Arrhythmia is to be scored only if required specific treatment at any time point in the patient’s past medical history. Lack of any details on treatment for a prior arrhythmia should not preclude scoring the arrhythmia as comorbidity. However, if careful review of the medical chart or evaluation of patient’s medical history raises doubt whether a treatment was given or not for an arrhythmia, no score should be assigned.

The arrhythmia is to be scored even if the patient was in normal sinus rhythm at the time of start of conditioning for HCT. This comorbidity does not include transient arrhythmias that never required treatment in the patient’s past medical history.

• Coronary artery disease: history of a documented diagnosis of chronic exertional angina, unstable angina, or myocardial infarction at any time point in the patient’s past medical history. This comorbidity will also include history of a patient with placement of a coronary stent or undergoing coronary artery bypass graft surgery.
• Congestive heart failure: includes patients who have had exertional or paroxysmal nocturnal dyspnea and who have responded symptomatically (or on physical examination) to digitalis, diuretics, or afterload reducing agents at any time point in their past medical history.
• Ejection fraction or shortening fraction (for pediatric patients): % as assessed by echocardiogram or Multi-Gated Acquisition (MUGA) scan. Evaluation of this comorbidity should be restricted to the most recent measurements of EF or SF prior to start of conditioning regimen.

Inflammatory bowel disease comorbidity is to be scored only if required treatment at any time point in the patient’s past medical history.

Diabetes or steroid-induced hyperglycemia is to be scored only if required continuous treatment with insulin or oral hypoglycemic drugs within the 4 weeks period prior to the start of conditioning regimen.

Patients treated with diet only are not to be scored for this comorbidity.

Patients who previously received treatment for diabetes or steroid-induced hyperglycemia but stopped these medication 4 weeks before the start of conditioning regimen are not to be scored for this comorbidity.

Cerebro-vascular disease is to be scored if happened at any time point in the past medical history.

Psychiatric disturbance comorbidity is to be scored if required continuous treatment during the 4 weeks period prior to start of conditioning regimen.

Patients who are receiving only “as needed” medications for any of the above disorders are not to be scored for this comorbidity.

The upper limit of normal value should be determined based on each institution laboratory criteria.

Diagnosis of infection with hepatitis B or C or documented diagnosis of liver cirrhosis at any time point prior to the start of conditioning regimen should be scored for this comorbidity.

Assignment of scores for elevated total bilirubin, AST, or ALT requires at least two elevated values of each laboratory parameter at two different days within a period extending from day -24 till day -10 prior to HCT. That period could be extended back to day -40 only in the case that liver function tests were done only once between days -24 and -10 before HCT.

The laboratory value done at the closest time point prior to start of conditioning should be used in the calculator.

Evaluation of this comorbidity should be based on the most recent measurement of BMI (or weight and height needed for the calculation of BMI) prior to the start of conditioning regimen.

Infection comorbidity is to be scored only if required starting a specific anti-microbial treatment (or TB prophylaxis for PPD positive patients) before the start of conditioning regimen with a recommendation, documented in the chart either by the primary treating team or the infection consultant team, to continue the same anti-microbial therapy (or a similar agent) during and after receiving the conditioning regimen.

Rheumatologic comorbidity is to be scored only if required specific treatment at any time point in the patient’s past medical history.

Patients with quiescent rheumatologic diseases, who are receiving no treatment in the immediate period prior to the start of conditioning regimen, are still to be scored for this comorbidity if they fulfilled the prior criteria.

Peptic ulcer comorbidity is to be scored only if there was a prior endoscopic diagnosis of gastric or duodenal ulcer any time point in the patient’s past medical history.

Patients with quiescent peptic ulcer, who are receiving no treatment in the immediate period prior to the start of conditioning regimen, are still to be scored for this comorbidity if they fulfilled the prior criteria.

Assignment of scores for elevated serum creatinine requires at least two elevated values found on two different days within a period extending from day -24 till day -10 prior to HCT. That period could extend back to day -40 only in the case that renal function tests were done once between days -24 and -10 before HCT.

Renal dialysis is to be scored only if it was done within 4 weeks prior to start of conditioning regimen.

Renal transplantation that happened at any time point in the patient’s past medical history is to be scored for renal comorbidity.

The most recent measurements of both DLco and FEV1 prior to start of conditioning regimen are to be used for scoring this comorbidity.

Shortness of breath has to be assessed during a clinic visit within two weeks prior to the start of conditioning regimen.

The requirement for intermittent or continuous oxygen supplementation is to be scored if occurred during the entire 4 weeks duration prior to the start of conditioning regimen.

Among patients who receive a bronchodilator challenge during pulmonary function tests, only the pre-bronchodilator values are to be considered for evaluation of pulmonary comorbidity.

This comorbidity includes prior diagnosis of any solid tumor that required specific treatment at any time point in the patient’s past medical history regardless of the type of treatment (surgery, radiotherapy, and/or drug therapy).

Lymphomas are to be scored for this comorbidity only if the primary malignant diagnosis is of a myeloid nature (For example acute myeloid leukemia or myelodysplastic syndromes, or chronic myeloid leukemia).

Melanoma is the only type of skin cancer to be scored for this comorbidity and no scores should be assigned for basal or squamous cell carcinoma of the skin.

Patients with prior solid tumor that never required specific treatment are not to be scored for this comorbidity.

Impairment of heart valve function, whether stenosis or insufficiency, has to be of at least a moderate degree to be considered for this comorbidity.

The most recent heart valuation by echocardiogram prior to the start of conditioning regimen should be used for scoring this comorbidity.

Adding a score for age allows for calculating the combined HCT-CI/Age score.

Note: Age will not be counted in the HCT-CI score, only the HCT-CI/Age score.