Clinical practice of the endothelial activation and stress index and its modified versions in multiple myeloma - Prognostic values of EASIX

Sep 29, 2026

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Objective evaluates prognostic values of the endothelial activation and stress index (EASIX) and derivatives—modified EASIX (mEASIX) and simplified EASIX (sEASIX)—in multiple myeloma (MM) patients. Methods retrospectively analyze 134 newly diagnosed MM cases from January 2020 to December 2024, stratifying survival by EASIX-based cut-offs, using ROC analysis, and applying univariate and multivariate Cox regression for independent factors. Results define EASIX and mEASIX cut-offs and identify key negative prognostic variables. Conclusion supports EASIX, especially mEASIX, as an easily computed prognostic tool.

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TherapeuTic advances in hematology Original Research | Clinical practice of the endothelial activation and stress index and its modified versions in multiple myeloma and the effects on prognosis
Vildan Gursoy, Ozgur Omer Gul, Elif Kose and Sevil Sadri
Abstract
Objective: Here, we aimed to evaluate the prognostic values of the endothelial activation and stress index (EASIX) and its derivatives, modified EASIX (mEASIX) and simplified EASIX (sEASIX), in patients with multiple myeloma (MM) .
Methods: The data of 134 newly diagnosed MM patients between January 2020 and December 2024 were retrospectively analyzed. Patients were divided into groups based on EASIX and its derivatives, and the outcomes of survival rates in groups were compared. Optimal cut-off points were determined using the receiver-operating characteristic analysis, and mortality predictive values of the scores were investigated. The independent prognostic factors were evaluated through univariate and multivariate Cox regression analyses.
Results: The optimal cut-off point for EASIX was detected as > 1.03, and survival times were significantly shorter in patients with higher EASIX scores (p < 0. 001) . Even so, the optimal cutoff point for mEASIX was >26. 5, showing higher specificity (area under curve (AUC) = 0 . 663; p = 0 . 003) . The sEASIX score predicted lower mortality (AUC = 0 . 586; p = 0 . 123) . In multivariate analysis, high EASIX scores, not performing autologous stem cell transplantation, and not receiving immunomodulatory therapy were identified as independent negative prognostic factors for survival.
Conclusion: EASIX, especially mEASIX, is a valuable prognostic tool for predicting survival in MM patients. EASIX can be easily integrated into clinical practice due to its simple computability and reliance on commonly used laboratory parameters. However, larger prospective studies are needed to determine how these scores can be integrated with traditional prognostic systems such as the International Staging System (ISS) and RevisedISS.
Keywords: EASIX, hematological malignancy, multiple myeloma, prognosis, risk assessment, survival
Received: 23 March 2025; revised manuscript accepted: 16 September 2025. | | TherAdv Hematol 2026, Vol. 17: 1–15
DOI: 10. 1177/ 20406207251387409 © The Author(s), 2026.
Article reuse guidelines: [sagepub.com/journals](sagepub.com/journals)permissions
Correspondence to:
Vildan Gursoy
Division of Internal Medicine, Department of Hematology, Bursa Uludag University, Faculty of Medicine, Bursa, Türkiye
vildangursoy@uludag. [edu.tr](edu.tr)
Ozgur Omer Gul Elif Kose
Department of Internal Medicine, Bursa City Hospital, Bursa, Türkiye
Sevil Sadri
Division of Hematology, Department of Internal Medicine, Bursa City Hospital, Bursa, Türkiye | | --- | --- | --- | | Introduction
Characterized by clonal proliferation of malignant plasma cells, multiple myeloma (MM) is a heterogeneous hematological malignancy.1 Clonal evolution and additional genetic events during the disease influence the progression from the asymptomatic to the symptomatic stage of the disease and lead to a refractory disease state.2 In MM, | increased production of monoclonal immunoglobulin and resulting complications such as bone marrow suppression, hypercalcemia, renal failure, and osteolytic lesions are frequently encountered. Despite significant advances in therapeutic approaches, MM is still far from being a completely curable challenge and the prognosis of MM varies widely among individuals. Therefore, | | [journals.sagepub.com/home/tah](journals.sagepub.com/home/tah) 1 Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)) which permits non-commercial use, reproduction and distribution of the work without

FAQs

What is the study objective regarding EASIX in multiple myeloma?

To evaluate prognostic values of EASIX and its derivatives (mEASIX and sEASIX) in multiple myeloma patients.

How were patients analyzed in this study?

Data from 134 newly diagnosed MM patients (Jan 2020–Dec 2024) were retrospectively analyzed, with groups formed by EASIX-based scores; ROC analysis identified optimal cut-offs and survival was compared using Cox regression.

Which factors were independent negative prognostic factors for survival?

High EASIX scores, not performing autologous stem cell transplantation, and not receiving immunomodulatory therapy were identified as independent negative prognostic factors.

Sep 29, 2026

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