Development of IgG lambda multiple myeloma in a patient with cutaneous CD30(+) anaplastic T-cell lymphoma

We report a patient with an epidermotropic cutaneous T-cell lymphoma which transformed into an anaplastic cutaneous CD30(+) T-cell lymphoma. Repeated relapses required prolonged systemic PUVA therapy. Two years after diagnosi s, the patient had several episodes of infections of the respiratory tract. Serum electrophoresis now revealed significantly reduced polyclonal immung lobubin production and an additional band in the gamma fraction correspondi ng to IgG lambda monoclonal gammopathy. Thereafter, the patient suffered a pathologic fracture of the dorsolateral 5th rib on the right side and an ac cumulation of monoclonal plasma cells in the bone marrow confirmed the diag nosis of multiple myeloma (IgG lambda). Accordingly, 6 cycles of cytoreduct ive chemotherapy (alkeran, decortin) were given. After one year of steady s tate disease the patient lost weight and bone pain increased while only a f ew papular eruptions were detectable. Radiography showed multiple small ost eolytic areas. A few months later he died with signs of bone marrow insuffi ciency.