If you are experiencing any signs and symptoms of chronic lymphocytic leukemia (CLL) your doctor should perform the following tests to confirm it is CLL. As well, the following tests will help identify the stage and type of the disease to help determine the best treatment plan for the patient.

Common Tests for CLL Patients

Diagnosis Tests 

• Flow cytometry:
  • Looks for CLL cells based on common surface proteins. 
• IHC on biopsy sample:
  • Helps doctors visualize cancer-specific cell markers.  

Genetic Biomarkers 

• Fluorescence in situ hybridization (FISH):
  • Checks for CLL cells by looking for chromosome deletions in B-cells. A B-cell is labeled as CLL if it has a certain combination of chromosome deletions. 
• DNA sequencing:
  • Checks for gene mutations that may influence the progression rate of the cancer and affect treatment decisions. 
• CpG-stimulated karyotype:
  •  Checks a patient’s chromosome for deletions, additions, and re-arranged parts (translocations).

Health History and Exam

• Health history and exam:
  • Assesses your physical condition to check for CLL signs and symptoms. 

Blood Tests 

• Complete blood count (CBC) with differential:
  • Looks at a sample of the patient's blood under a microscope to see if CLL cells are crowding out other types of blood cells (red blood cells, platelets, and white blood cells). 
• Comprehensive metabolic panel (CMP):
  • A blood test CLL patients should receive which screens for multiple diseases. It tests for 14 chemicals to evaluate liver and kidney health, blood sugar levels, the acid and base balance of the blood, and the fluid/electrolyte balance. The information gained from the test helps influence treatment decisions for CLL patients and gives insight into the status of the disease. 
• Lactate dehydrogenase (LDH)
  • LDH is a protein in almost all cells. It can be released into the blood when a cell is damaged. A high level of LDH is an important sign of cell damage. CLL is typically slow-growing. If the type of CLL is more fast-growing, there will often be higher amounts of LDH in the blood sample and treatment may be needed soon. 

Minimal Residual Disease Tests (MRD)

• What is MRD testing for CLL?:
  • Minimal residual disease (MRD) testing helps find the smallest number of cancer cells that may remain in a patient's body following treatment, or during remission periods. Its sensitivity is so high that it can identify remaining cancer cells that often go undetected by conventional clinical or laboratory tests.  
  • Types of MRD tests include:  
    • Next-generation DNA sequencing
    • Polymerase chain reaction
    • Flow cytometry    

Tests that May be Useful for CLL Patients

Biopsy Tests

• Bone marrow tests (aspiration and biopsy):
  • The majority of blood cells are created in the bone marrow. Looking at the bone marrow helps determine if the CLL cells are overcrowding other types of blood cells or if treatment is working and CLL cells are decreasing. This is not commonly used for CLL. 
• Lymph node biopsy
  • CLL cells are often found in the lymph system. If the cancer cells build up in lymph nodes, it can cause them to swell. A CLL patient’s doctor may decide to examine a sample of the patient’s lymph nodes using a lymph node biopsy if the doctor is uncertain about the diagnosis after blood work alone. They may also check cells inside lymph nodes for a rare and aggressive form of CLL disease progression called Richter's Transformation. 

Blood Tests

• Quantitative immunoglobulins:
  • If immunoglobulin (antibody) levels are low, patients can qualify for an immunoglobulin infusion to help boost their immune system (often referred to as IVIG). Click here for more about IVIG for CLL patients. 
• Beta-2 microglobulin (B2M): 
  • Checks for CLL cell growth. CLL cells release a surface protein called beta-2 microglobulin (B2M) into the blood when they replicate. CLL cells release more of the B2M protein than regular cells. Doctors use the B2M test to assess how much cancer is in your body and how fast it is growing. 
• Uric acid: 
  • Reviews the amount of uric acid in the blood. There are a variety of reasons uric acid may be high. If uric acid is high, it can negatively impact a patient’s health, and supportive measures need to be taken to reduce negative side effects. 
• Hepatitis test:
  • Checks for hepatitis B and hepatitis C antigens (fragments from the virus that trigger your immune system to detect the virus) and antibodies (proteins made by your immune system that attack the virus). The test is recommended because the hepatitis B virus can reactivate during treatment, and the hepatitis C virus could affect treatment results. 

Imaging

• PET/CT scan: 
  • CLL is a cancer that affects B-cells which are located in the blood, bone marrow, and lymph system. When CLL cells build up in the lymph system, it causes areas like the lymph nodes, spleen, and liver to swell. To detect these enlarged areas, a positron emission tomography (PET)/computed tomography (CT) scan is used. 

Fertility and Pregnancy

• Fertility counseling and/or pregnancy test: 
  • Medicines that treat CLL can cause harm to an unborn baby. As well, certain CLL medicines may affect an individual’s ability to have a baby after treatment (fertility).  Before starting treatment, a fertility specialist may be able to help men store sperm and women store eggs or ovarian tissue by collecting and freezing them. 

Need help finding a CLL specialist to make sure you are getting accurate care? Visit HealthTree's CLL Specialist Directory.