Leukemia is a type of blood cancer that starts in the bone marrow. Marrow is the inner part of bones where new blood cells are made. In 2020, approximately 474,519 new cases were reported globally, with nearly 500,000 cases in 2022, making it one of the top ten cancers in many countries. It affects white blood cells, which are responsible for fighting infections. When someone has leukemia, their body produces large numbers of abnormal white blood cells that don't function properly. These cells proliferate and crowd out healthy blood cells, causing problems such as anemia, infections, and bleeding.
The cost of leukemia treatment in India ranges from ₹30,000 to ₹40,00,000 (approximately $500 to $36,000), depending on the type of leukemia, stage of diagnosis, treatment approach, and whether a bone marrow transplant is required. Compared to many Western countries, India offers advanced leukemia care at a fraction of the price, making it an ideal destination for overseas patients seeking affordable and effective treatment.

What Is Leukemia?

Leukemia is a form of cancer that begins in the blood and bone marrow. The marrow is the spongy tissue inside your bones where blood cells are made. In a healthy person, the bone marrow produces three types of blood cells: red blood cells (to carry oxygen), white blood cells (to fight infections), and platelets (to stop bleeding).

In leukemia, the body starts making large numbers of abnormal white blood cells. These cells don't function the way they should. Instead of protecting the body from infections, they grow uncontrollably and crowd out the healthy cells in the blood and bone marrow. It leads to serious health problems like anemia, frequent infections, and unexplained bleeding.

Leukemia is not a single disease. It is a group of blood cancers classified based on how rapidly they progress and which type of blood cell is affected. It can develop quickly (acute leukemia) or slowly (chronic leukemia). It can also begin in different kinds of white blood cells—either lymphoid or myeloid cells.

Understanding the type and stage of leukemia is crucial because it determines the treatment plan and ultimately affects the overall outcome. Thanks to medical advancements, many types of leukemia are now treatable and even curable, especially when detected early and managed properly.

Types of Leukemia 

There are four major types of leukemia, each with unique features, symptoms, treatment approaches, and outcomes. Understanding the type of leukemia helps doctors decide on the most effective treatment plan.

Acute Lymphoblastic Leukemia (ALL)

Acute Lymphoblastic Leukemia (ALL) is a fast-growing cancer that affects immature white blood cells called lymphocytes. These cells are usually either B-cells or T-cells. This type of leukemia is most common in children, especially under the age of 15, although it can also occur in adults.

The symptoms of ALL include fatigue, frequent fevers, unexplained bleeding or bruising, bone pain, and swollen lymph nodes. Because it progresses quickly, treatment must begin promptly.

The standard treatment involves multi-phase chemotherapy. It includes induction therapy to kill the bulk of leukemia cells, consolidation therapy to eliminate remaining cells, and maintenance therapy to prevent relapse. Patients also receive CNS prophylaxis, which means they are given chemotherapy in the spinal fluid to stop the cancer from spreading to the spinal cord or brain. For patients who do not respond well to chemotherapy or who relapse, doctors may recommend a bone marrow transplant.

The prognosis for children with ALL is excellent, with cure rates above 85% to 90%. In adults, the outlook is more variable but improves with the use of targeted therapies.

Acute Myeloid Leukemia (AML)

Acute Myeloid Leukemia, or AML, is another fast-growing form of leukemia. AML begins in the bone marrow and affects immature myeloid cells, which are supposed to develop into WBCs, RBCs, or platelets. AML is more common in older adults, typically those over 60 years old, but it can also occur in children.

Patients with AML often experience fatigue, infections that don't go away, anemia, easy bleeding, fever, and bone pain. Because AML progresses rapidly, it requires intensive treatment soon after diagnosis.

Treatment usually starts with induction chemotherapy using a combination known as the "7+3" regimen—seven days of cytarabine and three days of daunorubicin. Once remission is achieved, high-dose cytarabine is used in consolidation therapy. In patients with specific genetic mutations, doctors may add targeted therapies, such as Midostaurin or Gemtuzumab ozogamicin.

The prognosis for AML varies depending on age, genetic abnormalities, and how well the leukemia responds to treatment. Outcomes are better in younger patients with favorable risk factors.

Chronic Lymphocytic Leukemia (CLL)

Chronic Lymphocytic Leukemia, known as CLL, is a slow-growing leukemia that usually affects mature B-lymphocytes. It is the most common type of leukemia in older adults, especially those over 55 years of age.

CLL may not cause symptoms in its early stages and is often found by accident during routine blood tests. When symptoms appear, they may include enlarged lymph nodes, unintentional weight loss, fatigue, and a higher frequency of infections.

In early-stage CLL, treatment may not be necessary right away. Hematologists may recommend a "watch and wait" approach with regular monitoring. If the disease progresses or symptoms become severe, treatment is started. Targeted therapies such as Ibrutinib, Acalabrutinib, or Venetoclax (often combined with Obinutuzumab) are now the first choice for most patients. Traditional chemotherapy is rarely used today but may still be considered for younger or fit patients.

Thanks to these modern treatments, many people with CLL live for many years, and the disease is now considered manageable for most.

Chronic Myeloid Leukemia (CML)

Chronic Myeloid Leukemia, or CML, is a slow-developing leukemia that starts in the myeloid cells and is defined by the presence of a genetic mutation called the Philadelphia chromosome, which creates the BCR-ABL gene fusion.

CML is most often diagnosed in adults between the ages of 30 and 60. Symptoms may include fatigue, a feeling of fullness in the abdomen, fever, and weight loss. Some patients are diagnosed during routine blood tests before they experience any symptoms.

Treatment for CML is typically based on targeted oral therapies known as Tyrosine Kinase Inhibitors (TKIs). These include drugs such as Imatinib, Dasatinib, and Nilotinib, which directly block the abnormal BCR-ABL protein driving the disease. Most patients take these medications daily and undergo periodic PCR testing to monitor the disease's progression and control.

In rare cases where the disease becomes resistant to TKIs or transforms into a more aggressive phase (called blast crisis), patients may require a bone marrow transplant. However, most patients respond well to TKIs and can enjoy long-term survival with good quality of life.

Symptoms of Leukemia

Leukemia symptoms vary from person to person. Some people may feel sick quickly, especially in acute leukemia, while others may not notice any symptoms for a long time, especially in chronic leukemia. Many signs of leukemia are similar to those of common illnesses, such as the flu, which is why the disease is sometimes diagnosed late. 

Below are the most common symptoms to watch for:

• Fatigue and Weakness: Individuals with leukemia frequently experience persistent fatigue, even after rest. It happens because the body is not making enough healthy RBCs to carry oxygen.
• Frequent Infections: White blood cells are typically responsible for fighting infections. However, in leukemia, the abnormal white blood cells don't function correctly. As a result, people may frequently become ill, even with relatively minor ailments such as a cold or sore throat.
• Fever and Night Sweats: Recurring fevers without an apparent reason and night sweats (waking up soaked in sweat) are common in leukemia.
• Easy Bruising and Bleeding: Leukemia affects platelet production, which helps the blood to clot. It can cause frequent nosebleeds, bleeding gums, or bruises without any injury.
• Shortness of Breath: Low red blood cell levels (anemia) can make it hard for your body to get enough oxygen, leading to difficulty breathing, especially during physical activity.
• Swollen Lymph Nodes or Gums: Leukemia can cause swelling in areas like the neck, armpits, or groin. In some cases, gums may become enlarged or swollen.
• Bone or Joint Pain: Because leukemia starts in the bone marrow, some people experience aching bones or joint pain, especially in the legs or arms.
• Pale Skin: A low red blood cell (RBC) count can cause the skin to look unusually pale, which may be a sign of anemia caused by leukemia.
• Loss of Appetite and Weight Loss: Leukemia may also cause a feeling of fullness after eating small amount of food or a general loss of appetite, leading to unexpected weight loss.

Important Note: Less serious health problems can also cause these symptoms. However, if symptoms persist, it's essential to consult a doctor. Early diagnosis of leukemia improves the chances of successful treatment.

Diagnosis of Leukemia

Diagnosing leukemia involves various tests to confirm the presence of cancer in the blood or bone marrow. Since early symptoms can be mild or similar to other common illnesses, proper testing is essential to find the exact type and stage of leukemia. The results of diagnostic tests help doctors decide on the best treatment plan.

• Complete Blood Count (CBC): This is often the first test done. A blood sample is taken to check the levels of red blood cells, white blood cells, and platelets.
  • What it shows: Abnormally high or low white blood cell counts, low red blood cells, or low platelets may suggest leukemia.
  • Why it matters: It gives a clear picture of how the blood is functioning.
• Peripheral Blood Smear: This test looks at the number and shape of blood cells under a microscope.
  • What it shows: It can reveal immature or abnormal white blood cells.
  • Why it matters: It helps spot signs of leukemia early.
• Bone Marrow Aspiration and Biopsy: In this test, a small amount of bone marrow is removed—usually from the hip bone—using a special needle. It is done under local anesthesia to reduce pain.
  • What it shows: Whether leukemia cells are present in the bone marrow.
  • Why it matters: It confirms the diagnosis and helps determine the stage of the disease.
• Flow Cytometry and Immunophenotyping: These tests look at specific proteins on the surface of cells. They help identify the exact type of leukemia.
  • What it shows: The exact leukemia subtype (e.g., ALL vs. AML).
  • Why it matters: Different types require different treatments.
• Cytogenetic Testing and Molecular Analysis: These advanced tests examine genetic changes in leukemia cells.
  • What it shows: Mutations or chromosomal abnormalities (like the Philadelphia chromosome in CML).
  • Why it matters: Helps predict how aggressive the leukemia is and guides targeted therapy.
• Imaging Tests (if needed): Scans such as X-rays, ultrasounds, CT scans, or MRIs may be used to check if leukemia has spread to other body parts, including the spleen, liver, or brain.
  • What it shows: Enlargement of organs or lymph nodes.
  • Why it matters: Helps in staging and planning treatment.

Is Leukemia Curable?

Many types of leukemia are curable, especially when diagnosed early and treated with the right medical approach. However, the chances of a complete cure depend on several factors, such as the type of leukemia, the patient's age, overall health, and how well the cancer responds to treatment.

Younger patients generally respond better to treatment. Older adults may require modified treatment plans, particularly if they have additional health concerns.

When leukemia is found early, before it spreads or becomes more aggressive, treatment is often more effective and less intensive.

Advanced therapies, such as targeted drugs, immunotherapy, and bone marrow transplants, have significantly improved cure rates for many types of leukemia.

• Acute Lymphoblastic Leukemia (ALL): This is one of the most curable forms of leukemia, especially in children. With proper chemotherapy and sometimes a bone marrow transplant, over 85% of children with ALL achieve long-term remission or cure.
• Chronic Myeloid Leukemia (CML): Thanks to targeted therapy like tyrosine kinase inhibitors (TKIs), CML is now considered a manageable chronic condition. Many patients can live a normal lifespan and may even discontinue medication under close medical supervision.
• Acute Myeloid Leukemia (AML): AML can also be cured in some patients, especially younger individuals. However, long-term survival depends on how the body responds to chemotherapy and whether a bone marrow transplant is done.
• Chronic Lymphocytic Leukemia (CLL): CLL progresses slowly and is not always curable, but it is very treatable. Some patients can live for many years with a good quality of life, using medications and undergoing regular monitoring.

What are the Treatment Options for Leukemia?

Leukemia treatment encompasses several medical approaches aimed at eliminating cancerous cells, restoring normal blood cell production, and preventing relapse. The choice of treatment depends on the type of leukemia, the stage of the disease, the patient's age, overall health, and specific genetic markers present in the cancer cells. With advances in medical science, multiple effective treatment options are now available, ranging from standard chemotherapy to newer targeted and cell-based therapies. In many cases, a combination of treatments is used to achieve the best possible outcome.

Chemotherapy

• Chemotherapy uses powerful drugs to destroy leukemia cells throughout the body in scheduled cycles.
• It can be delivered intravenously, in pill form, or via injection, depending on the protocol.
• The primary goal is to achieve complete or partial remission of leukemia and prevent its spread.
• In many cases, primarily childhood leukemia, chemotherapy alone can achieve a cure or long-term remission.

Targeted Therapy

• Targeted therapy attacks specific genetic mutations or proteins in leukemia cells, causing minimal harm to healthy cells.
• A notable example is the use of tyrosine kinase inhibitors for treating Chronic Myeloid Leukemia.
• This therapy is typically taken as an oral pill, sometimes for long-term disease control.
• It offers effective, continuous management of leukemia, often with fewer side effects than standard chemotherapy.

Immunotherapy

• Immunotherapy boosts the body's immune system to attack leukemia cells.
• An advanced form of immunotherapy is CAR T-cell therapy, which involves collecting a patient's T cells, genetically modifying them in a laboratory, and reinfusing them to target and attack cancer cells specifically.
• India now offers locally developed CAR T-cell therapies, such as NexCAR19 and var-cel (Qartemi), which are priced significantly lower than their imported counterparts.
• In clinical trials, NexCAR19 demonstrated a complete response rate of nearly 73%, and var‑cel achieved an overall response rate of 83.3% within 90 days.

Radiation Therapy

• Radiation therapy utilizes high-energy X-rays to target and kill cancer cells in particular areas of the body.
• It is typically used when leukemia spreads to areas like the brain, spinal cord, or testes.
• Radiation is also used as a preparatory step before a bone marrow transplant.
• It can be delivered in multiple sessions over 1–3 weeks, depending on the treatment plan.

Bone Marrow Transplant (Stem Cell Transplant)

• This treatment replaces the patient's diseased bone marrow with healthy stem cells sourced from either the patient's own cells (autologous) or a donor (allogeneic).
• Patients undergo high-dose chemotherapy (and sometimes total-body radiation) before transplant to eliminate remaining leukemia cells.
• Transplanted stem cells help regenerate healthy blood-forming cells and restore immune function.
• Bone marrow transplant is usually recommended for aggressive or relapsed leukemias, offering a chance for a long-term cure or remission.

These treatment methods are often used in sequence or combination, such as chemotherapy to achieve remission, followed by transplant or CAR T‑cell therapy. The choice depends on the specifics of the disease and patient factors.

Leukemia Treatment Protocols in India

Treatment for leukemia follows a specific protocol—a structured plan that includes various phases to eliminate cancer cells, restore normal blood production, and prevent relapse. The protocol varies by leukemia type, patient age, genetic profile, and the disease's response to initial treatment.

Below are the general treatment protocols for the four main types of leukemia:

Acute Lymphoblastic Leukemia (ALL)

• Induction Phase
  • Goal: To kill as many leukemia cells as possible and bring the disease into remission (usually within 4–6 weeks).
  • Medications: Combination of chemotherapy drugs like vincristine, corticosteroids (e.g., prednisone or dexamethasone), and L-asparaginase.
  • Hospitalization is often required during this intensive phase.
• Consolidation/Intensification Phase
  • Goal: To destroy any remaining leukemia cells and reduce relapse risk.
  • Duration: Usually 4–6 months.
  • Drugs: High-dose methotrexate, cytarabine, or cyclophosphamide.
• CNS Prophylaxis (Preventive Brain Treatment)
  • Goal: Prevent leukemia from spreading to the brain and spinal cord.
  • Method: Intrathecal chemotherapy (injected into the spinal fluid), sometimes combined with radiation.
• Maintenance Phase
  • Goal: To keep the leukemia in remission.
  • Duration: 2–3 years.
  • Medications: Low-dose daily oral chemotherapy, like 6-mercaptopurine and weekly methotrexate.
  • Follow-up: Monthly blood tests and physical exams.
• Stem Cell Transplant (If Needed): Used in high-risk cases or if there is a relapse after initial treatment.

Acute Myeloid Leukemia (AML)

• Induction Therapy
  • Goal: Achieve remission by killing the bulk of leukemia cells.
  • Drugs: "7+3 regimen" – cytarabine for 7 days and daunorubicin (or idarubicin) for 3 days.
  • Duration: 1 week of inpatient chemotherapy followed by 2–3 weeks of monitoring.
• Consolidation Therapy
  • Goal: Eliminate remaining leukemia cells and strengthen remission.
  • Drugs: High-dose cytarabine (HiDAC) given in multiple cycles.
  • Duration: 2–4 cycles over a few months.
• Bone Marrow Transplant: Recommended for intermediate or high-risk AML, especially if genetic mutations (like FLT3 or TP53) are present. It may also be done after the first remission if there is a high chance of relapse.
• Targeted Therapy (If Indicated): FLT3 inhibitors (e.g., midostaurin), IDH1/2 inhibitors, or BCL-2 inhibitors, such as venetoclax, are added based on the results of genetic testing.

Chronic Lymphocytic Leukemia (CLL)

• Watchful Waiting (Early Stage): No immediate treatment is required if the patient has no symptoms and the disease progresses slowly. Regular monitoring is conducted through blood tests and physical examinations.
• First-Line Treatment (If Needed)
  • Drugs: Targeted therapies such as ibrutinib, acalabrutinib, or venetoclax.
  • Combination therapies (e.g., venetoclax + obinutuzumab) may be used depending on the patient's age and mutation profile.
• Immunotherapy: Monoclonal antibodies (e.g., rituximab, obinutuzumab) are often used in combination with chemotherapy or targeted drugs.
• Stem Cell Transplant: Rarely used, only in high-risk cases with poor response to standard therapies.

Chronic Myeloid Leukemia (CML)

• Targeted Therapy (First-Line): Tyrosine kinase inhibitors (TKIs), such as imatinib, dasatinib, or nilotinib, are the standard of care for this treatment. These drugs target the BCR-ABL fusion gene caused by the Philadelphia chromosome. Treatment is long-term and taken daily as oral tablets.
• Monitoring Response: Regular testing (PCR for BCR-ABL levels) every 3 months to ensure the leukemia is under control.
• Second-Line Therapy: If first-line TKIs are ineffective or cause side effects, newer TKIs like bosutinib or ponatinib may be used.
• Stem Cell Transplant: Considered in rare cases if the leukemia becomes resistant to TKIs or progresses to advanced stages (blast crisis).

CAR T-Cell Therapy Protocol (Used in Relapsed/Refractory ALL and some CLL/AML cases)

• Patient Evaluation: Patients must meet specific criteria, such as having relapsed or refractory leukemia with no response to standard therapy.
• T-Cell Collection (Leukapheresis): White blood cells are collected from the patient's blood.
• Cell Modification (In Lab): T cells are engineered to express a chimeric antigen receptor (CAR) targeting leukemia cells.
• Lymphodepleting Chemotherapy: Before infusion, patients receive chemotherapy to suppress their immune system, allowing the CAR T cells to expand.
• CAR T-Cell Infusion: Modified cells are infused back into the patient.
• Post-Infusion Monitoring: Close hospital monitoring for side effects like cytokine release syndrome (CRS) or neurotoxicity for 7–14 days. Continued monitoring for weeks to months.

Leukemia Treatment Cost in India

One of the primary reasons international patients from over 120 countries choose India for leukemia treatment is its affordability. In India, the cost of leukemia treatment ranges from $6,000 to $36,000. The cost of treatment is significantly lower, while the quality of treatment is comparable to that in hospitals in the United States, the United Kingdom, and Europe.

Average Cost Breakdown (In INR and USD)

Note: These are estimated costs. Actual prices may vary depending on the city, hospital, patient's condition, and treatment duration.

Why Is Treatment More Affordable in India?

• Lower infrastructure and labor costs in India bring down the price of world-class medical care.
• There are no waiting lists, unlike many Western healthcare systems.
• In-house drug manufacturing, including generic and domestically produced CAR T therapies, reduces costs.
• Multi-specialty cancer hospitals in India offer comprehensive care under one roof, eliminating the need for additional logistics costs and expenses.

What Affects the Cost of Leukemia Treatment?

• Type of Leukemia: Different types (ALL, AML, CML, CLL) require different treatment protocols, which impact the overall cost.
• Stage of the Disease: Advanced or relapsed leukemia may need more aggressive treatments, such as bone marrow transplants or CAR T-cell therapy.
• Type of Treatment: The costs vary based on whether you need chemotherapy, targeted therapy, immunotherapy, radiation, or a transplant.
• Length of Hospital Stay: Patients undergoing transplants or high-intensity chemotherapy may require a more extended hospital stay, which can increase the total cost.

To Conclude

Leukemia is a serious but increasingly treatable disease. Thanks to medical advancements, many patients—especially those diagnosed early—can achieve remission or even a complete cure. From chemotherapy and targeted therapy to stem cell transplant and CAR T-cell therapy, there are multiple ways to fight leukemia effectively.

India has become a trusted destination for leukemia treatment, offering world-class medical care at a fraction of the cost charged in many Western countries. With internationally trained doctors, advanced hospitals, and comprehensive support for international patients, the country provides high-quality, compassionate care that gives patients and their families real hope.