The use of the Endothelial Activation and Stress Index (EASIX) has potential to help predict nonrelapse mortality (NRM) in patients who have previously undergone allogeneic (allo) hematopoietic cell transplantation (HCT). This is according to the results of a study published in the journal Blood Advances.

The EASIX is a score calculated based on laboratory values that serves as a surrogate indicator of endothelial dysfunction. In prior research, the EASIX had shown prognostic value when measured before HCT. In the current analysis, the researchers aimed to establish its value in predicting NRM when measured after patients had undergone allo-HCT.

The study was a single-center, retrospective analysis of patients who underwent a first allo-HCT by either of 2 approaches. In Cohort 1, patients had nonmyeloablative or reduced-intensity conditioning with unmodified allo-HCT. In Cohort 2, patients received ex vivo, CD34+-selected, calcineurin inhibitor-free allo-HCT and myeloablative conditioning. Graft vs host disease (GVHD) prophylaxis was also given to Cohort 1, but Cohort 2 did not have planned pharmacologic GVHD prophylaxis.

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Overall survival (OS) and NRM rates were key outcomes evaluated, and EASIX scores were estimated and used for predicting NRM. EASIX scores were calculated based on the levels of lactate dehydrogenase and creatinine relative to platelet counts, and they were computed at multiple time points.

Cohort 1 included 149 patients, and Cohort 2 included 360 patients. Survivors had a median follow-up duration of 144 months (range, 20-300) overall. In the total population, the 3-year OS rate was 63% (95% CI, 59%-67%), and the 3-year NRM rate was 22% (95% CI, 18%-26%). The 1-year NRM rates were 8% (95% CI, 4%-12%) for Cohort 1 and 15% (95% CI, 12%-19%) for Cohort 2.

In the total population, EASIX scores showed a pattern of increasing rapidly post-HCT, peaking at day +8, and then dropping quickly until day +33. Scores following this time point showed gradual decreases while continuing to be above the baseline level measured prior to HCT, throughout the first year post-HCT. EASIX scores in Cohort 1 gradually decreased after HCT and remained higher than scores in Cohort 2 across most time points, while Cohort 2 showed a more rapid drop soon after HCT.

EASIX scores showed increasing concordance with NRM events in the first 180 days post-HCT until the period of day +180 to day +210 with either cohort. However, the prognostic value of EASIX varied between the 2 cohorts at different time points.

Univariate analysis also showed certain patient groups to have significantly elevated or reduced mean EASIX scores at day +180. Men and patients with GVHD of grades 2 to 4 showed higher mean EASIX scores. Patients with matched donors (related or unrelated) showed lower mean EASIX scores than those with mismatched donors did.

“Although pre-HCT EASIX can be used to help guide allo-HCT treatment decisions before allo-HCT, evaluation of the dynamic changes in EASIX scores may be better associated with NRM over time as patients acquire additional endothelial injury and toxicities after HCT,” the researchers wrote in their report.


Nawas MT, Sanchez-Escamilla M, Devlin SM, et al. Dynamic EASIX scores closely predict nonrelapse mortality after allogeneic hematopoietic cell transplantation. Blood Adv. 2022;6(22):5898-5907. doi:10.1182/bloodadvances.2022007381