Lymphoma is usually seen and knownas the disease of blood, which is categorized to two parts: Hodgkin Lymphomaand Non- Hodgkin Lymphoma (NHL).
Lymphoma only takes place when the growth ofone type of white blood cells named lymphocytes is out of control. The reasonlymphocytes are uncontrollable is that they can change their positions in thehuman body as they want, such as in the bone marrow, blood, and lymph nodes.There are two different methods of how lymphocytes changes to thestatus of lymphomas, which are Blymphocytes (B cells) and T lymphocytes (T cells). However, B cells have muchhigher possibility to form than T cells does, about 85% occurring rate. DiffuseLarge B-Cell Non-Hodgkins Lymphoma (DLBCL) is one type of the NHL, which is themost popular one recently in America.
It usually takes place on both female andmale aged people above 60 years old, but it does not mean it would not happenamong children. Unfortunately, the 70-year-oldpatient, Mrs. Bates is one of the elder patients suffering from DLBCL, which wasdiagnosed in the 2016, and was already on stage III of DLBCL currently.Therefore, she was admitted to the transplant unit for a matched allogeneicSCT. The current diagnosis is associated with the patient’s medical history ofDLBCL, psoriasis, and hypertension. Patients at the first or early stage ofDLBCL would not have shown obvious signs and symptoms, which is a pain-freeenlargementaround the neck and the area betweenthe abdomen and the thigh. The symptoms of DLBCL are high body temperature,unintended weight loss, as well as sweating during the nights. Also, somepatients feel tiredness, decreased appetite, shortness of breath (SOB), andpain.
The symptoms of fever, fatigue, dyspnea, unintentional weight loss, andloss of appetite of Mrs. Bates proves she had upon relapse of DCBCL, as shestated that “food just does not take good to her and does not want to eatmuch.”It is necessary to instantly starttreatments for DLBCL patients because of its rapid growth rate. Doctors usuallychoose to do combined therapies to maximize effectiveness. R-CHOP, which standsfor rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone, hasbeen operated to a large degree for DLBCL medical care, which usually takes 21days to complete. Also, a better performance will be gained if chemotherapydrugs could collaborate together, such as etoposide. Therefore, the smarttreatment plan Mrs.
Bates iscurrently on is the combination of myeloablative cyclophosphamide andetoposide. Honestly, there are no perfect treatment plans, which always comewith side effects on the human body to some degree. Combined medical care showsuccessful effectiveness at first or the beginning of the treatment for mostpatients (most patients). However, DCBCL happens again or is unmanageable bythe planned treatments for some patients, and Mrs.
Bates is one of those.Therefore, a designedtreatment for Mrs. Bates is not onlyfocused on chemotherapy drugs, but also a stem cell transplant. Clearly, three types of stem celltransplants are available to all patients with DLBCL, which are an autologoustransplant, syngeneic transplant, and allogeneic transplant. The way patientswould have their own stem transplanted is known as autologous stem celltransplant or autotransplant. Patient’s own stem cells are gather from theirpersonal bone marrow or blood. They are kept in the freezing area, and toutilize them when needed.
Those stem cells are necessary to return back topatients after experiencingintensive chemotherapy or radiationtherapy treatments. The syngeneic transplant, an unusual type of allogeneictransplant, specially and successfully only designs for identical twins.Identical twins have perfect matches between their genes and tissues, whichleads to high successful rate and low rejection rate.
An Allogeneic transplant,known as an allograft, is action of receiving stem cells from someone else ordonating to needed people. The situation normally happens between people from asame family. Commonly, brothers orsisters are good choice to donate their stem cells to their family member, butcontributors are required to above 17 and under 50 years old, with the goodamount of healthy stem cells. An Allogeneic transplant can be completed withany givers with matched stem cells, which is acknowledged as matched unrelateddonors (MUD). The procedure of pairing bone marrow is termed HLA, standing forhuman leukocyte antigen. The transplant Mrs.
Bates will do is a matchedallogenicSCT, which means the stem cells weredonated by some other people. Side effects are possible after the chemotherapytreatment is completed, and situations will vary depending on individualdifferences and the stage of DLBCL. Also, treatment of DLBCL may trigger lateor long terms effects, including fatigue, pain or discomfort, accelerated lossof bone density, and gained weight.Due to the greater complexity thanother transplants, an uncertain situation usually occur after an allogeneictransplant is called graft-versus-host disease (GVHD). It indicates that stemcells 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 bettersolution, called reduced-intensity conditioning (RIC) or non-myeloablativetransplant.The idea of RIC is to apply lowintensity of chemotherapy and / or radiotherapy before transplant starts.