A research study led by Professor Wenyu Shi from the Affiliated Hospital of Nantong University and Dr. Yi Miao from The First Affiliated Hospital with Nanjing Medical University (Jiangsu Provincial Hospital), under the Jiangsu Lymphoma Collaboration Group and the Jiangsu HLH Working Group, was selected for an oral presentation. This study is the first to show that the Endothelial Activation and Stress Index (EASIX) is a reliable predictor of outcomes in patients with T/NK cell lymphoma-associated hemophagocytic lymphohistiocytosis (T/NK-LA HLH).The 15th International T-Cell Lymphoma Forum successfully took place from June 6 to 8, 2024, in San Diego, USA. This forum brought together top clinicians, researchers, and distinguished representatives from the medical field worldwide, aiming to advance the research and innovation in T-cell lymphoma, ultimately improving patient survival and well-being.  "Oncology Frontier - Hematology Frontier" invited Professor Shi and Dr. Miao for an interview to share and interpret the study's content and significance.

Oncology Frontier – Hematology Frontier: Your team developed a prognostic index for T/NK-LA HLH that includes EASIX, age, and fibrinogen. How do you envision this prognostic index being applied in clinical practice? Can it help doctors more accurately assess patient survival and formulate treatment plans?

Dr. Yi Miao: The prognostic index we developed, which includes EASIX, age, and fibrinogen, has significant clinical application value and can help doctors more accurately assess patient survival and formulate treatment plans in the following ways:

1. Prognostic Assessment

By inputting the values of EASIX, age, and fibrinogen into the prognostic index, doctors can categorize patients into different risk groups (low, intermediate, and high risk). This stratification provides more precise survival predictions, helping doctors better understand the severity of the patient’s condition.

• Low-Risk Group: Likely to have a better prognosis with relatively high survival rates, potentially benefiting from standard treatment with long-term survival.
• Intermediate-Risk Group: Requires close monitoring and possibly additional interventions.
• High-Risk Group: Very low survival rates, possibly requiring more aggressive treatment strategies, such as early use of novel anti-HLH therapies and subsequent allogeneic hematopoietic stem cell transplantation.

2. Personalized Treatment Plans

The prognostic index can guide the formulation of personalized treatment plans:

• Treatment Intensity Adjustment: For high-risk patients, consider increasing treatment intensity or trying new treatment methods to improve survival rates.
• Treatment Choices: The prognostic index helps in choosing appropriate treatment options, such as whether to perform allogeneic hematopoietic stem cell transplantation or use novel anti-HLH drugs like emapalumab.

Overall, our prognostic index provides a reliable and practical tool for clinical practice, enabling doctors to more accurately assess the survival of T/NK-LA HLH patients and formulate more personalized and precise treatment plans, ultimately improving patient outcomes. This will help optimize the use of medical resources and enhance patient treatment experiences and quality of life.

Oncology Frontier – Hematology Frontier: Currently, the clinical management of T/NK-LA HLH patients remains challenging. What potential impacts do you think your team’s findings on EASIX as a prognostic marker will have on improving the clinical management of T/NK-LA HLH patients? Could it possibly drive the optimization of related treatment strategies or the development of new therapies?

Dr. Yi Miao: Our findings on EASIX as a prognostic marker have the following potential impacts on improving the clinical management of T/NK-LA HLH patients and could drive the optimization of related treatment strategies and the development of new therapies:

1. Precise Prognostic Assessment

EASIX as an effective prognostic marker can help doctors more accurately assess the severity of T/NK-LA HLH and patient survival rates, aiding in:

• Early Identification of High-Risk Patients: Timely identification of patients with poor prognosis to take more aggressive treatment measures early on, and, if necessary, transfer them to intensive care units (ICU) for multidisciplinary management including hematology, ICU, and nephrology, which may improve clinical outcomes.
• Personalized Treatment Plans: Formulating personalized treatment plans based on EASIX scores to optimize treatment effects and reduce unnecessary treatment burdens.

2. Treatment Strategy Optimization

Introducing EASIX as a prognostic indicator can make clinical management more scientific and systematic:

• Dynamic Monitoring and Adjustment: EASIX reflects endothelial cell activation and stress status. Regular monitoring of EASIX scores can help doctors dynamically assess disease progression and timely adjust treatment plans.
• Risk-Stratified Treatment: Stratifying patients based on EASIX scores to optimize treatment strategies. For example, high-risk patients might need more aggressive treatments, while low-risk patients could receive relatively conservative treatments, reducing treatment-related side effects and unnecessary medical resource consumption.

3. Development of New Therapies

Research findings on EASIX as a prognostic marker may provide new ideas and directions for developing new therapies:

• Targeted Therapy: Understanding the association between EASIX scores and patient prognosis could promote the development of targeted therapies for endothelial cell activation, including novel anti-inflammatory drugs, immunomodulators, or other drugs that improve endothelial cell function.
• Individualized Treatment: Research on individualized treatments based on EASIX scores can explore the effectiveness