High-Grade B-Cell Lymphoma Reflex FISH Panel

The High-Grade B-Cell Lymphoma Reflex 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/IgH/CEN8 will confirm heavy chain rearrangement when MYC is rearranged.

IGK/MYC t(2;8), IGL/MYC t(8;22) and BCL6/MYC t(3;8) studies are useful to further subclassify lymphomas that are positive for MYC gene rearrangements, but negative for the most common IGH/MYC translocation. In addition, when both MYC and BCL6 gene rearrangements are present, but no IGH/MYC translocation is identified, these studies may help to differentiate between the double-hit/triple-hit lymphomas (D/T-HL), which have a poor prognosis, and DLBCL with BCL6/IGH translocation, representing a subset of GC B-cell lymphomas distinct from conventional D/T-HL and with better prognosis (so-called "pseudo-double-hit lymphoma").

This reflex panel may be considered a cost-effective alternative to the High-Grade/Large B-Cell Lymphoma FISH Panel when clinical circumstances allow an additional few days for reflex testing if MYC is rearranged.

Bone Marrow Aspirate: 1-2 mL in sodium heparin tube. EDTA tube is acceptable.
Peripheral Blood: 2-5 mL in sodium heparin tube. EDTA tube is acceptable.
Fresh, Unfixed Tissue: Tissue in RPMI. Bone Marrow/Peripheral Blood Smear or Fresh Tissue Touch Preparation Slides: Minimum 3 slides, labeled with specimen type.
Fluids: Mix in equal parts with RPMI (specimen volume to RPMI ratio of 1:1).
Fixed Cell Suspension: A client-prepared fixed cell suspension is acceptable if received in 3:1 Methanol:Glacial Acetic Acid.
H&E slide (required) plus paraffin block.
Cut Slides: H&E slide (required) plus 4 unstained slides cut at 4-5 microns.