Dynamic EASIX scores closely predict nonrelapse mortality after allogeneic hematopoietic cell transplantation Journal Article


Authors: Nawas, M. T.; Sanchez-Escamilla, M.; Devlin, S. M.; Maloy, M. A.; Ruiz, J. D.; Sauter, C. S.; Giralt, S. A.; Perales, M. A.; Scordo, M.
Article Title: Dynamic EASIX scores closely predict nonrelapse mortality after allogeneic hematopoietic cell transplantation
Abstract: Endothelial activation and stress index (EASIX) predicts nonrelapse mortality (NRM) when assessed before hematopoietic cell transplantation (HCT). We sought to determine whether changes in EASIX after HCT may be an informative marker of NRM. We evaluated 509 adults who underwent reduced intensity, unmodified (N = 149, 29%), or myeloablative ex vivo CD34+-selected allogeneic HCT (allo-HCT) (N = 306, 71%) between 2008 and 2016. Patients who underwent unmodified allo-HCT received tacrolimus-based graft-versus-host disease (GVHD) prophylaxis, whereas CD34+-selected patients received no planned immunosuppression. EASIX (lactate dehydrogenase × creatinine/platelet count) was calculated continuously until 1-year after HCT. Log transformation using base 2 (log2) was applied to all EASIX variables to reduce skew. In total, 360 patients (71%) received CD34+selected and 149 (29%) unmodified allo-HCT. Among all patients, EASIX scores increased rapidly, peaked at day +8, then declined rapidly until day +33. Thereafter, scores declined gradually but remained above the pre-HCT baseline. In unmodified HCT, scores appeared higher over time than in CD34+-selected patients. EASIX discrimination of NRM was highest around day +180 (concordance index = 0.85) in both platforms, but the prognostic impact of EASIX across time points differed between the 2 platforms. Mean EASIX scores were higher in men (mean log2 +0.52) and in patients who developed grade 2 to 4 GVHD (+0.81) and lower in patients who received matched vs mismatched donors (-0.81, all P < .01). EASIX scores are dynamic and variably concordant with NRM when analyzed longitudinally, and patterns differ between HCT platforms. Compared to pre-HCT evaluation, post-HCT EASIX scores may better predict risk of NRM as patients acquire additional endothelial injury and toxicities. © 2022 by The American Society of Hematology.
Journal Title: Blood Advances
Volume: 6
Issue: 22
ISSN: 2473-9529
Publisher: American Society of Hematology  
Date Published: 2022-11-22
Start Page: 5898
End Page: 5907
Language: English
DOI: 10.1182/bloodadvances.2022007381
PUBMED: 35977079
PROVIDER: scopus
PMCID: PMC9661383
DOI/URL:
Notes: Article -- Export Date: 3 January 2023 -- Source: Scopus
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
  1. Sergio Andres Giralt
    1054 Giralt
  2. Craig Steven Sauter
    334 Sauter
  3. Miguel-Angel Perales
    918 Perales
  4. Molly Anna Maloy
    269 Maloy
  5. Sean McCarthy Devlin
    602 Devlin
  6. Michael Scordo
    368 Scordo
  7. Josel Dumo Ruiz
    54 Ruiz