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Prognostic Scoring Systems in CML – Improvement Impossible?

Edgar Faber

Since introduction of oral chemotherapy in the treatment of CML there is a continual effort for estimation of prognosis including future response to the therapy. Despite the first efficient prognostic scoring systems were designed for the patients treated with busulfan or hydroxyurea and interferon-alpha, respectively, Sokal and Hasford (Euro) scores are used for the patients treated with tyrosine kinase inhibitors (TKI) nowadays with a very good predictive value. The EUTOS score - specifically designed for the treatment with TKI - is (unlikely the previous scores) very easy to be counted, however, in some cohorts of patients failed to provide optimal predictive role for overall survival of patients. New strategies for CML prognostic score computation include implementation of newly designed statistic tools and end-points. On the other hand there is a simple possibility of designing the combination scores or including the early response to the treatment into the scoring system. However, because of significant role of biological properties of leukemic clones that may not be reflected by the score components the fate of the individual patients may not fit in 100% with their scores. For the further improvement of existing scores value implementation of new biological/molecular markers is clearly needed.