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

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IDRF-SOKAL-HIGH
TipoSinal de alerta
Estadoreviewed 2026-04-27 | pending_clinical_signoff
DoençasDIS-CML
FontesSRC-ELN-CML-2020 SRC-ESMO-CML-2017 SRC-NCCN-MPN-2025

Origem da bandeira vermelha

DefiniçãoCML 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
Direcção clínicaintensificar
Categoriarisco-ponto
Algoritmo de deslocamentosALGO-CML-1L

Lógica de Desencadeamento

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

Notas

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.

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