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EASIX predicts non-relapse mortality after haploidentical transplantation with post-transplant cyclophosphamide

Bone Marrow Transplantation volume 58, pages 247–256 (2023)Cite this article

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Abstract

Endothelial Activation and Stress Index (EASIX) is a prognostic score reflecting endothelial damage. It can identify cohorts of patients at higher risk of non-relapse mortality (NRM) after allogeneic stem cell transplantation (SCT) from a matched-related or -unrelated donor. No data are available in the setting of haploidentical-SCT with post-transplant cyclophosphamide (PT-Cy). We retrospectively analyzed the role of EASIX score in a cohort of 266 patients receiving Haplo-SCT with PT-Cy at our center. By a decision-tree model, 1-year NRM was 16% vs. 29% and overall survival was 59% vs. 32%, respectively, for patients with a pre-transplant EASIX (EASIX-PRE) <0.8 vs. ≥0.8 (p < 0.001). By multivariable analysis, EASIX-PRE was an independent predictor of NRM (hazard ratio [HR] 2.43, p < 0.001) and overall survival (HR: 1.64, p = 0.011). EASIX-PRE did not predict patients at higher risk of developing acute graft-versus-host disease (GVHD) but was an independent predictor of 1-year NRM (3.2 cutoff, HR 6.61, p = 0.002; <3.2 vs. ≥3.2: 10% vs. 56%, p < 0.001) in patients developing acute GVHD. EASIX score can also represent an important tool to predict mortality in the setting of Haplo-SCT with PT-Cy. It may help to make therapeutic decisions both before the transplant and at the onset of acute GVHD.

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Fig. 1: EASIX-PRE and EASIX-GVHD predict NRM and OS for patients undergoing Haplo-SCT with PT-Cy.

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All data are available from the corresponding author upon reasonable request.

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Acknowledgements

Editorial assistance was provided by Valentina Attanasio and Aashni Shah (Polistudium SRL, Milan, Italy). This assistance was supported by internal funds.

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Authors and Affiliations

  1. BMT and Cell Therapy Unit, Humanitas Clinical and Research Center – IRCCS, Humanitas Cancer Center, Rozzano, Italy

    Jacopo Mariotti, Filippo Magri, Chiara De Philippis, Barbara Sarina, Daniele Mannina, Daniela Taurino & Stefania Bramanti

  2. Biostatistics Unit, Humanitas Clinical and Research Center – IRCCS, Humanitas Cancer Center, Rozzano, Italy

    Laura Giordano & Armando Santoro

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JM designed and performed research, analyzed and interpreted data, wrote the manuscript; LG performed statistical analyses, analyzed and interpreted the data; FM, BS, CDP, and DM collected data; AS and SB revised the manuscript and provided data interpretation.

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Correspondence to Jacopo Mariotti.

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Mariotti, J., Magri, F., Giordano, L. et al. EASIX predicts non-relapse mortality after haploidentical transplantation with post-transplant cyclophosphamide. Bone Marrow Transplant 58, 247–256 (2023). https://doi.org/10.1038/s41409-022-01874-5

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