Fluorescence in situ hybridization (FISH) testing is a cytogenetic technique employed to detect specific chromosomal abnormalities associated with multiple myeloma. This laboratory procedure utilizes fluorescent probes that bind to particular DNA sequences on chromosomes. Analyzing the presence, absence, or altered location of these sequences allows clinicians to identify genetic changes common in myeloma, including deletions, duplications, and translocations. For example, the presence of the t(4;14) translocation, detected through FISH, is associated with a less favorable prognosis.
Accurate interpretation of these results is crucial for prognosis and treatment planning. Understanding the specific chromosomal abnormalities present in a patient’s myeloma cells allows for risk stratification and informs treatment choices, including targeted therapies and stem cell transplantation eligibility. Historical advancements in cytogenetics, including the development of FISH, have revolutionized the diagnosis and management of multiple myeloma, providing a more precise understanding of the disease’s heterogeneous nature and enabling personalized treatment approaches.
The following sections will detail the key chromosomal abnormalities commonly assessed in multiple myeloma using FISH, explain how results are typically reported, and outline the clinical implications of these findings.
1. Identify Target Probes
Accurate interpretation of fluorescence in situ hybridization (FISH) results for multiple myeloma hinges on correctly identifying the target probes utilized. These probes are designed to bind to specific DNA sequences associated with known chromosomal abnormalities relevant to the disease. Selection of appropriate probes is paramount, as each targets a unique genetic alteration, such as the t(4;14), t(11;14), or t(14;16) translocations, or deletion 17p. Employing probes irrelevant to multiple myeloma or failing to include probes for clinically significant abnormalities would render the analysis incomplete and potentially misinform treatment decisions. For instance, utilizing a probe designed to detect the BCR-ABL fusion gene, relevant in chronic myeloid leukemia, provides no useful information in the context of multiple myeloma.
The process of identifying target probes involves careful consideration of the patient’s clinical presentation and suspected disease stage. Standardized panels often incorporate probes for the most common and prognostically significant abnormalities. However, based on specific clinical scenarios, additional probes may be necessary for a comprehensive evaluation. For example, if a patient presents with features suggesting a high-risk disease, probes targeting 1q21 amplification or deletion 1p might be included in addition to standard panel probes. Accurate probe identification ensures the generated FISH results provide the specific genetic information necessary for informed clinical management.
In summary, target probe identification serves as a cornerstone of FISH result interpretation in multiple myeloma. Correct probe selection, guided by clinical context and established guidelines, ensures a complete and accurate assessment of relevant chromosomal abnormalities. This precise genetic information informs prognosis, guides treatment strategies, and ultimately contributes to personalized patient care. The inability to correctly identify target probes compromises the integrity of the FISH analysis and potentially leads to suboptimal treatment decisions.
2. Analyze signal patterns.
Analyzing signal patterns is fundamental to interpreting FISH results in multiple myeloma. FISH probes, labeled with fluorescent dyes, bind to specific DNA sequences. The resulting fluorescent signals, visualized under a fluorescence microscope, reveal the presence, absence, or altered location of these sequences. Distinct signal patterns correspond to specific chromosomal abnormalities. For instance, a normal signal pattern for a probe targeting a particular chromosome would typically show two signals, representing the two copies of the chromosome. However, in the case of a deletion, only one signal might be observed. Conversely, amplification of a chromosomal region might present as multiple signals clustered together. Translocations are identified by the presence of fusion signals, representing the joining of two different chromosomal segments. The precise pattern of these signals their number, location, and intensity provides crucial information about the underlying genetic abnormality.
Consider the example of the t(4;14) translocation, a common abnormality in multiple myeloma. A FISH test using probes specific to chromosomes 4 and 14 would reveal a fusion signal in cells carrying this translocation. This signal indicates the joining of genetic material from chromosome 4 and 14, confirming the presence of the t(4;14) translocation. Another example involves deletion 17p, a high-risk genetic feature in multiple myeloma. If a probe targeting the 17p region shows only one signal instead of the expected two, it suggests a deletion of this chromosomal region. These examples highlight the direct link between observed signal patterns and the presence of specific chromosomal abnormalities in multiple myeloma.
Accurate analysis of signal patterns is essential for accurate diagnosis, risk stratification, and treatment decisions. Misinterpretation of these patterns can lead to incorrect conclusions about the underlying genetic abnormalities, potentially affecting treatment strategies and patient outcomes. Therefore, expertise in recognizing and interpreting diverse signal patterns is crucial for effective utilization of FISH testing in multiple myeloma. Standardized reporting criteria and established guidelines aid in consistent and reliable interpretation of FISH results, enhancing diagnostic accuracy and facilitating informed clinical decisions.
3. Interpret probe location.
Interpreting probe location is critical for accurate analysis of FISH results in multiple myeloma. The physical location of the fluorescent signals produced by the probes provides essential information about the structural integrity of chromosomes. While the number of signals indicates the presence or absence of genetic material, the probe location reveals the spatial arrangement of that material within the chromosome. This spatial context distinguishes between different types of chromosomal abnormalities, even when the number of signals might be similar. For instance, two signals from a particular probe might represent two normal copies of a chromosome. However, if these signals are spatially separated within the nucleus, it could indicate a chromosomal break. Conversely, clustered signals might suggest gene amplification. Therefore, probe location adds a crucial layer of information beyond simple signal enumeration.
Consider the example of the IGH gene rearrangement, a hallmark of multiple myeloma. FISH probes targeting regions surrounding the IGH locus on chromosome 14 can reveal translocations involving this gene. The location of the probe signal relative to other chromosomal markers helps identify the specific translocation partner. A probe signal located near a chromosome 4 marker indicates a t(4;14) translocation, while proximity to a chromosome 16 marker signifies a t(14;16) translocation. Differentiating between these translocations, each with distinct prognostic implications, relies heavily on interpreting the probe location. Another example involves interstitial deletions, where a segment within a chromosome is lost. Probe location helps define the boundaries of the deleted region, providing a more precise understanding of the genetic loss.
Accurate interpretation of probe location is essential for distinguishing subtle yet clinically significant chromosomal changes. Failure to consider probe location might lead to misclassification of abnormalities, potentially impacting risk stratification and treatment decisions. Integrating probe location data with signal pattern analysis provides a comprehensive view of the underlying genomic architecture in multiple myeloma, enhancing the diagnostic and prognostic value of FISH testing. This precise understanding of chromosomal abnormalities allows for a more tailored approach to patient management, aligning treatment strategies with the specific genetic profile of the disease.
4. Quantify signal numbers.
Quantifying signal numbers is a crucial step in interpreting FISH results for multiple myeloma. The number of fluorescent signals observed for each probe directly correlates with the copy number of the targeted DNA sequence. Accurate enumeration of these signals is essential for identifying chromosomal abnormalities, such as deletions, amplifications, and gains or losses of whole chromosomes. These numerical data provide a quantitative measure of the genetic alterations, complementing the qualitative information obtained from signal patterns and probe locations.
-
Signal Counts and Copy Number Variations
Signal counts reflect the underlying copy number of the targeted DNA sequence. Two signals typically represent the two copies of a chromosome in a normal diploid cell. One signal suggests a deletion, while three or more signals indicate amplification or gain of extra copies. For example, in a patient with trisomy 12 (three copies of chromosome 12), a probe targeting chromosome 12 would show three distinct signals. Conversely, a single signal for a probe targeting chromosome 13 might indicate monosomy 13 (loss of one copy of chromosome 13), a common finding in multiple myeloma. Accurately quantifying these signals is crucial for determining the precise copy number alterations present, which can have significant prognostic and therapeutic implications.
-
Determining Ploidy
Signal numbers contribute to determining the ploidy of the myeloma cells. Ploidy refers to the number of sets of chromosomes present in a cell. Normal cells are diploid, having two sets of chromosomes. However, myeloma cells often exhibit aneuploidy, characterized by an abnormal number of chromosome sets. Analyzing signal numbers from multiple probes targeting different chromosomes helps assess ploidy. For instance, consistent gains or losses across multiple chromosomes suggest a shift in overall ploidy. This information aids in understanding the genomic instability of the myeloma cells and contributes to disease characterization.
-
Assessing Clonality
Quantifying signal numbers assists in evaluating the clonality of the myeloma cell population. Myeloma is a clonal disease, meaning it originates from a single aberrant plasma cell. Consistent signal number abnormalities across a significant proportion of analyzed cells indicate a clonal population. For instance, if the majority of cells show three signals for a specific probe, it suggests a clonal trisomy. Conversely, a heterogeneous mixture of signal numbers might indicate the presence of multiple subclones or contamination from normal cells. This assessment of clonality is important for understanding disease evolution and response to therapy.
-
Thresholds for Clinical Significance
Clinically significant thresholds exist for signal number variations. While minor variations might occur due to technical artifacts or normal cellular heterogeneity, significant deviations from the expected two signals are generally considered clinically relevant. Established guidelines and reporting criteria provide thresholds for defining gains, losses, and amplifications. For instance, more than three signals for a specific probe might be required to classify a finding as true amplification. These thresholds ensure consistent interpretation of FISH results and facilitate informed clinical decision-making.
In summary, quantifying signal numbers in FISH analysis provides critical information regarding copy number variations, ploidy, clonality, and the presence of clinically significant chromosomal abnormalities. This quantitative assessment, combined with analysis of signal patterns and probe location, offers a comprehensive understanding of the genomic landscape in multiple myeloma, directly impacting prognosis, risk stratification, and treatment selection. Accurate interpretation of signal numbers within the context of established guidelines is essential for utilizing FISH testing effectively in the management of multiple myeloma.
5. Correlate with clinical data.
Correlating FISH test results with clinical data is essential for accurate interpretation and effective utilization in multiple myeloma management. FISH results provide a snapshot of the genomic landscape, revealing specific chromosomal abnormalities. However, these genetic findings gain clinical relevance only when considered in the context of the patient’s overall clinical presentation. Integrating FISH data with clinical parameters, such as disease stage, protein levels, and response to prior therapies, refines prognostic assessments and guides personalized treatment decisions. Isolated interpretation of FISH results without clinical correlation risks misinterpreting their significance and potentially leading to suboptimal therapeutic strategies.
-
Disease Staging
FISH-identified abnormalities, such as the t(4;14) translocation or deletion 17p, carry prognostic weight. However, their impact on disease progression and survival varies depending on the disease stage. For instance, the presence of del(17p) in a newly diagnosed patient signifies a high-risk profile, impacting treatment intensity considerations. Conversely, detecting the same abnormality in a patient with relapsed/refractory disease, already associated with a poor prognosis, might not significantly alter the management approach. Therefore, correlating FISH results with disease staging refines risk stratification and helps tailor treatment decisions to the individual patient’s disease status.
-
Serum Protein Levels
Multiple myeloma is characterized by the overproduction of monoclonal proteins, detectable in serum and urine. Correlating FISH results with these protein levels enhances disease characterization and prognostication. Certain chromosomal abnormalities, like the t(11;14) translocation, are often associated with elevated levels of specific monoclonal proteins. Integrating this information with FISH findings improves the understanding of the underlying disease biology and its clinical manifestations. Furthermore, monitoring changes in protein levels alongside FISH analysis over time helps assess treatment response and detect disease progression, guiding adjustments in therapeutic strategies.
-
Response to Prior Therapies
FISH findings contribute to understanding treatment response and resistance mechanisms. For example, the persistence or emergence of high-risk chromosomal abnormalities, such as 1q21 amplification, after initial therapy might signify a higher likelihood of relapse and inform the choice of subsequent treatment modalities. Correlating FISH results with prior treatment history provides insights into the clonal evolution of the disease, aiding in personalized treatment selection and potentially guiding the use of targeted therapies based on specific genetic vulnerabilities.
-
Extramedullary Disease
Extramedullary disease, characterized by myeloma cell infiltration outside the bone marrow, is associated with an aggressive disease course. Specific chromosomal abnormalities, such as 1q21 gain or del(17p), are linked to an increased risk of extramedullary involvement. Correlating FISH results with clinical evidence of extramedullary disease provides a more complete picture of disease aggressiveness and informs treatment decisions, including the potential need for intensified or alternative therapies.
Integrating FISH data with clinical parameters provides a comprehensive view of multiple myeloma, guiding personalized treatment strategies and refining prognostic assessments. Clinical correlation clarifies the relevance of FISH findings, ensuring their appropriate interpretation and facilitating informed clinical decision-making tailored to the individual patient’s disease characteristics and clinical trajectory. The combination of genomic insights and clinical context optimizes patient management and improves treatment outcomes in multiple myeloma.
6. Consult established guidelines.
Interpreting Fluorescence in situ hybridization (FISH) results for multiple myeloma requires adherence to established guidelines to ensure accuracy and consistency. These guidelines, developed by professional organizations and expert panels, provide standardized criteria for analyzing and reporting FISH findings. Consulting these established guidelines is crucial for accurate result interpretation, risk stratification, and treatment decision-making. Standardization ensures consistent reporting practices across laboratories, facilitating data comparison and collaborative patient management. Deviation from established guidelines risks misinterpretation of FISH results, potentially impacting clinical decisions and patient outcomes.
-
International Myeloma Working Group (IMWG) Guidelines
The IMWG publishes comprehensive guidelines for the diagnosis, risk stratification, and treatment of multiple myeloma. These guidelines include recommendations for FISH testing, outlining which probes to use, how to interpret results, and the clinical significance of specific abnormalities. Adhering to IMWG guidelines ensures standardized FISH testing and result interpretation, facilitating consistent clinical practice and informed treatment decisions. For example, the IMWG guidelines specify criteria for defining high-risk cytogenetics based on FISH findings, such as the presence of del(17p) or t(4;14), informing prognosis and treatment selection.
-
European Myeloma Network (EMN) Recommendations
The EMN also provides recommendations for FISH testing in multiple myeloma, complementing the IMWG guidelines. EMN recommendations offer specific guidance on technical aspects of FISH analysis, including probe selection, signal pattern interpretation, and reporting criteria. Consulting EMN recommendations helps ensure consistent and reliable FISH testing practices across different laboratories, facilitating data comparison and collaborative research efforts. For instance, EMN recommendations address specific technical challenges in FISH analysis, such as interpreting complex signal patterns or dealing with suboptimal sample quality, enhancing the reliability of test results.
-
Clinical Cytogenetics Standards and Guidelines
General clinical cytogenetics standards and guidelines provide a broader framework for FISH testing, encompassing quality assurance, laboratory accreditation, and result reporting. These guidelines, developed by organizations like the American College of Medical Genetics and Genomics (ACMG) and the College of American Pathologists (CAP), establish quality standards for all cytogenetic testing, including FISH. Adhering to these standards ensures the quality and reliability of FISH results in multiple myeloma, supporting accurate clinical interpretation and decision-making. For example, these guidelines specify requirements for laboratory accreditation, personnel qualifications, and quality control measures, ensuring the overall quality of FISH testing.
-
Journal Publications and Consensus Statements
Peer-reviewed journal publications and consensus statements from expert panels provide valuable insights into evolving best practices in FISH testing for multiple myeloma. These publications often address emerging research findings, novel probe development, and updates to existing guidelines, contributing to continuous improvement in FISH analysis and interpretation. Staying informed about these updates ensures that clinical practice reflects the latest scientific advancements in the field. For example, recent publications might explore the clinical significance of newly identified chromosomal abnormalities or refine existing risk stratification models based on FISH findings, enhancing the precision of prognostic assessments and treatment selection.
Consulting established guidelines ensures consistent and accurate interpretation of FISH results in multiple myeloma, directly impacting clinical decision-making and patient outcomes. Adherence to IMWG, EMN, and general cytogenetics guidelines, coupled with awareness of evolving research findings, provides a robust framework for integrating FISH data into personalized treatment strategies. This standardized approach optimizes the use of FISH testing in multiple myeloma, enhancing diagnostic accuracy, refining risk stratification, and ultimately contributing to improved patient care.
7. Understand result limitations.
Accurate interpretation of fluorescence in situ hybridization (FISH) results in multiple myeloma requires acknowledging inherent limitations. While FISH provides valuable insights into the genomic landscape of the disease, understanding these limitations prevents overinterpretation and ensures appropriate clinical application. Recognizing factors that can influence FISH results, such as technical limitations, biological variability, and the evolving nature of the disease, is crucial for informed decision-making. Ignoring these limitations might lead to misinterpretation of findings, potentially impacting treatment strategies and patient outcomes.
-
Technical limitations
Technical limitations inherent to the FISH procedure can influence result interpretation. These include probe specificity, signal intensity, and the resolution of the microscopic analysis. Cross-hybridization of probes to non-target sequences can produce spurious signals, potentially mimicking true abnormalities. Weak signal intensity, due to suboptimal sample quality or probe degradation, can complicate signal enumeration and pattern recognition. The limited resolution of standard fluorescence microscopy might hinder the detection of subtle chromosomal changes, such as small interstitial deletions or insertions. Awareness of these technical limitations and adherence to strict quality control measures are essential for mitigating their impact on result accuracy. For example, using validated probes with high specificity and optimizing hybridization conditions minimizes the risk of false-positive results. Furthermore, incorporating appropriate controls and utilizing advanced imaging techniques, such as confocal microscopy, can enhance the sensitivity and resolution of FISH analysis.
-
Biological variability and tumor heterogeneity
Multiple myeloma exhibits significant biological variability and tumor heterogeneity, potentially influencing FISH results. The disease is characterized by the presence of multiple subclones within the tumor population, each with its own unique genetic profile. FISH analysis typically assesses a limited number of cells, which might not fully represent the entire tumor heterogeneity. Consequently, minor subclones with specific chromosomal abnormalities might be missed, leading to an incomplete representation of the genomic landscape. Furthermore, the dynamic nature of the disease, with ongoing clonal evolution and selection, can alter the prevalence of different subclones over time. This temporal heterogeneity can influence FISH results obtained at different time points during the disease course. For example, a FISH test performed at diagnosis might reveal a specific translocation in a minor subclone, while a subsequent test at relapse might show a different translocation becoming dominant. Understanding this inherent biological variability and its impact on FISH results is crucial for interpreting findings and predicting disease behavior.
-
Limited scope of detection
FISH analysis focuses on specific, pre-defined chromosomal regions targeted by the selected probes. Consequently, abnormalities outside these targeted regions remain undetected. While standard FISH panels cover the most common and clinically significant abnormalities in multiple myeloma, they do not capture the entire spectrum of potential genetic alterations. For example, cryptic translocations or small mutations within genes might not be detectable by standard FISH analysis. Furthermore, epigenetic modifications, such as DNA methylation or histone acetylation, which can significantly impact gene expression and disease behavior, are not assessable by FISH. Therefore, a normal FISH result does not necessarily rule out the presence of other clinically relevant genetic or epigenetic alterations. Integrating FISH findings with other diagnostic modalities, such as gene expression profiling or next-generation sequencing, provides a more comprehensive assessment of the genomic landscape in multiple myeloma.
-
Lack of standardized cutoff values for some markers
While established guidelines provide cutoff values for interpreting many FISH markers in multiple myeloma, some markers lack universally accepted thresholds for clinical significance. For example, the interpretation of 1q21 gain, a known adverse prognostic marker, can vary depending on the specific probe used and the cutoff value applied. This lack of standardization can complicate result interpretation and comparison across different laboratories. Furthermore, the clinical significance of some markers, particularly those associated with less common abnormalities, might not be fully elucidated. Ongoing research and refinement of guidelines are essential for improving the standardization and interpretation of FISH results in multiple myeloma. In the meantime, careful consideration of the specific probe used, the methodology employed, and the clinical context is crucial for interpreting results with less defined clinical thresholds. Consulting with expert hematopathologists and geneticists is often necessary for accurate interpretation of complex or ambiguous FISH findings.
Acknowledging these limitations ensures appropriate interpretation and clinical application of FISH results in multiple myeloma. Integrating FISH findings with other clinical and laboratory data, consulting established guidelines, and recognizing the evolving nature of the disease are crucial for informed decision-making. Understanding these limitations prevents overreliance on FISH results in isolation and promotes a comprehensive approach to patient management, integrating diverse data sources for optimal treatment strategies and improved patient outcomes.
Frequently Asked Questions
This section addresses common queries regarding the interpretation and clinical implications of fluorescence in situ hybridization (FISH) testing in multiple myeloma.
Question 1: What are the most common chromosomal abnormalities detected by FISH in multiple myeloma?
Common abnormalities include translocations involving the immunoglobulin heavy chain (IGH) gene, such as t(4;14), t(11;14), and t(14;16), as well as deletions like del(17p) and del(13q). Gain of 1q21 is also a frequent finding.
Question 2: How are FISH results typically reported?
Results are typically reported as a percentage of cells exhibiting each specific abnormality. The report specifies the probes used, the signal patterns observed, and the clinical interpretation based on established guidelines.
Question 3: Does a normal FISH result guarantee the absence of high-risk disease?
No. FISH targets specific abnormalities. Other genetic or epigenetic changes, undetectable by FISH, may contribute to high-risk disease. Furthermore, standard FISH panels may not encompass all potential genomic alterations.
Question 4: How do FISH results influence treatment decisions?
FISH findings contribute significantly to risk stratification. High-risk cytogenetics, such as del(17p) or t(4;14), may influence treatment intensity, including eligibility for stem cell transplantation and the choice of specific therapies.
Question 5: Can FISH results change over time?
Yes. Clonal evolution during disease progression or response to therapy can alter the prevalence of different chromosomal abnormalities within the myeloma cell population. Repeat FISH testing may be indicated to monitor these changes.
Question 6: Where can one find further information on FISH testing and interpretation guidelines for multiple myeloma?
Comprehensive guidelines and recommendations are available from organizations such as the International Myeloma Working Group (IMWG) and the European Myeloma Network (EMN), along with resources from reputable cancer centers and hematology/oncology societies.
Understanding these key aspects of FISH testing is essential for optimal utilization of this powerful diagnostic tool in the management of multiple myeloma. Accurate interpretation of FISH results facilitates informed clinical decisions and personalized treatment strategies.
The subsequent section will explore emerging technologies and future directions in multiple myeloma diagnostics.
Tips for Interpreting FISH Test Results in Multiple Myeloma
Accurate interpretation of fluorescence in situ hybridization (FISH) results in multiple myeloma requires careful consideration of several key factors. The following tips provide guidance for navigating the complexities of FISH analysis and maximizing its clinical utility.
Tip 1: Verify Probe Selection: Ensure the FISH panel includes probes targeting clinically relevant abnormalities in multiple myeloma, such as t(4;14), t(11;14), del(17p), and 1q21 gain. Probe selection should align with established guidelines and the patient’s specific clinical context.
Tip 2: Scrutinize Signal Patterns: Carefully analyze the number, location, and intensity of fluorescent signals. Distinct patterns correspond to specific chromosomal abnormalities. Consult established criteria for interpreting various signal patterns and differentiating true signals from artifacts.
Tip 3: Consider Probe Location: Interpreting the spatial arrangement of probe signals provides crucial context. Probe location helps distinguish between different types of abnormalities, such as translocations, deletions, and amplifications, even when signal numbers might be similar.
Tip 4: Quantify Signals Accurately: Precise enumeration of signals is essential for determining copy number alterations. Adhering to standardized thresholds for gains, losses, and amplifications ensures consistent interpretation and clinical relevance.
Tip 5: Integrate Clinical Data: Correlate FISH findings with clinical parameters, including disease stage, protein levels, and prior treatment response, to refine prognostic assessments and guide personalized treatment decisions.
Tip 6: Consult Established Guidelines: Adhere to guidelines from organizations like the IMWG and EMN for standardized result interpretation and risk stratification. These guidelines provide a framework for consistent and evidence-based clinical practice.
Tip 7: Acknowledge Result Limitations: Recognize the inherent limitations of FISH testing, including technical limitations, biological variability, and the potential for undetected abnormalities. Avoid overinterpreting results and consider complementary diagnostic modalities for a comprehensive genomic assessment.
Tip 8: Seek Expert Consultation: Complex or ambiguous FISH results may warrant consultation with expert hematopathologists or geneticists. Expert interpretation ensures accurate assessment and facilitates informed clinical decision-making, particularly in challenging cases.
By adhering to these tips, clinicians can effectively utilize FISH testing as a powerful tool in the management of multiple myeloma. Accurate interpretation of FISH results, combined with comprehensive clinical data, enables personalized treatment strategies and optimized patient outcomes.
The following conclusion summarizes the key takeaways and emphasizes the ongoing evolution of genomic analysis in multiple myeloma.
Conclusion
Accurate interpretation of fluorescence in situ hybridization (FISH) test results is crucial for effective multiple myeloma management. This analysis requires a comprehensive understanding of probe selection, signal pattern analysis, probe location interpretation, and signal quantification. Integrating these findings with clinical data, consulting established guidelines, and acknowledging inherent limitations ensures appropriate clinical application. Standardized reporting practices and adherence to evidence-based guidelines contribute to consistent and reliable result interpretation, impacting risk stratification, treatment selection, and ultimately, patient outcomes.
As genomic technologies evolve, FISH testing remains a cornerstone of multiple myeloma diagnostics. Ongoing research focusing on novel probes, refined interpretation criteria, and integration with other diagnostic modalities promises to enhance the precision and clinical utility of FISH analysis, further advancing personalized medicine in multiple myeloma.
