Lymphoma is not a single disease, but a large group of diseases of the lymphatic system, each requiring its own protocol. Classical Hodgkin lymphoma in a young patient, aggressive diffuse large B-cell lymphoma in an elderly patient, slowly progressing follicular lymphoma, rapidly progressing Burkitt lymphoma, and standalone primary central nervous system lymphoma are treated fundamentally differently. Therefore, the quality of treatment begins not with the drug, but with an accurate hematopathological diagnosis. At the Oncology Institute of the Ichilov (Sourasky) Medical Center in Tel Aviv, this is handled by a separate team: hematomorphologist, immunohistochemistry, flow cytometry, molecular genetics laboratory. The clinic works with the most modern options — from classical R-CHOP to CAR-T cell therapy and bone marrow transplantation — and conducts clinical trials that may include foreign patients. The program for guests from the CIS is organized with a Russian-speaking physician-coordinator: document translation, Tumor Board, hospitalization, outpatient courses, and subsequent monitoring. Below is how this is organized in practice.
Treatment Methods
- Review of histology and molecular diagnostics. Before the first infusion — repeated review of slides and blocks, immunohistochemistry, FISH for MYC/BCL2/BCL6 (for differentiation of DLBCL and "double-hit" lymphomas), flow cytometry of bone marrow, PET-CT for staging according to Lugano.
- First-line immunochemotherapy. R-CHOP and its modifications (dose-adjusted EPOCH-R for "double-hit", Pola-R-CHP for DLBCL), ABVD and escalated BEACOPP for Hodgkin lymphoma, R-CVP and bendamustine-R for follicular lymphoma.
- Next-generation anti-CD20 antibodies. Rituximab as standard, obinutuzumab (Gazyva) for follicular and relapsed B-cell lymphoma, maintenance therapy for up to two years.
- Targeted and immunotherapy. BTK inhibitors (ibrutinib, acalabrutinib) for mantle cell lymphoma and MCL/CLL, PD-1 inhibitors (nivolumab, pembrolizumab) for relapsed Hodgkin lymphoma, brentuximab vedotin for CD30-positive forms.
- CAR-T cell therapy. Tisagenlecleucel (Kymriah) and axicabtagene ciloleucel (Yescarta) for relapsed/refractory DLBCL, mantle cell lymphoma, and primary mediastinal B-cell lymphoma. Collection of T-lymphocytes, engineering at an external certified center, infusion and monitoring of cytokine storm in the intensive hematology department.
- Bone marrow transplantation. Autologous stem cell transplantation after high-dose BEAM chemotherapy — standard for chemosensitive relapses; allogeneic stem cell transplantation from a related or unrelated donor — for aggressive and T-cell lymphomas.
- Radiation therapy. Conformal radiation therapy IMRT and proton therapy (when indicated) for involved-site radiotherapy — targeted irradiation of initially bulky lesions after chemotherapy.
- Separate protocol for brain lymphoma. Primary CNS lymphoma requires its own approach: high-dose methotrexate with rituximab and temozolomide, in case of relapse — CAR-T or auto-SCT with thiotepa-containing conditioning. Typical symptoms that patients present with include persistent headache, changes in behavior and memory, increasing weakness in an arm or leg, vision disturbances, and a seizure for the first time in life; in such cases, an MRI of the brain with contrast is mandatory, and if findings are present, a stereotactic biopsy.
Send your records — an Ichilov physician will reply within 1–2 days, free of charge.
Treatment Program — Stages
- Remote document assessment. A Russian-speaking physician-coordinator reviews discharge summaries, histology, PET-CT/CT/MRI images and indicates what has already been done correctly and what needs to be reviewed. At this stage, the approximate scope of the program and its cost become clear.
- Arrival and diagnostics. Review of histological blocks in the Ichilov laboratory, additional immunohistochemistry and molecular tests, whole-body PET-CT, if necessary — bone marrow trepanobiopsy, lumbar puncture, MRI of the brain.
- Multidisciplinary Tumor Board. Hematologist-oncologist, radiation therapist, SCT specialist, if CNS is affected — neuro-oncologist; the decision is recorded in a written protocol, which the patient receives.
- First-line therapy. Courses of immunochemotherapy on an outpatient basis in a day hospital, intermediate PET-CT after 2–4 cycles to assess response according to Deauville, if necessary — change of protocol.
- Second-line therapy in case of relapse. Salvage regimens (R-DHAP, R-ICE, R-GDP), then auto-SCT or CAR-T — the route is chosen based on tumor sensitivity and the overall status of the patient.
- Consolidation and radiation therapy. Targeted irradiation of initially bulky or residual lesions, maintenance therapy for follicular lymphoma.
- Monitoring. The first two years — control every 3 months (clinic + tests + imaging if indicated), then less frequently. Remote reviews of results in Russian between visits.
Prices and Costs
The exact estimate depends on the type of lymphoma, stage, response to the first line, and whether CAR-T or HSCT will be needed. Below are benchmarks based on the clinic's current price list; the final cost of the program is fixed after the Tumor Board.
- Consultation with a hematologist-oncologist — from 550 USD, consultation with a leading professor — from 750 USD; second opinion online based on documents — from 450 USD.
- Diagnostic package (review of histology from 700 USD, PET-CT whole body from 1,900 USD, extended blood tests from 150 USD, if necessary MRI of the brain from 1,100 USD).
- One course of chemotherapy in the hospital — from 1,400 USD excluding the cost of drugs; immunotherapy and targeted drugs (rituximab, obinutuzumab, BTK inhibitors) are calculated individually based on actual use.
- High-tech options — CAR-T cell therapy and bone marrow transplantation — are not detailed in the public price list; the estimate is prepared based on documents after the Tumor Board.
Leading Doctors
Hematologist-oncologist, head of the hematology department. Manages primary patients with lymphomas, responsible for selecting the first-line protocol, interim assessments of response based on PET-CT, and transitioning to second-line therapy in case of relapse. The clinic has many years of experience in managing patients with classical Hodgkin lymphoma and aggressive B-cell lymphomas.
Professor-oncohematologist, specialist in bone marrow transplantation. Responsible for preparing and conducting autologous and allogeneic HSCT, managing patients after CAR-T infusion, and dealing with complications — cytokine storm and neurotoxicity. The department accepts patients from all over the world and participates in international clinical trials in cell therapy.
Neuro-oncologist and head of the neuro-oncology department. Curates all cases of primary central nervous system lymphoma: interprets MRI, plans stereotactic biopsy in collaboration with neurosurgeons, manages high-dose methotrexate therapy, and provides radiation therapy when indicated. Works closely with intensivists and an ophthalmologist (eye lymphoma).
FAQ
Are there age restrictions for treatment?
There is no upper limit as such — the decision is made based on the overall status of the patient, comorbidities, and tolerance. Elderly patients may be offered lighter protocols (mini-R-CHOP, bendamustine-R), and CAR-T is directed to people over 70 if physical condition and organ function allow.
Is a visa required for treatment in Israel?
Citizens of most CIS countries (Russia, Ukraine, Moldova, Georgia) do not need a visa for medical tourism — entry with a foreign passport is allowed for up to 90 days. For citizens of Belarus and Kazakhstan, a visa must be arranged in advance; the clinic prepares an invitation and a package of medical documents.
What language is used to communicate with the patient?
From the first contact until the last follow-up, a Russian-speaking coordinator accompanies the patient. During the consultation, either the doctor translates (many specialists in the clinic speak Russian), or a professional medical translator is used. All reports are issued in two versions — in Hebrew/English and in Russian.
How long does treatment take?
Diagnosis and the Tumor Board usually take 5–10 working days. The full course of first-line immunochemotherapy for DLBCL is about 4–5 months (6 cycles), for Hodgkin lymphoma — 4–6 months. Courses can be alternated between Tel Aviv and the home country if the protocol allows. CAR-T and HSCT require continuous stay of 4–8 weeks.
Is an advance payment required?
Yes, treatment is paid for on a deposit model: before the start of diagnosis, an estimated deposit based on the estimate is made, all services are charged based on actual use, and any unspent balance is returned. Upon completion of the program, the patient receives a detailed invoice with all items.
How to get a treatment program
To prepare a preliminary plan and estimate, the clinic needs to receive: the latest discharge summary with the diagnosis, histology results (ideally — photographs of slides or blocks that our pathologist will review), PET-CT/CT/MRI reports, and if possible, the studies on a disk or in DICOM format, recent blood tests. The coordinating doctor will review the documents, ask clarifying questions, and within 1–2 working days will get back to you with an answer: whether your case is suitable for the program at Ichilov (Sourasky), what examinations need to be repeated on-site, and the estimated duration and cost.