100+ Free TCTCN Practice Questions

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A patient 3 years post-transplant complains of chronic dry mouth, difficulty eating spicy foods, and oral mucosal lichenoid changes. What is the MOST likely cause?

Medication side effect from MMF

Oral candidiasis

Oral chronic GVHD

Vitamin B12 deficiency

to track

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Key Facts: TCTCN Exam

~70%

Pass Rate

ONCC

165

Total Questions

125 scored + 40 pretest

3 hrs

Time Limit

ONCC

2,000 hrs

Required Experience

HCT/cellular therapy nursing

$300-$420

Exam Fee

ONCC

4 years

Certification Validity

ONCC

Jan 2026

Renamed from BMTCN

ONCC

The TCTCN (Transplantation and Cellular Therapy Certified Nurse) exam is administered by ONCC and replaced the BMTCN credential in January 2026 to reflect expanded scope including CAR-T and cellular therapies. The exam has an approximate 70% pass rate. It consists of 165 multiple-choice questions (125 scored, 40 pretest) with a 3-hour time limit. Post-procedure care is the largest domain at 28% and now includes CRS and ICANS. Candidates must hold an active RN license with 2 years of RN practice and 2,000 hours of HCT or cellular therapy nursing experience. The credential is valid for 4 years.

Sample TCTCN Practice Questions

Try these sample questions to test your TCTCN exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A patient is being evaluated for an allogeneic hematopoietic stem cell transplant. Which factor is MOST critical in donor selection?

A.ABO blood type compatibility

B.HLA matching between donor and recipient

C.Donor age under 30 years

D.CMV serostatus of the donor

Explanation: HLA (human leukocyte antigen) matching is the most critical factor in allogeneic donor selection because mismatches significantly increase the risk of graft-versus-host disease (GVHD), graft failure, and transplant-related mortality. While ABO compatibility, donor age, and CMV status are considered, they are secondary to HLA matching. A fully HLA-matched sibling donor remains the preferred choice.

2Which conditioning regimen classification is associated with reduced transplant-related mortality but higher relapse rates?

A.Myeloablative conditioning (MAC)

B.Reduced-intensity conditioning (RIC)

C.Sequential conditioning

D.Tandem conditioning

Explanation: Reduced-intensity conditioning (RIC) uses lower doses of chemotherapy and/or radiation compared to myeloablative conditioning, resulting in less organ damage and lower transplant-related mortality. However, RIC relies more heavily on the graft-versus-tumor (GVT) effect for disease control, which can lead to higher relapse rates. RIC is often preferred for older patients or those with comorbidities.

3During informed consent for hematopoietic stem cell transplant, which information is essential to communicate to the patient?

A.The guarantee of a complete cure after transplant

B.Potential risks including GVHD, infection, organ toxicity, and graft failure

C.That the conditioning regimen will have no side effects

D.That the patient will not require any follow-up care after engraftment

Explanation: Informed consent must include a thorough discussion of potential risks and complications including graft-versus-host disease, infections, organ toxicity, graft failure, infertility, and the possibility of disease relapse. Patients must understand that transplant carries significant morbidity and mortality risks. No guarantees of cure should be made, and lifelong follow-up is typically required.

4A patient scheduled for autologous stem cell transplant requires peripheral blood stem cell (PBSC) mobilization. Which agent is most commonly used to mobilize stem cells?

A.Erythropoietin (EPO)

B.Granulocyte colony-stimulating factor (G-CSF)

C.Dexamethasone

D.Rituximab

Explanation: G-CSF (filgrastim or pegfilgrastim) is the standard agent for mobilizing peripheral blood stem cells. It stimulates the bone marrow to produce and release CD34+ hematopoietic progenitor cells into the peripheral blood, where they can be collected via apheresis. G-CSF may be used alone or in combination with plerixafor (a CXCR4 antagonist) for patients who are poor mobilizers.

5What is the minimum target CD34+ cell dose typically required for adequate engraftment in autologous peripheral blood stem cell transplant?

A.1 x 10^6 CD34+ cells/kg

B.2 x 10^6 CD34+ cells/kg

C.5 x 10^6 CD34+ cells/kg

D.10 x 10^6 CD34+ cells/kg

Explanation: The minimum target CD34+ cell dose for autologous PBSC transplant is generally 2 x 10^6 CD34+ cells/kg of recipient body weight. Doses below this threshold are associated with delayed engraftment and increased risk of graft failure. An optimal dose of 5 x 10^6 CD34+ cells/kg or higher is preferred, as higher cell doses correlate with faster neutrophil and platelet engraftment.

6A patient undergoing pre-transplant evaluation has an ejection fraction of 38%. What does this finding indicate?

A.The patient has adequate cardiac function for transplant

B.The patient may not be a suitable candidate due to reduced cardiac function

C.The patient requires only a dose reduction in conditioning

D.The finding is not relevant to transplant candidacy

Explanation: An ejection fraction of 38% indicates reduced left ventricular systolic function (normal is 55-70%). Most transplant programs require an ejection fraction of at least 45-50% for myeloablative conditioning. A value of 38% would raise serious concerns about the patient's ability to tolerate the cardiotoxic effects of conditioning regimens and may preclude transplant or require reduced-intensity conditioning.

7Which disease has the BEST overall survival outcomes following allogeneic hematopoietic stem cell transplant when performed in first complete remission?

A.Refractory acute myeloid leukemia

B.Acute promyelocytic leukemia (APL) in first remission

C.Acute lymphoblastic leukemia with Philadelphia chromosome in first remission

D.Chronic myeloid leukemia in blast crisis

Explanation: Acute lymphoblastic leukemia (ALL) with Philadelphia chromosome (Ph+) in first complete remission has excellent outcomes with allogeneic transplant, especially with the addition of tyrosine kinase inhibitors (TKIs) pre- and post-transplant. APL in first remission is typically cured with ATRA/ATO without transplant. Refractory AML and CML in blast crisis carry significantly worse transplant outcomes due to active disease.

8Which myeloablative conditioning regimen is MOST commonly used for patients with acute myeloid leukemia undergoing allogeneic transplant?

A.Fludarabine/melphalan

B.Busulfan/cyclophosphamide (BuCy)

C.BEAM (BCNU, etoposide, cytarabine, melphalan)

D.Total lymphoid irradiation (TLI) with antithymocyte globulin

Explanation: Busulfan/cyclophosphamide (BuCy) is one of the most commonly used myeloablative conditioning regimens for AML patients undergoing allogeneic transplant. It provides sufficient disease eradication and immunosuppression for engraftment. Fludarabine/melphalan is a reduced-intensity regimen, BEAM is primarily used for autologous transplant in lymphomas, and TLI/ATG is a non-myeloablative approach.

9What is the primary purpose of pre-transplant HCT-CI (Hematopoietic Cell Transplant Comorbidity Index) assessment?

A.To determine HLA match grade

B.To predict transplant-related mortality based on comorbidities

C.To calculate the optimal stem cell dose

D.To determine the conditioning regimen intensity

Explanation: The HCT-CI is a validated scoring tool that predicts non-relapse mortality and overall survival after hematopoietic stem cell transplant based on pre-existing comorbid conditions. It assigns weighted scores to 17 organ-specific comorbidities. Higher HCT-CI scores correlate with increased transplant-related mortality, helping guide treatment decisions including conditioning intensity and transplant candidacy.

10A patient asks the nurse why a central venous catheter (CVC) is needed before transplant. Which response is MOST appropriate?

A.It is only used during the stem cell infusion and will be removed immediately after

B.It provides reliable vascular access for blood draws, medications, transfusions, and stem cell infusion over weeks to months

C.It is required only for chemotherapy administration

D.It is a temporary line used only for the first week after transplant

Explanation: A central venous catheter is essential for transplant patients because it provides reliable, long-term vascular access for the frequent blood draws, IV medications, chemotherapy, blood product transfusions, nutritional support, and the stem cell infusion itself. The CVC typically remains in place for weeks to months post-transplant until the patient no longer requires frequent IV access.

About the TCTCN Exam

Specialty certification for registered nurses in hematopoietic cell transplantation (HCT) and cellular therapy nursing. ONCC renamed BMTCN to TCTCN effective January 2026 to reflect the expanded scope including CAR-T cell therapy and other immune effector cell treatments. The TCTCN validates expertise in pre-procedure evaluation, transplantation and cellular therapy administration, post-procedure management (including CRS and ICANS), survivorship care, and evidence-based practice.

Questions

165 scored questions

Time Limit

3 hours

Passing Score

Pass/Fail (scaled)

Exam Fee

$300 (ONS/APHON member) / $420 (non-member) (ONCC)

TCTCN Exam Content Outline

18%

Pre-Transplant/Cellular Therapy Patient Care

Patient and donor assessment, conditioning regimens, disease indications, CAR-T patient selection

22%

Transplantation/Cellular Therapy Procedure

Stem cell and CAR-T infusion, engraftment monitoring, acute reactions, supportive care

28%

Post-Transplantation/Cellular Therapy Patient Care

GVHD, CRS and ICANS, infection prevention, organ toxicities, immune reconstitution

18%

Long-Term Follow-Up and Survivorship

Late effects, secondary malignancies, chronic GVHD, quality of life

14%

Professional Practice

Evidence-based practice, ethics, education, quality improvement

How to Pass the TCTCN Exam

What You Need to Know

Passing score: Pass/Fail (scaled)
Exam length: 165 questions
Time limit: 3 hours
Exam fee: $300 (ONS/APHON member) / $420 (non-member)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

TCTCN Study Tips from Top Performers

1Focus on post-transplant/cellular therapy management (28% of exam) — master acute and chronic GVHD grading plus CRS and ICANS grading scales

2Know conditioning regimens (myeloablative vs reduced-intensity) and CAR-T lymphodepletion protocols

3Understand the differences between autologous, allogeneic, haploidentical transplants and CAR-T therapies

4Review tocilizumab and corticosteroid protocols for managing CRS and ICANS

5Complete at least 100 practice questions before scheduling your exam

Frequently Asked Questions

Why was BMTCN renamed to TCTCN?

ONCC renamed the BMTCN (Blood and Marrow Transplant Certified Nurse) credential to TCTCN (Transplantation and Cellular Therapy Certified Nurse) effective January 2026 to reflect the rapidly expanding scope of cellular therapies, including CAR-T cell therapy and other immune effector cell treatments. The same exam program continues with updated content. Existing BMTCN holders were automatically transitioned to TCTCN, with new certificates issued in March 2026.

What is the TCTCN exam pass rate?

The TCTCN exam (formerly BMTCN) has an approximate 70% pass rate. The exam uses a scaled scoring system where 125 of the 165 questions are scored (40 are unscored pretest items). With thorough preparation using practice questions and clinical experience, most well-prepared candidates pass on their first attempt.

What are the TCTCN eligibility requirements?

To sit for the TCTCN exam, you need: 1) A current, active, unencumbered RN license. 2) Minimum 2 years of RN practice. 3) Minimum 2,000 hours of HCT or cellular therapy nursing practice within the last 4 years. 4) At least 10 contact hours of continuing education in HCT or cellular therapy nursing within the last 4 years. The certification is renewed every 4 years.

What new content was added to TCTCN compared to BMTCN?

TCTCN expands BMTCN content to include cellular therapies, particularly CAR-T cell therapy and other immune effector cell treatments. Key new topics include CAR-T patient selection, infusion management, cytokine release syndrome (CRS) recognition and grading, immune effector cell-associated neurotoxicity syndrome (ICANS) management, and tocilizumab/corticosteroid protocols. Core HCT content (conditioning regimens, GVHD, engraftment) remains central.

How should I study for the TCTCN exam?

Plan for 60-100 hours of study over 8-12 weeks. Focus heavily on post-procedure management (28% of exam) — master GVHD classification and treatment plus CRS and ICANS grading. Use ONCC's TCTCN test content outline as your study framework. Complete at least 100 practice questions and aim to score 80%+ consistently before scheduling. Real-world HCT or cellular therapy nursing experience is essential for applying clinical knowledge.