Haematology A

HCT-CI — Haematopoietic Cell Transplant Comorbidity Index

Predicts non-relapse mortality (NRM) and survival after allogeneic haematopoietic cell transplantation from 17 weighted comorbidities (Sorror 2005): 0 low, 1–2 intermediate, ≥ 3 high risk.

Arrhythmia — atrial fibrillation or flutter, sick sinus syndrome, or ventricular arrhythmia*

Cardiac — coronary artery disease, congestive heart failure, myocardial infarction, or EF ≤ 50%*

Heart valve disease (except mitral valve prolapse)*

Inflammatory bowel disease (Crohn's disease or ulcerative colitis)*

Diabetes requiring insulin or oral hypoglycaemics*

Cerebrovascular disease (TIA or stroke)*

Psychiatric disturbance — depression or anxiety needing psychiatric consultation or treatment*

Hepatic disease*

Obesity — BMI > 35 kg/m²*

Infection needing antimicrobial treatment continued after day 0*

Rheumatologic — SLE, rheumatoid arthritis, polymyositis, mixed CTD or polymyalgia rheumatica*

Peptic ulcer requiring treatment*

Renal — creatinine > 2 mg/dL (177 µmol/L), on dialysis, or prior renal transplant*

Pulmonary disease*

Prior solid tumour, treated at any time (excluding non-melanoma skin cancer)*

Score interpretation

Low Risk 0

HCT-CI 0. Allogeneic HCT (CIBMTR 2015): 1-year NRM 17%, 3-year NRM 24%, 3-year OS 54%.

→ Standard conditioning regimen appropriate. Proceed with planned allo-SCT.

Intermediate Risk 1–2

HCT-CI 1–2. Allogeneic HCT: 1-year NRM 21%, 3-year NRM 28%, 3-year OS 47%.

→ Discuss increased NRM risk with patient. Optimise comorbidities pre-transplant. Consider reduced-intensity conditioning (RIC).

High Risk 3–26

HCT-CI ≥ 3. Allogeneic HCT: 1-year NRM 26%, 3-year NRM 35%, 3-year OS 38%.

→ Careful risk-benefit discussion. RIC or non-myeloablative conditioning preferred. Transplant in specialist centre. Consider clinical trial or alternative strategy.

Interpretation bands for the HCT-CI. Apply clinical judgement and local guidance.

References

Sorror ML et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood. 2005;106(8):2912-2919.
Sorror ML, et al. Prospective validation of the predictive power of the hematopoietic cell transplantation comorbidity index: a Center for International Blood and Marrow Transplant Research study. Biol Blood Marrow Transplant. 2015;21(8):1479-1487.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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