The Use of EUTOS Long-Term Survival Score Instead of Sokal Score Is Strongly Advised in Elderly Chronic Myeloid Leukemia Patients

Abstract

Background. Many prognostic scores have been proposed for risk stratification of chronic myeloid leukemia (CML) patients: the Sokal is the oldest and the most widely used score; the EUTOS long-term survival (ELTS), based on a large cohort of patients treated frontline with imatinib (IM), is the most recent score. The ELTS score, compared to Sokal score, showed superior ability to predict overall and leukemia-related survival, but data are limited and differences were small. Further evidence is required to support and to implement the clinical use of ELTS score. Aims. Given the different weight of the variable "age" in ELTS and Sokal score formulations, we hypothesized a different predictive value in specific age groups. Consequently, the aim of our study was to compare the prognostic value of ELTS and Sokal scores in a cohort of CML patients treated frontline with tyrosine kinase inhibitors (TKIs), according to the age, Methods. Nine hundred and four adult patients were included, 559 treated with IM and 345 treated with nilotinib (NIL). Patients were enrolled in six multicenter studies (NCT00481052, NCT00769327, NCT01535391, NCT00514488, NCT00510926, observational trial CML/023) conducted by the GIMEMA CML WP. The intention-to-treat population of each study was analyzed. Definitions: major molecular response (MR3 or MMR), BCR-ABL IS IS 10.000 copies; progression, transformation according to ELN criteria; leukemia related death (LRD): death after progression. Results. Median age, 52 years (range 18-86). Age distribution: 65 years) only the ELTS score was able to predict the achievement of MR3 (99%, 87% and 75% in low, intermediate and high-risk patients, respectively; p=0.001) and MR4 (82%, 61% and 50% in low, intermediate and high ELTS score patients, respectively; p=0.005). Interestingly, in elderly patients both scores predicted the OS, while only the ELTS score predicted a significantly different LRD probability (cumulative incidence 2%, 6% and 14% in low, intermediate and high-risk patients, respectively; p=0.049). The results were similar considering patients Summary/Conclusion. The risk distribution according to ELTS and Sokal score and the concordance between the two scores was different in young adults ( Disclosures Castagnetti: Bristol Myers Squibb: Consultancy, Honoraria; Incyte: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Novartis: Consultancy, Honoraria. Gugliotta: Pfizer: Honoraria; Incyte: Honoraria; Bristol-Myers Squibb: Honoraria; Novartis: Honoraria. Breccia: Incyte: Honoraria; Novartis: Honoraria; BMS: Honoraria; Pfizer: Honoraria. Levato: Novartis: Other: Advisory board. Abruzzese: Ariad: Consultancy; BMS: Consultancy; Novartis: Consultancy; Pfizer: Consultancy. Soverini: Incyte Biosciences: Consultancy; Novartis: Consultancy; Bristol Myers Squibb: Consultancy. Foa: GILEAD: Speakers Bureau; JANSSEN: Other: ADVISORY BOARD, Speakers Bureau; INCYTE: Other: ADVISORY BOARD; AMGEN: Other: ADVISORY BOARD; ROCHE: Other: ADVISORY BOARD, Speakers Bureau; CELGENE: Other: ADVISORY BOARD, Speakers Bureau; CELTRION: Other: ADVISORY BOARD; NOVARTIS: Speakers Bureau; ABBVIE: Other: ADVISORY BOARD, Speakers Bureau. Martinelli: Abbvie: Consultancy; Novartis: Speakers Bureau; Janssen: Consultancy; Roche: Consultancy; Jazz Pharmaceuticals: Consultancy; Amgen: Consultancy; Ariad/Incyte: Consultancy; Celgene: Consultancy, Speakers Bureau; Pfizer: Consultancy, Speakers Bureau. Cavo: AbbVie: Honoraria, Membership on an entity9s Board of Directors or advisory committees; Bristol-Myers Squibb: Honoraria, Membership on an entity9s Board of Directors or advisory committees; Amgen: Honoraria, Membership on an entity9s Board of Directors or advisory committees; GlaxoSmithKline: Honoraria, Membership on an entity9s Board of Directors or advisory committees; Janssen: Honoraria, Membership on an entity9s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Celgene: Honoraria, Membership on an entity9s Board of Directors or advisory committees, Research Funding, Speakers Bureau; Takeda: Honoraria, Membership on an entity9s Board of Directors or advisory committees; Adaptive Biotechnologies: Honoraria, Membership on an entity9s Board of Directors or advisory committees. Pane: Novartis: Research Funding, Speakers Bureau; BMS: Speakers Bureau; AMGEN: Speakers Bureau.