@suzjlance yes yours is a complicated picture indeed from my little time spent looking and you need a true expert. From my little knowledge I would assume your CD20 and PAX5 positivity confirms the B-cell population, but CD5 positive with CD23 and CD200 negative doesn't look like the usual classic CLL pattern to me.

One thing I would check on your reports is the exact MYD88 wording. You mention both MYD88 mutation detected and MYD88 L265P wild type. If the detected mutation was specifically L265P, I don't think it could also be L265P wild type on the same test/sample. It may be a different MYD88 mutation or results from two or more different tests? If it truly says MD88 L265P Wild Type you need to question this, as it seems an unusual statement, but again I am no expert.

Also, was it definitely FMC7 rather than FM27? If you can post the exact MYD88 and flow cytometry wording, it might make the picture much clearer. So you have an IgM m-spike (paraprotein) and are your IgA and IgM surpressed? and any Free Light Chains, kappa or lambda? It is looking like an LPL to me, but does the marrow report say two populations as this would explain why your favourite Doctor said this. T Cells are also in the mix from what I can see but these could just be normal background readings? again it is in the wording and well beyond my knowledge.

As you have been told it is an LPL it maybe worth you joining the IWMF forum, Waldemstoms Macroglobulinemia this site has some people with much more knowledge and experience than me and they also sometimes have indirect access to some of the experts and you really do need a very cleaver Doctor to work this out for you.

All the best

Jon