Clinical Brief – August 31st
Graft-vs-host disease (aka GVHD) is where the stem cell transplant develops into white blood cells that “rejects” the recipient.
To help predict what happens after an acute GVHD, a new study turned to some common biomarkers which are simple to test. Their risk score, EASIX, also came with an online calculator.
Back up a bit.
Stem cell transplants are immensely helpful for treating patients with leukemia and bone marrow disorders. Simply put, we wipe the patient’s defective blood cells out and replace it with a fresh version from a matched donor.
These transplants are tricky because the cells that grow up include white blood cells, which normally would be involved in transplant rejections. So, when the donor transplant becomes the only source of white blood cells for the patient, it’s like a reverse rejection.
GVHD is primarily treated with corticosteroids, but it doesn’t always work. When steroids fail, “mortality is very high without substantial improvement during the past 20 years”, wrote Dr Luft and colleagues, who ran the study.
Naturally, knowing what can happen after an episode of acute GVHD can help both clinicians and patients make better decisions down the road. This is where EASIX comes in.
For patients who had reduced intensity conditioning before their transplant, EASIX is a risk score we can use if the patient gets an episode of acute GVHD.
The score uses markers that measure cell death (LDH), kidney function (creatinine), and the platelet count. These are routine lab tests for most patients with a stem cell transplant, so there’s no added work or costs. Patients likely would have access to these results too, I’d imagine.
By calculating the EASIX score, we can predict the mortality 1-2 years after the episode of acute GVHD.
To help calculate the EASIX score, Dr Luft and colleagues published their EASIX calculator online free of charge. It’s fairly easy for clinicians to use and with the help of the “Google Thesaurus”, patients with access to their labs can use it too.
Does EASIX work?
That’s why Dr Luft and colleagues did the study to find out. They collected the records of about 300 patients from Heidelberg, Germany. All patients had acute GVHD, and they analyzed this data to look for links between mortality and their EASIX scores, among other factors.
They found that overall, a doubling in the EASIX score was linked to a significantly lower chance of survival. But looking closer at the data, they found that the EASIX score only worked for patients who had reduced intensity conditioning before their transplant.
They also successfully validated their models in two independent cohorts from Berlin, Germany, and Seattle, US, respectively. They also successfully tested their model on a pediatric cohort from Cincinnati, US.
The power of the EASIX score lies in how easy it is to use because all the tests it needs are already done in most clinics.
Here’s what other clinicians wrote in a commentary:
“[EASIX is] a simple tool that can be easily applied to any patient cohort.”
– Weissinger EM and Ganser A
Only time will tell just how accurate it can be in the real-world. For now, for anyone wishing to glean a bit more data after an unfortunate case of acute GVHD, at least there’s a calculator we can turn to.