Standard Document
Second Edition
Molecular Diagnostics

CLSI MM05

Nucleic Acid Amplification Assays for Molecular Hematopathology

This CLSI guideline provides essential guidance on nucleic acid-based testing for diagnosing and managing hematopoietic neoplasms. It covers key applications such as clonality analysis, chromosomal translocation detection, micromutation identification, and chimerism quantification in post-transplant monitoring.

The document details molecular techniques, including PCR, reverse-transcriptase PCR, real-time fluorescence-based PCR, DNA sequencing, FISH, and microarray assays. It also includes recommendations for specimen collection, validation, reporting, and quality assurance.

March 30, 2012
Daniel E. Sabath, MD, PhD

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Abstract

Analysis of nucleic acids is playing an increasing role in the diagnosis and management of patients with hematopoietic neoplasms. The tests include those for detection of clonality by analysis of gene rearrangements in the antigen receptor genes or detection of nonrandom inactivation of the X chromosome, detection and quantification of junctions formed by chromosomal translocations, detection of micromutations, quantification of chimerism after allogeneic hematopoietic transplantation, and quantification of normal DNA or RNA sequences. The methods used in clinical molecular hematopathology include end-point PCR, reverse-transcriptase PCR, real-time fluorescence-based PCR, DNA sequencing, FISH, and hybridization-based microarray and microbead assays. Clinical and Laboratory Standards Institute document MM05-A2—Nucleic Acid Amplification Assays for Molecular Hematopathology; Approved Guideline—Second Edition addresses the needs of the laboratory by providing recommendations on a variety of laboratory tests based on analysis of nucleic acids. It addresses preexamination and examination issues affecting assay performance, reporting of laboratory results, and QA. The guideline is designed to assist a molecular diagnostic laboratory in acquiring a new assay or new technology, as well as serve as a refresher for those already experienced with a particular area of analysis.

Scope
The use of molecular methods in clinical diagnosis has become an essential part of the practice of pathology. In hematopathology, molecular methods are used to identify clonal cell proliferations, chromosomal translocations, the production of abnormal RNA species, somatic mutations of neoplastic cell populations, and quantification of abnormal nucleic acids. Along with the development of new testing methods, molecular pathologists have actively worked to determine the clinical scenarios in which molecular diagnostic testing is indicated and to improve the quality of molecular diagnostic tests. To assure the continued success of nucleic acid–based diagnostics, several key areas warrant attention. This guideline is written for laboratory directors, surgical pathologists, medical technologists, other laboratory personnel, hematopathologists, hematologists, oncologists, and those involved in the promulgation of regulations under which laboratories and manufacturers must operate. This guideline is intended to assist laboratories that rely on nucleic acid–based hematology assay systems to properly implement these techniques, together with the appropriate controls in their laboratories. Furthermore, it is intended to help the laboratorian determine what types of materials and records must be preserved following the laboratory procedure, and for how long. Finally, it is intended to assist those responsible for monitoring compliance with QA programs. This document addresses the following topics as they relate to molecular detection of lymphoid and myeloid clonality, chromosomal translocations, somatic mutations in lymphoid and myeloid neoplasms, and quantification of donor/recipient cell populations after allogeneic transplants, mutations/translocations, and normal RNA species: • Indications for molecular diagnostic testing • Specimen collection, transport, and processing • Assessment of specimen adequacy • Conduct of molecular hematology assays, and sensitivity, specificity, controls, and artifacts • QA • Interpretation of results This document does not address genetic testing for inherited mutations. Refer to CLSI document MM01 for genetic testing guidelines. This document also does not address procedures for validation of molecular diagnostic tests. For information on validation of molecular diagnostic tests, refer to CLSI documents C28, EP05, EP06, EP09, EP12, EP15, EP17, MM01, MM03, and MM06. In addition, this document does not discuss next generation sequencing; therefore, discussion of sequencing or direct sequencing is in reference to Sanger sequencing.
Product Details
MM05A2E
1-56238-791-X
108
Additional Details

This document is available in electronic format only.

The U.S. Food and Drug Administration (FDA) has evaluated and recognized this approved-level consensus standard for use in satisfying a regulatory requirement.

This archived document is no longer being reviewed through the CLSI Consensus Document Development Process. However, this document is technically valid and because of its value to the laboratory community, it is being retained in CLSI’s library.

Authors
Daniel E. Sabath, MD, PhD
Rajyalakshmi Luthra, PhD
Elizabeth Algar, MSc, PhD, mHGSA, FFSc, RCPA
Richard D. Press, MD, PhD
Pritish K. Bhattacharyya, MD
Paul G. Rothberg, PhD, FACMG
Karen E. Bijwaard, MS, RAC, MB(ASCP)
Rana Domiati Saad, PhD
Tao Hong, PhD
Zeba N. Singh, MD
Neal Lindeman, MD
Emily S. Winn-Deen, PhD
Abstract

Analysis of nucleic acids is playing an increasing role in the diagnosis and management of patients with hematopoietic neoplasms. The tests include those for detection of clonality by analysis of gene rearrangements in the antigen receptor genes or detection of nonrandom inactivation of the X chromosome, detection and quantification of junctions formed by chromosomal translocations, detection of micromutations, quantification of chimerism after allogeneic hematopoietic transplantation, and quantification of normal DNA or RNA sequences. The methods used in clinical molecular hematopathology include end-point PCR, reverse-transcriptase PCR, real-time fluorescence-based PCR, DNA sequencing, FISH, and hybridization-based microarray and microbead assays. Clinical and Laboratory Standards Institute document MM05-A2—Nucleic Acid Amplification Assays for Molecular Hematopathology; Approved Guideline—Second Edition addresses the needs of the laboratory by providing recommendations on a variety of laboratory tests based on analysis of nucleic acids. It addresses preexamination and examination issues affecting assay performance, reporting of laboratory results, and QA. The guideline is designed to assist a molecular diagnostic laboratory in acquiring a new assay or new technology, as well as serve as a refresher for those already experienced with a particular area of analysis.

Scope
The use of molecular methods in clinical diagnosis has become an essential part of the practice of pathology. In hematopathology, molecular methods are used to identify clonal cell proliferations, chromosomal translocations, the production of abnormal RNA species, somatic mutations of neoplastic cell populations, and quantification of abnormal nucleic acids. Along with the development of new testing methods, molecular pathologists have actively worked to determine the clinical scenarios in which molecular diagnostic testing is indicated and to improve the quality of molecular diagnostic tests. To assure the continued success of nucleic acid–based diagnostics, several key areas warrant attention. This guideline is written for laboratory directors, surgical pathologists, medical technologists, other laboratory personnel, hematopathologists, hematologists, oncologists, and those involved in the promulgation of regulations under which laboratories and manufacturers must operate. This guideline is intended to assist laboratories that rely on nucleic acid–based hematology assay systems to properly implement these techniques, together with the appropriate controls in their laboratories. Furthermore, it is intended to help the laboratorian determine what types of materials and records must be preserved following the laboratory procedure, and for how long. Finally, it is intended to assist those responsible for monitoring compliance with QA programs. This document addresses the following topics as they relate to molecular detection of lymphoid and myeloid clonality, chromosomal translocations, somatic mutations in lymphoid and myeloid neoplasms, and quantification of donor/recipient cell populations after allogeneic transplants, mutations/translocations, and normal RNA species: • Indications for molecular diagnostic testing • Specimen collection, transport, and processing • Assessment of specimen adequacy • Conduct of molecular hematology assays, and sensitivity, specificity, controls, and artifacts • QA • Interpretation of results This document does not address genetic testing for inherited mutations. Refer to CLSI document MM01 for genetic testing guidelines. This document also does not address procedures for validation of molecular diagnostic tests. For information on validation of molecular diagnostic tests, refer to CLSI documents C28, EP05, EP06, EP09, EP12, EP15, EP17, MM01, MM03, and MM06. In addition, this document does not discuss next generation sequencing; therefore, discussion of sequencing or direct sequencing is in reference to Sanger sequencing.
Additional Details

This document is available in electronic format only.

The U.S. Food and Drug Administration (FDA) has evaluated and recognized this approved-level consensus standard for use in satisfying a regulatory requirement.

This archived document is no longer being reviewed through the CLSI Consensus Document Development Process. However, this document is technically valid and because of its value to the laboratory community, it is being retained in CLSI’s library.

Authors
Daniel E. Sabath, MD, PhD
Rajyalakshmi Luthra, PhD
Elizabeth Algar, MSc, PhD, mHGSA, FFSc, RCPA
Richard D. Press, MD, PhD
Pritish K. Bhattacharyya, MD
Paul G. Rothberg, PhD, FACMG
Karen E. Bijwaard, MS, RAC, MB(ASCP)
Rana Domiati Saad, PhD
Tao Hong, PhD
Zeba N. Singh, MD
Neal Lindeman, MD
Emily S. Winn-Deen, PhD