SINGLE MARKAR CD20

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B-cell marker staining.

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Single Marker CD20 Test Information Guide

Why is it done?
- CD20 is a cell surface antigen found on B lymphocytes used to identify and classify lymphoid malignancies and B-cell disorders
- Primary indication: Diagnosis and classification of B-cell lymphomas including diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, and chronic lymphocytic leukemia (CLL)
- Confirmation of B-cell origin of suspected lymphoid malignancies through flow cytometry or immunohistochemistry analysis
- Monitoring of treatment response in patients receiving CD20-targeted therapies such as rituximab
- Assessment of B-cell lymphomas and differentiating them from T-cell and other non-B-cell malignancies
- Evaluation of patients with unexplained lymphadenopathy or peripheral lymphocytosis
- Timing: Performed when lymphoma is suspected, during initial diagnostic workup, and at intervals during treatment monitoring
Normal Range
- CD20 marker expression: Reported as percentage of B-cells or absolute count (typically expressed as % positive cells or cells/μL)
- Normal B-cell percentage in peripheral blood: 10-20% of total lymphocytes or 100-500 cells/μL
- Negative result: CD20 antigen not detected or <5% of cells express CD20 (typically indicates non-B-cell malignancy or absence of B-cell process)
- Positive result: CD20 expression present on ≥20% of abnormal cells (consistent with B-cell lymphoma or B-cell leukemia)
- Interpretation context: Results must be correlated with clinical presentation, morphology, and other immunophenotypic markers; usually part of comprehensive panel
Interpretation
- CD20 Positive (≥20% cells):
  - Indicates B-cell origin of malignancy; consistent with B-cell lymphoma or B-cell leukemia
  - CD20-positive lymphomas include: diffuse large B-cell lymphoma (DLBCL), follicular lymphoma, marginal zone lymphoma, lymphoplasmacytic lymphoma, CLL/SLL
  - Patient is candidate for CD20-targeted immunotherapy (rituximab, obinutuzumab, ofatumumab)
- CD20 Negative (<5% cells or absent):
  - Rules out B-cell origin; indicates T-cell lymphoma, Hodgkin lymphoma, or other non-B-cell malignancy
  - Patient would not benefit from CD20-targeted therapies; alternative treatment approaches needed
  - Possible subset of CD20-negative B-cell lymphomas exists (rare); requires correlation with morphology
- Factors Affecting Results:
  - Prior rituximab therapy may reduce or eliminate CD20 expression on tumor cells, affecting detectability
  - Sample quality, cell viability, and technical issues with immunostaining or flow cytometry
  - Heterogeneous antigen expression; some lymphomas may show dim or partial CD20 expression
  - Source of tissue specimen (blood vs. lymph node vs. tissue biopsy) may affect results
- Clinical Significance:
  - CD20 positivity is essential for diagnosis of B-cell malignancies and determines eligibility for targeted therapy
  - Prognostic implications: CD20 expression level may correlate with response to therapy in some lymphomas
  - Treatment planning: Results guide selection of chemotherapy regimens and targeted immunotherapy
Associated Organs
- Primary Organ Systems:
  - Lymphatic system: Lymph nodes, spleen, bone marrow, thymus
  - Hematopoietic system: Bone marrow and peripheral blood (CD20+ B-lymphocytes originate here)
  - Immune system: Central component of humoral immunity and B-cell mediated responses
- Diseases Associated with CD20+ Results:
  - Diffuse Large B-Cell Lymphoma (DLBCL): Most common aggressive B-cell lymphoma
  - Follicular Lymphoma: Most common indolent (slow-growing) B-cell lymphoma
  - Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL): CD5+, CD19+, CD20+ B-cell malignancy
  - Marginal Zone Lymphoma: Including extranodal marginal zone lymphoma and splenic marginal zone lymphoma
  - Lymphoplasmacytic Lymphoma: Often associated with Waldenström macroglobulinemia
  - Burkitt Lymphoma: Aggressive B-cell lymphoma, CD20+, CD10+
  - Primary Mediastinal B-Cell Lymphoma: CD20+ malignancy originating in mediastinum
- Potential Complications with CD20+ Malignancies:
  - Tumor lysis syndrome: Rapid cell death releasing intracellular contents, causing hyperkalemia and renal failure
  - Cytopenias: Bone marrow infiltration causing anemia, thrombocytopenia, neutropenia
  - Hypogammaglobulinemia: Impaired immunoglobulin production leading to infections
  - Organomegaly: Splenomegaly or hepatomegaly from lymphoma infiltration
  - Disease progression and transformation: Some indolent lymphomas transform to aggressive forms
Follow-up Tests
- Comprehensive Immunophenotyping Panel:
  - CD19 (B-cell marker)
  - CD5 (helpful in CLL diagnosis)
  - CD10 (germinal center marker)
  - CD23 (for CLL/follicular lymphoma distinction)
  - Surface immunoglobulin light chains (kappa/lambda)
- Molecular and Cytogenetic Studies:
  - Cytogenetics/FISH: t(14;18), t(8;14), del(17p), del(13q) - for prognosis and subtype determination
  - TP53 mutation testing: Prognostic marker in lymphomas
  - MYC/BCL2/BCL6 translocations: Identifies double/triple hit lymphomas
  - Clonality studies: B-cell gene rearrangement analysis
- Staging and Imaging Studies:
  - PET-CT scan: For staging and assessment of disease extent
  - CT chest/abdomen/pelvis: Standard staging investigation
- Laboratory Monitoring Tests:
  - Complete Blood Count (CBC): Monitor for cytopenias during treatment
  - Lactate Dehydrogenase (LDH): Prognostic marker and indicator of disease burden
  - Beta-2 microglobulin: Prognostic marker in lymphomas
  - Comprehensive metabolic panel: Baseline and monitoring for toxicity
- Treatment Response Monitoring:
  - Repeat CD20 flow cytometry: During and after treatment to assess therapeutic response
  - Minimal Residual Disease (MRD) testing: Flow cytometry or molecular methods for early detection of relapse
  - Repeat PET-CT: Typically 3-4 months after completion of therapy
- Recommended Monitoring Frequency:
  - During active treatment: CBC and metabolic panel every 1-2 weeks or as per protocol
  - In remission: CBC every 3 months for first 2 years, then every 6 months for surveillance
  - Imaging: Based on clinician discretion and clinical suspicion for relapse
Fasting Required?
- Fasting Required: No
- CD20 is an immunophenotypic marker measured on blood cells and does not require fasting status; routine food and beverage intake do not affect results
- Sample Collection:
  - Blood specimen: EDTA (lavender-top) tube or heparinized tube is standard for flow cytometry
  - Tissue specimen: Fresh or fixed tissue for immunohistochemistry analysis
  - CSF or other body fluids may be used depending on clinical indication
- Patient Preparation and Special Instructions:
  - No special preparation required; standard phlebotomy procedures apply
  - Inform laboratory of any recent blood transfusion, as this may dilute the specimen
  - No medications need to be held prior to collection
  - Avoid excessive exercise or stress immediately before collection as this may affect lymphocyte counts
  - Prompt delivery to laboratory is essential for accurate results; samples should be processed within 24-48 hours
  - For tissue specimens: Ensure adequate fixation (if formalin-fixed); communicate with laboratory about specimen type for optimal processing

How our test process works!