Mature lymphoid neoplasms

 At diagnosis:

 

Disease subtype

 

Lymphoproliferative neoplasm

MM/MGUS

Morphology

Lymphocyte count

Lymphocyte morphology

Plasma cell count

Flow cytometry

LPD Screen

Extended B and/or T panel as appropriate

Clonality (κ/λ) if B

Plasma cell phenotype including cytoplasmic light chain expression

FISH

CLL, MCL, PLL, FL, Burkitt lymphoma

Prognostic abnormalities

Karyotype

 

N/A

N/A

Molecular genetics

Hairy cell leukaemia: BRAF V600E mutation analysis

Anaplastic large cell lymphoma: NPM-ALK

T cell LPD / lymphoma: TCR gene rearrangement (clonality)

B cell LPD / lymphoma: IG gene rearrangement

Chronic lymphocytic leukaemia:

·       TP53 mutation analysis (on specific request)

·       IGVH mutation status (on specific request – samples sent to Leeds HMDS)

N/A

BM histology

(Type of) involvement, staging

FISH, if confirmation needed

Plasma cell involvement

Plasma cell phenotype

 

At MRD*/ response evaluation**:

 

Disease subtype

 

LPD

MM/MGUS

Morphology

* Lymphocyte count

* Lymphocyte morphology

* Plasma cell count

Flow cytometry

* Specific B or T cell analysis as appropriate

High resolution (0.01%) assays for CLL

* Plasma cell phenotype/light chain restriction

FISH

 N/A

N/A

Karyotype

N/A

N/A

Molecular genetics

N/A

N/A

BM histology

* Lymphoma involvement if present at diagnosis

* Plasma cell involvement

 

At relapse:

 

Disease subtype

 

LPD

MM/MGUS

Morphology

Lymphocyte count

Lymphocyte morphology

Plasma cell count

Flow cytometry

If significant change in morphology

N/A

FISH

CLL

N/A

Karyotype

N/A

N/A

Molecular genetics

N/A

N/A

BM histology

Lymphoma involvement

Transformation

Plasma cell involvement

 

*MRD is used when morphological CR has to be monitored (repeatedly) with other, more sensitive techniques (e.g. cytogenetic CR or molecular CR)

**Response evaluation is used for investigation of the quality of clinical and morphological complete remission (after induction treatment) with more sensitive techniques e.g. as a prognostic marker