Abstract
BackgroundRecently, 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).MethodsThis 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.ResultsThe 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).ConclusionEASIX score at diagnosis is a simple and strong predictor for OS in patients with newly diagnosed MM.
Highlights
The endothelial Activation and Stress ISS International (Index) (EASIX) score has been reported to predict overall survival (OS) after allogeneic stem cell transplantation
The Revised International Staging System (R-ISS) was created by incorporating the chromosomal abnormalities and serum lactate dehydrogenase (LDH) into the original ISS and improved the prognostic power compared with the original ISS, cytogenetics, and LDH alone
83 patients with lack of laboratory data such as serum LDH, serum creatinine or platelet count at diagnosis were excluded and 1177 patients were included in the analysis
Summary
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). Recent molecular studies have shown that MM is a genetically heterogeneous disease. Cytogenetic abnormalities in the R-ISS do not include all the genetic abnormalities in MM and can be only assessed in selected institutions that can conduct gene analysis. For these reasons, there are still unmet needs about establishing a precise and convenient risk stratification model for MM
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