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HelpTest Code CEE20 CD20 Cell Expression Evaluation, Varies
Ordering Guidance
This test should not be used as a shortened diagnostic panel. For a complete diagnostic B-cell, T-cell, or acute immunophenotyping panel, order LCMS / Leukemia/Lymphoma Immunophenotyping, Flow Cytometry, Varies.
This test evaluates CD20 expression only. For CD52 expression, order CEE52 / CD52 Cell Expression Evaluation, Varies. For CD49d expression, order CEE49 / CD49d Cell Expression Evaluation, Varies.
Shipping Instructions
Specimen must arrive within 4 days of collection.
Necessary Information
The following information is required:
1. The therapeutic monoclonal antibody being used or considered
2. The pertinent hematologic diseases that have been diagnosed or considered
3. Specimen source
4. Date and time of collection
Specimen Required
Submit only 1 of the following specimens:
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Specimen Type: Whole Blood
Container/Tube:
Preferred: Yellow top (ACD solution A or B)
Acceptable: Lavender top (EDTA) or Green top (sodium heparin)
Specimen Volume: 10 mL
Collection Instructions:
1. Send whole blood specimen in original tube. Do not aliquot.
2. Label specimen as blood.
Specimen Stability Information: Ambient ≤4 days/Refrigerated ≤4 days
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Specimen Type: Bone marrow
Container/Tube:
Preferred: Yellow top (ACD solution A or B)
Acceptable: Lavender top (EDTA) or green top (sodium heparin)
Specimen Volume: 1 to 5 mL
Collection Instructions:
1. Submission of bilateral specimens is not required.
2. Label specimen as bone marrow.
3. Send bone marrow specimen in original tube. Do not aliquot.
Specimen Stability Information: Ambient/Refrigerated ≤4 days
Forms
If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.
Secondary ID
65660Useful For
Detecting cell-surface antigens on malignant cells that are potential therapeutic antibody targets, specifically CD20
Determining the eligibility of patients for monoclonal antibody therapies
Monitoring response to the therapeutic antibody
Testing Algorithm
A complete diagnostic B-cell, T-cell, or acute immunophenotyping panel is not performed. In some cases, a limited morphologic evaluation will be performed.
Method Name
Immunophenotyping
Reporting Name
CD20 Cell Expression Evaluation, VSpecimen Type
VariesSpecimen Minimum Volume
Blood: 3 mL
Bone Marrow: 1 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Varies | 4 days |
Reject Due To
All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.Clinical Information
Monoclonal antibodies are critical tools for detecting cellular antigens in various hematologic diseases and are used to provide critical prognostic information (CD49d). Monoclonal antibodies are also used as therapeutic agents in a variety of hematologic diseases. For example:
-Anti-CD20 (Rituxan): B-cell malignant lymphomas and multiple myeloma
-Anti-CD52 (Campath-1H): B-cell chronic lymphocytic leukemia and T-cell disorders
This list will undoubtedly expand over time to include other antibodies.
It may be necessary to document expression of these markers by the malignant cells prior to initiating the respective monoclonal antibody therapy. Expression of these markers may also be required for follow-up to monitor the impact of treatment on residual normal counterparts (eg, CD20-positive lymphocytes in patients treated with anti-CD20).
The distribution of these cellular antigens is well established in normal, reactive, and in various malignant disorders. The laboratory has several years of experience with therapeutic antibody monitoring of Mayo Clinic patients as part of the routine B-cell, T-cell, or acute immunophenotyping panels.
Reference Values
Normal individuals have B lymphocytes, T lymphocytes, or myeloid cells that express the corresponding cell-surface antigens in question.
Interpretation
The immunophenotyping report will summarize the pattern of antigenic expression on malignant cells and, if appropriate, the normal cellular counterparts that correspond to the therapeutic monoclonal antibody target.
Cautions
No significant cautionary statements.
Clinical Reference
1. Salles G, Barrett M, Foa R, et al. Rituximab in B-cell hematologic malignancies: A review of 20 years of clinical experience. Adv Ther. 2017;34(10):2232-2273. doi:10.1007/s12325-017-0612-x.
2. Braun T, von Jan J, Wahnschaffe L, Herling M. Advances and Perspectives in the Treatment of T-PLL. Curr Hematol Malig Rep. 2020;15(2):113-124. doi:10.1007/s11899-020-00566-5.
3. Piccaluga PP, Cascianelli C, Inghirami G. Tyrosine kinases in nodal peripheral T-cell lymphomas. Front Oncol. 2023;13:1099943. Published 2023 Feb 8. doi:10.3389/fonc.2023.10999434. Amhaz G, Bazarbachi A, El-Cheikh J. Immunotherapy in indolent Non-Hodgkin's Lymphoma. Leuk Res Rep. 2022;17:100325. Published 2022 May 18. doi:10.1016/j.lrr.2022.100325
5. Tissino E, Pozzo F, Benedetti D, et al. CD49d promotes disease progression in chronic lymphocytic leukemia: new insights from CD49d bimodal expression. Blood. 2020;135(15):1244-1254. doi:10.1182/blood.2019003179
Method Description
Flow cytometric immunophenotyping of peripheral blood, bone marrow, or tissue-derived lymphocytes is performed to assess the expression of the cell-surface antigen corresponding to the monoclonal antibody therapeutic target. The following antibody panels will be used:
-Anti-CD20 assessment: kappa/lambda/CD19/CD20
(Keren P, McCoy Jr JP, Carey J, eds. Flow Cytometry in Clinical Diagnosis. 4th ed. ASCP Press; 2007)
Day(s) Performed
Monday through Saturday
Report Available
1 to 4 daysSpecimen Retention Time
14 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed using an analyte specific reagent. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
88184-Flow cytometry; first cell surface, cytoplasmic or nuclear marker
88185 x 3-Flow cytometry; additional cell surface, cytoplasmic or nuclear marker
88187-Flow Cytometry Interpretation, 2 to 8 Markers
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| CEE20 | CD20 Cell Expression Evaluation, V | 100992-7 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| CK164 | CEE20 Result | No LOINC Needed |
| CK165 | Final Diagnosis | 22637-3 |