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    Patent Pending

    Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI)

    Predicts survival after HCT in patients with hematologic malignancies, including optional age adjustment.
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    INSTRUCTIONS

    Entering age to obtain age-adjusted HCT-CI is optional. The original HCT-CI (without age adjustment) is still considered the standard.

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with hematologic malignancies for whom allogeneic hematopoietic cell transplantation (allo-HCT) or autologous stem cell transplantation (ASCT) is being considered.

    • The HCT-CI predicts non-relapse mortality (NRM) after HCT, based on pre-HCT comorbidities and organ dysfunction.
    • Originally developed as a prognostic comorbidity model for HCT outcomes. A large, prospective, multi-center study (Sorror et al, BBMT 2015) validated its use in predicting NRM and overall survival in patients undergoing allo-HCT and ASCT for hematologic malignancies.
    • A modified HCT-CI incorporating age as a risk factor (aaHCT-CI) was recently studied and validated retrospectively, though the large prospective validation (Sorror et al, J Clin Oncol 2014) was done using the original HCT-CI Score (not the aaHCT-CI).
    • From Sorror 2013, “How I assess comorbidities before hematopoietic cell transplantation”:
      • By itself, the score is not intended to recommend which patients should or should not be treated with allogeneic HCT. Ultimately, this decision comes down to the treating physician and the patient.
      • When patients are assessed with pulmonary function testing, only pre-bronchodilator values of FEV₁ are used for the HCT-CI, and DLco should be corrected for hemoglobin using the Dinakara equation.
    • May help clinicians decide the appropriateness of proceeding with HCT, or to choose the appropriate conditioning regimen intensity for individual patients undergoing HCT.
    • Can also be used in statistical analyses to compare the baseline risk of NRM among different patients and studies.
    • Has become a routinely reported tool in many subsequent studies within the field of HCT, particularly if the study assesses the incidence of NRM.
    None
    0
    Afib/flutter, SSS, or ventricular arrhythmias
    +1
    None
    0
    CAD, CHF, MI, or EF ≤50%
    +1
    Valvular disease (except mitral prolapse)
    +3
    None
    0
    Crohn disease or ulcerative colitis
    +1
    None or diet-controlled
    0
    Treated w/insulin or oral hypoglycemics
    +1
    None
    0
    CVA or TIA
    +1
    None
    0
    Depression or anxiety requiring psych consult or treatment
    +1
    None
    0
    Chronic hepatitis (bilirubin >ULN to 1.5× ULN, or AST/ALT >ULN to 2.5× ULN)
    +1
    Liver cirrhosis (bilirubin >1.5× ULN, or AST/ALT 2.5× ULN)
    +3
    No
    0
    Yes
    +1
    None or abx only on day 0
    0
    Requiring continuation of abx after day 0
    +1
    None
    0
    SLE, RA, polymyositis, mixed CTD, or polymyalgia rheumatica
    +2
    None or not requiring treatment
    0
    Requiring treatment
    +1
    None or serum Cr ≤2 mg/dL (177 µmol/L), not on dialysis, and no prior renal transplant
    0
    Serum Cr >2 mg/dL (177 µmol/L), on dialysis, or prior renal transplant
    +2
    None or mild
    0
    DLco and/or FEV₁ 66%–80%, or dyspnea on slight activity
    +2
    DLco and/or FEV1 ≤65% or dyspnea at rest or requiring oxygen
    +3
    None or nonmelanoma skin cancer
    0
    Treated at any point in the patient’s history
    +3
    Allo-HCT
    ASCT

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Should be used in shared decision making with the physician and patient regarding treatment options, not to dictate who should and should not undergo HCT.

    Content Contributors
    • Michael Scordo, MD
    About the Creator
    Dr. Mohamed Sorror
    Are you Dr. Mohamed Sorror?
    Content Contributors
    • Michael Scordo, MD