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Test Code BALMF B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), Specified FISH, Varies


Ordering Guidance


This test is intended for instances when targeted B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/LBL) fluorescence in situ hybridization (FISH) probes are needed based on specific abnormality or abnormalities identified in the diagnostic sample. The FISH probes must be specified on the request when ordering.

 

If targeted FISH probes are not included with this test order, test processing will be delayed, and the test may be canceled by the laboratory.

 

If targeted probes are not included with this test request, the test may be canceled and automatically reordered by the laboratory as BALAF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), FISH, Adult, Varies or BALPF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), FISH, Pediatric, Varies depending on the age of the patient.

 

For an adult patient, if the entire B-cell ALL FISH panel is preferred, order BALAF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), FISH, Adult, Varies.

 

For a pediatric patient, if the entire B-cell ALL FISH panel is preferred, order BALPF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), FISH, Pediatric, Varies.

 

At diagnosis, both conventional cytogenetic studies (CHRBM / Chromosome Analysis, Hematologic Disorders, Bone Marrow) and either BALAF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), FISH, Adult, Varies or BALPF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), FISH, Pediatric, Varies should be performed.

 

If the patient clinically relapses, a conventional chromosome study may be useful to identify cytogenetic changes in the neoplastic clone or the possible emergence of a therapy-related myeloid clone.

 

 

If this test is ordered and the laboratory is informed that the patient is 30 years of age and under AND is on a Children's Oncology Group (COG) protocol, this test will be canceled and automatically reordered by the laboratory COGBF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), Children's Oncology Group Enrollment Testing, FISH, Varies.

   

For patients with B-cell lymphoma, order BLPMF / B-Cell Lymphoma, Specified FISH, Varies.

 

For testing paraffin-embedded tissue samples from patients with B-ALL/LBL, order BLBLF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma, FISH, Tissue. If a paraffin-embedded tissue sample is submitted for this test, it will be canceled and BLBLF will be added and performed as the appropriate test.



Shipping Instructions


Advise Express Mail or equivalent if not on courier service.



Necessary Information


1. A list of probes requested for analysis is required. Probes available for this test are listed in the Testing Algorithm section.

2. A reason for testing and a flow cytometry and/or a bone marrow pathology report should be submitted with each specimen. The laboratory will not reject testing if this information is not provided; however, appropriate testing and/or interpretation may be compromised or delayed in some instances. If not provided, an appropriate indication for testing may be entered by Mayo Clinic Laboratories.



Specimen Required


Submit only 1 of the following specimens:

 

Preferred

Specimen Type: Bone marrow

Container/Tube:

Preferred: Yellow top (ACD)

Acceptable: Green top (heparin) or lavender top (EDTA)

Specimen Volume: 2 to 3 mL

Collection Instructions:

1. It is preferable to send the first aspirate from the bone marrow collection.

2. Invert several times to mix bone marrow.

3. Send bone marrow specimen in original tube. Do not aliquot.

 

Acceptable

Specimen Type: Whole blood

Container/Tube:

Preferred: Yellow top (ACD)

Acceptable: Green top (heparin) or lavender top (EDTA)

Specimen Volume: 6 mL

Collection Instructions:

1. Invert several times to mix blood.

2. Send whole blood specimen in original tube. Do not aliquot.


Useful For

Detecting a neoplastic clone associated with recurrent common chromosome abnormalities associated with B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/LBL) and Philadelphia chromosome-like acute lymphoblastic leukemia (Ph-like ALL) using client specified probes

 

As an adjunct to conventional chromosome studies in patients with B-ALL/LBL

 

Evaluating specimens in which chromosome studies are unsuccessful

This test should not be used to screen for residual B-ALL/LBL.

Testing Algorithm

This test includes a charge for the probe application, analysis, and professional interpretation of results for one probe set (2 individual fluorescence in situ hybridization [FISH] probes). Additional charges will be incurred for all reflex or additional probe sets performed. Analysis charges will be incurred based on the number of cells analyzed per probe set. If no cells are available for analysis, no analysis charges will be incurred.

 

This test is performed using client-specified FISH probes and is not intended as a panel test. Specific probes must be listed in the probe request field. Reflex probes can be performed when appropriate if specified in the order request field.

 

When specified, any of the following probes will be performed:

t(Xp22.33;var) or t(Yp11.32;var) or CRLF2 rearrangement, request probe CRLF2 break-apart

t(X;14)(p22.33;q32) or t(Y;14)(p11.32;q32) or IGH::CRLF2 fusion, request probe CRLF2/IGH

t(Xp22.33;var) or t(Yp11.32;var) or P2RY8 rearrangement, request probe P2RY8 break-apart

t(1q25;var) or ABL2 rearrangement, request probe ABL2 break-apart

t(1;19)(q23;p13) or TCF3::PBX1 fusion, request probe PBX1/TCF3

Hyperdiploidy or +4,+10,+17, request probe D4Z1/D10Z1/D17Z1

t(5q32;var) or PDGFRB rearrangement, request probe PDGFRB break-apart

7p- or IKZF1 deletion, request probe IKZF1/CEP7

t(8;14)(q24.21;q32) or IGH::MYC fusion, request probe MYC/IGH

t(8q24.21;var) or MYC rearrangement, request probe MYC break-apart

t(3q27;var) or BCL6 rearrangement, request probe BCL6 break-apart

t(18q21;var) or BCL2 rearrangement, request probe BCL2 break-apart

t(14;18)(q32;q21) or IGH::BCL2 fusion, request probe BCL2/IGH

t(9p24.1;var) or JAK2 rearrangement, request probe JAK2 break-apart

t(9;22)(q34;q11.2) or BCR::ABL1 fusion, request probe ABL1/BCR

t(9q34;var) or ABL1 rearrangement, request probe ABL1 break-apart

t(11q23;var) or KMT2A rearrangement, request probe KMT2A break-apart

t(4;11)(q21;q23) or KMT2A::AFF1 fusion, request probe AFF1/KMT2A

t(6;11)(q27;q23) or KMT2A::AFDN fusion, request probe AFDN/KMT2A

t(9;11)(p22;q23) or KMT2A::MLLT3 fusion, request probe MLLT3/KMT2A

t(10;11)(p12;q23) or KMT2A::MLLT10 fusion, request probe MLLT10/KMT2A

t(11;19)(q23;p13.3) or KMT2A::MLLT1 fusion, request probe KMT2A/MLLT1

t(11;19)(q23;p13.1) or KMT2A::ELL fusion, request probe KMT2A/ELL

t(12;21)(p13;q22), ETV6::RUNX1 fusion and iAMP21, request probe ETV6/RUNX1

t(12p13;var) or ETV6 rearrangement, request probe ETV6 break-apart

t(14q32;var) or IGH rearrangement, request probe IGH break-apart

 

Appropriate ancillary probes may be performed at consultant discretion to render comprehensive assessment. Any additional probes will have the results included within the final report and will be performed at an additional charge.

 

For more information see:

-B-Lymphoblastic Leukemia/Lymphoma Genetic Testing Guidelines

-Acute Leukemias of Ambiguous Lineage Testing Algorithm

Method Name

Fluorescence In Situ Hybridization (FISH)

Reporting Name

ALL (B-cell), Specified FISH

Specimen Type

Varies

Specimen Minimum Volume

Whole blood: 2 mL; Bone marrow: 1 mL

Specimen Stability Information

Specimen Type Temperature Time
Varies Ambient (preferred)
  Refrigerated 

Reject Due To

All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

Reference Values

An interpretive report will be provided.

Day(s) Performed

Monday through Friday

Report Available

7 to 10 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

88271 x2, 88275 x1, 88291 x1- FISH Probe, Analysis, Interpretation; 1 probe sets

88271 x2, 88275 x1 - FISH Probe, Analysis; each additional probe set (if appropriate)

88271 x1 -FISH Probe; coverage for sets containing 3 probes (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
BALMF ALL (B-cell), Specified FISH 102099-9

 

Result ID Test Result Name Result LOINC Value
614217 Result Summary 50397-9
614218 Interpretation 69965-2
614219 Result Table 93356-4
614220 Result 62356-1
GC101 Reason for Referral 42349-1
GC102 Probes Requested 78040-3
GC103 Specimen 31208-2
614221 Source 31208-2
614222 Method 85069-3
614223 Additional Information 48767-8
614224 Disclaimer 62364-5
614225 Released By 18771-6

Forms

If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.