Alternative Name
Large B-Cell Lymphoma
Methodology
FISH
Test Description

Probes: BCL6 (3q27) | MYC (8q24) | IgH/BCL2 t(14;18) | Optional probes: MYC/IgH/CEN8 t(8;14) [available to all clients] and BCL2 (18q21) [non-New York clients only]
Disease(s): B-cell lymphoma, double-hit lymphoma, triple-hit lymphoma

Clinical Significance

This panel differentiates double-hit or triple-hit lymphomas (which have MYC rearrangements together with BCL2 and/or BCL6 rearrangements) from Burkitt lymphoma or diffuse large B-cell lymphoma. Double-hit and triple-hit lymphomas are difficult to classify morphologically without aid of cytogenetics/FISH or IHC, and are associated with an aggressive course. Testing is indicated when B-cell lymphoma patients experience transformation, relapse, or refractory disease. Clients may choose to add MYC/IgH/CEN8 t(8:14) and/or BCL2 breakapart testing to their initial test order. MYC/IgH/CEN8 will confirm heavy chain rearrangement when MYC is rearranged. BCL2 breakapart allows inclusion of BCL2 rearrangements other than IgH/BCL2 t(14;18).

 Clients may want to consider the High-Grade B-Cell Lymphoma Reflex FISH Panel as a cost-effective alternative.

Specimen Requirements
  • Bone marrow aspirate: 1-2 mL sodium heparin tube. EDTA tube is acceptable.
  • Peripheral blood: 2-5 mL sodium heparin tube. EDTA tube is acceptable.
  • Fresh, unfixed tissue: Tissue in RPMI.
  • Fluids: Equal parts RPMI to specimen volume.
  • Paraffin block: H&E slide (required) plus paraffin block. Circle H&E for tech-only. Testing on this specimen type is not yet available for NY specimens.
  • Cut slides: H&E slide (required) plus 6 unstained slides cut at 4 microns. Circle H&E for tech-only. Testing on this specimen type is not yet available for NY specimens.
Storage and Transportation

Refrigerate fresh specimens. Do not freeze. Use cold pack for transport, making sure cold pack is not in direct contact with specimen.

CPT Code(s)*
88374x3 automated. Add 88374x1 for each of the two optional probes sets ordered. Codes may differ if manual analysis is performed.
Turnaround Time

4 days for both unfixed and FFPE specimens

Level of Service
Global
Technical

*The CPT codes provided with our test descriptions are based on AMA guidelines and are for informational purposes only. Correct CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed.