Dr. Neil Kay on Prognostic Indicators and Standard Early Care for Chronic Lymphocytic Leukemia:
Dr. Neil Kay, a fellow Canadian, of the Mayo Clinic has been a leader in CLL research for decades including foundational work on clonal heterogeneity and evolution, prognostic indicators and algorithms, Monoclonal B-cell lymphocytosis (MBL) and patient popular subjects including on green tea, vitamin D, and the importance of having a CLL specialist as part of our team.
In his 20 plus minute lecture, the second of the CRC (the informative CLL Research Consortium Patient Empowerment and Education Conference from San Diego in April 2015), he gives us a strong foundation to help us understand our early stage CLL and to introduce the research on MBL, a CLL precursor.
Among the many practical points he makes, he laments the fact that important subjects such as response to vaccinations and the risk of live vaccines have suffered from a lack of research. As a result, recommendations are mostly based on expert consensus and not on strong data.
Take Away Points:
- Monoclonal B-cell lymphocytosis (MBL) is increasingly being investigated. 1% of patients with MBL progress to chronic lymphocytic leukemia (CLL) annually and they do have a higher infection risk
- There is tremendous variation in our outcomes.
- Some patients with CLL live for decades without needing treatment.
- Multiple algorithms can be used to predict outcomes for groups.
- Patients live longer today with CLL than have in the past.
- Early Standard of Care
- Follow-up schedule depends on staging and prognostics.
- Need to monitor renal and hepatic functions.
- Need to check for auto-immune complications such as ITP and AIHA.
- Infections are common even in early stages
- Role of IVIG is controversial
- Vaccine responses are low but should be done
- Best protocol is Prevnar 13 first
- Live vaccines should be avoided, although the data is weak
- Higher risk of cancer and of more aggressive cancers
- Appropriate age-specific cancer screenings, including skin exams
- Check and treat low Vitamin D levels
You couldn’t ask for a better 20-minute introduction focused on what to expect and best practices when first diagnosed than this recording of Dr. Kay’s CRC lecture.
Brian Koffman June 28, 2015