Acute Lymphoblastic Leukemia (ALL) — FISH Analysis

ALL Panel – Pediatric (≤ 18 years)
ALL Panel – Adult (> 18 years)
Ph-like ALL Reflex Panel (Adult)

CPT Code(s): 88237, 88275 (x per analyses), 88271 (x per probe)

Service Code (IU Health): 53101259, 53100707, 53100640

Ordering Recommendation: FISH is useful to identify chromosome abnormalities in patients with pediatric or adult acute lymphoblastic leukemia (ALL) for diagnostic and prognostic purposes as well as for follow-up to evaluate patient response to therapy. Companion testing with chromosome analysis is recommended.

Synonyms: FISH, Hematopoietic malignancy, acute lymphocytic leukemia, ALL, acute lymphoblastic leukemia.

Methodology: Fluorescence in situ hybridization (FISH) analysis.

Performed: Monday through Friday

Reported: 2-3 days

Panels:

ALL Panel – Pediatric (≤18): Xp22.3/Yp11.2 (CRLF2), t(1;19) (PBX1;TCF3), 1q25.2 (ABL2), 4/10/17 centromeres, 5q32 (PDGFRB), 9p21.3 (CDKN2A, 9cen), 9q34.1 (ABL1), t(9;22) (BCR/ABL1), 11q23.3 (KMT2A, formerly MLL), t(12;21) (ETV6/RUNX1). Each probe may be run individually.

ALL Panel – Adult (>18): Xp22.3/Yp11.2 (CRLF2), t(1;19) (PBX1;TCF3), 4/10/17 centromeres, 9p21.3 (CDKN2A, 9cen), t(9;22) (BCR/ABL1), 11q23.3 (KMT2A, formerly MLL), t(12;21) (ETV6/RUNX1)

Ph-like ALL Reflex Panel – Adult: 1q25.2 (ABL2), 5q32 (PDGFRB), 9q34.1 (ABL1)

Collect: Non-diluted bone marrow aspirate in dark green-top sodium heparin tube, heparinized syringe, or flask with sterile media (provided upon request).

Specimen Volume: Preferred: 2 mL for normal WBC (decreased WBC requires more, and elevated WBC requires less); Minimum: 0.5 mL

Storage/Transport: Room temperature. Do not freeze or expose to extreme temperatures.

Unacceptable Conditions: Frozen specimens. Formalin-fixed specimens.

Stability: Ambient: 48 hours; Frozen: Unacceptable  

Characteristics: When the percent of cells with an abnormality exceeds the established normal reference range for any given probe signal pattern, it is considered an abnormal clone. Absence of an abnormal clone does not rule out the possibility of a neoplastic disorder. A report detailing interpretation of results will be provided.

Limitations: The probes in this FISH panel detect only specific aberrations. Chromosomal alterations present outside the regions targeted by the probes will not be detected.   

References:

1. World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues, Revised 4th edition. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Arber DA, Hasserjian RP, Le Beau MM, Orazi A, and Siebert R, Editors. IARC Press: Lyon, France, 2017.
2. Iacobucci I, et al. Cytogenetic and molecular predictors of outcome in acute lymphocytic leukemia: recent developments. Curr Hematol Malig Rep 7(2):133-143, 2012. PMID: 22528731.
3. Inaba H, et al. Acute lymphoblastic leukaemia. Lancet 381(9881):1943-1955, 2013. PMID: 23523389.
4. Mullighan CG. The genomic landscape of acute lymphoblastic leukemia in children and young adults. Hematology Am Soc Hematol Educ Program 2014(1):174-180, 2014. PMID: 25696852.
5. Moorman AV. The clinical relevance of chromosomal and genetic abnormalities in B-cell precursor acute lymphoblastic leukaemia. Blood Rev 26(3):123-135, 2012. PMID: 22436535.
6. Roberts KG, et al. Targetable kinase-activating lesions in Ph-like acute lymphoblastic leukemia. N Engl J Med 371(11):1005-1015, 2014. PMID: 25207766.