A CLONALLY DISTINCT RECURRENCE OF BURKITTS-LYMPHOMA AT 15 YEARS

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.