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HelpTest Code LPLFX Lymphoplasmacytic Lymphoma/Waldenstrom Macroglobulinemia, MYD88 L265P with Reflex to CXCR4, Varies
Reporting Name
Reflex Testing of MYD88 and CXCR4Performing Laboratory
Mayo Clinic Laboratories in Rochester
Useful For
Establishing a diagnosis of lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia (LPL/WM)
Helping distinguish LPL/WM low-grade B-cell lymphoma from other subtypes
Aiding in the prognosis and clinical management of lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia
Method Name
Allele-Specific Polymerase Chain Reaction (AS-PCR)/Bridged Nucleic Acids (BNA) Clamp Sanger Sequencing/Routine Sanger Sequencing
(BNAClamp is utilized pursuant to a license agreement with BNA Inc.)
Shipping Instructions
Whole blood or bone marrow specimens must arrive within 10 days of collection.
Necessary Information
The following information is required:
1. Pertinent clinical history
2. Clinical or morphologic suspicion
3. Date and time of collection
4. Specimen source
Specimen Required
Submit only 1 of the following specimens:
Preferred:
Specimen Type: Bone marrow
Container/Tube:
Preferred: Lavender top (EDTA)
Acceptable: Yellow top (ACD)
Specimen Volume: 2 mL
Collection Instructions:
1. Invert several times to mix bone marrow
2. Send bone marrow specimen in original tube. Do not aliquot.
3. Label specimen as bone marrow
Specimen Stability Information: Ambient (preferred)/Refrigerated
Specimen Type: Paraffin-embedded tissue
Container/Tube: Paraffin block
Specimen Stability: Ambient
Specimen Type: Paraffin-embedded bone marrow aspirate clot
Container/Tube: Paraffin block
Specimen Stability: Ambient
Specimen Type: Tissue
Slides: Unstained slides
Specimen Volume: 10 to20 slides
Additional Information: Tissue must demonstrate involvement by a hematologic neoplasm (eg, acute myelocytic leukemia), not solid tumors.
Specimen Stability Information: Ambient
Acceptable:
Specimen Type: Whole blood
Container/Tube:
Preferred: Lavender top (EDTA)
Acceptable: Yellow top (ACD)
Specimen Volume: 3 mL
Collection Instructions:
1. Invert several times to mix blood
2. Send whole blood specimen in original tube. Do not aliquot.
3. Label specimen as blood
Specimen Stability Information: Ambient (preferred)/Refrigerated
Specimen Type: Extracted DNA
Container/Tube: 1.5- to 2-mL tube with indication of volume and concentration of the DNA
Specimen Volume: Entire specimen
Collection Instructions: Label specimen as extracted DNA and list the specimen source. Include indication of volume and concentration of the DNA.
Specimen Stability Information: Frozen (preferred)/Refrigerated/Ambient
Specimen Type
VariesSpecimen Minimum Volume
Whole blood, Bone marrow: 1 mL
Extracted DNA: 50 mcL with a concentration of at least 20 nanograms per mcL
Other specimen types: See Specimen Required
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Varies | 10 days |
Reject Due To
| Gross hemolysis | Reject |
| B5-fixed tissues Decalcified bone marrow biopsies Methanol-acetic acid (MAA)-fixed pellets Paraffin shavings Frozen tissue Moderately to severely clotted |
Reject |
Reference Values
MYD88 L265P: Mutation present or absent based on expected variant polymerase chain reaction product size for the MYD88 gene (NCBI accession NM_002468.4).
CXCR4: Mutation present or absent in the test region c. 898-1059 (amino acids 300-353) of the CXCR4 gene (NCBI NM_003467.2, GRCh37).
Interpretation
Mutation present or not detected; an interpretive report will be issued.
Day(s) Performed
Monday through Friday
Report Available
7 to 10 daysTest Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
81305
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| LPLFX | Reflex Testing of MYD88 and CXCR4 | 82140-5 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| MP042 | Specimen Type | 31208-2 |
| 601511 | LPLFX Reflex Result | 82140-5 |
| 601510 | Final Diagnosis | 50398-7 |
Forms
1. Hematopathology Patient Information (T676)
2. If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| CXCFX | CXCR4, Gene Mutation, Reflex | Yes, (order CXLPL), Bill Only | No |
Testing Algorithm
The algorithm starts with the sensitive MYD88 L265P testing by allele-specific polymerase chain reaction. If a MYD88 L265P variant is detected, additional CXCR4 testing will be performed. If a MYD88 L265P variant is not detected, the algorithm ends, and no further testing is necessary.