The EUTOS long-term survival (ELTS) score is superior to the Sokal score for predicting survival in chronic myeloid leukemia

Abstract

Prognostic scores support clinicians in selecting risk-adjusted treatments and in comparatively assessing different results. For patients with chronic-phase chronic myeloid leukemia (CML), four baseline prognostic scores are commonly used. Our aim was to compare the prognostic performance of the scores and to arrive at an evidence-based score recommendation. In 2949 patients not involved in any score development, higher hazard ratios and concordance indices in any comparison demonstrated the best discrimination of long-term survival with the ELTS score. In a second step, of 5154 patients analyzed to investigate risk group classification differences, 23% (n = 1197) were allocated to high-risk by the Sokal score. Of the 1197 Sokal high-risk patients, 56% were non-high-risk according to the ELTS score and had a significantly more favorable long-term survival prognosis than the 526 high-risk patients according to both scores. The Sokal score identified too many patients as high-risk and relatively few (40%) as low-risk (versus 60% with the ELTS score). Inappropriate risk classification jeopardizes optimal treatment selection. The ELTS score outperformed the Sokal score, the Euro, and the EUTOS score regarding risk group discrimination. The recent recommendation of the European LeukemiaNet for preferred use of the ELTS score was supported with significant statistical evidence.

Validation of CIP2A as a Biomarker of Subsequent Disease Progression and Treatment Failure in Chronic Myeloid Leukaemia

“…The Hasford and EUTOS scores did not predict progression-free survival (consistent with the findings of both the Italian and German studies) [ 8 , 10 ] or correlate with CIP2A levels ( Figure 1 c–f). However, the ELTS score correlated with progression-free survival ( Figure 1 g; p = 0.01), consistent with a recent report [ 30 ], though no correlation was seen between it and CIP2A levels ( Figure 1 h). No association was found between diagnostic CIP2A levels and the presence of trisomy 8 or 19, a second Ph translocation, or isochromosome 17 ( Figure 1 i).…”

The New ELN Recommendations for Treating CML

“…Risk score at diagnosis: In the TKI era, evaluation of risk at diagnosis should be done with the EUTOS score for long-term survival (ELTS), since it predicts death by CML more accurately than the other scores [ 11 , 12 ]. The ELTS score uses the same variables as the Sokal score, but with different weights ( Table 1 ).…”

The new ELN Recommendations for treating CML. Early transplantation in patients with high-risk ACA

“…The preferred risk score is the new EUTOS score for longterm survival (ELTS), since it predicts death by CML better than all other scores [14,15]. ELTS uses the same variables as the Sokal score, but with different weights.…”