Endothelial activation and stress index is an independent prognostic factor of diffuse large b‐cell lymphoma treated with standard immunochemotherapy

Background: The natural history of diffuse large B-cell lymphoma (DLBCL) is heterogeneous. Several prognostic models have been investigated to predict treatment outcomes of patients with DLBCL. Endothelial activation and stress index (EASIX) is a surrogate of endothelial dysfunction in various conditions including cancer. An elevated EASIX score was associated with inferior outcomes in patients with multiple myeloma, low-risk myelodysplastic syndrome and patients treated with cell-based immunotherapy. However, the data of EASIX in DLBCL is limited and warrants exploration. We evaluated the prognostic implication of EASIX score in patients with DLBCL treated with immunochemotherapy. Methods: This is a single center study enrolling adult patients with newly diagnosed DLBCL receiving immunochemotherapy at the University hospital between January 2013 and December 2022. Clinicopathological data were abstracted from medical record. EASIX score was calculated using serum creatinine, lactate dehydrogenase and platelet according to the original report by Luft et al. The optimal cutoff of EASIX for survival outcomes was determined by the time-dependent receiver operating characteristic curves (ROC). Relevant survival endpoints including progression free survival (PFS) and overall survival (OS) were analyzed using Kaplan Meier Estimate. Cox proportional hazards analysis was performed to explore the impact of EASIX on survival outcomes. Result: A total of 323 patients with newly diagnosed DLBCL were included. The median EASIX score was 1.00 (range, 0.17–136.94). The optimal EASIX cutoff by ROC analysis was 1.07 stratifying patients into the low EASIX (n = 174, 53.9%) and high EASIX (n = 149, 46.1%) groups (Figure). In the high EASIX group, there was a significantly higher proportion of patients with advanced stage, bulky disease, and impaired performance status. Patients with high EASIX score significantly presented with higher-risk diseases as determined by the International Prognostic Index. Of 290 evaluable patients, the overall response rate of the entire cohort was 91.7% (complete remission, CR 67.9%). Patients with high EASIX score had a significantly lower CR than those with low EASIX score (89.6% vs. 73.8%, p < 0.001). After a median follow up of 34.6 months, 79 patients (24.4%) relapsed, and 96 patients (29.7%) had died. Patients with high EASIX score had a significantly worse 2-year PFS (53.4% vs. 81.5%, p < 0.001) and 2-year OS (64.4% vs. 88.7%, p < 0.001) than patients with low EASIX score (Figure). Multivariate analysis revealed that older age, bulky disease, impaired performance status, and high EASIX score were associated with an unfavorable OS. Encore Abstract—previously submitted to EHA 2023 Keyword: aggressive B-cell non-Hodgkin lymphoma No conflicts of interests pertinent to the abstract.