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Explore Biomarker Testing

Blood Cancer

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Biomarker testing can lead to precise blood cancer care.

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While blood cancers like multiple myeloma (MM), lymphoma, and leukemia each respond to unique forms of treatment, biomarker testing can reveal what makes each subtype unique. It can help doctors move from one-size-fits-all care to more personalized treatment plans. Even if tests show no biomarkers, it's still important and helps your care team better evaluate treatment options.

Have questions? We can help you create a personalized guide for your next appointment.

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Did you know?

Your treatment plan can be based on your biomarkers.

Your plan could include targeted therapy — treatment designed to act on specific features of cancer cells, such as proteins or gene changes identified through biomarker testing, although it can also affect some normal cells.

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About biomarker testing

What are blood cancer biomarkers?

Cancer biomarkers are small signals in tumor cells, like gene changes or certain levels of proteins, that can show how your cancer behaves and how it may change, grow, or respond to treatment. Even two people with the same type of blood cancer can have very different biomarkers.

By testing for them, your care team can create an individualized treatment plan — and adjust it if the disease changes over time. Common blood cancer biomarkers doctors look for are CD20 and CD30 (lymphoma), M-Proteins (myeloma), and FLT3 (leukemia).

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Let’s go over a few of the basics.

Biomarker testing can make a difference in your blood cancer care. You probably have questions. We have answers.

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Who should get tested?

Anyone who's been newly diagnosed with blood cancer, or is starting new or alternative care, should ask about biomarker testing.

In blood cancers, testing is often done after initial lab and imaging results show the type of leukemia, lymphoma, or myeloma you may have. However, your doctor may order additional genetic or cellular testing to see if there’s any risk of your cancer spreading, and to help inform a more tailored treatment plan.

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What will my results show?

In blood cancer, biomarker testing can show your subtype and reveal if you have actionable biomarkers that can guide more personalized care.

For example, in acute myeloid leukemia, biomarker testing may also include next-generation sequencing (NGS) that looks at long strands of DNA from your tumor tissue. Changes NGS reveals — in several genes, like FLT3, IDH1, IDH2 — can help your care team learn more about your cancer’s mutations, and see how you may respond to different treatments.

If your results are inconclusive or negative for biomarkers, a test still helps your team assess your care options and need for a retest.

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Does this impact my care?

If you have any known biomarkers, your doctor can use that information to create, inform, or adjust a personalized treatment plan.

This is especially important for blood cancers, where care needs to be highly individualized.

From cancer cells moving rapidly through your bloodstream to single chromosome changes, the smallest details can have large systemic impacts. That’s why testing is helpful for spotting individual traits that can determine if you’re eligible for targeted therapy.

Testing can also predict possible responses to immunotherapy and shape your treatment’s goals, so you can find care that makes sense for you.

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When do I talk to a doctor?

Ask about biomarker testing as soon as you’re diagnosed with blood cancer, if you start discussing new treatments, or when switching your treatment.

As you talk more, your doctor may recommend comprehensive biomarker testing that looks for all recommended mutations at once, instead of single-gene testing that looks for one biomarker at a time over a longer period.

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What do I need to start asking about testing?

We know talking about biomarkers can feel overwhelming. Knowing what to ask, and having a few talking points ready, can help.

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Here’s how they’re tested.

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Liquid Biopsies

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Tissue Biopsies

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Liquid Biopsies

Your care team can learn a lot about your blood cancer by taking a sample of your blood to spot cell count, gene, and protein markers.

For example, a complete blood count (CBC) measures the number and shape of your blood cells, platelets, hemoglobin, and hematocrit to show how changes — especially in white blood cells — may be signs of progressing or new cancer.

Since liquid biopsies are less invasive, they’re faster to complete and easier to repeat than tissue biopsies — but they have their limits. The results may not always match tissue tests and may miss some cancer changes.

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Tissue Biopsies

A tissue biopsy can reveal your blood cancer’s stage, subtype, and cellular changes from a sample of your bone marrow’s tumor.

To do this, your doctor will surgically collect small pieces of marrow from inside your bone, and share them with a pathologist who will examine the marrow cells in a lab.

They’ll measure how much your cancer has progressed, if the tumor in your bone marrow is growing, and share any cell abnormalities, or non-inherited gene and protein changes. This process can help point to targeted therapies, and assess if immunotherapy may work for you.

Tissue biopsies are usually an outpatient procedure and do not require an overnight stay, however there are more invasive tissue that may require a hospital visit.

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Build your knowledge

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Biomarkers can change over time.

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Biomarker changes can occur over time and can reveal the way your tumor is growing or changing, or if it’s developing a resistance to treatment.

New biomarkers can indicate alternative treatment options that may work more effectively. That’s why it’s important to talk to your doctor about retesting before starting a new treatment plan.

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It’s actually true!

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Talk to your doctor

Do you have an appointment soon?

Get a full list of questions to ask about biomarkers, testing, and how it could impact your treatment plan.

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Still have questions?

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What biomarkers do doctors look for in blood cancers?

Blood cancer biomarkers differ based on the type of cancer you have. For multiple myeloma, the most common biomarkers are monoclonal protein (M spike) and serum free light chains (SFLC).

For leukemia, CD (cluster of differentiation) markers like CD13, CD33, CD5 and CD23 are most common, along with NPM1 and FLT3 — but there are other important biomarkers your doctor may test for as well. Make sure to ask about which biomarkers they’ll be looking for.

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Where do I go to get tested?

Where you begin biomarker testing will depend on your need for a liquid biopsy or tissue biopsy.

With blood cancer, liquid biopsies are done with a simple blood draw in a clinic or doctor’s office before samples are sent to a specialized lab for deeper evaluation. It’s also recommended for pediatric patients who are more easily tested with a less invasive blood sample.

However, tissue biopsies — taken from bone marrow — are more invasive, and are performed by collecting small pieces of bone marrow.

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What should I understand about my test results?

When you get your test results, your doctor will go over them with you to help you understand what they mean and how they can be used to determine your treatment options. You’ll most likely discuss:

What biomarkers were found — or if no biomarkers showed up
What treatment options match those specific biomarkers, and which ones may be available to you
If there aren’t treatment matches — what potential clinical trials may be available for those biomarkers, or other treatment options

Build a biomarker discussion guide you can take to your next appointment.

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Will I need to get retested?

Depending on how well your current treatment is working, your doctor may want to have you retested for any changes to your disease and the biomarkers that may show up.

Since changes can occur over time, it can reveal the way your tumor is growing or changing, or if it’s developing a resistance to treatment.

New biomarkers can indicate alternative treatment options that may work more effectively.

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Are there communities and advocacy groups I can join?

There are many patient advocacy and support groups in the blood cancer community. Here are a couple to get you started with connecting to other patients and caregivers, as well as resources to support you during your journey:

bloodcancerunited.org

lymphoma.org

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Biomarker testing resources and guidance

Discover information to help you understand biomarkers, testing, and talking to your doctor.

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/cancer/education/cancer-biomarkers
/cancer/education/importance-of-biomarker-testing
/cancer/education/how-biomarker-testing-works
/cancer/education/when-to-get-biomarker-testing
/cancer/education/talk-to-your-doctor-about-biomarker-testing
/cancer/education/monitor-cancer-with-biomarker-testing