The Blood and Marrow Transplant Certified Nurse credential is awarded by the Oncology Nursing Certification Corporation (ONCC) to registered nurses who practise in hematopoietic stem cell transplantation and cellular therapy. ONCC renamed the credential Transplantation and Cellular Therapy Certified Nurse (TCTCN), effective January 1, 2026, following its 2024 role delineation study. This guide sets out the current examination, its outline, and the route through it, from ONCC’s published record.
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The credential at a glance
| Item | Verified position |
|---|---|
| Program | Blood and Marrow Transplant Certified Nurse (BMTCN), renamed by ONCC to Transplantation and Cellular Therapy Certified Nurse (TCTCN) effective January 1, 2026 |
| Certifying body | Oncology Nursing Certification Corporation (ONCC); the program is accredited by the National Commission for Certifying Agencies (NCCA) |
| Examination | Three-hour test of 165 multiple-choice questions; 125 count toward the score and 40 are pretest or experimental questions, unidentified to the candidate |
| Passing standard | ONCC publishes performance as a scaled score from a minimum of 25 to a maximum of 75; the scaled score required to pass is 55 |
| Eligibility (initial) | Current, active, unencumbered RN licence in the US, its territories or Canada; at least two years (24 months) as an RN within four years of application; at least 2,000 hours of HSCT or cellular therapy nursing practice within four years; at least 10 contact hours of specialty continuing education within three years |
| ONCC test fee | $300 for ONS/APHON members; $420 for non-members, as published by ONCC |
| Credential term | Four years from passing |
| Administrator note | PassProfessor is independent and is not affiliated with ONCC, the Oncology Nursing Society, or APHON |
The guide below takes each verified element in turn: the rename and what it changed, eligibility as ONCC actually states it, the six-area outline in full, the sitting itself, a study plan built on the outline’s arithmetic, and the renewal clock that starts the day a candidate passes. The companion program page, Blood and Marrow Transplant Certified Nurse Exam Preparation (/nursing-exam-prep/bmtcn-exam-prep/), carries the preparation program itself.
Reading the verified facts
Two reading rules apply throughout this guide. First, the current name and current outline govern. Material published for the retired examination — including widely sold review products that still show the older area weightings — describes a test ONCC no longer gives. Second, the passing standard is printed only in the form ONCC publishes it: a scaled score of 55 on a scale running from 25 to 75. A scaled score is not a percentage of questions answered correctly, and converting it into one would invent a figure ONCC does not state. Where ONCC publishes a fee, a window or an hour count, the guide gives it; where ONCC does not publish a figure, the guide says so rather than borrowing one.
The rename, and what it actually changed
ONCC’s account is specific. A role delineation study of blood and marrow transplant nursing practice was completed in 2024; on its results, the ONCC Board approved changing the credential’s name to reflect how the practice had evolved toward cellular therapy. From January 1, 2026, credential holders use Transplantation and Cellular Therapy Certified Nurse, examinations are offered under that name, new certificates and digital badges were issued in the first quarter of 2026, and ONCC’s verification system was updated to show holders under the current credential. Nurses holding an emeritus form of the retired credential keep that emeritus designation.
Three practical consequences follow. Eligibility did not tighten: ONCC states the months and hours criteria are the same, with wording updated so practice and continuing education sit in HSCT or cellular therapy nursing. The test content outline, however, is a genuine revision, not a relabel: ONCC describes it as the update that would in any case follow a role delineation study, with more questions about cellular therapy — visible in the outline itself, where post-cellular therapy management now stands as its own 22% area alongside post-HSCT management. And accreditation carried over: the program continues NCCA accreditation under the current name, which is the accreditation Magnet and Commission on Cancer recognition frameworks rely on.
Eligibility in detail
All criteria must be met at the time of application and at examination. The licence must be current, active and unencumbered as a registered nurse in the United States, its territories or Canada. Experience as an RN must reach two years — 24 months — within the four years (48 months) before application. Specialty practice must reach 2,000 hours of hematopoietic stem cell transplantation or cellular therapy nursing practice within the same four years. Nursing practice, in ONCC’s definition, can be direct or indirect patient care in clinical practice, nursing administration, education, research or consultation, in a position that requires an RN or APRN; where a job title does not clearly show a nursing role, ONCC may request an employer job description on letterhead. Continuing education must reach 10 contact hours in HSCT or cellular therapy nursing — or an academic elective in the specialty — within the three years (36 months) before application, from an acceptable accredited provider or approver; at most five of the ten hours may be accredited continuing medical or pharmacy education, and interprofessional hours must specify the awarding body. On application, ONCC asks for the licence number, a supervisor’s name and telephone number, and continuing-education documentation, and uses the last four digits of the applicant’s social security number with the National Council of State Boards of Nursing ID to confirm licensure, without storing the digits.
The route, step by step
Step one — audit eligibility against the windows, not against memory. The four-year and three-year windows run backwards from application, so hours that were comfortably inside the window last year can fall outside it after a role change or a leave. Count RN months, specialty hours and contact hours on paper before applying. Step two — apply online through ONCC, with licence details, supervisor information and continuing-education documentation ready; incomplete applications are not processed. Step three — watch for the Authorization to Test. ONCC advises it arrives within four to six weeks of applying, by email from PSI, and it opens a testing window of about 90 days. Step four — schedule promptly with PSI at a test centre, and sit inside the window: an expired authorisation forfeits the test fees. Step five — sit the three-hour test and receive the result in the published pass/fail and scaled-score form. Step six — start the four-year clock deliberately: note the expiry year, the September and October renewal deadlines in that year, and the learning-plan habit that makes renewal by professional development possible.
The outline in full
The Test Content Outline is composed of six major subject areas, each with a percentage assigned to it. Each area is represented in every test with the appropriate percentage of questions; not all sub-areas are included on every form. To find the scored questions in an area, ONCC directs candidates to multiply the percentage by 125 — so the four large areas carry roughly 27 to 28 scored questions each, quality of life about 10, and professional performance about 5.
I. Foundations of HSCT and Cellular Therapy — 22%
This area tests whether the candidate can reason from first principles. Basic concepts include hematopoietic cell lineage and function, the immune system and its function, and histocompatibility, including HLA typing. Goals of therapy include the graft-versus-tumour effect, hematologic and immune reconstitution, and immunotherapy. Indications span malignant and non-malignant disease and immune system disorders. Types divide into autologous transplant; allogeneic transplant from matched related, matched unrelated, mismatched unrelated, umbilical cord and haploidentical donors; and cellular therapies — CAR T, tumour-infiltrating lymphocytes, natural killer cells, bispecific antibodies, gene therapy and donor lymphocyte infusion. Sources of cells are peripheral blood, bone marrow, umbilical cord and tumour. The area closes with recipient suitability and evaluation, recipient education, caregiver education, and donor selection, care and education. Items here reward the candidate who can connect a donor choice or a cell source to the risks it creates later in the course — the foundations are examined as the causes of everything the later areas manage.
II. HSCT and Cellular Therapy Process and Administration — 22%
This area covers the work of getting cells into the patient. It includes cellular therapy product collection and storage, and HSCT product mobilisation, collection, harvest and storage. Conditioning and preparative regimens are examined by intensity and by modality: chemotherapy, radiation therapy including total body irradiation and fractionated approaches, biotherapy, immunotherapy and targeted therapies. Management of the acute complications of preparative regimens sits in this area, as does product administration itself — fresh against cryopreserved product, infusion and injection management, and hematologic compatibilities. The examined skill is sequence and vigilance: what must be verified before the product arrives, what the infusion demands while it runs, and which early reactions belong to the regimen, the product, or the patient’s underlying state.
III. Post-HSCT Management and Education — 22%
Early post-HSCT management is the densest clinical ground on the paper: immunosuppressive therapy; acute graft-versus-host disease; infection prevention and management; sepsis; hematologic management including engraftment, pancytopenia and transfusion support; immune complications including engraftment syndrome, cytokine release syndrome and hemophagocytic lymphohistiocytosis; acute system-specific complications including sinusoidal obstruction syndrome and gastrointestinal complications; graft rejection or failure; chimerism; and symptom management across pain, nausea, vomiting, fatigue, nutrition and mobility. Late management covers chronic graft-versus-host disease including its medical management and photopheresis, system-specific late effects such as bronchiolitis obliterans syndrome, cataracts, infertility and cognitive deficits, infection prevention including immunisations and antimicrobial prophylaxis, disease relapse, subsequent malignancy, and follow-up and milestone visits. The dividing discipline is time: candidates must hold the early and late pictures apart, because presentations that look alike are managed differently at different points after transplant.
IV. Post-Cellular Therapy Management and Education — 22%
This area is the clearest mark of the revised outline. Early management after cellular therapy covers infection prevention and management, sepsis, hematologic care including pancytopenia and transfusion support, immune complications — neurotoxicity, cytokine release syndrome and hemophagocytic lymphohistiocytosis — symptom management, and treatment failure including disease progression and relapse. Late management covers system-specific late effects including neurotoxicity, pancytopenia and hypogammaglobulinemia, infection prevention including immunisations and prophylaxis, disease relapse, subsequent malignancy, and follow-up and milestone visits. The trap the area is built to catch is importing transplant reflexes wholesale: cytokine release syndrome and neurotoxicity after cellular therapy have their own grading, escalation and monitoring logic, and the candidate who manages them as if they were graft-versus-host disease answers the wrong question confidently.
V. Quality of Life — 8%
Eight percent is small enough to be under-studied and large enough — about ten scored questions — to matter at the margin. The area covers navigation and coordination throughout the continuum, psychosocial care including coping and family and caregiver support, health promotion and maintenance, sexuality, cultural and spiritual competence, survivorship, palliative care, and end-of-life care including hospice and legacy building. Items are judgement items: they test whether the nurse keeps the person, the family and the caregiver inside the plan while the clinical machinery runs, and they reward answers that protect dignity, culture and preference without abandoning clinical safety.
VI. Professional Performance — 4%
The smallest area carries the profession’s frame: standards of professional performance including scope of practice, evidence-based practice, research and quality improvement, communication and interprofessional collaboration, professional development, and environmental health and safety including protective equipment and safe handling; ethical and legal considerations including informed consent, advance directives, professional boundaries, and patient and donor advocacy; accreditation, including FACT, The Joint Commission and REMS; and self-care. Four percent is about five scored questions — few, but they are the questions most directly tied to whether practice is safe, lawful and sustainable, and they are rarely the ones a clinically strong candidate can afford to guess.
A closer look: the scaled score, stated exactly
ONCC’s published scoring language deserves a slow pass, because it is widely misreported. Performance on an ONCC certification test is expressed as a scaled score, with a minimum score of 25 and a maximum score of 75; the scaled score required to pass a certification test is 55. A candidate who does not pass receives a numeric score and the numeric score required to pass, as feedback for a retake. Three things follow. First, 55 is a point on a constructed scale, not 55 percent and not 55 questions; any source that restates it as a percentage has invented a number. Second, because the score is scaled, two candidates can answer different mixes of questions correctly and be held to the same standard of competence. Third, preparation should be aimed at the standard the scale represents — competence across all six areas at the outline’s weights — rather than at a hunt for a raw cut-off that ONCC does not publish. Candidates should also know the session shape: ONCC test sessions run three hours including a computer-based testing tutorial and a post-test survey, with no scheduled breaks, and a break taken does not stop the timer.
The sitting itself
ONCC examinations are computer-based at PSI test centres — ONCC describes more than 1,500 PSI centres worldwide, with year-round testing in the United States, its territories and Canada, and a limited annual international window with an additional fee. Each question is a statement or incomplete statement followed by four completions, with one correct answer. Only generic drug names are used. The candidate cannot tell the 125 scored questions from the 40 pretest questions, which settles the only pacing question that matters: there is no subset of the paper that can safely be rushed. ONCC also offers a free 50-question practice test for this credential and one further practice test for purchase; ONCC describes its practice tests as examples of question type, not as study guides or substitutes for preparation.
A study plan built on how this examination is actually put together
Build the plan on the outline’s arithmetic. First, foundations and process together — the science and the sequence — because the management areas presuppose both. Second, the two management areas in parallel, deliberately contrasted: for every early post-transplant complication, study its cellular-therapy counterpart in the same week, and keep a written contrast list — graft-versus-host disease against cytokine release syndrome and neurotoxicity, engraftment against prolonged cytopenias — so the contrast the examination tests is the contrast the plan trains. Third, quality of life and professional performance as a steady thread, a small block every week rather than a final-weekend afterthought, because judgement items improve with spaced exposure. Fourth, timed full-length practice under the real constraint: 165 questions, three hours, no pauses, every question answered as if scored. Leave the final week for the administrative facts — eligibility windows, the authorisation’s 90-day life, the scaled standard — the details candidates most often learn from a problem rather than from a plan.
The working method: turning the outline into a performance
Four habits convert this outline into marks. Timeline drills. For each major complication, write the expected window, the distinguishing signs, the first actions and the escalation trigger on one line; then practise being given the day count and the signs and producing the complication, because that is the direction the examination asks the question. Contrast tables, kept honestly. Every missed item is logged with its area and its error type: unknown fact, wrong window, transplant reflex applied to a cellular-therapy case, or a quality-of-life judgement overridden by a clinical reflex. After two weeks the log, not impressions, assigns the remaining study. Generic-name fluency. Because ONCC uses generic drug names only, study immunosuppression, prophylaxis and supportive care by generic name from the start, so no marks are lost to translation on the day. Donor-and-source reasoning. Practise tracing a stem’s donor type and cell source forward into its likely complications; the foundations area and both management areas reward the same chain of reasoning, so one skill earns marks in three places.
The errors this examination is built to catch
Studying the retired outline is now the largest avoidable error: the older weighting understates cellular therapy and overstates areas the revision shrank. Treating the scaled score as a percentage produces false comfort or false panic, depending on the direction of the error. Letting the authorisation age is the quiet administrative error: the 90-day window is short against a transplant unit’s rota. Confusing early and late presentations — managing a late effect with an early protocol, or missing relapse because a sign was filed under toxicity — is the clinical error the two management areas are weighted to expose. Finally, neglecting the small areas: quality of life and professional performance together carry roughly fifteen scored questions, which is a meaningful margin on a standard-referenced test.
After the sitting: the credential and its clock
Passing starts a four-year term. Renewal keeps the licence current and combines two of three components — practice hours, professional development points under a learning plan, or successful testing — in one of ONCC’s three options. The renewal practice threshold is lower than the initial one: one year as an RN within three years, and 1,000 hours of specialty practice within two and a half years. Applications and learning plans are due well before expiry — early-bird by September 15 and final by October 15 of the expiry year, with reinstatement possible until March 31 of the year after — and a holder who lets the credential lapse returns as an initial candidate under the full criteria. The disciplined holder treats the learning plan as a four-year habit rather than an autumn scramble, and keeps specialty hours documented as they accrue, because the windows, not the totals, are what audits test.
Frequently asked questions
What is the current name of this credential?
Transplantation and Cellular Therapy Certified Nurse (TCTCN). ONCC renamed the Blood and Marrow Transplant Certified Nurse credential effective January 1, 2026, after its 2024 role delineation study, and offers the examination under the current name.
Did the rename change who is eligible?
No. ONCC states the eligibility months and hours are the same; the wording now specifies hematopoietic stem cell transplantation or cellular therapy nursing for the practice hours and continuing education.
How many questions count toward my score?
125 of the 165 questions. The other 40 are pretest or experimental questions, and candidates cannot tell which is which.
What is the passing score, exactly as ONCC publishes it?
A scaled score of 55, on a scale with a minimum of 25 and a maximum of 75. It is not a percentage, and ONCC does not publish a raw number-correct cut-off for this test.
How long do I have to take the test once I apply?
The Authorization to Test arrives within about four to six weeks of applying and opens a testing window of about 90 days. The test must be taken inside that window or the fees are forfeited.
Can nursing administration or education hours count toward eligibility?
Yes, if the role is in the specialty and requires an RN or APRN. ONCC counts direct and indirect patient care across clinical practice, administration, education, research and consultation, and may ask for an employer job description where the title is unclear.
How much continuing education must I show before testing?
At least 10 contact hours in HSCT or cellular therapy nursing, or an academic elective in the specialty, within the three years before application, from an acceptable accredited provider; at most half may be accredited medical or pharmacy education.
What does the test cost?
ONCC publishes $300 for ONS/APHON members and $420 for non-members.
How is certification renewed?
Every four years, by combining two of three components — practice hours, professional development points, or successful testing — under one of ONCC’s three renewal options, with deadlines in the September and October of the expiry year.
Does ONCC endorse any review course or preparation provider?
No. ONCC states its examinations rest on a broad body of knowledge, not on any single resource, and that it does not endorse specific resources. PassProfessor is independent and is not affiliated with ONCC.
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