The Adult Comorbidity Evaluation 27 (ACE-27) score, which assesses the burden of comorbidities, may help predict outcomes, including overall survival (OS) and event-free survival (EFS), in patients with chronic myeloid leukemia (CML). These findings were presented in a poster at the 2021 American Society of Hematology (ASH) Annual Meeting.

ACE-27 is a scoring system that measures 27 factors related to 12 organ systems that has been studied as a predictor of outcomes for various conditions. The researchers sought to determine whether ACE-27 may have prognostic value in patients with newly diagnosed chronic phase CML treated with tyrosine kinase inhibitors (TKIs) as a first-line therapy. The study included 524 patients with chronic phase CML newly diagnosed between 2000 and 2014. Median age was 49 (range, 15 to 86), with 16% of participants older than 65. All the participants were enrolled in clinical trials.

For this investigation, complete cytogenetic remission (CCyR) was defined as the absence of Philadelphia chromosome (Ph) by karyotyping, and major cytogenetic response (MCyR) was defined as less than 35% of metaphases with Ph chromosome. Major molecular response (MMR), molecular response (MR) 4.0, and MR 4.5 were defined as BCR-ABL1 transcript ≤0.1%, ≤0.01%, and ≤0.0032% on the international scale, respectively.

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Median follow-up time was 98 months; patients were treated with imatinib (51%), dasatinib (21%), nilotinib (20%), or ponatinib (8%).

ACE-27 score was 0 in 284 patients (54%), 1 in 164 patients (31%), 2 in 64 patients (12%), and 3 in 13 patients (2%).

Grouped by score, patients with ACE-27 2-3 were less likely to achieve CCyR, MMR, MR4, or MR4.5 compared with ACE-27 0-1. Overall survival was worse for patients with ACE-27 2,3 with median survival at 12.5 years compared with not reached in patients with ACE-27 0 or 1, or 0 and 1.

Hazard ratios (HR) for death were higher in patients with lower ACE-27 scores. In ACE-27 2-3, HR was 9.7 compared with ACE-27 0. After adjusting for age older than 65, sokal score, type of TKIs, patients with ACE-27 2-3 had significantly worse survival compared with ACE-27 0, or ACE-27 0-1 (HR 7.18 and 6.7, respectively). When stratified by type of TKI, higher ACE-27 scores still indicated worse outcomes, although the small number of patients receiving ponatinib and dasatinib limited this analysis.

The researchers concluded that comorbidities have a significant impact on outcome in patients with chronic phase CML on TKI treatment. They also suggest that ACE-27 has potential as a prognostic instrument.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Kim K, Kantarjian H, Jabbour EJ, et al. The prognostic implication of adult comorbidity evaluation 27 score in CML patients on tyrosine-kinase inhibitors clinically relevant. Presented at ASH 2021; December 11-14, 2021. Abstract 2554.