CRLF2 (CML, AML, ALL) Test: Booking, Price, and Results
About CRLF2 (CML, AML, ALL) Test
| Field | Value |
|---|---|
| Also Known As | CRLF2 Expression Test, Cytokine Receptor-Like Factor 2 Test, TSLPR Expression Test |
| Sample Type | Bone marrow aspirate and peripheral blood |
| Fasting Required | Not required |
| Report Time | 8 days |
| Recommended For | Children, adolescents, and adults with suspected or confirmed B-cell acute lymphoblastic leukaemia (B-ALL) |
| Price | Starting at ₹4,800 |
What Is a CRLF2 (CML, AML, ALL) Test?
The CRLF2 (CML, AML, ALL) test detects abnormal expression or genetic rearrangement of the CRLF2 gene, also known as cytokine receptor-like factor 2, in blood cancer cells. Doctors order this test primarily for patients with suspected or confirmed B-cell acute lymphoblastic leukaemia (B-ALL), particularly those who may have a high-risk subtype. The test uses a method called FISH (fluorescence in situ hybridisation), a technique that identifies specific DNA sequences within cells. The samples collected are bone marrow aspirate and peripheral blood. This test is also known as the CRLF2 expression test, cytokine receptor-like factor 2 test, or TSLPR expression test.
What Does a CRLF2 (CML, AML, ALL) Test Measure?
The CRLF2 test analyses several related genetic and molecular features of leukaemia cells. The findings help doctors classify the disease and guide treatment decisions:
| Component | What It Tells Us |
|---|---|
| CRLF2 Surface Expression | Detects whether leukaemia cells carry abnormally high levels of the CRLF2 protein on their surface |
| CRLF2 Gene Expression Level | Identifies overexpression of the CRLF2 gene, seen in 5 to 15% of B-ALL cases |
| CRLF2 Rearrangements (FISH) | Locates specific gene fusions such as IGH-CRLF2 or P2RY8-CRLF2 caused by chromosomal changes |
Why Is a CRLF2 (CML, AML, ALL) Test Done?
This test is ordered when a doctor suspects a specific type of leukaemia or needs to assess its genetic profile more closely to guide treatment decisions.
Common Symptoms That May Require This Test
The following symptoms may prompt a doctor to order this test:
- Persistent fatigue and generalised weakness
- Frequent or recurring infections
- Unexplained bruising or bleeding
- Pale complexion (a sign of low red blood cell levels)
- Fever without a clear cause
- Unexplained weight loss
- Breathlessness during normal activity
Conditions This Test Can Help Detect
This test helps identify specific blood cancer subtypes, including:
- Philadelphia chromosome-like (Ph-like) B-cell ALL, where CRLF2 overexpression is the most common genetic change
- Down syndrome-associated ALL, which show high CRLF2 expression
- Acute myeloid leukaemia (AML) and chronic myeloid leukaemia (CML), where the test may be used for comparison or evaluation
- T-cell lymphoblastic leukaemia, assessed as part of wider diagnostic evaluation
CRLF2 (CML, AML, ALL) Test for Chronic Disease Monitoring
The CRLF2 (CML, AML, ALL) test has a role beyond initial diagnosis. It may be repeated during treatment to track how leukaemia cells are responding to therapy, and again at relapse to check for changes in the cancer cell population. Your haematologist will decide how often monitoring is needed based on your individual situation.
How to Prepare and What to Expect
Preparation for this test mainly relates to the bone marrow aspiration procedure. Here is what you need to know before your appointment.
Do You Need to Fast?
No fasting is required for the test itself. However, if your doctor plans to use sedation during the bone marrow procedure, you may be asked to avoid food and drink from the night before. Confirm fasting requirements with your doctor in advance.
Practical Tips Before Your Test
- Bring a detailed clinical history including your symptoms, previous test results, and family history, as this is required for the test
- Inform your doctor about any bleeding disorders (such as haemophilia) or medications you are taking, especially blood thinners
- Mention any vitamins or supplements you are currently taking, as some can affect bleeding
- Wear loose, comfortable clothing to allow easy access to the procedure site
- Arrange for someone to accompany you if sedation is planned
Step-by-Step Procedure
Two sample types are needed: a bone marrow aspirate and a peripheral blood sample. Here is what happens during the CRLF2 test procedure:
Bone Marrow Aspirate:
- A haematologist or specialist selects the site, usually the pelvic bone (iliac crest) or the sternum (breastbone).
- A local anaesthetic is injected into the area to numb the skin and underlying tissue.
- A thin hollow needle is carefully inserted, and a small amount of bone marrow fluid (aspirate) is withdrawn using a syringe.
- The sample is prepared for FISH analysis.
- Pressure is applied to the site once collection is complete, and you will be asked to remain lying down for at least 10 to 15 minutes.
Peripheral Blood:
- A phlebotomist (trained blood collection professional) cleans a vein in your arm with an antiseptic.
- A needle is inserted, and 3 ml of blood is drawn into a lavender-topped EDTA tube.
- The sample is labelled and stored under refrigeration (2 to 8° C) before being sent to the laboratory.
Factors That Can Affect Accuracy
The following factors may influence the reliability of results:
- Poor sample quality or low cellular viability
- Delay in transporting the sample
- Use of anticoagulant medications prior to the procedure
- Active infections at the time of sample collection
- Recent blood transfusions
Understanding Your CRLF2 (CML, AML, ALL) Test Results
Results from the CRLF2 test are interpreted qualitatively (positive or negative) rather than as numerical values. A haematologist will review findings alongside other genetic and clinical data. The table below provides a general reference:
| Parameter | Normal Finding | Abnormal Finding |
|---|---|---|
| CRLF2 Surface Expression | Absent or negative on B-cell precursors | Present or overexpressed on leukaemic blasts |
| CRLF2 Gene Expression (qRT-PCR) | Below laboratory-defined cut-off | 20-fold or more above the median (varies by method) |
| CRLF2 Rearrangement (FISH) | No rearrangement detected | Rearrangement present, indicating CRLF2-rearranged ALL |
Disclaimer: These ranges are general guidelines. Your doctor will interpret your results based on your age, health history, and other factors. Always consult a qualified healthcare professional for personalised medical advice.
Results During Special Conditions
- Children with Down syndrome have a significantly increased risk of ALL, and approximately 50% of Down syndrome-associated ALL cases show CRLF2 rearrangements. Results in this group need specialist interpretation alongside other genetic findings.
- Patients of Hispanic ethnicity show higher rates of CRLF2 overexpression, which may influence risk assessment.
- Patients with IKZF1 gene deletions (loss of a gene involved in B-cell development) are also more commonly found among CRLF2-positive cases, which may affect prognosis.
How to Maintain Healthy Levels
Leukaemia is not a condition that can be prevented or corrected through lifestyle changes alone, but the following general steps support overall well-being:
- Follow your haematologist's monitoring schedule and attend all follow-up appointments
- Report any new or worsening symptoms promptly, such as fever, unusual bruising, or fatigue
- Maintain good general health through adequate nutrition, rest, and hydration, as guided by your care team
Lupin Diagnostics CRLF2 (CML, AML, ALL) Test Price
The CRLF2 test cost at Lupin Diagnostics starts at ₹4,800. This test requires a visit to a hospital, as bone marrow sample collection must be performed by a trained specialist in a clinical setting. CRLF2 test home collection is not available. The table below shows indicative prices across major cities:
| City | Approximate Price (₹) |
|---|---|
| BHOPAL | 4800 |
| CHENNAI | 4800 |
| HYDERABAD | 4800 |
| KOLKATA | 4800 |
| NAVI MUMBAI | 4800 |
| PUNE | 4800 |
Disclaimer: Prices are indicative and may vary by location. Please confirm the current price at the time of booking.
How to Book
Follow these steps for CRLF2 test online booking:
- Select the test on the Lupin Diagnostics website.
- Choose your city and preferred centre location.
- Visit the centre at your scheduled time for peripheral blood sample collection. For bone marrow samples, a visit to a hospital as directed by your doctor is required.
- Receive your report via email or WhatsApp within the stipulated turnaround time.
Frequently Asked Questions
The CRLF2 (CML, AML, ALL) test identifies abnormal expression or rearrangement of the CRLF2 gene in leukaemia cells. It helps diagnose a high-risk B-ALL subtype known as Philadelphia-like ALL and guides decisions about treatment planning. Results are always reviewed alongside other genetic and clinical findings.
This test is primarily ordered for patients with newly diagnosed or relapsed B-cell ALL, especially those without common genetic markers. It is particularly relevant for children, adolescents, and young adults with ALL and for patients with Down syndrome who develop leukaemia.
The area is numbed with a local anaesthetic before the procedure, so you should not feel sharp pain. You may notice pressure and brief discomfort during sample withdrawal. Mild soreness at the site is normal afterwards and usually clears within a few days.
A positive result means CRLF2 overexpression or a gene rearrangement was detected. This is associated with a higher-risk form of leukaemia. Your haematologist will interpret this finding in the context of other test results and your overall clinical picture before discussing next steps.
At Lupin Diagnostics, the report is delivered within 8 days. The test results are delivered directly via email and WhatsApp.
No. This test requires a bone marrow aspirate, which must be collected by a trained specialist in a clinical setting. CRLF2 test home collection is not possible. You will need to visit a hospital for the procedure.
The test is usually done at the time of initial diagnosis. It may be repeated during treatment to monitor how leukaemia cells are responding, or again at relapse to detect changes in the cancer cell population. Your haematologist will recommend a testing schedule suited to your case.
CRLF2 (CML, AML, ALL) Test: Booking, Price, and Results
