Among patients with hematologic cancer who undergo haploidentical stem cell transplantation (haplo-SCT) with post-transplant cyclophosphamide (PT-Cy), a novel prognostic scoring system may help to predict the risk of non-relapse mortality (NRM), according to research published in Bone Marrow Transplantation.

It has previously been established that some forms of transplantation may lead to endothelial dysfunction, which may consequently be linked with NRM. It may therefore be the case that detecting or preventing endothelial damage may help to reduce NRM rates in this patient population.

Researchers previously designed the Endothelial Activation and Stress Index (EASIX), which is a widely available prognostic tool for determining endothelial damage among patients undergoing SCT. EASIX evaluates patient creatinine, lactate dehydrogenase, and thrombocyte levels, which are known to be linked with endothelial damage. For this retrospective study, researchers evaluated whether EASIX effectively predicts NRM among patients undergoing haplo-SCT and PT-Cy.


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Overall, data from 266 patients were included. The median age at receiving haplo-SCT and PT-Cy was 51 years, 42% of patients were female sex, the most common diagnosis was Hodgkin lymphoma (33%), and 65% had had a complete response prior to transplantation.

Pre-transplant EASIX scores of less than 0.8 were linked with 1-year NRM and 1-year overall survival rates of 16% and 59%, respectively; these rates were 29% and 32%, respectively, among patients with pretransplant EASIX scores of at least 0.8.

Multivariate analysis suggested that patient EASIX score predicted both NRM (hazard ratio, 2.43; P <.001) and overall survival (hazard ratio, 1.64; P =.011) independently. The EASIX score did not, however, effectively predict the risk of acute graft-vs-host disease.

“Given that readily available, standard routine lab parameters are employed, EASIX may become an essential tool to improve our clinical decisions,” the authors wrote.

Reference

Mariotti J, Magri F, Giordano L, et al. EASIX predicts non-relapse mortality after haploidentical transplantation with post-transplant cyclophosphamide. Bone Marrow Transplant. Published online November 21, 2022. doi:10.1038/s41409-022-01874-5