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Neil Kay, MD

Neil Kay, MD

A prognostic index is a clinical tool used by oncologists to predict the duration, function, and disease progression for a patient with a particular type of cancer. As researchers have learned more about the common biologic aspects of various lymphoma subtypes, it has become necessary to revise existing indices to more accurately predict the clinical outcomes for individual patients. Recently, the German CLL Study Group proposed a new prognostic index for chronic lymphocytic leukemia (CLL) with the goal of improving upon the existing prognostic tools for CLL, which were developed 30 years ago. The Study Group researchers collaborated with researchers from the Mayo Clinic in Minnesota to validate their findings. Neil Kay, MD, a Lymphoma Research Foundation (LRF) Scientific Advisory Board (SAB) member, was part of the Mayo component of this project, the results of which were published in Blood's July 3, 2014 issue.

Dr. Kay says the new index, which incorporates both traditional parameters, such as patient gender and age, and novel parameters, such as the presence of certain genetic anomalies, "has a much higher accuracy potential." Researchers working on prognostic indices evaluate the effectiveness of the index using a c-statistic, which indicates how much better a prognostic model is at predicting a given outcome than pure chance, with 0.5 indicating the model is no better than chance and 1.0 indicating a perfect prediction rate. The two common prognostic staging models currently in use have respective c-statistics of 0.56 and 0.58, well below the 0.7 threshold commonly considered the indicator of a useful prognostic tool. By contrast, using the new prognostic index in the initial group of 1,948 German CLL cases, the c-statistic was 0.75, while in the validation group of 676 additional Mayo cases, the c-statistic was 0.83. "By using easily obtainable prognostic parameters we will be able to more confidently predict individual patient outcome for both time to treatment and outcome with various therapies," Dr. Kay notes.

Dr. Kay received his MD from the University of Manitoba Medical School, and completed his residency and hematology fellowship at Upstate Medical Center in Syracuse, before a Immunohematology fellowship at Mount Sinai School of Medicine in New York, and a research fellowship at the Veterans Administration Medical Center in Minneapolis. Currently a Professor of Medicine at Mayo Clinic, Dr. Kay's research is focused on the CLL microenvironment and B-cell biology. His ongoing projects include the design and implementation of clinical trials and a database of clinical information and tissue samples from CLL and monoclonal B cell lymphocytosis patients. He began working on CLL at the outset of his research career, thanks to guidance from a senior investigator. "My original mentor pointed out to me many years ago that CLL was a very available primary tumor type to conduct laboratory studies on and that it was an unmet need," he says. Today he is regarded as an expert in the field, and serves as a regular member of the National Cancer Institute's (NCI) Leukemia Steering Committee.

Dr. Kay notes both "huge advances in treatment options" and "advances in understanding the pertinent biology of the CLL B cell and its microenvironment" since the beginning of his career. He advises newly diagnosed CLL patients in particular should be assured that there have been "significant strides" in the accuracy of specific diagnoses and prognosis, counseling advice in regard to more common disease complications, and when to initiate treatment.

Though Dr. Kay is not an LRF grantee himself, he notes that LRF funding has had an indirect contribution to his research. "By their support of other CLL investigators, both young and established, significant progress has occurred which have impacted on my own research and its direction."

The full text of the Blood paper outlining the prognostic index may be accessed online here.

For more on Chronic Lymphocytic Leukemia, please visit LRF's CLL/SLL Factsheet and FocusonCLL.org.

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