Test ID: FMFC
Myeloma, FISH, Fixed Cells

Aiding in the diagnosis of new cases of multiple myeloma

Identifying prognostic markers based on the anomalies found

The number of probes ordered will determine the price of the testing. When this test is ordered, a charge for 2 FISH probes and interpretation is included. If additional probes or the entire panel are ordered, additional probe charges will be added.

• Cytogenetics Hematologic FISH Panel Patient Information Sheet

Fluorescence In Situ Hybridization (FISH)

Provide a reason for referral with each specimen. The laboratory will not reject testing if this information is not provided, but appropriate testing and interpretation may be compromised or delayed.

Provide a pathology report with each specimen.

Container/Tube: Sterile container

Specimen Volume: 1 fixed cell pellet

Collection Instructions: Place specimen in a sterile container with a 3:1 (or similar) fixative (methanol:glacial acetic acid).

Additional Information: Advise Express Mail or equivalent if not on courier service.

Forms:

1. Cytogenetics Hematologic FISH Panel Patient Information Sheet (Supply T603) in Special Instructions

2. If not ordering electronically, submit a Cytogenetics Hematologic Disorders Request Form (Supply T607) with the specimen.

Multiple myeloma is a hematologic neoplasm that generally originates in the bone marrow and develops from malignant plasma cells. There are 4 main categories of myeloma: asymptomatic myeloma, smoldering myeloma, indolent myeloma, and multiple myeloma. Asymptomatic myeloma patients have nonspecific symptoms that may be attributed to other diseases. Generalized bone pain, anemia, numbness or limb weakness, symptoms of hypercalcemia, and recurrent infections are all symptoms that may indicate myeloma. In smoldering myeloma there is a monoclonal protein spike, but it is stable. Indolent myeloma is a slowly progressing myeloma.

As myeloma progresses, the malignant plasma cells interfere with normal blood product formation in the bone marrow resulting in anemia and leukopenia. Myeloma also causes an overstimulation of osteoclasts, causing excessive breakdown of bone tissue without the normal corresponding bone formation. These bone lesions are seen in approximately 66% of myeloma patients. In advanced disease, bone loss may reach a degree where the patient suffers fractures easily.

An interpretive report will be provided.

A neoplastic clone is detected when the percent of cells with an abnormality exceeds the normal reference range for any given probe.

This test is not approved by the FDA and is best used as an adjunct to existing clinical and pathologic information.

The establishment of normal cutoffs on fixed cell pellets was determined based on analysis of 25 normal bone marrow specimens. Validation of the probes was performed on 81 specimens referred with an indication of myeloma using the cytoplasmic immunoglobulin (cIg) FISH method. Of these 81 specimens, 45 had sufficient plasma cells for analysis (at least 25 plasma cells per hybridization site). Of 45 specimens, 44 (98%) specimens were found to be abnormal for the probe sets used.

1. Fonseca R, Blood E, Rue M, et al: Clinical and biologic implications of recurrent genomic aberrations in myeloma. Blood 2003 Jun 1;101(11):4569-4575

2. Fonseca R, Blood EA, Oken MM, et al: Myeloma and the t(11;14) (q13;q32); evidence for a biologically defined unique subset of patients. Blood 2002 May 15;99(10):3735-3741

3. Shaughnessy J, Tian E, Sawyer J, et al: High incidence of chromosome 13 deletion in multiple myeloma detected by multiprobe interphase FISH. Blood 2000 Aug 15;96(4):1505-1511

This test uses commercially available and laboratory-developed chromosome-specific fluorescent-labeled DNA probes for FISH testing. Deletions or monosomies of chromosomes 13 and 17 are detected using FISH enumeration strategies. Centromere probes are used to detect chromosomal aneusomies for chromosomes 3, 7, 9, and 15. Translocations involving chromosome 14 (IGH) with chromosomes 4 (FGFR3), 6 (CCND3), 11 (CCND1), 16 (MAF), or 20 (MAFB) are detected by D-FISH strategies. For the enumeration and BAP probe sets, 200 interphase nuclei are scored and for the D-FISH probe sets, 500 interphase nuclei are scored. Results for each abnormal probe set are expressed as percent abnormal nuclei. (Shaughnessy J, Tian E, Sawyer J, et al: High incidence of chromosome 13 deletion in multiple myeloma detected by multiprobe interphase FISH. Blood 2000 Aug 15;96[4]:1505-1511)

Samples processed Monday through Sunday. Results reported Monday through Friday, 8 a.m.-5 p.m. CST.

Myeloma, FISH, Fixed Cells

88271 x 2-DNA probe, each

88275 x 2-Interphase in situ hybridization

88291-Interpretation and report

One Additional FISH Probe

88271-DNA probe, each (if appropriate)

88275-Interphase in situ hybridization (if appropriate)

Two Additional FISH Probes

88271 x 2-DNA probe, each (if appropriate)

88275-Interphase in situ hybridization (if appropriate)

Three Additional FISH Probes

88271 x 3-DNA probe, each (if appropriate)

88275-Interphase in situ hybridization (if appropriate)

Four Additional FISH Probes

88271 x 4-DNA probe, each (if appropriate)

88275 x 2-Interphase in situ hybridization (if appropriate)

Five Additional FISH Probes

88271 x 5-DNA probe, each (if appropriate)

88275 x 2-Interphase in situ hybridization (if appropriate)

Six Additional FISH Probes

88271 x 6-DNA probe, each (if appropriate)

88275 x 3-Interphase in situ hybridization (if appropriate)

Seven Additional FISH Probes

88271 x 7-DNA probe, each (if appropriate)

88275 x 3-Interphase in situ hybridization (if appropriate)

Eight Additional FISH Probes

88271 x 8-DNA probe, each (if appropriate)

88275 x 4-Interphase in situ hybridization (if appropriate)

Nine Additional FISH Probes

88271 x 9-DNA probe, each (if appropriate)

88275 x 4-Interphase in situ hybridization (if appropriate)

Ten Additional FISH Probes

88271 x 10-DNA probe, each (if appropriate)

88275 x 5-Interphase in situ hybridization (if appropriate)

Eleven Additional FISH Probes

88271 x 11-DNA probe, each (if appropriate)

88275 x 5-Interphase in situ hybridization (if appropriate)

Twelve Additional FISH Probes

88271 x 12-DNA probe, each (if appropriate)

88275 x 6-Interphase in situ hybridization (if appropriate)

Thirteen Additional FISH Probes

88271 x 13-DNA probe, each (if appropriate)

88275 x 6-Interphase in situ hybridization (if appropriate)

Fourteen Additional FISH Probes

88271 x 14-DNA probe, each (if appropriate)

88275 x 7-Interphase in situ hybridization (if appropriate)

Fifteen Additional FISH Probes

88271 x 15-DNA probe, each (if appropriate)

88275 x 7-Interphase in situ hybridization (if appropriate)

Sixteen Additional FISH Probes

88271 x 16-DNA probe, each (if appropriate)

88275 x 8-Interphase in situ hybridization (if appropriate)

Seventeen Additional FISH Probes

88271 x 17-DNA probe, each (if appropriate)

88275 x 8-Interphase in situ hybridization (if appropriate)

Eighteen Additional FISH Probes

88271 x 18-DNA probe, each (if appropriate)

88275 x 9-Interphase in situ hybridization (if appropriate)

Nineteen Additional FISH Probes

88271 x 19-DNA probe, each (if appropriate)

88275 x 9-Interphase in situ hybridization (if appropriate)

Twenty Additional FISH Probes

88271 x 20-DNA probe, each (if appropriate)

88275 x 10-Interphase in situ hybridization (if appropriate)

 Twenty One Additional FISH Probes

88271 x21-DNA probe, each (if appropriate)

88275 x10-Interphase in situ hybridization (if appropriate)

Twenty Two Additional FISH Probes

88271 x22-DNA probe, each (if appropriate)

88275 x11-Interphase in situ hybridization (if appropriate)

Twenty Three Additional FISH Probes

88271 x23-DNA probe, each (if appropriate)

88275 x11-Interphase in situ hybridization (if appropriate)

Twenty Four Additional FISH Probes

88271 x24-DNA probe, each (if appropriate)

88275 x12-Interphase in situ hybridization (if appropriate)

Twenty Five Additional FISH Probes

88271 x25-DNA probe, each (if appropriate)

88275 x12-Interphase in situ hybridization (if appropriate)

Twenty Six Additional FISH Probes

88271 x26-DNA probe, each (if appropriate)

88275 x13-Interphase in situ hybridization (if appropriate)

Twenty Seven Additional FISH Probes

88271 x27-DNA probe, each (if appropriate)

88275 x13-Interphase in situ hybridization (if appropriate)

Twenty Eight Additional FISH Probes

88271 x28-DNA probe, each (if appropriate)

88275 x14-Interphase in situ hybridization (if appropriate)

Twenty Nine Additional FISH Probes

88271 x29-DNA probe, each (if appropriate)

88275 x14-Interphase in situ hybridization (if appropriate)

Thirty Additional FISH Probes

88271 x30-DNA probe, each (if appropriate)

88275 x15-Interphase in situ hybridization (if appropriate)