Acute Myeloid Leukemia — 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 acute myeloid leukemia (AML) or acute promyelocytic leukemia (APL) for diagnostic and prognostic purposes as well as for follow-up to evaluate patient response to therapy.

Synonyms: FISH, Hematopoietic malignancy, acute myeloid leukemia, AML, acute promyelocytic leukemia, APL

Methodology: Fluorescence in situ hybridization (FISH) analysis.

Performed: Monday through Friday

Reported: 2-3 days

Panels: AML Panel – t(3;3) or inv(3)(MECOM/RPN1), 5q, t(6;9)(DEK/NUP214), 7q, 8 centromere/20q, t(8;21)(RUNX1T1/RUNX1), t(11;var)(NUP98), t(11;var)(KMT2A, formerly MLL), t(15;17)(PML/RARA), inv(16)(CBFB/MYH11).

Each probe may also be ordered individually.

STAT t(15;17): Patients with a possible diagnosis of acute promyelocytic leukemia (APL) have life threatening clinical acute symptoms that require prompt treatment.  Lysis of neoplastic cells may lead to disseminated intravascular coagulopathy. For this reason, FISH for t(15;17) must be completed rapidly to assist the clinician in making appropriate patient care decisions. Preliminary results are generally conveyed to the physician within 24 hours of specimen receipt.     

Collect: Non-diluted bone marrow aspirate in sodium heparin (dark green top) 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. See Solid Tumors (Paraffin-Embedded Tissue – PET) – FISH Analysis for information for submitting PET 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. Morrissette JJ and Bagg A. Acute myeloid leukemia: conventional cytogenetics, FISH, and moleculocentric methodologies. Clin Lab Med 31(4):659-686, 2011. PMID: 22118743.

3. Grimwade D, Hills RK, Moorman AV, et al: Refinement of cytogenetics classification in acute myeloid leukemia: determination of prognostic significance or rare recurring chromosomal abnormalities among 5879 younger adult patients treated in the United Kingdom Research Council trials. Blood 116(3):354-365, 2010. PMID: 20385793.