Hematologist
CION Cancer Clinics
Fitness assessment and comorbidity scoring before transplant | CION Cancer Clinics
A transplant fitness assessment shows how well your body is likely to cope with a stem cell transplant. The main tool is the HCT-CI score, which adds up your other health conditions, such as heart, lung, liver or kidney disease and diabetes, weighted by severity. A higher score usually changes the type of transplant rather than ruling it out. This page explains what is counted, which tests feed in and what the score cannot tell you. At CION Cancer Clinics, our haematology team assesses whether a transplant or CAR-T fits your situation and coordinates care with qualified centres.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What is a fitness assessment before a transplant?
- Which health conditions does the comorbidity score count?
- Which tests feed into the fitness assessment?
- What do the scores and terms on the assessment mean?
- What do people misunderstand about the fitness score?
- What can you change before the assessment, and what can you not?
- What does a higher score change, and what can it not tell you?
- Common questions about transplant fitness scores
The short answer
What is a fitness assessment before a transplant?
A fitness assessment is a set of tests and scores that shows how well your body is likely to cope with a stem cell transplant. The best-known score is the HCT-CI, the Haematopoietic Cell Transplantation Comorbidity Index, which adds up your other health conditions and weights each one by how serious it is.
Why the team needs it
A transplant is one of the hardest treatments in medicine. Strong chemotherapy empties the bone marrow, and for weeks you have almost no defence against infection. A heart, lung, liver or kidney that is already weak is more likely to struggle. The assessment puts that risk into words and numbers the team can discuss openly with you.
What the score is used for
It helps the team decide three things. Whether a transplant is sensible at all. Which kind suits you, own-cell or donor. And how strong the conditioning chemotherapy should be. A higher score often points towards a lighter approach rather than a flat no.
The score describes risk across groups of patients. It does not predict what will happen to you as one person.Inside the score
Which health conditions does the comorbidity score count?
Each condition is graded by how severe it is. Mild problems add little; severe ones add more.
Heart
Past heart attacks, heart failure, irregular heartbeat, valve disease and a weaker pumping action on the echo scan.
Lungs
Breathlessness on activity or at rest, and lower results on breathing tests, including how well oxygen passes from the lungs into the blood.
Liver and kidneys
Hepatitis, cirrhosis or raised liver tests, and reduced kidney function, including anyone on dialysis or who has had a kidney transplant.
Long-term conditions
Diabetes that needs treatment, and conditions that affect the whole body.
Also counted
- Rheumatoid arthritis and lupus
- Inflammatory bowel disease
- Past stroke
- Obesity
Infections and past cancers
An infection that still needs treatment when the transplant starts, and a previous solid cancer treated at any time in the past.
Mental health
Depression or anxiety that needs treatment. It is counted because it affects how people cope with a long, isolating admission, and support helps.
Not sure whether this applies to you?
Ask an oncologistHow it is worked out
Which tests feed into the fitness assessment?
History and examination
The haematologist goes through every illness, operation and medicine you have had. Bring old discharge summaries and prescriptions. A forgotten condition can change the score.
Heart and lung tests
An ECG and an echo scan of the heart, and breathing tests that measure lung capacity and how well oxygen crosses into the blood.
Blood and infection tests
Liver and kidney function, blood sugar, and tests for hepatitis, HIV and other infections that could flare while immunity is low.
Everyday function
A performance status score records how active you are. Older patients may also have checks on walking, memory, mood and nutrition.
On your assessment
What do the scores and terms on the assessment mean?
- HCT-CI
- A score for other health conditions. Zero means none of the listed conditions were found; a higher score means more, or more serious, conditions.
- Karnofsky or ECOG score
- Two ways of recording how well you manage daily activity, from fully active to needing help with self-care.
- Ejection fraction
- How much blood the heart pumps out with each beat, measured on the echo scan.
- DLCO
- A breathing test showing how easily oxygen passes from the lungs into the blood.
- Frailty
- Reduced strength and reserve, often seen as slow walking, weight loss and tiring easily.
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Commonly believed
What do people misunderstand about the fitness score?
"A high score means the doctors have given up on him."
A higher score means more risk from the transplant, not from the disease. It often leads to a gentler transplant or a different treatment. It is information for planning, not a judgement on the person.
"A score of zero means the transplant will be safe."
A low score lowers the risk but does not remove it. Fit people still face serious infections and complications. The type of disease, the donor and the conditioning all matter as well.
"If we do not mention his old heart trouble, the score will be better."
Hiding a condition does not make the body stronger. It only means the team plans without knowing the risk. Tell them everything, including illnesses that seem unrelated or long past.
"The score is fixed once it is done."
Some parts can change. An infection can be treated, blood sugar brought under control and strength rebuilt. The team may repeat tests before a final decision.
Before the transplant
What can you change before the assessment, and what can you not?
Often can improve
Usually cannot change
Blood sugar and blood pressure control, with your doctor's guidance
A past heart attack or stroke
Active infections, including dental ones, once treated
Long-standing lung or kidney damage
Strength and stamina, through walking and physiotherapy
A previous cancer in your history
Nutrition and weight loss
Your calendar age
Stopping smoking and alcohol
Liver scarring from past disease
Being straight with you
What does a higher score change, and what can it not tell you?
A higher score usually changes the plan rather than ending it. The team may choose an own-cell transplant, lighter conditioning, a different donor or a non-transplant treatment. Sometimes they will suggest treating a health problem first and reassessing.
How to talk about the score with the team
Ask three plain questions. Which conditions were counted, and how serious was each judged to be? What does this score mean for the kind of transplant being offered? Is there anything we can improve before the final decision? Write the answers down, or ask whether a family member can record the key points. Scores are easy to misremember after a long and worrying appointment.
Who a transplant may not suit
People with several severe conditions together, such as heart failure with serious lung disease, or someone who is frail and mostly bed-bound, are often advised against a donor transplant. For them the risk from the treatment can outweigh the benefit. That is a hard conversation, and it is fair to ask exactly which findings led to the advice.
What the score cannot do
It cannot tell you how long anyone will live, or whether a transplant will control the disease. It was built from groups of patients and does not capture everything about one person. CION's haematology team reviews these results, presents the case at a tumour board and helps coordinate care with qualified transplant centres.
Questions we are asked
Common questions about transplant fitness scores
Who calculates the HCT-CI?
The transplant haematologist or their team works it out from your history, examination and test results. It is not a test you take. Ask them to show you which conditions were counted and how severe each was judged to be, so you understand where the number came from.
Is the HCT-CI used for own-cell transplants too?
It was designed mainly for donor transplants, but many centres use it for own-cell transplants as well. The same organs take strain in both. For own-cell transplants the overall risk is lower, so the same score may matter less to the final decision.
My father has controlled diabetes. Will that stop the transplant?
Unlikely on its own. Diabetes that needs treatment adds to the score, but many people with well-controlled diabetes have transplants. Steroids used during treatment can push sugar up, so the team will plan for that. Do not change his diabetes medicines without asking his doctors.
Does depression really count against a transplant?
It is counted because it affects how people cope with a long hospital stay, not because the person is judged. Being open about it means counselling and support can be arranged early. Many people with depression or anxiety go through a transplant with the right help.
Can the score be repeated if my health improves?
Yes. If an infection clears, blood sugar settles or strength returns, the team can repeat the relevant tests. Timing matters with blood cancer, so the team balances waiting for improvement against the risk of the disease returning in the meantime.
Why were breathing tests needed when I have no lung problems?
Chemotherapy and some earlier treatments can quietly affect the lungs, and infections during a transplant often start there. A baseline test shows your starting point. It sometimes finds mild changes you had not noticed, and it helps the team compare if problems appear later.
Is the comorbidity score the only thing that matters?
No. It is one tool among several. The type and risk of the blood cancer, how it has responded, performance status, age, the donor and your own wishes all shape the decision. A team will rarely decide on the score alone, and you can ask how it was weighed.
What should we bring to the fitness assessment?
Bring every discharge summary, current prescription, echo and ECG report, and all blood and marrow reports. Include records from other hospitals and old illnesses. A written list of current medicines helps. Bring the family member who will be the caregiver, as they will be part of the discussion.
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Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- National Cancer Institute — Stem Cell Transplants in Cancer Treatment
- American Cancer Society — Stem Cell Transplant for Cancer
- NHS — Stem cell and bone marrow transplants
- Cancer.Net — What Is a Bone Marrow Transplant (Stem Cell Transplant)?
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Who Is Eligible for a Stem Cell TransplantThe wider eligibility pictureTransplant-Related Mortality: The Number You Should Ask ForHow fitness links to the risk of the treatment itselfTransplant Workup: Every Test Before AdmissionThe complete test listDental, Cardiac and Infection Clearance Before TransplantProblems worth fixing before admission
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