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HelpTest Code BALLF B-Lymphoblastic Leukemia/Lymphoma, FISH, Varies
Useful For
Detecting a neoplastic clone associated with the common chromosome abnormalities seen in patients with B-cell acute lymphoblastic leukemia (B-ALL) and Philadelphia chromosome-like acute lymphoblastic leukemia (Ph-like ALL)
Identifying and tracking known chromosome abnormalities in patients with B-ALL and Ph-like ALL and tracking response to therapy
As an adjunct to conventional chromosome studies in patients with B-ALL and Ph-like ALL
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| _PBCT | Probe, +2 | 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 |
| _IL25 | Interphases, <25 | No, (Bill Only) | No |
| _I099 | Interphases, 25-99 | No, (Bill Only) | No |
| _I300 | Interphases, >=100 | No, (Bill Only) | No |
Testing Algorithm
This B-cell acute lymphoblastic leukemia (B-ALL) FISH test may be ordered in 4 distinct ways allowing different combinations of probes to be utilized based on the clinical question. The 4 ways this B-ALL FISH test can be ordered are as follows:
-Standard (diagnostic) B-ALL FISH panel
-Philadelphia chromosome-like acute lymphoblastic leukemia (Ph-like ALL) panel
-Combined-Standard (diagnostic) B-ALL FISH panel + Ph-like ALL panel
-Individual B-ALL FISH probes (per client request)
The specific B-ALL FISH panel or FISH probes requested must be noted on the request form or in the reason for referral. If no specific panel or FISH probe request is indicated, the "Standard (diagnostic) B-ALL FISH panel" will be performed.
The Standard (diagnostic) B-ALL FISH panel includes testing for the following abnormalities, using the FISH probes listed:
Hyperdiploidy, +4,+10,+17: D4Z1/D10Z1/D17Z1
t(12;21)(p13;q22), ETV6/RUNX1 fusion, ETV6/RUNX1 D-FISH
iAMP21, RUNX1 amplification, ETV6/RUNX1 D-FISH
t(9;22)(q34;q11.2), BCR/ABL1 fusion, BCR/ABL1 D-FISH
t(1;19)(q23;p13), PBX1/TCF3 fusion, PBX1/TCF3 D-FISH
t(11q23;var), MLL (KMT2A) rearrangement, MLL (KMT2A) break-apart
del(9p), CDKN2A deletions, CDKN2A/D9Z1
t(14q32;var), IGH rearrangement, IGH break-apart
del(17p), TP53 deletions, TP53/D17Z1
8q24.1 rearrangement, MYC break-apart
t(Xp22.33;var) or t(Yp11.32;var), P2RY8 rearrangement, P2RY8 break-apart
t(Xp22.33;var) or t(Yp11.32;var), CRLF2 rearrangement, CRLF2 break-apart
-7 or del(7p), IKZF1 deletions, IKZF1/CEN7
-When an MLL (KMT2A) rearrangement is identified, reflex testing will be performed to identify the translocation partner. Probes include identification of t(4;11)(q21;q23) AFF1/MLL, t(6;11)(q27;q23) MLLT4/MLL, t(9;11)(p22;q23) MLLT3/MLL, t(10;11)(p13;q23) MLLT10/MLL, t(11;19)(q23;p13.1) MLL/ELL, or t(11;19)(q23;p13.3) MLL/MLLT1.
-When an IGH and/or CRLF2 rearrangement is identified, reflex testing will be performed using the CRLF2/IGH fusion probe set to identify a potential t(X;14)(p22.33;q32) or t(Y;14) (p11.32;q32) "cryptic translocation."
-When an extra signal of ABL1 is identified in BCR/ABL1 testing, reflex testing will be performed using the ABL1 break-apart probe set to identify the presence or absence of an ABL1 rearrangement.
-If a MYC rearrangement is identified, break-apart probe sets for BCL2 and BCL6 will be performed.
*The "Standard (diagnostic) B-ALL FISH panel" will be automatically reflexed to the Philadelphia Ph-like ALL panel on pediatric and young adult patients (age <30) who demonstrate normal or nonclassical abnormalities on the Standard (diagnostic) panel. In other circumstances, the Ph-like ALL panel may be recommended and the client notified before performing this testing.
The Ph-like ALL panel includes testing for the following kinase activating chromosome abnormalities, using the FISH probes listed:
-t(1q25;var), ABL2 rearrangement, ABL2 break-apart
-t(5q33;var), PDGFRB rearrangement, PDGFRB break-apart
-t(9p24.1;var), JAK2 rearrangement, JAK2 break-apart
-t(9q34;var), ABL1 rearrangement, ABL1 break-apart
-t(Xp22.33;var) or t(Yp11.32;var), P2RY8 rearrangement, P2RY8 break-apart
-t(Xp22.33;var) or t(Yp11.32;var), CRLF2 rearrangement, CRLF2 break-apart
-monosomy 7 or del(7p), IKZF1 deletions, IKZF1/CEN7 enumeration
-When a PDGFRB rearrangement is identified, reflex testing may be performed using the PDGFRB/ETV6 fusion probe set to identify a potential t(5;12)(q33;p13) translocation.
-When a CRLF2 rearrangement is identified, reflex testing will be performed using the CRLF2/IGH fusion probe set to identify a potential t(X;14)(p22.33;q32) or t(Y;14) (p11.32;q32) "cryptic translocation."
-If an ABL1 rearrangement is identified, reflex testing will be performed using the BCR/ABL1 dual-color, double fusion FISH probe set to evaluate for the presence or absence of BCR/ABL1 fusion.
We recommend the following testing algorithm for patients with B-acute lymphoblastic leukemia (B-ALL):
-At diagnosis, standard (diagnostic) B-ALL FISH panel and/or conventional chromosome studies (CHRBM / Chromosome Analysis, Hematologic Disorders, Bone Marrow) should be performed. If there is limited specimen available, the BALLF test will be performed.
-If the patient clinically relapses, a conventional chromosome study is useful to identify cytogenetic changes in the neoplastic clone or the possible emergence of a new therapy-related myeloid clone.
See B-Lymphoblastic Leukemia/Lymphoma Algorithm in Special Instructions.
This test includes a charge for application of the first probe set (2 FISH probes) and professional interpretation of results. Additional charges will be incurred for all reflex probes 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.
If this test is ordered and the laboratory is informed that the patient is on a COG protocol, this test will be canceled and automatically reordered by the laboratory as COGBF / B-Lymphoblastic Leukemia/Lymphoma, Children's Oncology Group Enrollment Testing, FISH, Varies.
Method Name
Fluorescence In Situ Hybridization (FISH)
Reporting Name
ALL (B-cell), FISHSpecimen Type
VariesShipping Instructions
Advise Express Mail or equivalent if not on courier service.
Necessary Information
1. Provide a reason for referral 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.
2. A pathology and/or flow cytometry report may be requested by the Genomics Laboratory to optimize testing and aid in interpretation of results.
Specimen Required
Submit only 1 of the following specimens:
Specimen Type: Blood
Container/Tube: Green top (sodium heparin)
Specimen Volume: 7-10 mL
Collection Instructions: Invert several times to mix blood.
Specimen Type: Bone marrow
Container/Tube: Green top (sodium heparin)
Specimen Volume: 1-2 mL
Collection Instructions: Invert several times to mix bone marrow.
Specimen Minimum Volume
Blood: 2 mL
Bone Marrow: 1 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| 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.
Method Description
The B-acute lymphoblastic leukemia (B-ALL) FISH test is performed using commercially available and laboratory-developed probes. Deletion of the CDKN2A locus on chromosome 9 and TP53 on chromosome 17 and gain of chromosomes 4, 10, and 17 are detected using enumeration strategy probes. Rearrangements involving MLL, IGH, and MYC are detected using a dual-color break-apart (BAP) strategy probe. Dual-color, dual-fusion (D-FISH) strategy probe sets are used to detect t(9;22), t(12;21), t(1;19), and in reflex testing when rearrangements of the MLL and IGH genes are detected. If the Philadelphia chromosome-like acute lymphoblastic leukemia (Ph-like ALL) probes are requested, the test is performed using commercially available and laboratory-developed probes. Rearrangements involving ABL2, PDGFRB, JAK2, ABL1, CRLF2 and P2RY8 are detected using a dual-color break-apart (BAP) strategy probe. For enumeration and BAP strategy probe sets, 200 interphase nuclei are scored; 500 interphase nuclei are scored when D-FISH probes are used. Two technologists analyze each probe set and all results are expressed as the percent abnormal nuclei.(Unpublished Mayo method)
Day(s) and Time(s) Performed
Specimens are processed Monday through Sunday.
Results reported Monday through Friday, 8 a.m.-5 p.m.
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed using an analyte specific reagent. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. 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)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| BALLF | ALL (B-cell), FISH | In Process |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 51786 | Result Summary | 50397-9 |
| 51788 | Interpretation | 69965-2 |
| 51787 | Result Table | 93356-4 |
| 54528 | Result | 62356-1 |
| CG651 | Reason for Referral | 42349-1 |
| CG652 | Specimen | 31208-2 |
| 51789 | Source | 31208-2 |
| 51790 | Method | 49549-9 |
| 53426 | Additional Information | 48767-8 |
| 55272 | Disclaimer | 62364-5 |
| 51791 | Released By | 18771-6 |
Secondary ID
35256Forms
If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.