A human immunodeficiency virus-negative male was successfully treated
for two occurrences of Burkitt's lymphoma, 15 years apart. As consolid
ation of his second remission, he underwent high-dose chemotherapy wit
h peripheral blood stem cell transplantation. In an effort to prove wh
ether the second lymphoma was a relapse of the first or a second prima
ry lymphoma, we obtained paraffin-embedded material from both lymphoma
s, DNA was extracted from this material and amplified by polymerase ch
ain reaction (PCR) using consensus J(H) and V-H legion primers, Analys
is of the PCR products, which mostly reflects VDJ joints, showed two s
harp bands of different molecular size, proving the monoclonal nature
of the lymphomas and suggesting that each had different lg gene rearra
ngements. Sequencing of both PCR products showed a marked dissimilarit
y in nucleotide sequence in the clonally unique VDJ joint region, prov
iding strong evidence for the separate cellular genesis of each lympho
ma. These results suggest that late relapses of Burkitt's lymphoma sho
uld be examined for clonal distinctiveness. If the second lymphoma is
distinct from the primary one, it might be treated as a primary lympho
ma rather than as recurrent disease. (C) 1996 by The American Society
of Hematology.