Chronic Lymphocytic Leukemia (CLL): Tests After Diagnosis

What tests might I have after being diagnosed?

After a diagnosis of CLL, you will likely have other tests. These tests help your healthcare providers learn more about the cancer and how to treat it. Some of these tests can also be used to help show how well treatment is working. Or they can be used to look for signs that the leukemia might be coming back. If you have any questions about these or other tests, be sure to talk with your healthcare team.

The tests you’ll have may include:

  • Imaging tests

  • Blood tests

  • Biopsies

Imaging tests

Imaging tests might be done if the healthcare provider suspects a problem. For instance, they may be used to help see the extent of the leukemia or to look for other problems such as signs of infection in the body. These tests may include the following.

Chest X-ray

A chest X-ray uses radiation to produce a picture of the organs and glands inside your chest. This test cannot show leukemia cells. But it can show if you have an infection in your lungs from leukemia. It can also help your healthcare provider see if lymph nodes in this area are enlarged. The test takes only a few minutes, and it won't cause any pain.

CT scan

A CT scan takes X-ray pictures of different parts of your body from many different angles. Although this scan takes longer than an X-ray, it gives your healthcare provider a better look at an area of your body than an X-ray. A CT scan can spot enlarged lymph nodes and organs, pockets of infection in your organs, and large clusters of leukemia cells. The provider may use it to measure lymph nodes to compare the size in the future.

To have the test, you lie still on a table as it slides through the center of the CT scanner. The scanner directs a beam of X-rays at your body. A computer uses the data from the X-rays to make detailed pictures. You may be asked to hold your breath one or more times during the scan. In some cases, you will be asked to drink a contrast solution called a dye after the first set of pictures is taken. This dye may also be given through a small flexible tube put into a vein in your arm, instead of drinking it. IV contrast dye may cause a feeling of warmth. In rare cases, it can also cause hives or other allergic reactions. Let your healthcare provider know about any reactions you have or if you have had any reactions in the past.

Blood tests

Blood may be checked in a lab. Routine blood tests will be done often. These measure your blood cell levels and check things  such as how well your liver and kidneys are working. The special kinds of testing done to look at leukemia cells in the blood are noted below.

Biopsies

A biopsy is a small amount of tissue that’s taken and checked in a lab. There are several types of biopsies.

Bone marrow aspiration or biopsy

The healthcare provider takes a small amount of bone marrow fluid (aspiration), solid bone marrow tissue (core biopsy), or both. The fluid and bone marrow are looked at for the number, size, and maturity of blood cells and abnormal cells. Other tests can also be done on these cells. 

Bone marrow aspiration and biopsy are often done before starting treatment. They may be repeated during or after treatment to see if it’s working. Bone marrow samples are often taken from the back of the hip (pelvic) bone. For the bone marrow aspiration, the provider numbs the area over the hip and puts a thin, hollow needle into the hip bone. A small amount of liquid bone marrow is removed. Even with the anesthetic, you may have some brief pain when the marrow is removed. A bone marrow biopsy is usually done just after the aspiration. A small piece of bone and marrow is removed with a slightly larger needle that is pushed down into the bone. The biopsy may also cause some brief pain.

Lumbar puncture

This is also called a spinal tap. The healthcare provider puts a needle between the bones of the lower back, into the spinal canal. This is the area around the spinal cord. The provider removes a small amount of cerebrospinal fluid (CSF). CSF is the fluid that bathes the brain and spinal cord. The CSF is sent for testing to check for an infection, leukemia cells, or other problems. This test isn't usually needed for CLL unless your healthcare provider suspects a problem in the brain or spinal cord.

Lymph node biopsy

Part or all of a lymph node is removed to be looked at in the lab. This test isn't always needed in people with CLL. But it might be done if your healthcare provider wants to know if an enlarged lymph node contains leukemia cells.

How blood or bone marrow is tested

Tests can be done on blood or bone marrow samples to guide treatment decisions. These tests can also see how quickly the CLL cells are likely to grow. They can give some ideas about how well treatment is working. The tests include:

  • Flow cytometry and immunohistochemistry. These tests are used on blood, bone marrow, or other biopsy samples. The tests look for certain substances on the surface of the leukemia cells. This is called immunophenotyping. These tests can be used to make the diagnosis of CLL. Flow cytometry can also be used to test blood for certain substances that may be able to tell what type of B lymphocyte the leukemia is growing in.

  • Cytogenetics. These tests look for changes in the chromosomes of cells from samples of blood, bone marrow, or lymph nodes. For example, in some cases of CLL, part of a chromosome may be missing. This test usually takes a few weeks. This is because the cells need time to be grown in the lab.

  • Fluorescent in situ hybridization (FISH). This is a type of cytogenetic test. It uses special fluorescent dyes that only attach to certain parts of chromosomes. It can be used to look for changes in chromosomes that are found in blood or bone marrow samples. The FISH test is very accurate and gives results more quickly than standard cytogenetic tests. 

Working with your healthcare provider

Your healthcare provider will talk with you about which tests you'll have. Follow your healthcare provider's directions to get ready for the tests. Ask questions and talk about any concerns you have.