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Patients Against Lymphoma

 

Tests > Laboratory Tests for Lymphoma

Last Update: 04/02/2014

  Diagnostics | Imaging | Labs | Other Tests
 

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About Blood Tests

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Complete Blood Count (CBC)

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CRP (C-Reactive Protein)

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Lymphoma Disease Direction Indicators

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Serum CD25

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Immunoglobulins

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LDH / LD (Lactate Dehydrogenase)

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H-pylori (associated with MALT lymphoma)

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Human beta-2 Microglobulin  

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Interleukin 6 

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T-cells

About Blood Tests

Labtests Online: understanding lab tests

 

Ways to monitor lymphoma -
at a glance

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

See also Monitoring Lymphoma

 

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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  
   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
   Tissue damage LDH (enzyme) 
   Increased production or
   destruction of immune cells
Beta2-microglobulin (protein)
   Inflammation C-Reactive Protein (CRP) 

Related Information:

Creatinine Blood Test http://www.medicinenet.com/creatinine_blood_test/article.htm

Medical Author: Siamak Nabili, MD, MPH
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
 

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: 

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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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Disease Direction indicators
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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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Other resources:  Uthman | NHL Pt Ctr Guide | CellMate Wellness | Bloodbook.com


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/


Disease Direction indications

Related Topics

Diagnosis &
Pathology

  Getting a Second
Pathology Evaluation

Prognostic 
Indicators

Performance 
Standards

Diagnostic 
Tests

Disease Direction Indicators

 

 

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Increasing or decreasing lab values may help to gauge progression or response to treatmentIncreasing 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 identifying 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, might it indicate you have lymphoma as reliably as elevated PSA predicts for prostate cancer?

Such as: CD25, LDH, IL-6 Beta2-microglobulin, LDH...

 


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

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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


Human beta-2 microglobulin


It's important that when comparing test results, that the tests are done at the same lab.

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Beta2-microglobulin (Beta 2 M or B2M) 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 2M can be related to tumor cell load, disease activity and prognosis. Thus, 2M may be useful as a tumor marker. In disorders such as acute leukemia and lymphoma.

... where there is CNS involvement (rare), the CSF 2M may be elevated. This is often meaningful if measured simultaneously with serum 2M." ARUP's Guide

"In Hodgkins lymphoma 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

Causes of elevated B2M not related to lymphoma or cancer?

Severe infections, viral infections, inflammatory conditions and autoimmune disorders, can cause increases in B2M levels.  Recent nuclear medicine procedures and radiographic contrast media can affect test results. 1
 

  1. About Beta2-microglobulin test  labtestsonline.org
  2. Serum beta 2 microglobulin in malignant lymphoproliferative disorders.
    Cancer. 1985 May 15;55(10):2384-9. PMID: 3886124 | Related articles
  3. 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 
  4. Prognostic factors in follicular lymphoma: the importance of beta-2 microglobulin. http://www.ncbi.nlm.nih.gov/pubmed/20437868
  5. Value of serum beta 2 microglobulin as an indicator of early relapse in diffuse large cell lymphoma  ncbi.nlm.nih.gov
  6. Background wikipedia.org 


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

  1. About IL-6  test
  2. 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


Lactate Dehydrogenase (LDH)

The normal reference range for LDH can vary 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

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 a non-specific marker, a possible indication of disease progression, [but it can also rise from unrelated causes.] 

LDH is commonly monitored for elevation above normal and sharp changes when you have lymphoma. Sharp and steep 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.   

B2M is  another blood factor that's commonly monitored for elevation and abrupt change when you have lymphoma.

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.''  

Source: netwellness.org

Many things can affect LDH results that are not necessarily a cause for concern.

For example:
 
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Certain infections cat.inist.fr

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Neupogen4

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Strenuous exercise can cause temporary elevations in LDH.

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Hemolysis of the blood specimen can cause falsely elevated results. This may happen if the specimen is handled roughly, stored in extreme temperatures, or if the sample was difficult to collect.

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If your platelet count is increased, serum LDH will be artificially high and not reflective of the LDH actually present.

Source: labtestsonline.org/

Resources and Reports:

  1. LDH (Lactate Dehydrogenase)
     Medline Plus |
    labtestsonline.org | Wikipedia.org 
  2. TOPIC Search Family Practice Notebook
  3. FLIPI and LDH  PAL 
  4. LDH is not a great predictor of diffuse relapse

    Leuk Lymphoma: Elevated lactate dehydrogenase levels detected during routine follow up do not predict relapse in patients with diffuse large B cell lymphoma who achieve a complete remission after primary treatment with R-CHOP-like immunochemotherapy. http://1.usa.gov/I1drcP 
  5. Common question:

    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
  6. ASCO 2012:
    The utility of serum lactate dehydrogenase (LDH) in the follow-up of patients with DLBCL

    "A 1.5 fold increase in LDH, over a period of 3 months, is associated with increased likelihood of relapse from DLBCL. Modest elevations in LDH (<1.5 fold of baseline) doesnt seem to be associated with relapse. LDH, when elevated at least 1.5 fold of baseline, is a specific (i.e. 56%), but not a sensitive (i.e. 19%) marker, for relapse of DLBCL."
     

  7. ELeuk Lymphoma. 2012

    Elevated lactate dehydrogenase levels detected during routine follow-up do not predict relapse in patients with diffuse large B-cell lymphoma who achieve complete remission after primary treatment with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone-like immunochemotherapy.
    http://1.usa.gov/1gDz3XA


T-cells

T-cell 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. 

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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
 
 
Disclaimer:  The information on Lymphomation.org is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
Patients Against Lymphoma, Copyright 2004,  All Rights Reserved.