Test Catalog

Test Id : CALFM

Not Orderable

CALR Mutation Analysis, Myeloproliferative Neoplasm (MPN), Bone Marrow

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Method Name
A short description of the method used to perform the test

Polymerase Chain Reaction (PCR) and Fragment Analysis

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

No

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

CALR Gene Mutation, Exon 9, BM

Aliases
Lists additional common names for a test, as an aid in searching

CALR

Calreticulin

Essential Thrombocythemia

JAK2-negative Myeloproliferative Neoplasm

Myelofibrosis

Myeloproliferative Disorder

Myeloproliferative Neoplasm (MPN)

Primary Myelofibrosis

Specimen Type
Describes the specimen type validated for testing

Bone Marrow

Shipping Instructions

Specimen must arrive within 7 days of collection.

Necessary Information

The following information is required:

1. Pertinent clinical history

2. Clinical or morphologic suspicion

3. Date of collection

4. Specimen source

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Container/Tube: Lavender top (EDTA) or yellow top (ACD solution B)

Specimen Volume: 2 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
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

1 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject
Moderately to severely clotted Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Bone Marrow Ambient (preferred) 7 days
Refrigerated 7 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Mutations in the JAK2, CALR and MPL genes are considered driver events in the BCR-ABL1 negative myeloproliferative neoplasms (MPN) including polycythemia vera (PV), primary myelofibrosis (PMF) and essential thrombocythemia (ET). The JAK2 V617F mutation occurs in 95% to 98% of patients with PV, 50% to 60% of patients with PMF and 50% to 60% of patients with ET respectively at diagnosis. Other JAK2 mutations in exon 12 to 15 occur in the remaining patients with PV. Mutations in the CALR gene occur in 20% to 30% of patients with PMF and 20% to 30% of patients with ET at diagnosis. A 52 base pairs (bp) deletion (53%) and a 5 bp deletion (32%) are the most common mutations in the CALR gene while other types of mutations may occur in the remaining cases. MPL exon 10 mutations occur in 5% to 10% of patients with PMF and 5% to 10% of patients with ET. Mutations in JAK2, CALR and MPL are mutually exclusive. The JAK2 V617F mutation is detected by quantitative polymerase chain reaction (qPCR). The CALR mutations are detected by PCR targeting the exon 9. The MPL mutations in exon 10 are detected by Sanger sequencing. All mutations in JAK2, CALR and MPL can also be detected by next generation sequencing (NGS). In addition to the mutations in JAK2, CALR and MPL, mutations in many other genes including ASXL1, TET2, DNMT3A, SRSF2, SF3B1, U2AF1, ZRSR2, EZH2, IDH1, IDH2, CBL, KRAS, NRAS, STAG2, and TP53 can occur in MPN. These additional mutations are more frequent in PMF and advanced disease, as compared to PV and ET. It is known that mutations in the ASXL1, SRSF2, U2AF1, EZH2, IDH1 and IDH2 are correlated with a poor prognostic risk. While a single gene test on JAK2, CALR and MPL can be clinically useful, all above mentioned gene mutations can be detected by NGS.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

An interpretive report will be provided.

Interpretation
Provides information to assist in interpretation of the test results

An interpretive report will be issued.

 

The results will be reported as 1 of the 3 states if DNA amplification is successful (see Cautions):

-Positive. A deletion-insertion-type mutation was detected in CALR, exon 9.

-Negative. No deletion or insertion was detected in CALR, exon 9.

-Equivocal. A small amplicon suspicious for a deletion-insertion type mutation was detected in CALR, exon 9.

 

Positive mutation status is highly suggestive of a myeloid neoplasm but must be correlated with clinical and other laboratory and morphologic features for definitive diagnosis.

 

Negative mutation status does not exclude the presence of a myeloproliferative neoplasm or other neoplastic disorders.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

A positive result is not specific for a particular myeloproliferative neoplasm (MPN) diagnosis, and clinicopathologic correlation is necessary in all cases.

 

A negative result does not exclude the presence of MPN or other neoplastic processes.

 

This test is a fragment analysis assay and only detects deletions-insertions (delins). It will not detect point mutations. However, all reported disease-causing mutations in MPN described to date are insertions and/or deletions.

 

This test may not differentiate between out-of-frame and in-frame delins in rare cases. However, in-frame delin mutations are very rare (<0.5%) and have only been reported in few healthy individuals and myeloproliferative neoplasm patients with JAK2V617F mutation or out-of-frame CALR mutation. Most of the rare in-frame delins are considered germline variants and represent benign alterations (ie, polymorphisms).

 

Infrequently, amplification failure can be encountered in a sample, due to inadequate DNA, poor DNA quality, or a polymerase chain reaction inhibitor. In these circumstances, the assay will be reattempted and if persistently unsuccessful, the report will be issued with an "Invalid" result.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Klampfl T, Gisslinger H, Harutyunyan AS, et al. Somatic mutation of calreticulin in myeloproliferative neoplasms. N Engl J Med. 2013;369(25):2379-2390

2. Rumi E, Pietra D, Ferretti V, et al. JAK2 or CALR mutation status defines subtypes of essential thrombocythemia with substantially different clinical course and outcomes. Blood. 2014;123(10):1544-1551

3. Greenfield G, McMullin MF, Mils K. Molecular pathogenesis of the myeloproliferative neoplasms. J Hematol Oncol. 2021;14(1):103

4. Khoury JD, Solary E, Abla O, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/Dendritic Neoplasms. Leukemia. 2022;36(7):1703-1719. doi:10.1038/s41375-022-01613-1

Method Description
Describes how the test is performed and provides a method-specific reference

Polymerase chain reaction (PCR) amplification of CALR exon 9 is performed on DNA isolated from the patient sample. The PCR product is then run on an ABI 3130xl Genetic Analyzer for fragment analysis to detect insertions and deletions. An unmutated CALR will show an amplicon at 266 base pairs (bp), a mutated CALR with insertion will show an amplicon greater than 266 bp, and a mutated CALR with deletion will show an amplicon smaller than 266 bp. This assay has an analytical sensitivity of approximately 6% (ie, 6 mutation-containing cells in 100 total cells) in most mutation types, except for the rare type of 1-bp deletion, which has a sensitivity of approximately 20%.(Unpublished Mayo method)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

1 to 8 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

Bone marrow: 2 weeks; DNA: 1 year

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Jacksonville

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

81219

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
CALFM CALR Gene Mutation, Exon 9, BM 77174-1
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
618655 Final Diagnosis 69047-9
618656 Method 85069-3
618657 Signing Pathologist 18771-6
618659 Additional Information 48767-8
618660 Disclaimer 62364-5

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Setup Files
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Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports