EUTOS Score for Chronic Myelogenous Leukemia (CML)
INSTRUCTIONS
Use in newly-diagnosed patients before starting therapy.
Newly-diagnosed CML patients prior to discussions regarding prognosis and treatment options.
- The EUTOS (European Treatment and Outcome Study) Score predicts survival and can also be used to predict the probability of complete cytogenetic response at 18 months.
- Has better predictive value than the Sokal Score.
- Spleen size estimation is subjective; however, that subjectivity is also included in other CML prognostic scores.
- Developed in patients treated with imatinib, so outcomes may not apply with newer generation therapies.
- Estimates response to therapy to, and survival on, the reference TKI (tyrosine kinase inhibitor) imatinib.
- Only requires two values, which can be clinically detected prior to completing a bone marrow biopsy.
Result:
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Management
Though there is no broad consensus on management, a conservative strategy is to treat low-risk patients with imatinib and reserve newer-generation TKIs for high risk patients.
Critical Actions
Can only be applied to a newly-diagnosed patient before starting therapy.
Formula
EUTOS Score = (7 × basophil) + (4 × spleen), where
- “Basophil” is basophils as a percentage of peripheral blood leukocytes, and
- “Spleen” is spleen size palpable below left costal margin, in cm.
Probability of not achieving complete cytogenic response (CCyR) at 18 months = exp(−2.1007 + 0.0700 × basophils + 0.0402 × spleen size)/(1 + exp[−2.1007 + 0.0700 + basophils + 0.0402 × spleen size])
Facts & Figures
Interpretation:
EUTOS Score | Risk category | 5 year progression-free survival* | CCyR at 18 months* |
≤87 | Low | 90% | 86% |
>87 | High | 82% | 66% |
*Response rates based on imatinib treatment only.
CCyR, complete cytogenetic response rate.
Evidence Appraisal
The original derivation of the EUTOS Score came from a retrospective analysis of 1,223 European patients in the European Leukemia Network CML registry. All patients were treated with imatinib and divided into a learning cohort and a validation cohort. The prediction is based on a surrogate endpoint for survival of complete cytogenetic response at 18 months, but was found to also predict progression-free survival (PFS).
An attempt to validate the score by a single institution found that the score was not predictive for survival (Jabbour 2012). There are six major studies showing the EUTOS score predicts outcomes (Hoffman 2012, Hoffman 2013, Tiribelli 2012, Breccia 2012, Uz 2013, Yahng 2012) and three studies showing that it does not (Marin 2011, Jabbour 2012, Yamamoto 2014).
The EUTOS Score continues to evolve, with recent data from Pfirrmann et al (2016) showing that an EUTOS Long-Term Survival Score (ELTS) differentiated probability of death due to CML better than the original EUTOS Score.
Literature
Validation






Other References





About the Creator
To view Dr. Joerg Hasford's publications, visit PubMed
- Michael Mauro, MD