Sokal and ELTS risk scores (chronic myeloid leukaemia)
Sokal and ELTS are arithmetic from the first blood count: age, spleen size, platelets and blast percentage at diagnosis sort chronic myeloid leukaemia into low, intermediate and high risk, and high-risk patients are the ones more likely to be started on a second-generation drug rather than imatinib.
Overview
What is measured: the risk that chronic-phase CML will progress or kill. How: four variables recorded before any treatment (including hydroxyurea): age, spleen size in centimetres below the costal margin, platelet count and the percentage of blasts in blood. Sokal (1984) was built in the pre-drug era and predicts overall survival; Hasford or Euro (1998) added eosinophils and basophils; ELTS (2016) uses the same four variables as Sokal with different weights and was designed for patients on tyrosine kinase inhibitors to predict death from CML itself, which is why the European LeukemiaNet 2020 recommendations prefer it. About 12 percent of patients are ELTS high risk. What a result changes: high risk favours a second-generation drug (nilotinib, dasatinib, bosutinib) or asciminib first line rather than imatinib, and closer attention to the molecular milestones (BCR::ABL1 below 10 percent at three months, 1 percent at six, 0.1 percent at twelve); high-risk patients are less likely to reach a treatment-free remission. Where it matters: CML and its chronic-phase page.
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