{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T21:08:13Z","timestamp":1791666493579,"version":"4.3.4"},"reference-count":17,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Endothelial dysfunction is increasingly recognized as a key determinant of transplant outcomes. The Endothelial Activation and Stress Index (EASIX), originally validated in allogeneic stem cell transplantation, integrates markers of endothelial stress into a single composite score. Its prognostic role in autologous stem cell transplantation (ASCT) for multiple myeloma (MM) remains undefined. We evaluated the pre-transplant prognostic value of EASIX, an albumin-modified formulation (mEASIX_alb), and nutritional indices (Prognostic Nutritional Index [PNI] and Controlling Nutritional Status [CONUT] score) in a large MM-ASCT cohort. Materials and Methods: We retrospectively analyzed 274 MM patients who underwent ASCT at a single institution. The pre-ASCT EASIX (LDH \u00d7 Creatinine\/Platelets), mEASIX_alb (LDH \u00d7 Creatinine\/[Platelets \u00d7 Albumin]), PNI (10 \u00d7 Albumin [g\/dL] + 0.005 \u00d7 Lymphocyte count), and CONUT score were calculated from laboratory values obtained on day 3. Optimal binary cutoffs were determined by maximally selected rank statistics. Overall survival (OS) and progression-free survival (PFS) were analyzed with Cox models in which EASIX and mEASIX_alb were entered as continuous, log-transformed variables; binary cutoffs were used only for descriptive Kaplan\u2013Meier illustration. Internal model validity was assessed by bootstrap resampling (B = 1000). Results: Over a median follow-up of 81.3 months, 150 patients (54.7%) died, and 207 (75.5%) experienced disease progression or death. Using illustrative cutoffs (EASIX &gt; 0.471, mEASIX_alb &gt; 0.208, PNI &lt; 52.29), higher EASIX was associated with shorter OS (66.7 vs. 108.1 months; p = 0.012) and PFS (27.4 vs. 42.7 months; p = 0.018). In multivariable analysis, log-transformed EASIX (HR 1.40, 95% CI 1.10\u20131.77; p = 0.006) and mEASIX_alb (HR 1.38, 95% CI 1.09\u20131.73; p = 0.007) independently predicted OS after adjustment for baseline covariates (ISS stage, pre-transplant response, and age). EASIX remained independently prognostic in a day-100 landmark analysis (HR 1.35; p = 0.023). Critically, the PNI, prognostic for OS in univariate analysis (HR 0.973; p = 0.038), did not provide independent incremental prognostic value beyond the clinical model when EASIX was added (HR 0.99; p = 0.526); this does not establish shared information between EASIX and PNI. Conclusions: Pre-transplant EASIX and mEASIX_alb are independent prognostic biomarkers in MM-ASCT. The PNI did not provide independent incremental prognostic value beyond the clinical model. These scores may inform pre-transplant risk stratification, although the illustrative cutoffs require external validation before clinical use. EASIX retained prognostic significance across transplant eras and in a cytogenetically characterized subset, supporting its era-independent and cytogenetics-independent utility.<\/jats:p>","DOI":"10.3390\/medicina62081572","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T08:05:41Z","timestamp":1786953941000},"page":"1572","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Pre-Transplant Endothelial Activation and Stress Index (EASIX) and Albumin-Modified mEASIX (mEASIX_alb) Predict Survival in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation"],"prefix":"10.3390","volume":"62","author":[{"given":"Tuba","family":"G\u00fcll\u00fc Koca","sequence":"first","affiliation":[{"name":"Department of Hematology, Bursa \u015eehir Training & Research Hospital, University of Health Sciences, 16110 Bursa, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1457-4366","authenticated-orcid":false,"given":"Nizameddin","family":"Koca","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Bursa \u015eehir Training & Research Hospital, University of Health Sciences, 16110 Bursa, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4991-9830","authenticated-orcid":false,"given":"Faz\u0131l \u00c7a\u011fr\u0131","family":"Hunutlu","sequence":"additional","affiliation":[{"name":"Department of Hematology, Bursa \u015eehir Training & Research Hospital, University of Health Sciences, 16110 Bursa, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sinem","family":"\u00c7ubuk\u00e7u","sequence":"additional","affiliation":[{"name":"Department of Hematology, Ali Osman Sonmez Oncology Hospital, 16040 Bursa, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00fcmeysa","family":"Y\u0131lmaz","sequence":"additional","affiliation":[{"name":"Department of Hematology, Bursa Uluda\u011f University Hospital, Bursa Uluda\u011f University, 16059 Bursa, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5419-3221","authenticated-orcid":false,"given":"Tuba","family":"Ersal","sequence":"additional","affiliation":[{"name":"Department of Hematology, Bursa Uluda\u011f University Hospital, Bursa Uluda\u011f University, 16059 Bursa, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vildan","family":"G\u00fcrsoy","sequence":"additional","affiliation":[{"name":"Department of Hematology, Bursa Uluda\u011f University Hospital, Bursa Uluda\u011f University, 16059 Bursa, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9907-1498","authenticated-orcid":false,"given":"Ibrahim Ethem","family":"P\u0131nar","sequence":"additional","affiliation":[{"name":"Department of Hematology, Bursa Uluda\u011f University Hospital, Bursa Uluda\u011f University, 16059 Bursa, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vildan","family":"\u00d6zkocaman","sequence":"additional","affiliation":[{"name":"Department of Hematology, Bursa Uluda\u011f University Hospital, Bursa Uluda\u011f University, 16059 Bursa, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9710-134X","authenticated-orcid":false,"given":"Fahir","family":"\u00d6zkalemka\u015f","sequence":"additional","affiliation":[{"name":"Department of Hematology, Bursa Uluda\u011f University Hospital, Bursa Uluda\u011f University, 16059 Bursa, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1001\/jama.2022.0003","article-title":"Diagnosis and Management of Multiple Myeloma: A Review","volume":"327","author":"Cowan","year":"2022","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/S0140-6736(19)31240-1","article-title":"Bortezomib, thalidomide, and dexamethasone with or without daratumumab before and after autologous stem-cell transplantation for newly diagnosed multiple myeloma (CASSIOPEIA): A randomised, open-label, phase 3 study","volume":"394","author":"Moreau","year":"2019","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.annonc.2020.11.014","article-title":"Multiple myeloma: EHA-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"32","author":"Dimopoulos","year":"2021","journal-title":"Ann. 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