The Ichilov Clinic employs leading experts in hematology and oncology with extensive experience in diagnosing rare forms of diseases from a heterogeneous group and treating nodal marginal zone lymphoma in Israel. Positive statistics on long-term remissions are based on the collaborative work of various specialists. The team of doctors takes a comprehensive and thorough approach to diagnosis and treatment strategy development, considering all aspects of the specific case. The treatment plan is developed individually for each patient.
The Ichilov Clinic is equipped with the most modern medical technologies. Patients have access to the latest methods, including medications and technologies. The clinic's staff supports each patient throughout the treatment process, from the first visit to rehabilitation. The medical center has experience in serving international patients, providing personal accompanying services and translators, and assistance with logistical aspects.
About the Disease
Nodal marginal zone lymphoma (NMZL) is a rare type of B-cell non-Hodgkin lymphoma. The disease affects B-lymphocytes in the marginal zone of lymph nodes.
Nodal marginal zone lymphoma is a group of diseases that includes several different subtypes. The classification divides marginal zone lymphomas by their primary localization (in lymph nodes, extranodal organs, or the spleen):
- Nodal marginal zone lymphoma (NMZL). A rare pathology that accounts for about 2% of all non-Hodgkin lymphomas. This form of the disease affects the lymph node itself.
- Extranodal marginal zone lymphoma, also known as mucosa-associated lymphoid tissue (MALT). The most common subtype, accounting for about 8% of non-Hodgkin lymphomas, usually with extranodal localization: stomach, lungs, thyroid gland, salivary glands, and intestines.
- Spleen marginal zone lymphoma, which accounts for approximately 1% of non-Hodgkin lymphomas, characterized by spleen involvement.
The term “nodal marginal zone lymphoma” (NMZL) refers to the nodal form of the disease. This involves primary lymph nodes, unlike other subtypes of marginal zone lymphoma that may occur outside lymph nodes (extranodally) or in the spleen.
The exact causes of NMZL development are unknown. However, as with other types of lymphomas, a role for immune system disorders, viral infections (e.g., associations with Epstein-Barr virus), and exposure to various external factors, including possibly chemical carcinogens, is suggested.
The most common and characteristic signs may include:
- painless enlargement of lymph nodes, especially in the neck, armpits, and groin;
- fatigue;
- unexplained weight loss;
- night sweats;
- fever without signs of infection.
The clinical picture may vary, and in some cases, progress without symptoms, discovering the problem accidentally during a medical examination for another reason.
Treatment Methods for the Disease
Treatment depends on the stage of the disease, the overall health of the patient, and their symptoms. When choosing a specific strategy at Ichilov, the characteristics of the disease manifestation in the specific patient are considered along with other pathologies.
Observation or “Watch and Wait”
In cases of low disease aggressiveness and absence of symptoms, doctors may suggest an active surveillance strategy without immediate treatment. This approach involves regular monitoring at specified intervals through blood tests and imaging methods.
Chemotherapy
Chemotherapy for treating nodal marginal zone lymphoma is used both as monotherapy and in combinations. The Ichilov Clinic practices various regimens, schedules, and medications. The procedure is conducted in courses spread over several weeks or months. Each course includes a period of drug administration followed by a rest period, allowing the body to recover.
The goal of chemotherapy is to destroy malignant cells, achieve remission, optimize prognosis, and maintain the patient's quality of life.
Monoclonal Antibodies
This treatment method involves the use of laboratory-developed molecular agents for targeted attack on cancer cells expressing the CD20 antigen. Monoclonal antibody treatment at the Ichilov Clinic can be used as a standalone therapy or in combination with chemotherapy to enhance the effect.
Radiotherapy
The use of ionizing radiation to destroy cancer cells in a specific area of the body. Radiation may be prescribed when cancer is localized in one place or to alleviate symptoms.
At the Ichilov medical center, radiotherapy is conducted using the most modern TrueBeam and Lunac linear accelerators. These are the latest systems for conducting radiotherapy with very precise targeting, dosing, and minimal impact on healthy tissues. The equipment is highly effective, especially in performing conformal radiation therapy and stereotactic radiosurgery.
Surgical Removal
Surgical intervention is primarily considered for diagnostic purposes, such as performing a biopsy for more accurate diagnosis. However, in cases where the disease is localized and accessible for surgical intervention, or in the presence of certain complications, such as significant tumours causing mechanical compression, surgical intervention may be warranted:
- traditional open surgery;
- laparoscopic surgery;
- robot-assisted surgery. A robot-assisted surgical system, such as the da Vinci system, allows the surgeon to perform more precise maneuvers with reduced risk of complications and faster recovery after surgery;
- endoscopic surgery.
Although robotic and minimally invasive surgical methods provide certain advantages, their application in treating nodal marginal zone lymphoma is limited and depends on the unique clinical situation.
Targeted and Immunomodulatory Therapy
New, promising directions in medicine, using drugs that block the growth and spread of cancer. The feature of these substances is targeting specific biological mechanisms and pathways associated with tumour cells. Concurrently, the use of immunomodulatory drugs may be recommended, the main goal of which is to stimulate the patient's immune system to fight cancer cells.
Autologous Stem Cell Transplantation
In cases of relapse or aggressive disease course, stem cell transplantation may be considered. This therapeutic procedure involves:
- stimulating the release of stem cells from the bone marrow into the patient's bloodstream using special medications, such as colony-stimulating factors, and sometimes low doses of chemotherapy;
- then performing apheresis—a procedure in which stem cells are separated from the patient's blood using a machine, and the blood is returned to the bloodstream;
- after high-dose chemotherapy or radiotherapy and destruction of most cancer cells, the preserved stem cells are reintroduced into the bloodstream (similar to a blood transfusion). There, they migrate to the bone marrow and begin to restore its functions by producing new healthy blood cells.
- Stem Cell Treatment
- Surgery in Israel
- Radiotherapy
- Chemotherapy
- Monoclonal Therapy
Diagnostic Methods for the Disease
The diagnosis of nodal marginal zone lymphoma includes several stages and relies on various research methods and analyses. Typically, it takes 3 days to interpret the diagnostic results and establish a diagnosis.
First Day
The doctor reviews the medical history, studies the symptoms, and collects the anamnesis. A physical examination is mandatory, including palpation of the lymph nodes to detect possible enlargement.
Second Day
- Laboratory blood tests: general and biochemical.
- Immunophenotyping. Blood or bone marrow analysis using flow cytometry, which helps determine the type of lymphocytes affected by the lymphoma.
- Bone marrow examination: biopsy or trepanobiopsy to determine if the lymphoma has spread to the bone marrow.
- Lymph node biopsy.
- Molecular genetic studies.
- Immunohistochemistry. A specialized analysis that helps determine the expression of certain proteins in cells, which can assist in clarifying the diagnosis.
- Radiological studies: CT, PET, MRI.
Third Day
A multidisciplinary team of doctors, including hematologists, radiologists, oncologists, molecular biologists, and geneticists, interprets the test results and develops a personalized treatment plan.
- Biopsy
- Bone Marrow Biopsy
- Computed Tomography
- Magnetic Resonance Imaging (MRI)
- Diagnosis — PET CT
- X-ray
- Blood Biochemistry
How Much Does Treatment Cost
The cost of treatment is calculated individually and depends on many factors. The price is influenced by the composition of the multidisciplinary team, the need to involve specialists. Depending on the patient's condition at the time of admission to the clinic, the number and complexity of diagnostic procedures and therapeutic methods may vary.
Call a medical consultant to find out how to apply, how much treatment costs, where to find detailed information about departments and doctors, their ratings, and reviews. You can write all your questions in a special feedback form on the website or ask them in the online chat.
Advantages of Treating Nodal Marginal Zone Lymphoma in Israel
- Highly qualified specialists and a multidisciplinary approach
- Advanced medical equipment
- Individualized treatment and innovative therapy methods
- Close interaction with patients at all stages of treatment
- Support for international patients
The Ichilov Clinic offers a combination of medical competence and patient-centered approach, making it one of the leading medical institutions in Israel and beyond. You can schedule a video call via Zoom or Skype and receive a consultation from a leading specialist in the study and treatment of lymphomas. The doctor will review the available test results and provide recommendations for further actions, considering the specifics of the disease, the results of clinical studies, and the patient's condition.