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Sokal Index


Does anyone have information on the Sokal Index? A search on the web says that it is or was a tool in the pre-imatinib days to predict CML outcomes. Apparently some docs still use it to help determine whether to attempt TFR. I did find a calculator on the web that calculates a score but it needs things like spleen size and platelet count. There are other scores like EUTOS, ELT, and Hasford that use other criteria. Just wondering if it’s worth pursuing.

Sokal is often still used at diagnosis just because it sort of always has been. It is not a good determinator of TFR attempts on its own, but it does seem to capture some of the important pieces and just because it’s not modern doesn’t mean it should be discarded. For example the percentage of patients with a low, intermediate or high Sokal score who achieved TFR in the TWISTER study was 51%, 37% and 25%, respectively.

ELTS scoring is the newest of the lot, but it’s not so tried and tested. The thing is these scores are more useful from a research point of view to seperate patients into cohorts and are not always useful on an individual basis.

Personally, I have a Sokal score of high, a Hasford score of intermediate, a EUTOS score of low, and an ELTS score of high. So take your pick!!

That said, given I have had a recent disastrous TFR attempt (failed in just 4 or 5 weeks) the Sokal and ELTS scores might be more on the money.


Hi Pojo

I echo everything David has said but want to add my experience. My score was HIGH on all four of tbe indices at diagnosis and I was almost accelerated phase. My doctor told me numerous times that this would mean I would be on the TKIs for life and that TFR attempts would never be on the cards for me.

However, I became intolerant to both dasatinib and imatinib and had to involuntarily stop TKIs for 6 months to allow my blood counts and bone marrow to recover. During this time, my BCR-Abl stayed at a low level: fluctuating, but low. It's now 18 months since I stopped and I haven't had to restart treatment, although I receive the latest test results on Tueaday and that may change.

So my view is that the Sokal score is useful, but not gospel.

Best wishes


Thank you David and Martin for very informative responses. This is very helpful to me. I haven’t been scored but will ask to be once I approach the time where I am eligible for TFR.

I am already over a year at undetectable and I must admit when I read about people attempting TFR I seem to be under the impression that in the least you get a 6 month vacation from TKIs. Now I’m not so sure and in fact I am leaning to just lowering my dose over time. I don’t mind a vacation but not at the cost of going through withdrawal and then having to go through the re-introduction of TKIs and all that involves.

I know they are developing tests to determine who may be responsive to TFR but not sure those tests will be available any time soon.

Martin good luck Tuesday we’ll be pulling for you. Have you tried Nilotinib? I ask because I became resistant to Imatinib but quickly hit CMR on Nilotinib after an initial fumble on my part.

Thank you guys much appreciated.


Pojo, it’s fairly easy to score yourself provided you know a few facts surrounding your diagnosis.

- Your age at diagnosis
- Spleen size
- Platelet count
- % blasts in blood


Yes this site is nice provided you have all the component info. The spleen size and %blasts are the ones I will have to ask my oncologist about. Is any of this available in the PCR reports?

Hi again Pojo

As David has said, it's easy to calculate if you have all the info available, which I did as I asked my haematologist for everything. There's also this site which calculates all of them:

If you're able to get the information, make sure to use it with the following caveats:

1) Spleen size MUST be the distance "palpable below the intercostal margin", i.e. how much the physician could feel below the ribs. My report showed that my spleen was 22cm in length BUT the doctor told me that the length of the ribcage is around 10cm, so that means it's 22 -10 = 12cm that I had to enter in the calculator.

2) Take the results with a bag of salt as they DO NOT mean that you cannot attempt TFR. I had my latest results sent to me today on my pathology app and I'm still below the detection limit, now 19 months since I took my last TKI.

Just to answer your previous question - no, I haven't tried nilotinib yet, but that will be on the cards if my TFR attempt fails. Thanks so much for the good wishes and I'm sending the same your way.

Kind regards


Very nice. I see my doc in June and will ask him to perform the spleen size on me. I’m actually performing it on myself, I’ll see how close I come to him.

It would be interesting to run an informal survey of scores from willing participants to this site, maybe we could glean some interesting observations.

Martin 19 months off TKIs, now that’s a milestone. Perhaps your immune system has regained its defenses and it’s now doing its job against BCR/ABL.
My mom died from CLL and my sister also has CLL but the difference is my sister only had to get 1 course of chemo to keep it under the radar in her life and she’s nearing 70. I wouldn’t be surprised if that could be the case with you.

This has been a good discussion.


Pojo, the spleen size is only important at the time of diagnosis.c It, and the blast % would typically be in a clinic report that you got around the time of diagnosis. If it’s not something that was given to you at the time, I am sure your doctor will have records of it.


I am on my third oncologist. Not sure all of the original diagnosis info has been carried over through the years.
But I will certainly inquire with my current doc.
My fear is that he will cry foul and say “Why?”
He’s so sensitive when I talk shop with him.

For example he gets really annoyed when I tell him my goal is to get to 150mg per day at some point.
His position is that if it’s not in the current recommendations then he’s not willing to try anything new.
He says going under recommendations could possibly promote mutations.
When I say I don’t care I want to lower my exposure, he then threatens to drop me.

As I get closer to my appointment in June I may reach out to you David.

Much appreciated David.
Someday you will have to tell me your experience regarding your TFR attempt.


Feel free to get in touch any time.

Happy to talk about my TFR attempt any time too. It doesn’t work for everyone of course, and I am testament to that despite having really good numbers going into it. Safe to say I won’t be trying it again! It really went very badly and was over almost before it really started, and has reinforced my belief that MMR really is the main goal.