NCCN Guidelines for Patients® | Chronic Lymphocytic Leukemia
17 NCCN Guidelines for Patients ® : Chronic Lymphocytic Leukemia, 2019 2 Treatment planning Bone and marrow tests | Hepatitis B tests DNA sequencing DNA sequencing is a lab test of mutations in genes. It reveals the order of the chemicals that make up DNA. A blood or marrow sample can be used. IGHV mutation Normal antibodies are made of two heavy chain proteins and two light chain proteins. IGHV region genes contain instructions for making the heavy chain protein. These genes may or may not be mutated in people with CLL. The outlook is good if IGHV is mutated. Surface proteins CD38, CD49d, and ZAP-70 are markers for the IGHV mutation. If IGHV testing can’t be done, testing for these markers is an option. But, IGHV testing is preferred as protein levels are not as reliable. TP53 mutation TP53 is the gene for a protein that signals whether damaged cells should be repaired or destroyed. It helps to prevent tumors from forming. If TP53 is mutated, there are treatment options that may prevent poor outcomes. Bone and marrow tests Two procedures are used to remove bone marrow. A bone marrow aspiration removes a small amount of liquid bone marrow. A bone marrow biopsy removes a core of bone. These procedures may be done at the same time. They may be done to learn what’s causing low numbers of blood cells. Hepatitis B tests Hepatitis B can become active again due to certain cancer treatments. Tell your treatment team if you’ve been infected with hepatitis B. If you’re unsure, testing is advised. A sample of your blood is needed for testing. Figure 4 Karyotype A karyotype is a picture of chromosomes. It shows if there is a defect in the size, shape, and number of chromosomes.