Laboratory Service Report 1-800-533-1710

Patient Name Patient ID Age Gender Order # SAMPLEREPDCYTC,VALID20150511B00... SA00074794 34 M SA00074794 Ordering Phys DOB CLIENT,CLIENT 01/01/1981 Client Order # Account Information Report Notes SA00074794 Collected C7028846-DLMP Rochester 05/10/2015 18:05 SDSC 2 - Client Support Printed Rochester, MN 55901 11/03/2015 13:07

Reference Perform Test Flag Results Unit Value Site*

AML, FISH Result Summary Abnormal MCR Interpretation MCR The result is abnormal and indicates DEK/NUP214 fusion in 93% of nuclei. This result usually indicates a t(6;9), which is associated with both de novo and therapy-related AML. This translocation reportedly has an unfavorable prognosis at diagnosis (Grimwade et al., Blood 116:354-65, 2010).

For monitoring response to therapy in this patient, we suggest using FISH for DEK/NUP214 fusion. PDF Report available at: https://test.mmlaccess.com/Reports/C7028846-81olXaCgyX.ashx Result Table MCR ------Abnormality Name Result % Abn Cutoff (%) inv(3) RPN1/MECOM fusion Normal <0.6% -5q31(D5S630x2,EGR1x1) Normal <9.5% -5(D5S630,EGR1)x1 Normal <3.5% -7q31(D7Z1x2,D7S486x1) Normal <4.5% -7(D7Z1,D7S486)x1 Normal <3.5% +8(D8Z2,MYC)x3 Normal <2.5% -13q14.3(D13S319x1,LAMP1x2) Normal <7.0% -13q14.3x2(D13S319x0,LAMP1x2) Normal <1.5% -20q12(D20S109x1,20qterx2) Normal <9.5% 11q23(MLL sep) Normal <4.0% -17p13.1(TP53x1,D17Z1x2) Normal <9.5% -17(TP53,D17Z1)x1 Normal <5.5% t(6;9) DEK/NUP214 fusion Abnormal 93 <0.6% t(8;21) RUNX1T1/RUNX1 fusion Normal <0.6% t(15;17) PML/RARA fusion Normal <0.6% inv(16)/t(16;16) MYH11/CBFB Normal <0.6% fusion t(8;16) KAT6A/CREBBP fusion Normal <0.6% t(9;22) ABL1/BCR fusion Normal <0.6% t(3;5) MLF1/NPM1 fusion Normal <0.6% ------Result MCR nuc ish(DEK,NUP214)x3(DEK con NUP214x2)[465/500] Reason for Referral See Below MCR Result: acute myeloid leukemia/AML Specimen Blood MCR Method MCR Locus and probes [Strategy;#Nuclei;Class] ------3q21(RPN1),3q26.2(MECOM) [DFISH;500;LDT]

***Performing Site Legend on Last Page of Report*** Patient Name Collection Date and Time Report Status SAMPLEREPDCYTC,VALID20150511B00... 05/10/2015 18:05 Final Page 1 of 2 >> Continued on Next Page >> * Report times for Mayo performed tests are CST/CDT Laboratory Service Report 1-800-533-1710

Reference Perform Test Flag Results Unit Value Site*

5p15.2(D5S630),5q31(EGR1) [COPY#;200;ASR] 6p23(DEK),9q34(NUP214) [DFISH;500;LDT] 7CEN(D7Z1),7q31(D7S486) [COPY#;200;ASR] 8p11.2(KAT6A),16p13.3(CREBBP) [DFISH;500;LDT] 8q22(RUNX1T1),21q22(RUNX1) [DFISH;500;ASR] 8CEN(D8Z2),8q24.1(MYC) [COPY#;200;ASR] 9q34(ABL1),22q11.2(BCR) [DFISH;500;ASR] 11q23(5'MLL,3'MLL) [BAP;200;ASR] 13q14.3(D13S319),13q34(LAMP1) [COPY#;200;ASR] 15q24.1(PML),17q21(RARA) [DFISH;500;ASR] 16p13(MYH11),16q22(CBFB) [DFISH;500;LDT] 17p13(TP53),17CEN(D17Z1) [COPY#;200;ASR] 20q12(D20S108),20qter [COPY#;200;ASR]

Probe strategies include: DFISH=dual color, double fusion; BAP=break-apart probe; COPY#=region gain and loss. Disclaimer MCR Applicable to Analyte Specific Reagent (ASR) and Laboratory Developed Tests (LDT). This test was developed and its performance characteristics determined by Mayo Clinic. It has not been cleared or approved by the U.S. Food and Drug Administration. This FISH test does not rule out other chromosome abnormalities. Released By See Below MCR Result: Patricia T. Greipp, D.O.

RECEIVED: 05/11/2015 22:16 REPORTED: 06/03/2015 16:59

* Performing Site: Mayo Clinic Laboratories - Rochester Main Campus MCR Lab Director: William G. Morice, II, M.D., Ph.D. 200 First St SW Rochester, MN 55905

Patient Name Collection Date and Time Report Status SAMPLEREPDCYTC,VALID20150511B00... 05/10/2015 18:05 Final Page 2 of 2 ** End of Report ** * Report times for Mayo performed tests are CST/CDT Performing Site: Mayo Clinic Laboratories - Rochester Main Campus 200 First Street SW, Rochester MN 55905 William G. Morice, II, M.D., Ph.D. Lab Director Phone: 800-533-1710 http://www.mayomedicallaboratories.com

SAMPLEREPDCYTC, VALID20150511B0050 MEDICAL RECORD # (PATIENT ID) SA00074794

DOB 01/01/1981 CLIENT ID/WARD 7028846 ORDER # D411000668 SEX Male CLIENT/NAME WARD DLMP Rochester CLIENT ORDER # SA00074794 CLIENT MRN SA00074794 CITY, ST, ZIP Rochester REQUESTED BY CLIENT CLIENT MN 55901 DATE REPORTED 6/3/2015 4:59 PM

AML, FISH Result Summary: Abnormal

Interpretation: The result is abnormal and indicates DEK/NUP214 fusion in 93% of nuclei. This result usually indicates a t(6;9), which is associated with both de novo and therapy-related AML. This translocation reportedly has an unfavorable prognosis at diagnosis (Grimwade et al., Blood 116:354-65, 2010). For monitoring response to therapy in this patient, we suggest using FISH for DEK/NUP214 fusion.

Result Table: Abnormality Name Result % Abn Cutoff (%) inv(3) RPN1/MECOM fusion Normal <0.6% -5q31(D5S630x2,EGR1x1) Normal <9.5% -5(D5S630,EGR1)x1 Normal <3.5% -7q31(D7Z1x2,D7S486x1) Normal <4.5% -7(D7Z1,D7S486)x1 Normal <3.5% +8(D8Z2,MYC)x3 Normal <2.5% -13q14.3(D13S319x1,LAMP1x2) Normal <7.0% -13q14.3x2(D13S319x0,LAMP1x2) Normal <1.5% -20q12(D20S109x1,20qterx2) Normal <9.5% 11q23(MLL sep) Normal <4.0% -17p13.1(TP53x1,D17Z1x2) Normal <9.5% -17(TP53,D17Z1)x1 Normal <5.5% t(6;9) DEK/NUP214 fusion Abnormal 93 <0.6% t(8;21) RUNX1T1/RUNX1 fusion Normal <0.6% t(15;17) PML/RARA fusion Normal <0.6% inv(16)/t(16;16) MYH11/CBFB fusion Normal <0.6% t(8;16) KAT6A/CREBBP fusion Normal <0.6% t(9;22) ABL1/BCR fusion Normal <0.6%

PATIENT NAME: SAMPLEREPDCYTC, VALID20150511B0050 Page 1 of 2 The collected, received, and reported dates and times on the report are in the time zone of the performing location. SAMPLEREPDCYTC, VALID20150511B0050 MEDICAL RECORD # (PATIENT ID) SA00074794

t(3;5) MLF1/NPM1 fusion Normal <0.6%

Result: nuc ish(DEK,NUP214)x3(DEK con NUP214x2)[465/500]

Reason for Referral: acute myeloid leukemia/AML Specimen: Blood

Method: Locus and probes [Strategy;#Nuclei;Class] ------3q21(RPN1),3q26.2(MECOM) [DFISH;500;LDT] 5p15.2(D5S630),5q31(EGR1) [COPY#;200;ASR] 6p23(DEK),9q34(NUP214) [DFISH;500;LDT] 7CEN(D7Z1),7q31(D7S486) [COPY#;200;ASR] 8p11.2(KAT6A),16p13.3(CREBBP) [DFISH;500;LDT] 8q22(RUNX1T1),21q22(RUNX1) [DFISH;500;ASR] 8CEN(D8Z2),8q24.1(MYC) [COPY#;200;ASR] 9q34(ABL1),22q11.2(BCR) [DFISH;500;ASR] 11q23(5'MLL,3'MLL) [BAP;200;ASR] 13q14.3(D13S319),13q34(LAMP1) [COPY#;200;ASR] 15q24.1(PML),17q21(RARA) [DFISH;500;ASR] 16p13(MYH11),16q22(CBFB) [DFISH;500;LDT] 17p13(TP53),17CEN(D17Z1) [COPY#;200;ASR] 20q12(D20S108),20qter [COPY#;200;ASR] Probe strategies include: DFISH=dual color, double fusion; BAP=break-apart probe; COPY#=region gain and loss.

Disclaimer: Applicable to Analyte Specific Reagent (ASR) and Laboratory Developed Tests (LDT). This test was developed and its performance characteristics determined by Mayo Clinic. It has not been cleared or approved by the U.S. Food and Drug Administration. This FISH test does not rule out other chromosome abnormalities. Released By: Patricia T. Greipp, D.O.

PATIENT NAME: SAMPLEREPDCYTC, VALID20150511B0050 Page 2 of 2 The collected, received, and reported dates and times on the report are in the time zone of the performing location.