Risk Stratification of Chronic Myeloid Leukaemia Patients with ELTS Risk Score at a Tertiary Care Hospital in Bangladesh

Md. Raiq Raihan Chowdhury (1) , Ishwor Man Singh (2) , Nasrin Akhter (3) , Samim Reza (4) , Md. Maruf Reza Kabir (5) , Kazi Fazlur Rahman (6) , Nishat Mahzabin (7) , Md. Salahuddin Shah (8) , Md. Abdul Aziz (9)
(1) Bangabandhu Sheikh Mujib Medical University , Bangladesh
(2) BnC and Purbanchal Cancer Hospital, Nepal , Nepal
(3) Bangabandhu Sheikh Mujib Medical University , Bangladesh
(4) Dhaka Medical College and Hospital , Bangladesh
(5) Bangabandhu Sheikh Mujib Medical University , Bangladesh
(6) Bangabandhu Sheikh Mujib Medical University , Bangladesh
(7) Dhaka Medical College and Hospital , Bangladesh
(8) Bangabandhu Sheikh Mujib Medical University , Bangladesh
(9) Bangabandhu Sheikh Mujib Medical University , Bangladesh

Abstract

Introduction: Chronic Myeloid Leukaemia (CML) is a myeloproliferative neoplasm characterised by uncontrolled proliferation of white blood cells and its precursors. At diagnosis, various risk scoring systems have been formulated for risk stratification. In 2016, European Treatment Outcome Study (EUTOS) Long Term Survival (ELTS) score has been formulated most recently. This score was recommended by European LeukaemiaNet in 2020. Objective: The objective of the study was to estimate the frequency of high-risk patients among Chronic Myeloid Leukaemia patients in chronic phase using ELTS scoring system. Materials and Methods: This observational study was conducted among patients at Bangabandhu Sheikh Mujib Medical University (BSMMU) between September 2020 and October 2021. A total of fifty chronic myeloid leukaemia patients were enrolled using purposive sampling technique. Clinical information and haematological parameters were recorded. Bone marrow study was conducted to confirm phase of the disease. ELTS risk score was calculated, and risk stratification was done. Chi-square test was done to find out statistical association between variables. Results: Among study participants, 14% were identified as high-risk cases using ELTS score. 40% of patients were intermediate-risk and 46% were low-risk disease. Presence of hepatomegaly or splenomegaly were significantly more common among high-risk patients. Significantly increased eosinophil and blast percentages and significantly lower haemoglobin level were found in high-risk patients. Conclusion: A fair proportion of the CML patients were identified as high-risk patients. Hepatomegaly, splenomegaly, lower haemoglobin, higher eosinophil and higher blast percentages were identified to be independently associated with higher risk stratification of patients.

Full text article

Generated from XML file

References

Deininger M. Chronic Myeloid Leukaemia, In: Greer J, Arber D, Glader B, List A, Means R, Paraskevas F, Rodgers G, Foerster J (eds), Wintrobe’s Clinical Haematology, 13th ed., Philadelphia, Pennsylvania: Lippincott Williams & Wilkins; 2013. p. 1705 – 21.

Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al. WHO classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: International Agency for Research on Cancer; 2017.

Hehlmann R, Lauseker M, Saußele S, Pfirrmann M, Krause S, Kolb HJ et al. Assessment of imatinib as first-line treatment of chronic myeloid leukemia: 10-year survival results of the randomized CML study IV and impact of non-CML determinants. Leukemia. 2017;31(11):2398-2406. doi:10.1038/leu.2017.253

Hochhaus A, Baccarani M, Silver RT, Schiffer C, Apperley JF, Cervantes F, et al . European LeukemiaNet 2020 recommendations for treating chronic myeloid leukemia. Leukemia. 2020 Apr;34(4):966-984. doi: 10.1038/s41375-020-0776-2.

Pfirrmann M, Lauseker M, Hoffmann VS, Hasford J. Prognostic scores for patients with chronic myeloid leukemia under particular consideration of competing causes of death. Ann Hematol. 2015; 94:S209–18.

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.

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. Writing Committee for the Collaborative CML Prognostic Factors Project Group. J Natl Cancer Inst. 1998; 90:850–8.

Hoffmann VS, Baccarani M, Hasford J, Lindoerfer D, Burgstaller S, Sertic D, et al. The EUTOS population-based registry: incidence and clinical characteristics of 2904 CML patients in 20 European Countries. Leukemia. 2015; 29:1336–43

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.

Bower H, Bjorkholm M, Dickman PW, Hoglund M, Lambert PC, Andersson TM. Life expectancy of patients with chronic myeloid leukemia approaches the life expectancy of the general population. J Clin Oncol. 2016; 34:2851–7.

Pfirrmann M, Baccarani M, Saussele S, Guilhot J, Cervantes F, Ossenkoppele G, et al. Prognosis of long-term survival considering disease-specific death in patients with chronic myeloid leukemia. Leukemia. 2016; 30:48–56.

Breccia M, Pregno P, Castagnetti F, Bonifacio M, Tiribelli M, Gozzini A, et al. Eutos long-term survival score discriminates different Sokal score categories in chronic myeloid leukemia patients, showing better survival prediction. Analysis of the GIMEMA CML observational study. Leukemia. 2021 Jun; 35(6):1814-1816. doi: 10.1038/s41375-021-01292-4.

Pfirrmann M, Clark RE, Prejzner W, Lauseker M, Baccarani M, Saussele S, et al. The EUTOS long-term survival (ELTS) score is superior to the Sokal score for predicting survival in chronic myeloid leukemia. Leukemia. 2020 Aug;34(8):2138-2149. doi: 10.1038/s41375-020-0931-9.

Deininger MW, Shah NP, Altman JK, Berman E, Bhatia R, Bhatnagar B, et al. Chronic Myeloid Leukemia, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2020 Oct 1;18(10):1385-1415. doi: 10.6004/jnccn.2020.0047

Radich JP, Deininger M, Abboud CN, Altman JK, Berman E, Bhatia R, et al. Chronic myeloid leukemia, version 1.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2018; 16:1108–35.

Shah NP. Front-Line Treatment Options for Chronic-Phase Chronic Myeloid Leukemia. J Clin Oncol. 2018;36(3):220-224. doi:10.1200/JCO.2017.75.4663.

Cortes JE, Gambacorti-Passerini C, Deininger MW, Mauro MJ, Chuah C, Kim DW, et al. Bosutinib Versus Imatinib for Newly Diagnosed Chronic Myeloid Leukemia: Results from the Randomized BFORE Trial. J Clin Oncol. 2018; 36:231–7.

Kantarjian H, Shah NP, Hochhaus A, et al. Dasatinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. 2010;362(24):2260-2270. doi:10.1056/NEJMoa1002315.

Saglio G, Kim DW, Issaragrisil S, et al. Nilotinib versus imatinib for newly diagnosed chronic myeloid leukemia. N Engl J Med. 2010;362(24):2251-2259. doi:10.1056/NEJMoa0912614.

Hossain MS, Iqbal MS, Khan MA, Rabbani MG, Khatun H, Munira S, et al. Diagnosed hematological malignancies in Bangladesh - a retrospective analysis of over 5000 cases from 10 specialized hospitals. BMC Cancer. 2014; 14:438. doi: 10.1186/1471-2407-14-438.

Authors

Md. Raiq Raihan Chowdhury
raiq579@gmail.com (Primary Contact)
Ishwor Man Singh
Nasrin Akhter
Samim Reza
Md. Maruf Reza Kabir
Kazi Fazlur Rahman
Nishat Mahzabin
Md. Salahuddin Shah
Md. Abdul Aziz
Author Biographies

Md. Raiq Raihan Chowdhury, Bangabandhu Sheikh Mujib Medical University

Department of Haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Contact No: +8801673574552

Ishwor Man Singh, BnC and Purbanchal Cancer Hospital, Nepal

BnC and Purbanchal Cancer Hospital, Nepal

Nasrin Akhter, Bangabandhu Sheikh Mujib Medical University

Department of Haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Samim Reza, Dhaka Medical College and Hospital

Department of Haematology, Dhaka Medical College Hospital, Dhaka, Bangladesh

Md. Maruf Reza Kabir, Bangabandhu Sheikh Mujib Medical University

Department of Haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Kazi Fazlur Rahman, Bangabandhu Sheikh Mujib Medical University

Department of Haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Nishat Mahzabin, Dhaka Medical College and Hospital

Department of Paediatric Haematology & Oncology, Dhaka Medical College Hospital, Dhaka, Bangladesh

Md. Salahuddin Shah, Bangabandhu Sheikh Mujib Medical University

Professor of Haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Md. Abdul Aziz, Bangabandhu Sheikh Mujib Medical University

Professor of Haematology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Banglades

1.
Chowdhury MRR, Singh IM, Akhter N, Reza S, Kabir MMR, Rahman KF, et al. Risk Stratification of Chronic Myeloid Leukaemia Patients with ELTS Risk Score at a Tertiary Care Hospital in Bangladesh . Haematol J Bangladesh [Internet]. 2024 Feb. 14 [cited 2024 Mar. 4];7(1):3-9. Available from: https://journal.hematologybd.org/index.php/haematoljbd/article/view/96

Article Details

How to Cite

1.
Chowdhury MRR, Singh IM, Akhter N, Reza S, Kabir MMR, Rahman KF, et al. Risk Stratification of Chronic Myeloid Leukaemia Patients with ELTS Risk Score at a Tertiary Care Hospital in Bangladesh . Haematol J Bangladesh [Internet]. 2024 Feb. 14 [cited 2024 Mar. 4];7(1):3-9. Available from: https://journal.hematologybd.org/index.php/haematoljbd/article/view/96