Pretransplant Assessment of Mortality (PAM) Score


All copyrights to the PAM Calculator and the PAM Calculator Web site and its contents are the property of the Fred Hutchinson Cancer Research Center unless otherwise noted. No portion of this PAM Calculator may be copied, used to prepare derivative works, displayed for redistribution to third parties for commercial purposes or used for any non-permitted use without the prior written permission of FHCRC.


PLEASE REVIEW THESE TERMS OF USE (THE “TERMS”) FOR THE “PAM CALCULATOR” WEBSITE. BY USING THIS SITE, YOU AGREE TO FOLLOW AND BE BOUND BY THE TERMS. IF YOU DO NOT AGREE WITH ANY OF THE TERMS, PLEASE DO NOT USE THIS SITE. The “PAM Calculator” is designed to serve as a guide for conducting the medical care of a patient being considered for an allogeneic stem cell transplant. Although the “PAM Calculator” was developed and validated using rigorous statistical methods and data collected over a twelve-year period, the data were collected from transplants conducted at the Seattle Cancer Care Alliance (SCCA)/Fred Hutchinson Cancer Research Center (FHCRC). Therefore, validation of the “PAM Calculator” using data from other centers has not been formally conducted. The information generated by the “PAM Calculator” is not provided as a professional service. It is not a substitute for professional medical care, which a patient should receive from their health care provider. YOUR USE OF THE “PAM Calculator” IS AT YOUR OWN RISK. FHCRC AND ITS AFFILIATES, INCLUDING BUT NOT LIMITED TO SCCA EXPRESSLY DISCLAIM ANY AND ALL WARRANTIES REGARDING THE PAM Calculator, WHETHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES PERTAINING TO NON-INFRINGEMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. TO THE FULLEST EXTENT PERMISSIBLE BY LAW, FHCRC AND ITS AFFILIATES, INCLUDING BUT NOT LIMITED TO SCCA MAKE NO REPRESENTATIONS OR WARRANTIES OF ANY KIND IN CONNECTION WITH THE SITE. FHCRC PROVIDES THIS SITE, ALL CONTENTS, AND ALL INFORMATION OFFERED ON OR THROUGH THE SITE "AS IS" WITHOUT OBLIGATION BY FHCRC OR ANY OF ITS AFFILIATES, INCLUDING BUT NOT LIMITED TO SCCA, TO PROVIDE ACCOMPANYING SERVICES, SUPPORT, UPDATES OR IMPROVEMENTS. NEITHER FHCRC NOR ANY OF ITS AFFILIATEES, INCLUDING BUT NOT LIMITED TO SCCA WILL BE LIABLE FOR ANY DAMAGES RELATED TO YOUR USE OF OR INABILITY TO USE THIS SITE, INCLUDING WITHOUT LIMITATION, DIRECT, INDIRECT, SPECIAL, COMPENSATORY OR CONSEQUENTIAL DAMAGES. Some jurisdictions may not allow the exclusion of implied warranties, so some of the above exclusions may not apply to you. FHCRC and its affiliates, including but not limited to SCCA do not warrant that your use of the “PAM Calculator” or the operation or function of the “PAM Calculator” will be uninterrupted or error free, that defects will be corrected, or that the “PAM Calculator” or its server are free of viruses or other harmful elements. Neither FHCRC nor any of its affiliates, including but not limited to SCCA SCCA/FHCRC does not make any representations regarding the currency, accuracy or reliability of information provided by the “PAM Calculator”.


This calculator is designed to calculate a “PAM score” (Pretransplant Assessment of Mortality Score) that provides information with regard to the mortality risk a patient is likely to experience if he or she undergoes an allogeneic hematopoietic stem cell transplant (HCT).   The scoring algorithm was developed and validated using clinical data from over 2800 allogeneic transplants performed from 1990 to 2002 at the Seattle Cancer Care Alliance/Fred Hutchinson Cancer Research Center. Five validation cohorts from our Center were used to assess the performance of this predictor tool: 1990 to1997 cohort, 1997 to 2002 cohort, all chronic myeloid leukemia patients, all acute myeloid leukemia patients, and all myelodysplastic syndrome patients. The analyses found that this tool can predict the mortality risk of a patient considering allogeneic HCT with reasonably high accuracy.  The details of the methods and results are described in the publication (Annals of Internal Medicine, 2006 Mar 21;144(6):407-14).  This manuscript is available by clicking on the link below.

To use this calculator, data for the eight clinical and laboratory variables below must be collected and entered using the drop down menus.  For instance a 45 year old patient with chronic myeloid leukemia in accelerated phase, with a pretransplant percent of predicted FEV1 of 75%, percent of predicted DLCO of 95%, creatinine of 1.5 mg/dL, SGPT 110 mg/dL, and is scheduled to receive a 12 Gy total body irradiation based myeloablative transplant from an unrelated donor receives a PAM score of 1+8+3+1+8+2+8+3=34.  The mortality rates, which were estimated using data from all patients who were transplanted between January 1, 1998 and December 31, 2002 (N=1,069), are provided for each possible PAM score in this cohort. The sensitivity and specificity for each score is also provided.  The c-statistic, which can be interpreted as the area under a receiver operating characteristic curve (AUC) when used to measure the discrimination of a model for a binary outcome such as mortality, is 0.7011 for this cohort.
Current Age In Years:      
Donor Type:      
Disease Risk categorized as follows:      
  Low-risk diseases:
  • Chronic myeloid leukemia (CML) in chronic phase
  • Refractory anemia
  • Aplastic anemia
  • Blackfan-Diamond syndrome
  Intermediate-risk diseases:
  • CML in accelerated phase or in chronic phase after blast phase
  • Acute leukemia or lymphoma in remission
  • Refractory anemia with excess blasts
  • Chronic lymphocytic leukemia
  • Paroxysmal nocturnal hemoglobinuria
  • Myelodysplastic syndrome, in remission
  High-risk diseases:
  • CML in blast phase
  • Juvenile chronic myeloid leukemia
  • Acute leukemia or lymphoma in relapse
  • Refractory anemia with excess blasts in transformation
  • Myeloma
  • All solid malignancies and non-hematologic diseases
  • Myelodysplastic syndrome
Conditioning Regimens:      
Pretransplant serum creatinine expressed as mg/dL:      
SGPT expressed as mg/dL:      
Percent of predicted forced expiratory volume in one-second (FEV1):      
  Performed according to American Thoracic Society guidelines 1; and expressed as a percent of the predicted values calculated according to published equations by Crapo 2.
Percent of predicted carbon monoxide diffusion capacity (DLCO), adjusted for hematocrit:      
  Performed according to American Thoracic Society guidelines 3; and expressed as a percent of the predicted values calculated according to published equations by Crapo 4.

PAM Score output will display here!  
(1)   Standardization of spirometry, 1994 update: American Thoracic Society. Am J Respir Crit Care Med 1995; 152:1107-1136.  
(2)   Crapo RO, Morris AH, Gardner RM. Reference spirometric values using techniques and equipment that meet ATS recommendations. Am Rev Respir Dis 1981; 123:659-664.  
(3)   American Thoracic Society. Single-breath carbon monoxide diffusing capacity (transfer factor). Recommendations for a standard technique - 1995 update. Am J Respir Crit Care Med 1995; 152:2185-2198.  
(4)   Crapo RO, Morris AH. Standardized single breath normal values for carbon monoxide diffusing capacity. Am Rev Respir Dis 1981; 123:185-189.  
(5)   Parimon T, Au DH, Martin PJ, Chien JW. A risk score for mortality after allogeneic hematopoietic cell transplantation. Ann Int Med 2006;144(6):407-414.
   PAM Abstract
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