Treatment of non-Hodgkin lymphoma in Germany

Non-Hodgkin lymphoma is a group of oncological illnesses when the tumor grows of the lymphoid tissue. It includes all the pathologies of the group except the lymphomatoid granulomatosis (Hodgkin’s disease).


Non-Hodgkin lymphoma


This is a highly common group of illnesses averaging 4-4,5% of all  malignancies.  Non-Hodgkin lymphoma incidence is 20 cases in 100,000 a year. 95% of patients are adults and 5% are children.


Causes of non-Hodgkin lymphoma


Direct risk factors of getting non-Hodgkin lymphoma are unknown. However, few risk factors  are known andincrease the chances of this illness:


Viruses. Chances of getting non-Hodgkin lymphoma are increasing if the following viral infections are present:

  • Infectious mononucleosis
  • HIV
  • Hepatitis C
  • Helicobacter pylori infection
  • Herpes type 8
  • Human T-leukemia virus


Extrinsic factors. Chances of getting non-Hodgkin lymphoma can be increased by:

  • Some of the medications (corticosteroids, cyclosporine, cytostatics)
  • Ionizing irradiation (including the radiation therapy of the other malignant formations)
  • Carcinogenic and mutagenic chemicals (dioxin, phenytoin, polychlorinated biphenyls)


Intrinsic factors. Some of the genetic diseases such as ataxia telangiectasia syndrome, Klinefelter syndrome, and Chediak-Higashi syndromecan increase chances of getting non-Hodgkin lymphoma. Chances of developing lymphoma also increase if the autoimmune pathologies are present, eg. systemic lupus erythematosus,rheumatoid arthritis, and Sjogren's syndrome.


Non-Hodgkin lymphoma symptoms


Non-Hodgkin lymphoma - Symptoms


Clinical manifestations of non-Hodgkin lymphoma depend of its location. According to the location of the primary tumor the following types of illness are distinguished:

  • Nodal type develops when tumor is formed on the lymphoid organs (thymus, spleen)
  • Leukemic type is distinguished when the primary tumor is formed in the bone marrow
  • Extra-nodal type is distinguished when the tumor is growing on the non-lymphoid organs (skin, bronchus, stomach)


The three basic groups of non-Hodgkin lymphoma symptoms are:


“Plustissue” syndrome is characterized by the increased volume of tissues, which the tumor is growing of. Lymph nodes, spleen or other organs are enlarged. The surrounding tissues can be constricted in the process that is manifested by the appearance of the corresponding symptoms, depending on the location of the pathological process.

Intoxication syndrome is manifested by nausea, weakness, headache, sweating, increased body temperature and other symptoms typical of almost all malignant cancers.

Immunodeficiency syndrome can appear if the bone marrow is affected. The syndrome can be manifested by the risk of secondary infectious disease, secondary tumor as a result of weakened  antitumor protection and it’s rarely manifested by the autoimmune pathology.


Due to the proliferative activity, non-Hodgkin lymphoma can be indolent or aggressive. Indolent lymphomas occur more often. They can be characterized by the slow growth of the tumor mass and the prolonged period of asymptomatic stage. Aggressive non-Hodgkin lymphomas are manifested by the obvious intoxication syndrome at the very beginning and can lead to the extra-nodal organs damage (most often, the lungs, skin, central nervous system and structures of the gastrointestinal tract).


If the bone marrow is damaged, changes in blood might appear and be characteristic for leukemia. It can result in increased level of leukocytes and reduced level of erythrocytes and platelets. Corresponding clinical picture appears which is connected with the anemia and coagulation failure (hemorrhagic and anemic syndromes).


Non-Hodgkin lymphoma diagnostics


Non-Hodgkin lymphoma - Diagnostics


Diagnostics of Non-Hodgkin lymphomas is based on the laboratory and instrumental research methods. It has three basic goals:

  • Diagnosis
  • Assessment of the pathological process spreading (staging)
  • Definition of the risk group for prognosis assessment and determination of the optimal treatment strategies


The lymph node or tumor tissue biopsy is done to establish the nosological diagnosis of the non-Hodgkin lymphoma. Further, its histoimmunochemical and morphologic analysis is done.


Visualizing methods, such as CT (computed tomography), MRI (magnetic resonance imaging) and ultrasound are used to define the tumor mass. Other ways of analysis are also prescribed depending on the tumor localization spot. If the GIT (gastrointestinal tract) is affected, the EGD (fibrogastroduodenoscopy) is indicated.


Based on the analysis the stage of the non-Hodgkin lymphoma is established:

  • Stage 1 – one group of the lymph nodes or one extra-nodal section (organ) is damaged.
  • Stage 2 –several groups of lymph nodes, located on the same side of the diaphragm are damaged; or if one of the extra-nodal sections with the regional lymph nodes located on the same side of the diaphragm are involved.
  • Stage 3 – several lymph nodes groups on the different sides of diaphragm are involved and the process is accompanied by the spleen and extra-nodal sections damage.
  • Stage 4 – the lymph nodes on the both sides of the diaphragm are affected, the bone marrow is damaged and the tumor is present in the extra-nodal sections with metastasis into the distant lymph nodes.


Each stage can be:

  • A – without intoxication
  • B – withintoxication (10% weight loss in 6 months, heavynightsweats, feverhigherthan38 degrees)


Damage of the extra-nodal and nodal sections like liver, lungs, bone marrow, spleen, pleura, skin, bones is determined which also matters for the diagnosis.


Non-Hodgkin lymphoma treatment abroad


Treatment of non-Hodgkin lymphoma abroad

Treatment goals can be patient’s full recovery from some types of non-Hodgkin lymphomas (aggressive types of lymphomas). But, mostly the goal is to get the remission and to prolong its duration.


Basic treatment methods are:

  • Chemotherapy
  • Immunotherapy
  • Radiationtherapy


Surgeries are rarely or never done. The surgery is done occasionally if the primary focus of non-Hodgkin lymphoma is located in the spleen, thyroid gland or the stomach. But in the recent years the preference is given more and more often to the radiation therapy for the treatment of isolated forms of this disease.


Stem cells transplant is indicated in case of bone marrow damage. Allotransplantation (donor’s stem cells) can be done as well as the autotransplantation (patient’s own stem cells). Allotransplantation is considered to be more effective although it is more dangerous for the patient.


New treatment methods of non-Hodgkin lymphoma

A vaccine for non-Hodgkin lymphoma BiovaxID stimulates the immune system to destroy the tumor cells. Research shows that the vaccine allows prolonging the remission period for one year on average for the patients with the follicular lymphoma after the chemotherapy. Clinical trials of the BiovaxIDare still ongoing.


Targeted therapy. Medications that destroy the tumor cells and have minimal impact on the healthy tissues are being already used for the non-Hodgkin lymphoma treatment.


Following drugs are used for this purpose:

  • Proteasome inhibitors
  • HDAC inhibitors
  • Kinase inhibitors


New approaches to the stem cell transplantation. With the autotransplantation, there is still high risk of the recurrent entering of the tumor cells into the bone marrow. Monoclonal antibodies are used to reduce this possibility. Antibodies help to get rid of the lymphoma cells from the stem cells culture before last ones are transplanted to the patient.


Non-Hodgkin lymphoma prognosis


Non-Hodgkin lymphoma - Prognosis

Prognosis depends on the number of factors that are listed into the International Prognostic Index. It includes such factors as the age of the patient, stage of the non-Hodgkin lymphoma, level of the LDH in blood and the patient’s general state of health. Based on these factors, the risk can be low, high or intermediate.


According to the International Prognostic Index, the information on survival is shown in the table below:


Non-Hodgkin lymphoma prognostic index


According to the latest research, general survival of the patients suffering from the non-Hodgkin lymphoma is

  • 5-year – 69%
  • 10-year  – 59%


Life expectancy of the patients having a non-Hodgkin lymphoma has tendency to increase that is connected to the optimal choice of the medications combination for the chemotherapy and the introduction of the new drugs and ways of treatment.



Here you can find the cost of treatment for this disease at the German University Hospitals. Leave a request and we will provide a free consultation with a doctor and will start organizing the whole treatment process.

The program includes the following:

  • Issuing of an invitation for getting a visa for treatment as quick as possible
  • Fixing an appointment at a time convenient for you
  • Preliminary organization of a comprehensive examination and discussion of the forthcoming treatment plan
  • Arranging transfer from the airport to the hospital and back to the airport
  • Provision of interpreting services and services of a personal medical coordinator
  • If necessary, assistance in the organization of further surgical treatment
  • Provision of a medical insurance against treatment complications covering up to 200,000 euro
  • Preparation and translation of medical records and recommendations from the hospital
  • Assistance in the subsequent communication with your attending physician, including consultations on repeated X-ray images through the unique medical document management system E-doc

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