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Acute Myeloid Leukemia PediatricNon-Hodgkin lymphoma is a large group of tumors originating from T lymphocytes or B lymphocytes. Most neoplasms initially develop in the lymph nodes, which can then spread to soft tissues, internal organs, bone marrow, and the central nervous system. Lymphomas can be indolent (smoldering) and aggressive. These neoplasms develop more often in adults and less often in children.
Symptoms:
Signs and symptoms of non-Hodgkin's lymphoma may include:
Your doctor will likely ask you about your personal and family medical history. He or she may then have you undergo tests and procedures used to diagnose non-Hodgkin's lymphoma, including:
Your doctor uses information from these tests and procedures to determine the subtype of your non-Hodgkin's lymphoma and which treatments may be most effective. Many types of non-Hodgkin's lymphoma exist, including rare forms that some doctors may have never seen.
Treatment:
Chemotherapy is considered the main method for the treatment of non-Hodgkin lymphoma. A treatment regimen depends on the type of the tumor and a patient's age. This may include alkylating agents, corticosteroids, platinum-based drugs, purine analogues, antimetabolites, and other agents. The CHOP or CVP regimen is used for many neoplasms. Chemotherapy is often complemented by targeted therapy and immunotherapy.
The advantage of chemotherapy is that this acts immediately on all tumor foci in the body, so it works well at all stages. To which Most types of lymphoma are sensitive. Successful therapy leads to a complete cure of the disease.
Sometimes lymphoma spreads to the central nervous system. Most drugs do not penetrate it from the blood due to the blood-brain barrier. In such cases, doctors use intrathecal chemotherapy: drugs are injected into the cerebrospinal fluid through a lumbar puncture.
Doctors often use immunotherapy in addition to chemotherapy for non-Hodgkin lymphomas. This treatment can be carried out in different versions:
Monoclonal antibodies can target the CD20, CD19, CD52, CD30, and CD79b proteins, depending on the type of the tumor. Chemotherapy agents can sometimes be attached to monoclonal antibodies. As a result, they are delivered directly to the cancer cells. Such drugs are called antibody-drug conjugates. They are usually used as a second-line therapy when "regular" monoclonal antibodies have already been tried.
Immune checkpoint inhibitors are used much less often. These can be applied only for certain types of non-Hodgkin lymphoma, such as primary mediastinal large B-cell lymphoma that has recurred after chemotherapy. The mechanism of action of these drugs is to block molecules that allow the tumor to evade the immune response.
Immunomodulators are usually used for lymphoma in cases where other treatment methods have already been tried and failed. Drugs are prescribed in pills. They stimulate the immune response, allowing a patient's body to fight lymphoma more successfully. Medicines from this group are used with caution in pregnant women because there is a risk of developing congenital malformations in the fetus.
Unlike chemotherapy, which affects all cells in the body, targeted therapy targets particular molecular targets detected exclusively in lymphoma cells. Therefore, this drug therapy is more selective about the tumor. At the same time, this requires a personalized approach to prescribing treatment. The therapy is selected based on the molecular diagnosis of cancer and is usually used as a "fallback" treatment option if there is no response to chemotherapy or the tumor recurs after its initial treatment.
For some lymphomas, other drug therapy options can also be used.
For example, MALT lymphoma is caused by Helicobacter pylori infection. Antibiotics are required to suppress it. In the case of gastric lymphomas, patients also receive proton pump inhibitors to reduce the production of hydrochloric acid.
Splenic marginal zone B-cell lymphoma can sometimes be associated with viral hepatitis C. Its destruction by antiviral drugs helps to reduce the tumor size or even cure cancer completely.
Lymphomas often affect not only the lymph nodes, but also the bone marrow. Such patients have a decreased production of blood cells, weak immunity, and blood clotting disorders are possible as well. To prevent complications and to cope with complications that have already developed, doctors use antibiotics, antiviral agents, intravenous immunoglobulin, erythrocyte or platelet mass transfusions.
Radiation therapy for lymphoma can be used in the following cases:
In the most severe and advanced cases, lymphoma can be treated with a stem cell transplant. This procedure is usually conducted in children or young patients but is rarely used for older people.
Stem cells provide hematopoiesis. All other blood cells develop from them: erythrocytes, platelets, and immune cells, namely leukocytes. A stem cell transplant can be autologous or allogeneic, depending on whether the cells are transplanted from a patient or from a donor.
When dealing with lymphoma treatment, autologous cells are more commonly used. However, this is only possible if the lymphoma has not spread to the bone marrow. The essence of this procedure is that stem cells are harvested from a patient and frozen, followed by a course of high-dose chemotherapy, sometimes combined with radiation therapy. High doses of drugs completely destroy the lymphoma, but they also irreversibly suppress the bone marrow. The previously harvested stem cells are injected back into the body after a while to restore it.
If the lymphoma has spread to the bone marrow, an autologous transplant is unlikely to eliminate cancer completely. This is because the biomaterial taken from a patient is highly likely to contain cancer cells. In the future, they will grow, and the lymphoma is highly likely to recur after a transplant procedure. Therefore, doctors resort to an allogeneic stem cell transplant in such cases. Donor bone marrow definitely does not contain any cancer cells. In addition, this transplant cannot activate "graft-versus-tumor" responses, which provides an additional therapeutic effect due to immune mechanisms.
Surgery for lymphoma is rare. If this treatment becomes an option of choice, this is an auxiliary method, but not the main one.
Sometimes surgery can be performed at an early stage of thyroid or gastric lymphoma. However, radiation therapy is the preferred option for dealing with these tumors. Surgery can be considered if radiation therapy is contraindicated (for example, a patient has already received radiation therapy before), or if cancer has to be removed immediately (for example, it compresses the neck and prevents breathing).
Low red blood cell levels become a problem for many patients. To reduce their destruction, doctors may perform a splenectomy, an operation to remove the spleen.
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1-Diagnosis:
The program includes:
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 6 days
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2-Chemotherapy:
The program includes:
Required documents
Price from: on request
Type of program: Inpatient or outpatient (related to your diagnosis and treatment protocol).
Expected duration of the program: may differ and be related to your diagnosis and treatment protocol.
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3-Radiotherapy:
The program includes:
How program is carried out
During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will conduct radiotherapy planning with the help of CT or MRI, make the permanent tattoo marks on the skin and conduct CT simulation to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).
Radiation therapy is carried out as an inpatient procedure, with mandatory admission to the hospital. Before each session the physician will assess your general condition and the marks on the skin. After that, you will be placed in a shielded radiation therapy room, on a special table.
Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will have from 1 to 3-5 sessions of radiation therapy a week.
After the completion of the radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 30 days
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4-Bone marrow transplantation:
The program includes:
How program is carried out
During the first visit, the doctor will conduct a clinical examination and go through the results of the available diagnostic tests. After that, you will undergo the necessary additional examination, such as the assessment of liver and kidney function, ultrasound scan, CT scan and MRI.
Also, the doctor will conduct a bone marrow biopsy followed by cytological examination of the harvested material. This will help him to determine the histological features of your bone marrow (in particular, identify HLA system antigens) and the use of a person’s own stem cells. They typically involve harvesting your cells before beginning a damaging therapy to cells like chemotherapy or radiation. After the treatment is done, your own cells are returned to your body.
This type of transplant isn’t always available. It can only be used if you have a healthy bone marrow. However, it reduces the risk of some serious complications, including GVHD.
Before the procedure, you will receive chemotherapy, if necessary, in combination with radiation therapy. The course of chemo- or chemoradiation therapy lasts from 2 to 8 days.
The bone marrow transplant procedure is an intravenous infusion, i.e. the healthy bone marrow will be injected through a catheter, intravenously. You will stay in your room during the procedure. A bone marrow transplant is completely painless and does not require anesthesia.
During the period of healthy bone marrow engraftment, you will stay in a sterile ward. This is a necessary precaution because during this time your immune system is very weak and cannot withstand environmental pathogens. The risk of bleeding is also quite high, so you will be advised to avoid mechanical damage.
A relative or other close person may stay in the ward with you. You will not be allowed to go outside the department and leave your ward often. The rehabilitation period can last from 1 to 2 months.
When your complete blood count returns to normal, your doctor will schedule your discharge from the department. You will receive information about the rules that you will need to follow at home, the frequency and type of control examinations, and subsequent treatment measures. You will also receive a detailed medical report, which will reflect the entire course of treatment.
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 57 days
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