The endothelial activation and stress index (EASIX) as a prognostic predictor in aggressive B-cell lymphoma

Abstract

Aggressive B-cell lymphoma is the most common subtype of non-Hodgkin lymphoma, with a generally poor prognosis. This study aimed to evaluate the prognostic value of the endothelial activation and stress index (EASIX) score in patients with newly diagnosed aggressive B-cell lymphoma. We retrospectively analyzed clinical data from 574 adult patients with aggressive B-cell lymphoma diagnosed at our center between January 2011 and June 2025. The EASIX was calculated as creatinine (Cr, mg/dL) × lactate dehydrogenase (LDH, U/L)/platelet count (× 10 9 /L). Patients were stratified into groups based on quartiles of baseline EASIX scores. Patients in the high-EASIX group had significantly lower 1-year and 5-year overall survival (OS) and progression-free survival (PFS) than those in the low-EASIX group (all p < 0.001). Time-dependent receiver operating characteristic curve analysis showed that the area under the curve values of the EASIX model for predicting 1-year and 5-year OS and PFS were not significantly different from those of the International Prognostic Index model. Multiple linear regression analysis indicated that high-EASIX scores were associated with ECOG PS ≥ 2, presence of B symptoms, Ann Arbor stage III-IV, presence of hemophagocytic lymphohistiocytosis, as well as bone marrow and liver involvement in diffuse large B-cell lymphoma (DLBCL) patients, whereas stomach involvement was associated with low-EASIX scores. EASIX is a simple and effective prognostic indicator that can be used for risk stratification and rapid identification of high-risk patients with newly diagnosed aggressive B-cell lymphoma.