CML high-risk by ELTS (EUTOS Long-Term Survival score) — favors 2nd-generation TKI (nilot...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-CML-HIGH-RISK-ELTS`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	`DIS-CML`
Sources	`SRC-ELN-CML-2020` `SRC-ESMO-CML-2017` `SRC-NCCN-MPN-2025`

Red Flag Origin

Definition	CML high-risk by ELTS (EUTOS Long-Term Survival score) — favors 2nd-generation TKI (nilotinib / dasatinib / bosutinib) over imatinib for faster deep molecular response and improved long-term outcomes
Clinical direction	intensify
Category	high-risk-biology
Shifts algorithm	ALGO-CML-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "cml_elts_risk",
      "value": "high"
    },
    {
      "finding": "cml_sokal_risk",
      "value": "high"
    },
    {
      "finding": "cml_eutos_risk",
      "value": "high"
    }
  ],
  "type": "risk_score"
}

Notes

ELN 2020 prefers ELTS over Sokal for predicting CML-related death and guiding 1L TKI selection in younger patients seeking treatment-free remission. High-risk patients gain more from 2nd-gen TKIs in early deep molecular response, but no consistent OS difference vs imatinib. Comorbidity profile (RF-CML-COMORBIDITY-COMPLEX) co-determines which 2nd-gen agent. STUB — requires clinical co-lead signoff.

Used By

Algorithms

ALGO-CML-1L - ALGO-CML-1L

Indications

IND-CML-1L-IMATINIB - IND-CML-1L-IMATINIB

Red flag

RF-CML-COMORBIDITY-COMPLEX - CML patient with cardiovascular / metabolic / pulmonary comorbidity profile that constrai...
RF-HASFORD-HIGH - CML chronic phase with Hasford (EURO) high risk — supports 2nd-generation TKI 1L (dasatin...
RF-SOKAL-HIGH - CML chronic phase with Sokal high risk — supports 2nd-generation TKI 1L (dasatinib / nilo...