Lymphoma skin treatment in Israel

Skin lymphoma is a malignant disease of the skin, which is characterized by the development of skin lesions by altered lymphoid cells (T- and B-lymphocytes). The pathology is rare, has a chronic and long-term course, mainly adults are affected. It occurs with equal frequency among both women and men. The course of the disease depends on the degree of malignancy of the process and the types of cells that give rise to the tumor.

Oncohematology in modern medicine is at a high level of its development, these diseases are especially successfully treated in Israel. The Department of Adult Oncohematology of Tel Aviv Medical Clinic is engaged in the diagnosis and modern treatment of all hematological diseases, including cutaneous lymphomas.

We offer our patients:

• Individual and patient-oriented approach to the diagnostic and treatment program.
• Meticulous work of an entire multidisciplinary team on each individual case of lymphoma.
• Efficient, fast and comprehensive diagnostics, which takes no more than 3-4 working days.
• If necessary, specialists actively use the latest, and sometimes experimental, treatment methods, such as bone marrow transplantation, immunobiological therapy, CAR-T cell therapy and other advanced technologies.
• To select the ideal bone marrow donor, Tel Aviv Medical Clinic oncohematologists use the services of a state-of-the-art HLA laboratory and a local molecular diagnostic laboratory.
• Our medical center is a member of the National Bone Marrow Donation Program, which has a large bank of hematopoietic stem cells at its disposal.
• Patients with lymphoma are treated by world-famous specialists with extensive practical experience.
• Use of the latest generation of chemotherapy drugs, advanced and effective targeted agents (Nivolumab, Pembrolizumab and Brentuximab), immunobiological therapy.
• Innovative and effective CAR-T cell therapy.

What are the possible causes of cutaneous lymphoma?

To date, the exact cause of lymphoma is unknown. Under the influence of any negative factors, T- or B-lymphocytes acquire signs of malignancy. Due to such mutations, the cell is capable of uncontrolled growth and reproduction, which gives rise to tumor growth.

Risk factors for the development of Non-Hodgkin’s lymphoma:

• Primary or secondary immunodeficiencies.
• Infection with certain types of viruses (for example, the herpes virus family).
• Negative influence of environmental factors (carcinogenic chemicals, ionizing radiation, etc.).
• Hereditary diseases and syndromes.

Symptoms of cutaneous lymphoma

Signs of Lymphoma skin rash depend primarily on the type of cells that give rise to the tumor and the degree of malignancy of the process.

Depending on the location of the primary tumor site, cutaneous lymphoma can be:

• primary – pathological changes are initially localized in the skin;
• secondary – metastasis of malignant lymphocytes to the skin from the primary lesion (spleen, lymph nodes, bone marrow, etc.).

Depending on the precursor cells, cutaneous lymphoma can be:

• T-cell and NK-cell – grow from T-lymphocytes and natural killers (70% of all cutaneous lymphomas).
• B-cell – grow from B-lymphocytes (20% of all cutaneous lymphomas).
• Undifferentiated cutaneous lymphomas (10% of all cases of cutaneous lymphomas).

The most common types of T-cell lymphoma of the skin:

• mycosis fungoides
• Sezary syndrome

The most common types of B-cell lymphoma of the skin:

• reticulosis (reticulosarcoma) of the skin.

All symptoms of lymphoma of the skin can be divided into 2 groups:

1. General.
2. Local.

Early symptoms of lymphoma

At the beginning of the disease there are no general symptoms. The patient develops various skin manifestations – spots, redness, rash, nodules. The area of ​​​​the skin with the rash may itch and hurt. As the tumor grows, signs characteristic of various forms of skin lymphomas appear.

With mycosis fungoides, the rash is localized on closed areas of the body. At first, red-brown spots appear, which gradually merge into plaques that have a smooth surface or peeling. Some patients have severe skin itching. Gradually, such plaques increase in size, acquire the character of nodes that spread to the deep layers of the skin, subcutaneous tissue, muscles and internal organs.

Sezary syndrome. At the initial stage, the skin turns red, there is severe itching and peeling. Then the affected areas of the skin become keratinized, hair falls out. Then the peripheral lymph nodes enlarge and the disease spreads throughout the body.

Reticulosarcoma of the skin. This type of B-cell lymphoma of the skin is characterized by the appearance of large plaques on the skin near the nodes of a red-violet color. Itching, pain and peeling are not typical.

As the disease progresses, general symptoms of lymphoma of the skin appear:

• enlargement of the lymph nodes, liver, spleen;
• changes in the clinical blood test;
• general malaise, weakness;
• loss of appetite, weight loss;
• constant fever.
• Persistent red or purple rash
• Itching and scaling skin
• Enlarged lymph nodes
• Unexplained weight loss

What are the modern methods of diagnosing cutaneous lymphoma?

The earlier the correct diagnosis of a malignant disease, including skin lymphoma, is established, the better the prognosis and treatment outcome. Therefore, high-quality and fast diagnostics are a very important stage. Tel Aviv Medical Clinic uses only modern expert-class equipment, all our doctors are fluent in all methods of examining a patient with suspected lymphoma, and are able to accurately interpret the data obtained, which helps them create a modern, individual and effective treatment plan.

The disease can be suspected by its characteristic external signs, their long course and the lack of effect from various conservative methods of treating skin rashes at a dermatologist.

The main method for diagnosing skin lymphoma is a skin biopsy followed by pathohistological and immunohistochemical examination of the obtained tissue samples. After the biopsy, we send all materials to the best pathohistological laboratories in Israel, where they are examined by pathologists with extensive experience and a world-famous name. Thanks to such thorough diagnostics, we are absolutely sure of the diagnosis.

To determine the stage of the malignant process and search for all foci of lymphoma in the body, various modern medical imaging techniques are used: CT, MRI, PET-CT, PET-MRI, osteoscintigraphy, bone marrow biopsy, various endoscopic studies (bronchoscopy, laparoscopy, thoracoscopy, gastroscopy), etc.

What Genetic tests should be done for Cutaneous Lymphoma?

We send all materials after the biopsy to the best gene laboratories in the USA for innovative molecular genetic studies. This is an obligatory part of modern diagnostics of oncological diseases.

The immediate cause of many tumors is a mutation in a certain gene. Patients for whom traditional treatment methods were ineffective and in whom certain mutations were detected demonstrated a positive response to targeted therapy. Therefore, it is very important to identify these “genetic rearrangements”, which is what we do for our patients. Thanks to molecular genetic diagnostics, we can find these mutations and select the most effective treatment regimens, because the response to the action of certain drugs depends on the type of changes.

Thanks to such advanced diagnostic methods, we are confident in the correctness of the diagnosis and the effectiveness of the chosen treatment tactics.

Examples of modern genetic testing panels for patients with lymphoma:

• SLL | Small Lymphocytic Lymphoma, FISH, Tissue.
• BCLL | IGH Somatic Hypermutation Analysis, B-Cell Chronic Lymphocytic Leukemia (B-CLL), Varies.
• P53CA | Hematologic Neoplasms, TP53 Somatic Mutation, DNA Sequencing Exons 4-9, Varies.

The full list of molecular genetic studies that TAMS offers to its patients can be viewed here. All genetic tests are unique tests that can be performed on the Tel Aviv Medical Clinic base.

What is the prognosis for recovery from cutaneous lymphoma?

The prognosis for skin lymphoma depends on the stage at which the disease is diagnosed. At the initial stages, the 5-year survival rate is 80-100%. If the pathology has progressed to stage 3-4, the prognosis is worse and depends on the range of treatment measures used to treat a particular patient.

What are the modern methods of treatment for skin lymphoma?

One of the important advantages of treating malignant blood diseases at TAMS is the use of an integrated approach to each individual clinical case. In the fight against the disease, the doctor uses the entire available arsenal of methods. Therapy is always a combination of two, three, or even more methods. As a rule, the treatment regimen includes polychemotherapy alone or in combination with radiation therapy, sometimes with hematopoietic stem cell transplantation. In some cases, certain innovative treatment methods are added to the treatment program (targeted drugs, immunobiological drugs, etc.). 

In the complex treatment of skin lymphomas, the following is used:

• Polychemotherapy.
• Radiation therapy.
• Immunotherapy (for example, monoclonal antibodies, CAR-T-cell therapy).
• Targeted drugs.
• In some cases, bone marrow transplantation.

All our patients can become participants in clinical trials of new drugs, treatment protocols, and innovative methods. Our doctors actively participate in such experiments, and they also actively improve and refine standard treatment protocols for various malignant diseases. If the patient meets the necessary parameters (we will be able to give an answer after studying all your medical documents), he can become a participant in such an experimental program and try closed protocols (developed within the clinic) as an alternative treatment. Sometimes, this is the only chance for a patient to overcome a serious disease, especially in situations where standard treatment protocols have proven ineffective.

Chemotherapy for skin lymphoma can be local and systemic. The effectiveness of chemotherapy at TAMS is guaranteed by the use of proven drugs and a clear selection of dosages in accordance with international protocols. Doctors also additionally prescribe drugs to minimize side effects. Examples of chemotherapy drugs used to treat lymphomas: bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine.

Local treatment options for skin lymphoma:

• local chemotherapy;
• phototherapy (PUVA therapy);
• topical corticosteroids;
• retinoids;
• contact radiation therapy.

New drugs include histone deacetylase inhibitors used intravenously or orally (Vorinostat “Zolinza”).

Immunotherapy is an innovative method of treating malignant diseases, aimed at activating the patient’s own immune system to fight cancer cells. Molecular genetic diagnostics can be performed in advance, which allows choosing the most effective treatment regimens.

CAR-T-cell therapy is an innovative immunotherapy technique, the essence of which is to change T-cells using genetic engineering. The purpose of the changes is that such cells can quickly find and destroy malignant lymphocytes. For each patient, CAR-T-cells are made individually using genetic engineering. They are modified so that chimeric antigen receptors (CAR) appear on the surface in accordance with the type of tumor cells found in the same patient. Then, such “modernized” CAR-T cells are multiplied and returned back to the patient’s blood, where they actively “track down” and destroy malignant lymphocytes.

Targeted therapy is a modern treatment method, which also belongs to the category of immunotherapy. Monoclonal antibodies are most often used as active agents. They do not interact with healthy cells, due to which the risk of complications is minimal. Examples of drugs for targeted therapy in patients with lymphomas are Brentuximab, Pembrolizumab, Nivolumab. 

In each individual case, the decision on the combination of certain treatment methods is made jointly by a team of specialists. Each person and their disease are different, so our doctors, relying on their experience in treating lymphomas, often go beyond standard protocols, changing treatment regimens and doses of necessary drugs, radiation methods in order to achieve the best results for their patients.

“Our world-class lymphoma specialists provide personalized treatment plans with the latest targeted therapies – ensuring the best outcome for you.”