We occasionally see absent CD20 in CLL as well. One day recently we received two cases (from outside institutions) in the same day from patients who had been treated with rituxan but the requisitions did not note this fact. To further complicate matters they arrived roughly coincident to a change in the aliqout of anti-CD20. The ensuing troubleshooting eventually arrived at the conclusion that our antibody and technique were working well. The treatment history was elicted from the clinicians by the outside pathologists at our request after we concluded that we were on sound techinical grounds in our attempt to reconcile our findings with the clinical situation. The points of this cautionary tale are to reiterate the presence of "rituxan effect", emphasize the importance of clinical correlation especially as we enter more deeply in an era of more varied biologic and immunologic treatments for the more common malignancies. Richard McFarland
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