1
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Finke D, Hund H, Frey N, Luft T, Lehmann LH. EASIX (endothelial activation and stress index) predicts mortality in patients with coronary artery disease. Clin Res Cardiol 2024:10.1007/s00392-024-02534-y. [PMID: 39256221 DOI: 10.1007/s00392-024-02534-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 08/22/2024] [Indexed: 09/12/2024]
Abstract
BACKGROUND Coronary interventions reduce morbidity and mortality in patients with acute coronary syndrome. However, the risk of mortality for patients with coronary artery disease (CAD) additionally depends on their systemic endothelial health status. The 'Endothelial Activation and Stress Index' (EASIX) predicts endothelial complications and survival in diverse clinical settings. OBJECTIVE We hypothesized that EASIX may predict mortality in patients with CAD. METHODS In 1283 patients undergoing coronary catheterization (CC) and having a diagnosis of CAD, EASIX was measured within 52 days (range - 1 year to - 14 days) before CC and correlated with overall survival. In an independent validation cohort of 1934 patients, EASIXval was measured within 174 days (+ 28 days to + 11 years) after CC. RESULTS EASIX predicted the risk of mortality after CC (per log2: hazard ratio (HR) 1.29, 95% confidence interval: [1.18-1.41], p < 0.001) in multivariable Cox regression analyses adjusting for age, sex, a high-grade coronary stenosis ≥ 90%, left ventricular ejection fraction, arterial hypertension and diabetes. In the independent cohort, EASIX correlated with EASIXval with rho = 0.7. The long-term predictive value of EASIXval was confirmed (per log2: HR 1.53, [1.42-1.64], p < 0.001) and could be validated by integrated Brier score and concordance index. Pre-established cut-offs (0.88-2.32) associated with increased mortality (cut-off 0.88: HR training: 1.63; HR validation: 1.67, p < 0.0001 and cut-off 2.32: HR training: 3.57; HR validation: 4.65, p < 0.0001). CONCLUSIONS We validated EASIX as a potential biomarker to predict death of CAD patients, irrespective of the timing either before or after catheterization.
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Affiliation(s)
- Daniel Finke
- Department of Cardiology, Medizinische Klinik III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partnersite Heidelberg/Mannheim, Heidelberg, Germany
| | - Hauke Hund
- Department of Cardiology, Medizinische Klinik III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Medizinische Klinik III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- German Center for Cardiovascular Research (DZHK), Partnersite Heidelberg/Mannheim, Heidelberg, Germany
| | - Thomas Luft
- Department of Oncology and Haematology, Medizinische Klinik V, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Lorenz H Lehmann
- Department of Cardiology, Medizinische Klinik III, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- German Center for Cardiovascular Research (DZHK), Partnersite Heidelberg/Mannheim, Heidelberg, Germany.
- German Cancer Research Center (DKFZ), 69120, Heidelberg, Germany.
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2
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Zhang Q, Zhu X, Xiao Y. The critical role of endothelial cell in the toxicity associated with chimeric antigen receptor T cell therapy and intervention strategies. Ann Hematol 2024; 103:2197-2206. [PMID: 38329486 PMCID: PMC11224091 DOI: 10.1007/s00277-024-05640-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024]
Abstract
Chimeric antigen receptor (CAR)-T cell therapy has shown promising results in patients with hematological malignancies. However, many patients still have poor prognoses or even fatal outcomes due to the life-threatening toxicities associated with the therapy. Moreover, even after improving the known influencing factors (such as number or type of CAR-T infusion) related to CAR-T cell infusion, the results remain unsatisfactory. In recent years, it has been found that endothelial cells (ECs), which are key components of the organization, play a crucial role in various aspects of immune system activation and inflammatory response. The levels of typical markers of endothelial activation positively correlated with the severity of cytokine release syndrome (CRS) and immune effector cell-associated neurotoxic syndrome (ICANS), suggesting that ECs are important targets for intervention and toxicity prevention. This review focuses on the critical role of ECs in CRS and ICANS and the intervention strategies adopted.
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Affiliation(s)
- Qi Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaojian Zhu
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Yi Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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3
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Zhao Y, Zhang X, Zhang M, Guo R, Zhang Y, Pu Y, Zhu H, Liu P, Zhang Y, He X, Lyu C, Lyu H, Xiao X, Zhao M. Modified EASIX scores predict severe CRS/ICANS in patients with acute myeloid leukemia following CLL1 CAR-T cell therapy. Ann Hematol 2024; 103:969-980. [PMID: 38214708 DOI: 10.1007/s00277-024-05617-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
Chimeric antigen receptor T (CAR-T) cell therapy targeting CLL1 has been considered a potent weapon for patients with acute myeloid leukemia (AML). This study aims to evaluate the efficacy and toxicity of CLL1 CAR-T cell therapy in a larger cohort, with particular attention to cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Among the 32 patients assessed for efficacy, complete remission occurred in 71.88% (23/32) of cases and undetectable minimal residual disease in 14 patients. The CRS developed in all patients, with 8 individuals experiencing ICANS. Severe CRS and ICANS were observed in 11 and 2 patients, respectively. Furthermore, the Endothelial Activation and Stress Index (EASIX) and its derivatives measured before and after CLL1 CAR-T cell infusion were employed for predicting the severe complications. Significant differences were observed in EASIX scores on the day before lymphodepletion (Day BL, P = 0.023), -1 (P < 0.001), +1 (P < 0.001), and +3(P = 0.014); sEASIX scores on Day BL (P = 0.007), -1 (P < 0.001), +1 (P < 0.001), and +3 (P < 0.001); and mEASIX score on Day -1 (P = 0.004) between patients with mild and severe CRS/ICANS. Additionally, there was a significant difference in mEASIX scores between responders and non-responders on Day BL (P = 0.004) and Day -1 (P = 0.044). Our findings indicate that pre- and post-infusion assessments of EASIX/mEASIX/sEASIX scores serve as reliable prognostic indicators for severe CRS/ICANS and treatment response following CLL1 CAR-T cell therapy, which can assist physicians in implementing preemptive treatment strategies for potential severe complications and screening patients who are suitable candidates for CLL1 CAR-T cell therapy. EASIX/mEASIX/sEASIX scores serve as reliable prognostic indicators for severe CRS/ICANS following CLL1 CAR-T cell therapy. The preinfusion mEASIX scores of CLL1 CAR-T cells can effectively predict treatment response.
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Affiliation(s)
- Yifan Zhao
- The First Central Clinical College of Tianjin Medical University, Tianjin, 300380, China
| | - Xiaomei Zhang
- Nankai University School of Medicine, Tianjin, 300380, China
| | - Meng Zhang
- The First Central Clinical College of Tianjin Medical University, Tianjin, 300380, China
| | - Ruiting Guo
- The First Central Clinical College of Tianjin Medical University, Tianjin, 300380, China
| | - Yi Zhang
- The First Central Clinical College of Tianjin Medical University, Tianjin, 300380, China
| | - Yedi Pu
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300380, China
| | - Haibo Zhu
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300380, China
| | - Pengjiang Liu
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300380, China
| | - Yu Zhang
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300380, China
| | - Xiaoyuan He
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300380, China
| | - Cuicui Lyu
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300380, China
| | - Hairong Lyu
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300380, China
| | - Xia Xiao
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300380, China.
| | - Mingfeng Zhao
- Department of Hematology, Tianjin First Central Hospital, Tianjin, 300380, China.
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4
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Penack O, Luft T, Peczynski C, Benner A, Sica S, Arat M, Itäla-Remes M, Corral LL, Schaap NPM, Karas M, Raida L, Schroeder T, Dreger P, Metafuni E, Ozcelik T, Sandmaier BM, Kordelas L, Moiseev I, Schoemans H, Koenecke C, Basak GW, Peric Z. Endothelial Activation and Stress Index (EASIX) to predict mortality after allogeneic stem cell transplantation: a prospective study. J Immunother Cancer 2024; 12:e007635. [PMID: 38199608 PMCID: PMC10806535 DOI: 10.1136/jitc-2023-007635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND We previously reported that the "Endothelial Activation and Stress Index" (EASIX; ((creatinine×lactate dehydrogenase)÷thrombocytes)) measured before start of conditioning predicts mortality after allogeneic hematopoietic stem cell transplantation (alloSCT) when used as continuous score. For broad clinical implementation, a prospectively validated EASIX-pre cut-off is needed that defines a high-risk cohort and is easy to use. METHOD In the current study, we first performed a retrospective cohort analysis in n=2022 alloSCT recipients and identified an optimal cut-off for predicting non-relapse mortality (NRM) as EASIX-pre=3. For cut-off validation, we conducted a multicenter prospective study with inclusion of n=317 first alloSCTs from peripheral blood stem cell in adult patients with acute leukemia, lymphoma or myelodysplastic syndrome/myeloproliferative neoplasms in the European Society for Blood and Marrow Transplantation network. RESULTS Twenty-three % (n=74) of alloSCT recipients had EASIX-pre ≥3 taken before conditioning. NRM at 2 years was 31.1% in the high EASIX group versus 11.5% in the low EASIX group (p<0.001). Patients with high EASIX-pre also had worse 2 years overall survival (51.6% vs 70.9%; p=0.002). We were able to validate the cut-off and found that EASIX ≥3 was associated with more than twofold increased risk for NRM in multivariate analysis (HR=2.18, 95% CI 1.2 to 3.94; p=0.01). No statistically significant difference could be observed for the incidence of relapse. CONCLUSIONS The results of this study provide a prospectively validated standard laboratory biomarker index to estimate the transplant-related mortality risk after alloSCT. EASIX ≥3 taken before conditioning identifies a population of alloSCT recipients who have a more than twofold increased risk of treatment-related mortality.
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Affiliation(s)
- Olaf Penack
- Department for Haematology, Oncology and Tumorimmunology, Charité Universitätsmedizin Berlin, Berlin, Germany
- EBMT Transplant Complications Working Party, Heidelberg, Germany
| | - Thomas Luft
- Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Christophe Peczynski
- EBMT Transplant Complications Working Party, Paris, France
- Department of Haematology, Sorbonne University, Paris, France
| | - Axel Benner
- German Cancer Research Centre, Heidelberg, Germany
| | - Simona Sica
- Istituto di Ematologia, Universita Cattolica S. Cuore, Rome, Italy
| | - Mutlu Arat
- Florence Nightingale Hospital, Hematopoietic SCT Unit, Demiroglu Bilim University Istanbul, Istanbul, Turkey
| | | | - Lucia López Corral
- Department for Haematology, Hospital Clinico San Carlos, Salamanca, Spain
| | | | - Michal Karas
- Hospital Dept. of Hematology/Oncology, Charles University, Pilsen, Czech Republic
| | - Ludek Raida
- Olomouc University Social Health Institute, Olomouc, Czech Republic
| | - Thomas Schroeder
- Dept. of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | - Peter Dreger
- Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Tulay Ozcelik
- Florence Nightingale Hospital, Hematopoietic SCT Unit, Demiroglu Bilim University Istanbul, Istanbul, Turkey
| | | | - Lambros Kordelas
- Dept. of Hematology and Stem Cell Transplantation, University Hospital Essen, Essen, Germany
| | - Ivan Moiseev
- EBMT Transplant Complications Working Party, Paris, France
- First Pavlov State Medical University of St Petersburg, St Petersburg, Russian Federation
| | - Hélène Schoemans
- EBMT Transplant Complications Working Party, Paris, France
- Department of Hematology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Christian Koenecke
- Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Grzegorz W Basak
- EBMT Transplant Complications Working Party, Paris, France
- Department of Hematology, Oncology and Internal Medicine, the Medical University of Warsaw, Warsaw, Poland
| | - Zinaida Peric
- EBMT Transplant Complications Working Party, Paris, France
- Department of Hematology, University of Rijeka, Rijeka, Croatia
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5
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Escribano-Serrat S, Rodríguez-Lobato LG, Charry P, Martínez-Cibrian N, Suárez-Lledó M, Rivero A, Moreno-Castaño AB, Solano MT, Arcarons J, Nomdedeu M, Cid J, Lozano M, Pedraza A, Rosiñol L, Esteve J, Urbano-Ispizua Á, Palomo M, Fernández-Avilés F, Martínez C, Díaz-Ricart M, Carreras E, Rovira M, Salas MQ. Endothelial Activation and Stress Index in adults undergoing allogeneic hematopoietic cell transplantation with post-transplant cyclophosphamide-based prophylaxis. Cytotherapy 2024; 26:73-80. [PMID: 37952139 DOI: 10.1016/j.jcyt.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/09/2023] [Accepted: 10/27/2023] [Indexed: 11/14/2023]
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.
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Affiliation(s)
- Silvia Escribano-Serrat
- Department of Hematology and Hemotherapy, Hospital Clínico San Carlos, IdiSSC, Madrid, Spain; Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Luis Gerardo Rodríguez-Lobato
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Paola Charry
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Nuria Martínez-Cibrian
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - María Suárez-Lledó
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Andrea Rivero
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Ana Belén Moreno-Castaño
- Hematopathology, Pathology Department, CDB, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - María Teresa Solano
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Jordi Arcarons
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Meritxell Nomdedeu
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Joan Cid
- Apheresis and Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Miquel Lozano
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Alexandra Pedraza
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Laura Rosiñol
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Jordi Esteve
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Álvaro Urbano-Ispizua
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Marta Palomo
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Francesc Fernández-Avilés
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Carmen Martínez
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - Maribel Díaz-Ricart
- Hematopathology, Pathology Department, CDB, Hospital Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Enric Carreras
- Fundació i Institut de Recerca Josep Carreras Contra la Leucèmia (Campus Clínic), Barcelona, Spain
| | - Montserrat Rovira
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain
| | - María Queralt Salas
- Hematopoietic Transplantation Unit, Hematology Department, Clinical Institute of Hematology and Oncology, IDIBAPS, Hospital Clínic Barcelona, Barcelona, Spain.
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6
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Thanhakun R, Wudhikarn K, Bunworasate U, Rattanathammethee T, Norasetthada L, Kanya P, Chaloemwong J, Wongkhantee S, Phiphitaporn P, Chansung K, Jit-Ueakul D, Laoruangroj C, Prayongratana K, Wong P, Julamanee J, Lekhakula A, Chuncharunee S, Niparuck P, Kanitsap N, Makruasi N, Suwanban T, Praditsuktavorn P, Khuhapinant A, Intragumtornchai T. Endothelial activation and stress index as a prognostic factor of diffuse large B-cell lymphoma: the report from the nationwide multi-center Thai Lymphoma Study Group. Ann Hematol 2023; 102:3533-3541. [PMID: 37718327 DOI: 10.1007/s00277-023-05437-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Abstract
Several prognostic models have been introduced to predict outcomes of patients with diffuse large B-cell lymphoma (DLBCL). Endothelial activation and stress index (EASIX) is a surrogate of endothelial dysfunction which has been shown to predict outcomes of patients with various hematologic malignancies. However, the prognostic implication of EASIX for DLBCL is limited and warrants exploration. We conducted a retrospective study enrolling adult DLBCL patients including a discovery cohort from the single-centered university hospital database and a validation cohort from the independent nationwide multi-center registry. EASIX scores were calculated using creatinine, lactate dehydrogenase, and platelet levels. The receiver operating characteristic curve analysis was used to determine optimal cutoff. Statistical analysis explored the impact of EASIX on survival outcomes. A total of 323 patients were included in the discovery cohort. The optimal EASIX cutoff was 1.07 stratifying patients into low (53.9%) and high EASIX (46.1%) groups. Patients with high EASIX had worse 2-year progression-free survival (PFS) (53.4% vs. 81.5%, p<0.001) and overall survival (OS) (64.4% vs. 88.7%, p<0.001) than patients with low EASIX. Multivariate analysis revealed that older age, bulky disease, impaired performance status, and high EASIX were associated with an unfavorable OS. In the validation cohort of 499 patients, the optimal EASIX cutoff was 1.04. Similar to the discovery cohort, high EASIX score was associated with high-risk diseases, worse PFS, and inferior OS. In conclusion, EASIX score was significantly associated with survival outcomes and may be used as a simple prognostic tool to better risk-classify DLBCL.
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Affiliation(s)
- Ronakrit Thanhakun
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kitsada Wudhikarn
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
| | - Udomsak Bunworasate
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | | | - Lalita Norasetthada
- Division of Hematology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Piyapong Kanya
- Division of Hematology, Chiang Rai Prachanukroh Hospital, Chiang Rai, Thailand
| | | | | | - Pisa Phiphitaporn
- Division of Hematology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kanchana Chansung
- Division of Hematology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Dusit Jit-Ueakul
- Division of Hematology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Chonlada Laoruangroj
- Division of Hematology, Faculty of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Kannadit Prayongratana
- Division of Hematology, Faculty of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Peerapon Wong
- Division of Hematology, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Jakrawadee Julamanee
- Hematology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Arnuparp Lekhakula
- Hematology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Suporn Chuncharunee
- Division of Hematology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pimjai Niparuck
- Division of Hematology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nonglak Kanitsap
- Division of Hematology, Faculty of Medicine, Thammasart University, Bangkok, Thailand
| | - Nisa Makruasi
- Division of Hematology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Tawatchai Suwanban
- Division of Hematology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | | | - Archrob Khuhapinant
- Division of Hematology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tanin Intragumtornchai
- Division of Hematology and Center of Excellence in Translational Hematology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
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7
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Yegin ZA, Savaş EM, Yıldız Ş, Kök Mİ, Erdemir MB, Bostankolu Değirmenci B, Özkurt ZN, Yağcı M. Preconditioning Modified-Easix as a Predictor of Prognosis in Allogeneic Hematopoietic Stem Cell Transplant Recipients. Indian J Hematol Blood Transfus 2023; 39:586-597. [PMID: 37786821 PMCID: PMC10542067 DOI: 10.1007/s12288-022-01623-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (alloHCT) is associated with severe complications, most of which share a common physiopathological background characterized by endothelial dysfunction. A novel risk assessment model, endothelial activation and stress index (EASIX), has been introduced as a predictor of endothelial activation. This retrospective study was performed to evaluate the predictive impact of EASIX/modified-EASIX (mEASIX) on transplant outcome. Medical records of 398 alloHCT recipients [median age: 43(17-71) years; M/F: 243/155] were examined. EASIX/mEASIX were calculated at specific time points before and after transplantation. EASIX/mEASIX were significantly associated with transplant complications including engraftment syndrome, sinusoidal obstruction syndrome, febrile neutropenia and transplant associated thrombotic microangiopathy. The probability of overall survival was significantly higher in low-preconditioning mEASIX (day -7) group (37% vs 25.2%; p = 0.008; HR: 2.057; 95% CI: 1.208-3.504). The probabilities of day30 mortality (2.9% vs 19.4%; p = 0.017; HR: 7.028; 95% CI: 1.418-34.836), day100 mortality (9% vs 33%; p = 0.004; HR: 4.469; 95% CI: 1.619-12.336) and non relapse mortality (44.8% vs 61.4%; p = 0.005; HR: 2.551; 95% CI: 1.318-4.941) were lower in low-preconditioning mEASIX (day -7) group. This retrospective cohort analysis demonstrates the significant impact of EASIX/mEASIX on transplant complications and survival. Prospective analyses are mandatory to assess the predictive role of EASIX/mEASIX in clinical practice.
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Affiliation(s)
- Zeynep Arzu Yegin
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emine Merve Savaş
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Şeyma Yıldız
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Münevver İrem Kök
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Meltem Büşra Erdemir
- Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Zübeyde Nur Özkurt
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Münci Yağcı
- Department of Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
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8
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Kordelas L, Terzer T, Gooley T, Davis C, Sandmaier BM, Sorror M, Penack O, Schaeper NDE, Blau IW, Beelen D, Radujkovic A, Dreger P, Luft T. EASIX-1year and late mortality after allogeneic stem cell transplantation. Blood Adv 2023; 7:5374-5381. [PMID: 37477588 PMCID: PMC10509665 DOI: 10.1182/bloodadvances.2022008617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 04/18/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
Patients with hematological malignancies who survive the first year after allogeneic stem cell transplantation (allo-SCT) without relapse have a substantial risk of nonrelapse mortality (NRM) and missing predictive markers. The Endothelial Activation and Stress Index (EASIX) predicts endothelial complications and NRM early after allo-SCT. We hypothesized that EASIX assessed 1 year after allo-SCT in survivors who were disease free may predict late NRM. Survivors who were relapse-free at 1 year after allo-SCT were retrospectively studied in 2 independent cohorts (training cohort, n = 610; merged validation cohort, n = 852). EASIX determined 1 year after allo-SCT correlated with the overall survival (OS), NRM, and relapse. Serum endothelial and inflammatory markers were measured in the training cohort and correlated with EASIX-1year, which predicted OS and NRM but not relapse risk in both the training and validation cohorts in univariable and multivariable Cox regression analyses. Brier score and c-index analyses validated the univariable EASIX effects. There was no significant interaction between EASIX-1year and incidence of chronic graft-versus-host disease (GVHD) on OS. EASIX-1year predicted the outcome irrespective of preexisting comorbidities. Principal causes of NRM in both training and validation cohorts were infections with and without GVHD as well as cardiovascular complications. EASIX-1year correlated with sCD141 and interleukin-18 but not with C-reactive protein, suppressor of tumorigenicity-2, angiopoietin-2, CXCL9, or CXCL8. To our knowledge, EASIX-1year is the first validated predictor of late overall and NRM. Patients who are high risk as defined by EASIX-1year might be considered for intensified surveillance and prophylactic measures.
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Affiliation(s)
- Lambros Kordelas
- Department of Bone Marrow Transplantation, West German Cancer Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Tobias Terzer
- Division of Biostatistics, German Cancer Research Centre, Heidelberg, Germany
| | - Ted Gooley
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington, Seattle, WA
| | - Chris Davis
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Brenda M. Sandmaier
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington, Seattle, WA
| | - Mohamed Sorror
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington, Seattle, WA
| | - Olaf Penack
- Hematology, Oncology and Tumorimmunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nigel D. E. Schaeper
- Hematology, Oncology and Tumorimmunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Igor W. Blau
- Hematology, Oncology and Tumorimmunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Dietrich Beelen
- Department of Bone Marrow Transplantation, West German Cancer Centre, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Peter Dreger
- Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Luft
- Medicine V, University Hospital Heidelberg, Heidelberg, Germany
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9
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Xu HB, Ye Y, Xue F, Wu J, Suo Z, Zhang H. Association Between Endothelial Activation and Stress Index and 28-Day Mortality in Septic ICU patients: a Retrospective Cohort Study. Int J Med Sci 2023; 20:1165-1173. [PMID: 37575274 PMCID: PMC10416722 DOI: 10.7150/ijms.85870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Background: Endothelial Activation and Stress Index (EASIX) is a reliable alternative biomarker of endothelial dysfunction. Because endothelial activation is involved in sepsis pathophysiology, we aimed to investigate the association between EASIX and prognosis in septic patients. Methods: Data were extracted from the Medical Information Mart for Intensive Care (MIMIC) IV database. EASIX scores were calculated using the formula: lactate dehydrogenase (U/L) × creatinine (mg/dL)/platelet count (109/L). Patients were grouped into tertiles according to log2 transformed EASIX. The primary and secondary outcomes were 28-day and 90-day mortality. Cox proportional hazards models, Kaplan-Meier curves, restricted cubic spline curves, and subgroup analyses were conducted to evaluate the association between EASIX and prognosis in septic patients. Results: A total of 7504 patients were included. Multivariable Cox proportional hazards analyses showed that higher log2-EASIX was associated with increased risk of 28-day mortality (HR, 1.10; 95% CI, 1.07-1.13; P < 0.001). Compared with tertile 1, the tertile 2 and 3 groups had higher risk of 28-day mortality [HR (95% CI) 1.24 (1.09-1.41); HR (95% CI) 1.51 (1.31-1.74)]; P for trend < 0.001). Similar results were found for 90-day mortality. Kaplan-Meier curves showed that patients with higher EASIX had lower 28-day and 90-day survival rates. A linear relationship was found between log2-EASIX and 28-day and 90-day mortality. Conclusion: High EASIX was significantly associated with an increased risk of 28-day and 90-day all-cause mortality in patients with sepsis.
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Affiliation(s)
- Hong-Bo Xu
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518033, China
- Department of Critical Care Medicine, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518033, China
| | - Yuan Ye
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518033, China
- Department of Critical Care Medicine, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518033, China
| | - Fang Xue
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518033, China
- Department of Critical Care Medicine, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518033, China
| | - Jinglan Wu
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518033, China
- Department of Critical Care Medicine, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518033, China
| | - Zhijun Suo
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518033, China
- Department of Critical Care Medicine, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518033, China
| | - Haigang Zhang
- Department of Critical Care Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen 518033, China
- Department of Critical Care Medicine, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen 518033, China
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10
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Schult D, Rasch S, Schmid RM, Lahmer T, Mayr U. EASIX Is an Accurate and Easily Available Prognostic Score in Critically Ill Patients with Advanced Liver Disease. J Clin Med 2023; 12:jcm12072553. [PMID: 37048641 PMCID: PMC10094870 DOI: 10.3390/jcm12072553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/18/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
Acute-on-chronic liver failure (ACLF) is associated with high mortality. Objective prognostic scores are important for treatment decisions. EASIX (Endothelial Activation and Stress Index) is a simple biomarker consisting of LDH, platelets, and creatinine, reflecting endothelial dysfunction after allogeneic stem cell transplantation. Considering endothelial dysfunction in the pathogenesis of ACLF, this study aimed to test the discriminative ability of EASIX in advanced liver disease. We retrospectively analysed the prognostic potential of EASIX to predict 28-day and 3-month mortality in a total of 188 liver cirrhotic patients requiring treatment at the intensive care unit. We evaluated the ability of EASIX to rule out early infections and predict the need for hemodialysis. EASIX performed moderately better than established scores in predicting 28-day mortality (AUC = 0.771) and was nearly equivalent (AUC = 0.791) to SOFA and APACHE-II in the prediction of 3-month mortality. Importantly, EASIX showed better diagnostic potential in ruling out clinically apparent infections than common proinflammatory markers (AUC = 0.861, p < 0.001) and showed suitable accuracy in predicting the need for hemodialysis (AUC = 0.833). EASIX is an accurate, objective and easily assessable biomarker for predicting mortality and complications in patients with advanced liver disease.
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11
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Pabst C, Schreck N, Benner A, Hegenbart U, Schönland S, Radujkovic A, Schmitt M, Müller-Tidow C, Orsatti L, Dreger P, Luft T. Statin-based endothelial prophylaxis and outcome after allogeneic stem cell transplantation. Eur J Clin Invest 2023; 53:e13883. [PMID: 36199203 DOI: 10.1111/eci.13883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/01/2022] [Accepted: 10/02/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Allogeneic haematopoietic stem cell transplantation (alloSCT) often remains the only curative therapy for hematologic malignancies. Although the management of transplant-associated adverse events considerably improved over the last decades, nonrelapse mortality (NRM) remains a challenge, and endothelial dysfunction was identified as a major contributor to NRM. METHODS Statin-based endothelial prophylaxis (SEP) has been implemented in the standard of care in our transplant centre to reduce NRM caused by endothelial injury. Here, we retrospectively analysed the impact of SEP on clinical outcome in a cohort of 347 alloSCT patients. RESULTS SEP (n = 209) was associated with significantly reduced NRM (hazard ratio 0.61, 95% CI 0.38-0.96) and better overall survival (OS) after acute graft-versus-host disease (HR 0.59, 95% CI 0.37-0.93). Subgroup analyses showed that the NRM benefit was mainly found in patients with an intermediate endothelial activation and stress index (EASIX), while relapse risk was not affected. On day 100 post-alloSCT, patients receiving SEP had significantly higher levels of the rate-limiting enzyme of tryptophan metabolism, indoleamine 2,3-dioxygenase (IDO), higher kynurenine to tryptophan ratios as a proxy of IDO activity and tended to have lower levels of the endothelial injury marker ST2 (p = .055). No significant differences in interferon-gamma or IL18 levels were observed. These biomarker signatures suggest that the beneficial effects of SEP might be mediated by both endothelial protection and immunomodulation. CONCLUSIONS Together, these data suggest that SEP improves NRM and OS post-alloSCT in particular in patients with intermediate endothelial risk and provide first mechanistic clues about its potential mode of action.
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Affiliation(s)
- Caroline Pabst
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicholas Schreck
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Ute Hegenbart
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Schönland
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Michael Schmitt
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Laura Orsatti
- ADME/DMPK Department, IRBM SpA, Pomezia, Rome, Italy
| | - Peter Dreger
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Luft
- Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
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12
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Mądry K, Lis K, Fenaux P, Bowen D, Symeonidis A, Mittelman M, Stauder R, Čermák J, Sanz G, Hellström-Lindberg E, Langemeijer S, Malcovati L, Germing U, Holm MS, Guerci-Bresler A, Culligan D, Sanhes L, Kotsianidis I, van Marrewijk C, Crouch S, de Witte T, Smith A. Cause of death and excess mortality in patients with lower-risk myelodysplastic syndromes (MDS): A report from the European MDS registry. Br J Haematol 2023; 200:451-461. [PMID: 36335984 DOI: 10.1111/bjh.18542] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022]
Abstract
Information on causes of death (CoDs) and the impact of myelodysplastic syndromes (MDS) on survival in patients with lower-risk MDS (LR-MDS) is limited. A better understanding of the relationship between disease characteristics, clinical interventions and CoDs may improve outcomes of patients with LR-MDS. We prospectively collected data on patients with LR-MDS in the European MDS registry from 2008 to 2019. Clinical, laboratory and CoDs data were obtained. To examine MDS-specific survival, relative survival (RS) was estimated using national life tables. Of 2396 evaluated subjects, 900 died (median overall survival [OS]: 4.7 years; median follow-up: 3.5 years). The most common CoDs were acute myeloid leukaemia/MDS (20.1%), infection (17.8%) and cardiovascular disease (CVD; 9.8%). Patients with isolated del(5q) and with red cell transfusion needed during the disease course, had a higher risk of fatal CVD. The 5-year OS was 47.3% and the 5-year RS was 59.6%, indicating that most patients died due to their underlying MDS. Older patients (aged >80 years) and the lowest-risk patients were more likely to die from competing causes. This study shows that MDS and its related complications play crucial role in the outcome of patients with LR-MDS.
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Affiliation(s)
- Krzysztof Mądry
- Department of Haematology, Transplantation and Internal Medicine, Warszawa Medical University, Warsaw, Poland
| | - Karol Lis
- Department of Haematology, Transplantation and Internal Medicine, Warszawa Medical University, Warsaw, Poland
| | - Pierre Fenaux
- Service d'Hématologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris (AP-HP) and Université Paris 7, Paris, France
| | - David Bowen
- St. James's Institute of Oncology, Leeds Teaching Hospitals, Leeds, UK
| | - Argiris Symeonidis
- Department of Medicine, Division of Hematology, University of Patras Medical School, Patras, Greece
| | - Moshe Mittelman
- Department of Medicine A, Tel Aviv Sourasky (Ichilov) Medical Center and Sackler Medical Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Reinhard Stauder
- Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Jaroslav Čermák
- Department of Clinical Hematology, Institute of Hematology & Blood Transfusion, Praha, Czech Republic
| | - Guillermo Sanz
- Department of Haematology, Hospital Universitario y Politécnico La Fe & Scientific Director IIS La Fe, Madrid, Spain
| | - Eva Hellström-Lindberg
- Department of Medicine, Division of Hematology, Karolinska Institutet, Stockholm, Sweden
| | - Saskia Langemeijer
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Luca Malcovati
- Department of Hematology Oncology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Ulrich Germing
- Department of Haematology, Oncology and Clinical Immunology, Universitätsklinik Düsseldorf, Düsseldorf, Germany
| | - Mette Skov Holm
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | - Agnes Guerci-Bresler
- Service d'Hématologie, Centre Hospitalier Universtaire Brabois Vandoeuvre, Nancy, France
| | - Dominic Culligan
- Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Laurence Sanhes
- Service d'Hématologie, Centre Hospitalier de Perpignan, Perpignan, France
| | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace Medical School, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Corine van Marrewijk
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Simon Crouch
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
| | - Theo de Witte
- Department of Tumor Immunology - Nijmegen Center for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alex Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, UK
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13
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Neidemire-Colley L, Robert J, Ackaoui A, Dorrance AM, Guimond M, Ranganathan P. Role of endothelial cells in graft-versus-host disease. Front Immunol 2022; 13:1033490. [PMID: 36505438 PMCID: PMC9727380 DOI: 10.3389/fimmu.2022.1033490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
To date, the only curative treatment for high-risk or refractory hematologic malignancies non-responsive to standard chemotherapy is allogeneic hematopoietic transplantation (allo-HCT). Acute graft-versus-host disease (GVHD) is a donor T cell-mediated immunological disorder that is frequently fatal and the leading cause of non-relapse mortality (NRM) in patients post allo-HCT. The pathogenesis of acute GVHD involves recognition of minor and/or major HLA mismatched host antigens by donor T cells followed by expansion, migration and finally end-organ damage due to combination of inflammatory cytokine secretion and direct cytotoxic effects. The endothelium is a thin layer of endothelial cells (EC) that line the innermost portion of the blood vessels and a key regulator in vascular homeostasis and inflammatory responses. Endothelial cells are activated by a wide range of inflammatory mediators including bacterial products, contents released from dying/apoptotic cells and cytokines and respond by secreting cytokines/chemokines that facilitate the recruitment of innate and adaptive immune cells to the site of inflammation. Endothelial cells can also be damaged prior to transplant as well as by alloreactive donor T cells. Prolonged EC activation results in dysfunction that plays a role in multiple post-transplant complications including but not limited to veno-occlusive disease (VOD), transplant associated thrombotic microangiopathy (TA-TMA), and idiopathic pneumonia syndrome. In this mini review, we summarize the biology of endothelial cells, factors regulating EC activation and the role of ECs in inflammation and GVHD pathogenesis.
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Affiliation(s)
- Lotus Neidemire-Colley
- Biomedical Sciences Graduate Program, The Ohio State University, Columbus, OH, United States,Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - Jérémy Robert
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Antoine Ackaoui
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada
| | - Adrienne M. Dorrance
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Martin Guimond
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC, Canada,Collège Bois de Boulogne, Montréal, QC, Canada,Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montréal, QC, Canada
| | - Parvathi Ranganathan
- Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States,Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States,*Correspondence: Parvathi Ranganathan,
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14
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Go SI, Park S, Kang MH, Kim HG, Kang JH, Kim JH, Lee GW. Endothelial activation and stress index (EASIX) as a predictive biomarker in small cell lung cancer. Cancer Biomark 2022; 35:217-225. [PMID: 36120771 DOI: 10.3233/cbm-220032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Endothelial activation and insult may contribute to the aggressive clinical course of small-cell lung cancer (SCLC); however, no predictive biomarker for this pathogenesis has been identified. OBJECTIVE To evaluate the clinical impact of the endothelial activation and stress index (EASIX) in SCLC. METHODS In this retrospective study, the EASIX was calculated from measurements of serum lactate dehydrogenase, creatinine, and platelet levels. A total of 264 patients with SCLC treated with platinum-based chemotherapy were stratified into high and low EASIX groups. RESULTS Complete and objective response rates in the limited-stage (LD) were 19.5% vs. 33.3% (P= 0.050) and 85.4% vs. 97.9% (P= 0.028) in the high and low EASIX groups, respectively. There was no significant difference in the response rate between the two groups in the extensive-stage (ED). The median overall survival was 9.8 vs. 40.5 months in LD (P< 0.001) and 7.2 vs. 11.9 months in ED (P< 0.001) in the high and low EASIX groups, respectively. In multivariate analyses, a high EASIX level was an independent prognostic factor for worse progression-free and overall survival irrespective of stage. CONCLUSION EASIX may be a potential predictive biomarker of SCLC.
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Affiliation(s)
- Se-Il Go
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Sungwoo Park
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Myoung Hee Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Hoon-Gu Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Jung Hun Kang
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jung Hoon Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Gyeong-Won Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
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15
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Park S, Go SI, Lee GW. The Endothelial Activation and Stress Index (EASIX) score is an independent prognostic factor in patients with diffuse large B-cell lymphoma. BMC Cancer 2022; 22:816. [PMID: 35879680 PMCID: PMC9312320 DOI: 10.1186/s12885-022-09915-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The endothelial activation and stress index (EASIX) score has been reported to predict overall survival (OS) in hematological cancers. However, it has not been validated as a prognostic marker for diffuse large B-cell lymphoma (DLBCL) to date. METHODS The records of 265 patients who presented with DLBCL in the Republic of Korea between January 07, 2004, and March 05, 2020 were retrospectively reviewed. For all included patients, EASIX scores were calculated using serum lactate dehydrogenase (LDH) and creatinine levels and the platelet count measured at diagnosis as follows: LDH (U/L) × creatinine (mg/dL)/platelet count (109/L). RESULTS The median age of the patients was 64 years. The optimal cutoff value of EASIX according to the receiver operating characteristic analysis for OS was 1.33. All the patients were treated with cyclophosphamide, doxorubicin, vincristine, and prednisone combined with rituximab. The 1-year OS and progression-free survival (PFS) rates were lower in the high-EASIX group than in the low EASIX group (63.8% vs. 84.4%, p < 0.001 and 54.0% vs. 79.6%, p < 0.001, respectively). A high EASIX was an independent poor prognostic factor for OS and PFS (hazard ratio, 1.606; 95% CI, 1.077-2.395; p = 0.020 and hazard ratio, 1.621; 95% CI, 1.066-2.464; p = 0.024, respectively). CONCLUSIONS EASIX is a readily available and cheaply obtainable parameter in clinical studies and shows considerable potential as a new prognostic marker for patients with newly diagnosed DLBCL.
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Affiliation(s)
- Sungwoo Park
- Division of Hematology and Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - Se-Il Go
- Division of Hematology and Oncology, Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, South Korea
| | - Gyeong-Won Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, South Korea.
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16
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Liang HP, Luo XC, Zhang YL, Liu B. Del(5q) and inv(3) in myelodysplastic syndrome: A rare case report. World J Clin Cases 2022; 10:3601-3608. [PMID: 35582053 PMCID: PMC9048554 DOI: 10.12998/wjcc.v10.i11.3601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/03/2022] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Del(5q) is the most common molecular event in myelodysplastic syndrome (MDS), accounting for 10%-15% of cases. Inv(3) is an adverse cytogenetic abnormality observed in less than 1% of MDS patients. Few studies have reported the coexistence of del(5q) and inv(3) in MDS. Therefore, the pathological mechanism, treatment strategy and prognosis of this subtype need to be elucidated.
CASE SUMMARY A 66-year-old woman was admitted to the hospital due to chest tightness and shortness of breath. Combining clinical assessments with laboratory examinations, the patient was diagnosed with MDS containing both del(5q) and inv(3). Considering the deletion of chromosome 5q, we first treated the patient with lenalidomide. When drug resistance arose, we tried azacitidine, and the patient had a short remission. Finally, the patient refused treatment with haematopoietic stem cell transplantation and died of severe infection four months later.
CONCLUSION MDS patients with del(5) and inv(3) have a poor prognosis. Azacitidine may achieve short-term remission for such patients.
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Affiliation(s)
- Hai-Ping Liang
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xing-Chun Luo
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Ya-Li Zhang
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Bei Liu
- Department of Hematology, The First Affiliated Hospital, Lanzhou University, Lanzhou 730000, Gansu Province, China
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Korell F, Penack O, Mattie M, Schreck N, Benner A, Krzykalla J, Wang Z, Schmitt M, Bullinger L, Müller-Tidow C, Dreger P, Luft T. EASIX and Severe Endothelial Complications After CD19-Directed CAR-T Cell Therapy—A Cohort Study. Front Immunol 2022; 13:877477. [PMID: 35464403 PMCID: PMC9033201 DOI: 10.3389/fimmu.2022.877477] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background Endothelial dysfunction is associated with two main complications of chimeric antigen receptor T (CAR-T) cell therapy, cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). This study evaluates the Endothelial Activation and Stress Index (EASIX) as a prognostic marker for high-grade CRS and ICANS in patients treated with CD19-directed CAR-T cells. Methods In this retrospective study, a training cohort of 93 patients from the ZUMA-1 trial and a validation cohort of 121 patients from two independent centers (University Hospital Heidelberg, Charité University Medicine Berlin) were investigated. The primary objective was to assess the predictive capacity of EASIX measured immediately before the start of lymphodepletion (EASIX-pre) for the occurrence of grade ≥3 CRS and/or ICANS. To explore a possible endothelial link, serum levels of endothelial stress markers (angiopoietin-2, suppressor of tumorigenicity-2, soluble thrombomodulin, and interleukin-8) were determined before lymphodepletion and on day 7 after CART infusion in the validation cohort (n = 47). Results The prognostic effect of EASIX-pre on grade ≥3 CRS and/or ICANS was significant in the training cohort [OR 2-fold increase 1.72 (1.26–2.46)] and validated in the independent cohort. An EASIX-pre cutoff >4.67 derived from the training cohort associated with a 4.3-fold increased odds ratio of severe CRS/ICANS in the independent cohort. Serum endothelial distress markers measured on day+7 correlated with EASIX-pre and associated with severe complications. Conclusions EASIX-pre is a powerful predictor of severe CRS/ICANS after CD19-directed CART therapy and might be used as a basis for risk-adapted prevention strategies.
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Affiliation(s)
- Felix Korell
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Olaf Penack
- Department of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mike Mattie
- Kite Pharma, Gilead, Santa Monica, CA, United States
| | - Nicholas Schreck
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Julia Krzykalla
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Zixing Wang
- Kite Pharma, Gilead, Santa Monica, CA, United States
| | - Michael Schmitt
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Lars Bullinger
- Department of Hematology, Oncology and Tumor Immunology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Carsten Müller-Tidow
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Dreger
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Luft
- Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
- *Correspondence: Thomas Luft,
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18
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Gu JS, Ryu JW, Yu SH, Chung HS, Hwang JE, Bae WK, Ku JY, Lee CH, Ha HK, Jung SI, Hwang EC, Kwon DD. Prognostic value of the endothelial activation and stress index in patients with upper tract urothelial cancer undergoing radical nephroureterectomy. Investig Clin Urol 2022; 63:623-630. [PMID: 36347551 PMCID: PMC9643726 DOI: 10.4111/icu.20220204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/30/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The relationship with endothelial activation and stress index (EASIX), which represents the degree of endothelial dysfunction, is unwell known in upper tract urothelial carcinoma (UTUC). The present study aims to assess the prognostic value of the EASIX for recurrence-free survival (RFS) and overall survival (OS) in patients with UTUC who underwent radical nephroureterectomy (RNU). Materials and Methods We retrospectively reviewed the clinical data of 627 patients with UTUC who underwent RNU without neoadjuvant chemotherapy at three hospitals between 2002 and 2019. EASIX scores were calculated using the formula “serum lactate dehydrogenase (U/L)×creatinine (mg/dL)/platelet count (109/L)” and evaluated based on log2-transformed values. We divided the patients according to the EASIX score (>1.27 vs. ≤1.27). Results Among 627 patients, 380 were finally analyzed. Using maximally selected log-rank statistics, the optimal EASIX cutoff value was 1.27 on the log2 scale. The baseline characteristics were similar between the two groups except for age. The high EASIX score group had worse RFS and OS than the low EASIX score group (log-rank p=0.001 and p=0.006, respectively). At 5 years, the mean RFS and OS difference between the low and high EASIX score groups was 11.1 and 7.35 months, respectively. High EASIX score remained a key prognosticator of RFS and OS after RNU in multivariable analysis. Conclusions EASIX score may represent endothelial dysfunction in patients with UTUC and may serve as a readily available prognostic factor for oncologic outcomes.
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Affiliation(s)
- Jin Seok Gu
- Department of Urology, Chonnam National University Medical School, Hwasun, Korea
| | - Ji Won Ryu
- Department of Urology, Chonnam National University Medical School, Hwasun, Korea
| | - Seong Hyeon Yu
- Department of Urology, Chonnam National University Medical School, Hwasun, Korea
| | - Ho Seok Chung
- Department of Urology, Chonnam National University Medical School, Hwasun, Korea
| | - Jun Eul Hwang
- Department of Hemato-Oncology, Chonnam National University Medical School, Hwasun, Korea
| | - Woo Kyun Bae
- Department of Hemato-Oncology, Chonnam National University Medical School, Hwasun, Korea
| | - Ja Yoon Ku
- Department of Urology, Dongnam Institute of Radiological & Medical Sciences, Busan, Korea
| | - Chan Ho Lee
- Department of Urology, Inje University School of Medicine, Busan, Korea
| | - Hong Koo Ha
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Hwasun, Korea
| | - Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Hwasun, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Hwasun, Korea
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19
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Luft T, Dreger P, Radujkovic A. Endothelial cell dysfunction: a key determinant for the outcome of allogeneic stem cell transplantation. Bone Marrow Transplant 2021; 56:2326-2335. [PMID: 34253879 PMCID: PMC8273852 DOI: 10.1038/s41409-021-01390-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/08/2021] [Accepted: 06/22/2021] [Indexed: 01/26/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (alloSCT) carries the promise of cure for many malignant and non-malignant diseases of the lympho-hematopoietic system. Although outcome has improved considerably since the pioneering Seattle achievements more than 5 decades ago, non-relapse mortality (NRM) remains a major burden of alloSCT. There is increasing evidence that endothelial dysfunction is involved in many of the life-threatening complications of alloSCT, such as sinusoidal obstruction syndrome/venoocclusive disease, transplant-associated thrombotic microangiopathy, and refractory acute graft-versus host disease. This review delineates the role of the endothelium in severe complications after alloSCT and describes the current status of search for biomarkers predicting endothelial complications, including markers of endothelial vulnerability and markers of endothelial injury. Finally, implications of our current understanding of transplant-associated endothelial pathology for prevention and management of complications after alloSCT are discussed.
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Affiliation(s)
- Thomas Luft
- Department Medicine V, University of Heidelberg, Heidelberg, Germany.
| | - Peter Dreger
- Department Medicine V, University of Heidelberg, Heidelberg, Germany.
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20
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Endothelial Activation and Stress Index (EASIX) as an Early Predictor for Mortality and Overall Survival in Hematological and Non-Hematological Patients with COVID-19: Multicenter Cohort Study. J Clin Med 2021; 10:jcm10194373. [PMID: 34640390 PMCID: PMC8509351 DOI: 10.3390/jcm10194373] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 12/27/2022] Open
Abstract
COVID-19, as a disease involving the endothelium of multiple organs, is characterized by high mortality rates among hospitalized patients. Patients with hematological malignancies are particularly at risk of an unfavorable course of COVID-19. The endothelial activation and stress index (EASIX) score has been used as a simple predictor of overall survival (OS) in specific groups of hematological cancer patients. EASIX, as a biomarker of endothelial dysfunction, might play a prognostic role in patients with COVID-19. Here, we performed a comprehensive retrospective analysis of the EASIX score in 523 hospitalized COVID-19 patients with or without coexisting hematological cancer. Hematological cancer COVID-19 patients had higher EASIX scores compared to the overall population with COVID-19. In hematological patients, EASIX was a strong predictor of the occurrence of sepsis during COVID-19. Our findings demonstrated EASIX as a strong predictor of intensive care unit admission, in-hospital mortality, the occurrence of acute renal failure and the need for hemodialysis, both in hematological and non-hematological COVID-19 patients. Patients with a high EASIX score on COVID-19 diagnosis had significantly inferior OS compared to patients with low EASIX. We showed for the first time that EASIX might serve as a simple, universal prognostic tool of OS in both hematological and non-hematological COVID-19 patients.
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21
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Pérez-García F, Bailén R, Torres-Macho J, Fernández-Rodríguez A, Jiménez-Sousa MÁ, Jiménez E, Pérez-Butragueño M, Cuadros-González J, Cadiñanos J, García-García I, Jiménez-González M, Ryan P, Resino S. Age-Adjusted Endothelial Activation and Stress Index for Coronavirus Disease 2019 at Admission Is a Reliable Predictor for 28-Day Mortality in Hospitalized Patients With Coronavirus Disease 2019. Front Med (Lausanne) 2021; 8:736028. [PMID: 34568391 PMCID: PMC8455820 DOI: 10.3389/fmed.2021.736028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/05/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Endothelial Activation and Stress Index (EASIX) predict death in patients undergoing allogeneic hematopoietic stem cell transplantation who develop endothelial complications. Because coronavirus disease 2019 (COVID-19) patients also have coagulopathy and endotheliitis, we aimed to assess whether EASIX predicts death within 28 days in hospitalized COVID-19 patients. Methods: We performed a retrospective study on COVID-19 patients from two different cohorts [derivation (n = 1,200 patients) and validation (n = 1,830 patients)]. The endpoint was death within 28 days. The main factors were EASIX [(lactate dehydrogenase * creatinine)/thrombocytes] and aEASIX-COVID (EASIX * age), which were log2-transformed for analysis. Results: Log2-EASIX and log2-aEASIX-COVID were independently associated with an increased risk of death in both cohorts (p < 0.001). Log2-aEASIX-COVID showed a good predictive performance for 28-day mortality both in the derivation cohort (area under the receiver-operating characteristic = 0.827) and in the validation cohort (area under the receiver-operating characteristic = 0.820), with better predictive performance than log2-EASIX (p < 0.001). For log2 aEASIX-COVID, patients with low/moderate risk (<6) had a 28-day mortality probability of 5.3% [95% confidence interval (95% CI) = 4-6.5%], high (6-7) of 17.2% (95% CI = 14.7-19.6%), and very high (>7) of 47.6% (95% CI = 44.2-50.9%). The cutoff of log2 aEASIX-COVID = 6 showed a positive predictive value of 31.7% and negative predictive value of 94.7%, and log2 aEASIX-COVID = 7 showed a positive predictive value of 47.6% and negative predictive value of 89.8%. Conclusion: Both EASIX and aEASIX-COVID were associated with death within 28 days in hospitalized COVID-19 patients. However, aEASIX-COVID had significantly better predictive performance than EASIX, particularly for discarding death. Thus, aEASIX-COVID could be a reliable predictor of death that could help to manage COVID-19 patients.
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Affiliation(s)
- Felipe Pérez-García
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, Madrid, Spain
| | - Rebeca Bailén
- Servicio de Hematología y Hemoterapia, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Juan Torres-Macho
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Amanda Fernández-Rodríguez
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Ángeles Jiménez-Sousa
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Eva Jiménez
- Servicio de Medicina Preventiva, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Juan Cuadros-González
- Servicio de Microbiología Clínica, Hospital Universitario Príncipe de Asturias, Madrid, Spain
- Departamento de Biomedicina y Biotecnología, Facultad de Medicina, Universidad de Alcalá de Henares, Madrid, Spain
| | - Julen Cadiñanos
- Servicio de Medicina Interna, Hospital General de Villalba, Collado Villalba, Spain
| | - Irene García-García
- Servicio de Farmacología Clínica, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | | | - Pablo Ryan
- Servicio de Medicina Interna, Hospital Universitario Infanta Leonor, Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Salvador Resino
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
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22
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Luft T, Wendtner CM, Kosely F, Radujkovic A, Benner A, Korell F, Kihm L, Bauer MF, Dreger P, Merle U. EASIX for Prediction of Outcome in Hospitalized SARS-CoV-2 Infected Patients. Front Immunol 2021; 12:634416. [PMID: 34248931 PMCID: PMC8261154 DOI: 10.3389/fimmu.2021.634416] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/04/2021] [Indexed: 12/17/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and has evoked a pandemic that challenges public health-care systems worldwide. Endothelial cell dysfunction plays a key role in pathophysiology, and simple prognosticators may help to optimize allocation of limited resources. Endothelial activation and stress index (EASIX) is a validated predictor of endothelial complications and outcome after allogeneic stem cell transplantation. Aim of this study was to test if EASIX could predict life-threatening complications in patients with COVID-19. Methods SARS-CoV-2-positive, hospitalized patients were enrolled onto a prospective non-interventional register study (n=100). Biomarkers were assessed at hospital admission. Primary endpoint was severe course of disease (mechanical ventilation and/or death, V/D). Results were validated in 126 patients treated in two independent institutions. Results EASIX at admission was a strong predictor of severe course of the disease (odds ratio for a two-fold change 3.4, 95%CI 1.8-6.3, p<0.001), time to V/D (hazard ratio (HR) for a two-fold change 2.0, 95%CI 1.5-2.6, p<0.001) as well as survival (HR for a two-fold change 1.7, 95%CI 1.2-2.5, p=0.006). The effect was retained in multivariable analysis adjusting for age, gender, and comorbidities and could be validated in the independent cohort. At hospital admission EASIX correlated with increased suppressor of tumorigenicity-2, soluble thrombomodulin, angiopoietin-2, CXCL8, CXCL9 and interleukin-18, but not interferon-alpha. Conclusion EASIX is a validated predictor of COVID19 outcome and an easy-to-access tool to segregate patients in need for intensive surveillance.
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Affiliation(s)
- Thomas Luft
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Clemens-Martin Wendtner
- Munich Clinic Schwabing, Academic Teaching Hospital, Ludwig-Maximilians University (LMU), Munich, Germany
| | | | | | - Axel Benner
- Division of Biostatistics, German Cancer Research Center, Heidelberg, Germany
| | - Felix Korell
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Lars Kihm
- Department of Internal Medicine I, University of Heidelberg, Heidelberg, Germany
| | - Matthias F Bauer
- Institute of Laboratory Diagnostics, Hygiene and Transfusion Medicine, Hospital Ludwigshafen, Ludwigshafen, Germany
| | - Peter Dreger
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Internal Medicine IV, University of Heidelberg, Heidelberg, Germany
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23
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Liapis K, Papadopoulos V, Vrachiolias G, Galanopoulos AG, Papoutselis M, Papageorgiou SG, Diamantopoulos PT, Pappa V, Viniou NA, Kourakli A, Τsokanas D, Vassilakopoulos TP, Hatzimichael E, Bouronikou E, Ximeri M, Pontikoglou C, Megalakaki A, Zikos P, Panayiotidis P, Dimou M, Karakatsanis S, Papaioannou M, Vardi A, Kontopidou F, Harchalakis N, Adamopoulos I, Symeonidis A, Kotsianidis I. Refinement of prognosis and the effect of azacitidine in intermediate-risk myelodysplastic syndromes. Blood Cancer J 2021; 11:30. [PMID: 33574231 PMCID: PMC7878783 DOI: 10.1038/s41408-021-00424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/20/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Konstantinos Liapis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece.
| | - Vasileios Papadopoulos
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - George Vrachiolias
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | | | - Menelaos Papoutselis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | | | | | - Vassiliki Pappa
- Second Department of Internal Medicine, Attikon University General Hospital, Athens, Greece
| | - Nora-Athina Viniou
- First Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Kourakli
- Greece Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Dimitris Τsokanas
- Department of Clinical Hematology, Georgios Gennimatas Hospital, Athens, Greece
| | - Theodoros P Vassilakopoulos
- Department of Hematology, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eleni Bouronikou
- Department of Hematology, University Hospital of Larissa, Larissa, Greece
| | - Maria Ximeri
- Department of Hematology, University General Hospital of Heraklion, Voutes, Heraklion, Greece
| | - Charalambos Pontikoglou
- Department of Hematology, University General Hospital of Heraklion, Voutes, Heraklion, Greece
| | | | - Panagiotis Zikos
- Department of Hematology, Aghios Andreas General Hospital, Patras, Greece
| | - Panayiotis Panayiotidis
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Dimou
- First Propedeutic Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Maria Papaioannou
- Department of Hematology, AHEPA University Hospital, Thessaloniki, Greece
| | - Anna Vardi
- Department of Hematology and Stem cell Transplantation, Georgios Papanicolaou General Hospital, Thessaloniki, Greece
| | - Flora Kontopidou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Hippokratio General Hospital, Athens, Greece
| | - Nikolaos Harchalakis
- Department of Hematology and Bone Marrow Transplantation Unit, Evangelismos Hospital, Athens, Greece
| | - Ioannis Adamopoulos
- Department of Hematology and Thalassemia, Kalamata General Hospital, Kalamata, Greece
| | - Argiris Symeonidis
- Greece Department of Internal Medicine, University Hospital of Patras, Rio, Greece
| | - Ioannis Kotsianidis
- Department of Hematology, Democritus University of Thrace Medical School, Alexandroupolis, Greece
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24
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Song GY, Jung SH, Kim K, Kim SJ, Yoon SE, Lee HS, Kim M, Ahn SY, Ahn JS, Yang DH, Kim HJ, Lee JJ. Endothelial activation and stress index (EASIX) is a reliable predictor for overall survival in patients with multiple myeloma. BMC Cancer 2020; 20:803. [PMID: 32831058 PMCID: PMC7446202 DOI: 10.1186/s12885-020-07317-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/18/2020] [Indexed: 01/01/2023] Open
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.
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Affiliation(s)
- Ga-Young Song
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Sung-Hoon Jung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea.
| | - Kihyun Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea.
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, Republic of Korea
| | - Ho Sup Lee
- Kosin University Gospel Hospital, Busan, Republic of Korea
| | - Mihee Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Seo-Yeon Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Jae-Sook Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Deok-Hwan Yang
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Hyeoung-Joon Kim
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
| | - Je-Jung Lee
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, 322 Seoyangro, Hwasun, Jeollanamdo, 519-763, Republic of Korea
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25
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Liapis K, Vrachiolias G, Papadopoulos V, Kourakli A, Galanopoulos AG, Papoutselis M, Papageorgiou SG, Diamantopoulos PT, Pappa V, Viniou N, Vassilakopoulos TP, Hatzimichael E, Bouronikou E, Ximeri M, Pontikoglou C, Panayiotidis P, Karakatsanis S, Vardi A, Symeonidis A, Kotsianidis I. Risk factors for cardiovascular disease mortality in patients with myelodysplastic syndromes: A nationwide, registry‐based cohort study. EJHAEM 2020; 1:255-261. [DOI: https:/doi.org/10.1002/jha2.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Konstantinos Liapis
- Department of HematologyDemocritus University of Thrace Medical School Alexandroupolis Greece
| | - Georgios Vrachiolias
- Department of HematologyDemocritus University of Thrace Medical School Alexandroupolis Greece
| | - Vasileios Papadopoulos
- Department of HematologyDemocritus University of Thrace Medical School Alexandroupolis Greece
| | | | | | - Menelaos Papoutselis
- Department of HematologyDemocritus University of Thrace Medical School Alexandroupolis Greece
| | | | | | - Vassiliki Pappa
- Second Department of Internal MedicineAttikon University General Hospital Athens Greece
| | - Nora‐Athina Viniou
- First Department of Internal MedicineNational and Kapodistrian University of Athens Athens Greece
| | | | | | - Eleni Bouronikou
- Department of HematologyUniversity Hospital of Larissa Larissa Greece
| | - Maria Ximeri
- Department of HematologyUniversity General Hospital of Heraklion Heraklion Greece
| | | | - Panayiotis Panayiotidis
- First Propaedeutic Department of Internal MedicineNational and Kapodistrian University of Athens Athens Greece
| | | | - Anna Vardi
- Department of Hematology and Stem Cell TransplantationGeorgios Papanicolaou General Hospital Thessaloniki Greece
| | | | - Ioannis Kotsianidis
- Department of HematologyDemocritus University of Thrace Medical School Alexandroupolis Greece
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26
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Liapis K, Vrachiolias G, Papadopoulos V, Kourakli A, Galanopoulos AG, Papoutselis M, Papageorgiou SG, Diamantopoulos PT, Pappa V, Viniou N, Vassilakopoulos TP, Hatzimichael E, Bouronikou E, Ximeri M, Pontikoglou C, Panayiotidis P, Karakatsanis S, Vardi A, Symeonidis A, Kotsianidis I. Risk factors for cardiovascular disease mortality in patients with myelodysplastic syndromes: A nationwide, registry-based cohort study. EJHAEM 2020; 1:255-261. [PMID: 35847690 PMCID: PMC9176014 DOI: 10.1002/jha2.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 12/19/2022]
Abstract
Cardiovascular disease (CVD) emerges as a major cause of death in patients with myelodysplastic syndrome (MDS), but predictors of fatal CVD and the effect of MDS-specific treatments on CVD mortality remain largely unknown. In an analysis involving 831 patients with MDS with known causes of death, we noted an independent association of lower risk MDS, age >70 years, pre-existing CVD, and treatment with erythropoiesis-stimulating agents with a higher risk of death from CVD. If externally validated, these simple risk factors could increase clinicians' awareness toward CVD complications and guide early introduction of intensive monitoring and preventive interventions in MDS patients.
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Affiliation(s)
- Konstantinos Liapis
- Department of HematologyDemocritus University of Thrace Medical SchoolAlexandroupolisGreece
| | - Georgios Vrachiolias
- Department of HematologyDemocritus University of Thrace Medical SchoolAlexandroupolisGreece
| | - Vasileios Papadopoulos
- Department of HematologyDemocritus University of Thrace Medical SchoolAlexandroupolisGreece
| | | | | | - Menelaos Papoutselis
- Department of HematologyDemocritus University of Thrace Medical SchoolAlexandroupolisGreece
| | | | | | - Vassiliki Pappa
- Second Department of Internal MedicineAttikon University General HospitalAthensGreece
| | - Nora‐Athina Viniou
- First Department of Internal MedicineNational and Kapodistrian University of AthensAthensGreece
| | | | | | - Eleni Bouronikou
- Department of HematologyUniversity Hospital of LarissaLarissaGreece
| | - Maria Ximeri
- Department of HematologyUniversity General Hospital of HeraklionHeraklionGreece
| | | | - Panayiotis Panayiotidis
- First Propaedeutic Department of Internal MedicineNational and Kapodistrian University of AthensAthensGreece
| | | | - Anna Vardi
- Department of Hematology and Stem Cell TransplantationGeorgios Papanicolaou General HospitalThessalonikiGreece
| | | | - Ioannis Kotsianidis
- Department of HematologyDemocritus University of Thrace Medical SchoolAlexandroupolisGreece
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27
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Varma A, Rondon G, Srour SA, Chen J, Ledesma C, Champlin RE, Ciurea SO, Saliba RM. Endothelial Activation and Stress Index (EASIX) at Admission Predicts Fluid Overload in Recipients of Allogeneic Stem Cell Transplantation. Biol Blood Marrow Transplant 2020; 26:1013-1020. [PMID: 32045652 DOI: 10.1016/j.bbmt.2020.01.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 12/13/2022]
Abstract
Fluid overload (FO) grade ≥2 (more than 10% weight gain from baseline) has recently been recognized as an important toxicity associated with a high rate of nonrelapse mortality in recipients of allogeneic hematopoietic cell transplantation (AHCT). The causes for FO remain unclear. We hypothesized that endothelial damage, possibly due to treatments received prior to AHCT, may be associated with this toxicity and sought to determine whether the Endothelial Activation and Stress Index (EASIX) (defined as lactate dehydrogenase [U/L] × creatinine [mg/dL]/platelets [109 cells/L]) correlates with grade ≥2 FO in 2 cohorts of recipients of AHCT at our institution. We tested our hypothesis in a cohort of 145 consecutive recipients (study cohort) of AHCT transplant from HLA-haploidentical donors and validated the findings in a cohort of 449 (validation cohort) recipients of AHCT from HLA-matched donors who underwent transplantation between 2010 and 2015. Predictors of grade ≥2 FO were evaluated using competing risks regression in univariate analysis and classification and regression tree (CART) analysis in multivariate analysis. The cumulative incidence of grade ≥2 FO was estimated considering death as a competing risk. EASIX scores were evaluated based on log2-transformed values. Optimal predictive EASIX cutoff values were determined based on receiver operating characteristics curve analysis. Grade ≥2 FO occurred in 21% and 6% of the study and validation cohorts, respectively, with the majority of these cases being diagnosed before the day of AHCT. Median log2 EASIX score at admission was 2.4 (interquartile range [IQR], 1.3, 3.7) and 2.5 (IQR, 1.4, 3.9) in the 2 respective cohorts. In univariate analysis, high EASIX at admission was a significant predictor of grade ≥2 FO in the study (cutoff: 4.4, hazard ratio [HR] = 4.8, P < .001) and in the validation (cutoff: 4.3, HR = 4.8, P < .001) cohorts. The significant effect of EASIX persisted in multivariate CART analysis in the study (HR = 6.3, P < .001) and the validation (HR = 28, P = .002) cohorts. Additional predictors in multivariate analysis included body weight below 80 kg in recipients older than 55 years (HR = 4.5, P < .001) in the study cohort and diabetes (HR = 34, P = .001) and age >60 years (HR = 9.6, P = .04) in the validation cohort. At admission, the prevalence of EASIX score of >4.3 (18% versus 17%, P = .9) was not different between the diabetics and nondiabetics. EASIX score at admission is a significant predictor of grade ≥2 FO in recipients of AHCT from HLA-haploidentical or HLA-matched donors. Independently of EASIX, older patients with low weight were associated with increased risk of grade ≥2 FO for recipients of HLA-haploidentical transplants. For the HLA-matched cohort, diabetes and older age were associated with increased FO risk. These findings require validation in external cohorts.
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Affiliation(s)
- Ankur Varma
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas; Division of Hematology, Oncology and Cellular Therapy, Rush University, Chicago, Illinois
| | - Gabriela Rondon
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Samer A Srour
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Julianne Chen
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Celina Ledesma
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard E Champlin
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stefan O Ciurea
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rima M Saliba
- Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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