The Sokal (1984) and Hasford/Euro (1998) scores were developed in the chemotherapy and interferon eras respectively and are still widely used as prognostic indicators in CML patients. Recently (2011), European Treatment and Outcome Study (EUTOS) scoring metric was introduced to risk stratify CML patients on Imatinib treatment. CML is predominantly a disease of elderly, but around 5-10% of patients are adolescent and young adults (AYA). Data on presentation, risk stratification and outcome in this population was lacking. It lead us to study the effectiveness of EUTOS risk score in predicting the response and outcome among AYA CML-CP patients on front line Imatinib.
Hospital records of AYA CML CP patients (age 15-30 years) from 2010 to 2012, were analyzed retrospectively for clinical features, EUTOS risk score, cytogenetic, molecular response and EFS at the end of three years. All patients received Imatinib under the Glivec international patient assistance program (GIPAP).
A total of 39 patients were included in this study, with the median age of 24 years (range 15-30years) and male preponderance (M:F- 1.2:1). Majority (72%) of them were in EUTOS low risk group. Complete cytogenetic response [CCyR] rate at 12 months was 76% and 73% in low and high risk groups respectively. Major molecular response [MMR] rate at 18 months was 85% and 79% in low and high risk groups respectively. 3 year EFS was 89% and 80% in low and high risk groups respectively.
Risk groups response and outcome comparison
|Response â||EUTOS low risk n = 28 (72%)||EUTOS high risk n = 11 (28%)||p value (fishers test)||PPV for low risk||NPV for high risk|
|CHR at 3mon||28 (100%)||9 (81%)||0.07||75%||100%|
|CCyR at 12mon||22 (78%)||5 (45%)||0.06||81%||50%|
|MMR at 18mon||24 (86%)||6 (54%)||0.08||80%||55%|
|EFS at 36mon||26 (92%)||6 (54%)||0.01||81%||71%|
EUTOS low risk AYA CML CP patients on Imatinib responded better than high risk, but not statistically significant. Low risk patients had statistically significant higher 3 year EFS than high risk. It effectively predicted the outcome but not the response in AYA CML CP.
Clinical trial identification
All authors have declared no conflicts of interest.