title: Analysis of immunoglobulin heavy chain rearrangement in a child with recurrent Burkitt lymphoma to determine clonality.
abstract: BACKGROUND
  Burkitt lymphoma (BL) is an aggressive, rapidly proliferating neoplasm of B-cell origin. A late recurrence should be investigated to differentiate whether it is a true relapse or a de novo lymphoma as this has therapeutic implications.
  
  
  METHODS
  We report an HIV-negative white male individual, who at the age of 14 presented with recurrent BL in the abdomen occurring 6 years after successful treatment. Analysis of VDJ rearrangement showed marked dissimilarity in clonal peaks between the 2 tumors, suggesting that each tumor was associated with separate origins. The second tumor was treated as a de novo BL, and the patient remained in complete remission 2 years from recurrence without any evidence of the disease.
  
  
  CONCLUSIONS
  We present a case with 2 distinct BLs verified by the VDJ rearrangement analysis in a non-HIV infected individual. Our case supports the finding that a genetically discrete BL can be treated as if it were a new tumor, thereby reducing chemotherapeutic burden and treatment-related morbidity associated with the regimens for relapsed or refractory disease. Analysis of VDJ rearrangement seems to be a reliable assessment of tumor clonality.
authors.affiliation: Departments of *Pediatrics †Pathology, Ronald McDonald Children's Hospital, Loyola University Chicago Health Sciences Division, Maywood, IL.
authors.forename: Jimmy T
authors.initials: JT
authors.lastname: Nguyen
authors.forename: Ameet R
authors.initials: AR
authors.lastname: Kini
authors.forename: Yanxia
authors.initials: Y
authors.lastname: Li
authors.forename: Marie E
authors.initials: ME
authors.lastname: Sarvida
authors.forename: Ricarchito
authors.initials: R
authors.lastname: Manera
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002051:Burkitt Lymphoma / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics*; D005434:Flow Cytometry; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics*; D008297:Male; D016609:Neoplasms, Second Primary / Q000175:diagnosis / Q000188:drug therapy / Q000235:genetics*; D016133:Polymerase Chain Reaction; D060152:V(D)J Recombination / Q000235:genetics*
chemical_list: D007143:Immunoglobulin Heavy Chains