CD38

Immunity

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Flow cytometry panel of immune cell surface markers.

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CD38 Test Information Guide

Why is it done?
- CD38 is a cell surface protein marker used in flow cytometry to identify and classify immune cells, particularly B cells and T cells
- Diagnosis and classification of hematologic malignancies, particularly chronic lymphocytic leukemia (CLL) and multiple myeloma
- Prognostic assessment in CLL - CD38 positive status indicates more aggressive disease and shorter survival
- Monitoring immune system status in HIV/AIDS patients to track CD4+ and CD8+ T cell populations
- Evaluation of immunodeficiency disorders and immune reconstitution
- Classification of lymphoproliferative disorders and differentiation from reactive processes
- Treatment planning and monitoring - CD38 expression affects eligibility for CD38-targeted therapies
Normal Range
- CD38 is typically expressed as percentage of positive cells or mean fluorescence intensity (MFI) in flow cytometry analysis
- Normal reference values: In healthy individuals, CD38 is normally expressed on a subset of B cells and T cells at low to moderate levels
- CD38 negative (< 30% positive): Normal or non-aggressive disease pattern in CLL
- CD38 positive (≥ 30% positive): Associated with more aggressive disease and worse prognosis
- In multiple myeloma: CD38 expression >25-30% is considered positive and affects treatment selection
- Units: Percentage of positive cells (%) or MFI (Mean Fluorescence Intensity)
Interpretation
- CD38 Negative (< 30%): Generally indicates lower disease aggressiveness in CLL; better prognosis and longer median survival (10+ years); may not require immediate treatment; responds better to standard therapies
- CD38 Positive (≥ 30%): Indicates more aggressive disease behavior in CLL; worse prognosis with shorter median survival (< 5 years); earlier treatment intervention often recommended; CD38-directed therapies (daratumumab) are targeted options
- In Multiple Myeloma: Positive status makes patients eligible for CD38-targeted monoclonal antibody therapy; high expression correlates with increased disease burden
- In HIV/AIDS: Elevated CD38 on T cells correlates with immune activation and disease progression; useful for monitoring treatment effectiveness and immune reconstitution
- Factors affecting interpretation:
- Flow cytometry methodology and standardization; cutoff values may vary between laboratories; prior cytotoxic therapy may alter expression patterns; clone heterogeneity in lymphoproliferative disorders; co-expression with other markers (FISH, molecular findings) affects clinical interpretation
Associated Organs
- Primary systems involved:
- Hematopoietic system (bone marrow) - site of B and T cell production; Lymphoid tissue (lymph nodes, spleen); Immune system (circulating lymphocytes)
- Conditions associated with abnormal CD38 expression:
- Chronic Lymphocytic Leukemia (CLL) - prognostic marker; Multiple Myeloma - therapeutic target; Acute Lymphoblastic Leukemia (ALL); Lymphomas; HIV/AIDS - immune status marker; Autoimmune disorders; Transplant rejection; Acute leukemias and other hematologic malignancies
- Clinical complications associated with CD38-positive disease:
- Rapid disease progression requiring intensive treatment; Lymphoid organ infiltration and enlargement; Cytopenias (anemia, thrombocytopenia, leukopenia); Tumor lysis syndrome with initiation of therapy; End-organ damage in myeloma (renal dysfunction, bone disease); Infection risk from immunosuppression; Potential transformation to aggressive lymphoma
Follow-up Tests
- Additional flow cytometry markers: CD23, CD19, CD5 (for CLL diagnosis); CD38, CD138, CD45 (for myeloma); CD4, CD8, CD3 (for HIV monitoring)
- Genetic and molecular testing: FISH for del(13q), del(11q), del(17p), trisomy 12; TP53 mutation status; Complex karyotype analysis; Mutational status (IGHV, TP53)
- Complete blood count (CBC): To assess degree of leukocytosis, lymphocytosis, and cytopenias
- Biochemical markers: LDH (lactate dehydrogenase); Beta-2 microglobulin; Serum/urine protein electrophoresis (SPEP/UPEP); Serum free light chains
- Imaging studies: CT scan for lymphadenopathy assessment; PET-CT for staging; Bone survey or skeletal survey (for myeloma)
- Monitoring frequency: CD38-positive CLL: Every 3-6 months during active surveillance or treatment; Multiple myeloma: Baseline and at each treatment cycle; HIV patients: Every 3-6 months for CD4+ count monitoring
- Prognostic assessment: Combined with other markers (FISH, TP53, IGHV) for international prognostic indices
Fasting Required?
- Fasting: No - fasting is NOT required for CD38 testing
- Sample collection: Blood sample collected via venipuncture into EDTA (ethylenediaminetetraacetic acid) tube or appropriate anticoagulant for flow cytometry; sample should be processed and analyzed promptly (ideally within 24-48 hours) to maintain cell viability
- Medications: No medications need to be avoided; continue all routine medications as prescribed
- Patient preparation: Arrive for appointment at scheduled time; inform healthcare provider of recent infections or medical procedures; note timing of any recent blood transfusions; inform about current treatments or recent chemotherapy; no special preparation required; may eat and drink normally
- Sample stability: Must be analyzed within 24-48 hours of collection; cell viability is critical for accurate flow cytometry results; samples should not be frozen unless specifically directed by the laboratory

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