Endothelial Activation and Stress Index predict GVHD-free, relapse-free survival in adults undergoing haploidentical haematopoietic stem cell transplantation

Abstract The Endothelial Activation and Stress Index (EASIX) is a prognostic score including creatinine, lactate dehydrogenase, and thrombocytes. Its prognostic value in the context of haploidentical SCT (haplo-HSCT) remains to be fully elucidated. To explore the significance of pre-transplant EASIX for clinical outcome, we conducted a retrospective study in 434 consecutive patients who received haplo-HSCT with ATG/G-CSF-based protocol for the treatment of hematologic malignancies In multivariate analysis, the EASIX score was independently associated with graft-versus-host disease (GVHD)-free, relapse-free survival (GRFS, (HR = 1.2, P < 0.001)). The cutoff value of EASIX for GRFS was 1.6, with 3-year GRFS being 63% and 72% in the high- and low-risk groups, respectively ( P < 0.001). The cumulative incidences of grade III-IV aGVHD were 24% and 12% ( P = 0.004), and the 3-year cumulative incidences of moderate to severe cGVHD were 40% and 20% in the high- and low-risk groups, respectively ( P < 0.001). In the MDS subgroup, an optimal cutoff of 0.7 was established, and EASIX remained significantly associated with the GRFS (HR = 5.4, P = 0.02). Pre-transplant EASIX serves as an independent predictor for GRFS as an easily accessible tool.