Risk Stratification of Chronic Myeloid Leukemia According to Different Prognostic Scores

Abstract

Introduction Several prognostic indices are in use to stratify chronic myeloid leukemia (CML) patients: Sokal, Hasford, and the European Treatment and Outcome Study (EUTOS) being the most commonly reported ones. The application of different scores may cause variability in the determination of disease prognosis. This study was conducted to stratify patients of CML in accordance with Sokal, Hasford, and EUTOS scoring systems and to determine the concordance rate of risk categories, calculated by using all three scoring systems. Methods This study was conducted at King Edward Medical University from January 2013 to May 2019. A total of 114 patients were diagnosed with CML in the chronic phase during the study period and included in the analysis. Variables of interest were computed using Microsoft Excel. These variables include age, spleen size, platelet count, the percentage of myeloblasts in the peripheral blood, as well as the percentage of basophils and eosinophils in the peripheral blood. Using these baseline variables, the prognostic category of each patient was calculated using Sokal, Hasford, and EUTOS scores. Results The male to female ratio of patients included in the study was 1.43. The mean age was 39.3±1.58 years, with an age range of 13 to 95 years. A total of only 4 out of 73 patients were categorized as a low-risk category, whereas 23 out of 80 patients were categorized into a highrisk category by all three scoring systems. The assignment of prognostic categories was variable, depending on which prognostic score was applied. The concordance rate of Sokal vs Hasford was 53%, Sokal vs EUTOS 64%, and Hasford vs EUTOS 98%. Conclusion There is considerable inter-variability between the various prognostic indicators. In general, the Hasford and EUTOS scores assign some patients to a lower risk category when compared to Sokal score.

Chronic Myeloid Leukemia Prognosis and Therapy: Criticisms and Perspectives

“…The Sokal score has been paired, but not replaced, by the Euro score generated and adapted for patients candidated to receive IFNα therapy and, more recently, by the EUTOS score for patients receiving TKIs. Although it is based on simple clinical and hematologic parameters (age, spleen size, platelet and blast cells count), it is still used as it remains a fundamental tool for planning the therapeutic strategy [ 12 , 13 , 14 , 15 ].…”

Long-Term Outcomes with Sequential Tyrosine Kinase Inhibitors Treatment in Chronic Myeloid Leukemia Patients

“…According to European Leukemia Net (ELN), each imatinib, nilotinib or dasatinib is recommended as front-line therapy. Other TKIs could be used as a second or third-line treatment, depending on the patient's risk score (Sokal score) (Aijaz et al, 2020) and EUTOS long-term survival (ELTS) score) (Pfirrmann et al, 2016), mutation of BCR-ABL tyrosine kinase and comorbidities (Baccarani et al, 2013;Hochhaus et al, 2020).…”

Chronic myeloid leukemia: cytogenetics and molecular biology’s part in the comprehension and management of the pathology and treatment evolution

“…More recently, European Leukemia Network validated a new risk score the "European treatment and outcome study long-term survival" (ELTS) which assesses the likelihood of death from CML in patients treated with TKI, taking into account the age parameter as a negative prognostic value [98].…”