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HelpTEST ID BCRAB BCR::ABL1, p210, mRNA Detection, Reverse Transcription-PCR (RT-PCR), Quantitative, Monitoring Chronic Myeloid Leukemia (CML), Varies
Additional Codes
BCRABL
Reporting Name
BCR/ABL1, p210, Quant, MonitorSpecimen Type
VariesOrdering Guidance
This test is intended for monitoring patients with known e13/a2 or e14/a2 BCR::ABL1 (p210) fusion forms.
This test should not be used to screen for BCR::ABL1 fusions at the time of diagnosis.
To screen for BCR::ABL1 fusions at the time of diagnosis, order one of the following:
-BADX / BCR::ABL1, Qualitative, Diagnostic Assay, Varies
-BCRFX / BCR::ABL1 Qualitative Diagnostic Assay with Reflex to BCR::ABL1 p190 Quantitative Assay or BCR::ABL1 p210 Quantitative Assay, Varies .
To monitor patients carrying BCR::ABL1 fusion forms coding for the p190 (e1/a2) protein, order BA190 / BCR::ABL1, p190, mRNA Detection, Reverse Transcription-PCR (RT-PCR), Quantitative, Monitoring Assay, Varies.
To monitor patients carrying rare BCR::ABL1 fusion forms coding for e19a2, e13/e14a3, e1a3, e6a2, e19a3, e8a2, e12a2, e6a3, e8a3, and e12a3, order BARQ / BCR::ABL1, Rare Fusion Monitoring, Quantitative, Varies.
If the patient has a negative history for p210 but has positive history of p190 or a rare fusion form, this test will be cancelled, and one of the following appropriate monitoring tests will be added:
-BA190 / BCR::ABL1, p190, mRNA Detection, Reverse Transcription-PCR (RT-PCR), Quantitative, Monitoring Assay, Varies
-BARQ / BCR::ABL1, Rare Fusion Monitoring, Quantitative, Varies
Shipping Instructions
Specimen must arrive within 3 days (72 hours) of collection. Collect and package specimen as close to shipping time as possible.
Necessary Information
Pertinent clinical history including if the patient has a diagnosis of chronic myeloid leukemia or other BCR::ABL1-positive neoplasm information is required.
Specimen Required
Submit only 1 of the following specimens:
Specimen Type: Whole blood
Container/Tube:
Preferred: Lavender top (EDTA)
Acceptable: Yellow top (ACD)
Specimen Volume: 10 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 whole blood.
Specimen Type: Bone marrow
Container/Tube:
Preferred: Lavender top (EDTA)
Acceptable: Yellow top (ACD)
Specimen Volume: 3 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 Minimum Volume
Whole blood: 4 mL; Bone marrow: 1 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Varies | Refrigerated (preferred) | 72 hours | PURPLE OR PINK TOP/EDTA |
| Ambient | 72 hours | PURPLE OR PINK TOP/EDTA |
Special Instructions
Testing Algorithm
For information see BCR/ABL1 Ordering Guide for Blood and Bone Marrow.
Method Name
Quantitative Reverse Transcription-Polymerase Chain Reaction (RT-PCR)
Reject Due To
| Gross hemolysis | Reject |
| Moderately to severely clotted | Reject |
Reference Values
The presence or absence of BCR::ABL1 messenger RNA (mRNA) fusion form e13/e14-a2 producing the p210 fusion protein is identified. If positive, the quantitative level is reported as the normalized ratio of BCR::ABL1 (p210) to endogenous ABL1 mRNA with conversion to a percentage referenced to the international scale (IS), on which 0.1% BCR::ABL1:ABL1 (also represented on a log scale as Molecular Response 3, or MR3) is designated as a major molecular response (MMR) threshold.
Day(s) Performed
Monday through Saturday
Report Available
3 to 6 daysSpecimen Retention Time
2 weeksPerforming Laboratory
Mayo Clinic Laboratories in Rochester
CPT Code Information
81206
Forms
1. Hematopathology Patient Information (T676)
2. If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.
Useful For
Monitoring response to therapy in patients with chronic myeloid leukemia who are known to have e13/a2 or e14/a2 BCR::ABL1 fusion transcript forms
Clinical Information
Chronic myeloid leukemia (CML) is a hematopoietic stem cell neoplasm included in the broader diagnostic category of myeloproliferative neoplasms. CML is consistently associated with fusion of the breakpoint cluster region gene (BCR) at chromosome 22q11 to the Abelson gene (ABL1) at chromosome 9q23. This fusion is designated BCR::ABL1 and may be seen on routine karyotype as the Philadelphia chromosome.
Although various breakpoints within the BCR and ABL1 genes have been described, more than 95% of CMLs contain a consistent messenger RNA (mRNA) transcript in which either the BCR exon 13 (e13) or BCR exon 14 (e14) is fused to the ABL1 exon 2 (a2), yielding fusion forms e13/a2 and e14/a2, respectively. The e13/a2 and e14/a2 fusion forms produce a 210-kDa protein (p210). The p210 fusion protein is an abnormal tyrosine kinase known to be critical for the clinical and pathologic features of CML, and agents that block the tyrosine kinase activity (ie, tyrosine kinase inhibitors or TKI, such as imatinib mesylate) have been used successfully for treatment. Monitoring the level of BCR::ABL1 mRNA in CML patients during treatment is helpful for both prognosis and management of therapy.(1-3) Rising BCR::ABL1 mRNA levels following attainment of critical therapeutic milestones (see Clinical References) can be indicative of acquired resistance mutations involving the ABL1 portion of the BCR::ABL1 fusion gene.
Quantitative reverse-transcription polymerase chain reaction is the most sensitive method for monitoring BCR::ABL1 levels during treatment. This test detects the BCR::ABL1 mRNA fusion forms found in CML (e13/a2 and e14/a2).