cause which organ toxicities
- ABO incompatibility — Major vs. minor, hemolysis risk, pure red cell aplasia
- Read qualifiers carefully — “MOST appropriate,” “FIRST action,” “BEST response”
- Pretest questions — 40 unscored; answer every question
- Manage time — 1.09 minutes per question; flag and return to difficult items
Recommended Resources
Primary:
- •ONCC TCTCN Test Content Outline (oncc.org)
- •Hematopoietic Stem Cell Transplantation: A Handbook for Nurses — Ezzone
- •ASTCT (American Society for Transplantation and Cellular Therapy) guidelines
Supplementary:
- •Thomas’ Hematopoietic Cell Transplantation — Appelbaum et al.
- •NCCN Guidelines for Hematopoietic Cell Transplantation
- •FACT-JACIE Standards
- •ONCC practice exam
Free Resources:
- •ASTCT Clinical Guidelines (astct.org)
- •NMDP/Be The Match educational resources
- •CIBMTR data and outcomes (cibmtr.org)
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
Frequently Asked Questions
What is the TCTCN exam?
The TCTCN is a standardized exam. For a comprehensive study guide with practice questions and full-length exams, see our Transplant Nurse Study Guide.
How should I prepare for the TCTCN?
Start with a structured study plan, use official exam blueprints, and practice with realistic exam questions. Our Transplant Nurse Study Guide covers the complete exam content with detailed rationales.
Where can I find TCTCN practice questions?
Our Transplant Nurse Study Guide includes full-length practice exams with detailed answer rationales covering every content area on the actual exam.
Related Resources
Ready to Take the Next Step?
Our Transplant Nurse Study Guide covers every content area with practice questions and detailed answer rationales.