Treatment of Subcutaneous Panniculitis-like T-cell Lymphoma in Israel

At Ichilov, the focus is maximally on fighting the disease and ensuring that patients and their relatives have maximum comfort and quality of life during treatment. Programs for psychological support have been created, and unique physiotherapy and rehabilitation procedures have been developed. The staff speaks several languages, and foreign patients receive comprehensive support – assistance in finding accommodation, transfers, and personal translator services.

About the Disease

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare form of non-Hodgkin lymphoma arising from αβ T-cell phenotype. A feature of this type of lymphoma is the imitation of symptoms of inflammation of subcutaneous adipose tissue, complicating early diagnosis. The pathology is characterized by the presence of infiltrates of atypical T-cells in the subcutaneous adipose tissue, which reproduce the clinical picture of panniculitis but with a malignant nature.

The exact causes of the disease are not fully known. It is believed that a combination of genetic and external factors may contribute to the development of the disease.

Signs of the pathology vary and may manifest as:

• painful nodes or plaques under the skin, resembling manifestations of panniculitis;
• fever, fatigue, loss of appetite and weight;
• localization of affected areas on the legs and arms. Sometimes – on other parts of the body;
• in some cases, the disease may lead to more serious complications, including liver dysfunction, hemophagocytic syndrome.

Treatment Methods for the Disease

Treatment of subcutaneous panniculitis-like T-cell lymphoma (SPTCL) involves a multidisciplinary approach and varies depending on the stage of the disease and the overall health status of the patient.

Steroid Therapy

As a first-line treatment, systemic corticosteroids are often used. These medications help reduce inflammation and control symptoms. Steroids can be applied locally as an injection directly into the affected areas or systemically. Most often, steroid therapy begins with the highest possible doses of medications, gradually decreasing as symptoms improve.

Chemotherapy

In cases of aggressive manifestations or insufficient effectiveness of steroids, chemotherapy may be prescribed. A specific regimen of systemic chemotherapy drugs is selected individually, taking into account many factors. The goal of therapy is to completely destroy malignant cells throughout the body.

Targeted Therapy

In some cases, targeted therapy shows high effectiveness for the treatment of subcutaneous panniculitis-like T-cell lymphoma. This method is applied to patients with identified specific molecular targets, such as antibodies against CD52 (alemtuzumab). Targeted therapy is based on destroying cancer cells directly with minimal harm to healthy tissues.

Immunomodulatory Therapy

Immunotherapy is a type of treatment aimed at activating the patient's own internal reserves to fight cancer. Approaches in immunotherapy are aimed at enhancing the natural ability of the immune system to recognize and destroy pathologically altered cells. For the treatment of subcutaneous panniculitis-like T-cell lymphoma, the following are used:

• checkpoint inhibitors that block specific proteins present on the surface of immune and cancer cells;
• adoptive cell therapy. A method of identifying immune cells capable of killing cancer cells. They are extracted from the patient's blood, modified, cultured in large quantities in the laboratory, and then returned to the body;
• cancer vaccines that stimulate the immune system to attack cancer cells. Specific immunity is "awakened" by antigens contained in the vaccine that are characteristic of cancer cells. Unlike traditional vaccines used for the prevention of infectious diseases, cancer vaccines are designed for the treatment of existing pathology;
• immunomodulators. Medications that alter the immune system's response;
• targeted antibodies aimed at specific protein targets on the surface of cancer cells. Some antibodies directly attack cancer cells, while others can block signals necessary for malignant cells to grow and develop.

Hematopoietic Stem Cell Transplantation

In some cases, to restore the patient's bone marrow after intensive chemotherapy or radiotherapy, hematopoietic stem cell transplantation may be considered. Ichilov has extensive experience in successful transplants. The procedure is performed in two ways:

• autologous transplantation, during which the patient's own stem cells, collected before intensive treatment procedures, are transplanted;
• allogeneic transplantation, where the transplant material is taken from a donor.

Radiotherapy

Radiation is one of the methods for treating subcutaneous panniculitis-like T-cell lymphoma. This method is used as symptomatic or local treatment to control specific affected areas. The goal is to prevent the growth and spread of cancer cells, reduce tumor size, pain, and other symptoms caused by lymphoma.

At Ichilov, TrueBeam and Lunac linear accelerators are used, which generate high-energy X-rays or electrons to treat cancer cells. Modern linear accelerators can target the tumor very precisely, minimizing the impact on surrounding healthy tissues thanks to IMRT (intensity-modulated radiation therapy) and VMAT (volumetric modulated arc therapy) technologies. They deliver radiation doses over shorter intervals compared to older systems, allowing for the use of different types of energy with minimal side effects.

Diagnostic Methods for the Disease

The manifestations of subcutaneous panniculitis-like T-cell lymphoma (SPTCL) may resemble other diseases, including more common forms of panniculitis, so Ichilov conducts thorough step-by-step diagnostics, typically taking about three days.

First Day

The diagnostic process begins with taking a medical history and physical examination. The doctor clarifies complaints, analyzes the nature of symptoms, their duration, and rules out other diseases with similar signs.

Second Day

• Specialized laboratory blood tests.
• Biopsy of the suspicious area with subsequent microscopic examination.
• Immunohistochemistry and molecular studies
• Computer imaging: CT of the abdomen and chest, MRI.

Third Day

A multidisciplinary team of doctors, including dermatologists, hematologists, oncologists, and other specialists, conducts a comprehensive assessment of the diagnostic results. After confirming the diagnosis, an individual treatment plan is developed.

How Much Does Treatment Cost

How Much Does Treatment Cost

Advantages of Treatment at Ichilov

1. High level of medical services
2. Qualified staff
3. Practical experience in treating complex and rare lymphomas
4. Multidisciplinary teams of doctors developing personalized therapeutic strategies
5. Experience in treating patients from other countries

Israeli medicine is characterized by a high level of innovation and progressive approaches. This country actively engages in scientific research, implements advanced techniques and medications, often unavailable in other countries. Thanks to modern means of internet communication, it is possible to organize a video meeting via Zoom or Skype with top specialists in the treatment of lymphoblastic lymphomas. Send your available test results and receive expert evaluation and recommendations for further actions.