Pre-transplant Comorbidities: Influence on Decision-Making and Outcomes

Part of the Advances and Controversies in Hematopoietic Transplantation and Cell Therapy book series (ACHTCT)


The advent of allogeneic hematopoietic cell transplantation (allo-HCT) brought potential cures to a large number of malignant and non-malignant hematological disorders. Unfortunately, the curative benefits associated with allo-HCT are eclipsed by an increased risk of adverse effects on organ systems. Comorbidities present at the time of transplantation also adversely influence post-transplant outcomes. Combined, these risks complicate patient selection for allo-HCT. To account for this, the HCT comorbidity index (HCT-CI) was developed to predict post-transplant complications, organ toxicities, and acute and chronic graft-versus-host-disease (GVHD), as well as transplant outcomes like morbidity, mortality, and quality of life. The HCT-CI has been verified to be a clinically meaningful tool for the stratification of risk prior to transplant. The predictive power of the HCT-CI can be augmented by the addition of patient- and/or disease-specific risk factors and further expanded by analyzing its utility in conjunction with other available indices. Here we describe the impact of comorbidities on transplant outcomes, the development of comorbidity-specific prediction models, other composite models, their application to guide decision-making, the use of the HCT-CI for autologous transplant, and future directions to refine strategies of predicting post-transplant outcomes.


Transplant Comorbidities Hematopoietic cell transplant Comorbidity index 


  1. Ali AM, DiPersio JF, Schroeder MA (2016) The role of biomarkers in the diagnosis and risk stratification of acute graft-versus-host disease: a systematic review. Biol Blood Marrow Transplant 22(9):1552–1564PubMedPubMedCentralCrossRefGoogle Scholar
  2. Artz AS, Wickrema A, Dinner S, Godley LA, Kocherginsky M, Odenike O et al (2008) Pretreatment C-reactive protein is a predictor for outcomes after reduced-intensity allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 14(11):1209–1216PubMedPubMedCentralCrossRefGoogle Scholar
  3. Barba P, Piñana JL, Martino R, Valcárcel D, Amorós A, Sureda A et al (2010) Comparison of two pretransplant predictive models and a flexible HCT-CI using different cut points to determine low-, intermediate-, and high-risk groups: the flexible HCT-CI is the best predictor of NRM and OS in a population of patients undergoing allo-RIC. Biol Blood Marrow Transplant 16(3):413–420PubMedCrossRefPubMedCentralGoogle Scholar
  4. Barba P, Martino R, Perez-Simon JA, Fernandez-Aviles F, Castillo N, Pinana JL et al (2014) Combination of the Hematopoietic Cell Transplantation Comorbidity Index and the European Group for Blood and Marrow Transplantation score allows a better stratification of high-risk patients undergoing reduced-toxicity allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 20(1):66–72PubMedCrossRefPubMedCentralGoogle Scholar
  5. Barba P, Ratan R, Cho C, Ceberio I, Hilden P, Devlin SM et al (2017) Hematopoietic cell transplantation comorbidity index predicts outcomes in patients with acute myeloid leukemia and myelodysplastic syndromes receiving CD34+ selected grafts for allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 23(1):67–74PubMedCrossRefPubMedCentralGoogle Scholar
  6. Bayraktar UD, Shpall EJ, Liu P, Ciurea SO, Rondon G, de Lima M et al (2013) Hematopoietic cell transplantation-specific comorbidity index predicts inpatient mortality and survival in patients who received allogeneic transplantation admitted to the intensive care unit. J Clin Oncol 31(33):4207–4214PubMedPubMedCentralCrossRefGoogle Scholar
  7. Birninger N, Bornhäuser M, Schaich M, Ehninger G, Schetelig J (2011) The hematopoietic cell transplantation-specific comorbidity index fails to predict outcomes in high-risk AML patients undergoing allogeneic transplantation—investigation of potential limitations of the index. Biol Blood Marrow Transplant 17(12):1822–1832PubMedCrossRefPubMedCentralGoogle Scholar
  8. Bochud PY, Chien JW, Marr KA, Leisenring WM, Upton A, Janer M et al (2008) Toll-like receptor 4 polymorphisms and aspergillosis in stem-cell transplantation. N Engl J Med 359(17):1766–1777PubMedPubMedCentralCrossRefGoogle Scholar
  9. Boehm A, Sperr WR, Leitner G, Worel N, Oehler L, Jaeger E et al (2008) Comorbidity predicts survival in myelodysplastic syndromes or secondary acute myeloid leukaemia after allogeneic stem cell transplantation. Eur J Clin Investig 38(12):945–952CrossRefGoogle Scholar
  10. Bokhari SW, Watson L, Nagra S, Cook M, Byrne JL, Craddock C et al (2012) Role of HCT-comorbidity index, age and disease status at transplantation in predicting survival and non-relapse mortality in patients with myelodysplasia and leukemia undergoing reduced-intensity-conditioning hemopoeitic progenitor cell transplantation. Bone Marrow Transplant 47(4):528–534PubMedCrossRefPubMedCentralGoogle Scholar
  11. Broglie L, Thakar M, Logan B, Artz A, Jacobsohn D, Bunin N et al (2018) Evaluation of the hematopoietic cell comorbidity index (HCT-CI) in recipients of allogeneic transplantation for non-malignant Diseases. 2017 BMT Tandem Meetings Abstract. Biol Blood Marrow Transplant 24(3):S38CrossRefGoogle Scholar
  12. Brunello A, Sandri R, Extermann M (2009) Multidimensional geriatric evaluation for older cancer patients as a clinical and research tool (Review). Cancer Treat Rev 35(6):487–492PubMedCrossRefPubMedCentralGoogle Scholar
  13. Castagna L, Furst S, Marchetti N, El CJ, Faucher C, Mohty M et al (2011) Retrospective analysis of common scoring systems and outcome in patients older than 60 years treated with reduced-intensity conditioning regimen and alloSCT. Bone Marrow Transplant 46(7):1000–1005PubMedCrossRefPubMedCentralGoogle Scholar
  14. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383PubMedPubMedCentralCrossRefGoogle Scholar
  15. Chemnitz JM, Chakupurakal G, Basler M, Holtick U, Theurich S, Shimabukuro-Vornhagen A et al (2014) Pretransplant comorbidities maintain their impact on allogeneic stem cell transplantation outcome 5 years posttransplant: a retrospective study in a single german institution. ISRN Hematol Print 2014:853435Google Scholar
  16. Crawford SW, Fisher L (1992) Predictive value of pulmonary function tests before marrow transplantation. Chest 101:1257–1264PubMedCrossRefPubMedCentralGoogle Scholar
  17. Decook L, Chang YH, Slack J, Gastineau D, Leis J, Noel P et al (2017) Association of hematopoietic cell transplantation-specific comorbidity index with resource utilization after allogeneic transplantation. Bone Marrow Transplant 52(7):998–1002PubMedCrossRefPubMedCentralGoogle Scholar
  18. Defor TE, Majhail NS, Weisdorf DJ, Brunstein CG, McAvoy S, Arora M et al (2010) A modified comorbidity index for hematopoietic cell transplantation. Bone Marrow Transplant 45(5):933–938PubMedCrossRefPubMedCentralGoogle Scholar
  19. Diaconescu R, Flowers CR, Storer B, Sorror ML, Maris MB, Maloney DG et al (2004) Morbidity and mortality with nonmyeloablative compared to myeloablative conditioning before hematopoietic cell transplantation from HLA matched related donors. Blood 104(5):1550–1558PubMedCrossRefPubMedCentralGoogle Scholar
  20. Ehrlich KB, Miller GE, Scheide T, Baveja S, Weiland R, Galvin J et al (2016) Pre-transplant emotional support is associated with longer survival after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 51(12):1594–1598PubMedCrossRefPubMedCentralGoogle Scholar
  21. Elsawy M, Storer BE, Sandmaier BM, Delaney C, Appelbaum FR, Woolfrey AE et al (2014a) Role of comorbidities in prognostic evaluation of outcomes following allogeneic hematopoietic cell transplantation (HCT) from HLA-mismatchedf (MM) and umbilical cord blood (UCB) donor grafts. Blood 125(21):Abstract #2583CrossRefGoogle Scholar
  22. Elsawy M, Storer BE, Sorror ML (2014b) To combine or not to combine: optimizing risk assessment before allogeneic hematopoietic cell transplantation (Letter). Biol Blood Marrow Transplant 20(9):1455–1456PubMedCrossRefPubMedCentralGoogle Scholar
  23. ElSawy M, Storer BE, Pulsipher MA, Maziarz RT, Bhatia S, Maris MB et al (2015) Multi-centre validation of the prognostic value of the haematopoietic cell transplantation-specific comorbidity index among recipients of allogeneic haematopoietic cell transplantation. Br J Haematol 170(4):574–583PubMedPubMedCentralCrossRefGoogle Scholar
  24. Extermann M (2000) Measuring comorbidity in older cancer patients (Review). Eur J Cancer 36(4):453–471PubMedCrossRefPubMedCentralGoogle Scholar
  25. Extermann M, Overcash J, Lyman GH, Parr J, Balducci L (1998) Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 16(4):1582–1587PubMedCrossRefPubMedCentralGoogle Scholar
  26. Farina L, Bruno B, Patriarca F, Spina F, Sorasio R, Morelli M et al (2009) The hematopoietic cell transplantation comorbidity index (HCT-CI) predicts clinical outcomes in lymphoma and myeloma patients after reduced-intensity or non-myeloablative allogeneic stem cell transplantation. Leukemia 23(6):1131–1138PubMedCrossRefPubMedCentralGoogle Scholar
  27. Federmann B, Faul C, Meisner C, Vogel W, Kanz L, Bethge WA (2015) Influence of age on outcome after allogeneic hematopoietic cell transplantation: a single center study in patients aged 60. Bone Marrow Transplant 50(3):427–431PubMedCrossRefPubMedCentralGoogle Scholar
  28. Feinstein AR (1970) The pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis 23(7):455–468CrossRefGoogle Scholar
  29. Figueroa Turienzo CM, Cernadas C, Roizen M, Pizzi S, Staciuk R (2016) Validation of the Hematopoietic Cell Transplantation-Specific Comorbidity Index in a retrospective cohort of children and adolescents who received an allogeneic transplantation in Argentina. Arch Argent Pediatr 114(4):337–342PubMedPubMedCentralGoogle Scholar
  30. Fujimaki K, Maruta A, Yoshida M, Sakai R, Tanabe J, Koharazawa H et al (2001) Severe cardiac toxicity in hematological stem cell transplantation: predictive value of reduced left ventricular ejection fraction. Bone Marrow Transplant 27(3):307–310PubMedCrossRefPubMedCentralGoogle Scholar
  31. Goldberg SL, Klumpp TR, Magdalinski AJ, Mangan KF (1998) Value of the pretransplant evaluation in predicting toxic day-100 mortality among blood stem-cell and bone marrow transplant recipients. J Clin Oncol 16(12):3796–3802PubMedCrossRefPubMedCentralGoogle Scholar
  32. Gratwohl A (2012) The EBMT risk score (Review). Bone Marrow Transplant 47(6):749–756PubMedCrossRefPubMedCentralGoogle Scholar
  33. Gratwohl A, Hermans J, Goldman JM, Arcese W, Carreras E, Devergie A et al (1998) Risk assessment for patients with chronic myeloid leukaemia before allogeneic blood or marrow transplantation. Lancet 352(9134):1087–1092PubMedCrossRefPubMedCentralGoogle Scholar
  34. Gruss E, Bernis C, Tomas JF, Garcia-Canton C, Figuera A, Motellon JL et al (1995) Acute renal failure in patients following bone marrow transplantation: prevalence, risk factors and outcome. Am J Nephrol 15(6):473–479PubMedCrossRefPubMedCentralGoogle Scholar
  35. Guilfoyle R, Demers A, Bredeson C, Richardson E, Rubinger M, Szwajcer D et al (2009) Performance status, but not the hematopoietic cell transplantation comorbidity index (HCT-CI), predicts mortality at a Canadian transplant center. Bone Marrow Transplant 43(2):133–139PubMedCrossRefPubMedCentralGoogle Scholar
  36. Gyurkocza B, Sandmaier BM (2014) Conditioning regimens for hematopoietic cell transplantation: one size does not fit all. Blood 124(3):344–353PubMedPubMedCentralCrossRefGoogle Scholar
  37. Hamilton BK, Law AD, Rybicki L, Abounader D, Dabney J, Dean R et al (2015) Prognostic significance of pre-transplant quality of life in allogeneic hematopoietic cell transplantation recipients. Bone Marrow Transplant 50(9):1235–1240PubMedCrossRefPubMedCentralGoogle Scholar
  38. Hashmi S, Oliva JL, Liesveld JL, Phillips GL, Milner L, Becker MW (2013) The hematopoietic cell transplantation specific comorbidity index and survival after extracorporeal photopheresis, pentostatin, and reduced dose total body irradiation conditioning prior to allogeneic stem cell transplantation. Leuk Res 37(9):1052–1056PubMedCrossRefPubMedCentralGoogle Scholar
  39. Hertenstein B, Stefanic M, Schmeiser T, Scholz M, Göller V, Clausen M et al (1994) Cardiac toxicity of bone marrow transplantation: predictive value of cardiologic evaluation before transplant. J Clin Oncol 12:998–1004PubMedCrossRefPubMedCentralGoogle Scholar
  40. Horak DA, Schmidt GM, Zaia JA, Niland JC, Ahn C, Forman SJ (1992) Pretransplant pulmonary function predicts cytomegalovirus-associated interstitial pneumonia following bone marrow transplantation. Chest 102:1484–1490PubMedCrossRefPubMedCentralGoogle Scholar
  41. Junghanss C, Marr KA (2002) Infectious risks and outcomes after stem cell transplantation: are nonmyeloablative transplants changing the picture? Curr Opin Infect Dis 15:347–353PubMedCrossRefPubMedCentralGoogle Scholar
  42. Kataoka K, Nannya Y, Ueda K, Kumano K, Takahashi T, Kurokawa M (2010) Differential prognostic impact of pretransplant comorbidity on transplant outcomes by disease status and time from transplant: a single Japanese transplant centre study. Bone Marrow Transplant 45(3):513–520PubMedCrossRefPubMedCentralGoogle Scholar
  43. Kerbauy DM, Chyou F, Gooley T, Sorror ML, Scott B, Pagel JM et al (2005) Allogeneic hematopoietic cell transplantation for chronic myelomonocytic leukemia. Biol Blood Marrow Transplant 11(9):713–720PubMedCrossRefPubMedCentralGoogle Scholar
  44. Kerbauy DMB, Gooley TA, Sale GE, Flowers MED, Doney KC, Georges GE et al (2007) Hematopoietic cell transplantation as curative therapy for idiopathic myelofibrosis, advanced polycythemia vera, and essential thrombocythemia. Biol Blood Marrow Transplant 13(3):355–365PubMedCrossRefPubMedCentralGoogle Scholar
  45. Labonté L, Iqbal T, Zaidi MA, McDiarmid SA, Huesbsch LB, Tay J et al (2008) Utility of comorbidity assessment in predicting transplantation-related toxicity following autologous hematopoietic stem cell transplantation for multiple myeloma. Biol Blood Marrow Transplant 14(9):1039–1044PubMedCrossRefPubMedCentralGoogle Scholar
  46. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9(3):179–186CrossRefGoogle Scholar
  47. Le RQ, Jain NA, Tian X, Ito S, Lu K, Haggerty J et al (2013) Comorbidity measures in ex vivo T cell depleted allogeneic hematopoietic stem cell transplantation (HCT). Blood 122(21):2124CrossRefGoogle Scholar
  48. Lim ZY, Ingram W, Brand R, Ho A, Kenyon M, Devereux S et al (2010) Impact of pretransplant comorbidities on alemtuzumab-based reduced-intensity conditioning allogeneic hematopoietic SCT for patients with high-risk myelodysplastic syndrome and AML. Bone Marrow Transplant 45(4):633–639PubMedCrossRefPubMedCentralGoogle Scholar
  49. Lowe T, Bhatia S, Somlo G (2007) Second malignancies after allogeneic hematopoietic cell transplantation (Review). Biol Blood Marrow Transplant 13(10):1121–1134PubMedCrossRefPubMedCentralGoogle Scholar
  50. Majhail NS, Brunstein CG, McAvoy S, Defor TE, Al-Hazzouri A, Setubal D et al (2008) Does the hematopoietic cell transplantation specific comorbidity index predict transplant outcomes? A validation study in a large cohort of umbilical cord blood and matched related donor transplants. Biol Blood Marrow Transplant 14(9):985–992PubMedCrossRefPubMedCentralGoogle Scholar
  51. Martinez C, Jorge AS, Pereira A, Moreno M, Nunez J, Gayoso J et al (2017) Comorbidities, not age, are predictive of survival after autologous hematopoietic cell transplantation for relapsed/refractory Hodgkin’s lymphoma in patients older than 50 years. Ann Hematol 96(1):9–16PubMedCrossRefPubMedCentralGoogle Scholar
  52. Maruyama D, Fukuda T, Kato R, Yamasaki S, Usui E, Morita-Hoshi Y et al (2007) Comparable antileukemia/lymphoma effects in nonremission patients undergoing allogeneic hematopoietic cell transplantation with a conventional cytoreductive or reduced-intensity regimen. Biol Blood Marrow Transplant 13(8):932–941PubMedCrossRefPubMedCentralGoogle Scholar
  53. McClune BL, Weisdorf DJ, Pedersen TL, Tunes da Silva G, Tallman MS, Sierra J et al (2010) Effect of age on outcome of reduced-intensity hematopoietic cell transplantation for older patients with acute myeloid leukemia in first complete remission or with myelodysplastic syndrome. J Clin Oncol 28(11):1878–1887PubMedPubMedCentralCrossRefGoogle Scholar
  54. McDonald GB, Hinds MS, Fisher LD, Schoch HG, Wolford JL, Banaji M et al (1993) Veno-occlusive disease of the liver and multiorgan failure after bone marrow transplantation: a cohort study of 355 patients. Ann Intern Med 118(4):255–267PubMedCrossRefPubMedCentralGoogle Scholar
  55. Mo XD, Xu LP, Liu DH, Zhang XH, Chen H, Chen YH et al (2013) The hematopoietic cell transplantation-specific comorbidity index (HCT-CI) is an outcome predictor for partially matched related donor transplantation. Am J Hematol 88(6):497–502PubMedCrossRefPubMedCentralGoogle Scholar
  56. Mohty M, Labopin M, Basara N, Cornelissen JJ, Tabrizi R, Malm C et al (2009) Association between the Hematopoietic Cell Transplantation-Specific Comorbidity Index (CI) and non-relapse mortality (NRM) after reduced intensity conditioning (RIC) allogeneic stem cell transplantation (allo-SCT) for acute myeloid leukemia (AML) in first complete remission (CR1). Blood 114(22):270, #650CrossRefGoogle Scholar
  57. Muffly LS, Kocherginsky M, Stock W, Chu Q, Bishop MR, Godley LA et al (2014) Geriatric assessment to predict survival in older allogeneic hematopoietic cell transplantation recipients. Haematologica 99(8):1373–1379PubMedPubMedCentralCrossRefGoogle Scholar
  58. Nakaya A, Mori T, Tanaka M, Tomita N, Nakaseko C, Yano S et al (2014) Does the hematopoietic cell transplantation specific comorbidity index (HCT-CI) predict transplantation outcomes? A prospective multicenter validation study of the Kanto Study Group for Cell Therapy. Biol Blood Marrow Transplant 20(10):1553–1559PubMedCrossRefPubMedCentralGoogle Scholar
  59. Nassereddine S, Rafei H, Elbahesh E, Tabbara I (2017) Acute graft versus host disease: a comprehensive review. Anticancer Res 37(4):1547–1555PubMedCrossRefPubMedCentralGoogle Scholar
  60. Ozdogan O, Ratip S, Ahdab YA, Dane F, Ahdab HA, Imeryuz N et al (2003) Causes and risk factors for liver injury following bone marrow transplantation. J Clin Gastroenterol 36(5):421–426PubMedCrossRefPubMedCentralGoogle Scholar
  61. Parimon T, Madtes DK, Au DH, Clark JG, Chien JW (2005) Pretransplant lung function, respiratory failure, and mortality after stem cell transplantation. Am J Respir Crit Care Med 172(3):384–390PubMedPubMedCentralCrossRefGoogle Scholar
  62. Passweg JR, Walker I, Sobocinski KA, Klein JP, Horowitz MM, Giralt SA et al (2004) Validation and extension of the EBMT Risk Score for patients with chronic myeloid leukaemia (CML) receiving allogeneic haematopoietic stem cell transplants. Br J Haematol 125(5):613–620PubMedCrossRefPubMedCentralGoogle Scholar
  63. Pavlu J, Kew AK, Taylor-Roberts B, Auner HW, Marin D, Olavarria E et al (2010) Optimizing patient selection for myeloablative allogeneic hematopoietic cell transplantation in chronic myeloid leukemia in chronic phase. Blood 115(20):4018–4020PubMedPubMedCentralCrossRefGoogle Scholar
  64. Petersdorf EW, Malkki M, Gooley TA, Spellman SR, Haagenson MD, Horowitz MM et al (2012) MHC-resident variation affects risks after unrelated donor hematopoietic cell transplantation. Sci Transl Med 4(144):144ra01CrossRefGoogle Scholar
  65. Pidala J, Sigdel TK, Wang A, Hsieh S, Inamoto Y, Martin PJ et al (2017) A combined biomarker and clinical panel for chronic graft versus host disease diagnosis. J Pathol Clin Res 3(1):3–16PubMedCrossRefPubMedCentralGoogle Scholar
  66. Qazilbash MH, Amjad AI, Qureshi S, Qureshi SR, Saliba RM, Khan ZU et al (2009) Outcome of allogeneic hematopoietic stem cell transplantation in patients with low left ventricular ejection fraction. Biol Blood Marrow Transplant 15(10):1265–1270PubMedPubMedCentralCrossRefGoogle Scholar
  67. Raimondi R, Tosetto A, Oneto R, Cavazzina R, Rodeghiero F, Bacigalupo A et al (2012) Validation of the Hematopoietic Cell Transplantation-Specific Comorbidity Index: a prospective, multicenter GITMO study. Blood 120(6):1327–1333PubMedCrossRefPubMedCentralGoogle Scholar
  68. Ratan R, Ceberio I, Hilden P, Devlin SM, Malloy MA, Barker JN et al (2013) The Hematopoietic Cell Transplant-Co-Morbidity Index (HCT-CI) predicts outcomes after T cell depleted (TCD) allogeneic HCT for AML and MDS. Blood 122(21):2045CrossRefGoogle Scholar
  69. Rosenberg AR, Syrjala KL, Martin PJ, Flowers ME, Carpenter PA, Salit RB et al (2015) Resilience, health, and quality of life among long-term survivors of hematopoietic cell transplantation. Cancer 121(23):4250–4257PubMedPubMedCentralCrossRefGoogle Scholar
  70. Saad A, Mahindra A, Zhang MJ, Zhong X, Costa LJ, Dispenzieri A et al (2014) Hematopoietic cell transplant comorbidity index is predictive of survival after autologous hematopoietic cell transplantation in multiple myeloma. Biol Blood Marrow Transplant 20(3):402–8.e1PubMedCrossRefPubMedCentralGoogle Scholar
  71. Savani BN, Montero A, Srinivasan R, Singh A, Shenoy A, Mielke S et al (2006) Chronic GVHD and pretransplantation abnormalities in pulmonary function are the main determinants predicting worsening pulmonary function in long-term survivors after stem cell transplantation. Biol Blood Marrow Transplant 12(12):1261–1269PubMedPubMedCentralCrossRefGoogle Scholar
  72. Schwind S, Maharry K, Radmacher MD, Mrozek K, Holland KB, Margeson D et al (2010) Prognostic significance of expression of a single microRNA, miR-181a , in cytogenetically normal acute myeloid leukemia: a Cancer and Leukemia Group B study. J Clin Oncol 28(36):5257–5264PubMedPubMedCentralCrossRefGoogle Scholar
  73. Smith AR, Majhail NS, MacMillan ML, Defor TE, Jodele S, Lehmann LE et al (2011) Hematopoietic cell transplantation comorbidity index predicts transplantation outcomes in pediatric patients. Blood 117(9):2728–2734PubMedCrossRefPubMedCentralGoogle Scholar
  74. Socié G, Ritz J (2014) Current issues in chronic graft-versus-host disease. Blood 124(3):374–384PubMedPubMedCentralCrossRefGoogle Scholar
  75. Sorror M (2013) How I assess comorbidities prior to hematopoietic cell transplantation. Blood 121(15):2854–2863PubMedPubMedCentralCrossRefGoogle Scholar
  76. Sorror ML, Maris MB, Storer B, Sandmaier BM, Diaconescu R, Flowers C et al (2004) Comparing morbidity and mortality of HLA-matched unrelated donor hematopoietic cell transplantation after nonmyeloablative and myeloablative conditioning: influence of pretransplant comorbidities. Blood 104(4):961–968PubMedCrossRefPubMedCentralGoogle Scholar
  77. Sorror ML, Maris MB, Sandmaier BM, Storer BE, Stuart MJ, Hegenbart U et al (2005a) Hematopoietic cell transplantation after nonmyeloablative conditioning for advanced chronic lymphocytic leukemia. J Clin Oncol 23(16):3819–3829PubMedCrossRefPubMedCentralGoogle Scholar
  78. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG et al (2005b) Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 106(8):2912–2919PubMedPubMedCentralCrossRefGoogle Scholar
  79. Sorror ML, Giralt S, Sandmaier BM, de Lima M, Shahjahan M, Maloney DG et al (2007a) Hematopoietic cell transplantation-specific comorbidity index as an outcome predictor for patients with acute myeloid leukemia in first remission: combined FHCRC and MDACC experiences. Blood 110(13):4608–4613CrossRefGoogle Scholar
  80. Sorror ML, Sandmaier BM, Storer BE, Maris MB, Baron F, Maloney DG et al (2007b) Comorbidity and disease status-based risk stratification of outcomes among patients with acute myeloid leukemia or myelodysplasia receiving allogeneic hematopoietic cell transplantation. J Clin Oncol 25(27):4246–4254PubMedCrossRefPubMedCentralGoogle Scholar
  81. Sorror M, Storer B, Gopal A, Holmberg L, Sandmaier BM, Bensinger WI et al (2007c) Comorbidity, lactate dehydrogenase (LDH), and chemosensitivity are independent predictors of mortality after autologous hematopoietic cell transplantation (HCT) for patients (pts) with lymphoma. Blood 110(Part 1, 11):190a, #616Google Scholar
  82. Sorror M, Storer B, Sandmaier BM, Maloney DG, Chauncey TR, Langston A et al (2008a) Hematopoietic cell transplantation-comorbidity index and Karnofsky performance status are independent predictors of morbidity and mortality after allogeneic nonmyeloablative hematopoietic cell transplantation. Cancer 112(9):1992–2001PubMedCrossRefPubMedCentralGoogle Scholar
  83. Sorror ML, Storer BE, Maloney DG, Sandmaier BM, Martin PJ, Storb R (2008b) Outcomes after allogeneic hematopoietic cell transplantation with nonmyeloablative or myeloablative regimens for treatment of lymphoma and chronic lymphocytic leukemia. Blood 111(1):446–452PubMedPubMedCentralCrossRefGoogle Scholar
  84. Sorror ML, Storer BE, Sandmaier BM, Maris M, Shizuru J, Maziarz R et al (2008c) Five-year follow-up of patients with advanced chronic lymphocytic leukemia treated with allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning. J Clin Oncol 26(30):4912–4920PubMedPubMedCentralCrossRefGoogle Scholar
  85. Sorror ML, Sandmaier BM, Storer BE, Franke GN, Laport GG, Chauncey TR et al (2011a) Long-term outcomes among older patients following nonmyeloablative conditioning and allogeneic hematopoietic cell transplantation for advanced hematologic malignancies. JAMA 306(17):1874–1883PubMedPubMedCentralCrossRefGoogle Scholar
  86. Sorror ML, Storer B, Storb R (2011b) Assignment of scores for the Hematopoietic Cell Transplantation-Comorbidity Index: integer vs exact weights (Letter to the Editor). Bone Marrow Transplant 46(3):464–466PubMedCrossRefPubMedCentralGoogle Scholar
  87. Sorror ML, Yi JC, Storer BE, Rock EE, Artherholt SB, Storb R et al (2013) Association of pre-transplant comorbidities with long-term Quality of Life (QOL) among survivors after allogeneic Hematopoietic Cell Transplantation (HCT). Biol Blood Marrow Transplant 19(2):S153CrossRefGoogle Scholar
  88. Sorror ML, Martin PJ, Storb R, Bhatia S, Maziarz RT, Pulsipher MA et al (2014a) Pretransplant comorbidities predict severity of acute graft-versus-host disease and subsequent mortality. Blood 124(2):287–295PubMedPubMedCentralCrossRefGoogle Scholar
  89. Sorror ML, Storb RF, Sandmaier BM, Maziarz RT, Pulsipher MA, Maris MB et al (2014b) Comorbidity-age index: a clinical measure of biologic age before allogeneic hematopoietic cell transplantation. J Clin Oncol 32(29):3249–3256PubMedPubMedCentralCrossRefGoogle Scholar
  90. Sorror ML, Logan BR, Zhu X, Rizzo JD, Cooke KR, McCarthy PL et al (2015a) 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 21(8):1479–1487PubMedPubMedCentralCrossRefGoogle Scholar
  91. Sorror ML, Gooley TA, Maclean K, Roy S, Hubbard J, Marcondes M et al (2015b) Pre-transplant expressions of microRNAs are associated with both comorbidity burden and mortality risks in patients with acute leukemia in complete remission given allogeneic hematopoietic cell transplantation. Blood 126(23):#385CrossRefGoogle Scholar
  92. Terwey TH, Hemmati PG, Martus P, Dietz E, Vuong LG, Massenkeil G et al (2010) A modifed EBMT risk score and the hematopoietic cell transplantation-specific comorbidity index for pre-transplant risk assessment in adult acute lymphoblastic leukemia. Haematologica 95(5):810–818PubMedCrossRefPubMedCentralGoogle Scholar
  93. Tichelli A, Rovo A, Gratwohl A (2008) Late pulmonary, cardiovascular, and renal complications after hematopoietic stem cell transplantation and recommended screening practices (Review). Hematology 2008:125–133CrossRefGoogle Scholar
  94. Vaughn JE, Gooley T, Maziarz RT, Pulsipher MA, Bhatia S, Maloney DG et al (2015a) Pre-transplant comorbidity burden and post-transplant chronic graft-versus-host disease. Br J Haematol 171(3):411–416PubMedPubMedCentralCrossRefGoogle Scholar
  95. Vaughn JE, Storer BE, Armand P, Raimondi R, Gibson C, Rambaldi A et al (2015b) Design and validation of an augmented hematopoietic cell transplantation-comorbidity index comprising pretransplant ferritin, albumin, and platelet count for prediction of outcomes after allogeneic transplantation. Biol Blood Marrow Transplant 21(8):1418–1424PubMedPubMedCentralCrossRefGoogle Scholar
  96. Wedding U, Rohrig B, Klippstein A, Pientka L, Hoffken K (2007) Age, severe comorbidity and functional impairment independently contribute to poor survival in cancer patients. J Cancer Res Clin Oncol 133(12):945–950PubMedCrossRefPubMedCentralGoogle Scholar
  97. Wildes TM, Augustin KM, Sempek D, Zhang QJ, Vij R, Dipersio JF et al (2008) Comorbidities, not age, impact outcomes in autologous stem cell transplant for relapsed non-Hodgkin lymphoma. Biol Blood Marrow Transplant 14(7):840–846PubMedCrossRefPubMedCentralGoogle Scholar
  98. Williams M, Murray J, Kulkarni S, Bloor A (2012) HCT-CI correlates poorly with outcome following allogeneic stem cell transplant: impact of underlying diagnosis, patient selection and assessment of organ function. 38th annual meeting of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 47(1):S205–S2S6, #646Google Scholar
  99. Wilson CS, Davidson GS, Martin SB, Andries E, Potter J, Harvey R et al (2006) Gene expression profiling of adult acute myeloid leukemia identifies novel biologic clusters for risk classification and outcome prediction. Blood 108(2):685–696PubMedPubMedCentralCrossRefGoogle Scholar
  100. Wood W, Deal A, Whitley J, Sharf A, Serody J, Gabriel D et al (2011) Usefulness of the hematopoietic cell transplantation-specific comorbidity index (HCT-CI) in predicting outcomes for adolescents and young adults with hematologic malignancies undergoing allogeneic stem cell transplant. Pediatr Blood Cancer 57(3):499–505PubMedCrossRefPubMedCentralGoogle Scholar
  101. Wood WA, Le-Rademacher J, Syrjala KL, Jim H, Jacobsen PB, Knight JM et al (2016) Patient-reported physical functioning predicts the success of hematopoietic cell transplantation (BMT CTN 0902). Cancer 122(1):91–98PubMedCrossRefPubMedCentralGoogle Scholar
  102. Xhaard A, Porcher R, Chien JW, de Latour RP, Robin M, Ribaud P et al (2008) Impact of comorbidity indexes on non-relapse mortality. Leukemia 22(11):2062–2069PubMedPubMedCentralCrossRefGoogle Scholar
  103. Zhang W, Fang F, He Y, Chen Y, Jiang SF (2017) Treatment selection of elderly acute myeloid leukemia patients guided by HCT-CI Score. Zhongguo Shi Yan Xue Ye Xue Za Zhi 25(2):387–392PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Fred Hutchinson Cancer Research Center, Clinical Research DivisionSeattleUSA
  2. 2.Kasr Alainy Faculty of MedicineCairo UniversityCairoEgypt
  3. 3.Department of MedicineUniversity of Washington School of MedicineSeattleUSA

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