[NancyStLou]

FISH results - IGH-MAF fusion and others

by NancyStLou on Sun Dec 28, 2014 12:57 am

Just looked at my FISH test results from a recent bone marrow biopsy (BMB). My myeloma numbers are once again on the rise after two years of maintenance free remission since auto stem cell transplant. Transplant did leave me with lower blood counts, including platelets, so maintenance drugs were not used.

FISH now reads as follows – very confusing – except of course the words that pop out of "poor prognosis." Sorry for the gobbly goop that follows, but such are the test results. As I read this, it sounds that the 14;16 IGH_MAF fusion and the gains of three 1q signals are not good indicators for me.

Any help in interpreting would be appreciated. Will be calling my doctor for his translation also, but am curious what info I can receive here. Thanks in advance.

"The multiple myeloma interphase fluorescence in situ hybridization (FISH) panel analysis of CD138+ enriched plasma cells was positive for a single IGH-MAF fusion signal, three 1q signals, and loss of 13q14/q34 signals consistent with monosomy 13. There were no cells with FGFR3-IGH or CCND1-IGH fusion. Results for TP53 were normal. No aneuploidies for chromosomes 7, 9 and 15 were observed. The observed IGH-MAF signal pattern suggests that MAF and IGH were deleted from the non-oncogenic derivative chromosome or that the non-oncogenic derivative chromosome was lost. The translocation 14;16, resulting in IGH-MAF fusion, is reported to have a poor prognosis in multiple myeloma. Gains of 1q have been associated with advanced disease and adverse outcome in patients with multiple myeloma. Loss of the tumor suppressor genes at 13q is a recurrent finding in multiple myeloma.

SPECIFIC PROBE RESULTS:

IGH/MAF: ABNORMAL nuc ish 14q32(IGHx2),16q23(MAFx2)(IGH con MAFx1)[60/100] .
1p36/1q21: ABNORMAL nuc ish 1p36.3(SRDx2),1q21(CKS1Bx3)[50 /100] .
13q: ABNORMAL nuc ish 13q14(DLEU1x1),13q34(TFDP1x1)[ 44/100] .
FGFR3/IGH: NORMAL nuc ish 4p16(FGFR3x2),14q32(IGHx2)[100 ] .
CCND1/IGH: NORMAL nuc ish 11q13(CCND1x2),14q32(IGHx2)[10 0] .
TP53: NORMAL nuc ish 17p13(TP53x2)[100] .
CEP7/9/15: NORMAL nuc ish 7cen(D7Z1x2),9cen(D9Z4x2),15ce n(D15Z4x2)[100]"

[Multibilly]

Re: FISH results - IGH-MAF fusion and others

by Multibilly on Sun Dec 28, 2014 10:16 am

Hi Nancy,

These results are always difficult for any layman to interpret.

But I believe you got the main takeaways right (but I'm not a pathologist, so take this with a grain of salt):

• "1q gain" - also known as a "1q+"
• "Translocation (14;16)" - also known as a "t(14;16)"

The Mayo mSMART guidelines touch on these mutations as intermediate and high risk cyto­genetic features, respectively.

http://www.msmart.org/newly%20diagnosed%20myeloma.pdf

The interpretations in your report are based on a visual examination of the FISH probe patterns. So, of course, your doc really needs to make the final call on these results.

[NancyStLou]

Re: FISH results - IGH-MAF fusion and others

by NancyStLou on Mon Dec 29, 2014 2:54 pm

Thank you MultiBilly! This was very helpful! Am awaiting callback from my doctor now and I can talk to him from a more educated point of view because of your posting. Thank you!