Is the Sokal or EUTOS long-term survival (ELTS) score a better predictor of responses and outcomes in persons with chronic myeloid leukemia receiving tyrosine-kinase inhibitors?

• Published in: Leukemia Vol. 36; no. 2; pp. 482 - 491
• Main Authors: Zhang, Xiao-Shuai, Gale, Robert Peter, Huang, Xiao-Jun, Jiang, Qian
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.02.2022; Nature Publishing Group
• Subjects: 631/67/1059/602; 631/67/1990/283/1896; Adolescent; Adult; Aged; Aged, 80 and over; Cancer Research; Chronic myeloid leukemia; Critical Care Medicine; Cytogenetics; Enzyme inhibitors; Female; Follow-Up Studies; Hematology; Humans; Imatinib; Inhibitor drugs; Intensive; Internal Medicine; Kinases; Leukemia; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - drug therapy; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - mortality; Leukemia, Myelogenous, Chronic, BCR-ABL Positive - pathology; Male; Medicine; Medicine & Public Health; Middle Aged; Myeloid leukemia; Nomograms; Oncology; Prognosis; Protein Kinase Inhibitors - therapeutic use; Retrospective Studies; Risk Factors; Survival; Survival Rate; Targeted cancer therapy; Therapy; Tyrosine; Young Adult
• ISSN: 0887-6924; 1476-5551; 1476-5551
• DOI: 10.1038/s41375-021-01387-y

Data from 1661 consecutive subjects with chronic-phase chronic myeloid leukemia (CML) receiving initial imatinib ( n  = 1379) or a 2 nd -generation tyrosine-kinase inhibitor (2G-TKI; n  = 282) were interrogated to determine whether the Sokal or European Treatment and Outcome Study for CML (EUTOS) long-term survival (ELTS) scores were more accurate responses and outcome predictors. Both scores predicted probabilities of achieving complete cytogenetic response (CCyR), major molecular response (MMR), failure- and progression-free survivals (FFS, PFS), and survival in all subjects and those receiving imatinib therapy. However, the ELTS score was a better predictor of MR 4 , MR 4.5 , and CML-related survival than the Sokal score. In subjects receiving 2G-TKI therapy, only the ELTS score accurately predicted probabilities of CCyR, MMR, MR 4 , FFS, and PFS. In the propensity score matching, subjects classified as intermediate risk by the ELTS score receiving a 2G-TKI had better responses ( p  < 0.001~0.061), FFS ( p  = 0.002), and PFS ( p   =  0.03) but not survival. Our data suggest better overall prediction accuracy for the ELTS score compared with the Sokal score in CML patients, especially those receiving 2G-TKIs. People identified as intermediate risk by the ELTS score may benefit more from initial 2G-TKI therapy in achieving surrogate endpoints but not survival, especially when a briefer interval to stopping TKI therapy is the therapy objective.