Detecting the prognostically significant cytogenetics FISH abnormalities used in the CLL/SLL NCCN guidelines
Only one specimen tube is required to perform all ordered cytogenetics testing.
The more testing ordered, the closer to the optimal volume requirements is preferred.
Dk green Sodium heparin (Na hep), no gel
EDTA whole blood (not recommended)
Bone marrow
Collect bone marrow aspirate in a sterile Sodium heparin (Na hep) syringe and transfer to a sterile vial/tube
- or -
Collect bone marrow in sterile syringe (non-heparinized) and transfer to a Dk green Sodium heparin (Na hep), no gel
Bone marrow:
Sterile vial/tube
Dk green Sodium heparin (Na hep), no gel
EDTA whole blood:
Lavender (EDTA), 4mL
Ambient
Fluorescence in situ hybridization (FISH)
Normal or Abnormal with interpretation
Deletion of ATM or TP53 are classified as unfavorable cytogenetics prognostic indicators in CLL/SLL.
Trisomy 12 and deletion of 13q14.3 are classified as neutral, however, CLL cases with a high proportion of cells with a deletion 13q14.3 do not do well.
6q21 deletions do not have any particular prognostic significance but help identify CLL patients when other FISH is negative.
MYC rearrangement is an indication of potential histologic (Richter’s) transformation to a more aggressive lymphoma.
CCND1/IGH is strictly used on newly diagnosed CLL/SLL patients in order to rule out mantle cell lymphoma.