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Acute leukaemia is a medical emergency. If you have been diagnosed with acute leukaemia, seek treatment locally now — do not wait to arrange travel. Also seek emergency care for fever during chemotherapy, uncontrolled bleeding, severe breathlessness, or new confusion.

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Blood cancers: leukaemia, lymphoma and myeloma

Cancers of the blood, bone marrow and lymphatic system. Unlike solid tumours they are not removed by surgery — they are treated with drugs, and in some cases with a bone marrow transplant.

These are also the cancers where the distinction between urgent and non-urgent is sharpest. Some require treatment within days and should be started locally without delay. Others are managed for years without any treatment at all.

Clinically reviewed by Dr. Annie Varughese, Consultant Medical Oncologist Clinical oversight Dr. Annie Varughese, MD, FACC Last reviewed August 2026 Editorial and medical review policy
Acute or chronic
Decides urgency
Acute needs treatment in days; chronic often does not
Subtype matters most
More than stage
Modern classification determines the drugs used
Transplant
For selected patients
Not everyone with a blood cancer needs one
Time in India
2 weeks to 4 months
Diagnosis and planning at the short end, transplant at the long end
On this page
  1. What it is
  2. Symptoms and warning signs
  3. How it is diagnosed
  4. Treatment options
  5. How the choice is made
  6. How urgent is your case
  7. What to send us
  8. Questions patients ask
The condition

What these conditions are

Leukaemia arises in the bone marrow, where abnormal white cells crowd out normal blood production. Acute leukaemia develops over days to weeks and requires urgent treatment. Chronic leukaemia develops over years, and some forms are monitored for a long time without any treatment being needed.

Lymphoma arises in the lymphatic system and usually presents as painless enlarged lymph nodes. The broad division is between Hodgkin lymphoma, which is highly curable, and the many types of non-Hodgkin lymphoma, which range from indolent forms that may need no treatment for years to aggressive forms that need prompt intensive treatment and are also potentially curable.

Multiple myeloma arises from plasma cells in the marrow and characteristically causes bone pain, fractures, anaemia, kidney impairment and raised calcium. It is generally treated as a long-term condition with sequences of drug therapy, often including an autologous stem cell transplant.

In all three, the precise subtype matters more than almost anything else. Modern classification uses immunophenotyping, cytogenetics and molecular testing, and the same broad diagnosis can carry entirely different treatment and outlook depending on those results.

Symptoms

Symptoms and warning signs

Common symptoms
  • Persistent tiredness and breathlessness from anaemia
  • Frequent or unusual infections
  • Easy bruising, bleeding gums, or a rash of tiny red spots
  • Painless swollen lymph nodes in the neck, armpit or groin
  • Drenching night sweats
  • Unexplained weight loss and fever
  • Bone pain, particularly in the back or ribs, in myeloma
Warning signs of an emergency
  • A new diagnosis of acute leukaemia — this is urgent
  • Fever with a low white cell count
  • Uncontrolled bleeding or extensive bruising
  • Severe breathlessness or chest pain
  • Confusion, severe thirst or drowsiness
  • Sudden severe back pain with leg weakness

Acute leukaemia should be treated where you are, immediately

Acute leukaemia can progress within days. Arranging an international journey while it is untreated is dangerous, and no responsible facilitator should encourage it. Start treatment locally, get the disease under control, and then let us help plan what comes next — including a transplant, if one is needed. That sequence is safe. The other is not.

Diagnosis

How it is diagnosed

Diagnosis in blood cancers is laboratory work rather than imaging, and the detail of that laboratory work is what determines treatment.

Initial tests

  • Full blood count and blood film — often the first indication
  • Bone marrow aspirate and trephine biopsy — the central test in leukaemia and myeloma
  • Lymph node biopsy — an excision biopsy is strongly preferred to a needle sample in suspected lymphoma
  • Blood chemistry — kidney and liver function, calcium, LDH and uric acid

The deciding tests

  • Immunophenotyping by flow cytometry — identifies the exact cell lineage
  • Cytogenetics and molecular testing — detects specific chromosomal and genetic abnormalities that determine treatment and prognosis
  • PET-CT — the standard staging and response assessment in most lymphomas
  • Serum and urine protein electrophoresis — for myeloma, with free light chain assay

Ask for an excision biopsy if lymphoma is suspected

A fine needle aspirate is frequently inadequate to classify a lymphoma, because the architecture of the node carries diagnostic information that a needle cannot capture. If you have had a needle sample and the diagnosis is uncertain, the answer is usually to remove a whole node rather than repeat the needle. Send us the pathology report, the flow cytometry, and any cytogenetic or molecular results — those three together are what we need.

Options

Treatment options

Treatment is by drugs, in defined protocols. Which protocol depends on the exact subtype and on genetic findings.

Option one

Watchful waiting

For chronic lymphocytic leukaemia without symptoms, and for indolent lymphomas that are not causing problems, monitoring rather than treating is the evidence-based approach. Treating early does not improve outcomes in these situations and exposes you to side effects for no benefit. Being told no treatment is needed is a good outcome, not a failure to act.

Usually appropriate whenThe disease is indolent, causing no symptoms, and blood counts and organ function are stable.
Option two

Chemotherapy and immunotherapy protocols

Combination regimens given in cycles, frequently with antibody therapy added — rituximab in many B-cell lymphomas, for example. Aggressive lymphomas are treated with curative intent. Acute leukaemias require intensive inpatient induction followed by consolidation, and this phase must be given somewhere equipped to support a patient with no functioning immune system.

Usually appropriate whenAggressive lymphoma, acute leukaemia, symptomatic myeloma, or chronic disease that has progressed.
Option three

Targeted oral therapies

For several blood cancers, tablets that block a specific molecular pathway have transformed treatment — tyrosine kinase inhibitors in chronic myeloid leukaemia being the clearest example, where a once-fatal disease is now generally controlled with daily tablets taken at home for years.

Usually appropriate whenThe subtype has an identified molecular target, which is why cytogenetic and molecular testing matters so much.
Option four

Bone marrow or stem cell transplant

An autologous transplant uses your own stem cells, collected and returned after high-dose treatment, and is standard in myeloma and some relapsed lymphomas. An allogeneic transplant uses cells from a sibling, a half-matched parent or an unrelated donor, and is used in acute leukaemias at higher risk of relapse. It requires several weeks in protective isolation.

Usually appropriate whenDetermined by subtype, risk category and response to initial treatment — not by the diagnosis alone.
The decision

How the choice is made

Acute or chronic decides urgency

Acute disease is treated immediately and locally. Chronic disease allows time to plan properly, and in some cases needs no treatment at all.

Subtype and genetics decide the protocol

Immunophenotyping, cytogenetics and molecular results determine which regimen is appropriate and whether transplant should be planned from the outset.

Then donor availability, for transplant

If an allogeneic transplant may be needed, HLA typing of siblings is the first step and can usually be arranged in your own country before anyone travels.

If a transplant may be in your future, ask about HLA typing for your brothers and sisters now. It is inexpensive, it can be done at home, and it determines what is possible later.

Urgency

How urgent is your case

Usually safe to plan travel
  • Chronic leukaemia under monitoring
  • Indolent lymphoma without symptoms
  • Stable between treatment cycles, no fever
  • Seeking transplant planning after remission achieved locally
Needs local assessment before travel
  • Newly diagnosed acute leukaemia
  • Fever with a low white cell count
  • Active bleeding or very low platelets
  • Severe breathlessness
  • Raised calcium with confusion or severe thirst

We will tell you which column you are in

Blood cancers are the group where we most often say start locally, then come. Getting acute disease under control where you are is not a delay — it is what makes safe travel possible afterwards.

Next step

What to send us

Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.

Most useful

  • Bone marrow or lymph node biopsy report
  • Flow cytometry and immunophenotyping results
  • Cytogenetics and molecular testing results
  • Full blood counts, current and over time

Also helpful

  • PET-CT or CT staging reports
  • Kidney function, calcium and LDH
  • Details of any treatment already given, with drug names and cycles
  • Whether you have siblings, and their ages
Send my reports for review See published cost ranges
Questions

Questions patients ask

Not before treatment has started. Acute leukaemia progresses over days and needs induction chemotherapy urgently, wherever you are. Once remission is achieved and you are stable, travelling for a transplant or for specialist reassessment becomes a reasonable and often excellent plan. Anyone encouraging you to fly with untreated acute leukaemia is putting you at serious risk.

No. Many blood cancers are treated successfully without one, and transplant carries significant risks of its own. Whether it is indicated depends on the subtype, genetic risk category, and how well the disease responds to initial treatment. Send the cytogenetics and molecular results and we will give you a proper answer rather than a default one.

It may well be. For chronic lymphocytic leukaemia without symptoms and for indolent lymphomas, monitoring rather than treating is the evidence-based approach — treating early does not improve outcomes and exposes you to side effects for nothing. If you are being watched rather than treated, that is usually good news.

Possibly. A full sibling has roughly a one in four chance of being a match. HLA typing is a simple blood test and can usually be done in your own country. If you may need an allogeneic transplant, arrange it now — it determines whether a matched sibling transplant, a haploidentical transplant from a parent or child, or an unrelated donor search is the route.

Many types are, and this is one of the more hopeful areas of oncology. Hodgkin lymphoma is curable in a high proportion of patients including at advanced stage, and aggressive non-Hodgkin lymphomas are treated with curative intent. Indolent lymphomas are usually controlled over many years rather than cured. The subtype determines which applies, which is why the pathology detail matters.

Because classifying lymphoma depends partly on the architecture of the node, which a needle sample destroys or misses. An excision biopsy of a whole node gives the pathologist enough tissue for morphology, immunophenotyping and molecular testing together. If your diagnosis rests on a needle sample and remains uncertain, an excision biopsy is usually the right next step.

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Contact

Send us your reports

Send the bone marrow or lymph node biopsy report together with flow cytometry and any cytogenetic or molecular results. Those three determine everything that follows.

Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.

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