Sign in →

Test ID: CHRGB Chimerism-Recipient Germline (Pretransplant), Varies

Reporting Name

Chimerism-Recipient Germline

Useful For

Evaluating the recipient cells prior to bone marrow transplant

Testing Algorithm

Initial Chimerism Testing:

Complete chimerism analysis requires 3 specimens. These specimens should be submitted when collected. An interpretive report will be provided once all specimens are received.

 

CHRGB / Chimerism-Recipient Germline (Pre), Varies

CHIDB / Chimerism-Donor, Varies

CHIMU / Chimerism Transplant No Cell Sort, Varies or CHIMS / Chimerism Transplant Sorted Cells, Varies

 

Billing occurs with tests CHRGB / Chimerism-Recipient Germline (Pre), Varies (for the Pre and Donor specimens) and CHIMU / Chimerism Transplant No Cell Sort, Varies (for unsorted Post specimens), or SORT1 / Chimerism Cell Sort 1 (Bill Only) and/or SORT2 / Chimerism Cell Sort 2 (Bill Only) (for sorted Post specimen). If an additional donor specimen is submitted, ADONO / Additional Chimerism Donor (Bill Only) will be performed at an additional charge.

 

See Chimerism-Recipient Germline Testing Algorithm in Special Instructions.

Specimen Type

Varies


Advisory Information


This test is for the pre-bone marrow transplant evaluation of the recipient specimen.



Shipping Instructions


1. Specimen must arrive within 7 days of collection.

2. Collect and package specimen as close to shipping time as possible.



Necessary Information


The following information is required:

1. Pertinent clinical history

2. Specimen source

3. Donor identifier and donor date of birth

4. Donor date of collection



Specimen Required


Submit only 1 of the following specimens:

 

Specimen Type: Blood

Container/Tube:

Preferred: Lavender top (EDTA)

Acceptable: Yellow top (ACD)

Specimen Volume: 4 mL

Collection Instructions:

1. Invert several times to mix blood.

2. Send specimen in original tube.

3. Label specimen as blood.

 

Specimen Type: Bone marrow

Container/Tube:

Preferred: Lavender top (EDTA)

Acceptable: Yellow top (ACD)

Specimen Volume: 2 mL

Collection Instructions:

1. Invert several times to mix bone marrow.

2. Send specimen in original tube.

3. Label specimen as bone marrow.

 

Specimen Type: Buccal swab

Supplies: Buccal Swab Kit (T543)

Container/Tube: Buccal Smear Collection Kit

Specimen Volume: 2 Cyto-Pak brushes-1 per cheek

Collection Instructions:

1. Patient should rinse out mouth vigorously with mouthwash for approximately 15 seconds.

2. Remove Cyto-Pak brush from container only touching "stick" end. Save container.

3. Using medium pressure, rotate brush several times on inside of cheek.

4. Return brush to container and cap.

5. Repeat steps 2 through 4 on other cheek using second brush.

6. It is important that patient's buccal cells are not contaminated with cells from any other source. Do not touch bristles. Do not brush too vigorously. If blood appears, discard brush and restart collection process.

7. Label each container with patient's name and order number or hospital/clinic number.

Additional Information: It is important that the cells do not dry out during shipping. Ensure that container is tightly sealed.


Specimen Minimum Volume

Blood: 2 mL
Bone Marrow: 2 mL

Specimen Stability Information

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

Reference Values

An interpretive report will be provided.

Day(s) and Time(s) Performed

Monday through Friday; Varies

Test Classification

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

CPT Code Information

81265-Comparative analysis using Short Tandem Repeat (STR) markers; patient and comparative specimen (e.g., pre-transplant recipient and donor germline testing, post-transplant non-hematopoietic recipient germline [e.g., buccal swab or other germline tissue sample] and donor testing, twin zygosity testing or maternal cell contamination of fetal cells)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
CHRGB Chimerism-Recipient Germline 31208-2

 

Result ID Test Result Name Result LOINC Value
MP007 Donor 44780-5
MP014 Specimen Type 31208-2
83186 Chimerism-Recipient Germline No LOINC Needed

Clinical Information

Patients who have had donor hematopoietic cells infused for the purpose of engraftment (ie, bone marrow transplant recipients) may have their blood or bone marrow monitored for an estimate of the percentage of donor and recipient cells present. This can be done by first identifying unique features of the donor's and the recipient's DNA prior to transplantation and then examining the recipient's blood or bone marrow after the transplantation procedure has occurred. The presence of both donor and recipient cells (chimerism) and the percentage of donor cells are indicators of transplant success.

 

Short tandem repeat (STR) sequences are used as identity markers. STRs are di-, tri-, or tetra-nucleotide repeat sequences interspersed throughout the genome at specific sites. There is variability in STR length among people and the STR lengths remain stable throughout life, making them useful as identity markers. PCR is used to amplify selected STR regions from germline DNA of both donor and recipient. The lengths of the amplified fragment are evaluated for differences (informative markers). Following allogeneic hematopoietic cell infusion, the recipient blood or bone marrow can again be evaluated for the informative STR regions to identify chimerism and estimate the proportions of donor and recipient cells in the specimen.

 

This test evaluates the recipient specimen prior to bone marrow transplant.

Interpretation

An interpretive report will be provided, which includes whether chimerism is detected or not and, if detected, the approximate percentage of donor and recipient cells. Sorted cell analysis permits more detailed evaluation of chimeric status in T-cell and myeloid cell fractions, which can be helpful in clinical management.

 

It is most useful to observe a trend in chimerism levels. Clinically critical results should be confirmed with 1 or more subsequent specimens.

Clinical Reference

1. Antin JH, Childs R, Filipovich AH, et al: Establishment of complete and mixed donor chimerism after allogenic lymphohematopoietic transplantation: recommendations from a workshop at the 2001 Tandem Meetings. Biol Blood Marrow Transplant 2001;7:473-485

2. Tang X, Alatrash G, Ning J, et al: Increasing chimerism following allogeneic stem cell transplantation is associated with longer survivial time. Biol Blood Marrow Transplant. 2014 August;20(8):1139-1144. doi:10.1016/j.bbmt.2014.04.003

3. Tyler J, Kumer L, Fisher C, et al: Personalized Chimerism Test that Uses Selection of Short Tandem Repeat or Quantitative PCR Depending on Patient's Chimerism Status. J Mol Diagn. 2019 May;21(3):483-490. doi: 10.1016/j.jmoldx.2019.01.007

4. Lion T, Watzinger F, Preuner S, et al: The EuroChimerism concept for a standardized approach to chimerism analysis after allogeneic stem cell transplantation. Leukemia. 2012 Aug;26(8):1821-1828. doi: 10.1038/leu.2012.66

Analytic Time

4 days

Method Name

Polymerase Chain Reaction (PCR) Amplification/Capillary Electrophoresis

Forms

1. Chimerism Analysis Information Sheet (T594) in Special Instructions.

2. If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.

Mayo Clinic Laboratories | Hematology Catalog Additional Information:

mml-bone-marrow-transplant