Non-Hodgkin’s Lymphoma: Therapy

General measures

• Watch and wait – this strategy can be followed for very slowly progressing forms
• Nicotine restriction (abstaining from tobacco use).
• Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
• Aim to maintain a normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised weight loss program or program for the underweight.
  • BMI ≥ 25 → participation in a medically supervised weight loss program.
  • Falling below the BMI lower limit (from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.
• Avoidance of environmental stress:
  • Solvents such as benzene, toluene, xylene.
  • Exposure to radioactive substances

Cryopreservation

Because of therapy-related gonadotoxicity (toxicity to the gonads), the following should be done preventively before chemotherapy:

• In men: cryopreservation of sperm/sperm depot (Grade of recommendation: A).
• In woman:
  • Cryopreservation of fertilized or unfertilized oocytes (after administration of GNRH analogues).
  • Cryopreservation of ovarian tissue (Grade of recommendation: A).

Vaccinations

The following vaccinations are advised before starting therapy:

• Influenza vaccination (seasonal quadrivalent inactivated vaccine).
• Pneumococcal vaccination: immunocompromised individuals should be vaccinated sequentially with the 13-valent conjugate vaccine PCV13 and six to 12 months later with the 23-valent polysaccharide vaccine PPSV23 against pneumococcus.
• Meningococcal vaccination (ACWY and B).
• Herpes zoster vaccination (only with inactivated vaccine.
• If necessary, booster vaccination against diphtheria, Haemophilus influenzae capsule type b (Hib), pertussis and tetanus.

Regular checkups

• Regular follow-up examinations for early detection of a relapse (recurrence of the disease) are required, especially during the first five years. This involves examinations at intervals of three months, and after two years often every six months.

Nutritional medicine

• Nutritional counseling based on nutritional analysis
• Nutritional recommendations according to a mixed diet, taking into account the general knowledge of nutrition in a tumor disease. This means:
  • Consume only limited energy-rich foods.
  • Moderate total fat intake
  • Little red meat (pork, beef, lamb, veal) and sausages.
  • Once or twice a week fresh sea fish, ie fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
  • High-fiber diet (whole grains, vegetables).
  • Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
  • Reduce consumption of smoked and cured foods, because they contain nitrate or nitrite as a component of curing salt. Their preparation produces compounds (nitrosamines), which are risk factors for various tumor diseases.
  • Refrain from polluted foods such as offal and wild mushrooms.
  • Do not eat moldy food
• Observe the following special dietary recommendations:
  • Diet rich in:
    • Vitamins (A, C, D, E, folic acid).
    • Minerals
    • Trace elements (selenium, zinc)
    • Omega-3 fatty acids
    • Secondary plant compounds (e.g. carotenoids, polyphenols).
• Selection of appropriate food based on the nutritional analysis
• See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
• Detailed information on nutritional medicine you will receive from us.

Sports Medicine

• Endurance training (cardio training) and strength training (muscle training).
  • In general, endurance training on a bicycle ergometer can be recommended, which is performed according to the principle of interval training.This means that load phases lasting 1 to 3 minutes alternate with rest phases also lasting 1 to 3 minutes. The training should be performed at about 80% of the maximum heart rate for a total of 30 minutes.
  • During and after treatment, the patient should be active in sports (Recommendation grade. B).
• Preparation of a fitness or training plan with appropriate sports disciplines based on a medical check (health check or athlete check).
• Detailed information on sports medicine you will receive from us.

Psychotherapy

• Psychosocial care
• Detailed information on psychosomatic care (including stress management) is available from us.