NCCN Guidelines for Patients® | Mantle Cell Lymphoma

12 NCCN Guidelines for Patients ® : Mantle Cell Lymphoma, 2019 1  MCL basics Tests for MCL IN DEPTH: Diagnostic tests There are many cancers of B cells. Knowing which type you have is very important so you get the right treatment. Mantle cell lymphoma (MCL) has common patterns or a “signature” of proteins. A hematopathologist will look for these patterns. If needed, he or she will also perform genetic tests. Protein tests To get the right diagnosis, a hematopathologist tests for many cell proteins. MCL cells often have CD5, CD20, CD43, and high levels of cyclin D1. CD10 and CD23 are found on most but not all the cells. Sometimes the type of cancer is unclear, so more protein tests are done. MCL does not have LEF1 or CD200. If either protein is found, the cancer is likely chronic lymphocytic leukemia. Rarely, MCL has normal cyclin D1 levels. If cyclin D1 is normal, testing for SOX11 can help guide diagnosis. SOX11 is found in almost every case of MCL. It can also help decide the prognosis. A low or absent SOX11 level is a good marker of slow-growing MCL. Genetic tests Translocations often occur in lymphomas. But, the chromosomes involved differ between the types of lymphomas. Testing for a translocation may help guide diagnosis. In MCL, a translocation between chromosomes 11 and 14 is often found. It is referred to as t(11;14). This translocation can cause too much cyclin D1. If cyclin D1 is normal, it may be useful to test for t(11;14). Certain test results can rule out MCL. If the translocation called t(14;18) is found, you likely have follicular lymphoma or maybe diffuse large B-cell lymphoma. Likewise, the cancer is likely to be chronic lymphocytic leukemia if errors are found in chromosomes 11, 12, 13, or 17. To decide the prognosis, your doctor may want to test for gene mutations. MCL with IGHV mutations grows slowly. It often has low or absent SOX11 levels. TP53 mutations are linked to a faster-growing MCL and poor outcomes with certain treatments.