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Test ID AMLAF Acute Myeloid Leukemia (AML), FISH, Adult, Varies


Ordering Guidance


This test is only performed on specimens from patients with acute myeloid leukemia (AML) who are 31 years of age or older.

 

This test is intended for instances when the entire AML fluorescence in situ hybridization (FISH) panel is needed for an adult patient.

-If this test is ordered on a patient 30 years of age or younger, this test will be canceled and automatically reordered by the laboratory as AMLPF / Acute Myeloid Leukemia (AML), FISH, Pediatric, Varies.

- If this test is ordered and the laboratory is informed that the patient is on a Children's Oncology Group (COG) protocol, this test will be canceled and automatically reordered by the laboratory as COGMF / Acute Myeloid Leukemia (AML), Children's Oncology Group Enrollment Testing, FISH, Varies.

 

This test should not be used to screen for residual acute myeloid leukemia (AML). If the patient is being treated for known abnormalities or if limited AML FISH probes are preferred, order AMLMF / Acute Myeloid Leukemia (AML), Specified FISH, Varies and request specific probes or abnormalities.

 

At follow-up, targeted AML FISH probes can be evaluated based on the specific abnormalities identified in the diagnostic study. Order AMLMF and request specific probes or abnormalities.

 

For testing paraffin embedded tissue samples from patients with myeloid sarcoma, order MSTF / Myeloid Sarcoma, FISH, Tissue.



Shipping Instructions


Advise Express Mail or equivalent if not on courier service.



Necessary Information


A reason for testing and 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; however, appropriate testing and/or interpretation may be compromised or delayed in some instances. If not provided, an appropriate indication for testing may be entered by Mayo Clinic Laboratories.



Specimen Required


Submit only 1 of the following specimens:

 

Preferred:

Specimen Type: Bone marrow

Container/Tube:

Preferred: Yellow top (ACD)

Acceptable: Green top (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.

 

Acceptable:

Specimen Type: Blood

Container/Tube:

Preferred: Yellow top (ACD)

Acceptable: Green top (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.


Useful For

Detecting a neoplastic clone associated with recurrent chromosome abnormalities seen in adult patients with acute myeloid leukemia (AML) or other myeloid malignancies

 

An adjunct to conventional chromosome studies in patients with AML

 

Evaluating specimens in which standard cytogenetic analysis is unsuccessful

 

This test should not be used to screen for residual AML.

Testing Algorithm

This test includes a charge for the probe application, analysis, and professional interpretation of results for 4 probe sets (8 individual fluorescence in situ hybridization [FISH] probes). Additional charges will be incurred for all reflex or additional probe sets performed.

 

The initial panel includes testing for the following abnormalities using the probes listed:

-inv(16), [M4, Eos], MYH11/CBFB

-t(8;21), [M2], RUNX1T1/RUNX1

-t(15;17), [M3], PML/RARA

-11q23 rearrangement, [M0-M7], MLL (KMT2A)

 

If testing was ordered concurrently with a chromosomal study (CHRBM / Chromosome Analysis, Hematologic Disorders, Bone Marrow or CHRHB / Chromosome Analysis, Hematologic Disorders, Blood), secondary testing will not be performed. Appropriate secondary FISH probes will be recommended if the chromosome results are informative.

 

Based on the results from the initial panel, the following secondary panel of FISH probes will be performed, when appropriate, if testing was NOT ordered concurrently with a chromosomal study.

-t(6;9), [M2,M4], DEK/NUP214

-inv(3) or t(3;3), [M1,2,4,6,7], RPN1/MECOM

-5/5q-, D5S630/EGR1

-7/7q-, D7Z1/D7S486

-17p-, TP53/D17Z1

-t(9;22), ABL1/BCR

 

When an MLL (KMT2A) rearrangement is identified, appropriate 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(AFDN)/MLL, t(9;11)(p22;q23) MLLT3/MLL, t(10;11)(p12;q23) MLLT10/MLL, t(11;16)(q23;p13.3) MLL/CREBBP, t(11;19)(q23;p13.1) MLL/ELL or t(11;19)(q23;p13.3) MLL/MLLT1. In the event an 11q23 translocation is identified by conventional chromosome analysis, only the targeted MLL reflex probe will be performed if applicable.

 

In the absence of RPN1/MECOM and RUNX1/RUNX1T1 fusion, when an extra MECOM signal and an extra RUNX1 signal are identified, reflex testing using the MECOM/RUNX1 probe set will be considered at the laboratory's discretion to identify a potential t(3;21)(q26.2;q22) rearrangement. Laboratory discretion may be influenced by available karyotype results.

 

In the absence of RPN1/MECOM fusion, when an extra RPN1 signal is identified, reflex testing using the PRDM16/RPN1 probe set will be considered at the laboratory's discretion to identify a potential t(1;3)(p36;q21). Laboratory discretion may be influenced by available karyotype results.

 

In the absence of MYH11/CBFB fusion, when an extra CBFB signal is identified, reflex testing may be performed at the laboratory's discretion using the CBFB break-apart probe set to evaluate for the presence or absence of an CBFB rearrangement. Laboratory discretion may be influenced by available karyotype results.

 

In the absence of PML/RARA fusion, when an extra or atypical RARA signal is identified, testing using the 5'RARA/3'RARA rearrangement probe set may be performed at the laboratory's discretion to identify a potential variant translocation involving RARA. example: t(17;var)(q21;?). Laboratory discretion may be influenced by available karyotype results.

 

In the absence of BCR/ABL1 fusion, when an extra ABL1 signal is identified, reflex testing may be performed at the laboratory's discretion using the ABL1 break-apart probe set to evaluate for the presence or absence of an ABL1 rearrangement. Laboratory discretion may be influenced by available karyotype results.

 

The following algorithms are available:

Acute Promyelocytic Leukemia: Guideline to Diagnosis and Follow-up

Acute Leukemias of Ambiguous Lineage Testing Algorithm

Acute Myeloid Leukemia: Testing Algorithm

Method Name

Fluorescence In Situ Hybridization (FISH)

Reporting Name

Adult AML, FISH

Specimen Type

Varies

Specimen Minimum Volume

Blood: 2 mL
Bone Marrow: 1 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Ambient (preferred)
  Refrigerated 

Reference Values

An interpretive report will be provided.

Day(s) Performed

Monday through Friday

Report Available

7 to 10 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test Classification

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

88271 x 8, 88275 x 4, 88291-FISH Probe, Analysis, Interpretation; 4 probe sets

88271 x 2, 88275 FISH Probe, Analysis; each additional probe set (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
AMLAF Adult AML, FISH In Process

 

Result ID Test Result Name Result LOINC Value
609518 Result Summary 50397-9
609519 Interpretation 69965-2
609520 Result Table 93356-4
609521 Result 62356-1
GC059 Reason for Referral 42349-1
GC060 Specimen 31208-2
609522 Source 31208-2
609523 Method 85069-3
609524 Additional Information 48767-8
609525 Disclaimer 62364-5
609526 Released By 18771-6

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
AMLAB Probe, Each Additional (AMLAF) No, (Bill Only) No

Forms

If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.