Chronic Lymphocytic Leukemia (CLL) — FISH Analysis

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 and track chromosome abnormalities in patients with chronic lymphocytic leukemia (CLL) for diagnostic and prognostic purposes as well as for follow-up to evaluate patient response to therapy.

Synonyms: FISH, Hematopoietic malignancy, Chronic Lymphocytic Leukemia, CLL, Chronic Lymphoid Leukemia, fluorescence in situ hybridization

Methodology: Fluorescence in situ hybridization (FISH) analysis.

Performed: Monday through Friday

Reported: 2-3 days

Panels: CLL Panel – 6q21 (PRDM1) with 6q23.3 (MYB), ATM (11q22.3) with TP53 (17p13.1), 12 centromere with D13S319 (13q14.2) and LAMP1 (13q34)

Collect: Blood in dark green-top sodium heparin tube, heparinized syringe (invert several times to mix); OR non-diluted bone marrow aspirate in dark green-top sodium heparin tube, heparinized syringe (invert to mix), or flask with sterile media (provided upon request).

Specimen Volume: Preferred: 7-10 mL blood OR 2 mL bone marrow; 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. Cramer P and Hallek M. Prognostic factors in chronic lymphocytic leukemia-what do we need to know? Nat Rev Clin Oncol 8(1):38-47, 2011. PMID: 20956983.

3. Dewald GW, et al. Chromosome anomalies detected by interphase FISH: correlation with significant biological features of B-cell chronic lymphocytic leukemia. Brit J Haematol 121(2):287-295, 2003. PMID: 12694251.

4. Dohner H, et al. Genomic aberrations and survival in chronic lymphocytic leukemia. N Engl J Med 343(26):1910-1916, 2000. PMID: 11136261.