Sokal, Hasford and EUTOS Score Calculator

Prognostic scores for chronic-phase chronic myeloid leukemia

Assess Sokal, Hasford (Euro) and EUTOS scores at time of diagnosis, before commencing CML treatment

Enter pre-treatment values, then press “Next”

Age, spleen size, platelet count and peripheral blood blasts are required for Sokal score. Peripheral blood eosinophil and basophil percentage also required for Hasford (Euro) score.

Commentary

The Sokal score1 derives from a multivariate analysis of survival of 813 patients diagnosed with chronic phase CML between 1962 and 1981. Most patients were treated with single-agent chemotherapy, typically busulfan. Spleen size and percentage blasts were most strongly associated with survival. The score, which is a hazard ratio, is calculated using the following formula: exp (0.0116 x (age [years] – 43.4)) + (0.0345 x (spleen size [cm] – 7.51) + (0.188 x ((platelets [109/L]/700)^2 – 0.563)) + (0.0887 x (blasts [%] – 2.10)). Sokal et al proposed three risk groups: low-risk (Sokal score < 0.8, 39% of patients), intermediate-risk (Sokal score 0.8 - 1.2, 38% of patients) and high-risk (> 1.2, 23% of patients).

The Hasford score (or Euro score)2 derives from multivariate analysis of survival of 981 patients with early CML who started treatment between 1983 and 1994. All were treated with interferon alpha alone, or in combination with another therapy. The score was validated in a separate cohort of 322 patients. The score is calculated using the following formula: (0.6666 x age [0 when age < 50 years; 1 otherwise]) + (0.0420 x spleen size [cm]) + (0.0584 x blasts [%]) + (0.0413 x eosinophils [%]) + (0.2039 x basophils [0 when basophils < 3%; 1 otherwise]) + (1.0956 x platelet count [0 when platelets < 1500 x 109/L; 1 otherwise]) x 1000). Three risk groups were identified: low-risk (score ≤ 780, 40.6% of patients), intermediate-risk (score 781 – 1480, 44.7% of patients) and high-risk (score ≥ 1481, 14.6% of patients).

The European Treatment and Outcome Study (EUTOS) risk score for chronic myeloid leukemia (CML) was derived from multivariate analysis of response of 2060 patients treated with imatinib for CML between 2002 and 2006.3 The score is applied at diagnosis, before starting therapy.3 The EUTOS score is calculated as (7 x basophil [%]) + (4 x spleen [cm]). Two risk groups were identified: low-risk (score < 87, 79% of patients) and high-risk (score ≥ 87, 21% of patients). The EUTOS manuscript also provides the following formula for predicting the probability of no CCgR at 18 months: exp(−2.1007 + 0.0700 × basophils + 0.0402 × spleen size)/(1 + exp[−2.1007 + 0.0700 + basophils + 0.0402 × spleen size]). [/box] [box]

References

  1. Sokal JE, Cox EB, Baccarani M, Tura S, Gomez GA, Robertson JE et al. Prognostic discrimination in “good-risk” chronic granulocytic leukemia. Blood 1984; 63: 789-99.
  2. Hasford J, Pfirrmann M, Hehlmann R, Allan NC, Baccarani M, Kluin-Nelemans JC et al. A new prognostic score for survival of patients with chronic myeloid leukemia treated with interferon alfa. J Natl Cancer Inst. 1998; 90: 850-8.
  3. Hasford J, Baccarani M, Hoffmann V, Guilhot J, Saussele S, Rosti G et al. Predicting complete cytogenetic response and subsequent progression-free survival in 2060 patients with CML on imatinib treatment: the EUTOS score. Blood 2011; 118: 686-92.