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Acute lymphoblastic leukemia (ALL) is a malignant disease of the lymphoid cell line occurring predominantly in children.
Tests generally appear in the order most useful for common clinical situations
| Test name: CBC with Platelet Count & Automated Differential |
| ARUP #: 0040003 |
| Methodology: Automated Cell Count with Flow Cell Differential |
| Use: Initial evaluation of suspected leukemia |
| Test name: Sudan Black B Stain |
| ARUP #: 0049040 |
| Methodology: Stain |
| Use: Differentiate type of leukemia |
| Test name: Esterase Stain, Specific |
| ARUP #: 0049055 |
| Methodology: Cytochemical Stain |
| Use: Differentiate type of leukemia |
| Test name: Leukemia/Lymphoma Phenotyping (Comprehensive - Whole Blood) |
| ARUP #: 0096299 |
| Methodology: Flow Cytometry |
| Use: Important test for workup as therapy; prognosis is different for B- and T-cells Available Antigens Included: |
| Test name: Leukemia/Lymphoma Phenotyping (Comprehensive - Bone Marrow) |
| ARUP #: 0095244 |
| Methodology: Flow Cytometry |
| Use: Important test for workup as therapy; prognosis is different for B- and T-cells Available Antigens Included: |
| Test name: TdT by Immunohistochemistry |
| ARUP #: 2004142 |
| Methodology: Immunohistochemistry |
| Use: Aid in histologic diagnosis of ALL Stained and returned to client pathologist; consultation available if needed |
| Test name: CD10 (CALLA) by Immunohistochemistry |
| ARUP #: 2003523 |
| Methodology: Immunohistochemistry |
| Use: Aid in histologic diagnosis of ALL Stained and returned to client pathologist; consultation available if needed |
| Test name: CD19 by Immunohistochemistry |
| ARUP #: 2005114 |
| Methodology: Immunohistochemistry |
| Use: Aid in histologic diagnosis of B-cell leukemia/lymphoma Stained and returned to client pathologist for interpretation; consultation available if needed |
| Test name: CD20, L26 by Immunohistochemistry |
| ARUP #: 2003532 |
| Methodology: Immunohistochemistry |
| Use: Aid in histologic diagnosis of ALL Stained and returned to client pathologist; consultation available if needed |
| Test name: CD79A by Immunohistochemistry |
| ARUP #: 2003800 |
| Methodology: Immunohistochemistry |
| Use: Aid in histologic diagnosis of ALL Stained and returned to client pathologist; consultation available if needed |
| Test name: CD3 by Immunohistochemistry |
| ARUP #: 2003508 |
| Methodology: Immunohistochemistry |
| Use: Aid in histologic diagnosis of ALL Stained and returned to client pathologist; consultation available if needed |
| Test name: Acute Lymphocytic Leukemia (ALL) Panel by FISH, Adult |
| ARUP #: 2002647 |
| Methodology: Fluorescence in situ Hybridization |
| Use: Provides prognostic information and supplements diagnosis in adult patients with B-ALL Detects the following genetic abnormalities: t(9;22) (BCR-ABL1) and rearrangements of MLL, TCF3(E2A), and IGH Rearrangement of MYC rarely present in pre-B-ALL adults; probe detects this abnormality |
| Limitations: Chromosome alterations outside regions complementary to these probes are not detected Other recurrent aberrations, such as hyperdiploidy and t(12;21), are rarely present in adults with B-ALL but may warrant additional FISH tests/chromosome analysis |
| Test name: Acute Lymphocytic Leukemia (ALL) Panel by FISH, Pediatric |
| ARUP #: 2002719 |
| Methodology: Fluorescence in situ Hybridization |
| Use: Provides prognostic information and supplements diagnosis in pediatric patients with B-ALL Detects the following genetic abnormalities: hyperdiploidy, t(9;22) (BCR-ABL1), t(12;21) (ETV6-RUNX1) and rearrangements of MLL, and TCF3(E2A) |
| Test name: Chromosome FISH, Interphase |
| ARUP #: 2002298 |
| Methodology: Fluorescence in situ Hybridization |
| Use: May be used to order individual probes rather than adult or pediatric ALL panels Translocations detected include: t(12;21) TEL-AML1(ETV6-RUNX1) fusion; t(9;22) BCR-ABL1 fusion; 14q32 IGH rearrangement; E2A rearrangement, 11q23 MLL rearrangement, and hyperdiploidy; CDNK2 (p16) deletions Indicate names of probes needed for testing ARUP Oncology FISH Probes menu |
| Test name: Chromosome Analysis, Bone Marrow |
| ARUP #: 2002292 |
| Methodology: Giemsa-Band Analysis |
| Use: Detect chromosome abnormalities in bone marrow aspirate consistent with the diagnosis of ALL, some of which also have classification and prognostic significance |
| Test name: ETV6-RUNX1 (TEL-AML1) Translocation, t(12;21) by RT-PCR |
| ARUP #: 0056008 |
| Methodology: Reverse Transcription Polymerase Chain Reaction |
| Use: Prognosticator for ALL |
| Limitations: Not designed to detect minimal residual disease Limit of detection is 1/100 cells |
| Test name: MLL-AFF1 (MLL-AF4) Translocation, t(4;11) by RT-PCR |
| ARUP #: 0050446 |
| Methodology: Reverse Transcription Polymerase Chain Reaction |
| Use: Prognosticator for ALL |
| Limitations: Negative result does not exclude the presence of t(4;11) translocation Not designed to detect minimal residual disease Limit of detection is 1/100 cells |
| Test name: TCF3-PBX1 (E2A-PBX1) Translocation, t(1;19) by RT-PCR |
| ARUP #: 0055346 |
| Methodology: Reverse Transcription Polymer/Polymerase Chain Reaction |
| Use: Follow up minimal residual disease Prognosticator for ALL |
| Limitations: Negative result does not exclude the presence of t(1;19) translocation |
| Test name: BCR-ABL1, Major (p210), Quantitative |
| ARUP #: 2005017 |
| Methodology: Reverse Transcription/Quantitative Polymerase Chain Reaction |
| Use: Identify and monitor p210 BCR-ABL1 mRNA fusion in a subset of ALL with confirmed p210 Ph+ Assess treatment milestones and detect early signs of resistance to TKI therapy |
| Limitations: Results must always be interpreted in context of morphologic and other relevant data and should not be used alone for diagnosis of malignancy Samples identified as negative may still harbor BCR-ABL1-positive cells at levels below limit of detection BCR-ABL1 mRNA with minor breakpoint (e1a2; p190) not detected |
| Test name: BCR-ABL1, Minor (p190), Quantitative |
| ARUP #: 2005016 |
| Methodology: Reverse Transcription/Quantitative Polymerase Chain Reaction |
| Use: Detect and monitor p190 BCR-ABL1 fusion found in an ALL subset Diagnosis, prognosis, and therapeutic monitoring in patients with confirmed p190 Ph+ leukemia |
| Limitations: Results must always be interpreted in context of morphologic and other relevant data and should not be used alone for diagnosis of malignancy Samples identified as negative may still harbor BCR-ABL1-positive cells at levels below limit of detection BCR-ABL1 mRNA with major breakpoint (e13a2, e14a2; p210) not detected |
| Test name: BCR-ABL1, Qualitative with Reflex to BCR-ABL1 Quantitative |
| ARUP #: 2005010 |
| Methodology: Reverse Transcription Polymerase Chain Reaction |
| Use: Detect presence of BCR-ABL1 fusion when form is unknown or unclear If either p210 or p190 fusion detected, appropriate quantitative test will be performed |
| Test name: BCR-ABL1, T315I Mutation Detection, Quantitative |
| ARUP #: 2004924 |
| Methodology: Reverse Transcription Polymerase Chain Reaction/Pyrosequencing |
| Use: Identify T315I mutation in patients using TKI-directed therapy (Gleevec) who have a known BCR-ABL1 translocation to determine therapy options |
| Limitations: Only the T315I mutation will be identified |