Statistical & Clinical Analysis
EUTOS & Sokal CML Risk Scores: Chronic Myeloid Leukemia TKI Prognosis
Calculate the European Treatment and Outcome Study score EUTOS = 7 * Basophils_% + 4 * Spleen_cm (<= 87 Low vs. > 87 High Risk) alongside Sokal’s exponential hazard ratio in newly diagnosed chronic-phase CML.
Why blood basophil % and spleen size below the costal margin drive frontline 2G-TKI selection in chronic-phase CML!
Jörg Hasford and the European LeukemiaNet (2011, Blood — 2,060 imatinib-treated chronic-phase CML patients) distilled 18-month Complete Cytogenetic Response (CCyR) prediction into the remarkably clean EUTOS linear score: EUTOS = 7 * Basophils_% + 4 * Spleen_cm (palpable cm below left costal margin), stratifying patients into Low Risk (<= 87) vs. High Risk (> 87)!
Alongside EUTOS, NCCN and ELN guidelines still reference Joseph E. Sokal’s (1984, Blood) 4-variable exponential relative hazard HR_Sokal = EXP[0.0116*(Age - 43.4) + 0.0345*(Spleen_cm - 7.51) + 0.188*((Platelets_k / 700)^2 - 0.563) + 0.0887*(Blasts_% - 2.10)] (< 0.8 Low, 0.8–1.2 Intermediate, > 1.2 High Risk—favoring frontline second-generation TKIs nilotinib/dasatinib/bosutinib)! At Age = 58, Spleen = 12 cm, Basophils = 9%, Platelets = 850 × 10^9/L, and Peripheral Blasts = 4%, EUTOS = 111.0 (> 87 High Risk) and Sokal HR = 1.943 (> 1.2 High Risk)!
| Chronic-Phase CML Presentation | EUTOS Score (Cutoff 87) | Sokal Hazard Ratio (<0.8 / 0.8–1.2 / >1.2) | ELN / NCCN TKI Implication |
|---|---|---|---|
| Age 58, Spleen 12 cm, Baso 9%, Plt 850, Blasts 4% | 111.0 (High Risk > 87) | 1.943 (High Risk > 1.2) | Favor 2nd-Generation TKI Frontline |
| Age 40, Spleen 3 cm, Baso 4%, Plt 350, Blasts 1% | 40.0 (Low Risk <= 87) | 0.704 (Low Risk < 0.8) | Imatinib or 2G-TKI Appropriate |
| Blasts >= 20% (Blast Crisis) or Negative Labs | Not Chronic Phase | "Requires Chronic-Phase CML Inputs" | Phase Eligibility Guard |
EUTOS Chronic Myeloid Leukemia Score = 7 * Basophils_% + 4 * Spleen_cm
Evaluates EUTOS from peripheral blood basophils % (B4) and spleen size cm below costal margin (B3) across chronic-phase CML (Blasts < 15–20%).
=IF(OR(B2 < 18, B3 < 0, B4 < 0, B5 <= 0, B6 < 0, B6 >= 20), "Requires Chronic-Phase CML Inputs", ROUND(7 * B4 + 4 * B3, 1))Sokal Exponential Relative Hazard Ratio HR_Sokal
Computes EXP(0.0116*(Age - 43.4) + 0.0345*(Spleen - 7.51) + 0.188*((Platelets/700)^2 - 0.563) + 0.0887*(Blasts - 2.10)).
=IF(OR(B2 < 18, B3 < 0, B4 < 0, B5 <= 0, B6 < 0, B6 >= 20), "Requires Chronic-Phase CML Inputs", ROUND(EXP(0.0116 * (B2 - 43.4) + 0.0345 * (B3 - 7.51) + 0.188 * (((B5 / 700) ^ 2) - 0.563) + 0.0887 * (B6 - 2.1)), 3))Try the example
Use the original values or change them to test your understanding.