Endothelial Activation and Stress Index (EASIX) to Predict Survival in T or NK Cell Lymphoma-Associated Hemophagocytic Lymphohistiocytosis
Year: 2024
Type: conference-abstract
Abstract: Introduction: Lymphoma is the most common underlying cause of secondary hemophagocytic lymphohistiocytosis (HLH). In Asian countries, T or NK-cell lymphoma-associated HLH (T/NK-LAHLH) is more common than B-cell lymphoma-associated HLH. There are no established prognostic markers for T/NK-LAHLH. Endothelial Activation and Stress Index (EASIX) is a marker of endothelial activation and could predict mortality in patients treated with allogeneic stem cell transplantation. Whether EASIX could predict survival in T/NK-LAHLH remains to be determined. Materials and Methods: Patients with T/NK-LAHLH were included. EASIX was calculated by the formula: lactate dehydrogenase (U/L)×creatinine (mg/dL)/thrombocytes (10⁹ cells per L). The diagnosis of HLH was based on the HLH-2004 criteria. Only patients with a histological diagnosis and follow-up were included. The subtyping was based on the 2016 World Health Organization classification of lymphoid neoplasms. X-tile was used to determine the best cutoff of EASIX for survival prediction. Results: A total of 212 cases of T/NK-LAHLH were identified. The most common subtype of T/NK cell malignancy was extranodal NK/T cell lymphoma, nasal type (57, 26.9%) followed by aggressive NK cell leukemia (55, 25.9%) and peripheral T cell lymphoma, not otherwise specified (29, 13.7%). The best cutoff of EASIX for predicting 60-day survival was 40.1. Patients with high EASIX values (>40.1) had a significantly poorer 60-day survival than those with low EASIX values (≤40.1) (60-day survival rate: 15.6% vs. 63.9%, p<0.0001). Patients with high EASIX also showed significantly poorer overall survival (median survival: 14 days vs. 79 days, p<0.0001). For patients with NK cell malignancies, a higher EASIX also significantly predicted a reduced 60-day survival rate (p<0.0001) and overall survival (p<0.0001). Patients with high EASIX values showed significantly lower levels of hemoglobin, neutrophil count, albumin, and fibrinogen and higher levels of aspartate aminotransferase, alanine aminotransferase, and triacylglycerol (p values all < 0.05). EASIX>40.1 (hazards ratio[HR] 3.60, 95%CI: 2.31-5.60; p<0.0001), fibrinogen≤1.5g/L (HR 1.67, 95%CI: 1.07-2.58; p=0.023), and age>60 (HR 1.76, 95%CI:1.14-2.71; p=0.011) were identified as independent predictors of worse 60-day survival in multivariate analysis. A prognostic index was established by combining these three independent predictors. We assigned a weighted score of 1 to fibrinogen and age, and 2 to EASIX. Finally, a prognostic index for T/NK-LAHLH (T/NK-LAHLH-PI) ranged from 0 to 5 was established (T/NK-LAHLH-PI: low-risk 1, intermediate-risk 2, high-risk ≥2). T/NK-LAHLH-PI significantly predicted different 60-day survival rates (low-risk 77.3% vs. intermediate-risk 50.1% vs. high-risk 24.9%, p<0.0001) and overall survival (median survival: low-risk 340 days vs. intermediate-risk 63 days vs. high-risk 20 days, p<0.0001). Conclusions: Our study demonstrated that EASIX was a robust marker for predicting outcomes in patients with T/NK-LAHLH. T/NK-LAHLH-PI, a prognostic index containing EASIX, could be used to predict the outcomes of patients with T/NK-LAHLH.
Source: Blood
Authors: Wenyu Shi, Yi Miao, Jianyong Li, Jing Zhang, Xuzhang Lu, Bingzong Li, Chunling Wang, Yun Zhuang, Yuqing Miao, Haiwen Ni, Xiaoyan Xie, Jingyan Xu, Yunping Zhang, Min Zhao, Min Xu, Wanchuan Zhuang, Weiying Gu, Guoqiang Lin, Haiying Hua, Jianfeng Zhu, Maozhong Xu, Tao Jia, Ping Liu, Lijia Zhai
Institutions: Nantong University, Affiliated Hospital of Nantong University, Xuzhou Medical College, Yancheng First People's Hospital, Jiangsu Province Hospital, Nanjing Medical University, Second Affiliated Hospital of Soochow University, Huaian First People’s Hospital, Wuxi People's Hospital, Nanjing University of Chinese Medicine, Nanjing University, Northern Jiangsu People's Hospital, Yangzhou University, Nanjing Drum Tower Hospital, Jiangsu University, First Affiliated Hospital of Soochow University, Southeast University, Soochow University, The First People's Hospital of Changzhou, Second People’s Hospital of Huai’an, Jiangnan University, The Affiliated Taizhou People's Hospital of Nanjing Medical University, The First People’s Hospital of Lianyungang, Wuxi No.2 People's Hospital
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4405040329