Endothelial activation and stress index (EASIX) to predict engraftment syndrome after autologous hematopoietic cell transplantation in patients with multiple myeloma. A single center experience.

This study examines engraftment syndrome (ES) and the predictive role of the Endothelial Activation and Stress Index (EASIX) in multiple myeloma (MM) patients undergoing autologous hematopoietic cell transplantation (auto-HCT). We analyzed 187 patients who received at-home auto-HCT (2015-2022), assessing EASIX at pre-apheresis, post-apheresis, and hospital admission. ES occurred in 16.6% despite corticosteroid prophylaxis and G-CSF avoidance, resolving completely with treatment; only one patient required hospitalization. An EASIX cutoff of ≥0.9 may help identify high-risk patients. Higher post-apheresis EASIX values (HR 1.19, p = 0.03) and any grade of mucositis (HR 1.82, p = 0.04) were significantly associated with ES. These findings support EASIX as a valuable tool for risk stratification and personalized interventions, improving ES management. Its incorporation into clinical workflows may optimize outcomes, especially in at-home settings where rapid response is crucial to prevent readmission.