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Alert Number 247

FISHing in Murky Waters

Date: August 29, 2007

If you go fishing and don’t catch any fish, does that prove conclusively there are no fish in the lake? Perhaps you were using the wrong lure or the water is so murky the fish can’t even see your bait?

The typical commercially available CLL FISH panel contains four probes which seek to establish the presence or absence of the four common cytogenetic abnormalities in CLL. Results that do not have one of these four common deletions or mutations are labeled “normal” — a very misleading label. The right label ought to be “none of the above”, and/or “we don’t know, because we did not use the right probe”.

Even for those patients who have one or more of the 4 common defects (13q, 11q, 17p or 12 Trisomy), a probe set limited to just these four defects could mask additional abnormalities that may have a bearing on risk assessment and treatment. It is high time that the probe-set used in CLL FISH testing is expanded. Especially in view of very recent information about a powerful tumor suppressor gene at the 6q21 location, a gene that is AWOL in a significant percent of CLL patients. FISHing in Murky Waters is our review of this important subject.

Be well,


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