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Lymphoma affects the lymphatic system and B and T cell populations of white blood cells (WBCs). Lymphoma develops with the malignant transformation of lymphocytes. Most lymphomas originate from B cells with only 10–15% being of T and NK cell origins.1
As with many cancers, genetic alterations have been identified in several types of lymphoma and family history of the disease accounts for 5% of cases. Several factors are considered as risks promoting the development of lymphoma. These include radiation therapy, immune deficiency and viral infections such as from human immunodeficiency virus (HIV), human T lymphotropic virus type 1 (HTLV-1), hepatitis C virus (HCV) and Epstein-Barr virus (EBV).2
More than 70 kinds of lymphomas have been described, and they are grouped in two main types—Hodgkin and non-Hodgkin lymphoma.
In most cases of Hodgkin lymphoma (HL), the neoplastic cells are derived from mature B-cells. It preferentially develops in young adults between 20 and 34 years old. Hodgkin Reed-Sternberg (HRS) cells are a hallmark of Hodgkin lymphoma. They are giant multinucleated cells forming a clonal tumor pool of Hodgkin lymphoma. CD30 is the hallmark of HL and HRS cell surface markers.3
Non-Hodgkin lymphoma (NHL) is one of the most common forms of lymphoma.4 It preferentially develops in older adults and is less responsive to treatment than Hodgkin lymphoma. It preferentially develops in older adults and is less responsive to treatment than Hodgkin lymphoma. Surface markers such as CD20 and CD19 are expressed in NHL that are derived from B lymphocytes.5 Flow cytometry–based immunophenotypic analysis of NHL relies on the detection of specific lineage markers of B and T cells.
Immunophenotyping by flow cytometry is a solution to determine the type of lymphoma as panels of markers can be run to track the aberrant expression of antigens on lymphocytes.
When a lymphoproliferative disorder remains a significant possibility after clinical evaluation, cell surface and some intracellular phenotyping of lymphocytes is warranted.
Flow cytometry allows the screening of peripheral blood mononuclear cells (PBMCs), bone marrow and other fluids such as cerebrospinal fluid (CSF) to monitor not only the percentage of lymphocytes positive for a specific antigen but also the density of the antigens. Normal PBMC composition includes approximately 10% B cells, 80% T cells and 10% NK cells. Variations in these cell populations are cause for suspicion of lymphoproliferative disease. Specific flow cytometry panels can be run to assess each of these populations. Flow cytometry can also be used for phenotyping other lymphoid cells and tissues, including lymph nodes, skin, organs and brain as well as body fluids.
Diffuse large B cell lymphoma (DLBCL) is the largest category of lymphoma and accounts for 30 to 40% of adult NHL in western countries. This category of lymphoma can be a progression from another lymphoid malignancy such as follicular lymphoma (FL) or chronic lymphocytic leukemia (CLL). It is characterized by large lymphocytes that can be detected by flow cytometry. A standard immunophenotyping panel for DLBCL includes pan-B cell markers (CD19, CD22, CD79a), germinal center marker CD10, and proliferation marker Ki67. A high Ki67 indicates increased proliferation of the malignant lymphoma cells.6,7
Abnormalities in pan-T cell antigens, e.g., CD2, CD3, CD5, CD7, are indicative of a T cell lymphoproliferative disorder.8 T cell non-Hodgkin lymphoma (T cell NHL) represents about 12% of all non-Hodgkin lymphomas.9
T/NK cell neoplasms represent a small portion of lymphomas. They display an aberrant T cell or NK cell phenotype. Chronic lymphoproliferative disorders of NK cells (CLPD-NK) are rare heterogeneous disorders with continuous expansion of NK cells in peripheral blood, expressing CD16 and low levels of CD56 and CD57.10 Peripheral T cell lymphoma is an uncommon heterogeneous malignancy, accounting for less than 15% of all lymphomas.11
BD Biosciences offers a large portfolio of single-color antibody reagents that span across a range of specificities and dyes that can help in the characterization of hematologic neoplasia. These panels are to be verified and validated by the lab.
Furthermore, BD Biosciences provides the BD OneFlow™ Solution, comprising a comprehensive set of reagents, setup beads, protocols and assay templates, to help standardize leukemia and lymphoma immunophenotyping. This can improve laboratory efficiency and enable reliability and accuracy of results.12,13
BD Biosciences clinical flow cytometry solutions, including instrumentation, software and reagents, offer the building blocks for laboratory-developed tests used in the identification of markers associated with lymphomas.
These solutions are not FDA cleared or approved for the diagnosis of lymphomas. Analyte Specific Reagent. Analytical and performance characteristics are not established.
