Acute lymphoblastic Leukemia Testing – Update
Dr. J. Armstrong
5/8/2024
B-ALL: ClonoSEQ
- We can now send material to Adaptive Biotechnologies for ClonoSEQ MRD testing, which is composed of two tests as follows:
1. ClonoSEQ B-Cell Clonality (ID): Performed on initial diagnostic material OR relapse
§ Requires high tumor burden sample
§ May be done on the following samples:
· Fresh peripheral blood
· Fresh bone marrow aspirate
· Non-decal FFPE sections (3-5 slides)
· Touch preps and aspirate smears (3-5 slides, will accept unstained or stained slides)
2. ClonoSEQ B-Cell Tracking (MRD): Performed on each follow-up sample
§ ID must be performed in order to run this test, but may be ordered concurrently with an ID order
§ Can only be run on fresh material (blood or bone marrow, bone marrow is preferred) – Contact oncology to request a peripheral blood sample if there is not enough marrow in EDTA to send for this test
- Please provide the following to the reference lab team (Crystal and Beverly at the moment):
1. Which test to order (clonality or tracking)
2. Indication (e.g. ALL in remission; ALL not having achieved remission)
3. Material to be sent out – Please also inform them of what type of material it is
4. Name of the oncologist taking care of the patient
§ Dr. Rios for adult patients (will include Dr. Taveras soon)
§ Specific oncologist for pedi patients (most, if not all, should be available in the online portal)
- I am planning on putting together a “requisition” that would include the necessary information, and will distribute it once complete.
- Per discussion with adult oncology service, B-ALL MRD flow cytometry is still desired given the prolonged TaT for ClonoSEQ (2-3 weeks in general)
T-ALL follow-up
- For all T-ALL follow-up patients, MRD flow cytometry is available through PhenoPath. Requisitions are in the hemepath signout room.
1. Polly Vinuya needs to be alerted as soon as we have received the sample, as it requires paperwork to be completed by Quest and faxed over to PhenoPath (handled by Polly and Quest). Quest refuses to complete the paperwork prior to a sample being received.
2. ClonoSEQ T-Cell Tracking
T-ALL: New Diagnoses (recommendations)
- T-ALL testing at NeoGenomics is fairly limited at the moment. I recommend the following for new T-ALL cases:
1. Send the purple tops to NeoGenomics for flow cytometry and NOTCH1 mutation analysis. Other molecular studies such as NGS can be considered if the oncologist would like, but this is the minimum pedi oncology has requested.
NeoGenomics NGS (Neo Comprehensive-Heme Cancers): https://neogenomics.com/test-menu/neo-comprehensivetm-heme-cancers
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Neo Comprehensive™ - Heme Cancers | NeoGenomics Laboratories The Neo Comprehensive™ - Heme Cancers assay analyzes 433 genes to detect DNA and RNA alterations through NGS for the purpose of diagnostic evaluation, prognosis, risk stratification, and therapy guidance of hematologic malignancies. neogenomics.com |
2. Send one sodium heparin tube to Mayo for TALPF (pedi FISH, <31 years old) or TALAF (adult FISH, >/=31 years old).
Mayo FISH (TLBF): https://www.mayocliniclabs.com/test-catalog/overview/65413#Specimen
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TLBLF - Overview: T-Lymphoblastic Leukemia/Lymphoma, FISH, Tissue Detecting a neoplastic clone associated with the common chromosome abnormalities seen in patients with T-cell lymphoblastic leukemia or lymphoma |
§ If initial FISH studies demonstrate an abnormality that can be tracked by NeoGenomics (e.g. CDKN2A deletion), we can do so.
3. Conventional cytogenetic studies can be performed either at NeoGenomics or Mayo
4. ClonoSEQ T-Cell Clonality
- All of this can also be done on blood as needed.
Sample Template
