已经进行了多种尝试来优化移植前风险评估，以改善造血干细胞移植（HSCT）决策并预测 HSCT 后的结果。然而，其与儿科人群的相关性仍不清楚。我们报告了 874 名儿童的 HCT-CI 重新验证结果，这些儿童在单一中心接受了 944 例恶性或非恶性疾病的 HSCT。在发现 HCT-CI 在我们的患者群体中无效后；我们提出了一种改进的儿科适应评分系统，该系统捕获与儿科相关的风险因素（RF）和合并症（CoM）。每个 RF/CoM 根据 TRM 的风险比 (HR) 分配一个整数权重； 0 (HR <1.2), 1 (1.2 ≥HR <1.75), 2 (1.75 ≥HR <2.5), 3 (HR ≥2.5) 。使用这些权重，设计了儿科适应 HSCT-RI (PARI)，并让患者分为4个风险组；第 1 组无 RF/CoM，第 2 组：分数 1-2，第 3 组：分数 3-4，第 4 组：分数 ≥5。从第 1 组到第 4 组，2 年 TRM 呈线性增加（第 1 组 TRM= 6.2%，第 4 组为 50.9%）。 PARI 已在内部和外部儿科患者队列中成功得到验证。比较使用 c 统计量的模型，发现 PARI 模型在预测 Akaike 和 Schwarz 贝叶斯信息标准（AIC 和 BIC）分别为 1069.245 和 1073.269 的儿童 2 年 TRM 方面比 HCT-CI 更好；分别使用 PARI 与 1223.158 和 1227.051；分别使用HCT-CI。我们相信 PARI 将成为一个有价值的工具，为儿科 HSCT 患者提供更好的咨询和决策。版权所有 © 2024 美国血液学会。

Several attempts have been made to optimize pre-transplant risk assessment to improve hematopoietic stem cell transplantation (HSCT) decision-making and to predict outcome post- HSCT. However, its relevance to the pediatric population remains unclear. We report the results of revalidation of the HCT-CI in 874 children who received 944 HSCTs for malignant or non-malignant diseases at a single centre. After finding the HCT-CI invalid in our patient population; we proposed a modified pediatric adapted scoring system that captures risk factors (RF) and comorbidities (CoM) relevant to pediatrics. Each RF/CoM was assigned an integer weight based on its hazard ratio (HR) for TRM; 0 (HR <1.2), 1 (1.2 ≥HR <1.75), 2 (1.75 ≥HR <2.5), 3 (HR ≥2.5) .Using these weights, the pediatric adapted HSCT-RI (PARI) was devised, and patients were divided into 4 risk groups; group 1 without RF/CoM, group 2: scores 1-2, group 3: scores 3-4, group 4: scores ≥5. There was a linear increase in 2-year TRM from group 1 to 4 (TRM= 6.2% in group 1, 50.9% in group 4). PARI was successfully validated on an internal and external cohort of pediatric patients. Comparing models using c-statistics, PARI was found to be a better model than HCT-CI in predicting 2-year TRM in children with Akaike's and Schwarz's Bayesian information criteria (AIC and BIC) of 1069.245 and 1073.269; respectively using PARI vs 1223.158 and 1227.051; respectively using HCT-CI. We believe that PARI will be a valuable tool enabling better counselling and decision making for pediatric HSCT patients.Copyright © 2024 American Society of Hematology.