The relationship between endothelial activation and stress index with survival and early mortality in acute myeloid leukemia
Abstract
Aim: The Endothelial Activation and Stress Index (EASIX) score is used as a marker of endothelial damage and used to predict acute graft-versus-host disease and sinusoidal obstruction syndrome. We wanted to evaluate the effects of EASIX, modified EASIX (mEASIX) and sepsis modified EASIX (sEASIX) on early mortality and overall survival (OS) in patients with acute myeloid leukemia.
Materials and Methods: We reviewed patients diagnosed and followed up with Acute Myeloid Leukemia (AML) in our Hematology Department, retrospectively. Patients between 18 -70 years of age and who were administered 7+3 (7 days cytarabine, and 3 days anthracycline) chemotherapy protocol (except acute promyelocytic leukemia) were included. EASIX, mEASIX and sEASIX scores of the patients, both at the time of diagnosis and at the end of the 4th week, were calculated.
Results: Seventy-five patients were included in the study. The mean age was 49.05 (19-68) years and 41% were alive. EASIX and mEASIX scores measured both at the time of diagnosis and at the end of induction therapy were found to be significantly associated with early mortality (p=0.01, p<0.01) and OS (p<0.01, p<0.01).
Conclusion: There is no specific scoring system or marker that we can use practically in the clinic to show early mortality in these patients who receive intensive treatment in AML. Of course, there are many factors that can affect mortality in this period. However, based on the current results, we think that EASIX, mEASIX and sEASIX scores can be used with other prognostic factors to predict early mortality and survival.
Ethical Statement
The study was conducted in accordance with the Declaration of Helsinki, Ethical Principles for Medical Research. This study was approved by Trakya University Faculty of Medicine Ethical Committee (TUTF-BAEK2020/439).
References
- Shallis RM, Wang R, Davidoff A and et al. Epidemiology of acute myeloid leukemia: Recent progress and enduring challenges. Blood Rev. 2019 Jul;36:70-87.
- Song GY, Jung SH, Kim K, et al. Endothelial activation and stress index (EASIX) is a reliable predictor for overall survival in patients with multiple myeloma. BMC Cancer. 2020 Aug 24;20(1):803.
- Merz A, Germing U, Kobbe G, et al. EASIX for prediction of survival in lower-risk myelodysplastic syndromes. Blood Cancer J. 2019 Nov 11;9(11):85.
- Pennisi M, Sanchez-Escamilla M, Flynn JR, et al. Modified EASIX predicts severe cytokine release syndrome and neurotoxicity after chimeric antigen receptor T cells. Blood Adv. 2021 Sep 14;5(17):3397-3406.
- Li Y, Jiang L, Song T, et al. A call for better understanding the role of albumin in mediating VE-cadherin phosphorylation and endothelial barrier dysfunction in septic patients. Crit Care. 2021 Jul 1;25(1):232.
- Sanchez-Escamilla M, Flynn J, Devlin S, et al. EASIX score predicts inferior survival after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2023 May;58(5):498-505.
- Vythoulkas D, Tsirigotis P, Griniezaki M, et aI. Endothelial Dysfunction Syndromes after Allogeneic Stem Cell Transplantation. Cancers (Basel). 2023 Jan 22;15(3):680.
- Aldecoa C, Llau JV, Nuvials X and Artigas A. Role of albumin in the preservation of endothelial glycocalyx integrity and the microcirculation: a review. Ann Intensive Care. 2020 Jun 22;10(1):85.
- Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M; Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001 Nov;86(5):1327-30.
Akut miyeloid lösemide endotel aktivasyonu ve stres indeksi ile sağkalım ve erken mortalitenin ilişkisi
Abstract
Amaç: Endotelyal Aktivasyon ve Stres İndeksi (EASIX) skoru, endotel hasarının bir belirteci olarak ve akut greft-versus-host hastalığı ile sinüzoidal obstrüksiyon sendromunu öngörmek için kullanılır. Bu çalışmada, EASIX, modifiye EASIX (mEASIX) ve sepsis modifiye EASIX (sEASIX) skorlarının akut miyeloid lösemi hastalarında erken mortalite ve genel sağkalım (OS) üzerindeki etkilerini değerlendirmek amaçlanmıştır.
Gereç ve Yöntem: Gereç ve Yöntem: Hematoloji kliniğimizde Akut Miyeloid Lösemi (AML) tanısı konulan ve takibi yapılan hastaları retrospektif olarak inceledik. Çalışmaya 18-70 yaş aralığında, 7+3 (7 gün sitarabin ve 3 gün antrasiklin) kemoterapi protokolü uygulanan (akut promiyelositik lösemi hariç) hastalar dahil edildi. Hastaların tanı anında ve dördüncü haftanın sonundaki EASIX, mEASIX ve sEASIX skorları hesaplandı.
Bulgular: Çalışmaya 75 hasta dahil edildi. Ortalama yaş 49,05 (19-68) yıldı ve %41'i hayattaydı. Hem tanı anında hem de indüksiyon tedavisinin sonunda ölçülen EASIX ve mEASIX skorlarının erken mortalite (p=0,01, p<0,01) ve OS (p<0,01, p<0,01) ile anlamlı şekilde ilişkili olduğu bulundu.
Sonuç: AML'de yoğun tedavi gören bu hastalarda erken mortaliteyi göstermek için klinikte pratik olarak kullanabileceğimiz spesifik bir skorlama sistemi veya belirteç bulunmamaktadır. Elbette, bu dönemde mortaliteyi etkileyebilecek birçok faktör bulunmaktadır. Ancak, mevcut sonuçlara dayanarak, EASIX, mEASIX ve sEASIX skorlarının erken mortalite ve sağkalımı öngörmek için diğer prognostik faktörlerle birlikte kullanılabileceğini düşünüyoruz.
References
- Shallis RM, Wang R, Davidoff A and et al. Epidemiology of acute myeloid leukemia: Recent progress and enduring challenges. Blood Rev. 2019 Jul;36:70-87.
- Song GY, Jung SH, Kim K, et al. Endothelial activation and stress index (EASIX) is a reliable predictor for overall survival in patients with multiple myeloma. BMC Cancer. 2020 Aug 24;20(1):803.
- Merz A, Germing U, Kobbe G, et al. EASIX for prediction of survival in lower-risk myelodysplastic syndromes. Blood Cancer J. 2019 Nov 11;9(11):85.
- Pennisi M, Sanchez-Escamilla M, Flynn JR, et al. Modified EASIX predicts severe cytokine release syndrome and neurotoxicity after chimeric antigen receptor T cells. Blood Adv. 2021 Sep 14;5(17):3397-3406.
- Li Y, Jiang L, Song T, et al. A call for better understanding the role of albumin in mediating VE-cadherin phosphorylation and endothelial barrier dysfunction in septic patients. Crit Care. 2021 Jul 1;25(1):232.
- Sanchez-Escamilla M, Flynn J, Devlin S, et al. EASIX score predicts inferior survival after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2023 May;58(5):498-505.
- Vythoulkas D, Tsirigotis P, Griniezaki M, et aI. Endothelial Dysfunction Syndromes after Allogeneic Stem Cell Transplantation. Cancers (Basel). 2023 Jan 22;15(3):680.
- Aldecoa C, Llau JV, Nuvials X and Artigas A. Role of albumin in the preservation of endothelial glycocalyx integrity and the microcirculation: a review. Ann Intensive Care. 2020 Jun 22;10(1):85.
- Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M; Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001 Nov;86(5):1327-30.
Details
| Primary Language | English |
|---|---|
| Subjects | Haematology |
| Journal Section | Research Article |
| Authors | |
| Publication Date | December 8, 2025 |
| Submission Date | February 2, 2025 |
| Acceptance Date | July 3, 2025 |
| Published in Issue | Year 2025 Volume: 64 Issue: 4 |
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