What laboratory tests are indicated for Chronic Lymphocytic Leukemia (CLL) or Chronic Myeloproliferative Neoplasms (CMP)?

From the Guidelines

For chronic lymphocytic leukemia (CLL) monitoring, the key laboratory tests include a complete blood count (CBC) with differential, flow cytometry to identify characteristic CD markers, beta-2 microglobulin, immunoglobulin levels, and genetic studies like FISH for chromosomal abnormalities, as well as TP53 mutation and IGHV mutation status, which help determine prognosis and treatment approach, as recommended by the most recent guidelines 1.

Key Laboratory Tests

• Complete blood count (CBC) with differential to assess lymphocyte count, hemoglobin, and platelet levels
• Flow cytometry to identify characteristic CD markers (CD5, CD19, CD20, CD23)
• Beta-2 microglobulin
• Immunoglobulin levels
• Genetic studies like FISH for chromosomal abnormalities (particularly del(17p), del(11q))
• TP53 mutation and IGHV mutation status

Additional Tests

• Comprehensive metabolic panel (CMP) testing to monitor organ function, particularly liver and kidney function
• Regular LDH testing to assess disease activity
• Direct Coombs test if autoimmune hemolytic anemia is suspected

Importance of Recent Guidelines

The most recent guidelines 1 emphasize the importance of these laboratory tests in diagnosing CLL, determining disease stage, selecting appropriate treatments, and monitoring disease progression and treatment response over time.

Prognostic Markers

Prognostic markers such as CD49d, CD38, and ZAP-70, as well as genetic mutations like NOTCH1, SF3B1, and BIRC3, can provide valuable information on disease prognosis and treatment outcomes, as discussed in previous studies 1.

Clinical Practice

In clinical practice, these laboratory tests and prognostic markers should be used in conjunction with clinical evaluation and patient history to provide personalized care for patients with CLL, as outlined in earlier guidelines 1.

From the Research

Labs for CLL or CMP

To diagnose and manage Chronic Lymphocytic Leukemia (CLL) or Chronic Myeloid Leukemia (CMP), several laboratory tests are essential. The following are some of the key labs:

• Flow cytometry to demonstrate the typical CLL immunophenotype, which includes CD5, CD19, dim CD20, dim CD22, CD23, bright CD43, dim CD45, dim to negative CD79b, dim CD81, CD200, and dim monoclonal surface immunoglobulin 2
• Immunophenotyping to distinguish atypical CLL from typical CLL, which relies on the lack of expression of one or fewer surface antigens, most commonly CD5 and CD23 3
• CD23 expression, which is considered important in the differentiation of CLL from other lymphoid leukemias 4
• Cytogenetic analysis, including FISH with the 4 probes, to guide prognosis 5
• Determination of the mutational status of the immunoglobulin heavy chain variable region (IGHV) before the first treatment 5
• Detection of TP53 mutations before the first and subsequent relapses 5
• Complete blood counts (CBC) to monitor cytopenias and lymphocyte counts
• Bone marrow biopsy and aspirate to assess bone marrow involvement and cytogenetic abnormalities

Immunophenotypic Characteristics

The immunophenotypic characteristics of CLL include:

• CD19 and CD5 positivity
• Dim CD20 and CD22 expression
• CD23 positivity
• Bright CD43 expression
• Dim CD45 expression
• Dim to negative CD79b expression
• Dim CD81 expression
• CD200 expression
• Dim monoclonal surface immunoglobulin expression 2, 3

Prognostic Factors

Prognostic factors in CLL include:

• CD23 expression 4
• IGHV mutational status 5
• TP53 mutations 5
• Cytogenetic abnormalities, such as del(17p) 5
• ZAP-70 expression 6
• CD38 expression 3