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Interpretation of submicroscopic deletions of the BCR or ABL gene should not depend on extra signal‐FISH: Problems in interpretation of submicroscopic deletion of the BCR or ABL gene with extra signal‐FISH

Several groups have demonstrated that a submicroscopic gene deletion in Ph+ chronic myelogenous leukemia (CML) is associated with a poor prognosis and reduced response to treatment. To assess the variation between detection methods in the interpretation of a submicroscopic gene deletion, we performed an extra signal (ES)–FISH BCR/ABL and double‐FISH (D‐FISH) BCR/ABL on frozen bone marrow cells from 79 patients with CML (63 in the chronic phase, 6 in the accelerated phase, and 10 in blast crisis) and 30 patients with a BCR/ABL‐negative myeloproliferative disorder as determined by RT‐PCR. The normal cutoff values were 0.22% for ES‐FISH and 0.25% for D‐FISH. The cutoff values for false‐positive signals from a juxtaposition of the BCR and ABL gene were 11% in ES‐FISH and 13% in D‐FISH. Of the 14 patients who showed an ABL gene deletion by ES‐FISH, 5 had an ABL deletion only, 5 had both a BCR and an ABL deletion, but 4 proved to have a classic BCR/ABL rearrangement without a submicroscopic deletion, as determined by D‐FISH. Discrepant results between ES‐ and D‐FISH were observed in 12 of the 79 patients (15.8%), and the main causes of a discrepancy were a false‐positive ABL deletion (4 of 12, 33%), a variant Philadelphia chromosome (3 of 12, 25%), an inversion of derivative chromosome 9 at the very breakpoint of the ABL gene (9q32) (1 of 12, 8.3%), a cryptic variant Ph chromosome (1 of 12, 8.3%), and a marker chromosome (1 of 12, 8.3%). Although there was no significant difference in the sensitivity for the detection of the fusion signal between ES‐ and D‐FISH, ES‐FISH showed a high percentage of cells with false‐positive fusion signals (1 orange, 1 green, 1 yellow), which makes it difficult to interpret the submicroscopic ABL deletion. In conclusion, an interpretation of the submicroscopic deletions of the BCR or ABL gene should not depend on ES‐FISH. © 2005 Wiley‐Liss, Inc.