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. 2024 Jan;26(1):73-80.
doi: 10.1016/j.jcyt.2023.10.008. Epub 2023 Nov 10.

Endothelial Activation and Stress Index in adults undergoing allogeneic hematopoietic cell transplantation with post-transplant cyclophosphamide-based prophylaxis

Silvia Escribano-Serrat  1 , Luis Gerardo Rodríguez-Lobato  2 , Paola Charry  2 , Nuria Martínez-Cibrian  2 , María Suárez-Lledó  2 , Andrea Rivero  2 , Ana Belén Moreno-Castaño  3 , María Teresa Solano  2 , Jordi Arcarons  2 , Meritxell Nomdedeu  2 , Joan Cid  4 , Miquel Lozano  2 , Alexandra Pedraza  2 , Laura Rosiñol  2 , Jordi Esteve  2 , Álvaro Urbano-Ispizua  2 , Marta Palomo  2 , Francesc Fernández-Avilés  2 , Carmen Martínez  2 , Maribel Díaz-Ricart  3 , Enric Carreras  5 , Montserrat Rovira  2 , María Queralt Salas  6
Affiliations

Endothelial Activation and Stress Index in adults undergoing allogeneic hematopoietic cell transplantation with post-transplant cyclophosphamide-based prophylaxis

Silvia Escribano-Serrat et al. Cytotherapy. 2024 Jan.

Abstract

Background aims: Post-transplant cyclophosphamide (PTCY)-based prophylaxis is becoming widespread for allogeneic hematopoietic cell transplantation (allo-HCT) performed independently of the selected donor source. In parallel, use of the Endothelial Activation and Stress Index (EASIX)-considered a surrogate parameter of endothelial activation-for predicting patient outcomes and clinical complications is gaining popularity in the allo-HCT setting.

Methods: We first investigated whether the dynamics of EASIX after allo-HCT differ between patients receiving PTCY and patients receiving other prophylaxis. We then investigated whether the predictive capacity of EASIX persists in PTCY-based allo-HCT. A total of 328 patients transplanted between 2014 and 2020 were included, and 201 (61.2%) received PTCY.

Results: EASIX trends differed significantly between the groups. Compared with patients receiving other prophylaxis, patients receiving PTCY had lower EASIX on day 0 and higher values between day 7 and day 100. In patients receiving PTCY, higher EASIX correlated significantly with higher non-relapse mortality (NRM) and lower overall survival (OS) when measured before and during the first 180 days after allo-HCT. In addition, higher EASIX scores measured at specific time points were predictors of veno-occlusive disease (VOD), transplant-associated thrombotic microangiopathy (TA-TMA) and grade 2-4 acute graft-versus-host disease (aGVHD) risk.

Conclusions: This study demonstrates how EASIX trends vary during the first 180 days after allo-HCT in patients receiving PTCY and those not receiving PTCY and validates the utility of this index for predicting NRM, OS and risk of VOD, TA-TMA and grade 2-4 aGVHD in patients receiving PTCY.

Keywords: EASIX; allogeneic hematopoietic cell transplantation; endothelial complications; outcomes; post-transplant cyclophosphamide; prediction.

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Conflict of interest statement

Declaration of Competing Interest The authors have no commercial, proprietary or financial interest in the products or companies described in this article.

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