Thanks for your detailed description of the case . Plasmablastic lymphoma is a rare type of very aggressive lymphoma. It’s prognosis is usually not that good , considered around less than 30% 3 year survival . Also it’s not that common in patients who are not immune compromised. As you have mentioned for patients who have responded well to initial chemotherapy, bone marrow transplant have shown benefit . Since we haven’t done that , no point in discussing that now . But in your case , once it’s relapsed and according to this PET CT is a extensive disseminated disease involving lung and multiple other sites My suggestion for treatment will be - if the patient is fit to take - chemotherapy then according the response , if we get a complete remission then can consider for bone marrow transplant . For pain relief as well as , as an acute management for spinal cord compressions can consider local radio therapy to the spinal sites . ( can’t be give final word without seeing the images ) Surgery- which you have mentioned may have been suggested as a possible solution for spinal cord compression, but considering the prognosis of disease and extensive relapse you can discuss with your treating doctor and decide it will be of limited use and also it wont alter the cause of the disease in anyways. Surgery in this case have no relation to your bone marrow transplant . Overall the prognosis is poor , plan for bone marrow transplants is depending on how the patient respond to chemo , and results of prognosis with transplant after a relapse are also limited . Also please consult pain specialist in your hospital regarding pain management possible at this stage , along with the planned therapy . Make sure that the best pain management is provided .