Endothelial activation and stress index (EASIX) is a reliable predictor for overall survival in patients with multiple myeloma

• Main Authors: Ga-Young Song, Sung-Hoon Jung, Kihyun Kim, Seok Jin Kim, Sang Eun Yoon, Ho Sup Lee, Mihee Kim, Seo-Yeon Ahn, Jae-Sook Ahn, Deok-Hwan Yang, Hyeoung-Joon Kim, Je-Jung Lee
• Format: Article
• Language: English
• Published: BMC 2020-08-01
• Series: BMC Cancer
• Subjects: Multiple myeloma; Prognosis; LDH; Platelets; Serum creatinine
• Online Access: http://link.springer.com/article/10.1186/s12885-020-07317-y

Abstract Background Recently, the endothelial Activation and Stress Index (EASIX) score has been reported to predict overall survival (OS) after allogeneic stem cell transplantation. This study evaluated the prognostic role of EASIX score in patients with newly diagnosed multiple myeloma (MM). Methods This retrospective study analyzed the records of 1177 patients with newly diagnosed MM between February 2003 and December 2017 from three institutions in the Republic of Korea. Serum lactate dehydrogenase (LDH), creatinine, and platelet count at diagnosis were measured in all included patients. EASIX scores were calculated using the formula-LDH (U/L) × Creatinine (mg/dL) / platelet count (109/L) and were evaluated based on log2 transformed values. Results The median age of patients was 63 years (range, 22–92), and 495 patients (42.1%) underwent autologous stem cell transplantation (ASCT). The median log2 EASIX score at diagnosis was 1.1 (IQR 0.3–2.3). Using maximally selected log-rank statistics, the optimal EASIX cutoff value for OS was 1.87 on the log2 scale (95% CI 0.562–0.619, p < 0.001). After median follow-up for 50.0 months (range, 0.3–184.1), the median OS was 58.2 months (95% CI 53.644–62.674). Overall, 372 patients (31.6%) showed high EASIX scores at diagnosis, and had significantly inferior OS compared to those with low EASIX (log2 EASIX ≤1.87) (39.1 months vs. 67.2 months, p < 0.001). In multivariate Cox analysis, high EASIX was significantly associated with poor OS (HR 1.444, 95% CI 1.170–1.780, p = 0.001). In the subgroup analysis of patients who underwent ASCT, patients with high EASIX showed significantly inferior OS compared to those with low EASIX (52.8 months vs. 87.0 months, p < 0.001). In addition, in each group of ISS I, II, and III, high EASIX was associated with significantly inferior OS (ISS 1, 45.2 months vs. 76.0 months, p = 0.001; ISS 2, 42.3 months vs. 66.5 months, p = 0.002; ISS 3, 36.8 months vs. 55.1 months, p = 0.001). Conclusion EASIX score at diagnosis is a simple and strong predictor for OS in patients with newly diagnosed MM.