Abstract
Sokal index was developed in the pre-imatinib era to predict and prognosticate the outcome of Chronic myeloid leukemia (CML) patients. In the Imatinib era, a new scoring system called EUTOS scoring system has been validated as a predictive marker in CML. The scores have shown variable correlation with complete cytogenetic response (CCyR) and major molecular response (MMR). To assess the performance of Sokal score and EUTOS score as a predictive marker for CCyR and MMR for newly diagnosed CML-CP patients treated with TKIs. 273 patients with newly diagnosed CML were included in the study. They were treated with upfront imatinib. They were followed up for a median period of 3 years. Cytogenetic and Molecular response to the treatment were monitored regularly. Out of 273 patients, 174 patients (63 %) were having low EUTOS score and 99 (37 %) were having high EUTOS score. Patients with low, intermediate and high sokal scores were 237 (86.8 %), 28 (10.3 %) and 8 (2.9 %) respectively. 122 patients with low EUTOS score achieved CCyR within 18 months compared to 42 patients with high EUTOS score (p = 0.000).113 patients with low EUTOS score achieved MMR in 18 months compared to 33 patients with high EUTOS score (p = 0.000). 148, 14, 2 patients with low, intermediate and high Sokal score respectively have achieved CCyR in 18 months (p = 0.054). 133, 11, 2 patients with low intermediate and high sokal score respectively have achieved MMR in 18 months.(p = 0.06). EUTOS is better than Sokal score in predicting the outcome of patients of CML treated with imatinib.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs12288-016-0667-x/MediaObjects/12288_2016_667_Fig1_HTML.gif)
Similar content being viewed by others
References
Rowley JD (1973) A new consistent abnormality in chronic myelogenous leukaemia identified by quinacrine fluorescence and Giemsa staining. Nature 243:290–293
Heisterkamp N, Stam K, Groffen J, de Klein A, Grosveld G (1985) Structural organization of the bcr gene and its role in the Ph’ translocation. Nature 315:758–761
Sokal JE, Cox EB, Baccarani M et al (1984) Prognostic discrimination in “good-risk” chronic granulocytic leukemia. Blood 63:789–799
Hasford J, Pfirrmann M, Hehlmann R et al (1998) A new prognostic score for survival of patients with chronic myeloid leukemia treated with interferon alfa. J Natl Cancer Inst 90(11):850–858
Baccarani M, Cortes J, Pane F et al (2009) Chronic myeloid leukemia: an update of concepts and management recommendations of European LeukemiaNet. J Clin Oncol 27(35):6041–6051
Pavey T, Hoyle M, Ciani O, Crathorne L, Jones-Hughes T, Cooper C et al (2012) Dasatinib, nilotinib and standard-dose imatinib for the first-line treatment of chronic myeloid leukaemia: systematic reviews and economic analyses. Health Technol Assess 16(42):i–vii
O’Brien SG, Guilhot F, Larson RA et al (2003) Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med 348:994–1004
Hughes T, Deininger M, Hochhaus A et al (2006) Monitoring CML patients responding to treatment with tyrosine kinase inhibitors: review and recommendations for harmonizing current methodology for detecting BCR-ABL transcripts and kinase domain mutations and for expressing results. Blood 108:28–37
Druker JB, Guilhot F, O’Brien S et al (2006) Five-year follow-up of patients receiving imatinib for chronic myeloid leukemia. N Engl J Med 355:2408–2417
Hasford J, Baccarani M, Hoffmann V, Guilhot J, Saussele S, Rosti G et al (2011) Predicting complete cytogenetic response and subsequent progression-free survival in 2060 patients with CML on imatinib treatment: the EUTOS score. Blood 118:686–692
Sokal JE, Baccarani M, Russo D (1988) Staging and prognosis in chronic myelogenous leukemia. Semin Hematol 25:49–61
Muller-Berat CN, Wantzin GL, Philip P, Baccarani M, Killmann S-A (1977) Agar culture studies of bone marrow, blood, spleen, and liver in chronic myeloid leukemia. Leuk Res 1:123–131
Schemionek M, Spieker T, Kerstiens L, Elling C, Essers M, Trumpp A et al (2011) Leukemic spleen cells are more potent than bone marrow-derived cells in a transgenic mouse model of CML. Leukemia 26:1030–1037
Hoffmann VS, Baccarani M, Lindoerfer D et al (2013) The EUTOS prognostic score: review and validation in 1288 patients with CML treated frontline with imatinib. Leukemia 27:2016–2022
Marin D, Ibrahim AR, Goldman JM (2011) European treatment and outcome study (EUTOS) score for chronic myeloid leukemia still requires more confirmation. J Clin Oncol 29:3944–3945
Pagnano KB, Lorand-Metze I, Miranda ECM, et al (2012) EUTOS score is predictive of event-free survival, but not for progression-freeand overall survival in patients with early chronic phase chronic myeloidleukemia treated with imatinib: a single Institution experience. Blood, 120 (ASH abstract no. 1681)
Tiribelli M, Bonifacio M, Calistri E, et al (2012) EUTOS score identifies cases with poor outcome in patients with early phase chronic myeloid leukemia though not predictive for optimal response to imatinib. Blood, 120 (ASH abstract 3778)
Than H, Kuan L, Seow CH, Li et al (2012) The EUTOS score is highly predictive for clinical outcome and survival in Asian patients with early chronic phase chronic myeloid leukemia treated with imatinib. Blood, 120 (ASH abstract 3758)
Yahng S-A, Jang E-J, Choi SY, et al (2012) Comparison of Sokal, Hasford and EUTOS scores in term of long-term treatment outcome according to the risks in each prognostic model: a single center data analysed in 255 early chronic phase chronic myeloid leukemia patients treated with frontline imatinib mesylate. Blood, 120: (ASH abstract no. 2794)
Jabbour E, Cortes J, Nazha A, O’Brien S et al (2012) EUTOS score is not predictive for survival and outcome in patients with early chronic phase chronic myeloid leukemia treated with tyrosine kinase inhibitors:a single institution experience. Blood 119:4524–4526
Baccarani M, Deininger MW, Rosti G et al (2013) European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013. Blood 122(6):872–884
Acknowledgments
We are grateful to the staff members of Department of Medical Oncology, Kidwai Memorial Institute of Oncology for helping us in making this manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All the authors declare that they have no conflict of interest
Informed Consent
Informed consent was obtained from all the individual participants
Ethical Approval
For this type of study formal consent is not required.
Rights and permissions
About this article
Cite this article
Ganguly, S., Lakshmaiah, K.C., Jacob, L.A. et al. Performance of Sokal and Eutos Scores for Predicting Cytogenetic and Molecular Response in Newly Diagnosed Chronic Myeloid Leukemia-Chronic Phase Patients on Imatinib. Indian J Hematol Blood Transfus 33, 82–86 (2017). https://doi.org/10.1007/s12288-016-0667-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12288-016-0667-x