[johanna]

Fish test has poor quality is it reliable ?

by johanna on Thu May 09, 2013 7:28 am

Hello,
Well we had quite a good day yesterday when Ian got FISH test results.
they are as follows :

13q14 (normal) / 13q34 (normal) / IGH (rearranged) / MYC (normal) / TP53 (normal)
alpha-17 (normal) / alpha-8 (normal)
a small subset of PC appear to show inbalanced IGH rearrangement, but it`s insufficinet to do further tests. NO evidence of TP53 gene DEL (Abbott/Vysis and Cytocell probes)
Fish on CD138 SELECTED pc
flow cytometry : PC = 2% of leucocytes & have neoplastic phenotype
CD19-CD56-CD27+CD45+(wk)

BUT , BMA had POOR quality .
my questions are :

1. How reliable is FISH when quality is poor ?
this was made (fish test) after Ian received 7 Cycles of chemo , CTD regimen , over 95 % reduction in m-protein (k light chain) disease is not stable , progressing
and starting next week Velcade 2 subcut. / week for 2 weeks + 10 days break.
the disease looks rather aggresive because of the massive rapid reduction of FLC in short period of time and how it`s behaving after 1 line therapy treatment but Fish looks normal ?!

2. The 3 main IGH translocations are : t(4;14)(p16;q32) , t(14;16)(q32;q23) & t(11;14)(q13;q32) so having small rearrangement on IGH includes all these translocations above i pressume ?

3. Most important question. How can you have such an aggresive type of LCMM and good FISH ? we don`t quite understand.

Last edited by johanna on Thu May 09, 2013 2:32 pm, edited 1 time in total.

[Multibilly]

Re: Questions on FISH test results

by Multibilly on Thu May 09, 2013 8:09 am

Hey There Johanna,

I'm not sure that I would agree that the FISH results are "good" or "normal" given there are three distinct translocations t(4;14), t(14;16) & t(11;14), a couple of which are somewhat significant. I'll send you a link directly that will give you some more insights on this.

[Dr. Edward Libby]

Re: Fish test has poor quality is it reliable ?

by Dr. Edward Libby on Sat May 11, 2013 3:43 pm

Hello Johanna,

The t(4;14)(p16;q32) , t(14;16)(q32;q23) & t(11;14)(q13;q32 are considered to increase the risk of progression in myeloma.
t(14;16)(q32;q23) is considered to be a high risk marker by many/most myeloma investigators.
t(4;14)(p16;q32) is considered to be intermediate risk and
t(11;14)(q13;q32 is standard risk according to the Mayo clinic guidelines at msmart.org

Not all investigators agree completely on the significane of each of these markers though.
The less than perfect quality of the aspiriate probably did not affect the FISH.
To answer your main question....to understand fully and predict how cancer /myeloma is going to behave is far more complex than metaphase cytogentics and/or FISH. Gene expression profiling or similar techniques may ultimately be better ways to understand these diseases. The Arkansas group has used a 70 gene GEP analysis to predict the behaviour of an individuals myeloma and to assist in tailoring therapy. There are at least two other groups who have used GEP to study patients.

I hope this is valuable for you

[johanna]

Re: Fish test has poor quality is it reliable ?

by johanna on Sun May 12, 2013 9:47 am

Dr. Libby ,

thank you for clearing things up...again...
it was important for us to know that we can rely on the fish test. though the quality is questionable. as well the biopsy coming after 7 cyles of CTD , we at least have some answers...
though there is only a small subset of PC rearranjement in IGH region (and all others are normal) there was no plateau of remmision after 1 line of treatment
(not in the true sense of the word)

Last CTD cycle (in march aprox) 588 mg/L (kappa sFLC) (the lowest) 13 MARCH
a break & treatment decision 1511 mg/L 23.APRIL

are there any other markers that can influence the agressiveness of LCMM ?
apart from genetics of course... which we have and look better than we hoped for.

thank you again Dr. Libby , we appreciate you reply.