Comorbidity list with corresponding weight distributions compared between HCT-CI and youth HCT-CI
| Comorbidity . | Definition . | HCT-CI . | Expanded youth HCT-CI . | Simplified youth HCT-CI . | |||
|---|---|---|---|---|---|---|---|
| Malignant . | Nonmalignant . | Malignant . | Nonmalignant . | ||||
| Arrhythmia | Atrial fibrillation or flutter, sick sinus syndrome, or ventricular arrhythmias | 1 | 1 | 1 | 0 | 0 | |
| Cardiac disease | Coronary artery disease, congestive heart failure, myocardial infarction, or EF ≤50% on most recent test | 1 | 1 | 1 | 1 | 1 | |
| Heart valve disease | Except asymptomatic mitral valve prolapse | 3 | 3 | 3 | 3 | 3 | |
| Inflammatory bowel disease | Crohn disease or ulcerative colitis | 1 | 1 | 1 | 0 | 1 | |
| Diabetes | Requiring treatment with insulin or oral hypoglycemics, but not diet alone | 1 | 1 | 1 | 1 | 1 | |
| Psychiatric disease | Requiring psychiatric consult or treatment in the last 4 weeks | 1 | 1 | 1 | 0 | 0 | |
| Cerebrovascular | Any history of transient ischemic attack, subarachnoid hemorrhage, or cerebrovascular accident | 1 | 1 | 1 | 0 | 1 | |
| Infection* | Requiring antimicrobial treatment for serious infection that continues through conditioning | 1 | 1 | 1 | 1 | 1 | |
| Or history of invasive fungal disease (proven, suspected, and/or documented) | N/A | ||||||
| Obesity* | >35 kg/m2 | 1 | 1 | 1 | 1 | 0 | |
| BMI >95th percentile by CDC guidelines for (≤18 years old) | N/A | ||||||
| Underweight* | Underweight: BMI <5th percentile by CDC guidelines for (≤18 years old) or <18 kg/m2 (>18 years old) | N/A | 0 | 1 | 0 | 1 | |
| Mild hepatic disease | Chronic hepatitis, bilirubin >upper limit of normal to 1.5 × upper limit of normal, or AST/ALT upper limit of normal to 2.5 × upper limit of normal | 1 | 1 | 1 | 0 | 0 | |
| Moderate/severe hepatic disease | Liver cirrhosis, bilirubin >1.5 × upper limit of normal, or AST/ALT >2.5 × upper limit of normal | 3 | 3 | 3 | 3 | 3 | |
| Mild renal disease* | Creatinine >2 mg/dL or prior renal transplant | or on dialysis | 2a | N/A | N/A | N/A | N/A |
| or eGFR 60-89 mL/min/1.73 m2 (by Bedside Schwartz calculation for <18 years old, CKD-EPI calculation for ≥18 years old) | N/A | 2 | N/A | 2 | N/A | ||
| eGFR 60-89 mL/min/1.73 m2 (by Bedside Schwartz calculation for <18 years old, CKD-EPI calculation for ≥18 years old) | N/A | N/A | 1 | N/A | 1 | ||
| Moderate/severe renal disease* | Creatinine >2 mg/dL, or prior renal transplant, or on dialysis | 2a | N/A | N/A | N/A | N/A | |
| Creatinine >2 mg/dL, on dialysis, or prior renal transplant | or eGFR <60 mL/min/1.73 m2 (by Bedside Schwartz calculation for <18 years old, CKD-EPI calculation for ≥18 years old) | N/A | N/A | 2 | N/A | 2 | |
| On dialysis | N/A | 3 | N/A | 3 | N/A | ||
| Moderate pulmonary disease | Corrected diffusion capacity of carbon monoxide and/or FEV1 66%-80%, or dyspnea on slight activity | 2 | 2 | 2 | 0 | 0 | |
| Severe pulmonary disease* | Corrected diffusion capacity of carbon monoxide and/or FEV1 ≤65%, dyspnea at rest, or requiring oxygen | 3 | 3 | 3 | 3 | 3 | |
| Or prior history of mechanical ventilation | N/A | ||||||
| Peptic ulcer disease | Confirmed by endoscopy and requiring treatment | 2 | 2 | 2 | 0 | 2 | |
| Rheumatologic disease | Systemic lupus, rheumatoid arthritis, polymyositis, mixed connective tissue disease, or polymyalgia rheumatica requiring treatment | 2 | 2 | 2 | 0 | 2 | |
| Prior solid tumor | At any point in patient's history, excluding nonmelanoma skin cancer, leukemia, lymphoma, or multiple myeloma; does not count if patient is being transplanted for indication of solid tumor | 3 | 3 | 3 | 3 | 3 | |
| Comorbidity . | Definition . | HCT-CI . | Expanded youth HCT-CI . | Simplified youth HCT-CI . | |||
|---|---|---|---|---|---|---|---|
| Malignant . | Nonmalignant . | Malignant . | Nonmalignant . | ||||
| Arrhythmia | Atrial fibrillation or flutter, sick sinus syndrome, or ventricular arrhythmias | 1 | 1 | 1 | 0 | 0 | |
| Cardiac disease | Coronary artery disease, congestive heart failure, myocardial infarction, or EF ≤50% on most recent test | 1 | 1 | 1 | 1 | 1 | |
| Heart valve disease | Except asymptomatic mitral valve prolapse | 3 | 3 | 3 | 3 | 3 | |
| Inflammatory bowel disease | Crohn disease or ulcerative colitis | 1 | 1 | 1 | 0 | 1 | |
| Diabetes | Requiring treatment with insulin or oral hypoglycemics, but not diet alone | 1 | 1 | 1 | 1 | 1 | |
| Psychiatric disease | Requiring psychiatric consult or treatment in the last 4 weeks | 1 | 1 | 1 | 0 | 0 | |
| Cerebrovascular | Any history of transient ischemic attack, subarachnoid hemorrhage, or cerebrovascular accident | 1 | 1 | 1 | 0 | 1 | |
| Infection* | Requiring antimicrobial treatment for serious infection that continues through conditioning | 1 | 1 | 1 | 1 | 1 | |
| Or history of invasive fungal disease (proven, suspected, and/or documented) | N/A | ||||||
| Obesity* | >35 kg/m2 | 1 | 1 | 1 | 1 | 0 | |
| BMI >95th percentile by CDC guidelines for (≤18 years old) | N/A | ||||||
| Underweight* | Underweight: BMI <5th percentile by CDC guidelines for (≤18 years old) or <18 kg/m2 (>18 years old) | N/A | 0 | 1 | 0 | 1 | |
| Mild hepatic disease | Chronic hepatitis, bilirubin >upper limit of normal to 1.5 × upper limit of normal, or AST/ALT upper limit of normal to 2.5 × upper limit of normal | 1 | 1 | 1 | 0 | 0 | |
| Moderate/severe hepatic disease | Liver cirrhosis, bilirubin >1.5 × upper limit of normal, or AST/ALT >2.5 × upper limit of normal | 3 | 3 | 3 | 3 | 3 | |
| Mild renal disease* | Creatinine >2 mg/dL or prior renal transplant | or on dialysis | 2a | N/A | N/A | N/A | N/A |
| or eGFR 60-89 mL/min/1.73 m2 (by Bedside Schwartz calculation for <18 years old, CKD-EPI calculation for ≥18 years old) | N/A | 2 | N/A | 2 | N/A | ||
| eGFR 60-89 mL/min/1.73 m2 (by Bedside Schwartz calculation for <18 years old, CKD-EPI calculation for ≥18 years old) | N/A | N/A | 1 | N/A | 1 | ||
| Moderate/severe renal disease* | Creatinine >2 mg/dL, or prior renal transplant, or on dialysis | 2a | N/A | N/A | N/A | N/A | |
| Creatinine >2 mg/dL, on dialysis, or prior renal transplant | or eGFR <60 mL/min/1.73 m2 (by Bedside Schwartz calculation for <18 years old, CKD-EPI calculation for ≥18 years old) | N/A | N/A | 2 | N/A | 2 | |
| On dialysis | N/A | 3 | N/A | 3 | N/A | ||
| Moderate pulmonary disease | Corrected diffusion capacity of carbon monoxide and/or FEV1 66%-80%, or dyspnea on slight activity | 2 | 2 | 2 | 0 | 0 | |
| Severe pulmonary disease* | Corrected diffusion capacity of carbon monoxide and/or FEV1 ≤65%, dyspnea at rest, or requiring oxygen | 3 | 3 | 3 | 3 | 3 | |
| Or prior history of mechanical ventilation | N/A | ||||||
| Peptic ulcer disease | Confirmed by endoscopy and requiring treatment | 2 | 2 | 2 | 0 | 2 | |
| Rheumatologic disease | Systemic lupus, rheumatoid arthritis, polymyositis, mixed connective tissue disease, or polymyalgia rheumatica requiring treatment | 2 | 2 | 2 | 0 | 2 | |
| Prior solid tumor | At any point in patient's history, excluding nonmelanoma skin cancer, leukemia, lymphoma, or multiple myeloma; does not count if patient is being transplanted for indication of solid tumor | 3 | 3 | 3 | 3 | 3 | |
This is a summary table combining the three different HCT-CI scores that have been validated in assessing pre-HCT comorbidities. Definitions of comorbidities and weighted scores are listed. Refer to original citations for accompanying hazard ratios and confidence intervals that justify weights assigned. New definitions that apply to the pediatric/AYA population (or youth scores) are indicated with an *. Please note that youth classification is further divided into 2 groups based on malignant or nonmalignant disease status. In validation models, having an underlying malignant or nonmalignant disease made a difference in weighted scores when using the simplified youth HCT-CI to assess inflammatory bowel disease, cerebrovascular disease, obesity, being underweight, renal disease, peptic ulcer disease, and rheumatologic disease. N/A is listed for those new definitions that are part of the youth HCT-CI measures that are not part of the original HCT-CI. For renal disease, the definitions are different for malignant compared to non-malignant conditions. Adapted from Sorror et al., Blood 2005; Friend et al., TCT 2023; and Broglie et al., TCT 2023.2,8,9
In the original HCT-CI, there was only one category listed for renal disease. With the pediatric definitions, the renal category is now split into mild or moderate/severe. The renal disease HCT-CI score is currently listed in both the mild and moderate/severe categories to reflect this.
Items modified for youth population (pediatric/AYA) include revised definitions or new definitions.
ALT, alanine transaminase; AST, aspartate aminotransferase; BMI, body mass index; CDC, Centers for Disease Control and Prevention; N/A, not applicable.