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Test Code BLBLF B-Cell Lymphoblastic Leukemia/Lymphoma, FISH, Tissue


Ordering Guidance


This test does not include a pathology consultation. If a pathology consultation is requested, order PATHC / Pathology Consultation, and appropriate testing will be added at the discretion of the pathologist and performed at an additional charge.

 

Mayo Clinic Hematopathology consultants are involved in the pre-analytic phase (tissue adequacy and probe selection, when applicable).

 

This test is not appropriate for testing blood and bone marrow from patients with B-lymphoblastic leukemia/lymphoma. If a non-paraffin embedded bone marrow or blood sample is received for this test, the test will be canceled and automatically reordered by the laboratory as BALAF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), FISH, Adult, Varies or BALFP / Pediatric B-Lymphoblastic Leukemia/Lymphoma Panel, FISH, Varies depending on the age of the patient.



Shipping Instructions


Advise Express Mail or equivalent if not on courier service.



Necessary Information


1. A pathology report is required for testing to be performed. If not provided, appropriate testing and/or interpretation may be compromised or delayed. Acceptable pathology reports include working drafts, preliminary pathology, or surgical pathology reports.

2. The following information must be included in the report provided:

-Patient name

-Block number - must be on all blocks, slides, and paperwork

-Date of collection

-Tissue source

3. A reason for testing must be provided. If this information is not provided, an appropriate indication for testing may be entered by Mayo Clinic Laboratories.

4. A list of probes is required if select probes are necessary or if the patient is being tracked for known abnormalities. See Table in Clinical Information.



Specimen Required


Submit only 1 of the following specimens:

 

Preferred

Specimen Type: Tissue block

Collection Instructions:

1. Submit a formalin-fixed, paraffin-embedded tumor tissue block. Blocks prepared with alternative fixation methods will be attempted but are less favorable for successful results.

2. Provide fixation method used.

Additional Information:

1. Paraffin embedded specimens can be from any anatomic location (skin, soft tissue, lymph node, etc).

2. Bone specimens that have been decalcified will be attempted for testing, but the success rate is approximately 50%.

 

Acceptable

Specimen Type: Tissue slides

Slides: 1 Hematoxylin and eosin stained and 2 unstained for each probe set

Collection Instructions:

1. Include 1 hematoxylin and eosin-stained slide for the entire test order.

2. If individual probe sets are chosen: For each probe set ordered, submit 2 consecutive, unstained, 5 micron-thick sections placed on positively charged slides.

3. If a complete B-lymphoblastic leukemia/lymphoma (BLBL) panel is ordered: Submit 20 consecutive, unstained, 5 micron-thick sections placed on positively charged slides.


Forms

If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-Hematopathology/Cytogenetics Test Request (T726)

-Children's Oncology Group Test Request (T829)

Useful For

Detecting, at diagnosis, 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) in paraffin-embedded specimens

 

Monitoring response to therapy by tracking known chromosome abnormalities in patients with B-ALL/LBL

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
_IL25 Interphases, <25 No, (Bill Only) No
_I099 Interphases, 25-99 No, (Bill Only) No
_I300 Interphases, >=100 No, (Bill Only) No
_PADD Probe, +1 No, (Bill Only) No
_PB02 Probe, +2 No, (Bill Only) No
_PB03 Probe, +3 No, (Bill Only) No
_PBCT Probe, +2 No, (Bill Only) No

Method Name

Fluorescence In Situ Hybridization (FISH)

Reporting Name

B-Lymphoblastic Leuk/Lymph, FISH,Ts

Specimen Type

Tissue

Specimen Minimum Volume

See Specimen Required

Specimen Stability Information

Specimen Type Temperature Time
Tissue Ambient (preferred)
  Refrigerated 

Reject Due To

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

Clinical Information

In the United States, the incidence of B-lymphoblastic leukemia/lymphoma (B-ALL/LBL) is roughly 6000 new cases per year, or approximately 1 in 50,000. B-ALL/LBL accounts for approximately 70% of all childhood leukemia cases (ages 0 to 19 years), making it the most common type of childhood cancer. It has a peak incidence at 2 to 5 years. This incidence decreases with age before increasing again at around 50 years.

 

Per National Comprehensive Cancer Network guidelines, a combination of cytogenetic and FISH testing is currently recommended in all pediatric and adult patients with B-ALL/LBL. Additional cytogenetic techniques, such as chromosomal microarray (CMAH / Chromosomal Microarray, Hematologic Disorders, Varies), may be helpful in resolving either questions related to ploidy (hyperdiploid clone vs doubled hypodiploid clone) or certain clonal structural rearrangements, such as the presence or absence of intrachromosomal amplification of chromosome 21 (iAMP21). A summary of the characteristic chromosome abnormalities identified in B-ALL is listed in the following table.

 

Table. Common Chromosome Abnormalities in B-cell Acute Lymphoblastic Leukemia

Leukemia type

Cytogenetic change

Typical demographic

Risk category

B-acute lymphoblastic leukemia/lymphoma

 

t(12;21)(p13;q22), ETV6::RUNX1

Pediatric

Favorable

Hyperdiploidy

Pediatric

Favorable

t(1;19)(q23;p13.3), TCF3::PBX1

Pediatric

Intermediate to favorable

t(9;22)(q34;q11.2), BCR::ABL1

All ages

Unfavorable

iAMP21, RUNX1

Pediatric

Unfavorable

t(11q23;var), KMT2A rearrangement

All ages

Unfavorable

t(4;11)(q21;q23), KMT2A::AFF1

All ages

Unfavorable

t(6;11)(q27;q23), KMT2A::AFDN

All ages

Unfavorable

t(9;11)(p21.3;q23), KMT2A::MLLT3

All ages

Unfavorable

t(10;11)(p12;q23), KMT2A::MLLT10

All ages

Unfavorable

t(11;19)(q23;p13.3), KMT2A::MLLT1

All ages

Unfavorable

t(11;19)(q23;p13.1), KMT2A::ELL

All ages

Unfavorable

t(14q32;var), IGH rearrangement

All ages

Variable

t(X;14)(p22;q32)/t(Y;14)(p11;q32), IGH::CRLF2

Adolescent/ young adult

Unfavorable

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

All ages

Unfavorable

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

All ages

Unfavorable

t(8q24.21;var), MYC rearrangement
*representing Burkitt or other mature B-cell lymphoma

Pediatric/ adolescent/ young adult

Complex karyotype (≥4 abnormalities)

Adult

Unfavorable

Low hypodiploidy/near-triploidy

Adult

Unfavorable

Near-haploid/hypodiploid

All ages

Unfavorable

del(7p) IKZF1 deletion

All ages

Unfavorable in absence of ERG deletion

BCR::ABL1-like acute lymphoblastic leukemia/lymphoma

t(1q25;var), ABL2 rearrangement

Pediatric/ adolescent/ young adult

Unfavorable

t(5q32;var), PDGFRB  rearrangement

t(9p24.1;var), JAK2 rearrangement

t(9q34;var), ABL1 rearrangement

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

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

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 x 2, 88291-DNA probe, each (first probe set), interpretation and report

88271 x 2-DNA probe, each; each additional probe set (if appropriate)

88271-DNA probe, each; coverage for sets containing 3 probes (if appropriate)

88271 x 2-DNA probe, each; coverage for sets containing 4 probes (if appropriate)

88271 x 3-DNA probe, each; coverage for sets containing 5 probes (if appropriate)

88274 w/modifier 52-Interphase in situ hybridization, <25 cells, each probe set (if appropriate)

88274-Interphase in situ hybridization, 25 to 99 cells, each probe set (if appropriate)

88275-Interphase in situ hybridization, 100 to 300 cells, each probe set (if appropriate)