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:
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,TsSpecimen Type
TissueSpecimen 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 |
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 daysPerforming Laboratory

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)