Even with aggressive centroblastic lymphoma, the Ichilov clinic achieves excellent results. Successful treatment is largely determined by the combination of the vast experience of doctors and access to the latest global protocols. Here, treatment is not just about following a set standard, but deeply studying each tumour to select an individual therapy that will work in a specific case. Such precision gives real hope for success even with rapid disease progression.
The clinic provides all conditions for a comfortable stay, and if desired, foreign patients can use the service of a personal companion. Such an assistant will take care of all organizational issues, allowing the person to focus on treatment and maintain peace of mind. Combined with powerful therapy, this helps to overcome the disease and return to a full life even in the most difficult cases.
About the disease
Centroblastic B-cell lymphoma is an aggressive subtype of diffuse large B-cell lymphoma characterized by the proliferation of large atypical lymphocytes with basophilic cytoplasm and multiple nucleoli. The disease includes the GCB subtype with a germinal phenotype and the ABC subtype with activated B-cells, differing in molecular markers and prognosis.
Causes
- Chromosomal translocations involving the BCL2, BCL6, or MYC genes
- Chronic stimulation of the immune system by Epstein-Barr virus or hepatitis C
- Prolonged immunosuppressive therapy after organ transplantation
- Autoimmune diseases with chronic B-cell activation
- Exposure to chemical carcinogens and ionizing radiation
Symptoms
- Rapidly growing painless enlarged lymph nodes
- Night sweats with the need to change bedding
- Unexplained fever above 38°C without signs of infection
- Unintentional weight loss of more than 10% over six months
- Weakness and increased fatigue with normal activity
- Abdominal pain with involvement of abdominal lymph nodes
- Shortness of breath and cough with mediastinal tumour localization
Treatment methods
At Ichilov, the choice of treatment methods for centroblastic B-cell lymphoma is based on immunohistochemical determination of subtype (GCB or ABC), disease stage, and international prognostic index, allowing for the creation of a personalized therapeutic strategy with an optimal balance of efficacy and tolerability.
First-line immunochemotherapy
From the moment of diagnosis of centroblastic lymphoma, the standard of treatment becomes a combination of chemotherapeutic agents with monoclonal antibodies targeting surface antigens of B-lymphocytes. The regimen combines alkylating agents, anthracycline antibiotics, vinca alkaloids, and corticosteroids, each attacking tumour cells through various mechanisms. The addition of targeted biological agents significantly improves outcomes compared to classical chemotherapy, enhancing the immune response against lymphoma.
Consolidation radiation therapy
After completing systemic treatment, patients with initially large tumour masses or with residual formations on control imaging are prescribed local radiation to the affected areas. IMRT technology ensures precise delivery of radiation doses to target areas with minimal impact on surrounding critical structures such as the lungs, heart, or spinal cord. Planning is based on CT data with three-dimensional modeling, allowing for the calculation of optimal radiation distribution considering the anatomical features of the specific patient.
High-dose chemotherapy with transplantation
When the disease demonstrates refractoriness to the first line or early relapse occurs within a year after treatment completion, the option of intensifying therapy with subsequent restoration of hematopoiesis is considered. First, mobilization and collection of the patient's own hematopoietic stem cells are performed during the achievement of at least partial remission using salvage chemotherapy. Then the patient receives myeloablative doses of cytostatics that completely destroy bone marrow hematopoiesis along with residual lymphoma, followed by reinfusion of preserved stem cells. The recovery period requires staying in sterile conditions in a specialized department of Ichilov with round-the-clock monitoring, infection prevention, and transfusion support until the transplant engrafts, which usually takes two to three weeks.
CAR-T cell immunotherapy
For patients with multiple relapses or failure of autologous transplantation, the possibility of using genetically modified own T-lymphocytes opens up. Cells are taken from peripheral blood, and in a specialized laboratory, a sequence encoding a chimeric antigen receptor that recognizes specific markers on the surface of lymphoma cells is integrated into their genome. After a period of proliferation in a bioreactor, the modified lymphocytes are returned to the patient as a single infusion, and they begin to actively seek and destroy the tumour throughout the body. Before the introduction of CAR-T cells, lymphodepleting chemotherapy is performed to create favorable conditions for their engraftment and expansion, and after infusion, careful monitoring in the hospital is required for early detection and management of cytokine release syndrome and neurological complications.
Targeted therapy for the ABC subtype
Molecular profiling may reveal an activated B-cell phenotype with constitutive activation of the NF-κB signaling pathway, making the tumour a target for specific inhibitors. These drugs block key kinases necessary for the survival of the ABC subtype of lymphoma, demonstrating synergy with traditional immunochemotherapy. The addition of targeted agents to standard regimens is particularly justified in patients with an unfavorable prognosis or in elderly individuals who poorly tolerate intensive chemotherapy regimens. In clinical studies, the combined approach has shown improved progression-free survival rates specifically in the ABC subtype group, confirming the importance of molecular stratification for personalizing treatment and achieving optimal results for each individual patient at Ichilov.
Maintenance immunotherapy
After achieving remission during induction therapy, some patients at high risk of relapse are prescribed long-term maintenance treatment with monoclonal antibodies. The drugs are administered at intervals of two to three months over two years, maintaining immune surveillance against possible residual tumour cells. This approach is particularly relevant for patients who have achieved remission after second or third-line therapy when the risk of disease recurrence remains elevated. Maintenance therapy is usually well tolerated and does not require hospitalization; procedures are performed on an outpatient basis in a day hospital.
Supportive therapy and complication prevention
The intensity of antitumor treatment for centroblastic lymphoma requires comprehensive management of side effects to maintain quality of life and the ability to complete planned courses. Granulocyte colony-stimulating factors are prescribed to reduce the duration of neutropenia and decrease infection risks, especially in elderly patients or when using intensive regimens. Modern antiemetics effectively control nausea and vomiting even with highly emetogenic chemotherapy regimens, and prophylactic antibacterial and antifungal therapy prevents the development of opportunistic infections in the context of immunosuppression.
- Stem cell treatment
- Radiation therapy
- Chemotherapy
- CAR-T therapy
Diagnostic methods for the disease
Early diagnosis of centroblastic B-cell lymphoma lays the foundation for successful therapy: the aggressive course of the disease requires precise determination of the biological characteristics of the tumour to select the optimal treatment protocol. At Ichilov, all studies are performed on high-precision modern equipment, and the entire diagnostic plan is formed in advance and carried out in the shortest possible time.
First day
Upon arrival at the clinic, the patient immediately meets with the attending physician. The specialist thoroughly collects the medical history, conducts a detailed examination, assesses the condition of the lymph nodes, and prescribes a series of studies to obtain a complete picture of the disease.
Second day
On this day, all necessary diagnostic procedures are performed.
- Complete blood count with leukocyte formula
- Biochemical blood analysis
- Blood test for tumor markers (including LDH, β2-microglobulin)
- Immunophenotyping of peripheral blood
- Ultrasound of lymph nodes
- CT of the neck, chest, abdomen, and pelvis
- PET-CT
- Lymph node biopsy (excisional or trephine biopsy)
- Histological examination of the biopsy
- Immunohistochemical study
- Cytogenetic analysis
- FISH for rearrangements of BCL2, BCL6, MYC
- NGS analysis (genetic profiling of the tumour)
Third day
The attending physician gathers a consultation of specialists (hematologists, oncologists, pathomorphologists, radiologists), during which all results are discussed. This allows for the formulation of the most accurate and relevant individual treatment plan.
- Computed tomography
- Diagnosis — PET CT
- Ultrasound
- Biopsy and histological studies
- Blood biochemistry
How much does treatment cost in Israel
The budget for treating centroblastic B-cell lymphoma in Israel depends on the complexity of the diagnostic program and the chosen therapy protocol. The main influencing factors are the cost of modern targeted drugs, the number of chemotherapy courses, and the need for high-precision genetic profiling of the tumour.
To obtain an accurate price calculation for a specific case, it is necessary to contact the clinic's consultant at the phone number provided on the website. The specialist will prepare a detailed estimate and answer all organizational questions.
Advantages of treatment in Israel
- Leading world experts in aggressive lymphoproliferative diseases
- High-tech diagnostic equipment for molecular analysis of cells
- Innovative protocols for immunotherapy and targeted therapies of the latest generation
- Individual treatment plans considering the genetic characteristics of the patient
- Impeccable level of medical service and comfortable accommodation conditions
Even before visiting the Israeli clinic, a remote online consultation with a specialized expert is available. During the communication, one can receive expert recommendations, comprehensive answers to questions about the diagnosis, and up-to-date information on the application of the latest global technologies.