Treatment of Splenic Marginal Zone Lymphoma in Israel

At Ichilov, leading oncologists and hematologists specializing in lymphoma treatment work, regularly exchanging experiences with the international expert community. Patients have access to the latest techniques, including targeted, immunotherapy, and stem cell transplantation. Radiation therapy and surgical procedures are performed using high-tech equipment, enhancing the accuracy and effectiveness of treatment.

The clinic provides comprehensive support, including psychological and rehabilitation services, helping patients cope with emotional and physical stress during treatment.

About the Disease

Splenic marginal zone lymphoma (SMZL) is a rare form of non-Hodgkin lymphoma that arises in the marginal zone of the spleen. The pathology is classified as one of the subtypes of marginal zone lymphoma, which includes:

• splenic MZL,
• nodal MZL,
• extranodal MZL or gastric MZL (mucosa-associated, MALT).

This disease belongs to the group of indolent (slowly progressing) B-cell lymphomas.

The specific causes of splenic marginal zone lymphoma are unknown, but it is believed that infections and viruses, such as hepatitis C virus, genetic disorders, and hereditary predisposition may play a role.

The most common and characteristic signs include:

• spleen enlargement (splenomegaly), which may lead to pain or discomfort in the left upper quadrant of the abdomen;
• manifestations of cytopenia – anemia, leukopenia, thrombocytopenia;
• general manifestations such as fatigue, weight loss, and elevated body temperature.

Due to the slow progression, some patients remain asymptomatic for long periods, and the disease is discovered incidentally during examinations for other reasons.

Treatment Methods for the Disease

The approach to treating splenic marginal zone lymphoma at the Ichilov Clinic varies depending on the stage, activity of the disease, and the overall health of the patient.

Observation or Watchful Waiting

In patients without symptoms or with slowly progressing disease, the "watch and wait" approach is often used. It does not involve immediate active treatment but entails regular monitoring and analysis of the dynamics of the condition.

Splenectomy

A procedure to remove the spleen. It may be considered to reduce symptoms and combat cytopenia. Splenectomy can be performed through open surgery or minimally invasive techniques. Open surgery is used when laparoscopic splenectomy is impractical or impossible, for example, when the spleen is very enlarged or complications are present.

Splenectomy may be included in the protocol:

• as a diagnostic procedure for detailed pathological assessment, especially in cases where the diagnosis is ambiguous,
• as part of treatment aimed at minimizing the number of painful and pathologically altered B-cells.

Chemotherapy

Chemotherapy is based on cytotoxic drugs that suppress the growth and proliferation of cancer cells. This method is used both as monotherapy and in combination with other treatment approaches, including immunotherapy.

In the case of SMZL, the following show effectiveness:

• alkylating agents that damage the DNA of cells, preventing their breakdown and proliferation;
• purine analogs that affect DNA synthesis, disrupting the life processes and proliferation of lymphoma B-cells;
• antimetabolites that act as analogs of natural metabolites, blocking vital biochemical pathways in cells.

Monoclonal Antibodies

Treatment with monoclonal antibodies for splenic marginal zone lymphoma involves the use of specialized proteins. They are developed in laboratories to target specific antigens. These drugs act more selectively than traditional chemotherapy.

The main monoclonal antibody used for treating SMZL targets the CD20 protein, which is present on the surface of most B-lymphocytes. By binding to CD20, the monoclonal antibody initiates cell destruction.

Immunomodulatory Agents

Immunomodulatory agents alter the patient's immune system function so that it more effectively recognizes and destroys cancer cells. These drugs do not directly target tumor cells, unlike chemotherapy or treatment with monoclonal antibodies. Instead, they adjust the body's natural defense mechanisms:

• enhancing the immune response by stimulating T-cells and other components of the immune system, improving their ability to attack cancer cells;
• inhibiting angiogenesis, affecting the vascular system that nourishes the tumor, increasing its vulnerability to attack by the immune system;
• modifying interactions between tumor and immune cells, making immune cells more aggressive towards the pathological ones;
• suppressing pro-tumor inflammatory processes by affecting cytokines and other inflammatory mediators.

Targeted Therapy

This approach is based on drugs that specifically target certain markers associated with cancer cells. It allows for more precise and selective attacks on the malignant process while minimizing damage to healthy tissues.

The mechanisms of action of targeted drugs include:

• inhibition of tyrosine kinases;
• blocking receptors on the surface of cells;
• interacting with signaling molecules, disrupting intracellular signaling pathways that are critical for the survival and proliferation of cancer cells.

Radiation Therapy

Local radiation therapy is used to achieve local control over the disease, especially in cases of spleen enlargement or isolated tumor nodules. During the procedure, targeted radiation is delivered to cancer cells using ionizing radiation, damaging their DNA.

At the Ichilov Clinic, the latest generation linear accelerators are used: TrueBeam and Lunac. The equipment ensures high precision in beam direction, avoiding damage to healthy tissues and organs while focusing on tumor areas. The system visualizes the tumor in real-time during the procedure, further enhancing accuracy, and is capable of performing various types of radiation, including intensity-modulated radiation therapy.

Diagnosis Methods for the Disease

The diagnosis of splenic marginal zone lymphoma typically involves several stages. The diagnostic process usually takes no more than 3 days.

First Day

The doctor conducts a thorough interview with the patient, gathers complaints, and clarifies symptoms. Then a physical examination is performed, during which the areas of the spleen or liver are palpated.

Second Day

• Laboratory blood tests.
• Immunophenotyping.
• Bone marrow biopsy (trepanobiopsy).
• Imaging tests: CT, MRI, abdominal ultrasound to assess the size of the spleen and liver, as well as to identify enlarged lymph nodes.

Third Day

At the Ichilov Clinic, a multidisciplinary group participates in clarifying the diagnosis and developing a treatment plan, which includes: hematologists, radiologists, histologists studying biopsy and surgical material, confirming the diagnosis at the cellular level, oncological surgeons, nuclear medicine specialists, and others. The diagnostic approach may vary depending on the clinical picture and the patient's condition.

How Much Does Treatment Cost

Advantages of Treating Splenic Marginal Zone Lymphoma in Israel

1. Wide diagnostic capabilities and the most modern equipment
2. Personalized approach to developing treatment programs
3. Extensive practical experience and qualifications of medical staff
4. Multidisciplinary teams practicing innovative treatment methods
5. Experience working with international clients and comprehensive support

There is no need to travel to another country to receive a consultation from a world-class expert. You can connect via video call through Zoom or Skype with leading specialists at the Ichilov Clinic to discuss all aspects of treatment and consider possible options based on your specific case.