My Reports
RGCIRC, Niti Bagh
Leukemia Treatment in Delhi, India
Overview
Leukemia is a blood cancer that can behave very differently depending on its type, and this means treatment is not the same for every patient. Whether you have acute or chronic leukemia, your treatment plan depends on the exact subtype, molecular and genetic findings, your overall health and how the disease responds to therapy.
At Rajiv Gandhi Cancer Institute & Research Centre (RGCIRC), leukemia treatment is planned by a multidisciplinary team comprising haemato-oncologists, bone marrow transplant specialists, pathologists and other specialists involved in your care. Depending on the type and risk profile of the leukemia, treatment may include chemotherapy, targeted therapy, immunotherapy, CAR-T cell therapy or stem cell/bone marrow transplantation. Guided by our values of Ethics, Empathy and Excellence, we focus on selecting treatment based on the individual characteristics of your disease while supporting you through every stage of care.
Understanding Leukemia and Its Types
Leukemia is a cancer of the blood-forming tissues, particularly the bone marrow. It causes abnormal blood cells to multiply and interfere with the production and function of healthy red blood cells, white blood cells and platelets.
Leukemia is broadly classified according to how quickly it develops and the type of blood-forming cell affected. Acute leukemia generally progresses quickly and often requires prompt treatment, while chronic leukemia usually develops more slowly. The four major types are:
Acute Lymphoblastic Leukemia
Acute lymphoblastic leukemia (ALL), also called acute lymphocytic leukemia, develops from immature lymphoid cells. It occurs in both children and adults and generally requires treatment soon after diagnosis.
ALL treatment usually involves different phases of systemic therapy. Targeted treatment, immunotherapy, stem cell transplantation or cellular therapy may be considered for selected patients according to disease characteristics and treatment response.
Acute Myeloid Leukemia
Acute myeloid leukemia (AML) develops from abnormal immature myeloid cells in the bone marrow and can progress rapidly.
Acute myeloid leukemia treatments depend substantially on the patient’s age and fitness, the genetic and molecular profile of the leukemia and the risk of recurrence. Treatment may involve intensive or lower-intensity systemic therapy, targeted medicines and, for selected patients, allogeneic stem cell transplantation.
Chronic Lymphocytic Leukemia
Chronic lymphocytic leukemia (CLL) affects lymphocytes and usually develops more slowly than acute leukemia.
Not everyone with CLL requires treatment immediately after diagnosis. Patients without indications for therapy may undergo active monitoring with regular clinical reviews and blood tests. Treatment is started when disease characteristics, symptoms or progression make it necessary.
Chronic Myeloid Leukemia
Chronic myeloid leukemia (CML) develops from myeloid blood-forming cells and is characterised in most patients by the BCR::ABL1 fusion gene associated with the Philadelphia chromosome.
Targeted medicines known as tyrosine kinase inhibitors form the mainstay of treatment for most patients. Molecular testing is used regularly to assess how well the leukemia is responding.
Symptoms and Findings That Need Evaluation
The signs of leukemia may develop because abnormal cells interfere with normal blood-cell production. Consult a doctor if you have persistent or unexplained symptoms such as:
- Fatigue or weakness: This may occur when leukemia reduces the number of healthy red blood cells.
- Paleness or breathlessness: Anaemia may cause pale skin, tiredness or shortness of breath.
- Frequent or persistent infections: Abnormal white blood cells may not protect the body effectively against infection.
- Repeated or unexplained fever: Fever may occur because of infection or the disease itself.
- Easy bruising or bleeding: Low platelet levels may lead to bruises, nosebleeds or bleeding gums.
- Tiny red or purple spots on the skin: These may occur because of bleeding beneath the skin.
- Bone or joint pain: Abnormal cells accumulating within the bone marrow may cause discomfort in some patients.
- Enlarged lymph nodes: Swelling may occur in areas such as the neck, armpits or groin.
- Abdominal fullness: Enlargement of the spleen or liver may cause discomfort or a feeling of fullness.
- Unexplained weight loss or reduced appetite: Persistent unexplained changes require assessment.
- Abnormal blood counts: Leukemia may first be suspected after a routine complete blood count shows abnormal white blood cells, anaemia, low platelets or immature blood cells.
These symptoms also occur with many non-cancerous conditions. Persistent symptoms or unexplained abnormalities in a blood test require appropriate medical evaluation rather than self-diagnosis.
Leukemia Diagnosis at RGCIRC
Accurate leukemia diagnosis goes beyond confirming the presence of abnormal blood cells. The team also needs to identify the exact subtype and biological characteristics because these findings help determine the most appropriate treatment.
Evaluation may include:
Complete Blood Count and Peripheral Blood Examination
A complete blood count measures red blood cells, different types of white blood cells and platelets. Leukemia may cause unusually high or low cell counts.
A peripheral blood smear allows specialists to examine the appearance and maturity of blood cells and identify abnormal or immature cells that require further investigation.
Bone Marrow Aspiration and Biopsy
Bone marrow aspiration and biopsy provide samples directly from the marrow where blood cells develop. These tests may be used to:
- Confirm the diagnosis
- Determine the type of leukemia
- Assess the proportion and characteristics of abnormal cells
- Provide samples for flow cytometry and molecular testing
- Evaluate response during treatment when required
RGCIRC’s Haematopathology services perform bone marrow aspiration and biopsy for diagnosis and disease monitoring.
Flow Cytometry and Immunophenotyping
Different leukemia cells carry characteristic markers on their surface or within the cell. Flow cytometry identifies these markers and helps classify leukemia more precisely.
The test is particularly important in distinguishing acute lymphoblastic leukemia from acute myeloid leukemia and in identifying specific lymphoid cell lineages. Flow cytometry may also be used for measurable residual disease assessment during or after treatment.
RGCIRC’s Haematopathology laboratory provides multicolour flow cytometry for the diagnosis and monitoring of haematological cancers, including MRD assessment in acute leukemias.
Cytogenetic and Molecular Testing
Leukemia cells may carry chromosome or gene changes that influence diagnosis, risk assessment and treatment selection.
Depending on the type of leukemia, molecular or cytogenetic testing may help:
- Confirm the diagnosis
- Define the leukemia subtype
- Estimate the likelihood of recurrence
- Identify targets for specific medicines
- Monitor response to therapy
RGCIRC’s Molecular Laboratory provides testing relevant to blood cancers, including BCR::ABL1 testing, AML molecular panels, CLL FISH panels, PML::RARA testing, NPM1 MRD monitoring and next-generation sequencing.
Other Tests When Required
Additional investigations depend on the leukemia type and the patient’s clinical condition. These may include:
- Kidney and liver-function tests
- Electrolytes and uric acid
- Blood-clotting tests
- Infection screening
- Lumbar puncture for selected acute leukemias
- HLA typing when stem cell transplantation is being considered
- Imaging when a particular clinical concern requires assessment
A PET-CT scan is not routinely required for most leukemias in the same way that it is used for many solid cancers or lymphomas. The haemato-oncology team at RGCIRC recommends imaging only when it is relevant to the individual diagnosis.
Personalised Leukemia Treatment Planning
At RGCIRC, leukemia care is planned by specialists from Haemato-Oncology, Haematopathology, Molecular Diagnostics and Bone Marrow Transplant, with Paediatric Haemato-Oncology, Radiation Oncology and supportive-care teams involved when required.
The approach depends on the type and biological characteristics of the leukemia, disease-risk category, age, general health, organ function, previous treatment and response to therapy. Based on these factors, care may involve chemotherapy, targeted therapy, immunotherapy, stem cell transplantation, CAR-T cell therapy or other disease-specific approaches.
Leukemia Treatment Options
There is no single treatment suitable for every type of leukemia. Some acute leukemias require intensive treatment soon after diagnosis, while certain chronic leukemias may be controlled with targeted medicines or monitored until treatment becomes necessary.
Chemotherapy for Leukemia
Chemotherapy for leukemia uses medicines that travel through the bloodstream and reach abnormal cells in the blood and bone marrow.
It remains central to the treatment of many acute leukemias. Treatment may involve combinations of medicines administered in phases, with the intensity and duration determined by the leukemia type, patient’s age, general health and risk profile.
For acute leukemia, treatment may include an initial phase aimed at achieving remission followed by further therapy intended to reduce the risk of the disease returning. Some ALL treatment programmes also include longer-term maintenance therapy.
Because chemotherapy may temporarily reduce normal blood-cell production, patients require close monitoring for infection, bleeding, anaemia and other treatment-related effects.
Targeted Therapy
Targeted therapy acts on specific abnormalities or biological pathways that help leukemia cells survive or multiply.
CML is an important example. Most patients receive tyrosine kinase inhibitors directed against the abnormal BCR::ABL1 protein. Molecular testing is used over time to measure the response.
Targeted medicines are also available for selected ALL, AML and CLL subtypes. The choice depends on the molecular or cellular characteristics identified during diagnostic testing.
Immunotherapy and Antibody-Based Treatment
Immunotherapy uses different approaches to help the immune system recognise or attack cancer cells.
Certain monoclonal antibodies and other immune-based treatments may be used in selected ALL, CLL and other blood cancers. Their role depends on the markers present on the leukemia cells, previous treatment and the overall treatment strategy.
Blood and Bone Marrow Stem Cell Transplantation
A stem cell or bone marrow transplant replaces blood-forming cells after intensive treatment and may provide an important treatment option for selected patients with leukemia.
For leukemia, allogeneic stem cell transplantation uses stem cells from a healthy donor. It may be considered for some patients with:
- High-risk acute leukemia
- Persistent disease after initial treatment
- Relapsed ALL or AML
- CML that does not respond adequately to targeted therapy
- Other clinical situations where transplantation offers an appropriate treatment strategy
Donor options may include a fully matched related donor, matched unrelated donor or haploidentical family donor.
The decision to proceed with transplantation considers the leukemia type and risk, response to previous therapy, donor availability, age, organ function, general health and potential transplant-related risks.
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RGCIRC’s Bone Marrow Transplant programme began in 2000 and has completed approximately 1,000 transplants to date. The Institute has a dedicated 21-bed BMT unit equipped with HEPA filtration and provides matched-related, matched-unrelated and haploidentical transplantation. |
CAR-T Cell Therapy for Selected Patients
CAR-T cell therapy is a form of cellular immunotherapy. T cells are collected from the patient and modified to recognise a specific marker on cancer cells before being returned to the body.
CAR-T may be considered for eligible patients with selected relapsed or refractory leukemias after detailed haemato-oncology assessment. Suitability depends on the leukemia type, disease status, previous treatment and overall clinical condition.
RGCIRC offers CAR-T cell therapy as part of advanced Haemato-Oncology and Bone Marrow Transplant care for eligible patients.
Radiation Therapy in Selected Cases
Radiation therapy does not form part of routine treatment for most patients with leukemia.
It may be considered in selected situations, such as disease affecting a particular anatomical site or as part of the conditioning strategy for certain stem cell transplants. The role of radiation depends on the leukemia type and individual treatment plan.
How Treatment Differs by Type of Leukemia
The term leukemia includes diseases with very different treatment pathways. The broad approach to the four major types includes:
|
Type of Leukemia |
General Treatment Approach |
|
Acute Lymphoblastic Leukemia (ALL) |
Acute lymphocytic leukemia treatment generally involves systemic therapy delivered in different phases. Targeted or immune-based treatment may be added for selected subtypes. Stem cell transplantation or CAR-T may be considered in certain high-risk, persistent or relapsed cases. |
|
Acute Myeloid Leukemia (AML) |
Acute myeloid leukemia treatments may include intensive or lower-intensity systemic therapy depending on age, health and disease biology. Molecularly targeted medicines may be used for selected abnormalities, while allogeneic stem cell transplantation may be considered for patients with particular risk profiles. |
|
Chronic Lymphocytic Leukemia (CLL) |
Some patients without progressive disease or significant symptoms undergo active monitoring without immediate treatment. When treatment becomes necessary, targeted and immune-based medicines have an important role. |
|
Chronic Myeloid Leukemia (CML) |
Most patients receive targeted therapy with a tyrosine kinase inhibitor. BCR::ABL1 molecular monitoring tracks response. Stem cell transplantation is generally considered for selected patients when targeted medicines do not provide adequate disease control or in particular advanced situations. |
The individual plan may differ considerably even between two people with the same broad type of leukemia because genetic findings, disease risk and response to treatment also influence subsequent decisions.
Supportive Care During Leukemia Treatment
Treating leukemia also means protecting the patient while the disease and therapy affect normal blood-cell production. Supportive care therefore forms an integral part of treatment.
Infection Prevention and Management
Leukemia and chemotherapy may reduce infection-fighting white blood cells. The care team monitors blood counts closely and assesses fever or other signs of infection promptly.
Antibacterial, antiviral or antifungal medicines may be prescribed for prevention or treatment when clinically indicated. Patients with very low white blood-cell counts may require additional infection-control precautions.
Blood and Platelet Support
Low haemoglobin may cause fatigue and breathlessness, while low platelets increase the risk of bleeding. Red blood-cell or platelet transfusions may therefore be required during treatment.
RGCIRC has dedicated Transfusion Medicine services that provide blood components including packed red blood cells and platelets and support patients undergoing cancer treatment and transplantation.
Managing Treatment-Related Effects
Supportive treatment may also address:
- Nausea and vomiting
- Mouth sores
- Fatigue
- Reduced appetite
- Pain
- Bleeding
- Electrolyte disturbances
- Nutrition
- Treatment-related infections
The specific support required changes throughout therapy according to blood counts, medicines and the patient’s clinical condition.
Monitoring Treatment Response and Measurable Residual Disease
Response assessment does not rely only on whether symptoms improve. Blood counts, bone marrow findings and specialised laboratory tests help determine how effectively treatment is controlling the leukemia.
For selected acute leukemias, measurable residual disease (MRD) testing can detect very small numbers of leukemia cells that remain after treatment. MRD results may help assess the depth of response and guide subsequent treatment decisions.
RGCIRC’s Haematopathology services provide flow-cytometry-based MRD assessment for acute leukemias, while molecular tests may be used for selected disease-specific markers.
For CML, quantitative BCR::ABL1 testing helps doctors monitor the molecular response to targeted therapy over time.
Treatment for Relapsed or Refractory Leukemia
Leukemia is described as relapsed when it returns after a period of remission. Refractory leukemia does not respond adequately to treatment.
When disease persists or returns, the team reassesses the diagnosis, previous therapy and current disease characteristics. Evaluation may include repeat bone marrow examination and updated molecular testing where appropriate.
Depending on the leukemia type and previous treatments, further care may include:
- A different chemotherapy or systemic treatment programme
- Targeted therapy
- Immunotherapy
- Allogeneic stem cell transplantation
- CAR-T cell therapy for eligible patients with selected leukemias
- Clinical trials where an appropriate trial is available
Treatment decisions consider what therapies the patient has already received, how long the previous response lasted, current disease biology and overall health.
Leukemia Treatment in Children and Adolescents
Children and adolescents with leukemia require age-specific treatment protocols and supportive care. ALL is the most common childhood leukemia, while AML and CML also occur in younger patients.
RGCIRC has dedicated Paediatric Haematology and Oncology services for patients up to 18 years of age. The programme manages childhood leukemias including ALL, AML and CML and includes paediatric outpatient, daycare, inpatient and bone marrow transplant services.
Paediatric treatment considers not only disease control but also infection prevention, nutrition, emotional wellbeing, growth, development and the potential long-term effects of therapy.
Stem cell transplantation may be considered for selected high-risk or relapsed childhood leukemias when clinically appropriate.
Why Choose RGCIRC for Leukemia Treatment?
Successful leukemia cancer treatment in Delhi depends on more than access to anti-cancer medicines. Accurate disease classification, molecular testing, treatment-response monitoring, transfusion support and access to transplantation or advanced therapies may all become important at different stages of care. Here’s why patients and families trust RGCIRC for leukemia treatment:
Dedicated Haemato-Oncology and BMT Expertise
RGCIRC has dedicated Haemato-Oncology and Bone Marrow Transplant services for leukemia and other blood disorders. The programme brings together specialists experienced in systemic treatment, stem cell transplantation and the management of treatment-related complications.
Advanced Haematopathology and MRD Assessment
The Institute has dedicated Haematopathology services for blood and bone marrow evaluation. Capabilities include bone marrow aspiration and biopsy, multicolour flow cytometry and MRD assessment for acute leukemias. This allows diagnosis and response monitoring to remain closely connected with treatment decisions.
Molecular Testing for Treatment Selection and Monitoring
RGCIRC’s Molecular Laboratory provides molecular and cytogenetic tests relevant to leukemia, including BCR::ABL1 testing, AML panels, CLL FISH testing, PML::RARA analysis and selected MRD assays. These tests help specialists characterise the disease more precisely, identify selected treatment targets and monitor specific leukemias over time.
Established Bone Marrow Transplant Programme
RGCIRC’s Bone Marrow Transplant programme has been operational since 2000 and reports approximately 1,000 transplants. The Institute has a dedicated 21-bed HEPA-filtered BMT unit supported by haemato-oncology specialists, trained nursing teams, laboratory services and round-the-clock blood-bank support. Transplant options include fully matched related donor, matched unrelated donor and haploidentical donor transplantation.
Advanced Cellular and Targeted Therapies
Patients with molecularly defined leukemias may have access to targeted treatment based on the biology of the disease. For eligible patients with selected relapsed or refractory blood cancers, RGCIRC also provides CAR-T cell therapy within the Haemato-Oncology and Bone Marrow Transplant programme.
Dedicated Paediatric Haemato-Oncology Care
Children and adolescents receive care through a dedicated Paediatric Haematology and Oncology service, with separate outpatient, daycare and inpatient support and access to paediatric bone marrow transplantation when required.
Accredited and Accessible Cancer Care
RGCIRC is a not-for-profit cancer centre with NABH-accredited hospital services and NABL-accredited laboratory services.
Patient Welfare and Philanthropy initiatives support eligible patients facing financial constraints. Assistance may include subsidised treatment, case-based financial support and access to applicable government, NGO or philanthropic programmes.
Consult the Haemato-Oncology Team at RGCIRC
If you have unexplained abnormalities in your blood counts, suspected or confirmed leukemia, recurrent disease or have been advised to consider stem cell transplantation, consult the Haemato-Oncology team for an individual assessment.
To book a consultation, visit www.rgcirc.org or book online at care.rgcirc.org. The RGCI Care app is also available on iOS and Android.
Appointments: +91-11-47022222
OPD: Monday to Saturday, 9:00 am to 5:00 pm
Emergency services: Available 24×7
Frequently Asked Questions
Myeloma/ Multiple Myeloma
Myeloma or Multiple Myeloma are same things and is a cancer arising from plasma cells. Plasma cells too are very important component of body’s immune system and reside in bone marrow. Myeloma can cause widespread damage in body including bone weakness or fractures, kidney dysfunction, infections and anemia. Diagnosis of Myeloma depends upon bone marrow tests or a biopsy from affected tissue apart from several blood tests. Treatment of Myeloma consists of chemotherapy or certain targeted immunotherapies and Autologous bone marrow/ hematopoietic stem cell transplantation. With appropriate therapy, a significant number of patients can achieve good disease control and lead a near normal life.