Lymphoma Phenotyping

During evaluation of peripheral lymphocytosis (absolute lymphocytosis >4,000/µL), the possibility of a malignant disorder requires evaluation. Laboratory studies include cell surface phenotyping of lymphocytes.

Diagnosis

Indications for Testing

  • Evaluation of peripheral lymphocytosis (absolute lymphocytosis >4,000/µL)
  • Unexplained lymphadenopathy
  • Lineage-associated antigens and minimal monoclonal antibody panels for diagnosis
  • Lymphoma Surface and Nuclear Antigens

    B-cell

    CD10, CD19, CD20, CD21, CD22, CD23, CD24, CD79a, CD79b, CD138, PCA-1, immunoglobulins (IgA, IgG, IgM, IgD, κ, λ)

    T-cell

    CD1, CD2, CD3, CD4, CD5, CD7, CD8, CD45RA, CD45RO, TCRαβ, TCRγδ

    NK-cell

    CD16, CD56, CD57

    Minimal Monoclonal Antibody Panels for Lymphoma Diagnosis

    B-cell

    κ/λ, CD5/CD19, CD23, CD10, CD200

    T-cell

    CD3/CD4, CD3/CD8, CD5, CD7, CD25, CD30, CD1a

    NK-cell

    CD2, CD3/CD4, CD3/CD8, CD16, CD56, CD57

Laboratory Testing

  • Rule out other disorders associated with lymphocytosis
  • If lymphoproliferative disorder remains a significant possibility after clinical evaluation, cell surface phenotyping of lymphocytes should be performed
    • Usually performed on peripheral blood using flow cytometry
      • Technique provides percentage of lymphocytes positive for a particular antigen and density of antigens
      • Normal peripheral blood lymphocytes consist of approximately 10% B-cells, 80% T-cells and 10% NK-cells
    • Most commonly used markers (CD = cluster designation)
      • B-cell – CD10, CD19, CD20, CD22, CD23, CD24, CD79b, CD103, Pax-5, kappa, lambda, CD200, cytoplasmic kappa, cytoplasmic lambda
      • T-cell – CD1, CD2, CD3, CD4, CD5, CD7, CD8, TCR α-β, TCR γ-δ, cytoplasmic CD3
      • Myeloid/monocyte – CD11b, CD13, CD14 (Mo2), CD14 (MY4), CD15, CD33, CD64, CD117, myeloperoxidase
      • Miscellaneous – CD11c, CD16, CD25, CD30, CD34, CD38, CD41, CD42b, CD45, CD56, CD57, CD61, HLA-DR, glycophorin, TdT, bcl-2

B-cell lymphoproliferative disorders

  • Probable if immunoglobulin light chain restriction is demonstrated by surface typing of kappa or lambda
  • B-cell CLL or mantle cell lymphomas (MCL) are suspected if CD5 is positive and CD10 is negative
  • Circulating MCL can be mistaken morphologically for B-cell CLL or B-cell prolymphocytic leukemia (B-PLL)
    • MCL considered in the following
      • CD20, CD19 – strong intensity
      • Surface immunoglobulin – strongly expressed
      • CD23 – absent
      • Diagnosis
        • Molecular and FISH testing
        • Requires t(11;14) translocation demonstration
    • CLL is more likely when
      • CD20 – weak intensity
      • Surface immunoglobulins –  weakly expressed
      • CD23 – present
      • CD200 – present
  • Circulating germinal center cell-derived lymphoma is probable if CD10 is positive and CD5 is negative
    • Germinal center lymphomas – follicular, Burkitt lymphoma, diffuse large B-cell lymphoma (DLBCL)
    • Diagnosis
      • Some cases can be confirmed by demonstration of  t(14;18) breakpoint by PCR or FISH testing
      • PCR detects approximately 80% of t(14;18) translocations found in follicular lymphoma
        • FISH is more sensitive for this translocation in fixed tissue
      • FISH can also detect an MYC or BCL6 rearrangement for BL or DLBCL
  • Marginal zone lymphoma should be considered if both CD5 and CD10 are negative
  • Hairy cell leukemia (HCL) has a characteristic phenotype that is CD5-, CD10-, CD11c+, CD22+, CD25+, and CD103+
    • CD103 antigen (also known as B-ly7) is present in virtually all cases
    • CD11c and CD25 are less specific but present in almost all cases of hairy cell leukemia
    • HCL variant can be considered in otherwise typical cases of HCL when CD25-

T-cell lymphoproliferative disorders

  • Most show abnormalities of pan T-cell antigens CD2, 3, 5, or CD7
  • T-cell disorders
    • Proliferating lymphocytes are usually positive for CD3
    • Most common form is large granular lymphocytosis
    • Usually show rearrangement of TCR locus
    • Clonality assessed by flow cytometry or polymerase chain reaction (PCR)
  • Large granular lymphocytosis is suspected if percentage of CD16+, CD56+, or CD57+ T cells is >50% or if absolute count of these cells >2,000/µL
  • Peripheral T-cell lymphoma (NOS)
    • Phenotypic abnormalities
  • Angioimmunoblastic lymphoma has characteristic CD10+ and CD4+, and CD52-, CD56-, and CD16-
  • Anaplastic large cell lymphoma – CD30+ and ALK(+)
    • Some pan T-cell antigens are frequently deleted
  • Sézary syndrome should be considered if CD4+, CD7-, and CD26-
  • Clinical spectrum and prognosis are variable in both T-cell and NK-cell types
    • Most behave in indolent fashion

NK-cell lymphoproliferative disorders

  • Many show abnormalities of pan NK-cell antigens CD2, CD7, CD16, CD56, and/or CD57

Histology

Prognosis

Non-Hodgkin B-cell lymphoma

  • Indolent
    • CLL/SLL – favorable 
      • Sequencing – >2% mutation of IGHV
      • Flow cytometry – <30% CD38
      • Cytogenetics – del(13q) as sole abnormality
    • CLL/SLL – unfavorable
      • Sequencing – ≤2% mutation of IGHV or any IGHV rearrangements involving VH3-21 even if mutated
      • Flow cytometry – ≥30% CD38
      • Cytogenetics – del(11q), del(17p)
    • Follicular lymphoma
      • Unfavorable – multiple prior therapies; transformation into DLBCL
    • MZL (includes nodal, MALT, and splenic)
      • MALT (extranodal MZL)
        • Gastric MALT associated with Helicobacter pylori infection; good prognosis if infection is eradicated
  • Aggressive
    • Diffuse large B-cell lymphoma (DLBCL)
      • Unfavorable – known risk factors, including age (>60 yrs), disease stage, elevated LD, therapy response (ECOG 1496 trial), number of extra-nodal sites
      • Favorable – no risk factors
    • Mantle cell lymphoma
      • Favorable – Ki-67 proliferation fraction <30%
  • Highly aggressive
    • Burkitt lymphoma and lymphoblastic lymphoma (T and B)
      • Unfavorable – elevated LD, concurrent HIV infection
    • AIDS-related B-cell lymphoma (includes Burkitt and PCNSL)
      • Unfavorable – PCNSL, persistent CD4 count <100
    • Double-/triple-hit lymphomas (B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt)
      • Most unfavorable – triple mutation (MYC, BCL2, BCL6)

Non-Hodgkin T-cell lymphoma

  • All considered aggressive
  •   Peripheral T-cell lymphoma (PTCL)
    • Favorable – ALK-positive ALCL subtype; normal LD level, younger age (<60 yrs)
    • Unfavorable – AILT, EBER-positive tumors
  • Mycosis fungoides/Sézary syndrome
    • Unfavorable – older age (>56 yrs), tumor-stage disease or erythrodermic skin involvement,TCR gene rearrangements, extracutaneous disease

Hodgkin lymphoma

  • Unfavorable prognostic factors
    • Mediastinal bulk in early stage disease
    • Presence of B-cell lymphoma symptoms
    • Disease found in ≥3 sites
    • Erythrocyte sedimentation rate of ≥50
    • Age ≥45 yrs
    • Male sex
    • Stage IV disease
    • Albumin level <4 g/dL
    • Hemoglobin level <10.5 g/dL
    • Leucocytosis – WBC >15,000/mm
    • Lymphocytopenia – lymphocyte count <8% of WBC count and/or <600/mm

Differential Diagnosis

Background

Classification

WHO Classification of Mature Lymphoid, Histiocytic, and Dendritic Neoplasms, 2016

Mature B-cell neoplasms

  • Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)
  • Monoclonal B-cell lymphocytosis
  • B-cell prolymphocytic leukemia
  • Hairy cell leukemia (HCL)
  • Splenic B-cell lymphoma/leukemia, unclassifiable (provisional entity)
    • Splenic diffuse red pulp small B-cell lymphoma
    • Hairy cell leukemia variant
  • Lymphoplasmacytic lymphoma
  • Monoclonal gammopathy of undetermined significance (MGUS), IgM
  • Heavy chain diseases
    • Alpha heavy chain disease
    • Gamma heavy chain disease
    • Mu heavy chain disease
  • MGUS, IgG/A
  • Plasma cell myeloma
  • Solitary plasmacytoma of bone
  • Extraosseous plasmacytoma
  • Monoclonal immunoglobulin deposition diseases
  • Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)
  • Nodal marginal zone lymphoma
    • Pediatric nodal marginal zone lymphoma (provisional entity)
  • Follicular lymphoma
    • In situ follicular neoplasia
    • Duodenal-type follicular lymphoma
  • Pediatric-type follicular lymphoma
    • Large B-cell lymphoma with IRF4 rearrangement (provisional entity)
  • Primary cutaneous follicle center lymphoma
  • Mantle cell lymphoma
    • In situ mantle cell neoplasia
  • Diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS)
    • Germinal center B-cell type
    • Activated B-cell type
  • T-cell/histiocyte-rich large B-cell lymphoma
  • Primary DLBCL of the central nervous system (CNS)
  • Primary cutaneous DLBCL, leg type
  • Epstein-Barr virus (EBV)-positive DLBCL, NOS
  • EBV-positive mucocutaneous ulcer (provisional entity)
  • DLBCL associated with chronic inflammation
  • Lymphomatoid granulomatosis
  • Primary mediastinal (thymic) large B-cell lymphoma
  • Intravascular large B-cell lymphoma
  • ALK-positive large B-cell lymphoma
  • Plasmablastic lymphoma
  • Primary effusion lymphoma
  • Human herpesvirus 8 (HHV8)-positive DLBCL, NOS (provisional entity)
  • Burkitt lymphoma
  • Burkitt-like lymphoma with 11q aberration (provisional entity)
  • High-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements
  • High-grade B-cell lymphoma, NOS
  • B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and classical Hodgkin lymphoma

Mature T and NK neoplasms

  • T-cell prolymphocytic leukemia
  • T-cell large granular lymphocytic leukemia
    • Chronic lymphoproliferative disorder of NK cells (provisional entity)
  • Aggressive NK-cell leukemia
  • Systemic EBV-positive T-cell lymphoma of childhood
  • Hydroa vacciniforme-like lymphoproliferative disorder
  • Adult T-cell leukemia/lymphoma (ATLL)
  • Extranodal NK/T-cell lymphoma, nasal type
  • Enteropathy-associated T-cell lymphoma
  • Monomorphic epitheliotropic intestinal T-cell lymphoma
  • Indolent T-cell lymphoproliferative disorder of the gastrointestinal (GI) tract (provisional entity)
  • Hepatosplenic T-cell lymphoma
  • Subcutaneous panniculitis-like T-cell lymphoma
  • Mycosis fungoides
  • Sézary syndrome
  • Primary cutaneous CD30-positive T-cell lymphoproliferative disorders
    • Lymphomatoid papulosis
    • Primary cutaneous anaplastic large cell lymphoma
  • Primary cutaneous gamma-delta T-cell lymphoma
  • Primary cutaneous CD8-positive aggressive epidermotropic cytotoxic T-cell lymphoma (provisional entity)
  • Primary cutaneous acral CD8-positive T-cell lymphoma (provisional entity)
  • Primary cutaneous CD4-positive small/medium T-cell lymphoma (provisional entity)
  • Peripheral T-cell lymphoma, NOS
  • Angioimmunoblastic T-cell lymphoma
  • Follicular T-cell lymphoma (provisional entity)
  • Nodal peripheral T-cell lymphoma with TFH phenotype (provisional entity)
  • Anaplastic large cell lymphoma (ALCL), ALK positive
  • ALCL, ALK negative
  • Breast implant–associated anaplastic large cell lymphoma (provisional entity)

Hodgkin lymphoma

  • Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL)
  • Classical Hodgkin lymphoma
    • Nodular sclerosis classical Hodgkin lymphoma
    • Lymphocyte-rich classical Hodgkin lymphoma – features recognized that are intermediate between NLPHL and other types of classical Hodgkin lymphoma
    • Mixed cellularity classical Hodgkin lymphoma
    • Lymphocyte-depleted classical Hodgkin lymphoma

Posttransplant lymphoproliferative disorders (PTLD)

  • Plasmacytic hyperplasia PTLD
  • Infectious mononucleosis PTLD
  • Polymorphic PTLD
  • Monomorphic PTLD (B- and T/NK-cell types)
  • Classical Hodgkin lymphoma PTLD

Histiocytic and dendritic cell neoplasms

  • Histiocytic sarcoma
  • Langerhans cell histiocytosis
  • Langerhans cell sarcoma
  • Indeterminate dendritic cell tumor
  • Interdigitating dendritic cell sarcoma
  • Follicular dendritic cell sarcoma
  • Fibroblastic reticular cell tumor
  • Disseminated juvenile xanthogranuloma
  • Erdheim-Chester disease

Clinical Presentation

  • Nonspecific symptoms frequently in initial presentation
    • Malaise, fatigue, weight loss, fever
  • Adenopathy – may be first presenting symptom; may be bulky
  • Related syndromes – autoimmune hemolytic anemia
  • Cutaneous – skin rashes in cutaneous lymphomas
  • Gastrointestinal
    • Hepato/splenomegaly
    • Common site of extranodal disease
Common Hematological Antigens in Lymphomas
Antigen or Cluster Designation (CD) Application

CD1a

T-cell lymphoma, particularly T-lymphoblastic lymphoma

CD2

T-cell lymphoma

CD3

T-cell lymphoma (immature T-cell neoplasms may have cytoplasmic CD3 without cell surface CD3)

CD4

Identify T-cell subset in all T-cell lymphomas

CD5

T/B-cell lymphoma, CLL; may be absent in peripheral T-cell lymphoma (PTCL) and plasmacytoid lymphoma

CD7

T-cell lymphoma (may be absent in PTCL, adult T-cell leukemia/lymphoma [ATLL], mycosis fungoides)

CD8

Identify T-cell subset in all T-cell lymphomas

CD9

Some CLL

CD10 (CALLA)

B-cell lymphoma (follicular lymphoma, Burkitt lymphoma), angioimmunoblastic T-cell lymphoma (AILT), lymphoblastic lymphomas

CD11a

May be absent in some B-cell neoplasms

CD11c

Hairy cell leukemia (HCL), marginal zone lymphoma (MZL), other B-cell neoplasms

CD14

Chronic myelomonocytic leukemia (CMML)

CD15

Hodgkin lymphoma

CD16

NK-cell disorder

CD18

Some B-cell neoplasms

CD19

B-cell lymphoma, CLL; usually absent in plasma cell neoplasms

CD20

B-cell lymphoma, CLL; usually absent in plasma cell neoplasms

CD21

B-cell lymphoma

CD22

B-cell lymphoma, HCL

CD23

B-cell lymphoma, CLL, small lymphocytic lymphoma (SLL); usually absent in mantle cell lymphoma (MCL)

CD24

Most mature B-cell neoplasms

CD25

ATLL, HCL, some T- and B-cell lymphomas, including anaplastic large cell lymphoma (ALCL), Hodgkin lymphoma

CD26

Usually absent in Sézary syndrome

CD30

Hodgkin lymphoma, ALCL

CD38

PTCL, some B-cell lymphomas, myeloma, plasmacytic neoplasms

CD45

Lymphomas/leukemias (usually reduced/absent in lymphoblastic lymphoma, ALCL, AILT, plasma cell proliferations) 

CD45RA

Follicular lymphoma, some T-cell lymphomas, some mature B-cell lymphomas

CD45RO

T-cell lymphoma

CD56

NK-cell disorder, large granular lymphocytic leukemia (LGLL), hematodermic neoplasms (blastic NK-cell lymphoma)

CD57

NK-cell disorder, LGLL

CD71

Acute leukemia/lymphoma, intermediate- and high-grade lymphomas, Hodgkin lymphoma

CD74

B-cell lymphoma

CDw75

B-cell lymphoma

CD79a

B-cell lymphoma

CD79b

B-cell lymphoma

CD103

HCL, some splenic lymphomas

CD138

B-cell lymphoma, myeloma

CD200 Present in CLL and absent in MCL; may be present in other B-cell neoplasms
BCL2 B-cell lymphoma
BCL6 B-cell lymphoma

HLA-DR

B-cell neoplasms, Hodgkin lymphoma, PTCL

PCA-1

Myeloma

TdT

Lymphoblastic lymphoma

TCR - α-β

T-cell lymphoma/leukemia (most T-cell neoplasms expressing CD3)

TCR - γ-δ

T-cell lymphoma/leukemia

ARUP Laboratory Tests

Aid in evaluation of hematopoietic neoplasms (ie, leukemia, lymphoma)

Specimens include bone marrow, whole blood, tissue, or fluid

Monitor therapy in patients with established diagnosis of hematopoietic neoplasms

Markers selected based on provided clinical history and/or previous test results

Some hematopoietic neoplasms do not show phenotypic abnormalities and therefore may not be detected by flow cytometry

Poor cell viability may adversely affect antigens and impede the ability to properly identify neoplastic cells

Flow results cannot be used alone to diagnose malignancy; should be interpreted in conjunction with morphology, clinical information, and other necessary ancillary tests for a definitive diagnosis

Antigens included:

T cell: CD1a, CD2, CD3, CD4, CD5, CD7, CD8, TCR γ-δ, cytoplasmic CD3

B cell: CD10, CD19, CD20, CD22, CD23, CD103, CD200, kappa, lambda, cytoplasmic kappa, cytoplasmic lambda

Myeloid/monocyte: CD11b, CD13, CD14 (Mo2), CD14 (MY4), CD15, CD33, CD64, CD117, myeloperoxidase

Miscellaneous: CD11c, CD16, CD25, CD30, CD34, CD38, CD41, CD42b, CD45, CD56, CD57, CD61, HLA-DR, glycophorin, TdT, bcl-2, CD123, CD138, CD26, CD45, CRLF-2

Aid in the diagnosis of lymphoproliferative disorders

Aid in differentiating malignant from reactive lymphoid proliferations

Equally sensitive for both kappa and lambda restricted populations

Clinical sensitivity: >95% for mature B-cell non-Hodgkin lymphomas

Analytical sensitivity: clone must represent at least 1-5% of population examined

Analytic specificity: >98%

False-negative results may result from specimen inadequacy and mutations affecting primer sites

Detection of clonally rearranged IgH is seen in a subset of T-cell neoplasms (ie, a positive result in the test should not be used to differentiate between T- and B-cell neoplasms)

Aid in the diagnosis of T-cell lymphoproliferative disorders

Use to order individual or multiple oncology FISH probes if standard FISH panels are not desired

Detect chromosome abnormalities associated with lymphoma

Specific FISH probes related to lymphoma must be specified and include MYC (c-Myc) rearrangements, t(11;14) (IGH-CCND1), t(14;18) (IGH-BCL2), IGH rearrangement with unknown partner, ALK rearrangements, and BCL6 rearrangements

ARUP Oncology FISH Probes menu

Fresh tissue specimen required

Diagnose follicular lymphoma in conjunction with clinical, morphologic, and flow cytometric data

Most sensitive method to detect IGH-BCL2 fusion in FFPE tissue specimens

Not validated for tissue fixed in alcohol-based or nonformalin fixatives

Negative result does not exclude possibility of translocations involving other partners nor rule out follicular lymphoma

Diagnose Burkitt lymphoma (BL) or diffuse large B-cell lymphoma (DLBCL) with features intermediate between BL and DLBCL in conjunction with clinical, morphologic, and flow cytometric data

Limitations 

Negative result does not rule out BL or B-cell lymphomas with features intermediate between BL and DLBCL involving MYC with other translocation partners such as t(2;8) or t (8;22)

IGH-MYC t(8;14) by FISH has not been validated for tissue fixed in alcohol-based or nonformalin fixatives

MYC is not specific for BL or B-cell lymphomas with features intermediate between BL and DLBCL

Diagnose Burkitt lymphoma (BL) or diffuse large B-cell lymphoma (DLBCL) with features intermediate between BL and DLBCL in conjunction with clinical, morphologic, and flow cytometric data

Negative result does not rule out BL or B-cell lymphomas with features intermediate between BL and DLBCL

Does not identify translocation partner

MYC (8q24) gene rearrangement by FISH has not been validated for tissue fixed in alcohol-based or nonformalin fixatives

MYC is not specific for BL or B-cell lymphomas with features intermediate between BL and DLBCL

 

Diagnose BL or DLBCL with features intermediate between BL and DLBCL in conjunction with clinical, morphologic, and flow cytometric data

Sensitive method for detecting BCL6 rearrangements in FFPE, which can contribute to diagnosis and prognostication in B-cell lymphomas

Interpretation of results requires correlation with morphology and immunophenotype

MYC and/or BCL2 overexpression can be due to other mechanisms not detected by this test

Chromosome alterations outside probe region are not detected

Diagnose, prognose, and monitor hematopoietic neoplasms

Repeat testing as clinically indicated to monitor disease progression

Diagnose mantle cell lymphoma (MCL) in conjunction with morphology and immunohistochemical studies

FFPE tissue specimens only

Alternate test to detect prognostically important genomic abnormalities in CLL

Specific genomic abnormalities tested for are ATM deletion, 13q deletion, p53 deletion, and trisomy 12

Limit of detection is probe dependent and ~1-5% in interphase nuclei

Repeat testing as clinically indicated to monitor disease progression

Aid in diagnosis of MCL if cyclin testing is noninformative

Not validated for tissue fixed in alcohol-based or nonformalin fixatives or decalcified tissue

Negative result does not exclude the possibility of translocations involving other partners

Mutation is not specific for MCL; results should be analyzed in conjunction with morphology, immunohistochemistry, and immunophenotyping results

Aid in diagnosis of aggressive large B-cell lymphoma with intermediate features between Burkitt lymphoma and diffuse large B-cell lymphoma (DLBCL) and confirmation of suspected double hit lymphoma

Specimens: formalin-fixed, paraffin-embedded (FFPE) tissue specimens

Interpretation of results requires correlation with morphology and immunophenotype

MYC and/or BCL2 overexpression can be due to other mechanisms not detected by this test

Chromosome alterations outside probe region are not detected

Reflex pattern: if MYC (8q24) gene rearrangements by FISH is positive, then IGH-BCL2 fusion t(14;18) by FISH is added; if IGH-BCL2 fusion, t(14;18) by FISH is negative, then BCL6 (3q27) gene rearrangement by FISH will be added

Aid in diagnosis of aggressive large B-cell lymphoma with intermediate features between Burkitt lymphoma and diffuse large B-cell lymphoma (DLBCL) and confirmation of suspected double hit lymphoma

For reflex test, refer to Aggressive B-Cell Lymphoma FISH Reflex, Tissue

Specimens: bone marrow or whole blood specimens; other specimens may be acceptable

Interpretation of results requires correlation with morphology and immunophenotype

MYC and/or BCL2 overexpression can be due to other mechanisms not detected by this test

Chromosome alterations outside probe region are not detected

FFPE and frozen specimens unacceptable

Probes in this panel include MYCBCL2IGH, BCL6

Confirm diagnosis of hairy cell leukemia (HCL)

Monitor tumor burden in patients with HCL

Analytical sensitivity: 0.2% mutant allele

Limit of detection is 0.2% mutant allele

Determine risk group in newly diagnosed CLL

Assay is designed for use with a confirmed diagnosis of CLL and includes sequencing

Use of this assay for all other diagnoses will terminate after amplification and will not include sequencing

Samples that do not yield amplification product may contain too few CLL cells (<50% B cells), express VH gene with high numbers of mutations that may compromise clonal B-cell amplification

Not intended to detect minimal residual disease

Primarily for evaluating lymphocyte function in patients with suspected cellular immune dysfunction, such as primary and secondary immunodeficiencies

Other uses include monitoring lymphocyte recovery and competence after hematopoietic stem cell transplantation and monitoring lymphocyte function during immunosuppressive therapy

Primarily for evaluating T-cell function in patients with suspected cellular immune dysfunction, such as primary and secondary immunodeficiencies

Other uses include monitoring lymphocyte recovery and competence after hematopoietic stem cell transplantation and monitoring lymphocyte function during immunosuppressive therapy

Not a first-level test; order after lymphocyte proliferation, mitogen induced, by flow cytometry has been performed

Immunohistochemistry Stain Offering
Related Tests

Primarily for evaluating recall antigen responses in patients with suspected cellular immune dysfunction, such as primary and secondary immunodeficiencies

Other uses include monitoring lymphocyte recovery and competence after hematopoietic stem cell transplantation and monitoring lymphocyte function during immunosuppressive therapy

Do not order for patients younger than 3 months unless clinical history of candidiasis is present

Primarily for evaluating lymphocyte function in patients with suspected cellular immune dysfunction, such as primary and secondary immunodeficiencies

Other uses include monitoring lymphocyte recovery and competence after hematopoietic stem cell transplantation and monitoring lymphocyte function during immunosuppressive therapy

Do not use for diagnosis of infectious mononucleosis

Order to detect Epstein-Barr virus (EBV) in individuals suspected of having EBV-related disease

Medical Experts

Contributor

Lamb

Allen N. Lamb, PhD, FACMG
Allen N. Lamb, PhD, FACMG
Retired Former Professor of Clinical Pathology, University of Utah
Retired Former Laboratory Section Chief, Cytogenetics and Genomic Microarray, ARUP Laboratories
Contributor
Contributor

References

Additional Resources
Resources from the ARUP Institute for Clinical and Experimental Pathology®