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Important info when ordering flow cytometry
Specify diagnosis in request
Specify that workup for Mycosis Fungoides and/or Sézary Syndrome is needed in the flow request form (eg, rule out Mycosis Fungoides, or workup for suspected Sézary Syndrome). This helps the pathologist to choose the disease-focused panel with the appropriate markers for detecting Sézary cells (eg, CD26). CD4+/CD7- and/or CD4+/CD26- are common phenotypes seen in Mycosis Fungoides and Sézary Syndrome1
Confirm where to send the specimen
At least a 6-color flow cytometry test is needed to identify the malignant Sézary cells.2 However, not all flow cytometry labs have this capability. Call lab to confirm where to send the specimen
Include recent CBC results
Submit recent CBC results to determine absolute number of aberrant lymphocytes. The absolute value is determined by the percentage of aberrant lymphocytes identified on flow cytometry multiplied by the total lymphocyte count and can be calculated as shown below:3
Absolute Sézary count = Total lymphocyte count x percent of atypical T-cell population
Example calculation: 3.36 K/µl x 0.62 = 2.083 K/µl or 2083 cells/µl
Use the same flow center
Send samples to the same flow center for sequential testing to help ensure consistency in flow methodology and the report summary4
Consider consultation
Consultation with CTCL specialists is recommended for diagnosis and staging, and for optimal patient management5
Lab-specific Instructions
Below is specific information about labs that conduct flow cytometry for CTCL, including the name of the panel, test code, and biomarkers that are included or available, as well as additional instructions for ordering. Please know that Kyowa Kirin does not endorse any of the labs listed below.
Test Name
Leukemia/Lymphoma Evaluation
Lab Test Code
35080
For New York patients, use test code 37340.
Biomarkers Included/Available
Initial markers evaluated: CD2, CD3, CD4, CD5, CD7, CD8, CD10, CD11c, CD13, CD19, CD20, CD23, CD33, CD34, CD38, CD56, CD64, CD117, HLA‐DR, sKappa, sLambda. CD45 is used for gating.
Additional markers may be performed based on the pathologist review.
Lab Instructions
CD26 may not automatically be included in the Leukemia/Lymphoma screening panel.
Indicate Mycosis Fungoides/Sézary Syndrome diagnosis for the lab to include Sézary markers (CD26) and report out on CD4+/CD7- and CD4+/CD26- cells.
Call lab to confirm where to send the specimen.
For questions, call 866-697-8378.
Learn more about the test at the Quest Diagnostics websiteTest Name
Hematolymphoid/Plasma Cell Neoplasia Assessment (HNA), Immunophenotyping by Flow Cytometry
Lab Test Code
480260
Biomarkers Included/Available
Markers included: CD2, CD3, CD4, CD5, CD7, CD8, CD10, CD11b, CD11c, CD13, CD14, CD15, CD16, CD19, CD20, CD22, CD23, CD33, CD34, CD38, CD56, CD57, CD103, CD117, FMC-7, HLA-DR, Kappa, Lambda, CD64. CD45 is used for gating.
Lab Instructions
CD26 may not automatically be included in the Leukemia/Lymphoma screening panel.
Indicate Mycosis Fungoides/Sézary Syndrome diagnosis for the lab to include Sézary markers (CD26) and report out on CD4+/CD7- and CD4+/CD26- cells.
Call lab to confirm where to send the specimen.
For questions, call 800-345-4363.
Learn more about the test at the Labcorp websiteTest Name
Sézary Diagnostic Flow Cytometry, Blood
Lab Test Code
SZDIA, SZMON
Biomarkers Included/Available
Triage Panel: CD3, CD10, CD16, CD19, CD34, CD45, and kappa and lambda light chains
Sezary Panel: CD2, CD3, CD4, CD5, CD7, CD8, CD26, CD45, and TRBC1
Lab Instructions
This Sézary panel (SZDIA) is usually ordered for patients with a clinical suspicion of Sézary Syndrome or cutaneous T-cell lymphoma (CTCL) with peripheral blood involvement.
For patients without a previously confirmed diagnosis of Sézary Syndrome, a triage panel (SZMON) will usually be perfomed to exclude a B-cell lymphoproliferative disorder.
For questions, call 800-533-1710.
Learn more about the test at the Mayo Clinic Laboratories websiteTest Name
Leukemia/Lymphoma Phenotyping Evaluation by Flow Cytometry
Lab Test Code
3001780
Biomarkers Included/Available
Available Markers*:
T-cell: CD1, CD2, CD3, CD4, CD5, CD7, CD8, TCR alpha-beta, TCR gamma-delta, Cytoplasmic CD3
B-cell: CD10, CD19, CD20, CD22, CD23, CD103, surface Kappa, surface Lambda, Cytoplasmic Kappa, Cytoplasmic Lambda
Myelo/Mono: CD11b, CD13, CD14 (Mo2), CD14 (MY4), CD15, CD33, CD64, CD117, myeloperoxidase
Misc.: CD11c, CD16, CD25, CD26, CD30, CD34, CD38, CD41, CD42b, CD45, CD56, CD57, CD61, HLA-DR, glycophorin, TdT, bcl-2, CD123, CD138, CD200, CRLF-2.
Lab Instructions
*Not all markers will be reported in all cases.
Requests for specific markers to be run must be listed on manual requisition or by footnote for electronic orders.
Indicate Mycosis Fungoides/Sézary Syndrome diagnosis on the request form.
International guidelines recommend a minimum of 6 panel markers to identify malignant Sezary cells: CD3, CD4, CD8, CD7, CD26, CD45.
For questions, call 800-533-1710.
Learn more about the test at the ARUP Laboratories websiteTest Name
TRBC1/T-Cell Lymphoma Companion Panel
Lab Test Code
n/a
Biomarkers Included/Available
Available Markers*:
Markers: CD3, CD4, CD7, CD8, CD25, CD26, CD30, CD45, CD279, and TRBC1
Lab Instructions
Available as stand-alone test (as described here) or as add-on to panels.
For questions, call 866-779-5907.
Learn more about the test at the NeoGenomics websiteTest Name
Specialized Hematopathology Laboratory
Lab Test Code
n/a
Biomarkers Included/Available
A comprehensive list of markers are available for flow cytometry testing, including CD3, CD4, CD7, CD8, CD26, CD45
Lab Instructions
Offers ten-color, 15-antibody panel for high volume testing that can separate normal cell populations from residual disease. Disease focused panels are offered.
Indicate Mycosis Fungoides/Sézary Syndrome diagnosis on the request form.
For questions, call (914) 339-5000.
Learn more about the test at the Cairo Diagnostics websiteBlue indicates Sézary cell-specific markers
This is not a complete list of labs that perform flow cytometry for Sézary cells.
For additions to the list, changes, or corrections, please contact USOncologyMarketing@kyowakirin.com
Updated on 8/11/2023
TopReferences: 1. Vermeer MH, Moins-Teisserenc H, Bagot M, et al. Flow cytometry for the assessment of blood tumour burden in cutaneous T-cell lymphoma: towards a standardized approach. Br J Dermatol. 2022;187(1):21-28. 2. Horna P, et al. Flow cytometric evaluation of peripheral blood for suspected Sézary syndrome or mycosis fungoides: international guidelines for assay characteristics. Cytometry B Clin Cytom. 2021;100(2):142-155. 3. Olsen EA, Whittaker S, Willemze R, et al. Primary cutaneous lymphoma: recommendations for clinical trial design and staging update from the ISCL, USCLC, and EORTC. Blood. 2022;140:419-437. 4. Guitart J. Sézary syndrome and mycosis fungoides flow cytometric evaluation: the clinicians’ perspective. Cytometry B Clin Cytom. 2021;100(2):129-131. 5. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Primary Cutaneous Lymphomas V.1.2023. © National Comprehensive Cancer Network, Inc. 2023. All rights reserved. Accessed March 5, 2023. To view the most recent and complete version of the guideline, go online to NCCN.org.