title: Minimal disseminated disease in high-risk Burkitt's lymphoma identifies patients with different prognosis.
abstract: OBJECTIVE
  To study minimal disseminated disease (MDD) in children with Burkitt's lymphoma (BL) and to determine its impact on prognosis.
  
  
  METHODS
  We established a simplified long-distance polymerase chain reaction (LD-PCR) assay that can amplify up to 15 to 20 Kb of DNA sequence, making it possible to detect the t(8;14) at the genomic level with sensitivity of 10(-4). We prospectively studied diagnostic biopsies and bone marrow aspirates from 134 patients affected by BL.
  
  
  RESULTS
  A specific LD-PCR product was detected in 96 (72%) of 134 BL biopsies. Among 84 patients with t(8;14) positivity on tumor biopsy and bone marrow (BM), 26 (31%) had LD-PCR-positive BM, and 15 (18%) were positive at standard morphologic analysis. Twenty (85%) of 26 MDD-positive patients belonged to the R4 risk group, according to Berlin-Frankfurt-Munster definition. The 3-year progression-free survival was 68% (SE, 10%) in MDD-positive patients in R4 compared with 93% (SE, 5%) in MDD-negative patients in R4 (P = .03). By multivariate analysis (including MDD, sex, lactate dehydrogenase, CNS involvement), only MDD was predictive of higher risk of failure (hazard ratio, 4.7; P = .04).
  
  
  CONCLUSIONS
  MDD identifies a poor-prognosis subgroup among children with high-risk BL. To improve disease control in these patients, a more effective risk-adapted therapy, possibly including anti-CD20 monoclonal antibody, should be considered.
authors.affiliation: Clinica di Oncoematologia Pediatrica, Azienda Ospedaliera-Università di Padova, Via Giustiniani 3, 35128 Padova, Italy.
authors.forename: Lara
authors.initials: L
authors.lastname: Mussolin
authors.forename: Marta
authors.initials: M
authors.lastname: Pillon
authors.forename: Emanuele S G
authors.initials: ES
authors.lastname: d'Amore
authors.forename: Valentino
authors.initials: V
authors.lastname: Conter
authors.forename: Matilde
authors.initials: M
authors.lastname: Piglione
authors.forename: Luca
authors.initials: L
authors.lastname: Lo Nigro
authors.forename: Alberto
authors.initials: A
authors.lastname: Garaventa
authors.forename: Salvatore
authors.initials: S
authors.lastname: Buffardi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Aricò
authors.forename: Angelo
authors.initials: A
authors.lastname: Rosolen
mesh_terms: D000293:Adolescent; D001853:Bone Marrow / Q000473:pathology; D002051:Burkitt Lymphoma / Q000235:genetics / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D002883:Chromosomes, Human, Pair 14; D002898:Chromosomes, Human, Pair 8; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012306:Risk; D014178:Translocation, Genetic