The Pretherapy Endothelial Activation and Stress Index (EASIX) in Patients with Newly Diagnosed Acute Myeloid Leukemia: A Pilot Study.

Background/

Objectives

The endothelial activation and stress index (EASIX; serum creatinine times lactate dehydrogenase/peripheral blood platelet count) seems to reflect endothelial cell activation/dysfunction. Furthermore, endothelial cells support acute myeloid leukemia (AML) cell proliferation and survival, and high bone marrow microvascular density is associated with adverse prognosis in human AML.

Methods

We investigated the pretreatment EASIX score in 160 AML patients (promyelocytic variants excluded) at the time of diagnosis before initiation of intensive cytarabine-based anti-AML therapy.

Results

We detected a significant association between the pretreatment EASIX score and the monocytic AML cell phenotype (Fisher's test, p = 0.0007). A weaker association was observed between a high pretreatment EASIX score and C-reactive protein levels (Spearman's test, p = 0.017). We could not detect any significant difference in 5-year overall survival when comparing patient subsets with a pretreatment EASIX score below versus above the median cohort level (Kaplan-Meier's test, p = 0.84), and the overall survival did not differ when comparing overall survival for the two contrasting upper and lower quartiles either (p = 0.88). Furthermore, the 5-year posttransplant survival did not differ between allotransplant recipients (n = 58) with a pretreatment (i.e., at the time of first diagnosis) EASIX score below versus above the cohort median level (p = 0.55). Finally, the 5-year overall survival did not differ when comparing patients with low versus high modified EASIX scores either (p = 0.46).

Conclusions

Our study suggests that the pretherapy EASIX score does not have any prognostic impact in non-promyelocytic AML patients receiving conventional intensive AML therapy. This is different from patients with promyelocytic AML variants, in whom a high EASIX score is associated with increased mortality. However, EASIX scoring should be further investigated in AML patients who receive new targeted therapies, including BCL2-inhibition, which is less effective in monocytic AML variants.