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Alternative Name
Large B-Cell Lymphoma
Test Description

Probes: BCL6 (3q27) | MYC (8q24) | BCL2 (18q21) | Optional probe: MYC/IgH/CEN8 t(8;14)

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. MYC rearranges with an immunoglobulin partner in approximately 60% of MYC-rearranged DLBCL/HGBCL of which 75% are MYC/IgH fusion. Clients may choose to add MYC/IgH/CEN8 t(8:14) testing to their initial test order. MYC/IgH/CEN8 will confirm heavy chain rearrangement when MYC is rearranged. In addition, a small subset of lymphomas with MYC rearrangement (4%) may be missed when using the MYC breakapart probe alone, but some of these cases may be detected using the MYC/IgH fusion probe set (PMID: 30523057).

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.
  • Cut slides: H&E slide (required) plus 6 unstained slides cut at 4 microns. Circle H&E for tech-only.
  • Note: Please exclude biopsy needles, blades, and other foreign objects from transport tubes. These can compromise specimen viability and yield, and create hazards for employees.
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 if the optional probe set is ordered. Codes may differ if manual analysis is performed
Turnaround Time

4 days for both unfixed and FFPE specimens

New York Approved
Level of Service

*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.