Indolent non-Hodgkin lymphoma (NHL) treatment in 761 Oncology clinics worldwide

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761 clinics specializing in Oncology providing treatment of Indolent non-Hodgkin lymphoma (NHL) Indolent non-Hodgkin lymphoma (NHL) is a slow-growing form of lymphoma characterized by abnormal lymphocyte proliferation. It tends to have a more chronic course with milder symptoms compared to aggressive NHL.
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disease worldwide.

Africa · 11
Americas · 168
Asia · 232
Europe · 316
Oceania · 34
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Africa · 11 Americas · 168 Asia · 232 Europe · 316 Oceania · 34
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Prices for popular procedures:
  1. Chimeric antigen receptor (CAR) T-cell therapy
    by request
  2. Natural killer (NK) cell therapy
    by request
  3. Targeted therapy
    by request
  4. Chemotherapy for lymphoma
    by request
  5. Monoclonal antibodies therapy (mAbs)
    by request
  6. Chemotherapy for melanoma
    by request
  7. Chemotherapy for endometrial cancer
    by request
  8. Chemotherapy for gallbladder cancer
    by request
  9. Chemotherapy for colorectal cancer
    by request
photo
Belo Horizonte, Brazil
Specializations: Oncology
Founded in 1999, Oncocentro was born with the purpose of offering an integral, welcoming and interdisciplinary service. Over the years, it has become a reference read more
Prices for popular procedures:
  1. Image-guided radiation therapy (IGRT)
    $2,355 - $3,563
  2. Intensity-modulated radiation therapy (IMRT)
    $2,355 - $3,563
  3. Volumetric modulated arc therapy (VMAT)
    $2,355 - $3,563
  4. Stereotactic radiation therapy (SRT)
    $2,537
  5. Radiosurgery
    $2,537 - $3,684
  6. CyberKnife radiosurgery
    $2,537 - $3,684
  7. Stereotactic spine radiosurgery
    $2,355 - $2,658
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Ufa, Russia
Specializations: Oncology
The center has equipment for PET / CT examinations from one of the leaders in the production of medical equipment. The same equipment is used read more
Prices for popular procedures:
  1. External beam radiotherapy (EBRT)
    $2,416
  2. Image-guided radiation therapy (IGRT)
    by request
  3. Three-dimensional conformal radiation therapy (3D CRT)
    by request
  4. Intensity-modulated radiation therapy (IMRT)
    $2,416
  5. Chemotherapy for lymphoma
    by request
  6. Radiation therapy for breast cancer
    $2,054 - $3,624
  7. Radiotherapy for prostate cancer
    $2,416
  8. LINAC based stereotactic radiosurgery
    $2,416
  9. Stereotactic radiation therapy (SRT)
    $2,416
photo
Balashikha, Russia
Specializations: Oncology
The PET-Technology oncology center in Balashikha was designed, built and equipped as part of a public-private partnership with the Government of the Moscow Region, the read more
Prices for popular procedures:
  1. Image-guided radiation therapy (IGRT)
    by request
  2. Three-dimensional conformal radiation therapy (3D CRT)
    by request
  3. Intensity-modulated radiation therapy (IMRT)
    $2,416
  4. Chemotherapy for lymphoma
    by request
  5. Radiation therapy for breast cancer
    $2,054 - $3,624
  6. Radiotherapy for prostate cancer
    $2,416
  7. LINAC based stereotactic radiosurgery
    $2,416
  8. Stereotactic radiation therapy (SRT)
    $2,416
  9. Radiosurgery
    $2,416
photo
Podolsk, Russia
Specializations: Oncology
The PET-Technology Cancer Radiology Center in Podolsk is a modern, comfortable medical facility for patients with any stage of the disease. The center has a read more
Prices for popular procedures:
  1. Targeted therapy
    by request
  2. Chemotherapy for lymphoma
    by request
  3. Chemotherapy for liver cancer
    by request
  4. Chemotherapy for brain cancer
    by request
  5. Chemotherapy for gallbladder cancer
    by request
  6. Chemotherapy for eye cancer
    by request
  7. Chemotherapy for myeloma
    by request
  8. Chemotherapy for melanoma
    by request
  9. Chemotherapy for non-melanoma skin cancer
    by request
photo
Budapest, Hungary
Specializations: Oncology
In the Oncology Profile of the Internal Medicine and Oncology Clinic patients with so-called solid tumors are treated with medication. The center offers traditional chemotherapy read more
Prices for popular procedures:
  1. Chimeric antigen receptor (CAR) T-cell therapy
    by request
  2. Natural killer (NK) cell therapy
    by request
  3. External beam radiotherapy (EBRT)
    by request
  4. Chemotherapy for lymphoma
    by request
  5. Monoclonal antibodies therapy (mAbs)
    by request
  6. Radiation therapy for breast cancer
    from $21,462
  7. Radiotherapy for prostate cancer
    from $34,018
  8. Brachytherapy for prostate cancer
    from $52,361
  9. Lumpectomy
    ≈ $6,974
photo
Helsinki, Finland
Specializations: Oncology
Docrates Cancer Center, based in Helsinki, Finland, is a leading international treatment facility specialising in the diagnostics, treatment and follow-up of cancers. The hospital opened read more
Prices for popular procedures:
  1. Autologous bone marrow transplantation (BMT)
    by request
  2. Allogeneic bone marrow transplantation (BMT)
    by request
  3. Chimeric antigen receptor (CAR) T-cell therapy
    by request
  4. Natural killer (NK) cell therapy
    by request
  5. Targeted therapy
    by request
  6. Image-guided radiation therapy (IGRT)
    by request
  7. Intensity-modulated radiation therapy (IMRT)
    by request
  8. Chemotherapy for lymphoma
    by request
  9. Monoclonal antibodies therapy (mAbs)
    by request
photo
Dubai, United Arab Emirates
Specializations: Thoracic surgery, Oncology
Languages: English, Arabic
Mediclinic City Hospital’s Comprehensive Cancer Centre (CCC), is Dubai’s most advanced facility for the diagnosis and treatment of cancer. Built in collaboration with Mediclinic Middle read more
Prices for popular procedures:
  1. Chimeric antigen receptor (CAR) T-cell therapy
    by request
  2. Natural killer (NK) cell therapy
    by request
  3. Monoclonal antibodies therapy (mAbs)
    by request
  4. Sentinel node biopsy
    from $15,340
  5. Mohs surgery
    from $12,600
  6. Melanoma surgical removal
    from $5,720
  7. Removal of benign skin lesions
    ≈ $4,300
  8. Skin cancer surgery
    ≈ $5,076
  9. Laser therapy for skin lesions
    ≈ $3,970
photo
Tel Aviv, Israel
Specializations: Oncology
Languages: English, Russian
In Melanoma Unit, immunological / biological treatments are also given on drugs that are not in the health basket under the supervision of senior oncologists. read more
Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Splenectomy
    ≈ $5,172
  4. Autologous bone marrow transplantation (BMT)
    by request
  5. Allogeneic bone marrow transplantation (BMT)
    by request
  6. Chimeric antigen receptor (CAR) T-cell therapy
    by request
  7. Natural killer (NK) cell therapy
    by request
  8. Targeted therapy
    by request
  9. Chemotherapy for lymphoma
    by request
photo
Medina, Saudi Arabia
Specializations: Vascular surgery, Thoracic surgery, Oncology
King Faisal Specialist Hospital & Research Centre (Gen. Org) Madinah (KFSH&RC-M) is the latest addition to our internationally recognized organization. Our mission at KFSH&RC-M is read more
Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Splenectomy
    ≈ $10,456
  4. Autologous bone marrow transplantation (BMT)
    by request
  5. Allogeneic bone marrow transplantation (BMT)
    by request
  6. Chimeric antigen receptor (CAR) T-cell therapy
    by request
  7. Natural killer (NK) cell therapy
    by request
  8. Targeted therapy
    by request
  9. Image-guided radiation therapy (IGRT)
    by request
photo
Toulouse, France
Specializations: Thoracic surgery, Oncology
Languages: English, German, Spanish; Castilian
The IUCT Oncopole comprises the Institut Claudius Regaud, a cancer center, and several teams from Toulouse University Hospital Center. The two institutions offer the expertise read more
Prices for popular procedures:
  1. Chimeric antigen receptor (CAR) T-cell therapy
    by request
  2. Natural killer (NK) cell therapy
    by request
  3. Monoclonal antibodies therapy (mAbs)
    by request
  4. Radiation therapy
    by request
  5. Immune checkpoint inhibitors
    by request
photo
São Paulo, Brazil
Specializations: Oncology
Occupying a total area of ​​1,550 m2, we have an infrastructure specially built to ensure the well-being of patients during cancer treatment. Humanism was the read more
Prices for popular procedures:
  1. Chimeric antigen receptor (CAR) T-cell therapy
    by request
  2. Natural killer (NK) cell therapy
    by request
  3. Targeted therapy
    by request
  4. Chemotherapy for lymphoma
    by request
  5. Monoclonal antibodies therapy (mAbs)
    by request
  6. Brachytherapy for prostate cancer
    $5,020
  7. Stereotactic radiation therapy (SRT)
    $2,740
  8. Radioactive Iodine therapy for thyroid cancer
    $1,561
  9. Hemicolectomy
    $1,331 - $2,317
photo
Kazan, Russia
Specializations: Cardiac surgery, Vascular surgery, Thoracic surgery, Oncology
GAUZ "Republican Clinical Oncological Dispensary of the Ministry of Health of the Republic of Tatarstan" named after Professor M.Z. Sigal "is one of the largest read more
Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Splenectomy
    ≈ $10,456
  4. Autologous bone marrow transplantation (BMT)
    by request
  5. Allogeneic bone marrow transplantation (BMT)
    by request
  6. Chimeric antigen receptor (CAR) T-cell therapy
    by request
  7. Natural killer (NK) cell therapy
    by request
  8. Targeted therapy
    by request
  9. Chemotherapy for lymphoma
    by request
photo
Marseille, France
Specializations: Vascular surgery, Thoracic surgery, Oncology
The Paoli-Calmettes Institute (IPC) is a center for the fight against cancer, a member of the Unicancer group , governed by the public health code. read more
Prices for popular procedures:
  1. Chemotherapy for lymphoma
    by request
  2. Conization
    ≈ $2,093
  3. Open hysterectomy
    ≈ $2,591
  4. Loop electrosurgical excision procedure (LEEP)
    ≈ $1,166
  5. Total laparoscopic hysterectomy (TLH)
    $1,570
  6. Laparoscopic cholecystectomy
    ≈ $1,531
  7. Total gastrectomy
    ≈ $18,692
  8. Total thyroidectomy
    ≈ $4,825
  9. Cholecystectomy
    ≈ $3,093
photo
Reynosa, Mexico
Specializations: Cardiac surgery, Vascular surgery, Oncology
Languages: English
The quality of CHRISTUS MUGUERZA on the Mexican border At CHRISTUS MUGUERZA Hospital Reynosa we provide high quality medical services to the Tamaulipas border community read more
Prices for popular procedures:
  1. Chemotherapy for lymphoma
    by request
  2. Hemicolectomy
    ≈ $4,515
  3. Rectum anterior resection
    ≈ $3,486
  4. Conization
    ≈ $735
  5. Open hysterectomy
    ≈ $1,643
  6. Loop electrosurgical excision procedure (LEEP)
    ≈ $411
  7. Total laparoscopic hysterectomy (TLH)
    ≈ $1,793
  8. Laparoscopic cholecystectomy
    ≈ $1,448
  9. Total gastrectomy
    ≈ $6,895
photo
Chittagong, Bangladesh
Specializations: Thoracic surgery, Oncology
Chattogram Maa-O-Shishu Hospital is a 650-bedded hospital, which includes Paediatrics Medicine, Neonatology, Pediatric Surgery, Paediatric Neorology, General Surgery, Obstetrics & Gynaecology, Medicine & it's sub-specialists. read more
Prices for popular procedures:
  1. Chimeric antigen receptor (CAR) T-cell therapy
    by request
  2. Natural killer (NK) cell therapy
    by request
  3. Monoclonal antibodies therapy (mAbs)
    by request
  4. Lumpectomy
    $900
  5. Simple mastectomy
    from $1,224
  6. Subcutaneous mastectomy
    $1,285
  7. Needle biopsy
    ≈ $236
  8. Vacuum-assisted breast biopsy
    ≈ $862
  9. Partial mastectomy
    ≈ $1,737
photo
Banská Bystrica, Slovakia
Specializations: Orthopedic surgery, Oncology
Mammacentrum St. Agáty is a member of the SVET ZDRAVIA hospital network. It is a specialized hospital that comprehensively deals with the diagnosis and treatment read more
Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Splenectomy
    ≈ $3,995
  4. Targeted therapy
    by request
  5. Total body irradiation (TBI)
    by request
  6. External beam radiotherapy (EBRT)
    by request
  7. Image-guided radiation therapy (IGRT)
    by request
  8. Three-dimensional conformal radiation therapy (3D CRT)
    by request
  9. Intensity-modulated radiation therapy (IMRT)
    by request
photo
Chennai, India
Specializations: Thoracic surgery, Orthopedic surgery, Oncology
The Cancer Institute (WIA), as you are aware, is a public charitable voluntary institute dedicated to the care of cancer for for the last 60 read more
Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Splenectomy
    ≈ $10,636
  4. Chemotherapy for lymphoma
    by request
  5. Cord blood stem cell transplantation
    by request
  6. Hemicolectomy
    $13,960
  7. Rectum anterior resection
    ≈ $16,839
  8. Radical prostatectomy
    ≈ $15,504
  9. Transurethral resection of the prostate (TURP)
    ≈ $6,011
photo
Melbourne, Australia
Specializations: Thoracic surgery, Orthopedic surgery, Oncology
Languages: Arabic, Croatian, Italian, Serbian, Somali, Turkish, Vietnamese, Spanish; Castilian, Chinese, Greek, Modern
St Vincent’s Hospitals Australia has a rich tradition of providing progressive and excellent health care. We combine the latest technology with exceptional and compassionate medical, read more
Prices for popular procedures:
  1. Autologous bone marrow transplantation (BMT)
    by request
  2. Allogeneic bone marrow transplantation (BMT)
    by request
  3. Image-guided radiation therapy (IGRT)
    by request
  4. Intensity-modulated radiation therapy (IMRT)
    by request
  5. Chemotherapy for lymphoma
    by request
  6. Hemicolectomy
    ≈ $17,002
  7. Rectum anterior resection
    ≈ $18,346
  8. Radical prostatectomy
    ≈ $16,501
  9. Transurethral resection of the prostate (TURP)
    ≈ $7,833
photo
Paris, France
Specializations: Thoracic surgery, Orthopedic surgery, Oncology
The Ambroise Paré, Pierre Cherest and Hartmann Clinics bring together specialized multidisciplinary teams. Regarding the financial aspect of care, every effort is made to ensure read more
Prices for popular procedures:
  1. Stem cell transplant (peripheral blood)
    by request
  2. Hematopoietic stem cell harvest
    by request
  3. Splenectomy
    ≈ $5,245
  4. Autologous bone marrow transplantation (BMT)
    by request
  5. Allogeneic bone marrow transplantation (BMT)
    by request
  6. Chimeric antigen receptor (CAR) T-cell therapy
    by request
  7. Natural killer (NK) cell therapy
    by request
  8. Targeted therapy
    by request
  9. Three-dimensional conformal radiation therapy (3D CRT)
    by request
photo
Buenos Aires, Argentina
Specializations: Cardiac surgery, Thoracic surgery, Orthopedic surgery, Oncology
As of March 14, 1994, the Alexander Fleming Institute opened its doors to medical and scientific excellence. Maximum technical-scientific level and comfort in one of read more

Clinics grouping by rating

Clinic with the highest rating of 5 — Berkana clinic in Moscow, Russia and 4 more, clinic with the most reviews number of 35757 — Aster CMI hospital in Bengaluru, India.

With rating 4.0 and over — 252 clinics .

Countries with the highest number of clinics treating the diseases:

Indolent non-Hodgkin lymphoma (NHL):

Related procedures:

Follicular Lymphoma: Overview and Treatment Management

Introduction & Classification of Follicular Lymphoma

Follicular lymphoma develops in the white blood cells, lymphatic system, and bone marrow. Follicular lymphoma is a well-defined subtype (low grade) of Non-Hodgkin Lymphoma (NHL), with cells of the lymphoid tissues in the lymphatic system multiplying uncontrollably to cause tumors to grow eventually.

Different types of lymphoma can develop from each type of lymphocyte, but follicular lymphoma arises in particular from B-lymphocytes. The malignant cells in lymphoma grow in clusters to form nodules. Some organs are also part of the lymphatic system and are partially constructed by lymphoid tissue, which includes the spleen, thymus, tonsils, and adenoids. The lymphatic system filters blood lymph (the liquid circulating in lymph vessels), drains fluid from tissues to the bloodstream, and fights infections. Since lymphoid tissue is found throughout the body, follicular lymphoma can begin in almost any body part. The bone marrow may become invaded by lymphocytes that do not function properly. As the bone marrow also produces platelets to stop bleeding critically and red blood cells to deliver oxygen to all cells in the body, excess accumulation of lymphocytes prevents the normal production of red blood cells and platelets. Follicular lymphoma is usually slow-growing.

Compared to breast cancer in women or prostate cancer in men, NHLs are not common. Nevertheless, they are the sixth most common cancer in Europe. They account for around 3% of all cancers; follicular lymphomas represent approximately 25% of all NHLs. In Western Europe, follicular lymphoma is the second most frequent subtype.

The number of patients diagnosed with follicular lymphoma yearly has increased from 2-3 cases per 100,000 people in the 1950s to 5-7 cases per 100,000 people.

In general, the risk of getting NHL increases with age. There is a 5-7-fold increase in cases among patients older than 65 years.

Follicular lymphoma staging is the process of determining whether the tumor has spread and, if so, how far. It is essential to know the stage of the disease to plan the treatment. The staging system used to describe the spread of follicular lymphoma is called the Ann Arbor Staging System. It uses Roman numerals (I-IV) for different stages:

  • Stage I - The lymphoma is in one group of the body's lymph nodes, such as the groin or neck, or one organ of the lymph system.
  • Stage II - Two or more groups of lymph nodes, or one organ close to the affected lymph nodes, and one or more groups of lymph nodes on the same side of the diaphragm contain lymphoma cells. The diaphragm is the muscle that divides the chest and abdomen. For example, lymphoma might be above the diaphragm in lymph nodes in the neck and armpits. Or, the lymphoma might be below the diaphragm in the lymph nodes in the groin and abdomen.
  • Stage III - The lymphoma is in lymph nodes on both sides of the diaphragm. It may have also spread into an organ close to the affected lymph nodes or spleen.
  • Stage IV - The lymphoma is in stage IV if the lymphoma involves the bone marrow or distant organs.

Follicular lymphoma stages are also noted by the presence or absence of certain findings and/or symptoms of the disease:

  • A lymphoma that affects organs or tissues other than the lymph nodes has an "E," for
  • extranodal, added to its staging nomenclature.
  • If a nodal mass is at least 7.5 cm in diameter, it translates as a bulky disease.
  • If it affects the spleen, an "S" is added.
  • If the patient has a fever, night sweats, or unexplained weight loss, the letter "B" is added.
  • If none of these is present, an "A" is added.

The grading from the WHO organization could be 1, 2, 3A, and 3B to reflect the number of lymphoma cells or blasts under the microscope using maximal magnification. Grade 3B is the highest grade and is considered an aggressive lymphoma.

A Follicular Lymphoma-specific International Prognostic Index (FLIPI) should be determined for predictive purposes. FLIPI allows us to identify the disease's progression risk after treatment and adapt treatment and follow-up accordingly. The parameters used in the original version of FLIPI 1 are > four involved nodal sites, age >60 years, elevated lactate dehydrogenase (LDH) level, stage III or IV disease, and hemoglobin <12 g/dl. Each of the above characteristics is assigned one point, ranging this index score between 0 and 5. For each index relevance, the 0-1 risk is considered low, the two risks as intermediate, and the 3-5 risk as high.

Pediatric follicular lymphoma is characterized by a localized disease that is histologically more aggressive, and some have specific molecular features. However, pediatric follicular lymphoma shows a much more indolent course and should be managed with local therapy only.

Phases of Treatment

How is follicular lymphoma treatment structured?

Treatment plan for stage I-II follicular lymphoma

In the small proportion of patients with limited non-bulky stage I-II disease, the administration of radiotherapy targeting the site of the involved lymph nodes has curative potential.

In selected cases, watchful waiting may be discussed to avoid the side effects of radiation and it could be of the same efficacy as active treatment.

The presence of bulky, large tumors or with two or more sites involved helps identify patients who could benefit from chemotherapy (vincristine, doxorubicin) and monoclonal antibody rituximab. In this case, the role of radiotherapy may be considered after this initial treatment if the sites of involved lymph nodes are located so that radiotherapy can be given without significant side effects.

Treatment plan for stage III-IV follicular lymphoma

The disease could disappear or regress without treatment in 10-20% of lymphoma cases. Early initiation of therapy in asymptomatic patients did not show any improvement in survival. Therefore, watchful waiting is recommended.

Treatment should only be utilized due to symptoms, including B-symptoms (fever for an unknown reason, drenching night sweats, and undesired or unintentional weight loss), impairment in blood cell formation, bulky disease, compression of important organs, abnormal presence of fluid in the abdominal cavity (ascites), or in the space between the lungs and thoracic wall (pleural effusion) and rapid progression of the disease.

The induction treatment (chemo with vincristine, cyclophosphamide, and prednisone) is the first step in reducing the number of cancer cells. From there, a consolidation phase (with rituximab) further reduces the number of cancer cells and increases the probability of the lymphoma not returning. This is followed by a maintenance phase with goals to maintain the remission and prevent a relapse.

Relapsed or Refractory Follicular lymphoma treatment approach

Relapse is the reappearance of the disease. A repeated biopsy is strongly recommended to know if the lymphoma that relapsed turned into an aggressive form.

The treatment given when the disease relapsed is called salvage treatment, and selection depends on the effectiveness of the previous treatments administered. In early relapse (< 12- 24 months disease-free), the disease might be resistant to the drugs used previously. As a result, a regimen of different drugs to overcome resistance is preferred. An example comes from bendamustine after CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) and vice versa. Rituximab could be used again for the patient if it had previously achieved a disease-free period of more than 6-12 months.

Radioimmunotherapy (radioactive substance combined/attached to a monoclonal antibody, such as <sup>90</sup>Y-Ibritumomab-tiuxetan (Zevalin) and <sup>131</sup>I-tositumomab (Bexxar)) represents an effective approach, especially in patients over 65 years of age with other diseases present who are not eligible for chemotherapy.

Rituximab maintenance for up to 2 years as a single treatment every three months can be administered in patients who received it as a part of induction and did not receive it in the first-line treatment.

In young patients, high-dose chemotherapy with a stem cell transplantation using the patient's stem cells could be considered. Research indicates that treatment combination for young cancer patients delays the progression of the disease and prolongs survival. However, it is not always required now. Instead, rituximab is widely used for patients, especially in patients experiencing late relapses.

Prognosis, Survival Rates, and Follow-up

What are the survival rates and factors affecting prognosis?

Generally, for people with follicular lymphoma, around 85% of people survive their cancer for five years or more after diagnosis. They will be from the low-risk group (100%), intermediate-risk group (90%), and high-risk group (75%).

Patients should undergo:

  • History-taking, monitoring of symptoms, and physical examination every three months for two years, every four to six months for an additional three years, and subsequently once a year.
  • Blood count and other routine blood analyses are performed every six months for two years and only if suspicious symptoms appear.
  • Evaluation of thyroid function at one, two, and five years if the patient received irradiation to the neck.
  • Radiological and ultrasound studies are recommended every six months for two years and annually thereafter. However, CT scans are not mandatory outside clinical trials.
  • Alejandro Santos, M.D.
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