TEST CATALOG ORDERING & RESULTS SPECIMEN HANDLING CUSTOMER SERVICE EDUCATION & INSIGHTS
Test Catalog

Test ID: LLTOF    
Leukemia and Lymphoma Phenotyping, Technical Only, Varies

Useful For Suggests clinical disorders or settings where the test may be helpful

Evaluating lymphocytoses of undetermined etiology

 

Identifying B- and T-cell lymphoproliferative disorders involving blood and bone marrow

 

Distinguishing acute lymphoblastic leukemia from acute myeloid leukemia (AML)

 

Immunologic subtyping of acute leukemias

 

Distinguishing reactive lymphocytes and lymphoid hyperplasia from malignant lymphoma

 

Distinguishing between malignant lymphoma and acute leukemia

 

Phenotypic subclassification of B- and T-cell chronic lymphoproliferative disorders, including chronic lymphocytic leukemia, mantle cell lymphoma, and hairy cell leukemia

 

Recognizing AML with minimal morphologic or cytochemical evidence of differentiation

 

Recognizing monoclonal plasma cells

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

Note: This test is only available to clients who have MayoAccess or MayoLink.

 

The client is responsible for the interpretation and billing of the professional component; Mayo Clinic will bill the technical component only.

 

The testing process begins with a screening panel. The screening panel will be charged based on the number of markers tested (FIRST for first marker, ADD1 for each additional marker). In addition, reflex testing may occur to fully characterize a disease state or clarify any abnormalities from the screening test. Reflex tests will be performed at an additional charge for each marker tested (ADD1 if applicable).

 

The triage panel is initially performed on peripheral blood, bone marrow, and fluid samples to evaluate for monotypic B cells by kappa and lambda light chain expression, increased numbers of blasts by CD34 and CD45 expression along with side scatter gating, and increased plasma cells by CD45 expression with side scatter gating. The triage panel also includes antibodies to assess the number of CD3-positive T cells and CD16-positive/CD3-negative natural killer (NK) cells present. This triage panel also determines if there is an increase in the number of T cells that aberrantly coexpress CD16, an immunophenotypic feature of T-cell granular lymphocytic leukemia.

 

The tissue panel is initially performed to evaluate for monotypic B-cells by kappa and lambda light chain expression, increased numbers of blasts, and plasma cells by CD45 expression along with side scatter gating. The panel can also evaluate T cells with CD3, CD5, and CD7. Additionally, viability is assessed on all tissue specimens using 7-AAD exclusion.

 

These panels, together with the provided clinical history and morphologic review, are used to determine what, if any, further testing is needed for disease diagnosis or classification. If additional testing is required, it will be added per algorithm to fully characterize a disease state with a charge per unique antibody tested.

 

Cases requiring the granular lymphocytic leukemia flow panel or V-beta panel will have an interpretation added and performed by a Mayo Clinic pathologist.

 

If no abnormalities are detected by the initial panel, no further flow cytometric assessment will be performed unless otherwise indicated by specific features of the clinical presentation or prior laboratory results.

 

The following algorithms are available in Special Instructions:

-Bone Marrow Staging for Known or Suspected Malignant Lymphoma Algorithm

-Acute Promyelocytic Leukemia: Guideline to Diagnosis and Follow-up

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Diagnostic hematopathology has become an increasingly complex subspecialty, particularly with neoplastic disorders of blood and bone marrow. While morphologic assessment of blood smears, bone marrow smears, and tissue sections remains the cornerstone of lymphoma and leukemia diagnosis and classification, immunophenotyping is a very valuable and important complementary tool.

 

Immunophenotyping hematopoietic specimens can help resolve many differential diagnostic problems posed by the clinical or morphologic features. This test is appropriate for hematopoietic specimens only.

 

This is a technical only test and does not include interpretation unless reflex testing is performed. At any point, clients may request to have a Mayo Clinic hematopathologist provide an interpretation at an additional charge.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Not applicable

Interpretation Provides information to assist in interpretation of the test results

Report will include a summary of the procedure.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Specimens will be initially screened to determine which, if any, of the immunophenotyping panels should be performed.

Clinical Reference Recommendations for in-depth reading of a clinical nature

1. Hanson CA, Kurtin PJ, Katzman JA, et al: Immunophenotypic analysis of peripheral blood and bone marrow in the staging of B-cell malignant lymphoma. Blood 1999;94:3889-3896

2. Hanson CA: Acute leukemias and myelodysplastic syndromes. In Clinical Laboratory Medicine. Edited by KD McClatchey. Williams and Wilkins, Inc, 1994, pp 939-969

3. Morice WG, Leibson PJ, Tefferi A: Natural killer cells and the syndrome of chronic natural killer cell lymphocytosis. Leuk Lymphoma 2001;41(3-4):277-284

4. Langerak AW, van Den Beemd R, Wolvers-Tettero IL, et al: Molecular and flow cytometric analysis of the Vbeta repertoire for clonality assessment in mature TCR alpha beta T-cell proliferations. Blood 2001;98(1):165-173

5. Hoffman RA, Kung PC, Hansen QP, Goldstein G: Simple and rapid measurement of T-lymphocytes and their subclass in peripheral blood. Proc Natl Acad Sci USA 1980;77:4914-4917

6. Jaffe ES, Cossman J: Immunodiagnosis of lymphoid and mononuclear phagocytic neoplasms. In Manual of Clinical Immunology. Third edition. Edited by NR Rose, H Friedman, JL Fahey. ASM Press, 1987, pp 779-790

7. Morice WG, Kimlinger T, Katzmann JA, et al: Flow cytometric assessment of TCR-V-beta expression in the evaluation of peripheral blood involvement by T-cell lymphoproliferative disorders: a comparison with conventional T-cell immunophenotyping and molecular genetic techniques. Am J Clin Pathol 2004;121(3):373-383

8. Stelzer GT, Shultz KE, Loken MR: CD45 gating for routine flow cytometric analysis of bone marrow specimens. Ann NY Acad Sci 1993;677:265-280

Special Instructions Library of PDFs including pertinent information and forms related to the test