Symptoms and Tests | Testing

Blood Cell Counts: A complete blood count (CBC) with differential is a test that measures the levels of red cells, white cells, and platelets in your blood. People with CLL often have a high white blood cell and lymphocyte count. You may also have low levels of red blood cells and platelets.
Flow Cytometry: CLL cells have distinctive markers on the outside of the cell, called cell surface proteins. These tests help provide information about leukemia and its subtype and are used to distinguish CLL from other kinds of leukemia. It’s an important test to confirm a diagnosis of CLL and also known as immunophenotyping.
Comprehensive Metabolic Panel: This is a test that measures up to 14 different substances in your blood.
- Other Blood Tests: Your healthcare team may recommend other blood tests, which include:
  - Lactate dehydrogenase: This is a protein in almost all your cells and high levels are an important sign of cell damage and can be caused by a fast growing cancer.
  - Quantitative Immunoglobulins: This test measures the amount of each type of antibody (immunoglobulins) in the blood, and may be used to assess risk of infections.
  - Serum Beta-2 Microglobulin (β2-M): Β2-M is a protein that plays a role in your body’s immune response, and this test may be used to assess CLL cell growth.
  - Haptoglobin, reticulocytes and Coombs tests: This test may be used to assess if your body is attacking your blood cells.
  - Uric acid: This test helps to assess the risk of tumor lysis syndrome from dying leukemia cells.
  - Hepatitis B & C antibodies and antigens since the virus could reactivate during certain cancer treatments and can affect treatment results.
Minimal Residual Disease (MRD) Tests: During or after treatment, this test may used to look for small amounts of leukemia cells and include:
- Allele-specific oligonucleotide polymerase chain reaction (ASO-PCR)
- Six-color flow cytometry (MRD flow)
- Next-generation DNA sequencing (NGS)-based assays

Bone Marrow Aspiration and Biopsy: Bone marrow is the soft center in the middle of most of your bones. Blood tests are often enough to diagnose CLL, but bone marrow tests may be conducted to assess how many leukemia cells are in marrow. These are often done at the same time through the pelvic bone (located in the lower back by the hip). An aspiration removes a sample of the fluid and a biopsy removes a small amount of tissue. An excisional biopsy removes a whole lymph node, and an incisional biopsy removes part of a lymph node.

Not all leukemias are the same. Lab tests on a blood and/or bone marrow sample may be recommended to identify specific chromosomes, genes and proteins that are unique to your leukemia. Knowing the specific type of leukemia can help identify genetic biomarkers that can predict prognosis or outlook of CLL and also help determine the most appropriate treatment option for you. Biomarkers may change during watchful waiting and/or after treatment begins. Talk to your doctor about repeating biomarker testing before starting a new treatment. Some of the genetic changes in CLL include: deletion of the long arm of chromosome 13 del(13q), which is found in about half of patients, extra copy of chromosome 12 (trisomy 12), del(11q), del(17p), NOTCH1 mutations, SF3B1 mutations, TP53 abnormalities, MYD88 mutations, IGVH.

Cytogenetics is the study of genetic changes in cells, and molecular testing may be conducted on a tissue sample to understand how aggressive the cancer is.
Fluorescence in situ hybridization (FISH) is a type of cytogenetic test that uses a fluorescent dye to see changes in a person’s chromosomes and can show missing parts or extra chromosomes. In CLL, the leukemia cells may have 11q, 13q, or 17p deletions. The cells may also have an extra copy of chromosome 12 also called trisomy 12.
DNA sequencing is used to look for mutations in the TP53 and IGHV genes. It can help the doctor know how aggressive the CLL is.
A karyotype can show defects in chromosomes and complex genetic changes.

CT or CAT Scan (Computed Tomography Scan): This scan uses detailed 3-D computer-generated images of the inside of your body to show any abnormalities.
PET Scan (Positron Emission Tomography): This test uses a radioactive sugar substance (injected into the body) and a special camera to take pictures inside of the body. These pictures show areas where sugar is collected through the body, since cancer cells absorb high amounts of this sugar. Usually combined with a CAT scan and useful in showing the best area to biopsy and/or if your healthcare team thinks that CLL is turning into a fast-growing cancer called Richter’s transformation.
ECHO (Echocardiogram) or MUGA (Multigated Acquisition) Scan: Certain treatments can affect the heart and your doctor may use one of these tests to plan treatment. An ECHO is an ultrasound that uses sound waves to assess how well the heart is working. A MUGA scan makes pictures using an injected radiotracer and special camera.

Testing

What types of tests will I receive?

Blood Tests

Bone Marrow Tests/Biopsies

Biomarker/Molecular Testing

Imaging Tests