Chronic Lymphocytic Leukemia - CLL | Choose the Right Test

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Author

Leonard

Nicole Leonard, MD

Anatomic and Clinical Pathology Resident, University of Utah School of Medicine and ARUP Laboratories

Contributor

Hong

Bo Hong, MD, FACMG

Associate Professor of Pathology (Clinical), Co-Director of Laboratory Genetics and Genomics Fellowship, University of Utah

Medical Director, Cytogenetics and Genomic Microarray, ARUP Laboratories

Contributor

Karner

Kristin Hunt Karner, MD

Associate Professor of Pathology (Clinical), University of Utah

Medical Director, Hematopathology and Molecular Oncology, ARUP Laboratories

Contributor

Ng

David P. Ng, MD, FCAP, BSEE

Assistant Professor of Pathology (Clinical), University of Utah

Medical Director, Hematopathology, ARUP Laboratories

Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are different forms of a common malignancy that is characterized by the presence of small, mature neoplastic lymphocytes (referred to as monoclonal B lymphocytes) in the blood, bone marrow, and lymphoid tissues.¹

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.

^{2

Eichhorst B, Robak T, Montserrat E, et al. Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021;32(1):23-33.}^{3

Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745-2760.} The diagnosis of CLL is usually made from blood cell counts and examination of peripheral smears. Additional laboratory testing, including cytogenetic testing, molecular testing, and flow cytometry, is used in prognosis and treatment decision-making. Determining the prognosis and appropriate treatment are especially important because CLL, which is usually indolent, may transform into a more aggressive disease such as diffuse large B-cell lymphoma (DLBCL) or Hodgkin lymphoma.

Quick Answers for Clinicians

How are chronic lymphocytic leukemia and small lymphocytic lymphoma diagnosed?

A CBC followed by peripheral smear interpretation and flow cytometry testing are generally sufficient to establish the diagnosis of chronic lymphocytic leukemia (CLL).¹

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.

Evidence of lymphadenopathy by physical exam and/or imaging followed by a lymph node biopsy are necessary for the diagnosis of small lymphocytic lymphoma (SLL).^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.}

Genetic tests, including gene sequencing, cytogenetics, and karyotyping, are used for prognosis and treatment decision-making. Bone marrow biopsy is not always necessary for diagnosis and prognosis because it is possible to test circulating lymphocytes for prognostic markers; however, biopsy may be helpful if there are concerns about immune-mediated disease or cytopenias that need to be evaluated before treatment.¹

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.

What role does next generation sequencing play in the investigation of chronic lymphocytic leukemia?

Next generation sequencing (NGS) can be used to assess for single gene variants, including substitutions and small insertions or deletions, that may have implications for prognosis or clinical management decisions. This testing complements the recommended immunophenotyping and cytogenetic workup of chronic lymphocytic leukemia (CLL) and other lymphoid malignancies and is used to tailor treatment (eg, in clinical trials), improve prognostication, and look for resistance mutations at relapse.

Which laboratory tests can be used to distinguish chronic lymphocytic leukemia from mantle cell lymphoma?

Several tests can distinguish between chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL), which is important for prognosis and treatment planning; such testing should always be performed at diagnosis. Unlike CLL, MCL exhibits the IGH-CCND1 fusion, t(11;14). MCL can often be excluded with flow cytometry testing for cyclin D1 [a surrogate marker for t(11;14)], or by using the gold standards of immunohistochemistry for cyclin D1 or fluorescence in situ hybridization (FISH) testing for IGH-CCND1.¹

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.

Other tests that may exclude MCL include flow cytometry for CD200 and immunohistochemistry for LEF1 and SOX11.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.} MCL is usually negative for both CD200 and LEF1.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.}^{3

Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745-2760.}

Indications for Testing

Testing for CLL should be considered in adult individuals who present with abnormal CBCs (showing persistent, unexplained lymphocytosis lasting ≥3 months) and/or lymphadenopathy.

Laboratory Testing

Initial Evaluation

The initial evaluation for CLL/SLL should include a complete assessment of performance status and systemic symptoms, patient history, and a physical examination with an evaluation of the size of the liver and spleen.¹

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.

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Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745-2760.} Recommended laboratory tests include a CBC with differential and a metabolic panel.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.} Additional laboratory tests that may be useful include beta-2 (β2)-microglobulin, direct antiglobulin (direct Coombs), haptoglobin, lactate dehydrogenase (LDH), quantitative immunoglobulin (Ig), and uric acid tests.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.} A bone marrow aspirate with biopsy is no longer recommended for diagnosis but may be helpful if other tests are not diagnostic or to diagnose immune-mediated disease or cytopenias.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.}^{2

Eichhorst B, Robak T, Montserrat E, et al. Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021;32(1):23-33.}^{3

Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745-2760.}

Diagnosis

A hematopathology slide review and immunophenotyping via flow cytometry on peripheral blood to detect and determine the concentration of monoclonal B lymphocytes are necessary to diagnose CLL, SLL, or monoclonal B lymphocytosis.¹

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.

^{2

Eichhorst B, Robak T, Montserrat E, et al. Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021;32(1):23-33.}^{3

Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745-2760.} Monoclonal B lymphocytes must be present for at least 3 months to support a diagnosis.^{3

Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745-2760.}

Diagnostic Criteria for CLL, SLL, and Monoclonal B Lymphocytosis
Diagnosis	Monoclonal B Lymphocytes per Liter	Other Features
CLL	≥5 x 10⁹	Other atypical lymphocytes may be present but must be <55% of total lymphocytes
SLL^a	May be <5 x 10⁹	Lymphadenopathy and/or splenomegaly
Monoclonal B lymphocytosis^b	<5 x 10⁹	None present
^aConfirm diagnosis with histopathology on a lymph node biopsy specimen. ^bMonoclonal B lymphocytosis is not a malignancy but may progress to CLL. Sources: NCCN, 2023¹ National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023. ; Eichhorst, 2021^{2 Eichhorst B, Robak T, Montserrat E, et al. Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021;32(1):23-33.}; Hallek, 2018^{3 Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745-2760.}

Flow Cytometry

Flow cytometry should be used to confirm the clonality of B cells in both CLL and SLL, which have the same immunophenotype.¹

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.

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Eichhorst B, Robak T, Montserrat E, et al. Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021;32(1):23-33.} Immunophenotyping with CD5, CD10, CD19, CD20, CD23, CD200, and kappa/lambda cell surface markers is recommended.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.} Additional testing [eg, flow or immunohistochemistry for cyclin D1 or fluorescence in situ hybridization (FISH) testing for the IGH-CCND1 fusion t(11;14)] may be useful to exclude similar conditions such as mantle cell lymphoma (MCL).^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.}

Flow cytometry is also useful for prognosis and treatment decision-making.

Histology

Although histology is insufficient and generally not necessary to diagnose CLL, it should be performed to confirm an SLL diagnosis and may be necessary if flow cytometry fails to establish a CLL diagnosis.¹

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.

^{3

Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745-2760.} Cytology or histology testing is also useful to exclude large-cell transformation to DLBCL, although this is rare. A lymph node biopsy specimen is preferred, followed by a bone marrow aspirate if the biopsy is nondiagnostic.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.}^{2

Eichhorst B, Robak T, Montserrat E, et al. Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021;32(1):23-33.} Fine needle aspiration or core needle biopsy is usually insufficient but can be performed in conjunction with other techniques if a lymph node is not readily accessible.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.}

Staging, Prognosis, and Treatment Decision-Making

Laboratory tests play an important role in staging, prognosis, and treatment decision-making in CLL. The prognostic significance of specific markers depends on the patient and treatment regimen.¹

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.

In addition to flow cytometry and standard blood tests, the National Comprehensive Cancer Network (NCCN) recommends CpG-stimulated karyotyping, FISH testing for del(17p), immunoglobulin heavy chain variable region (IGHV) gene testing (if not already performed), and TP53 testing before treatment.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.} Other tests may also be helpful.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.}^{3

Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745-2760.}

Molecular Genetic Testing

IGHV Sequencing

Somatic IGHV sequencing to determine mutation status is particularly useful for prognosis and treatment decision-making, and the NCCN recommends somatic IGHV sequencing rather than flow cytometry testing.¹

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.

Unmutated IGHV (≤2% mutated) has adverse prognostic implications, as do VH3-21 IGHV rearrangements, regardless of mutation status.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.} IGHV testing is only required once (ie, at diagnosis or before treatment) because IGHV mutation status does not change.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.}

Gene Panels by Next Generation Sequencing

Although genes with prognostic implications may be tested individually, next generation sequencing (NGS) is now preferred to evaluate many genes at one time. The following genes have implications for prognosis or clinical management in patients with CLL and may be included in such panels: ATM, BCL2, BIRC3, BTK, NOTCH1, PLCG2, POT1, and TP53. This is an emerging area of testing.

Flow Cytometry

Several flow cytometric markers have prognostic significance in CLL.¹

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.

In cases in which it is not possible to test for IGHV mutation status, flow cytometry or other techniques to assess the expression of these markers may be considered instead, but this testing is not broadly recommended.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.}

Fluorescence In Situ Hybridization

In addition to recommended FISH testing for del(17p), FISH testing for del(11q), del(13q), and trisomy 12 is useful in prognosis and treatment decision-making.¹

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.

^{3

Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745-2760.} The del(13q) abnormality has favorable prognostic implications in isolation, whereas both del(11q) and del(17q) have adverse prognostic implications.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.}

Karyotyping

Identification of a complex karyotype by chromosome karyotyping analysis on CpG-stimulated CLL cells is useful in prognosis; a complex karyotype (≥3 unrelated abnormalities in multiple cells) has adverse prognostic implications.¹

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.

Karyotyping is also useful in treatment decision-making for some patients, including those being considered for targeted treatment (eg, with Bruton’s tyrosine kinase inhibitor therapy).^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.}

Other Testing

Testing for cytomegalovirus, hepatitis B, and hepatitis C is recommended both before and during treatment because some CLL treatments may reactivate these infections.¹

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.

^{3

Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745-2760.} Pregnancy testing may also be useful before treatment.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.}

Monitoring for Treatment Response

Regular follow-up, including a CBC with differential, imaging, history, and physical examination, is recommended.³

Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745-2760.

Examination of a bone marrow biopsy and minimal residual disease (MRD) testing may also be useful in some circumstances.^{3

Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745-2760.}

Minimal Residual Disease

MRD testing is used in the context of clinical trials in CLL but is not currently recommended for monitoring in other contexts,¹

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.

^{2

Eichhorst B, Robak T, Montserrat E, et al. Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2021;32(1):23-33.}^{4

Wierda WG, Rawstron A, Cymbalista F, et al. Measurable residual disease in chronic lymphocytic leukemia: expert review and consensus recommendations. Leukemia. 2021;35(11):3059-3072.} although it has potential for use in prognosis.^{1

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: chronic lymphocytic leukemia/small lymphocytic lymphoma. Version 2.2023. Updated Jan 2023; accessed Apr 2023.}^{4

Wierda WG, Rawstron A, Cymbalista F, et al. Measurable residual disease in chronic lymphocytic leukemia: expert review and consensus recommendations. Leukemia. 2021;35(11):3059-3072.}

ARUP Laboratory Tests

Flow Cytometry

3001780

Leukemia/Lymphoma Phenotyping Evaluation by Flow Cytometry 3001780

Method

Flow Cytometry

3003142

Chronic Lymphocytic Leukemia Minimum Residual Disease by Flow Cytometry 3003142

Method

Flow Cytometry

Karyotyping

2002292

Chromosome Analysis, Bone Marrow 2002292

Method

Giemsa Band

2002290

Chromosome Analysis, Leukemic Blood 2002290

Method

Giemsa Band

2007130

Chromosome Analysis, Bone Marrow with Reflex to Genomic Microarray 2007130

Method

Giemsa Band/Genomic Microarray (Oligo-SNP array)

2007131

Chromosome Analysis, Leukemic Blood with Reflex to Genomic Microarray 2007131

Method

Giemsa Band/Genomic Microarray (Oligo-SNP array)

FISH

2002295

Chromosome FISH, CLL Panel 2002295

Method

Fluorescence in situ Hybridization (FISH)

Specimens: bone marrow, peripheral blood

For individual FISH probes, refer to the ARUP Oncology FISH Probes menu.

Cytogenomic Microarray

2006325

Cytogenomic SNP Microarray - Oncology 2006325

Method

Genomic Microarray (Oligo-SNP Array)

Specimens: bone marrow, peripheral blood

Polymerase Chain Reaction

0040227

IGHV Mutation Analysis by Sequencing 0040227

Method

Sequencing

NGS

3001858

Chronic Lymphocytic Leukemia Mutation Panel by Next Generation Sequencing 3001858

Method

Massively Parallel Sequencing

For immunohistochemical tests that may be useful in the diagnosis or differential diagnosis of CLL, refer to ARUP’s Immunohistochemistry Stain Offerings.

Chronic Lymphocytic Leukemia - CLL

Medical Experts

Leonard

Hong

Karner

Ng

Quick Answers for Clinicians

Indications for Testing

Laboratory Testing

Initial Evaluation

Diagnosis

Flow Cytometry

Histology

Staging, Prognosis, and Treatment Decision-Making

Molecular Genetic Testing

IGHV Sequencing

Gene Panels by Next Generation Sequencing

Flow Cytometry

Fluorescence In Situ Hybridization

Karyotyping

Other Testing

Monitoring for Treatment Response

Minimal Residual Disease

ARUP Laboratory Tests

Immunophenotyping

Cytogenetics

Molecular Testing

Immunohistochemistry

References

NCCN - chronic lymphocytic leukemia v2.2023

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29540348

34168283

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Chronic Lymphocytic Leukemia - CLL

Educational Videos From ARUP Laboratories

Medical Experts

Quick Answers for Clinicians

Indications for Testing

Laboratory Testing

Initial Evaluation

Diagnosis

Flow Cytometry

Histology

Staging, Prognosis, and Treatment Decision-Making

Molecular Genetic Testing

IGHV Sequencing

Gene Panels by Next Generation Sequencing

Flow Cytometry

Fluorescence In Situ Hybridization

Karyotyping

Other Testing

Monitoring for Treatment Response

Minimal Residual Disease

ARUP Laboratory Tests

Immunophenotyping

Cytogenetics

Molecular Testing

Immunohistochemistry

References