Laboratory Evaluation of Lymphoma

Initial Laboratory Evaluation

The National Comprehensive Cancer Network recommends lactate dehydrogenase (LDH) as a prognostic marker, with levels >2× normal being particularly significant in aggressive subtypes 3, 4
The American Society of Clinical Oncology suggests serum calcium should be measured, as hypercalcemia occurs in certain T-cell lymphomas, particularly adult T-cell leukemia/lymphoma 3
A comprehensive metabolic panel, including liver and renal function tests, is required for initial evaluation 4, 5
Uric acid levels should be obtained to assess tumor lysis risk 6
HIV, hepatitis B, and hepatitis C serology are mandatory for all patients 5, 7
Erythrocyte sedimentation rate (ESR) should be measured as part of the initial evaluation 7

Flow cytometry is essential for distinguishing reactive from neoplastic lymphocytosis and determining lymphoma subtype, according to the College of American Pathologists 4, 2
The World Health Organization recommends a minimum panel for B-cell lymphomas, including CD19, CD20, CD23, and surface immunoglobulin light chains (kappa/lambda) to assess clonality 4
Additional markers, such as CD5, CD10, BCL2, and BCL6, are recommended for specific B-cell lymphoma subtypes 1, 5
For T-cell lymphomas, a minimum panel including CD2, CD3, CD4, CD5, CD7, CD8, and CD25 is recommended 3, 4
Genetic testing through FISH, conventional cytogenetics, and molecular analysis is critical for diagnosis, risk stratification, and treatment selection, as stated by the National Cancer Institute 1, 2

The European Society for Medical Oncology recommends essential FISH testing by lymphoma subtype, including t(11;14)(q13;q32) CCND1-IGH for mantle cell lymphoma 1, 2
For follicular lymphoma, t(14;18)(q32;q21) BCL2-IGH and immunoglobulin light chain variants are recommended 1, 2
Diffuse large B-cell lymphoma requires assessment of MYC, BCL2, and BCL6 rearrangements, according to the American Society of Clinical Oncology 1, 2, 5

Complex karyotypes and TP53 loss in mantle cell lymphoma indicate unfavorable prognosis, as stated by the National Comprehensive Cancer Network 2
Genomic complexity detected by chromosomal microarray is an independent marker of aggressive disease, according to the College of American Pathologists 2, 9