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Test ID BALAF B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), FISH, Adult, Varies


Ordering Guidance


This test is only performed on specimens from patients with B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/LBL) who are older than 30 years of age.

 

This test is intended to be ordered when the entire B-ALL/LBL fluorescence in situ hybridization (FISH) panel is needed for an adult patient.

-If this test is ordered on a patient 30 years of age or younger, this test will be canceled and automatically reordered by the laboratory as BALPF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), FISH, Pediatric, Varies.

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

 

If limited B-cell ALL FISH probes are preferred, order BALMF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), Specified FISH, Varies.

 

At follow-up, conventional cytogenetic studies (CHRBM / Chromosome Analysis, Hematologic Disorders, Bone Marrow) and targeted B-ALL FISH probes can be evaluated based on the abnormalities identified in the diagnostic study. Order BALMF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), Specified FISH, Varies and request specific probes or abnormalities.

 

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 new therapy-related myeloid clone.

 

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 (ALL), FISH, Tissue.



Additional Testing Requirements


At diagnosis, conventional cytogenetic studies (CHRBM / Chromosome Analysis, Hematologic Disorders, Bone Marrow) and this panel should be performed per National Comprehensive Cancer Network guidelines. If there is limited specimen available, only this test will be performed.



Shipping Instructions


Advise Express Mail or equivalent if not on courier service.



Necessary Information


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 interpretation may be compromised or delayed in some instances. If this information is 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: 2-3 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.

 

Acceptable

Specimen Type: Blood

Container/Tube:

Preferred: Yellow top (ACD)

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

Specimen Volume: 6 mL

Collection Instructions: Invert several times to mix blood.


Useful For

Detecting a neoplastic clone associated with the common chromosome abnormalities and classic rearrangements seen in adult patients with B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/LBL)

 

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

 

Evaluating specimens in which standard cytogenetic analysis is unsuccessful

Testing Algorithm

This test includes a charge for the probe application, analysis and professional interpretation of results for 2 probe sets (4 individual fluorescence in situ hybridization [FISH] probes). Additional charges will be incurred for all reflex or additional probe sets performed.

 

The initial panel includes testing for the following abnormalities using the probes listed:

t(9;22), BCR/ABL1t(X;14)(p22.33;q32)

t(Y;14)(p11.32;q32), CRLF2/IGH

If results for the initial panel are negative, the following reflex probe sets will be performed as a secondary panel:

1q25 rearrangement, ABL2 break-apart

5q33 rearrangement, PDGFRB break-apart

9p24.1 rearrangement, JAK2 break-apart

9q34 rearrangement, ABL1 break-apart

t(Xp22.33;var) or t(Yp11.32;var), CRLF2 rearrangement

t(Xp22.33;var) or t(Yp11.32;var), P2RY8 rearrangement

 

Finally, if results for the secondary panel are negative, the following probe sets will be performed as a tertiary panel:

t(1;19)(q23;p13), PBX1/TCF3 fusion

Hyperdiploidy, +4,+10,+17: D4Z1/D10Z1/D17Z1

t(12;21)(p13;q22), ETV6/RUNX1 & iAMP21

14q32 rearrangement, IGH break-apart

11q23 rearrangement, MLL(KMT2A) break-apart

7p-, IKZF1/CEP7

 

When a KMT2A (MLL) rearrangement is identified, reflex testing will be performed to identify the translocation partner. Probes include identification of:

t(4;11)(q21;q23) AFF1/MLL

MLLT4(AFDN)/MLL

t(6;11)(q27;q23)

t(9;11)(p22;q23) MLLT3/MLL

t(10;11)(p12;q23) MLLT10/MLL

t(11;19)(q23;p13.1) MLL/ELL

t(11;19)(q23;p13.3) MLL/MLLT1

 

B-Lymphoblastic Leukemia/Lymphoma Algorithm is available in Special Instructions.

Method Name

Fluorescence In Situ Hybridization (FISH)

Reporting Name

Adult ALL (B-cell), FISH

Specimen Type

Varies

Specimen Minimum Volume

Blood: 2 mL
Bone Marrow: 1 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Ambient (preferred)
  Refrigerated 

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. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

88271 x4,88275 x2, 88291 - FISH Probe, Analysis, Interpretation; 2 probe sets

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

88271 - FISH Probe (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
BALAF Adult ALL (B-cell), FISH In Process

 

Result ID Test Result Name Result LOINC Value
609538 Result Summary 50397-9
609539 Interpretation 69965-2
609540 Result Table 93356-4
609541 Result 62356-1
GC065 Reason for Referral 42349-1
GC066 Specimen 31208-2
609542 Source 31208-2
609543 Method 85069-3
609544 Additional Information 48767-8
609545 Disclaimer 62364-5
609546 Released By 18771-6

NY State Approved

Yes