Predictive Value of the Zhang Scoring System for Imatinib Failure in Chronic Myeloid Leukemia: A Comparative Analysis with Established Prognostic Models

Objective: The aim of this study was to evaluate the predictive performance of the Zhang score in comparison with other chronic myeloid leukemia (CML) risk scores for predicting imatinib treatment failure. Materials and Methods: A total of 201 patients with CML treated between January 1, 2000, and January 10, 2025, were included [94 (46.7%) female and 107 (53.3%) male; mean age 47 ± 16 years; median follow-up 107.0 months (minimum-maximum) (6.4-359.6)]. Results: Compared with the Sokal, Hasford, EUTOS, and ELTS scores, the Zhang score demonstrated the highest discriminative ability for predicting treatment failure, with the highest 5-year time-dependent AUC (0.775, 95% CI 0.700-0.849). In competing-risk regression analysis, both the intermediate-risk (subdistribution hazard ratio (SHR)=5.36, 95% CI 2.19-13.10; p<0.001) and high-risk (SHR=11.40, 95% CI 4.49-29.00; p<0.001) Zhang groups were significantly associated with treatment failure compared with the low-risk group. Conclusion: In conclusion, the Zhang score showed better predictive performance than the other four CML scoring systems for first-line imatinib treatment failure.