What are the limitations of the elts score?

While the elts score is highly validated, it should not replace clinical judgment. OpiCalc provides the latest evidence-based limitations for the elts score to ensure safe bedside use and optimal diagnostic accuracy.

How does the elts score compare to other Hematology scores?

The elts score is a gold-standard diagnostic tool. OpiCalc provides side-by-side clinical guidance to help clinicians choose the most specific evidence-based tool for their patient's presentation.

Is the elts score free to use?

Yes. OpiCalc provides the elts score completely ad-free and optimized for mobile bedside use, ensuring you can calculate medical risk swiftly and without distraction.

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ELTS Score (CML)

ELTS Score: EUTOS Long-Term Survival score for CML. Specifically designed to predict CML-specific death in patients receiving Tyrosine Kinase Inhibitors (TKIs).

Age (years)

Spleen Size (cm subcostal)

Peripheral Blasts (%)

Platelets (× 10⁹/L)

Guidelines & Evidence

Clinical Details

Section 1

When to Use

Risk stratification of patients with Chronic Myeloid Leukemia (CML) at the time of diagnosis (Chronic Phase).

Predicting the probability of CML-related death in the era of Tyrosine Kinase Inhibitors (TKIs).

Differentiating risk groups to guide TKI selection (standard vs. 2nd-generation).

Patient Population

Adult patients with newly diagnosed Ph-positive CML in Chronic Phase starting TKI therapy.

When Not to Rely on This Score Alone

CML in Accelerated Phase or Blast Crisis — requires immediate aggressive therapy regardless of score.

Pediatric CML — while Sokal and ELTS are used, their predictive value is less established in children.

To monitor response to therapy — use BCR::ABL1 transcript levels (IS) for molecular monitoring.

Section 2

Formula & Logic

Scoring Formula

The ELTS score uses a continuous mathematical model: 0.0025 × (age/10)³ + 0.0615 × (spleen) + 0.1052 × (blasts) + 0.4104 × (platelets/1000)⁻⁰.⁵.

Risk Thresholds

Score	Risk Group	Proportion of CML Deaths
≤ 1.5691	Low Risk	Very low
1.5692 - 2.2185	Intermediate Risk	Moderate
> 2.2185	High Risk	Increased

Section 3

Pearls/Pitfalls

Why This Outperforms Sokal

The Sokal Score was developed in the 1980s (chemotherapy/interferon era). It tends to overestimate CML-related death in the era of modern TKIs like Imatinib and Nilotinib. The ELTS score was specifically designed to predict CML-specific mortality and identifies a larger proportion of low-risk patients with excellent outcomes.

Section 4

Evidence Appraisal

Primary Score

Prognostic score for survival of patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors.

Pfirrmann M et al. • Journal of the National Cancer Institute. 2016;108(1):djv301. n=2,205 patients validated.

View Source

Section 5

Literature

Development

Developed by the European Treatment and Outcome Study (EUTOS) group. It incorporates spleen size, age, blasts, and platelets into a non-linear model to reflect the modern natural history of TKI-treated CML.

Last Comprehensive Review: 2026

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