Tests > Laboratory Tests
for Lymphoma
Last Update: 06/11/2009
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Direction Indicators
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About
Blood
Tests
Ways to monitor lymphoma:
Imaging
(where and how many lesions: enlarged lymph nodes or /tumors)
Biopsy
(what is the nature of the lesions)
Blood tests (nonspecific signals of
change)
Direct examination by your
doctor: Palpation (feeling for lesions); Inquiry about symptoms;
Review of blood tests and imaging tests
and patient-reported symptoms
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About
Blood
Tests
A Blood Test is a
procedure in which a sample of blood is taken and later analyzed in a
laboratory for signals (markers) of infection, disease or abnormality.
There are many kinds of
blood tests, but the most common are for markers of organ function
(bone marrow, liver, and kidney).
Blood Cell Counts (see CBC)
are measured to check bone marrow function. For example, a decreasing red blood count would
help to explain a common cause of fatigue, anemia.
Liver and Kidney markers are commonly checked for evidence of damage
or stress to these organs from disease processes or drug effects.
Other markers may be checked for
signals of disease direction or treatment effects. We have
provided only three examples below. Of these, LDH and
Beta2-microglobulin are sometimes watched as possible signals
of lymphoma status.
| Markers of
Organ function |
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| Bone marrow (hematopoiesis) |
Blood Counts (WBC,
CBC) |
| Liver (hepatic) |
Albumin, Liver enzymes (ALT, AST,
GGT and ALP), Bilirubin, Prothrombin time, Cholesterol, Total
protein |
| Kidney (renal) |
Creatinine / BUN |
| Other
markers of abnormalities |
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| Tissue damage |
LDH (enzyme) |
Increased production
or
destruction of immune cells |
Beta2-microglobulin (protein) |
| Inflammation |
C-Reactive Protein (CRP) |
NOTES:
Often it is not the specific lab
result that matters, but
the change from a previous test. You
may wish to track such changes with the spreadsheet. (Download
MyLabs: MS
Excel)
Reference ranges (normal
range) in blood
tests
can vary per lab.
(See for Common Blood Test Reference Ranges: PDF)
What is "normal" can also vary
by age, gender, and race, but also by clinical circumstances, such
as the drugs you are taking or have taken recently.
The ability to monitor the status of a lymphoma with blood tests is quite
limited. Imaging is the more definitive way to monitor disease direction - as it's more specific to the condition (measuring changes in the size and number of enlarged lymph nodes).
Many lab results, such as LDH, can be influenced by factors unrelated
to lymphoma, such as injury and infection.
What should you do if you have
abnormal blood test results?
- Talk to your doctor first. He or
she will know best how to interpret the results and may schedule a
second test to rule out a false reading; or schedule follow up tests
if the results are not explained by your clinical circumstances
(your age, the drugs you are taking, known medical conditions, and
so on).
Related Resources:
 | Facts about Blood Cells University
of Chicago
"Blood cells are made in the bone marrow. The
bone marrow is the soft, spongy material in the center of the
bones that produces about 95 percent of the body's blood cells.
There are other organs and systems in our bodies that help
regulate blood cells.
The lymph nodes, spleen, and liver help regulate the production,
destruction, and differentiation (developing a specific function)
of cells. The production and development of new cells is a process
called hematopoiesis."
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| Urinalysis NIH
"Urinalysis is the examination of urine for
certain physical properties, solutes, cells, casts, crystals,
organisms, or particulate matter."
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Labs
A to Z
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Under construction
Labs
A to Z
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CBC
Complete Blood Count with Differential
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Moved here
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CRP
C-Reactive Protein
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"C-Reactive Protein (CRP) is a
pentameric serum protein which rapidly increases in concentration at
the onset of inflammation, infection and tissue injury, and is
considered the classical acute phase reactant.
Its measurement is comparable to following erythrocyte sedimentation
rates (ESR), but CRP levels correlate more closely with the degree of
tissue damage and are more reliable and rapid in detecting changes in
disease activity.
Measurement of CRP serum levels may be helpful in the management of
inflammatory disorders such as rheumatoid arthritis, bacterial
infections, tissue injury such as myocardial infarction or burns,
neoplasia, and leukemias and lymphomas. CRP levels also can aid in the
differential diagnosis of a number of diseases" See for
details http://depts.washington.edu/
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Disease
Direction
indications
Related Topics
Diagnosis
&
Pathology
Getting a Second
Pathology Evaluation
Prognostic
Indicators
Performance
Standards
Diagnostic
Tests
Disease
Direction Indicators
|
Disease Direction Indications
Increasing or decreasing lab
values may help to gauge progression or response to treatment. However,
location of disease, and treatments can affect interpretation of the indicators provided here.
Therefore, it's important to consult with your doctor about questions
you may have.
Increased
levels: ALT (sSGPT), Alkaline Phosphatase, AST (sGOT), Beta2-microglobulin,
BIlirubin, Total Calcium, Creatinine, LD (LDH), Lymphocytes, Monocytes,
Sodium, BUN, Uric Acid
Decreased
levels: Albumin, Cholesterol, Globulin Iron, Total MCH,
MCHC, MCV, Protein
Source: NHL disease-specific disease Lab pattern
indications CellMate
Wellness
Lay comment on
the importance of identify biomarkers for lymphomas
Unlike breast and prostate cancers, there are no screening tests for
the early detection of lymphomas. So the search for reliable biomarkers continues.
Perhaps investigators should look for elevated levels of multiple indicators that
together predict for lymphoma, instead of trying to find the ideal
single marker. For example, if all of the following are elevated, it may indicate you have lymphoma as reliably as elevated PSA predicts for prostate
cancer: CD25, LDH, IL-6 Beta2-microglobulin, LDH...
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Serum CD25
Levels of CD25 are not typically
tested for in lymphoma patients outside of investigational settings.
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Serum CD25 a receptor expressed on immune cells
This marker is not commonly tested for
(if at all) outside investigative settings.
Topic search
Serum
CD25 AND lymphoma
| Indicator of tumor burden
"serum levels of sCD25, sCD8, sCD54, and sCD44 are roughly proportional to the burden of neoplasm (tumor), but sCD25 is clearly a more sensitive marker -- use for stage assessment is recommended.
Heamatological 1998; 83:750-768 PDF
| PDF-Help
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Human beta-2 microglobulin
Important that when comparing test
results, that the tests are done at the same lab.
|
 Topic Search:
ASCO
| Medscape
| PubMed
Background wikipedia.org
Beta2-microglobulin
(Beta 2 M) is a
protein found on the surface of many cells, including white blood
cells. "Increased production or destruction of these cells
causes Beta2-microglobulin levels in the blood to
increase." 4
The test helps in evaluating a person
with certain kinds of cancer affecting white blood cells including
chronic lymphocytic leukemia, and non-Hodgkin's lymphoma.
"The degree of elevation of ß2M can be related to tumor cell load, disease activity and prognosis.
Thus, ß2M may be useful as a tumor marker. In disorders such as
acute leukemia and lymphoma ...
... where there is CNS involvement
(rare), the
CSF ß2M may be elevated. This is often meaningful if measured
simultaneously with serum ß2M." ARUP's Guide
"In HD patients a significant
association was found between the level of S-beta 2M and stage of
disease (P less than 0.05) and presence of splenomegaly (P less than
0.05).
No association was found between S-beta 2M level and histologic
subtypes, lymph nodes greater than 3 cm in diameter, bone marrow
involvement, and B symptoms. A significant relation was found between
S-beta 2M level and survival in HD patients with widespread disease (P
less than .025)." 2
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Serum beta 2 microglobulin in malignant
lymphoproliferative disorders.
Cancer. 1985 May 15;55(10):2384-9. PMID:
3886124 | Related
articles
Correlation
and prognostic value of serum soluble ICAM-1, beta-2
microglobulin, and IL-2alphaR levels in non-Hodgkin's lymphoma.
Leuk Lymphoma. 1999 May;33(5-6):551-8.
PMID: 10342582 PubMed
| Related
abstracts
Beta2-Microglobulin Test enotes.com
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Interleukin
6
(IL-6)
Levels of IL-6 are not typically
tested for in lymphoma patients outside of investigational settings.
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Topic Search:
ASCO
| Web
Interleukin-6
(IL-6) is a cytokine (signaling protein) that has many functions related
to immune activity, especially inflammation. It is also described as a
biological response modifier - a substance that can improve the body's response to infection and
disease.
Higher than normal levels of IL-6 is
often associated with the progression of some lymphomas.
Background wikipedia.org
About IL-6 test
-
High serum interleukin-6 levels
correlate with a shorter failure-free survival in indolent
lymphoma. Leuk Lymphoma. 1998 Aug;30(5-6):563-71. PMID:
9711918 | More
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Reference range varies widely per
lab.
Therefore, when comparing test
results, that the tests are done at the same lab.
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TOPIC
SEARCH: LDH
AND Lymphoma | PubMed
Background wikipedia.org
Lactate Dehydrogenase (LDH) or (LD) is an enzyme that
is expressed at higher levels when lymphocytes are dividing or, more
commonly, when cells are distressed and damaged, particularly red
blood cells.
Elevating LDH is an indirect indication of disease progression.
Sharp increases can indicate transformation. " Drugs that
can increase LDH measurements include: anesthetics, aspirin,
clofibrate, fluorides, mithramycin, narcotics, and procainamide."
- MedlinePlus [1]
Your doctor will interpret LDH in the context of
clinical symptoms and other lab results. Normal variability of results
can be 20 points or more. Treatments can also affect LDH levels
temporarily. Tumor lysis (death) resulting from treatment might raise
LDH initially - in that context uric acid and magnesium levels will
also increase as well.
If you have unexplained high LDH?
W. Fred Miser, MD writes: "The first
step with any abnormal value is to repeat the test to make sure it
isn't a false positive.
LDH can also be "fractionated" into
five different isoenzymes, which help figure out where the elevated
LDH is coming from. For example, LDH-1 is from the heart, LDH-2
is from the immune system, LDH-3 is in the lungs and other tissues,
LDH-4 is in the kidney and pancreas, and LDH-5 is in the liver and
muscle. That will help your doctor pinpoint the cause for your
elevated LDH.'' http://www.netwellness.org/question.cfm/71867.htm
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FLIPI and LDH PAL
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Rising serum
LDH often caused by granulocyte-or Granulocyte-macrophage colony stimulating
factor (GM-CSF) and not tumor progression in patients with lymphoma or myeloma.
Leuk Lymphoma. 1995 May;17(5-6):473-7. Review. PMID: 7549840
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T-cells
Adult reference range/units varies
per lab:
CD4% = 32.14 - 59.30%
CD8% = 15.05 - 36.11%
CD4 Abs# = 522-1594/mm3
CD 8 Abs# = 135 - 1047/mm3
CD4/CD8 Ratio = 0.67 - 3.11
Source:
UTMB.edu
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Testing T-cell
counts and function can help to measure immune competence. These tests
are not commonly ordered for NHL pts, but they might provide useful
information for doctors when considering immune-based therapies
for their patients.
| T-Cell Subset Panel (CD4 Count) path.upmc.edu
"Performed on peripheral blood. It may be identified as
T-lymphocyte test, T-Cell Subsets, T and B Cells, CD4/CD8 ratio,
immunodeficiency panel, or by other synonyms. It includes a total
or pan-T-cell antibody, a total or pan B cell antibody, a T Helper
cell (CD4) antibody, a T Suppressor cell (CD8) antibody, and two
natural killer cell associated antibodies. No functional tests are
performed. Results include both relative and absolute values for
each cell type as well as the T helper/suppressor ratio. The test
is performed according to CDC guidelines."
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Cellular Immune Deficiencies as the Underlying
Cause of Elevated of Elevated Epstein-Barr Virus (EBV) Antibody
Titers in EBV-Associated Illnesses Ourworld.compuserve.com
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| Activated Natural Killer/IL-2R www.labcorp.com
"Natural killer (NK) cells are large granular lymphocytes that mediate MCH-unrestricted cytotoxicity against virus-infected and malignant cells and manufacture a number of cytokines following stimulation of the immune system."
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| Understanding T-cells wikepedia
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