Recurrence with histological transformation 40 days after autologous peripheral blood stem cell transplantation (APBSCT) for cutaneous CD30-negative large T cell lymphoma

Localized cutaneous nontender nodules appeared on the back of a 52-year-old Japanese woman. Skin biopsy revealed atypical large T-lymphocytes infiltra ting the dermis, CD30 staining was negative in tumor cells. The diagnosis w as CD30-negative cutaneous large T cell lymphoma. There was no evidence of peripheral lymphadenopathy or bone marrow involvement. Six cycles of induct ion chemotherapy were administered and a complete clinical remission (CCR) was attained, Local irradiation was not given. As the clinical course of CD 30-negative cutaneous large T cell lymphoma is recurrent and often incurabl e with conventional chemoradiotherapy, she received high-dose chemotherapy without total body irradiation (TBI) followed by unpurged autologous periph eral blood stem cell transplantation (APBSCT), A relapse in the skin follow ed 40 days after APBSCT, but tumor cells transformed into a CD30-positive a naplastic large cell lymphoma (ALCL), We question the need for TBI in condi tioning and for purged stem cells for APBSCT in patients with high risk cut aneous lymphomas.