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HelpTest Code BALAF B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), FISH, Adult, Varies
Additional Codes
| Hospital Order Code |
| Lab2608 MISMGO |
Ordering Guidance
This test is only performed on specimens from patients with B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/LBL) who are aged 31 years or older.
This test is intended for instances when the entire B-ALL/LBL fluorescence in situ hybridization (FISH) panel is needed for an adult patient.
This test should NOT be used to screen for residual B-ALL/LBL. At follow-up, or if the patient clinically relapses, conventional cytogenetic studies (CHRBM / Chromosome Analysis, Hematologic Disorders, Bone Marrow) are useful to identify cytogenetic changes in the neoplastic clone or the possible emergence of a new therapy-related myeloid clone. Additionally, targeted B-ALL FISH probes can be evaluated based on the abnormalities identified in the diagnostic study.
If targeted B-cell ALL FISH probes are preferred, order BALMF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), Specified FISH, Varies, and request specific probes for targeted abnormalities.
If this test is ordered on a patient aged 30 years or younger, this test will be canceled and automatically reordered by the laboratory as BALFP / Pediatric B-Lymphoblastic Leukemia/Lymphoma panel, FISH, 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 either AMLFA / Adult Acute Myeloid Leukemia Panel, FISH, Varies?or TALAF / T-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), FISH, Adult, Varies, are ordered concurrently with this test, the laboratory may cancel this test and automatically reorder as BALMF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), Specified FISH, Varies with the following FISH probes: ETV6/RUNX1, PBX1/TCF3, 4/10/17, break-apart IGH, break-apart CRLF2, break-apart ABL2, and IKZF1/cep7. If an abnormality is identified that would result in reflex testing in BALAF, the same reflex testing will be performed in the BALMF. This cancellation is necessary to avoid duplicate testing. Probes for break-apart PDGFRB, break-apart JAK2, ABL1/BCR, break-apart ABL1, break-apart KMT2A will still be performed as part of the adult T-ALL FISH panel.
If PHLDF / Philadelphia Chromosome-like Acute Lymphoblastic Leukemia (Ph-like ALL), Diagnostic FISH, Varies, is ordered concurrently with this test, PHLDF testing will be canceled. This cancellation is necessary to avoid duplicate testing as PHLDF probes are included within this test when appropriate.
For patients with B-cell lymphoma, order BLPMF / B-Cell Lymphoma, Specified FISH, Varies.
For testing paraffin-embedded tissue samples from patients with B-LBL, order BLBLF / B-Cell 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.
Additional Testing Requirements
At diagnosis, conventional cytogenetic studies (CHRBM / Chromosome Analysis, Hematologic Disorders, Bone Marrow) and this fluorescence in situ hybridization panel should be performed. 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
1. 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.
2. 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, but appropriate testing and interpretation may be compromised or delayed.
3. If the patient has received an opposite sex bone marrow transplant, note this information on the request.
4. If the patient has Down syndrome, note this information on the request.
Specimen Required
Submit only 1 of the following specimens:
Preferred
Specimen Type: Bone marrow
Container/Tube:
Preferred: Yellow top (ACD)
Acceptable: Green top (sodium 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 (sodium 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, at diagnosis, recurrent common chromosome abnormalities associated with B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/LBL) and BCR::ABL1-like B-ALL in adult patients using a laboratory-designated probe set algorithm
As an adjunct to conventional chromosome studies in adult 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 2 probe sets (4 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 as panel testing only using the following analysis algorithm.
The diagnostic adult B-lymphoblastic leukemia (B-ALL) FISH panel includes testing for the following abnormalities using the FISH probes listed:
t(9;22)(q34;q11.2) or BCR::ABL1 fusion, ABL1/BCR probe set
CRLF2 (Xp22.33) or (Yp11.32) rearrangement, CRLF2 break-apart probe set
If results for the initial panel are negative or demonstrate nonclassical abnormalities, the following Philadelphia chromosome-like acute lymphoblastic leukemia (Ph-like ALL) panel will be performed as a secondary panel. The Ph-like ALL panel includes testing for the following kinase activating chromosome abnormalities, using the FISH probes listed below, as well as IKZF1 deletion, which often accompanies Ph-like ALL.
t(1q25;var) or ABL2 rearrangement, ABL2 break-apart probe set
t(5q32;var) or PDGFRB rearrangement, PDGFRB break-apart probe set
t(9p24.1;var) or JAK2 rearrangement, JAK2 break-apart probe set
t(9q34;var) or ABL1 rearrangement, ABL1 break-apart probe set
Finally, if results for the initial and secondary panels are negative or demonstrate nonclassical abnormalities, the following probe sets will be performed as a tertiary panel:
t(1;19)(q23;p13) or TCF3::PBX1 fusion, PBX1/TCF3 probe set
Hyperdiploidy or +4,+10,+17, D4Z1/D10Z1/D17Z1 probe set
7p- or IKZF1 deletion, IKZF1/CEP7 probe set
t(11q23;var) or KMT2A rearrangement, KMT2A break-apart probe set
t(12;21)(p13;q22) or ETV6::RUNX1 fusion or iAMP21, ETV6/RUNX1 probe set
t(14q32;var) or IGH rearrangement, IGH break-apart probe set
Appropriate ancillary probes may be performed at consultant discretion to render comprehensive assessment. Any additional probes used will have the results included within the final report and will be performed at an additional charge. In the following situations, additional (reflex) testing may be performed at the laboratory's discretion and may be influenced by available karyotype results or other FISH testing.
When a KMT2A rearrangement is identified, appropriate reflex testing with 1 or more dual-fusion FISH (D-FISH) probe sets may be performed in an attempt to identify the translocation partner for the following abnormalities:
t(4;11)(q21;q23) or KMT2A::AFF1 fusion, AFF1/KMT2A probe set
t(6;11)(q27;q23) or KMT2A::AFDN ;fusion, AFDN/KMT2A probe set
t(9;11)(p22;q23) or KMT2A::MLLT3 fusion, MLLT3/KMT2A probe set
t(10;11)(p12;q23) or KMT2A::MLLT10 fusion, MLLT10/KMT2A probe set
t(11;19)(q23;p13.1) or KMT2A::MLLT1 fusion, KMT2A/ELL probe set
t(11;19)(q23;p13.3) or KMT2A::ELL fusion, KMT2A/MLLT1 probe set
When an unbalanced CRLF2 rearrangement is identified concurrently with an IGH rearrangement, testing using the CRLF2/IGH probe set will be considered to identify a potential t(X;14)(p22.33;q32) or t(Y;14)(p11.32;q32) cryptic translocation.
When a MYC rearrangement is identified, testing using both the BCL2 and BCL6 break-apart probe sets will be performed.
If an unbalanced rearrangement of the BCL2 is identified, testing using the IGH/BCL2 probe set will be performed to identify a potential t(14;18)(q32;q21) or IGH::BCL2 fusion.
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.
Special Instructions
Method Name
Fluorescence In Situ Hybridization (FISH)
Reporting Name
Adult ALL (B-cell), FISHSpecimen Type
VariesSpecimen Minimum Volume
Bone marrow: 1 mL; Whole blood: 2 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 daysPerforming 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 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 | 102099-9 |
| 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 |
Forms
If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.