HCT-CI

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Use this calculator to identify comorbidities in the allogeneic stem cell transplantation population and to enable risk assessment before allogeneic transplant using the Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI).

Choose which of the following co-morbitidies apply to your patient.

Hepatic disease (choose one)
None
Mild (chronic hepatitis, bilirubin > ULN to 1.5 x ULN, or AST/ALT > ULN to 2.5 x ULN)
Moderate or severe (cirrhosis, bilirubin > 1.5 x ULN, or AST/ALT > 2.5 x ULN)
Pulmonary disease (choose one)
None or mild disease
Moderate pulmonary (DLCO and/or FEV1 66% to 80% or dyspnea on slight activity)
Severe pulmonary (DLCO and/or FEV1 = 65% or dyspnea at rest or requiring oxygen)
Other factors
Arrhythmia (Atrial fibrillation or flutter, sick sinus syndrome, or ventricular arrhythmias)
Cardiac (CAD, CHD, myocardial infarction or ejection fraction = 50%)
Inflammatory bowel disease (Crohn’s or ulcerative colitis)
Diabetes (requiring insulin or oral hypoglycemics)
Psychiatric disturbance (depression or anxiety requiring psychiatric consult or treatment)
Obesity (body mass index > 35 kg/m2)
Infection (requiring continuation of antimicrobial treatment after day 0)
Cerebrovascular disease (TIA or cerebrovascular accident)
Rheumatologic (SLE, RA, polymyositis, mixed CTD, or polymyalgia rheumatica)
Peptic ulcer (requiring treatment)
Moderate or severe renal failure (serum Cr > 2 mg/dL or 177 µmol/L, dialysis, or prior renal transplant)
Prior solid tumor (excluding nonmelanoma skin cancer)
Valvular Heart Disease (except mitral valve prolapse)

About this calculator

The Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) was developed to identify relevant comorbidities in the allogeneic stem cell transplantation population and to enable risk assessment before allogeneic transplant. Data were collected retrospectively from 1055 patients undergoing nonablative (n=294) and ablative (n=761) conditioning prior to stem cell transplantation. Median age of the group was 45 and myeloid malignancies constituted the majority of diagnoses (66%). The investigators identified relevant comorbidities and derived a scoring system that predicted 2-year non-relapse mortality post transplantation, after adjusting for age, disease risk, and conditioning regimen. The HCT-CI is able to classify patients into three risk groups: low risk (non-relapse mortality 14% at 2-years), intermediate risk (non-relapse mortality 21% at 2-years) and high risk (non-relapse mortality 41% at 2-years). The authors caution that other major pretransplant factors, including age and disease stage, should be considered when determining risk for allogeneic transplant.

Citations

The HCT-CI was derived and validated by investigators at the Fred Hutchinson Cancer Research Center (Seattle, WA). Sorror et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 106:2912-2919. (2005)

The HCT-CI modifies and adds to a well-validated comorbidity index, the Charlson Comorbidity Index (CCI). Charlson et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373-38. (1987)

The CCI was previously applied to patients undergoing allogeneic HCT but appears to provide less survival prediction and discrimination than the HCT-CI scoring system.

Contributor

QxMD Hematology contributing author: Dr. Matthew Cheung, MD, SM, FRCP(C)