Test ID BALAF B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), FISH, Adult, Varies
Ordering Guidance
This test is only performed on specimens from patients with B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/LBL) who are 31 years of age or older.
This test is intended to be ordered when the entire B-ALL/LBL 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 BALPF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), Pediatric, FISH, 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 COGBF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), Children's Oncology Group Enrollment Testing, FISH, Varies
-If TALAF / T-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), Adult, FISH, Varies, is ordered concurrently with this test, the laboratory may cancel BALAF and automatically reorder as BALMF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), Specified FISH, Varies with the following FISH probes: ETV6/RUNX1, PBX1/TCF3, 4/10/17, break-apart IGH, break-apart CRLF2, break-apart P2RY8, break-apart ABL2, and IKZF1/cep7. If an abnormality is identified that would result in reflex testing in BALAF, the same reflex testing will be performed in the BALMF. This cancellation is necessary to avoid duplicate testing. Probes for break-apart PDGFRB, break-apart JAK2, CDKN2A/D9Z1, ABL1/BCR, break-apart ABL1, break-apart MLL, TP53/D17Z1 will still be performed as part of the adult T-ALL FISH panel.
If PHLDF / Philadelphia Chromosome-like Acute Lymphoblastic Leukemia (Ph-like ALL), Diagnostic FISH, Varies, is ordered concurrently with this test, PHLDF testing will be canceled. The probes offered in PHLDF are included within this test, when appropriate.
If limited B-cell ALL FISH probes are preferred, order BALMF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), Specified FISH, Varies.
At follow-up, conventional cytogenetic studies (CHRBM / Chromosome Analysis, Hematologic Disorders, Bone Marrow) and targeted B-ALL FISH probes can be evaluated based on the abnormalities identified in the diagnostic study. Order BALMF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma (ALL), Specified FISH, Varies and request specific probes or abnormalities.
If the patient clinically relapses, a conventional chromosome study may be useful to identify cytogenetic changes in the neoplastic clone or the possible emergence of a new therapy-related myeloid clone.
For patients with B-cell lymphoma, order BLPMF / B-Cell Lymphoma, Specified FISH, Varies.
For testing paraffin-embedded tissue samples from patients with B-ALL/LBL, order BLBLF / B-Cell Acute Lymphoblastic Leukemia/Lymphoma, FISH, Tissue. If a paraffin-embedded tissue sample is submitted for this test, it will be canceled and BLBLF will be added and performed as the appropriate test.
Additional Testing Requirements
At diagnosis, conventional cytogenetic studies (CHRBM / Chromosome Analysis, Hematologic Disorders, Bone Marrow) and this panel should be performed per National Comprehensive Cancer Network guidelines. If there is limited specimen available, only this test will be performed.
Shipping Instructions
Advise Express Mail or equivalent if not on courier service.
Necessary Information
A reason for testing and a flow cytometry and/or 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 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:
Specimen Type: Bone marrow
Container/Tube:
Preferred: Yellow top (ACD)
Acceptable: Green top (heparin) or lavender top (EDTA)
Specimen Volume: 2-3 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 specimen in original tube. Do not aliquot.
Acceptable
Specimen Type: Whole 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 specimen in original tube. Do not aliquot.
Useful For
Detecting a neoplastic clone associated with the common chromosome abnormalities and classic rearrangements seen in adult patients with B-cell acute lymphoblastic leukemia/lymphoma (B-ALL/LBL)
An adjunct to conventional chromosome studies for patients with B-ALL/LBL
Evaluating specimens in which standard cytogenetic analysis is unsuccessful
Testing Algorithm
The initial panel includes testing for the following abnormalities using the probes listed:
t(9;22), BCR/ABL1
t(X;14)(p22.33;q32)/ t(Y;14)(p11.32;q32), CRLF2/IGH
If results for the initial panel are negative, the following reflex probe sets will be performed as a secondary panel:
1q25 rearrangement, ABL2 break-apart
5q32 rearrangement, PDGFRB break-apart
9p24.1 rearrangement, JAK2 break-apart
9q34 rearrangement, ABL1 break-apart
t(Xp22.33;var) or t(Yp11.32;var), CRLF2 rearrangement
t(Xp22.33;var) or t(Yp11.32;var), P2RY8 rearrangement
Finally, if results for the secondary panel are negative, the following probe sets will be performed as a tertiary panel:
t(1;19)(q23;p13), PBX1/TCF3 fusion
Hyperdiploidy, +4,+10,+17: D4Z1/D10Z1/D17Z1
t(12;21)(p13;q22), ETV6/RUNX1 & iAMP21
14q32 rearrangement, IGH break-apart
11q23 rearrangement, MLL(KMT2A) break-apart
When a KMT2A (MLL) rearrangement is identified, reflex testing will be performed to identify the translocation partner. Probes include identification of:
t(4;11)(q21;q23) AFF1/MLL
MLLT4(AFDN)/MLL
t(6;11)(q27;q23)
t(9;11)(p22;q23) MLLT3/MLL
t(10;11)(p12;q23) MLLT10/MLL
t(11;19)(q23;p13.1) MLL/ELL
t(11;19)(q23;p13.3) MLL/MLLT1
For more information, see B-Lymphoblastic Leukemia/Lymphoma Algorithm.
Special Instructions
Method Name
Fluorescence In Situ Hybridization (FISH)
Reporting Name
Adult ALL (B-cell), FISHSpecimen Type
VariesSpecimen 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 daysPerforming Laboratory

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 x4,88275 x2, 88291 - FISH Probe, Analysis, Interpretation; 2 probe sets
88271 x2, 88275 - FISH Probe, Analysis; each additional probe set (if appropriate)
88271 - FISH Probe (if appropriate)
LOINC Code Information
Test ID | Test Order Name | Order LOINC Value |
---|---|---|
BALAF | Adult ALL (B-cell), FISH | In Process |
Result ID | Test Result Name | Result LOINC Value |
---|---|---|
609538 | Result Summary | 50397-9 |
609539 | Interpretation | 69965-2 |
609540 | Result Table | 93356-4 |
609541 | Result | 62356-1 |
GC065 | Reason for Referral | 42349-1 |
GC066 | Specimen | 31208-2 |
609542 | Source | 31208-2 |
609543 | Method | 85069-3 |
609544 | Additional Information | 48767-8 |
609545 | Disclaimer | 62364-5 |
609546 | Released By | 18771-6 |
Forms
If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.