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An interesting environmental risk factor that has been correlated to the development of NHL is women who have used hair dye before 1980. Bassig and colleagues aimed to examine the interaction between variants in DNA repair genes and hair dye use with risk of NHL in a population-based case control study of Connecticut women. Previous studies focused on hair dyes used before 1980 and observation of hair dye associated cancer was not observed after 1980 so they focused on hair dye use prior to 1980. Essentially what they did was examined DNA repair genes among 518 NHL cases and 597 controls and evaluated the risk between hair dye use and development of NHL and different subtypes of NHL based on genotypes. One important mechanism underlying this association is that a number of hair dye ingredients, such as phenylenediamines and paraphenylenediamine, are suspected carcinogens that can cause cytogenetic alterations and DNA damage (Bassig 2012). Their hypothesis was DNA repair mechanisms are important in maintaining genomic stability, and defects in DNA repair pathways may increase chromosomal aberrations induced by hair dye use leading to the development of NHL. The results proved their hypothesis that women who used hair dye before 1980 had a significantly increased risk of developing NHL, particularly for the follicular lymphoma (FL) and Diffuse large B-cell lymphoma (DLBCL) subtype if they carried the WRNrs1346044 TT genotype which resulted in key polymorphisms in key DNA repair genes (Bassig 2012). Of the 518 NHL cases 21% were diagnosed with FL subtype and 31% were diagnosed with DLBCL subtype. One possible explanation for these differences in risk by time period observed in our study may relate to higher levels of mutagenic chemicals in hair dye formulations before 1980, as reformulation of hair dye products beginning in the early 1980s involved the replacement or elimination of some of the dyes that had been reported to produce tumors in NCI bioassays. Even though this study was limited to only the state of Connecticut, the sample size was relatively decent in size with over 1,000 cases of control and NHL groups. This is a confident number when determining whether or not hair dye prior to 1980 is truly a factor in contributing to NHL, which after analyzing the findings, it is. Important nursing teaching is to inform your patients of all risk factors of cancer. Even though hair dye is not considered a mainstream risk factor, hair dyes with the ingredients phenylenediamines and paraphenylenediamine should be avoided completely to reduce the risk of developing NHL.Benzene is a very prevalent environmental substance that is found in many industries such as cigarette smoke, rubber, plastic, gasoline, and many other industrial products. The association between benzene exposure and (NHL) has been the subject of debate as a result of inconsistent epidemiologic evidence. An International Agency for Research on Cancer (IARC) working group evaluated benzene in 2009. The study is a prospective cohort of 74,942 women living in urban Shanghai who were enrolled between the ages of 40 and 70 years, with a diverse occupation history. Of the 74,942 women only 10,788 women were even exposed to benzene over their careers while 62,299 were not. Benzene exposure estimates were derived using a previously developed exposure assessment framework that combined ordinal job-exposure matrix intensity ratings with quantitative benzene exposure measurements from an inspection database of Shanghai factories collected between 1954 and 2000 (Bassig 2015). Among workers exposed to benzene, the predominant industries of employment in terms of person years from the occupational histories included manufacturing of rubber products (13%), organic chemicals (10%), motor vehicles (8%), miscellaneous electronics (7%), and television sets and audio equipment (6%).  The study showed that the longer the exposure to benzene the higher the risk for development of NHL.  A significantly higher risk of NHL was observed in the women who were exposed for the longest period of time( > 27 years; HR = 2.65, 95% CI: 1.21, 5.77) (Bassig 2015). Benzene exposure among workers in China are associated with increased mitochondrial DNA (mtDNA) copy number (Shen et al. 2008). Increased mtDNA of benzene on this marker may represent an early biologic effect that is relevant to the development of NHL (Lan et al. 2008). This study had a large sample size that provided tangible results to support the claim that benzene contributes to NHL. Further research would never hurt but it is safe to deduce from this research alone that increasing exposure to benzene over long periods of time can significantly increase the risk of developing NHL. As a nurse it is important to educate our patients who are in these job fields to make them aware of these risks. Protective masks, although may be uncomfortable at first, are a simple yet very effective strategy in the defense of benzene exposure.Treatment There are five common treatment modalities employed by healthcare providers treating patients with NHL. They include: chemotherapy, radiation therapy, stem cell transplantation, immunotherapy, and radioimmunotherapy. Stem cell transplantation is a procedure that involves the injection of healthy stem cells into a patient’s body. Once inside the body, the stem cells differentiate into blood cells. The stem cells are acquired from the patient (autologous) or from a donor. This procedure is done after patients undergoes chemotherapy or radiation treatment. Recently, a study was done to determine the efficacy of autologous hematopoietic stem cell transplantation in patients 65 and older, diagnosed with B-cell Non-Hodgkin’s lymphoma. This was of concern to the researchers because the number of elderly patients receiving this treatment has risen in recent years. These patients have shown increased mortality and morbidity as a result of the transplant and comorbid diseases. Therefore, it is imperative that research is done to determine if this treatment modality is worth the risks these patients may incur.The researchers collected data on thirty-six patients age 65 and older. All these patients were diagnosed with B-cell Non-Hodgkin’s lymphoma and underwent autologous hematopoietic stem cell transplantation. Patients received chemotherapy or radiation therapy prior to this procedure. Researchers performed a survival analysis using the data they collected. The overall survival was 58%. Of that 58%, patients who had a complete response to chemotherapy and radiation therapy had a greater survival advantage. Patients that received BEAM therapy, a form of radiation therapy had better results. When researchers grouped the recipients as younger than 70 and older than 70, data showed no statistical difference between the two. The results showed that autologous hematopoietic stem cell transplantation can be beneficial in elderly patients despite the risk of transplant related mortality and disease comorbidity. However, certain criteria were met by the patients who survived. Of those who had increases survivability, the majority had complete or partial response to first-line therapy before undergoing stem cell transplantation. Those who experienced complete response had a statistically significant advantage on survival rate and their overall survival length was longer. The researchers also determined that there was no significant difference in survival rates between patient younger than 70 and older than 70. Therefore, age was not a relative factor. The researchers concluded that stem cell transplantation is a viable treatment option for patients age 65 and older, and long as they met the criteria mentioned. As a nurse taking care of patient undergoing stem cell transplantation, your primary role is as an educator. Prior to the procedure, a patient may undergo chemotherapy. Chemotherapy can impact a patient’s immune system making them more susceptible to infections. The patient may be placed in an isolation room. The nurse should inform the patient and their family about the importance of maintaining isolation precautions. They should instruct them to wash their

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