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

HCT-CI
Arrhythmia
Cardiac (CAD, CHF, MI, EF≤50%)
Inflammatory Bowel Disease
Diabetes (requiring treatment)
Cerebrovascular Disease
Psychiatric Disturbance
Hepatic – Mild
Obesity (BMI ≥35)
Infection (requiring continuation of treatment)
Rheumatologic
Peptic Ulcer
Renal – Moderate/Severe
Pulmonary – Moderate
Prior Solid Tumor
Heart Valve Disease
Hepatic – Moderate/Severe
Pulmonary – Severe (DLco/FEV1 ≤65% or dyspnea at rest)
HCT-CI Score:0
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Predicts survival after HCT in patients with hematologic malignancies, including optional age adjustment.

Why Use

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.

When to Use

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

Formula

Addition of the selected points: 0 points 1 point 2 points 3 points History of arrhythmia None Atrial fibrillation or flutter, sick sinus syndrome, or ventricular arrhythmias -- -- Cardiac dysfunction None CAD*, CHF, MI, or EF ≤50% -- -- Heart valve disease None -- -- Heart valve disease (except mitral valve prolapse) Inflammatory bowel disease None Crohn disease or ulcerative colitis -- -- Diabetes None or diet-controlled Treated with insulin or oral hypoglycemics -- -- Cerebrovascular disease None CVA or TIA -- -- Psychiatric disturbance None Depression or anxiety requiring psychiatric consult or treatment -- -- Hepatic dysfunction None Chronic hepatitis (bilirubin > ULN to 1.5× ULN, or AST/ALT >ULN to 2.5× ULN) -- Liver cirrhosis (bilirubin >1.5× ULN, or AST/ALT 2.5× ULN) Obesity ( BMI ≥35 kg/m 2 ) No Yes -- -- Infection None or antibiotics only on day 0 Requiring continuation of antimicrobial treatment after day 0 -- -- Rheumatologic disease None -- SLE , RA , polymyositis, mixed CTD , or polymyalgia rheumatica -- Peptic ulcer None or not requiring treatment -- Requiring treatment -- Renal dysfunction None or serum creatinine ≤2 mg/dL (177 µmol/L), not on dialysis, and no prior renal transplant -- Serum creatinine >2 mg/dL (177 µmol/L), on dialysis, or prior renal transplant -- Pulmonary dysfunction None or mild -- DLco ** and/or FEV₁ 66%–80%, or dyspnea on slight activity DLco and/or FEV 1 ≤65% or dyspnea at rest or requiring oxygen Prior solid tumor None or nonmelanoma skin cancer -- -- Treated at any point in the patient’s history For age-adjusted HCT-CI (aaHCT-CI, optional): Age (years) <40 ≥40 -- -- *One or more vessel-coronary artery stenosis requiring medical treatment, stent, or bypass graft. **Dinakara equation for DLco: DLco (% predicted normal) = 6.07 + 6.49 × Hgb (in mg/dL)

Pearls / Pitfalls

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.

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.

More Information

Interpretation: Allo-HCT (All types of patients and transplants: nonmyeloablative, reduced-intensity conditioning, myeloablative conditioning): HCT-CI Score 0 1–2 ≥3 1-year NRM 17% 21% 26% OS 69% 62% 56% 3-year NRM 24% 28% 35% OS 54% 47% 38% ASCT (All types of patients and transplants): HCT-CI Score 0 1–2 ≥3 1-year NRM 3% 3% 5% OS 91% 88% 86% 3-year NRM 5% 6% 9% OS 79% 73% 70% Age-adjusted HCT-CI (Allo-HCT only , including patients undergoing allo-HCT for nonmalignant diseases): aaHCT-CI Score Allo-HCT only 0 1–2 3–4 ≥5 2-year NRM NMA: 5% RIC: 12% MAC: 10% NMA: 9% RIC: 18% MAC: 20% NMA: 17% RIC: 36% MAC: 37% NMA: 35% RIC: 41% MAC: 49% OS NMA: 81% RIC: 87% MAC: 79% NMA: 74% RIC: 70% MAC: 66% NMA: 59% RIC: 50% MAC: 45% NMA: 37% RIC: 35% MAC: 29% NRM, non-relapse mortality. OS, overall survival. NMA, nonmyeloablative. RIC, reduced-intensity conditioning. MAC, myeloablative conditioning.

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