Sokal、Hasford和EUTOS积分系统在慢性粒细胞白血病中的临床意义.docx

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Sokal, Hasford, and EUTOS Scoring Systems in the Clinical Significance of Chronic Myeloid Leukemia
Introduction
Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by the abnormal presence of the Philadelphia chromosome, resulting from a reciprocal translocation between chromosomes 9 and 22. The identification and subsequent development of tyrosine kinase inhibitors (TKIs) have significantly improved the prognosis and overall survival of patients with CML. However, the management of CML is complex, requiring frequent monitoring and therapeutic decisions. The Sokal, Hasford, and EUTOS scoring systems have been developed to predict prognosis, guide treatment decisions, and aid clinical management in CML. This paper aims to discuss the clinical significance of these scoring systems in the context of CML.
Sokal Scoring System
The Sokal scoring system, developed by Richard P. Sokal, was the first prognostic scoring system for patients with CML. It is based on four clinical and laboratory factors: age, spleen size, platelet count, and blast cell percentage at the time of diagnosis. The Sokal score categorizes patients into three risk groups: low risk, intermediate risk, and high risk. The Sokal score has been widely used for over three decades and has helped guide treatment decisions, particularly in the era before the introduction of TKIs. However, it has limitations, such as not incorporating molecular markers, which are important predictors of response to TKI therapy.
Hasford Scoring System
The Hasford scoring system, developed by Jörg Hasford, addressed some limitations of the Sokal scoring system by incorporating additional factors, such as basophil count and eosinophil count, as well as spleen size and platelet count. It also introduced a dynamic scoring system that considers response to therapy at six months and one year. The Hasford score categorizes patients into three risk groups: low risk, intermediate risk, and high risk. The Hasford scoring system has demonstrated improved prognostic accuracy compared to the Sokal scoring system. It has been widely adopted in clinical practice, particularly in Europe, to guide treatment decisions and predict long-term outcomes in CML patients.
EUTOS Scoring System
The European Treatment and Outcome Study (EUTOS) scoring system was developed based on data from a large cohort of patients who underwent treatment with TKIs. It combines two variables: spleen size and percentage of basophils. The EUTOS score categorizes patients into two risk groups: low risk and high risk. The EUTOS scoring system demonstrated good prognostic accuracy and was specifically designed to predict early molecular response (EMR) after three months of TKI therapy. It has shown to be an independent prognostic factor for both progression-free survival and overall survival. The EUTOS scoring system complements the Sokal and Hasford scoring systems by providing a simpler and more focused tool for risk stratification in the context of TKI therapy.
Clinical Significance
The Sokal, Hasford, and EUTOS scoring systems have proven clinical significance in CML management. They aid in risk stratification, prognostication, treatment decision-making, and monitoring response to therapy. These scoring systems help identify patients with a higher risk of disease progression or poor outcome, enabling early intervention and closer monitoring. Additionally, they assist physicians in selecting the appropriate first-line therapy, such as choosing between standard-dose imatinib or newer TKIs with higher response rates, for patients with high-risk scores. The scoring systems also assist in assessing treatment response and guiding adjustments in therapy, such as switching to a second-line TKI in patients with suboptimal response or intolerance to initial therapy.
Conclusion
The Sokal, Hasford, and EUTOS scoring systems have significantly contributed to the management of CML by providing valuable prognostic information, aiding treatment decision-making, and monitoring therapeutic response in patients with CML. These scoring systems enable risk stratification, allow early intervention, and help tailor personalized therapy for optimal outcomes. While the Sokal and Hasford scoring systems have been widely used for many years, the EUTOS scoring system enhances risk stratification in the context of TKI therapy. Continued research and validation of these scoring systems will further improve our ability to predict outcomes and optimize treatment strategies for patients with CML.