Lymphoma one of the elder patients suffering from DLBCL,

Lymphoma is usually seen and known
as the disease of blood, which is categorized to two parts: Hodgkin Lymphoma
and Non- Hodgkin Lymphoma (NHL). Lymphoma only takes place when the growth of
one type of white blood cells named lymphocytes is out of control. The reason
lymphocytes are uncontrollable is that they can change their positions in the
human body as they want, such as in the bone marrow, blood, and lymph nodes.
There are two different methods of how lymphocytes changes to the

status of lymphomas, which are B
lymphocytes (B cells) and T lymphocytes (T cells). However, B cells have much
higher possibility to form than T cells does, about 85% occurring rate. Diffuse
Large B-Cell Non-Hodgkins Lymphoma (DLBCL) is one type of the NHL, which is the
most popular one recently in America. It usually takes place on both female and
male aged people above 60 years old, but it does not mean it would not happen
among children.

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Unfortunately, the 70-year-old
patient, Mrs. Bates is one of the elder patients suffering from DLBCL, which was
diagnosed in the 2016, and was already on stage III of DLBCL currently.
Therefore, she was admitted to the transplant unit for a matched allogeneic
SCT. The current diagnosis is associated with the patient’s medical history of
DLBCL, psoriasis, and hypertension. Patients at the first or early stage of
DLBCL would not have shown obvious signs and symptoms, which is a pain-free
enlargement

around the neck and the area between
the abdomen and the thigh. The symptoms of DLBCL are high body temperature,
unintended weight loss, as well as sweating during the nights. Also, some
patients feel tiredness, decreased appetite, shortness of breath (SOB), and
pain. The symptoms of fever, fatigue, dyspnea, unintentional weight loss, and
loss of appetite of Mrs. Bates proves she had upon relapse of DCBCL, as she
stated that “food just does not take good to her and does not want to eat
much.”

It is necessary to instantly start
treatments for DLBCL patients because of its rapid growth rate. Doctors usually
choose to do combined therapies to maximize effectiveness. R-CHOP, which stands
for rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, has
been operated to a large degree for DLBCL medical care, which usually takes 21
days to complete. Also, a better performance will be gained if chemotherapy
drugs could collaborate together, such as etoposide. Therefore, the smart

treatment plan Mrs. Bates is
currently on is the combination of myeloablative cyclophosphamide and
etoposide. Honestly, there are no perfect treatment plans, which always come
with side effects on the human body to some degree. Combined medical care show
successful effectiveness at first or the beginning of the treatment for most
patients (most patients). However, DCBCL happens again or is unmanageable by
the planned treatments for some patients, and Mrs. Bates is one of those.
Therefore, a designed

treatment for Mrs. Bates is not only
focused on chemotherapy drugs, but also a stem cell transplant.

Clearly, three types of stem cell
transplants are available to all patients with DLBCL, which are an autologous
transplant, syngeneic transplant, and allogeneic transplant. The way patients
would have their own stem transplanted is known as autologous stem cell
transplant or autotransplant. Patient’s own stem cells are gather from their
personal bone marrow or blood. They are kept in the freezing area, and to
utilize them when needed. Those stem cells are necessary to return back to
patients after experiencing

intensive chemotherapy or radiation
therapy treatments. The syngeneic transplant, an unusual type of allogeneic
transplant, specially and successfully only designs for identical twins.
Identical twins have perfect matches between their genes and tissues, which
leads to high successful rate and low rejection rate. An Allogeneic transplant,
known as an allograft, is action of receiving stem cells from someone else or
donating to needed people. The situation normally happens between people from a

same family. Commonly, brothers or
sisters are good choice to donate their stem cells to their family member, but
contributors are required to above 17 and under 50 years old, with the good
amount of healthy stem cells. An Allogeneic transplant can be completed with
any givers with matched stem cells, which is acknowledged as matched unrelated
donors (MUD). The procedure of pairing bone marrow is termed HLA, standing for
human leukocyte antigen. The transplant Mrs. Bates will do is a matched
allogenic

SCT, which means the stem cells were
donated by some other people. Side effects are possible after the chemotherapy
treatment is completed, and situations will vary depending on individual
differences and the stage of DLBCL. Also, treatment of DLBCL may trigger late
or long terms effects, including fatigue, pain or discomfort, accelerated loss
of bone density, and gained weight.

Due to the greater complexity than
other transplants, an uncertain situation usually occur after an allogeneic
transplant is called graft-versus-host disease (GVHD). It indicates that stem
cells from distributors develop abnormal reactions to patients’ stem cells,
because they are not familiar with patients’ cells and trying to kill them.
Comparing to the high risk rate of allogeneic transplant, there is a better
solution, called reduced-intensity conditioning (RIC) or non-myeloablative
transplant.

The idea of RIC is to apply low
intensity of chemotherapy and / or radiotherapy before transplant starts.