{"id":5236,"date":"2024-12-11T17:47:36","date_gmt":"2024-12-11T16:47:36","guid":{"rendered":"https:\/\/irccs.com\/patologie\/lymphomas\/"},"modified":"2026-06-22T18:04:37","modified_gmt":"2026-06-22T16:04:37","slug":"lymphomas","status":"publish","type":"pathology","link":"https:\/\/inoc.it\/en\/pathology\/lymphomas\/","title":{"rendered":"Lymphomas"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"><span  id=\"pathology\" class=\"h2_anchor\"><\/span>Pathology<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Lymphomas<\/strong> are a heterogeneous group of tumors originating from <strong>lymphocytes<\/strong>, the fundamental cells of the immune system. These cells circulate throughout the body to identify and eliminate foreign agents such as bacteria and viruses. When lymphocytes become malignant, they retain their ability to move through the <strong>blood and lymphatic system<\/strong>, which explains why lymphomas can involve not only <strong>lymph nodes<\/strong>, but also other lymphatic organs such as the <strong>bone marrow and spleen<\/strong>, as well as extra-lymphatic organs including the <strong>skin, lungs, central nervous system, stomach, and liver<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The incidence of lymphomas has been increasing in both sexes since 1975. However, <strong>mortality has decreased<\/strong> due to <strong>advances in research<\/strong> and the development of new treatments, which have <strong>significantly improved patient outcomes.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Types<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Lymphomas are broadly classified into two main categories:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Hodgkin lymphoma<\/strong>: Named after the physician who first described it, Hodgkin lymphoma primarily affects young individuals, typically between <strong>15 and 35 years of age<\/strong>, with a second, less frequent peak after <strong>60 years<\/strong>. It is a rare disease, with an incidence of approximately <strong>3\u20135 cases per 100,000 people per year<\/strong>.<\/li>\n\n\n\n<li><strong>Non-Hodgkin lymphoma<\/strong>: Non-Hodgkin lymphomas represent a highly heterogeneous group of malignancies of the lymphatic system. They can occur across a wide age range, most commonly between <strong>30 and 80 years<\/strong>, with a peak between <strong>50 and 70 years<\/strong>. They are significantly more common than Hodgkin lymphoma, accounting for about <strong>3 percent of all cancers<\/strong> and ranking among the most frequent malignancies in Italy. More than <strong>60 subtypes<\/strong> are currently recognized.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Their classification depends on the type of lymphocyte involved. In about <strong>80\u201385 percent of cases<\/strong>, they originate from <strong>B lymphocytes<\/strong>, while <strong>15\u201320 percent<\/strong> arise from <strong>T lymphocytes<\/strong>. Because lymphocytes are distributed throughout lymphoid tissues in multiple organs, non-Hodgkin lymphomas are often <strong>widespread at diagnosis<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A key feature is growth behavior. Some subtypes are <strong>slow-growing (indolent)<\/strong>, such as <strong>follicular lymphoma<\/strong>, which accounts for about <strong>20\u201325 percent of cases<\/strong>. Others are <strong>rapidly progressive and require urgent treatment<\/strong>, such as <strong>diffuse large B-cell lymphoma<\/strong>, the most common subtype, representing approximately <strong>30\u201340 percent of all non-Hodgkin lymphomas<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">The Numbers in Italy<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">According to data from the <strong><a href=\"https:\/\/www.registri-tumori.it\/cms\/pubblicazioni\/i-numeri-del-cancro-italia-2023\">AIRTUM<\/a><\/strong> (Italian Association of Cancer Registries), in 2024 there were approximately <strong>13,271 new cases of non-Hodgkin lymphoma<\/strong> (7,321 men and 5,950 women) and <strong>2,218 new cases of Hodgkin lymphoma<\/strong> (1,203 men and 1,015 women).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"risk-factors\" class=\"h2_anchor\"><\/span>Risk Factors<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The exact causes of lymphomas are not fully understood, but several factors may increase risk. The presence of these factors does not necessarily imply disease development.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Age:<\/strong> risk increases with advancing age<\/li>\n\n\n\n<li><strong>Sex:<\/strong> slightly higher incidence in men<\/li>\n\n\n\n<li><strong>Family history:<\/strong> a history of lymphoma in close relatives may increase risk<\/li>\n\n\n\n<li><strong>Infections:<\/strong> HIV, hepatitis C virus (HCV), Epstein\u2013Barr virus (EBV), HHV8, <em>Helicobacter pylori<\/em>, and <em>Chlamydia psittaci<\/em><\/li>\n\n\n\n<li><strong>Chemical exposure:<\/strong> prolonged exposure to benzene or pesticides<\/li>\n\n\n\n<li><strong>Immunosuppression:<\/strong> post-transplant patients or those on immunosuppressive therapy<\/li>\n\n\n\n<li><strong>Autoimmune diseases:<\/strong> such as Sj\u00f6gren\u2019s syndrome and systemic lupus erythematosus<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"symptoms\" class=\"h2_anchor\"><\/span>Symptoms<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Lymphomas can present with variable and sometimes non-specific symptoms. The most common sign is <strong>enlarged lymph nodes<\/strong>, particularly in the <strong>neck, armpits, or groin<\/strong>. In some cases, this may be the only manifestation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">General symptoms may include <strong>fever of unknown origin, night sweats, unintentional weight loss, and sometimes persistent itching<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Clinical presentation varies depending on disease location:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Abdominal involvement may cause <strong>pain, bloating, or early satiety<\/strong>, often linked to splenic enlargement<\/li>\n\n\n\n<li>Thoracic involvement may cause <strong>cough or breathing difficulties<\/strong><\/li>\n\n\n\n<li>Bone marrow involvement may lead to <strong>fatigue due to anemia, increased bleeding tendency, and higher infection risk<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Prompt medical evaluation is essential, especially when symptoms persist or occur in combination, as early diagnosis significantly improves outcomes.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"diagnosis-and-examination\" class=\"h2_anchor\"><\/span><strong>Diagnosis and Examination<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The diagnostic pathway often begins with the <strong>general practitioner<\/strong>, who performs a physical examination of lymph nodes and assesses possible enlargement of the liver and spleen. Initial tests may include <strong>blood and urine analyses, abdominal ultrasound, or chest X-ray<\/strong>, to exclude infectious or alternative causes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If lymphoma is suspected, referral to an <strong>oncohematologist<\/strong> is required. The key diagnostic test is <strong>lymph node biopsy<\/strong>, involving removal of a suspicious lymph node for histological examination by a pathologist.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Once lymphoma is confirmed, further investigations are performed to determine the <strong>stage and extent of disease<\/strong>, which is essential for defining the most appropriate treatment strategy.<\/p>\n\n\n\t<div id=\"block_6a395d1433153\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Lymph Node Biopsy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"26\" data-end=\"127\">This procedure consists of the <strong data-start=\"57\" data-end=\"126\">partial or complete removal of one or more suspicious lymph nodes<\/strong>.<\/p>\n<p data-start=\"129\" data-end=\"304\">If the suspected lymph node is <strong data-start=\"160\" data-end=\"188\">superficial and palpable<\/strong>, the procedure is performed in an <strong data-start=\"223\" data-end=\"245\">outpatient setting<\/strong> under <strong data-start=\"252\" data-end=\"272\">local anesthesia<\/strong>, through a small skin incision.<\/p>\n<p data-start=\"306\" data-end=\"419\">If the lymph node is located <strong data-start=\"335\" data-end=\"367\">deep in the chest or abdomen<\/strong>, tissue sampling can be performed in two main ways:<\/p>\n<ul data-start=\"421\" data-end=\"1058\" data-is-last-node=\"\" data-is-only-node=\"\">\n<li data-section-id=\"1kzv307\" data-start=\"421\" data-end=\"818\"><strong data-start=\"423\" data-end=\"454\">Image-guided needle biopsy:<\/strong> performed using minimally invasive techniques with dedicated needles under <strong data-start=\"530\" data-end=\"559\">CT or ultrasound guidance<\/strong>. This approach, carried out under <strong data-start=\"594\" data-end=\"614\">local anesthesia<\/strong>, allows collection of small tissue fragments from the lymph node or involved organ where imaging suggests possible lymphoma. An adequate tissue sample is essential for accurate pathological evaluation.<\/li>\n<li data-section-id=\"1ol0c9v\" data-start=\"820\" data-end=\"1058\" data-is-last-node=\"\"><strong data-start=\"822\" data-end=\"842\">Surgical biopsy:<\/strong> performed under <strong data-start=\"859\" data-end=\"881\">general anesthesia<\/strong>, involving removal of a lymph node or tissue sample suspected for lymphoma. The procedure is guided by <strong data-start=\"985\" data-end=\"1013\">CT or ultrasound imaging<\/strong> to ensure precision and diagnostic accuracy.<\/li>\n<\/ul>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Histological and Molecular Examination<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"47\" data-end=\"260\">Lymph nodes or tissue samples obtained by biopsy are sent to the pathology laboratory, where they undergo <strong data-start=\"153\" data-end=\"181\">histological examination<\/strong>, complemented by <strong data-start=\"199\" data-end=\"259\">immunohistochemical, cytogenetic, and molecular analyses<\/strong>.<\/p>\n<p data-start=\"262\" data-end=\"993\">The diagnosis of lymphoma is complex and requires a multidisciplinary team of <strong data-start=\"340\" data-end=\"410\">pathologists, cytogeneticists, and other specialized professionals<\/strong> to ensure an accurate diagnosis and precise identification of the lymphoma type and subtype. This step is essential because treatment selection depends primarily on a <strong data-start=\"578\" data-end=\"612\">correct and detailed diagnosis<\/strong>, as different lymphoma subtypes require different therapeutic approaches. For this reason, such evaluations should be performed in <strong data-start=\"744\" data-end=\"774\">highly specialized centers<\/strong>. The <strong data-start=\"780\" data-end=\"809\">INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong> is one such center, equipped with advanced diagnostic technologies and a dedicated team for lymphoma diagnosis, ensuring accurate classification and individualized treatment planning.<\/p>\n<p data-start=\"995\" data-end=\"1202\">In addition to conventional microscopic evaluation, biopsy samples undergo <strong data-start=\"1070\" data-end=\"1092\">molecular analyses<\/strong> to identify abnormalities in tumor DNA, allowing for highly precise characterization of the lymphoma subtype.<\/p>\n<p data-start=\"1204\" data-end=\"1377\" data-is-last-node=\"\" data-is-only-node=\"\">Once the diagnosis is confirmed, patients undergo additional examinations to assess their <strong data-start=\"1294\" data-end=\"1319\">overall health status<\/strong> and to determine the <strong data-start=\"1341\" data-end=\"1376\">extent and stage of the disease<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Blood Test<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Blood tests are used to assess the <strong data-start=\"54\" data-end=\"69\">blood count<\/strong>, including possible <strong data-start=\"90\" data-end=\"100\">anemia<\/strong>, <strong data-start=\"102\" data-end=\"129\">white blood cell levels<\/strong>, and <strong data-start=\"135\" data-end=\"154\">platelet counts<\/strong>, as well as <strong data-start=\"167\" data-end=\"196\">kidney and liver function<\/strong>. They also measure specific molecules such as <strong data-start=\"243\" data-end=\"274\">lactate dehydrogenase (LDH)<\/strong> and <strong data-start=\"279\" data-end=\"303\">beta-2 microglobulin<\/strong>, which can provide information about the <strong data-start=\"345\" data-end=\"390\">biological characteristics of the disease<\/strong>, including its potential <strong data-start=\"416\" data-end=\"434\">aggressiveness<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Bone Marrow Needle Aspiration and Bone Marrow Biopsy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"61\" data-end=\"158\">These tests are performed to determine whether <strong data-start=\"108\" data-end=\"157\">lymphoma cells are present in the bone marrow<\/strong>.<\/p>\n<p data-start=\"160\" data-end=\"399\">The procedure is carried out under <strong data-start=\"195\" data-end=\"215\">local anesthesia<\/strong>. The physician inserts a needle into the upper part of the buttock, reaching the <strong data-start=\"297\" data-end=\"312\">pelvic bone<\/strong>, and collects two samples: one of <strong data-start=\"347\" data-end=\"371\">bone marrow aspirate<\/strong> and one of <strong data-start=\"383\" data-end=\"398\">bone tissue<\/strong>.<\/p>\n<p data-start=\"401\" data-end=\"588\">In some lymphoma subtypes, such as <strong data-start=\"436\" data-end=\"456\">Hodgkin lymphoma<\/strong> and <strong data-start=\"461\" data-end=\"494\">diffuse large B-cell lymphoma<\/strong>, this examination is no longer routinely required, while it remains important in other types.<\/p>\n<p data-start=\"590\" data-end=\"703\" data-is-last-node=\"\" data-is-only-node=\"\">The collected samples are sent to <strong data-start=\"624\" data-end=\"648\">anatomical pathology<\/strong> for <strong data-start=\"653\" data-end=\"702\">histological examination and further analyses<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Total Body CT  <\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<div class=\"qMYqUG_convSearchResultHighlightRoot\">\n<div class=\"\" data-turn-id-container=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-73\" data-is-intersecting=\"true\">\n<section class=\"text-token-text-primary w-full focus:outline-none has-data-writing-block:pointer-events-none [&amp;:has([data-writing-block])&gt;*]:pointer-events-auto R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]\" dir=\"auto\" data-turn-id=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-73\" data-turn-id-container=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-73\" data-testid=\"conversation-turn-148\" data-scroll-anchor=\"false\" data-turn=\"assistant\">\n<div class=\"text-base my-auto mx-auto pb-10 [--thread-content-margin:var(--thread-content-margin-xs,calc(var(--spacing)*4))] @w-sm\/main:[--thread-content-margin:var(--thread-content-margin-sm,calc(var(--spacing)*6))] @w-lg\/main:[--thread-content-margin:var(--thread-content-margin-lg,calc(var(--spacing)*16))] px-(--thread-content-margin)\">\n<div class=\"[--thread-content-max-width:40rem] @w-lg\/main:[--thread-content-max-width:48rem] mx-auto max-w-(--thread-content-max-width) flex-1 group\/turn-messages focus-visible:outline-hidden relative flex w-full min-w-0 flex-col agent-turn\" data-conversation-screenshot-content=\"\">\n<div class=\"flex max-w-full flex-col gap-4 grow\">\n<div class=\"min-h-8 text-message relative flex w-full flex-col items-end gap-2 text-start break-words whitespace-normal outline-none keyboard-focused:focus-ring [.text-message+&amp;]:mt-1\" dir=\"auto\" tabindex=\"0\" data-message-author-role=\"assistant\" data-message-id=\"67a8a5c6-8afb-4734-83d5-84f59745c6c7\" data-message-model-slug=\"gpt-5-3-mini\" data-turn-start-message=\"true\">\n<div class=\"flex w-full flex-col gap-1 empty:hidden\">\n<div class=\"markdown prose dark:prose-invert wrap-break-word w-full light markdown-new-styling\">\n<p data-start=\"22\" data-end=\"233\">CT (computed axial tomography) is a radiological examination in which data obtained from X-rays passing through the body are processed by a computer to generate <strong data-start=\"183\" data-end=\"232\">three-dimensional images of different tissues<\/strong>.<\/p>\n<p data-start=\"235\" data-end=\"482\">A <strong data-start=\"237\" data-end=\"259\">total body CT scan<\/strong> (neck, chest, abdomen, and pelvis) allows visualization of <strong data-start=\"319\" data-end=\"375\">deep lymph nodes potentially involved by the disease<\/strong>, assessment of their size, and detection of possible involvement of organs such as the <strong data-start=\"463\" data-end=\"481\">lungs or liver<\/strong>.<\/p>\n<p data-start=\"484\" data-end=\"629\" data-is-last-node=\"\" data-is-only-node=\"\">The examination requires the injection of an <strong data-start=\"529\" data-end=\"559\">intravenous contrast agent<\/strong>. It is performed on an <strong data-start=\"583\" data-end=\"600\">empty stomach<\/strong> in the radiology department.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/div>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">PET (Positron Emission Tomography)<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"43\" data-end=\"375\"><strong data-start=\"43\" data-end=\"81\">PET (positron emission tomography)<\/strong> is a diagnostic technique in <strong data-start=\"111\" data-end=\"131\">nuclear medicine<\/strong> that identifies tumor presence and activity by detecting <strong data-start=\"189\" data-end=\"221\">abnormal cellular metabolism<\/strong>. After the injection of a <strong data-start=\"248\" data-end=\"278\" data-is-only-node=\"\">radioactive glucose tracer<\/strong>, PET imaging can highlight cancer cells because they consume <strong data-start=\"340\" data-end=\"374\">more glucose than normal cells<\/strong>.<\/p>\n<p data-start=\"377\" data-end=\"639\">By measuring cellular glucose uptake, PET allows the identification of the <strong data-start=\"452\" data-end=\"480\">initial sites of disease<\/strong> and is considered more sensitive than CT in detecting <strong data-start=\"535\" data-end=\"557\">very small lesions<\/strong> or disease in locations that are difficult to evaluate with CT, such as <strong data-start=\"630\" data-end=\"638\">bone<\/strong>.<\/p>\n<p data-start=\"641\" data-end=\"858\" data-is-last-node=\"\" data-is-only-node=\"\">In addition, PET is a key tool for assessing <strong data-start=\"686\" data-end=\"709\">response to therapy<\/strong>. The disappearance of areas showing increased metabolic activity is often indicative of a <strong data-start=\"800\" data-end=\"831\">complete treatment response<\/strong> in many types of lymphoma.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Assessment of Cardiac Function<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<div class=\"qMYqUG_convSearchResultHighlightRoot\">\n<div class=\"\" data-turn-id-container=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-75\" data-is-intersecting=\"true\">\n<section class=\"text-token-text-primary w-full focus:outline-none has-data-writing-block:pointer-events-none [&amp;:has([data-writing-block])&gt;*]:pointer-events-auto R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]\" dir=\"auto\" data-turn-id=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-75\" data-turn-id-container=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-75\" data-testid=\"conversation-turn-152\" data-scroll-anchor=\"false\" data-turn=\"assistant\">\n<div class=\"text-base my-auto mx-auto pb-10 [--thread-content-margin:var(--thread-content-margin-xs,calc(var(--spacing)*4))] @w-sm\/main:[--thread-content-margin:var(--thread-content-margin-sm,calc(var(--spacing)*6))] @w-lg\/main:[--thread-content-margin:var(--thread-content-margin-lg,calc(var(--spacing)*16))] px-(--thread-content-margin)\">\n<div class=\"[--thread-content-max-width:40rem] @w-lg\/main:[--thread-content-max-width:48rem] mx-auto max-w-(--thread-content-max-width) flex-1 group\/turn-messages focus-visible:outline-hidden relative flex w-full min-w-0 flex-col agent-turn\" data-conversation-screenshot-content=\"\">\n<div class=\"flex max-w-full flex-col gap-4 grow\">\n<div class=\"min-h-8 text-message relative flex w-full flex-col items-end gap-2 text-start break-words whitespace-normal outline-none keyboard-focused:focus-ring [.text-message+&amp;]:mt-1\" dir=\"auto\" tabindex=\"0\" data-message-author-role=\"assistant\" data-message-id=\"47377967-6181-478f-939d-b0b7f0766dfd\" data-message-model-slug=\"gpt-5-3-mini\" data-turn-start-message=\"true\">\n<div class=\"flex w-full flex-col gap-1 empty:hidden\">\n<div class=\"markdown prose dark:prose-invert wrap-break-word w-full light markdown-new-styling\">\n<p data-start=\"39\" data-end=\"198\">Lymphoma treatment may involve drugs that can have <strong data-start=\"90\" data-end=\"122\">adverse effects on the heart<\/strong>. For this reason, a careful evaluation of <strong data-start=\"165\" data-end=\"185\">cardiac function<\/strong> is required.<\/p>\n<p data-start=\"200\" data-end=\"418\" data-is-last-node=\"\" data-is-only-node=\"\">This assessment is performed through a <strong data-start=\"239\" data-end=\"268\">cardiological examination<\/strong> and an <strong data-start=\"276\" data-end=\"294\">echocardiogram<\/strong>, which help determine the presence or absence of <strong data-start=\"344\" data-end=\"369\">cardiac abnormalities<\/strong> to be considered when planning lymphoma therapy.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/div>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Staging<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Once the investigations are completed, the <strong>stage of the lymphoma<\/strong> and the presence of specific <strong>prognostic factors<\/strong> are determined based on the findings. This information is essential for planning the most appropriate <strong>treatment strategy<\/strong>.<\/p>\n\n\n\t<div id=\"block_6a395d14331f8\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Hodgkin&#8217;s Lymphomas<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"52\" data-end=\"138\">For <strong data-start=\"56\" data-end=\"76\">Hodgkin lymphoma<\/strong>, the <strong data-start=\"82\" data-end=\"102\">Ann Arbor system<\/strong> is used, consisting of four stages:<\/p>\n<ul data-start=\"140\" data-end=\"574\">\n<li data-section-id=\"fr9tx7\" data-start=\"140\" data-end=\"207\"><strong data-start=\"142\" data-end=\"154\">Stage I:<\/strong> lymphoma confined to a single group of lymph nodes<\/li>\n<li data-section-id=\"16tk8ga\" data-start=\"208\" data-end=\"378\"><strong data-start=\"210\" data-end=\"223\">Stage II:<\/strong> lymphoma involving two or more lymph node groups, all located either <strong data-start=\"293\" data-end=\"325\">above or below the diaphragm<\/strong> (the muscle separating the chest from the abdomen)<\/li>\n<li data-section-id=\"akcxi1\" data-start=\"379\" data-end=\"475\"><strong data-start=\"381\" data-end=\"395\">Stage III:<\/strong> lymphoma present in lymph node regions <strong data-start=\"435\" data-end=\"473\">both above and below the diaphragm<\/strong><\/li>\n<li data-section-id=\"1c24pc2\" data-start=\"476\" data-end=\"574\"><strong data-start=\"478\" data-end=\"491\">Stage IV:<\/strong> lymphoma spread to <strong data-start=\"511\" data-end=\"536\">extralymphatic organs<\/strong>, such as the <strong data-start=\"550\" data-end=\"574\">bone marrow or liver<\/strong><\/li>\n<\/ul>\n<p data-start=\"576\" data-end=\"768\" data-is-last-node=\"\" data-is-only-node=\"\">At each stage, the letter <strong data-start=\"602\" data-end=\"607\">A<\/strong> is added if there are <strong data-start=\"630\" data-end=\"654\">no systemic symptoms<\/strong> (fever, night sweats, weight loss), while the letter <strong data-start=\"708\" data-end=\"713\">B<\/strong> is added if one or more of these symptoms are present.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Non-Hodgkin&#8217;s Lymphomas<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"51\" data-end=\"304\">For <strong data-start=\"55\" data-end=\"80\">non-Hodgkin lymphomas<\/strong>, in addition to the <strong data-start=\"101\" data-end=\"129\">Ann Arbor staging system<\/strong>, several internationally recognized <strong data-start=\"166\" data-end=\"188\">prognostic factors<\/strong> specific to the lymphoma subtype are used to estimate the likelihood of response to treatment and overall survival.<\/p>\n<p data-start=\"306\" data-end=\"424\">These factors are combined into validated <strong data-start=\"348\" data-end=\"363\">risk scores<\/strong>, which consider multiple clinical and biological parameters:<\/p>\n<ul data-start=\"426\" data-end=\"735\">\n<li data-section-id=\"1qczet7\" data-start=\"426\" data-end=\"514\"><strong data-start=\"428\" data-end=\"450\">Extent of disease:<\/strong> stage and number of involved lymph nodes or extranodal organs<\/li>\n<li data-section-id=\"xkts8c\" data-start=\"515\" data-end=\"626\"><strong data-start=\"517\" data-end=\"541\">Laboratory findings:<\/strong> such as <strong data-start=\"550\" data-end=\"560\">anemia<\/strong> or elevated <strong data-start=\"573\" data-end=\"604\">lactate dehydrogenase (LDH)<\/strong> levels in the blood<\/li>\n<li data-section-id=\"oj7vw0\" data-start=\"627\" data-end=\"735\"><strong data-start=\"629\" data-end=\"657\">Patient-related factors:<\/strong> particularly <strong data-start=\"671\" data-end=\"678\">age<\/strong> and overall <strong data-start=\"691\" data-end=\"733\">general condition (performance status)<\/strong><\/li>\n<\/ul>\n<p data-start=\"737\" data-end=\"930\" data-is-last-node=\"\" data-is-only-node=\"\">These parameters make it possible to distinguish <strong data-start=\"786\" data-end=\"811\">more aggressive forms<\/strong> from those with a <strong data-start=\"830\" data-end=\"864\">more favorable clinical course<\/strong>, allowing for a more tailored and appropriate treatment strategy.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"treatment-planning-and-reassessment\" class=\"h2_anchor\"><\/span><strong>Treatment Planning and Reassessment<\/strong><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">After diagnosis is confirmed, the <strong><a href=\"https:\/\/inoc.it\/en\/pathology\/lymphomas\/#multi-disciplinary-team\">Multidisciplinary Team<\/a><\/strong> evaluates multiple factors, including <strong>stage, symptoms, risk factors, age, general condition, and any associated diseases<\/strong>, in order to define a <strong>personalized treatment plan<\/strong>. The <strong>hematologic oncologist<\/strong> explains the therapeutic strategy to the patient, clarifying <strong>treatment modalities, duration, possible side effects<\/strong>, and, when available, <strong>alternative options with comparable efficacy<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The main treatments include <strong>chemotherapy, immunotherapy, radiotherapy, and stem cell transplantation<\/strong> in selected cases. The choice of therapy depends on the <strong>type and aggressiveness of the lymphoma<\/strong>, as well as the patient\u2019s <strong>age, overall health status, and prognostic factors<\/strong>, including stage, disease distribution, and laboratory results.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In <strong>indolent non-Hodgkin lymphomas<\/strong>, when there are no significant symptoms or bulky disease, an <strong>active surveillance approach<\/strong> may be adopted, involving regular outpatient monitoring without immediate treatment initiation.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For selected patients with particularly <strong>aggressive or treatment-resistant disease<\/strong>, participation in <strong>experimental clinical trials<\/strong> at <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong> may be considered, following shared discussion with the patient.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">During and after therapy, a careful <strong>reassessment of disease status<\/strong> is performed using the same diagnostic tools employed at baseline, such as <strong>CT, PET, and in some cases bone marrow biopsy<\/strong>, to evaluate <strong>complete or partial remission or treatment failure<\/strong>. Based on these results, discussed within the <strong>Interdisciplinary Team<\/strong>, a decision is made whether to conclude therapy or to modify and continue the treatment plan.<\/p>\n\n\n\t<div id=\"block_6a395d14332bf\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Chemotherapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"21\" data-end=\"438\">The term <strong data-start=\"30\" data-end=\"46\">chemotherapy<\/strong> refers to drugs that eliminate cancer cells by exploiting their <strong data-start=\"111\" data-end=\"168\">faster rate of reproduction compared to healthy cells<\/strong>. Because chemotherapy interferes with <strong data-start=\"207\" data-end=\"242\">cellular replication mechanisms<\/strong>, it can also damage normal cells in the body, leading to side effects. These effects often <strong data-start=\"334\" data-end=\"361\">resolve after treatment<\/strong> and are generally well controlled with appropriate <strong data-start=\"413\" data-end=\"437\">supportive therapies<\/strong>.<\/p>\n<p data-start=\"440\" data-end=\"923\">In most cases, chemotherapy is administered <strong data-start=\"484\" data-end=\"501\">intravenously<\/strong>, and less frequently <strong data-start=\"523\" data-end=\"533\">orally<\/strong>. The duration of each administration, performed in either an <strong data-start=\"595\" data-end=\"630\">outpatient or inpatient setting<\/strong> depending on the treatment regimen, may vary from <strong data-start=\"681\" data-end=\"709\">minutes to several hours<\/strong>, particularly when multiple drugs are combined. In some cases, the placement of a <strong data-start=\"792\" data-end=\"824\">central venous access device<\/strong> is required before starting therapy, allowing medication to be delivered safely into a large vein.<\/p>\n<p data-start=\"925\" data-end=\"1218\" data-is-last-node=\"\" data-is-only-node=\"\">Chemotherapy is administered in <strong data-start=\"957\" data-end=\"967\">cycles<\/strong>. Each cycle may last one or more days and is followed by a <strong data-start=\"1027\" data-end=\"1059\">rest period of several weeks<\/strong>. The total number of cycles depends on the <strong data-start=\"1103\" data-end=\"1123\">type of lymphoma<\/strong> and the patient\u2019s <strong data-start=\"1142\" data-end=\"1167\">response to treatment<\/strong>, which can vary significantly between individuals.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Immunotherapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<div class=\"text-base my-auto mx-auto [--thread-content-margin:var(--thread-content-margin-xs,calc(var(--spacing)*4))] @w-sm\/main:[--thread-content-margin:var(--thread-content-margin-sm,calc(var(--spacing)*6))] @w-lg\/main:[--thread-content-margin:var(--thread-content-margin-lg,calc(var(--spacing)*16))] px-(--thread-content-margin)\">\n<div class=\"[--thread-content-max-width:40rem] @w-lg\/main:[--thread-content-max-width:48rem] mx-auto max-w-(--thread-content-max-width) flex-1 group\/turn-messages focus-visible:outline-hidden relative flex w-full min-w-0 flex-col agent-turn\" data-conversation-screenshot-content=\"\">\n<div class=\"flex max-w-full flex-col gap-4 grow\">\n<div class=\"min-h-8 text-message relative flex w-full flex-col items-end gap-2 text-start break-words whitespace-normal outline-none keyboard-focused:focus-ring [.text-message+&amp;]:mt-1\" dir=\"auto\" data-message-author-role=\"assistant\" data-message-id=\"1dca2744-50b9-4cdb-96e3-0dcdd312e172\" data-message-model-slug=\"gpt-5-3-mini\">\n<div class=\"flex w-full flex-col gap-1 empty:hidden\">\n<div class=\"markdown prose dark:prose-invert wrap-break-word w-full light markdown-new-styling\">\n<p data-start=\"22\" data-end=\"196\"><strong data-start=\"22\" data-end=\"39\">Immunotherapy<\/strong> involves the use of drugs that act through mechanisms similar to the immune system or restore the patient\u2019s ability to recognize and eliminate cancer cells.<\/p>\n<p data-start=\"198\" data-end=\"253\">Four main types of immunotherapy are used in lymphomas:<\/p>\n<ul data-start=\"255\" data-end=\"375\">\n<li data-section-id=\"nelbak\" data-start=\"255\" data-end=\"284\"><strong data-start=\"257\" data-end=\"282\">Monoclonal antibodies<\/strong><\/li>\n<li data-section-id=\"12yl2jj\" data-start=\"285\" data-end=\"320\"><strong data-start=\"287\" data-end=\"318\">Immunoconjugated antibodies<\/strong><\/li>\n<li data-section-id=\"1biwvd3\" data-start=\"321\" data-end=\"350\"><strong data-start=\"323\" data-end=\"348\">Bispecific antibodies<\/strong><\/li>\n<li data-section-id=\"1ot1y1w\" data-start=\"351\" data-end=\"375\"><strong data-start=\"353\" data-end=\"375\">CAR T-cell therapy<\/strong><\/li>\n<\/ul>\n<h3><span role=\"text\"><strong data-start=\"385\" data-end=\"410\">Monoclonal Antibodies<\/strong><\/span><\/h3>\n<p data-start=\"412\" data-end=\"712\">Monoclonal antibodies act similarly to natural antibodies produced by the immune system. They bind to specific proteins (receptors) on the surface of cancer cells and activate immune mechanisms that lead to their destruction, in a manner comparable to the immune response against viruses or bacteria.<\/p>\n<p data-start=\"714\" data-end=\"831\">Examples include <strong data-start=\"731\" data-end=\"744\">Rituximab<\/strong> and <strong data-start=\"749\" data-end=\"765\">Obinutuzumab<\/strong>, which target the <strong data-start=\"784\" data-end=\"800\">CD20 protein<\/strong> expressed in B-cell lymphomas.<\/p>\n<p data-start=\"833\" data-end=\"958\">These drugs are commonly combined with <strong data-start=\"872\" data-end=\"888\">chemotherapy<\/strong> to enhance treatment efficacy and are administered <strong data-start=\"940\" data-end=\"957\">intravenously<\/strong>.<\/p>\n<h3><span role=\"text\"><strong data-start=\"968\" data-end=\"999\">Immunoconjugated Antibodies<\/strong><\/span><\/h3>\n<p data-start=\"1001\" data-end=\"1236\">Immunoconjugated antibodies are monoclonal antibodies linked in the laboratory to <strong data-start=\"1083\" data-end=\"1103\">cytotoxic agents<\/strong>. After administration, the antibody binds to tumor cells and delivers the toxic substance directly into them, leading to cell death.<\/p>\n<p data-start=\"1238\" data-end=\"1255\">Examples include:<\/p>\n<ul data-start=\"1256\" data-end=\"1480\">\n<li data-section-id=\"wolgir\" data-start=\"1256\" data-end=\"1349\"><strong data-start=\"1258\" data-end=\"1281\">Brentuximab vedotin<\/strong>, targeting <strong data-start=\"1293\" data-end=\"1301\">CD30<\/strong> in Hodgkin lymphoma and some T-cell lymphomas<\/li>\n<li data-section-id=\"du4hax\" data-start=\"1350\" data-end=\"1431\"><strong data-start=\"1352\" data-end=\"1375\">Polatuzumab vedotin<\/strong>, targeting <strong data-start=\"1387\" data-end=\"1396\">CD79b<\/strong> in diffuse large B-cell lymphoma<\/li>\n<li data-section-id=\"m0qq4j\" data-start=\"1432\" data-end=\"1480\"><strong data-start=\"1434\" data-end=\"1460\">Loncastuximab tesirine<\/strong>, targeting <strong data-start=\"1472\" data-end=\"1480\">CD19<\/strong><\/li>\n<\/ul>\n<h3><span role=\"text\"><strong data-start=\"1490\" data-end=\"1515\">Bispecific Antibodies<\/strong><\/span><\/h3>\n<p data-start=\"1517\" data-end=\"1797\">Bispecific antibodies are engineered to bind simultaneously to two targets: one on the <strong data-start=\"1604\" data-end=\"1618\">tumor cell<\/strong> and one on the patient\u2019s <strong data-start=\"1644\" data-end=\"1660\">immune cells<\/strong>, particularly T lymphocytes. This brings the two cells into close proximity, enabling immune-mediated destruction of the malignant cell.<\/p>\n<p data-start=\"1799\" data-end=\"1965\">Currently used bispecific antibodies typically target <strong data-start=\"1853\" data-end=\"1876\">CD20 on tumor cells<\/strong> and <strong data-start=\"1881\" data-end=\"1899\">CD3 on T cells<\/strong>. Examples include <strong data-start=\"1918\" data-end=\"1964\">epcoritamab, glofitamab, and mosunetuzumab<\/strong>.<\/p>\n<p data-start=\"1967\" data-end=\"2244\">Administration is usually <strong data-start=\"1993\" data-end=\"2024\">intravenous or subcutaneous<\/strong>. Early side effects may include <strong data-start=\"2057\" data-end=\"2100\">fever, chills, fatigue, and muscle pain<\/strong>, and in some cases <strong data-start=\"2120\" data-end=\"2149\">cytokine release syndrome<\/strong>, which presents with flu-like symptoms but is generally manageable with appropriate treatment.<\/p>\n<h3><span role=\"text\"><strong data-start=\"2254\" data-end=\"2276\">CAR T-Cell Therapy<\/strong><\/span><\/h3>\n<p data-start=\"2278\" data-end=\"2552\"><strong data-start=\"2278\" data-end=\"2300\">CAR T-cell therapy<\/strong> is a form of personalized cellular treatment. The patient\u2019s own <strong data-start=\"2365\" data-end=\"2382\">T lymphocytes<\/strong> are collected, genetically modified in the laboratory to express a <strong data-start=\"2450\" data-end=\"2485\">chimeric antigen receptor (CAR)<\/strong>, and reinfused to specifically recognize and destroy cancer cells.<\/p>\n<p data-start=\"2554\" data-end=\"2646\">The CAR receptor is designed to target <strong data-start=\"2593\" data-end=\"2601\">CD19<\/strong>, a protein expressed on many lymphoma cells.<\/p>\n<p data-start=\"2648\" data-end=\"2913\">This therapy is generally indicated for younger patients but may also be used in selected older patients (up to approximately <strong data-start=\"2774\" data-end=\"2796\">75\u201380 years of age<\/strong>, depending on clinical condition) who are in good overall health, due to the potential for significant side effects.<\/p>\n<p data-start=\"2915\" data-end=\"3250\">Treatment is administered as a <strong data-start=\"2946\" data-end=\"2977\">single intravenous infusion<\/strong>, following a short course of preparatory chemotherapy, and requires <strong data-start=\"3046\" data-end=\"3070\">inpatient monitoring<\/strong>. During hospitalization, vital signs and neurological status are closely observed to manage possible early inflammatory reactions such as <strong data-start=\"3209\" data-end=\"3249\">fever, chills, fatigue, or confusion<\/strong>.<\/p>\n<p data-start=\"3252\" data-end=\"3418\">Follow-up after discharge is essential to evaluate response and ensure safe recovery. Patients and families are instructed to promptly report any concerning symptoms.<\/p>\n<p data-start=\"3420\" data-end=\"3511\">CAR T-cell therapy is used in cases of <strong data-start=\"3459\" data-end=\"3493\">relapsed or refractory disease<\/strong>, particularly in:<\/p>\n<ul data-start=\"3512\" data-end=\"3592\" data-is-last-node=\"\" data-is-only-node=\"\">\n<li data-section-id=\"c9qukx\" data-start=\"3512\" data-end=\"3545\">Diffuse large B-cell lymphoma<\/li>\n<li data-section-id=\"1w33hw2\" data-start=\"3546\" data-end=\"3570\">Mantle cell lymphoma<\/li>\n<li data-section-id=\"1vdr2w2\" data-start=\"3571\" data-end=\"3592\" data-is-last-node=\"\">Follicular lymphoma<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Molecularly Targeted or Immunomodulatory Drugs<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"55\" data-end=\"246\">These drugs are capable of blocking specific <strong data-start=\"100\" data-end=\"125\">molecular alterations<\/strong> that drive the growth of certain types of lymphoma, including <strong data-start=\"188\" data-end=\"245\">mantle cell, lymphocytic, and marginal zone lymphomas<\/strong>.<\/p>\n<p data-start=\"248\" data-end=\"344\">They are generally administered <strong data-start=\"280\" data-end=\"290\">orally<\/strong> and are typically taken on a <strong data-start=\"320\" data-end=\"343\">continuous schedule<\/strong>.<\/p>\n<p data-start=\"346\" data-end=\"424\" data-is-last-node=\"\" data-is-only-node=\"\">Examples include <strong data-start=\"363\" data-end=\"423\">Ibrutinib, Acalabrutinib, Zanubrutinib, and Lenalidomide<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Radiation Therapy<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<div class=\"qMYqUG_convSearchResultHighlightRoot\">\n<div class=\"\" data-turn-id-container=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-83\" data-is-intersecting=\"true\">\n<section class=\"text-token-text-primary w-full focus:outline-none has-data-writing-block:pointer-events-none [&amp;:has([data-writing-block])&gt;*]:pointer-events-auto R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]\" dir=\"auto\" data-turn-id=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-83\" data-turn-id-container=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-83\" data-testid=\"conversation-turn-168\" data-scroll-anchor=\"false\" data-turn=\"assistant\">\n<div class=\"text-base my-auto mx-auto pb-10 [--thread-content-margin:var(--thread-content-margin-xs,calc(var(--spacing)*4))] @w-sm\/main:[--thread-content-margin:var(--thread-content-margin-sm,calc(var(--spacing)*6))] @w-lg\/main:[--thread-content-margin:var(--thread-content-margin-lg,calc(var(--spacing)*16))] px-(--thread-content-margin)\">\n<div class=\"[--thread-content-max-width:40rem] @w-lg\/main:[--thread-content-max-width:48rem] mx-auto max-w-(--thread-content-max-width) flex-1 group\/turn-messages focus-visible:outline-hidden relative flex w-full min-w-0 flex-col agent-turn\" data-conversation-screenshot-content=\"\">\n<div class=\"flex max-w-full flex-col gap-4 grow\">\n<div class=\"min-h-8 text-message relative flex w-full flex-col items-end gap-2 text-start break-words whitespace-normal outline-none keyboard-focused:focus-ring [.text-message+&amp;]:mt-1\" dir=\"auto\" tabindex=\"0\" data-message-author-role=\"assistant\" data-message-id=\"1bda4355-2591-4666-b031-849a5aff6b04\" data-message-model-slug=\"gpt-5-3-mini\" data-turn-start-message=\"true\">\n<div class=\"flex w-full flex-col gap-1 empty:hidden\">\n<div class=\"markdown prose dark:prose-invert wrap-break-word w-full light markdown-new-styling\">\n<p data-start=\"26\" data-end=\"382\"><a href=\"https:\/\/inoc.it\/en\/medical-area\/radiotherapy\/\"><strong>Radiation therapy<\/strong><\/a> is a treatment modality that uses <strong data-start=\"78\" data-end=\"103\">high-energy radiation<\/strong> to destroy cancer cells. In lymphoma treatment, it may be used as a <strong data-start=\"172\" data-end=\"194\">standalone therapy<\/strong> or in combination with <strong data-start=\"218\" data-end=\"252\">chemotherapy and immunotherapy<\/strong>. It is mainly indicated in <strong data-start=\"280\" data-end=\"303\">early-stage disease<\/strong> and is typically delivered to the <strong data-start=\"338\" data-end=\"381\">lymph node regions involved by lymphoma<\/strong>.<\/p>\n<p data-start=\"384\" data-end=\"592\">Radiation therapy is administered using a device called a <strong data-start=\"442\" data-end=\"472\">linear accelerator (LINAC)<\/strong>, in <strong data-start=\"477\" data-end=\"517\">daily sessions from Monday to Friday<\/strong> over several weeks. Each session usually lasts about <strong data-start=\"571\" data-end=\"591\">10 to 15 minutes<\/strong>.<\/p>\n<p data-start=\"594\" data-end=\"850\">Treatment consists of the application of <strong data-start=\"635\" data-end=\"688\">radiation fields shaped to match the tumor volume<\/strong>, allowing protection of surrounding healthy organs. This approach enables delivery of a <strong data-start=\"777\" data-end=\"805\">higher dose to the tumor<\/strong> while minimizing exposure to normal tissues.<\/p>\n<p data-start=\"852\" data-end=\"1080\"><strong data-start=\"852\" data-end=\"900\">Intensity-modulated radiation therapy (IMRT)<\/strong> allows modulation of the intensity of each radiation beam, ensuring a high degree of <strong data-start=\"986\" data-end=\"1025\">dose conformity to diseased tissues<\/strong> while further reducing exposure to healthy structures.<\/p>\n<p data-start=\"1082\" data-end=\"1297\" data-is-last-node=\"\" data-is-only-node=\"\">In addition, <strong data-start=\"1095\" data-end=\"1131\">image-guided radiotherapy (IGRT)<\/strong> enables real-time verification of the target\u2019s position and its relationship to surrounding organs, ensuring accurate patient positioning for each treatment session.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/div>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Stem Cell Transplantation<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"34\" data-end=\"347\">Stem cell transplantation is a treatment reserved for selected cases in which lymphoma does not respond to standard therapies or recurs after initial treatment. Its use has become less frequent with the introduction of highly effective immunotherapies such as <strong data-start=\"294\" data-end=\"316\">CAR T-cell therapy<\/strong> and <strong data-start=\"321\" data-end=\"346\">bispecific antibodies<\/strong>.<\/p>\n<p data-start=\"349\" data-end=\"686\">The aim of transplantation is to allow the administration of <strong data-start=\"410\" data-end=\"436\">high-dose chemotherapy<\/strong>, which is more intensive than what the bone marrow can normally tolerate, in order to achieve greater anti-tumor efficacy. Since these high doses can severely damage the <strong data-start=\"607\" data-end=\"622\">bone marrow<\/strong>, transplantation is necessary to restore blood cell production.<\/p>\n<p data-start=\"349\" data-end=\"686\"><span role=\"text\"><strong data-start=\"696\" data-end=\"724\">Types of Transplantation<\/strong><\/span><\/p>\n<ul data-start=\"726\" data-end=\"942\">\n<li data-section-id=\"27ygl7\" data-start=\"726\" data-end=\"854\"><strong data-start=\"728\" data-end=\"786\">Autologous transplantation (most common in lymphomas):<\/strong><br data-start=\"786\" data-end=\"789\" \/>The patient\u2019s own stem cells are collected and later reinfused.<\/li>\n<li data-section-id=\"oyq14w\" data-start=\"856\" data-end=\"942\"><strong data-start=\"858\" data-end=\"889\">Allogeneic transplantation:<\/strong><br data-start=\"889\" data-end=\"892\" \/>Stem cells are obtained from a compatible donor.<\/li>\n<\/ul>\n<p><strong data-start=\"952\" data-end=\"992\">Autologous Transplantation Procedure<\/strong><\/p>\n<ol data-start=\"994\" data-end=\"1475\">\n<li data-section-id=\"1mw8g1p\" data-start=\"994\" data-end=\"1126\"><strong data-start=\"997\" data-end=\"1023\">Stem cell stimulation:<\/strong><br data-start=\"1023\" data-end=\"1026\" \/>The patient receives growth factors via subcutaneous injections to increase stem cell production.<\/li>\n<li data-section-id=\"p8vfk9\" data-start=\"1128\" data-end=\"1271\"><strong data-start=\"1131\" data-end=\"1158\">Collection (apheresis):<\/strong><br data-start=\"1158\" data-end=\"1161\" \/>Stem cells are collected from the blood using a procedure similar to blood donation and then cryopreserved.<\/li>\n<li data-section-id=\"17jsqw3\" data-start=\"1273\" data-end=\"1371\"><strong data-start=\"1276\" data-end=\"1303\">High-dose chemotherapy:<\/strong><br data-start=\"1303\" data-end=\"1306\" \/>Intensive treatment is administered to eliminate cancer cells.<\/li>\n<li data-section-id=\"1vdjpto\" data-start=\"1373\" data-end=\"1475\"><strong data-start=\"1376\" data-end=\"1391\">Reinfusion:<\/strong><br data-start=\"1391\" data-end=\"1394\" \/>Previously collected stem cells are reinfused to restore bone marrow function.<\/li>\n<\/ol>\n<p><strong data-start=\"1485\" data-end=\"1510\">Post-Transplant Phase<\/strong><\/p>\n<p data-start=\"1512\" data-end=\"1792\" data-is-last-node=\"\" data-is-only-node=\"\">After transplantation, white blood cell levels remain very low for approximately <strong data-start=\"1593\" data-end=\"1607\">12\u201315 days<\/strong>, until bone marrow recovery begins. During this period, the patient is hospitalized in a <strong data-start=\"1697\" data-end=\"1722\">protected environment<\/strong> to reduce the risk of infection and ensure close clinical monitoring.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"ongoing-support\" class=\"h2_anchor\"><\/span>Ongoing Support<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>, continuous support is ensured <strong>before, during, and after treatment<\/strong>, accompanying each patient throughout the entire therapeutic and recovery pathway.<\/p>\n\n\n\t<div id=\"block_6a395d1433ba9\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Management of Side Effects<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"35\" data-end=\"319\">All cancer treatments are associated with\u00a0<strong data-start=\"77\" data-end=\"93\">side effects<\/strong>\u00a0that can affect the patient\u2019s\u00a0<strong data-start=\"124\" data-end=\"143\">quality of life<\/strong>\u00a0to varying degrees. Treatments for acute leukemia may also cause significant\u00a0<strong data-start=\"221\" data-end=\"259\">physical and psychological effects<\/strong>, which can impact daily functioning and overall well-being.<\/p>\n<p data-start=\"321\" data-end=\"676\" data-is-last-node=\"\" data-is-only-node=\"\">At<strong> INOC \u2013 Istituto Nazionale Oncologico Candiolo<\/strong>, attention to the patient\u2019s\u00a0<strong data-start=\"386\" data-end=\"405\">quality of life<\/strong>\u00a0remains a priority throughout the entire treatment pathway. The physicians and nurses of the\u00a0<strong data-start=\"499\" data-end=\"525\">Multidisciplinary Team<\/strong>\u00a0provide ongoing support to help manage side effects, including\u00a0<strong data-start=\"589\" data-end=\"615\">nutritional counseling<\/strong>,\u00a0<strong data-start=\"617\" data-end=\"642\">psychological support<\/strong>, and\u00a0<strong data-start=\"648\" data-end=\"675\">pain management therapy<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Direct Access to Specialists<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">To ensure timely support and provide prompt answers to questions or concerns, <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>\u00a0offers a dedicated assistance service for all patients.<\/p>\n<p class=\"isSelectedEnd\">From\u00a0<strong>Monday through Friday<\/strong>, between\u00a0<strong>8:00 a.m. and 5:00 p.m.<\/strong>, patients can contact the\u00a0<a href=\"https:\/\/inoc.it\/en\/medical-area\/oncology-day-hospital\/\">Oncology Day Hospital<\/a>\u00a0Secretariat at\u00a0<strong>+39 011 993 3775<\/strong>\u00a0to request an urgent consultation.<\/p>\n<p>Patients are promptly connected with their specialist physician, ensuring rapid access to expert advice, clear information, and immediate support when needed.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Supportive and Palliative Care<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p class=\"isSelectedEnd\">Cancer patients often have\u00a0<strong>complex needs<\/strong>\u00a0that extend beyond the treatment of the disease itself and require comprehensive,<strong>\u00a0multidisciplinary care.<\/strong><\/p>\n<p class=\"isSelectedEnd\">At <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>, patients who need additional support have access to specialists from a range of disciplines, ensuring personalized management of cancer-related symptoms and associated conditions. Services may include nutritional counseling, physical rehabilitation, pain management, and support for other medical needs that may arise during the course of treatment and recovery.<\/p>\n<p>The goal is to\u00a0<strong>improve quality of life, promote overall well-being, and provide comprehensive care<\/strong>\u00a0tailored to each patient\u2019s individual needs.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Psychological Support<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"30\" data-end=\"249\">The impact of cancer also extends to the\u00a0<strong data-start=\"71\" data-end=\"95\">psychological sphere<\/strong>. A cancer diagnosis is often a\u00a0<strong data-start=\"127\" data-end=\"146\">traumatic event<\/strong>\u00a0that affects all aspects of a person\u2019s life and may generate\u00a0<strong data-start=\"208\" data-end=\"248\">anxiety, fear, anger, and depression<\/strong>.<\/p>\n<p data-start=\"251\" data-end=\"527\">At <strong>INOC \u2013 Istituto Nazionale Oncologico Candiolo<\/strong>, alongside advanced medical therapies, the care pathway always includes\u00a0<strong data-start=\"360\" data-end=\"402\">specialized psycho-oncological support<\/strong>, helping patients cope not only with treatment but also with the delicate phases of\u00a0<strong data-start=\"487\" data-end=\"526\">physical and psychological recovery<\/strong>.<\/p>\n<p data-start=\"529\" data-end=\"690\" data-is-last-node=\"\" data-is-only-node=\"\">Patients may also participate in\u00a0<strong data-start=\"562\" data-end=\"594\">psychological support groups<\/strong>, where they can share experiences with others who are facing or have faced a similar condition.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Social Work Services<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p data-start=\"26\" data-end=\"278\">The Social Work Service at INOC &#8211; Istituto Nazionale Oncologico Candiolo provides\u00a0<strong>information, guidance, and support to patients and their families<\/strong>\u00a0regarding access to community services and the welfare and social security benefits available under current legislation.<\/p>\n<p data-start=\"280\" data-end=\"491\">During dedicated consultations, social workers assist with matters such as disability recognition, access to aids and prosthetic devices, employment-related benefits and leave, and other social support services.<\/p>\n<p data-start=\"493\" data-end=\"621\" data-is-last-node=\"\" data-is-only-node=\"\">The service is available on\u00a0<strong data-start=\"521\" data-end=\"575\">Wednesdays and Fridays from 9:00 a.m. to 1:00 p.m.<\/strong>\u00a0and can be contacted at\u00a0<strong data-start=\"600\" data-end=\"620\">+39 011 993 3059<\/strong>.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Follow-up<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<div class=\"qMYqUG_convSearchResultHighlightRoot\">\n<div class=\"\" data-turn-id-container=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-86\" data-is-intersecting=\"true\">\n<section class=\"text-token-text-primary w-full focus:outline-none has-data-writing-block:pointer-events-none [&amp;:has([data-writing-block])&gt;*]:pointer-events-auto R6Vx5W_threadScrollVars scroll-mb-[calc(var(--scroll-root-safe-area-inset-bottom,0px)+var(--thread-response-height))] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]\" dir=\"auto\" data-turn-id=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-86\" data-turn-id-container=\"request-WEB:2f69e866-3ec6-42f8-b022-0d1ff61893ab-86\" data-testid=\"conversation-turn-174\" data-scroll-anchor=\"false\" data-turn=\"assistant\">\n<div class=\"text-base my-auto mx-auto pb-10 [--thread-content-margin:var(--thread-content-margin-xs,calc(var(--spacing)*4))] @w-sm\/main:[--thread-content-margin:var(--thread-content-margin-sm,calc(var(--spacing)*6))] @w-lg\/main:[--thread-content-margin:var(--thread-content-margin-lg,calc(var(--spacing)*16))] px-(--thread-content-margin)\">\n<div class=\"[--thread-content-max-width:40rem] @w-lg\/main:[--thread-content-max-width:48rem] mx-auto max-w-(--thread-content-max-width) flex-1 group\/turn-messages focus-visible:outline-hidden relative flex w-full min-w-0 flex-col agent-turn\" data-conversation-screenshot-content=\"\">\n<div class=\"flex max-w-full flex-col gap-4 grow\">\n<div class=\"min-h-8 text-message relative flex w-full flex-col items-end gap-2 text-start break-words whitespace-normal outline-none keyboard-focused:focus-ring [.text-message+&amp;]:mt-1\" dir=\"auto\" tabindex=\"0\" data-message-author-role=\"assistant\" data-message-id=\"a782c2c1-edad-480d-ac70-a05d0af4bbed\" data-message-model-slug=\"gpt-5-3-mini\" data-turn-start-message=\"true\">\n<div class=\"flex w-full flex-col gap-1 empty:hidden\">\n<div class=\"markdown prose dark:prose-invert wrap-break-word w-full light markdown-new-styling\">\n<p data-start=\"34\" data-end=\"497\">With the conclusion of therapy, a <strong data-start=\"68\" data-end=\"88\">follow-up period<\/strong> begins during which a series of clinical evaluations and diagnostic tests are performed to monitor <strong data-start=\"188\" data-end=\"273\">treatment effectiveness, late side effects, and the patient\u2019s functional recovery<\/strong>. Follow-up is also essential for the <strong data-start=\"311\" data-end=\"350\">early detection of possible relapse<\/strong>, allowing timely intervention. It further provides an important opportunity for ongoing discussion between the patient and the medical specialist.<\/p>\n<p data-start=\"499\" data-end=\"655\">Follow-up schedules are individualized according to the <strong data-start=\"555\" data-end=\"654\">type of lymphoma, treatment received, response to therapy, and patient-specific characteristics<\/strong>.<\/p>\n<p data-start=\"657\" data-end=\"731\">In general, follow-up visits become progressively less frequent over time:<\/p>\n<ul data-start=\"732\" data-end=\"869\">\n<li data-section-id=\"kk8msr\" data-start=\"732\" data-end=\"779\">every <strong data-start=\"740\" data-end=\"752\">3 months<\/strong> during the first 2 years<\/li>\n<li data-section-id=\"11txmn8\" data-start=\"780\" data-end=\"831\">every <strong data-start=\"788\" data-end=\"800\">6 months<\/strong> during the following 3 years<\/li>\n<li data-section-id=\"1jin9tv\" data-start=\"832\" data-end=\"869\"><strong data-start=\"834\" data-end=\"846\">annually<\/strong> after the fifth year<\/li>\n<\/ul>\n<p data-start=\"871\" data-end=\"1102\" data-is-last-node=\"\" data-is-only-node=\"\">In addition to <strong data-start=\"886\" data-end=\"926\">clinical examination and blood tests<\/strong>, routine follow-up may include imaging such as <strong data-start=\"974\" data-end=\"998\">abdominal ultrasound<\/strong>, while <strong data-start=\"1006\" data-end=\"1029\">CT and\/or PET scans<\/strong> are performed when there is clinical or laboratory suspicion of relapse.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<\/div>\n<p><!-- \/wp:paragraph --><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"multi-disciplinary-team\" class=\"h2_anchor\"><\/span>Multi Disciplinary Team<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Every cancer requires a&nbsp;<strong>multidisciplinary approach<\/strong>&nbsp;at all stages of disease management. At INOC &#8211; Istituto Nazionale Oncologico Candiolo, this is provided by a team of specialists from various clinical and surgical departments, known as the&nbsp;<strong>GIC<\/strong>, Interdisciplinary Care Group (or MDT). The GIC ensures that each patient is supported throughout the diagnostic and therapeutic process, including arranging and coordinating examinations and maintaining communication with the patient and their family.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">For each patient, the GIC (MDT) defines and shares a personalized care pathway based not only on the type and stage of the tumor but also on the patient\u2019s individual characteristics. The goal is to achieve the best possible outcomes both oncologically and functionally, while maintaining a high quality of life.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"clinical-divisions\" class=\"h2_anchor\"><\/span>Clinical Divisions<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong>, the diagnostic and therapeutic pathway for lymphomas is managed through a coordinated multidisciplinary approach involving several specialized clinical divisions, including:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/medical-oncology\/\" type=\"medical-area\" id=\"5169\">Medical Oncology<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/hemopoietic-stem-cell-transplantation-and-cellular-therapies-center\/\" type=\"medical-area\" id=\"5191\">Hemopoietic Stem Cell Transplantation and Cellular Therapies Center<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/oncology-day-hospital\/\" type=\"medical-area\" id=\"5183\">Day Hospital<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/radiotherapy\/\" type=\"medical-area\" id=\"5104\">Radiotherapy<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/laboratory-analysis\/\" type=\"medical-area\" id=\"5113\">Laboratory Analysis<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/inoc.it\/en\/medical-area\/pathologic-anatomy\/\" type=\"medical-area\" id=\"5118\">Anatomical Pathology<\/a><\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"clinical-studies\" class=\"h2_anchor\"><\/span>Clinical Studies<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Researchers at <strong>INOC &#8211; Istituto Nazionale Oncologico Candiolo<\/strong> are actively involved in several <strong>national and international lymphoma research projects<\/strong>, with the goal of developing increasingly <strong>effective and personalized therapies<\/strong>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The Institute is part of the <strong><a href=\"https:\/\/filinf.it\/en\/\">Italian Lymphoma Foundation national network<\/a><\/strong>, participating in collaborative studies coordinated at national level. It also plays an active role in <strong>clinical trials of new drugs and monoclonal antibodies<\/strong>, used alone or in combination with <strong>chemotherapy and immunomodulatory agents<\/strong>, with the aim of improving treatment efficacy and patient prognosis.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">In parallel, ongoing research programs focus on the identification of <strong>novel biomarkers in B-cell lymphomas<\/strong>, particularly in cases characterized by specific genetic alterations at diagnosis, such as <strong>c-MYC abnormalities<\/strong>, which are associated with increased treatment resistance. These studies integrate <strong>cytogenetic and molecular biology techniques<\/strong> to better understand why some patients do not respond adequately to standard therapies, including <strong>high-dose chemotherapy and autologous stem cell transplantation<\/strong>, with the ultimate goal of developing more targeted and effective therapeutic strategies.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span  id=\"why-choose-us\" class=\"h2_anchor\"><\/span>Why Choose Us<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">At INOC &#8211; Istituto Nazionale Oncologico Candiolo, acute leukemia patients are treated in a&nbsp;<strong>highly specialized<\/strong>&nbsp;manner, thanks to the synergistic work of the dedicated<a href=\"https:\/\/inoc.it\/en\/pathology\/lymphomas\/#multi-disciplinary-team\">&nbsp;Interdisciplinary Care Group (GIC)&nbsp;.<\/a><\/p>\n\n\n\t<div id=\"block_6a395d1433c1c\" class=\"accordion-block acf-block\">\n\t\t<div class=\"my-4 lg:my-6\">\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Clinical Experience and Tailored Approach<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Thanks to the large number of cases treated each year, INOC &#8211; Istituto Nazionale Oncologico Candiolo is a\u00a0<strong>national reference<\/strong>\u00a0center for the care of this disease. This extensive experience allows us to manage even the most complex cases, always using a\u00a0<strong>personalized approach<\/strong>, tailored to the clinical and individual profile of each patient.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Imaging Technologies and Advanced Diagnostics<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>Establishing a treatment plan always begins with an accurate and timely diagnosis. Patients have access to\u00a0<strong>state-of-the-art imaging technologies<\/strong>, such as ultrasound, contrast-enhanced CT, MRI, and cholangio-RM, which are critical for accurately assessing the extent of the tumor.<\/p>\n<p><strong>Advanced laboratory tests<\/strong>, including molecular analyses, are also available to help define biological features of the disease and guide treatment choices.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Minimally Invasive Surgical Techniques and Multidisciplinarity<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p>When appropriate, surgeries are performed using\u00a0<strong data-start=\"244\" data-end=\"268\">minimally invasive<\/strong>, laparoscopic or robotic\u00a0<strong data-start=\"244\" data-end=\"268\">techniques<\/strong>. These approaches involve the use of camera-equipped instruments introduced into the abdomen through small incisions, thus reducing surgical trauma.\u00a0<strong>Benefits<\/strong>\u00a0to the patient include\u00a0<strong>shorter hospital stay times, faster recovery, and lower risk of complications compared with traditional open surgery.<\/strong><\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Clinical Research and Access to Trials<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<h3 class=\"wp-block-heading\"><\/h3>\n<p><!-- \/wp:heading --><\/p>\n<p>As an IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare), INOC &#8211; Istituto Nazionale Oncologico Candiolo combines clinical care with a strong focus on scientific research. Patients can be considered for <a href=\"https:\/\/inoc.it\/en\/pathology\/lymphomas\/#clinical-studies\"><strong>participation in active clinical trials<\/strong><\/a>, offering access to innovative therapies not yet available in standard practice. This integration of care and research is a distinctive strength that translates into tangible benefits for patients.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"accordion group border-b border-white\/5\">\n\t\t\t<div class=\"flex items-center cursor-pointer group-hover:text-blue-light group-[.accordion--open]:text-red transition-colors\">\n\t\t\t\t<div class=\"rotate-90 text-blue-lighter group-[.accordion--open]:rotate-180 group-[.accordion--open]:text-red transition-all\">\n\t\t\t\t\t<svg width=\"18\" viewbox=\"0 0 500 500\" fill=\"currentColor\">\n\t\t\t\t\t\t<polygon points=\"250,60 100,400 400,400\"\/>\n\t\t\t\t\t<\/svg>\n\t\t\t\t<\/div>\n\t\t\t\t<h3 class=\"font-bold ml-5\">Care and Support Every Step of the Way<\/h3>\n\t\t\t<\/div>\n\t\t\t<div class=\"accordion-content max-h-0 overflow-hidden transition-all\">\n\t\t\t\t<div class=\"pb-5 pl-[38px] pt-1\">\n\t\t\t\t\t<p><a href=\"https:\/\/inoc.it\/en\/pathology\/lymphomas\/#multi-disciplinary-team\">The Interdisciplinary Care Group\u00a0<\/a>(GIC or MDT)\u00a0<strong>supports th<\/strong><strong>e patient at every stage<\/strong>: from diagnosis, through treatment, to follow-up. Special attention is paid to<strong>\u00a0nutritional support, psychological health and reintegration into daily life.<\/strong>\u00a0The organization of checkups, examinations, and treatment is designed to ensure\u00a0<strong>continuity, serenity, and a humane, caring<\/strong>\u00a0approach to each patient\u2019s needs.<\/p>\n\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\t<\/div>\n","protected":false},"featured_media":0,"template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"class_list":["post-5236","pathology","type-pathology","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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