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HelpTest ID: LLTOF Leukemia and Lymphoma Phenotyping, Technical Only, Varies
Useful For
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
This test is not intended for detection of minimal residual disease below 5% blasts.
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| FCINT | Flow Cytometry Interp, 2-8 Markers | No, (Bill Only) | No |
| FCIMS | Flow Cytometry Interp, 9-15 Markers | No, (Bill Only) | No |
| FCINS | Flow Cytometry Interp,16 or greater | No, (Bill Only) | No |
Testing Algorithm
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 panel will be charged based on the number of markers tested (FIRST for first marker, ADD1 for each additional marker). Additional testing may be performed at an additional charge for each marker tested (ADD1, as applicable) if needed to fully characterize a disease state or clarify any abnormalities from the screening panel.
The triage panel is initially performed to evaluate for monotypic B cells by kappa and lambda immunoglobulin 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.
This initial testing, together with the provided clinical history and morphologic review is used to determine what, if any, additional 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 testing for granular lymphocytic leukemia (killer-cell immunoglobulin-like receptor panel) will have an interpretation added and performed by a Mayo Clinic pathologist at an additional charge.
If no abnormalities are detected by the initial triage 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:
-Bone Marrow Staging for Known or Suspected Malignant Lymphoma Algorithm
-Acute Promyelocytic Leukemia: Guideline to Diagnosis and Follow-up
Special Instructions
Reporting Name
Leukemia/Lymphoma; Tech Only FlowSpecimen Type
VariesOrdering Guidance
This test is available to clients through MayoAccess or MayoLink.
For B-cell acute lymphoblastic leukemia minimal residual disease testing in either blood or bone marrow, order BALLM / B-Cell Lymphoblastic Leukemia Monitoring, Minimal Residual Disease Detection, Flow Cytometry, Varies.
For bone marrow specimens being evaluated for possible involvement by a myelodysplastic syndrome (MDS) or a myelodysplastic/myeloproliferative neoplasm (MDS/MPN) including chronic myelomonocytic leukemia (CMML), order MYEFL / Myelodysplastic Syndrome by Flow Cytometry, Bone Marrow.
Bronchoalveolar lavage specimens submitted for evaluation for leukemia or lymphoma are appropriate to send for this test.
This test is not appropriate for and cannot support diagnosis of sarcoidosis, hypersensitivity pneumonitis, interstitial lung diseases, or differentiating between pulmonary tuberculosis and sarcoidosis (requests for CD4/CD8 ratios); specimens sent for these purposes will be rejected.
This test is not intended for product of conception (POC) specimens. For POC specimens see CMAPC / Chromosomal Microarray, Autopsy, Products of Conception, or Stillbirth.
Additional Testing Requirements
For bone marrow testing, if cytogenetic tests are desired along with this test request, an additional specimen should be submitted. It is important that the specimen be obtained, processed, and transported according to instructions for the other test.
Shipping Instructions
Specimen must arrive within 4 days of collection.
Necessary Information
The following information is required:
1. Reason for testing
2. Specimen source
3. For spinal fluid specimens: spinal fluid cell and differential counts are required
Specimen Required
Submit only 1 of the following specimens:
Specimen Type: Whole blood
Container/Tube:
Preferred: Yellow top (ACD solution A or B)
Acceptable: Lavender top (EDTA) or green top (sodium heparin)
Specimen Volume: 10 mL
Slides: If possible include 5 to 10 unstained blood smears, labeled with two unique identifiers
Collection Instructions:
1. Send whole blood specimen in original tube. Do not aliquot.
2. Label specimen as blood.
Specimen Stability Information: Ambient ≤4 days/Refrigerated ≤4 days
Specimen Type: Bone marrow
Container/Tube:
Preferred: Yellow top (ACD solution A or B)
Acceptable: Lavender top (EDTA) or green top (sodium heparin)
Specimen Volume: 1 to 5 mL
Slides: If possible include 5 to 10 unstained bone marrow aspirate smears, which must be labeled with two unique identifiers
Collection Instructions:
1. Submission of bilateral specimens is not required.
2. Send bone marrow specimen in original tube. Do not aliquot.
3. Label specimen as bone marrow.
Specimen Stability Information: Ambient ≤4 days/Refrigerated ≤ 4 days
Specimen Type: Fluid
Sources: Serous effusions, pleural, pericardial, or abdominal (peritoneal fluid)
Container/Tube: Body fluid container
Specimen Volume: 20 mL
Collection Instructions:
1. If possible, fluids other than spinal fluid should be anticoagulated with heparin (1 U/mL of fluid).
2. Label specimen with fluid type.
Additional Information: The volume of fluid necessary to phenotype the lymphocytes or blasts in serous effusions depends upon the cell count in the specimen. Usually, 20 mL of pleural or peritoneal fluid is sufficient. Smaller volumes can be used if there is a high cell count.
Specimen Stability Information: Refrigerated ≤4 days/Ambient ≤4 days
Specimen Type: Spinal fluid
Container/Tube: Sterile vial
Specimen Volume: 1 to 1.5 mL
Collection Instructions:
1. An original cytospin preparation (preferably unstained) should be included with the spinal fluid specimen so correlative morphologic evaluation can occur.
2. Label specimen as spinal fluid.
Specimen Stability Information: Refrigerated /Ambient ≤4 days
Additional Information: The volume of fluid necessary to phenotype the lymphocytes or blasts in spinal fluid depends upon the cell count in the specimen. A cell count should be determined and submitted with the specimen. Usually, 1 to 1.5 mL of spinal fluid is sufficient. Smaller volumes can be used if there is a high cell count. If the cell count is less than 10 cells/mcL, a larger volume of spinal fluid may be required. When cell counts drop below 5 cells/mcL, the immunophenotypic analysis may not be successful.
Specimen Minimum Volume
Blood: 3 mL
Bone marrow: 0.5 mL
Spinal fluid: 1 mL
Fluid from serous effusions: 5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Varies | ||
Clinical Information
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
Not applicable
Interpretation
Report will include a summary of the procedure.
Clinical Reference
1. Jevremovic D, Dronca RS, Morice WG, et al. CD5+ B-cell lymphoproliferative disorders: Beyond chronic lymphocytic leukemia and mantle cell lymphoma. Leuk Res. 2010;34(9):1235-1238
2. Hanson CA. Acute leukemias and myelodysplastic syndromes. In: McClatchey KD, ed. Clinical Laboratory Medicine. Williams and Wilkins; 1994:939-969
3. Jevremovic D, Olteanu H. Flow cytometry applications in the diagnosis of T/NK-cell lymphoproliferative disorders. Cytometry B Clin Cytom. 2019;96(2):99-115
4. Rosado FG, Morice WG, He R, et al. Immunophenotypic features by multiparameter flow cytometry can help distinguish low grade B-cell lymphomas with plasmacytic differentiation from plasma cell proliferative disorders with an unrelated clonal B-cell process. Br J Haematol. 2015;169(3):368-376
5. Shi M, Ternus JA, Ketterling RP, et al. Immunophenotypic and laboratory features of t(11;14)(q13;q32)-positive plasma cell neoplasms. Leuk Lymphoma. 2018;59(8):1913-1919
6. 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
7. Shi M, Jevremovic D, Otteson GE, Timm MM, Olteanu H, Horna P. Single antibody detection of T-cell receptor alpha-beta clonality by flow cytometry rapidly identifies mature T-cell neoplasms and monotypic small CD8-positive subsets of uncertain significance. Cytometry B Clin Cytom. 2020;98(1):99-107
8. Jevremovic D, Olteanu H. Flow cytometry applications in the diagnosis of T/NK-cell lymphoproliferative disorders. Cytometry B Clin Cytom. 2019;96(2):99-115
Day(s) Performed
Monday through Sunday
Report Available
1 to 4 daysTest Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
88184-Flow cytometry; first cell surface, cytoplasmic or nuclear marker
88185-Flow cytometry; additional cell surface, cytoplasmic or nuclear marker (each)
Additional CPTs may be added if consultative help is needed with the case, or algorithm dictates Mayo consultant involvement.
88187-Flow cytometry interpretation, 2 to 8 markers (if appropriate)
88188-Flow cytometry interpretation, 9 to 15 markers (if appropriate)
88189-Flow cytometry interpretation, 16 or more markers (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| LLTOF | Leukemia/Lymphoma; Tech Only Flow | 101119-6 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| CK071 | Flow Cytometry | 69052-9 |
| CK072 | Final Diagnosis | 22637-3 |
| CK073 | Microscopic Description | 22635-7 |
| CK074 | Special Studies | 30954-2 |
| CKR2 | Reason for Referral | 42349-1 |
| CKS2 | Specimen Source | 31208-2 |
Method Name
Immunophenotyping
Additional Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| FIRST | Flow Cytometry, Cell Surface, First | No, (Bill Only) | Yes |
| ADD1 | Flow Cytometry, Cell Surface, Addl | No, (Bill Only) | Yes |
Forms
1. Hematopathology Patient Information (T676)
2. If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.
mml-acute-leukemia-myelodysplastic-syndromes, mml-bone-marrow-transplant, mml-myeloproliferative-neoplasm, mml-lymphoid-disorders, mml-myeloma-amyloidosis-dysprotenemia