Association of the easix score with survival and adverse outcomes in a large elderly hispanic cohort of patients with multiple myeloma.

Abstract Background: Risk stratification in multiple myeloma (MM) is critical for guiding treatment decisions. The Endothelial Activation and Stress Index (EASIX) score, a simple biomarker-based tool, has shown promise in hematologic malignancies but is not well-studied in MM. We aimed to evaluate the association of the EASIX score with mortality and other adverse outcomes in MM patients, with a sub-analysis based on age. Methods We conducted a retrospective analysis of 1,028 adult MM patients, who were dichotomized into High EASIX (n=514) and Low EASIX (n=514) groups by median score value. The primary outcome was all-cause mortality, analyzed using Kaplan-Meier curves and a multivariable Cox proportional hazards model. Secondary outcomes included sepsis and pneumonia, which were analyzed using competing risk regression models with death as the competing event. All models were adjusted for age, gender, race, insurance status, and total comorbidity count where appropriate. Results The median age of the cohort was 72 years, with 61% of patients being 70 years or older. Patients in the High EASIX group had a significantly higher unadjusted rate of mortality (9.1% vs. 0.4%), pneumonia (20% vs. 11%), and sepsis (15% vs. 5.6%) (all p<0.001). In the multivariable Cox model for mortality, the Low EASIX group had a 95% lower hazard of death compared to the High EASIX group (HR: 0.05, 95% CI: 0.01-0.20, p<0.001). In competing risk analyses, a low EASIX score was associated with a significantly lower hazard of developing both sepsis (SHR: 0.42, 95% CI: 0.27-0.66, p<0.001) and pneumonia (SHR: 0.63, 95% CI: 0.45-0.87, p=0.006). The prognostic value of the EASIX score was independent of age, which was not a significant predictor in any multivariable model. Conclusion The EASIX score is a powerful and independent predictor of mortality, sepsis, and pneumonia in patients with multiple myeloma. Its use can enhance risk stratification and may help identify high-risk patients who could benefit from more intensive monitoring or alternative therapeutic strategies.