Interpretation of results

[Sagarcanada]

Dear CLL-fellows and specialists,

I am in Nepal with my wife due our personal work. I decided to see the hematologist and seek his opinion. Accordingly, I went a Blood Hospital in Kathmandu with my wife and met a senior Hematologist and showed our all results brought from Canada. He asked to make a FISH test and the result of the FISH test is as follows:

nuc ish 11q13 (CCND1x2),14q32(IGHx3-4)(160/200)=80%

nuc ish 11q13 (CCND1x2),14q32(IGHx2)(040/200)=20%

Laboratory interpretation is as follows: There is no evidence of CCND1/IGH fusion in 100 % cells, indicating that 11;14) is absent. However, there is is evidence of three to four copies of the IGH gene on chromosome 14 in 80% of cells.

The hematologist had said there is no indication of Mantel as it is negative. I am really confused I really do not understand so I need your favor to discuss this result.

[gardening-girl]

Sc, If there had been a translocation it would have been written as t(11;14)(q13;q32) IGH/CCND1. The presence of that translocation is frequently found in MCL.

I'd have to look at the images of the chromosomes to understand the results of the 14q32(IGHx3-4). You quote the report as saying "However, there is is an evidence of three of three to four copies of IGH gee on chromosome 14 in 80% cells." That implies that the IGH probe picked up multiple copies of IGH on chromosome 14.

Another possible interpretation is that there has been a duplication of at least the 14q32 portion of chromosome 14, if not the whole chromosome, that picked up the extra copies of IGH. In a diploid cell one would expect to see two copies.

Please let us know what more you learn and best wishes to you and your wife.

[LeoPa]

Why did you go to the hematologist in the first place? Worries? Symptoms? What did you expect to find out?

[Smakwater in reply to LeoPa]

Looking at her profile, there was a CLL diagnosis in November 2020.

[Smakwater in reply to LeoPa]

I am also a bit confused as to who was tested?

[Sagarcanada in reply to Smakwater]

Smakwater,

My wife was tested as I am only care taker.

[Smakwater in reply to Sagarcanada]

based on the post, gardening-girl gave a better medical explanation than I am capable of, however in summary, not having the rest of the information from the test and assuming that there was no notation expressing concern nor elevated risk, It would appear that watch and wait is still your status.

It would also be fair to conclude as the norm that the doctor who ordered this test would have scheduled a future appointment in the next 3-6 months whereas this information will be considered in addition to previous and current test results to define a progression trend. At that time they would also re-evaluate the need for additional testing if there is another indicator that her risk profile may have changed.

If your wife is feeling well, and there is nothing stated on the lab report that flags an elevated prognostic concern, and the doctor has not upgraded the concern, then it would be more probable to follow up that there will be another review in the next six months.

Again, not having all the information does not mean that there is something that needs to be addressed. If you think that something on a report needs to be discussed, or any other reason that you feel the need to know about something, by all means ask the doctor. If the doctor's response seems inadequate, then you probably need to ask the question to another doctor.

Glad you are an advocate for your wife! Hope all goes well,

JM

[Sagarcanada in reply to LeoPa]

Hello LeoPa,

I am responding you very late so sorry for this. We are here in Nepal due to family work. While in Canada we did not have opportunity to talk to hematologist in Person so we wanted to talk and discuss in person here in Nepal since we had always consultation in telephone. Therefore we wanted more about the CLL from the mouth of hematologist. Definitely I was more worried in the beginning but after meeting this froufrou I learned more about the CLL and my worries have gone.

[LeoPa in reply to Sagarcanada]

If there is an obvious problem they will tell you bluntly so. Until that happens always assume the best. This is the only situation where I am very much in favor of an ostrich politics 🙂🙈🙉. I don't have a problem until they tell me that I have one. Try not to worry and good luck!

[janvog]

It is certainly good news, that highly qualified specialists are present in Nepal. We should also realize, for our treatment, the specialists have to train and study for decades. I do not worry about micro-understanding my series of numbers. But I do worry about the ranges in the CBC . Best luck to you up there in the Himalayas ! Buddhism might be supportive of medical care.

[Sagarcanada in reply to janvog]

Thanks for response!