NCCN Guidelines for Patients® | Mantle Cell Lymphoma

12 NCCN Guidelines for Patients ® : Mantle Cell Lymphoma, 2017 1 Mantle cell lymphoma basics Diagnosis The hematopathologist will assess the rate of cancer growth by noting how the cells look. Compared to other lymphomas, most mantle cell lymphomas don’t grow slowly but don’t grow very fast either. Doctors describe the growth as “moderately aggressive.” However, there are some mantle cell lymphomas that grow slowly and others that grow quite fast. Protein tests For diagnosis, the hematopathologist needs to study the proteins in the cells’ surface (membrane). This is called immunophenotyping. Mantle cell lymphoma has a common pattern or “signature” of proteins. See Figure 4. An IHC ( i mmuno h isto c hemistry) panel is a test for such proteins. It involves applying a chemical marker to cells and then looking at them with a microscope. IHC panel The IHC panel should test for BCL2, BCL6, CD3, CD5, CD10, CD20, CD21, CD23, cyclin D1, and Ki-67. Mantle cell lymphoma cells often have CD5, CD20, CD43, and high levels of cyclin D1. Rare cases may have normal cyclin D1 levels. CD10 and CD23 are found on most but not all mantle cell lymphoma cells. Sometimes it is helpful to include LEF1 and SOX11 in the IHC panel. If LEF1 is found, the cancer is likely chronic lymphocytic leukemia and not mantle cell lymphoma. SOX11 is found in almost every case of mantle cell lymphoma. Thus, SOX11 is helpful for diagnosis when the cells have normal levels of cyclin D1. On the other hand, a low or absent SOX11 level is a good marker of slow-growing mantle cell lymphoma. Figure 4 CD20 protein Mantle cell lymphoma cells have a common pattern of proteins in their membrane. This pattern includes the presence of CD5, CD20, CD43, and high levels of cyclin D1. CD10 and CD23 are found on most but not all cells. Immunophenotyping is the process of identifying the proteins in cells’ membranes. Derivative work of Rituximab Binding to CD20 on a B Cell Surface by NIAID available at commons. Rituxima_Binding_to_CD20_on_a_B_Cell_Surface_(6830897205).jpg under a Creative Commons Attribution 2.0 Generic license