CML chronic phase with Sokal high risk — supports 2nd-generation TKI 1L (dasatinib / nilo...

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

ID	`RF-SOKAL-HIGH`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-CML`
Sources	`SRC-ELN-CML-2020` `SRC-ESMO-CML-2017` `SRC-NCCN-MPN-2025`

Red Flag Origin

Definition	CML chronic phase with Sokal high risk — supports 2nd-generation TKI 1L (dasatinib / nilotinib / bosutinib) over imatinib for faster MMR/MR4.5 and improved long-term cumulative incidence of progression
Clinical direction	intensify
Category	risk-score
Shifts algorithm	ALGO-CML-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "cml_sokal_risk",
      "value": "high"
    },
    {
      "comparator": ">",
      "finding": "cml_sokal_score",
      "threshold": 1.2
    }
  ],
  "type": "composite_score"
}

Notes

Sokal score (Sokal 1984) uses age, spleen size, platelet count, blast %. High-risk (Sokal >1.2) marks ~20-25% of CML-CP at diagnosis with worse 10-yr OS and PFS on imatinib vs intermediate/low. ENESTnd (Saglio 2010) and DASISION (Kantarjian 2010) show 2nd-gen TKIs achieve faster + deeper molecular responses than imatinib in high-Sokal subgroups. ELN 2020 prefers ELTS (RF-CML-HIGH-RISK-ELTS, existing) but Sokal remains the more widely-used bedside score. Companion to RF-HASFORD-HIGH; both can fire together. Conflict- resolution: this RF intensifies toward 2nd-gen TKI; cardiotoxicity flags (RF-CML-COMORBIDITY-COMPLEX) may de-escalate back to imatinib.

Used By

Algorithms

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

Red flag

RF-HASFORD-HIGH - CML chronic phase with Hasford (EURO) high risk — supports 2nd-generation TKI 1L (dasatin...