Test Id : CLLDF
Chronic Lymphocytic Leukemia, Diagnostic FISH, Varies
Useful For
Suggests clinical disorders or settings where the test may be helpful
Detecting recurrent common chromosome abnormalities in patients with chronic lymphocytic leukemia (CLL) using a laboratory-designated probe set algorithm
Distinguishing patients with 11;14 translocations who have the leukemic phase of mantle cell lymphoma from patients who have CLL
Detecting patients with atypical CLL with translocations between IGH and BCL3
Evaluating specimens in which chromosome studies are unsuccessful
Reflex Tests
Lists tests that may or may not be performed, at an additional charge, depending on the result and interpretation of the initial tests.
| Test Id | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| CLLDB | Probe, Each Additional (CLLDF) | No, (Bill Only) | No |
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
This test includes a charge for the probe application, analysis, and professional interpretation of results for 6 probe sets (12 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 chronic lymphocytic leukemia (CLL) FISH panel includes testing for the following abnormalities using the FISH probes listed:
6q-, D6Z1/MYB probe set
11q-, D11Z1/ATM probe set
+12, D12Z3/MDM2 probe set
13q-, D13S319/LAMP1 probe set
-17/17p-, TP53/D17Z1 probe set
t(11;14)(q13;q32) or IGH::CCND1 fusion, CCND1/IGH 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.
In the absence of IGH::CCND1 fusion, when an extra IGH signal is identified, testing using the IGH/BCL3 probe set to identify a potential IGH::BCL3 fusion, t(14;19)(q32;q13) may be performed.
In the absence of IGH::CCND1 fusion, when an extra or atypical CCND1 signal is identified, testing using the CCND1 break-apart probe set to identify a potential variant translocation involving CCND1, t(11;var)(q13;?) may be performed.
Method Name
A short description of the method used to perform the test
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
B-CLL
CLL
6q- (6q deletion) or MYB
11q- (11q deletion) or ATM
t(11;14)(q13;q32.33)-IGH::CCND1 or CCND1/IGH
t(14;19)(q32.33;q13)-IGH::BCL3 or IGH/BCL3
CCND1 (11q13) rearrangement
+12/trisomy 12
13q- (13q deletion) or D13S319
17p- (17p deletion) or TP53
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
This test includes a charge for the probe application, analysis, and professional interpretation of results for 6 probe sets (12 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 chronic lymphocytic leukemia (CLL) FISH panel includes testing for the following abnormalities using the FISH probes listed:
6q-, D6Z1/MYB probe set
11q-, D11Z1/ATM probe set
+12, D12Z3/MDM2 probe set
13q-, D13S319/LAMP1 probe set
-17/17p-, TP53/D17Z1 probe set
t(11;14)(q13;q32) or IGH::CCND1 fusion, CCND1/IGH 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.
In the absence of IGH::CCND1 fusion, when an extra IGH signal is identified, testing using the IGH/BCL3 probe set to identify a potential IGH::BCL3 fusion, t(14;19)(q32;q13) may be performed.
In the absence of IGH::CCND1 fusion, when an extra or atypical CCND1 signal is identified, testing using the CCND1 break-apart probe set to identify a potential variant translocation involving CCND1, t(11;var)(q13;?) may be performed.
Specimen Type
Describes the specimen type validated for testing
Varies
Ordering Guidance
This test is intended for instances when the entire chronic lymphocytic leukemia (CLL) fluorescence in situ hybridization (FISH) panel is needed.
If targeted CLL FISH probes are preferred, order CLLMF / Chronic Lymphocytic Leukemia, Specified FISH, Varies and request specific probes for targeted abnormalities.
For testing paraffin-embedded tissue specimens from patients with CLL or small lymphocytic lymphoma, order SLL / Small Lymphocytic Lymphoma, FISH, Tissue. If a paraffin-embedded tissue sample is submitted for this test, this test will be canceled and SLL will be added and performed as the appropriate test.
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.
ORDER QUESTIONS AND ANSWERS
| Question ID | Description | Answers |
|---|---|---|
| GC088 | Reason for Referral | |
| GC089 | Specimen |
Whole Blood ACD Bone Marrow ACD Whole Blood Na Hep Bone Marrow Na Hep Whole Blood EDTA Bone Marrow EDTA |
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Submit only 1 of the following specimens:
Preferred
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 in original tube. Do not aliquot.
Acceptable
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 in original tube. Do not aliquot.
Forms
If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
Whole blood: 2 mL; Bone marrow: 1 mL
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Ambient (preferred) | ||
| Refrigerated | |||
Useful For
Suggests clinical disorders or settings where the test may be helpful
Detecting recurrent common chromosome abnormalities in patients with chronic lymphocytic leukemia (CLL) using a laboratory-designated probe set algorithm
Distinguishing patients with 11;14 translocations who have the leukemic phase of mantle cell lymphoma from patients who have CLL
Detecting patients with atypical CLL with translocations between IGH and BCL3
Evaluating specimens in which chromosome studies are unsuccessful
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
This test includes a charge for the probe application, analysis, and professional interpretation of results for 6 probe sets (12 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 chronic lymphocytic leukemia (CLL) FISH panel includes testing for the following abnormalities using the FISH probes listed:
6q-, D6Z1/MYB probe set
11q-, D11Z1/ATM probe set
+12, D12Z3/MDM2 probe set
13q-, D13S319/LAMP1 probe set
-17/17p-, TP53/D17Z1 probe set
t(11;14)(q13;q32) or IGH::CCND1 fusion, CCND1/IGH 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.
In the absence of IGH::CCND1 fusion, when an extra IGH signal is identified, testing using the IGH/BCL3 probe set to identify a potential IGH::BCL3 fusion, t(14;19)(q32;q13) may be performed.
In the absence of IGH::CCND1 fusion, when an extra or atypical CCND1 signal is identified, testing using the CCND1 break-apart probe set to identify a potential variant translocation involving CCND1, t(11;var)(q13;?) may be performed.
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Chronic lymphocytic leukemia (CLL) is one of the most common leukemias in adults. The most frequently seen cytogenetic abnormalities in CLL involve chromosomes 6, 11, 12, 13, and 17. These are detected and quantified using the CLL fluorescence in situ hybridization (FISH) panel.
Use of CpG-oligonucleotide mitogen will identify an abnormal CLL karyotype in at least 80% of cases. This mitogen is added to cultures when chromosome analysis is ordered and the reason for testing is B-cell lymphoproliferative disorders (CHRBM / Chromosome Analysis, Hematologic Disorders, Bone Marrow and CHRHB / Chromosome Analysis, Hematologic Disorders, Blood).
This FISH test detects an abnormal clone in approximately 70% of patients with indolent disease and in greater than 80% of patients who require treatment. At least 5% of patients referred for CLL FISH testing have translocations involving the IGH locus. Fusion of IGH with CCND1 is associated with t(11;14)(q13;q32), and fusion of IGH with BCL3 is associated with t(14;19)(q32;q13.3). Patients with t(11;14) usually have the leukemic phase of mantle cell lymphoma. Patients with t(14;19) may have an atypical form of B-CLL or the leukemic phase of a lymphoma.
The prognostic associations for chromosome abnormalities detected by this FISH assay are, from best to worst: 13q-, normal, +12, 6q-, 11q- and 17p-.
Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
An interpretive report will be provided.
Interpretation
Provides information to assist in interpretation of the test results
A neoplastic clone is detected when the percent of cells with an abnormality exceeds the normal reference range for any given probe set.
The absence of an abnormal clone does not rule out the presence of a neoplastic disorder.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
This test is not approved by the US Food and Drug Administration, and it is best used as an adjunct to clinical and pathologic information.
Fluorescence in situ hybridization (FISH) is not a substitute for conventional chromosome studies because the latter detects chromosome abnormalities associated with other hematological disorders that would go undetected in a targeted chronic lymphocytic leukemia FISH panel test.
If no FISH signals are observed post-hybridization, the case will be released indicating a lack of FISH results.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Dewald GW, Brockman SR, Paternoster SF, et al. Chromosome anomalies detected by interphase FISH: correlation with significant biological features of B-cell chronic lymphocytic leukemia. Br J Haematol. 2003;121:287-295
2. Dohner H, Stilgenbauer S, Benner A, et al. Genomic aberrations and survival in chronic lymphocytic leukemia. N Engl J Med. 2000;343(26):1910-1916
3. Van Dyke DL, Shanafelt TD, Call TG, et al. A comprehensive evaluation of the prognostic significance of 13q deletions in patients with B-chronic lymphocytic leukaemia. Br J Haematol. 2010;148:544-550
4. Shanafelt TD. Predicting clinical outcome in CLL: how and why. Hematology Am Soc Hematol Educ Program. 2009;421-429
5. Van Dyke DL, Werner L, Rassenti LZ, et al. The Dohner fluorescence in situ hybridization prognostic classification of chronic lymphocytic leukaemia (CLL): the CLL Research Consortium experience. Br J Haematol. 2016;173(1):105-113
6. Fang H, Reichard KK, Rabe KG, et al. IGH translocations in chronic lymphocytic leukemia: Clinicopathologic features and clinical outcomes. Am J Hematol. 2019;94(3):338-345
7. Huh YO, Schweighofer CD, Ketterling RP, et al. Chronic lymphocytic leukemia with t(14;19)(q32;q13) is characterized by atypical morphologic and immunophenotypic features and distinctive genetic features. Am J Clin Pathol. 2011;135(5):686-696
Method Description
Describes how the test is performed and provides a method-specific reference
This test is performed using commercially available and laboratory-developed probes. Deletion of chromosomes 6q, 11q, 13q and 17p, and trisomy of chromosome 12 are detected using enumeration strategy probes. Rearrangements involving CCND1 are detected using a dual-color break-apart (BAP) strategy probe. A dual-color, dual-fusion fluorescence in situ hybridization (D-FISH) strategy probe set is used to detect IGH::CCND1 rearrangements and for reflex testing to identify IGH::BCL3 rearrangements. For enumeration and BAP strategy probe sets, 100 interphase nuclei are scored; 200 interphase nuclei are scored when D-FISH probes are used. All results are expressed as the percent abnormal nuclei.(Unpublished Mayo method)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.
Monday through Friday
Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
Fees :
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.
- Authorized users can sign in to Test Prices for detailed fee information.
- Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
- Prospective clients should contact their account representative. For assistance, contact Customer Service.
Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.
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
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
CPT codes are provided by the performing laboratory.
CPT codes are provided by the performing laboratory.
88271x12, 88275x6, 88291-FISH Probe, Analysis, Interpretation; 6 probe sets
88271x2, 88275-FISH Probe, Analysis; each additional probe set (if appropriate)
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| CLLDF | CLL, Diagnostic FISH | 101788-8 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| 610714 | Result Summary | 50397-9 |
| 610715 | Interpretation | 69965-2 |
| 610716 | Result Table | 93356-4 |
| 610717 | Result | 62356-1 |
| GC088 | Reason for Referral | 42349-1 |
| GC089 | Specimen | 31208-2 |
| 610718 | Source | 31208-2 |
| 610719 | Method | 85069-3 |
| 610720 | Additional Information | 48767-8 |
| 610721 | Disclaimer | 62364-5 |
| 610722 | Released by | 18771-6 |