The immunoglobulin genes, which contain many different variable (V), diversity (D) and joining (J) gene segments, rearrange sequentially during B-cell development, with rearrangement of IGH first, followed by IGK. If the rearranged IGK genes are not functional and IgH/Igj is not expressed, IGKJ-IGKC or IGKC gene segments are deleted via recombination of IGKV segments or the IGKJ-IGKC intron with the downstream IGK deletion element (K de ), and IGL rearrangement proceeds, resulting in potential expression of IgH/Igk (Alt et al, 1986;Langerak & van Dongen, 2006). This process implies that the IGK loci are rearranged in essentially all differentiated B-cells. Using Southern blotting (Arnold et al, 1983;Cleary et al, 1984;Williams et al, 1987;Spencer et al, 1989) and polymerase chain reactions (PCR) (Bourguin et al, 1990;McCarthy et al, 1990;Trainor et al, 1990;Kuppers et al, 1993), it has been shown that both the rearranged IGH and IGK are highly sensitive and complementary markers in the detection of monoclonal B-cell proliferations. However, in routine practice IGH is more commonly used than IGK for PCR-based B-cell clonality analysis, despite being known to give a high false negative rate in germinal/post-germinal centre B-cell malignancies (Gong et al, 1999;Diss et al, 2002;Pai et al, 2005;Amara et al, 2006).To improve clonality analysis, the European BIOMED-2 study consortium optimised and standardized the PCR-based analysis of rearranged immunoglobulin and T-cell receptor genes (van Dongen et al, 2003). One of the most significant advances made in this study was the targeting of multiple complementary gene loci. For example, B-cell clonality assays include analysis of complete IGH V-D-J and incomplete IGH D-J rearrangements, IGK V-J and K de -involved rearrangements, and IGL V-J rearrangements. Based on frozen tissues, the sensitivity of the IGK assays was equivalent to that of the Summary B-cell clonality analysis is commonly performed by polymerase chain reaction (PCR) targeting the IGH genes although a high false-negative rate is recognized for germinal centre/post-germinal centre B-cell malignancies, especially follicular lymphoma. We assessed the diagnostic value of BIOMED-2 IGK assays and investigated the cause of IGH PCR failure in 77 patients with follicular lymphoma. Using the full set of BIOMED-2 reactions, clonal immunoglobulin gene rearrangements were detected in 74 (96%) cases. The clonality detection rate was 86% by two IGK reactions but only 68% by five IGH reactions (P < 0AE001). Sequencing of the clonal PCR products showed significantly fewer somatic mutations in the rearranged IGKV (9/27 cases, 33%, mean mutation rate 0AE5%) than IGHV (17/17 cases, 100%, rate 11AE0%) (P < 0AE01). All IGHV-IGHJ PCR failures occurred in cases with at least one mutation at the corresponding IGHV primer binding sites. t(14:18)(q32:q21)/IGH-BCL2 was detected in 50 of 71 (70%) cases and the presence of the translocation was not associated with the poor performance of IGH assays. Our results showed that BIOMED-2 IG...