Overview for Acute Lymphocytic Leukemia (ALL) Treatment in India

Introduction:

Acute Lymphocytic Leukemia (ALL) is a type of blood cancer that primarily affects adults. The mainstay of treatment for ALL involves a comprehensive and multi-phased approach, primarily centered around long-term chemotherapy. Recent advancements in intensive chemotherapy regimens have shown increased response rates, albeit with a higher likelihood of side effects. The treatment typically spans three phases: Induction, Consolidation, and Maintenance, spanning approximately two years.

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Induction Phase:

The primary goal of induction chemotherapy is to achieve complete remission, where leukemia cells are undetectable in bone marrow samples. This phase typically lasts around a month and employs a combination of chemotherapy drugs, including Vincristine, Dexamethasone or Prednisone, and anthracycline drugs like Doxorubicin or Daunorubicin. Additional drugs may be included based on prognostic factors, such as Cyclophosphamide, L-asparaginase, high doses of Methotrexate, or Cytarabine. For patients with the Philadelphia chromosome, targeted drugs like Imatinib or Dasatinib may be incorporated.

Central Nervous System (CNS) Prophylaxis:

Given the potential for ALL to spread to the brain and spinal cord, CNS prophylaxis is initiated during induction, continuing through subsequent phases. This may involve intrathecal chemotherapy, high-dose IV chemotherapy, or radiation therapy to the brain and spinal cord.

Consolidation Phase:

If remission is achieved, the consolidation phase involves another intense round of chemotherapy, often utilizing drugs from the induction phase. CNS prophylaxis continues during this phase. For high-risk patients, especially those with certain subtypes or poor prognostic factors, an allogeneic stem cell transplant (SCT) may be recommended.

Maintenance Phase:

Following consolidation, maintenance chemotherapy with drugs like Methotrexate and 6-mercaptopurine is administered for about two years. Patients with the Philadelphia chromosome may receive targeted drugs like Imatinib. CNS prophylaxis remains a part of this phase.

Response Rates:

Approximately 80% to 90% of adults achieve complete remission during treatment. However, relapse occurs in about half of these cases, resulting in an overall cure rate of around 40%, varying based on ALL subtype and prognostic factors.

Relapse or Refractory Cases:

In instances of refractory leukemia, more intensive or novel chemotherapy approaches may be attempted. Immunotherapy, such as monoclonal antibodies or CAR T-cell therapy, may be considered, as well as stem cell transplantation. Clinical trials exploring new treatment options could be an alternative.

Palliative Treatment:

For cases where further curative treatment is unlikely, the focus may shift to palliative treatment, aimed at controlling leukemia and managing symptoms. This may involve less intensive chemotherapy, pain relief through radiation and medication, correction of blood counts, fatigue management, and addressing infections.

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Conclusion:

The treatment journey for ALL in adults is a complex and phased process, emphasizing the importance of personalized approaches and ongoing research to enhance therapeutic options and improve outcomes.

FAQs:

Q1: What is the typical duration of the induction phase in ALL treatment?

A: The induction phase, focused on achieving complete remission, usually lasts around a month. The duration may vary based on individual response and medical considerations.

Q2: Are there alternatives for patients unable to tolerate intensive chemotherapy during induction?

A: For older patients or those with health concerns, similar drugs are used in induction, although doses might be adjusted. Close monitoring and supportive care help manage potential complications.

Q3: How does CNS prophylaxis work, and when is it administered?

A: CNS prophylaxis involves treatments like intrathecal chemotherapy, high-dose IV chemotherapy, or radiation therapy. It is initiated during induction and continues through subsequent phases to prevent or address CNS involvement.

Q4: What options are available for patients at high risk of relapse during the consolidation phase?

A: High-risk patients may be considered for allogeneic stem cell transplant (SCT) during consolidation. The decision is based on individual factors and donor availability, especially for those with a sibling match.

Q5: How long does the maintenance phase typically last, and what does it involve?

A: Maintenance chemotherapy spans approximately two years, employing drugs like Methotrexate and 6-mercaptopurine. Patients with the Philadelphia chromosome may also receive targeted drugs like Imatinib during this phase.

Q6: What happens if leukemia relapses after initial treatment?

A: If relapse occurs, treatment strategies vary. For late relapses, similar treatment may be attempted, while early relapses might necessitate more aggressive chemotherapy or alternative approaches like immunotherapy. Stem cell transplantation is often considered if a second remission is achieved.

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BLK-Max Hospital

Number of beds: 700
ICU Beds: 175
Airport Distance: 13 Km

About Hospital:

BLK Super Speciality Hospital was established by Dr. B.L. Kapur in 1959. It was inaugurated by the then Prime Minister of India, Pandit Jawahar Lal Nehru.
BLK Super Speciality Hospital was established by Dr. B.L. Kapur in 1959. It was inaugurated by the then Prime Minister of India, Pandit Jawahar Lal Nehru.
BLK has a unique combination of the best in class technology, put to use by the best names in the professional circles to ensure world-class health care to all patients.

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Spread on five acres of land, with a capacity of 700 beds,
BLK Super Speciality Hospital is one of the largest tertiary care private hospitals in the country,
BLK has consistently ranked amongst the Top 10 Multi Super Specialty Hospitals in Delhi NCR.
The outpatient services are spread on two floors with 80 consultation rooms. All ambulatory services have been designed with the intent to create dedicated aides for all specialities, with their interventional services in close vicinity.
The hospital has 17 state-of-the-art well equipped modular operation theatres with three-stage air filtration and gas scavenging system to ensure patient safety. All the Operation Theatres are fitted with best in class pendants, operating lights, anaesthesia workstations and advanced information management system.
The Hospital has one of the biggest critical care programmes in the region with 125 beds in different intensive care units viz Medical, Surgical, Cardiac, Paediatrics, Neonatology, Neurosciences and Organ Transplant.
Each Critical care unit is equipped with high-end patient monitoring devices, ventilators and dedicated isolation rooms.
Liver and Renal Transplant Centres have been equipped with dedicated ICUs with individual HEPA filters, specialized instruments and equipment.
Awarded the Prestigious Gold Award at Hospital Management Asia (HMA), Bangkok (2013) and HMA Awards 2014.

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Indraprastha Apollo Hospital

No. of beds: 900
ICU Beds: 262
Airport: 20kms

Brief About:

Indraprastha Apollo Hospital is a flagship hospital of India’s foremost healthcare groups,the Apollo Group. It is a highly renowned multi-speciality facility that offers tertiary and quaternary care services to domestic and international patients.
The 900 bedded hospital is outfitted with the most modern technology for diagnostics as well as therapeutic purposes.
A team of highly trained medical professionals work under all the 52 specialities at the hospital.

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Indraprastha Apollo is an accredited hospital with international standard quality services for patient care and safety norms.
The hospital uses its own system, called The Apollo Standards of Clinical Care (TASCC), to maintain top standards for all kinds of treatment and procedures.
The Apollo Organ Transplant Program is one of the most successful programs in the country that has performed over 1627 transplants (410 Liver and 1210 Kidney), including 979 transplants (289 Liver and 690 Kidney) performed at the Transplant Program in Delhi.
It is the First Hospital in India to perform a Paediatric Liver Transplant in 1998. They have successfully performed various kinds of liver transplant for different kinds of liver conditions.
Indraprastha Apollo Hospital has some world-reputed surgeons and specialists who are the pioneers of their specialities, especially in Cardiology and Neurology.
The hospital has won many national and international accolades and continues to be one of the top healthcare service providers in India.
It is the first hospital in India to get international accreditation by international (JCI) consecutively for the fourth time

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Fortis Memorial Research Institute

Number of beds:   1000
ICU Beds:     298
Airport Distance:  17 KMs

Brief About:

Fortis Memorial Research Institute was established in 2001.
It is an outstanding multi-speciality quaternary care hospital,having the top-notch infrastructure, advanced equipment, highly qualified and experienced medical professionals and super sub-specialists.
Fortis Hosptial Gurgaon is an advanced centre of excellence in Robotic Surgery, Neurosciences, Oncology, Renal Sciences, BMT, Organ Transplants, Orthopaedics, Cardiac Sciences and Obstetrics & Gynaecology.

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JCI & NABH Accredited Hospital, NABL Accredited Lab, NABH Certified Nursing Excellence, NABH Accredited Blood Bank
FMRI is a 1000 bedded and 15 Operation theaters and over 400 diagnostics centres (including JVs).
Medical facility endowed with a dedicated team of 200 world-renowned doctors, covering a number of specialities, who aim to provide the best quality medical care to all the patients, national as well as international.
This hospital is well set up with the latest technologies and equipment throughout all the specialties and research labs, which are accredited by NABL.
This ensures that the patients at FMRI receive diagnostic results and treatment with high accuracy and in minimum time.
With a vision for the community, FMRI operates various speciality clinics such as, for Paediatrics, Nephrology, Neurology, Gynecology, Orthopedics, Oncology and many more, which provide long term healthcare management and follow up care.
FMRI is the premium healthcare provider and endeavours to be known as the “Mecca of Medicine” – the ultimate healthcare destination.

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Medanta The Medicity Hospital

Number of beds: 1250
ICU Beds: 300
Airport Distance: 18 KMs

Brief About:

Medanta – The Medicity is amongst India’s largest and most renowned multi-super speciality healthcare centre with 1250 beds, 29 super speciality units and more than 800 accomplished doctors.
Supported by state-of-art infrastructure, all the departments in the hospital are fully equipped with cutting-edge technology, modular Operation Theatre and modernized monitoring systems in ICUs.
The panel of doctors from Medanta, headed by A.S.Soin performed the first successful intestinal transplant in India.

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The team of Medanta has performed over 15,000 cardiac surgeries and 2500 joint replacement surgeries.
It Has performed over 500 living donor liver transplants. It is the highest number of liver transplants done in India and the 2nd highest in the world.
Further to its credits, the doctors at Medanta are highly trained experts with international repute and have contributed in making world records and claimed many firsts not only in India but on a global scale.
It has all kinds of procedures like Liver transplant, intestine,transplant and Knee Replacement surgery.
The hospital maintains a high standard of quality clinical care and is operational with the latest technologies like 256 Slice CT, Brain Suite with Intraoperative MRI Imaging, Da Vinci a surgical system with Robot for Minimally Invasive Surgery, Artis- Zeego Endovascular Surgical Cath Lab- with combined operating room.

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Sanar International Hospital

Number of beds: 130
ICU Beds: 35
Airport Distance: 20 Km

About Hospital:

Sanar International Hospital was established in 2018.
Sanar International Hospital founded by Mr. Naresh Kapoor.
Sanar International Hospital offers comprehensive advanced surgical care in specialties like Cancer, Heart, Blood and Marrow Transplant, Lung, Liver, and Neurosciences along with other major departments with advanced state-of-the-art facilities.

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It establishes itself as a center of excellence with world-class infrastructure, a team of experienced surgeons, doctors, and nursing staff.
Sanar International Hospitals is not only leaving a mark amongst domestic patients but also making it a preferable choice for patients from other countries.
Sanar International Hospital offers comprehensive advanced surgical care in over 15 Specialties.
The hospital’s skilled faculty is on numerous medical clinical & advisory boards and lectures nationally & internationally on a regular basis.
It focuses on High-End Complex Surgeries with cutting-edge technology to enable the carrying-out of the most complex surgical procedures with clinical excellence at par with anywhere in the world.
All facilities are based on the latest revolutionary and technological advancements of global standards particularly in radio diagnosis, research, clinical and surgical practices.
Hospital technology & Radio Diagnostic foray is of the latest generation of MRI, CT, Digital X-Ray, Ultrasound, pharmacy, ambulance & 24 hrs Transfusion Medicine, Laboratory & Emergency services.

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Providing a doctor’s opinion and proper quotation
Selecting the best hospital and doctor as per your case
Arranging a call with the doctor (if the case required)
Visa assistance, Providing Visa Invitation Letter (VIL)
Providing full guidance how to get Visa from your country
Providing total cost including treatment, air tickets, accommodation, and food
Assitance to book flight ticket from your country
Arranging airport pick up/ drop
Providing professional language interpreter
Booking accommodation and guest house as per your budget/ prefrence
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Arranging video consultation with specialist doctor if case requires

Paras Hospitals Gurgaon

Number of beds: 250
No. of ICU Beds: 65
Airport Distance: 18 Kms or 26 minutes to reach

About Hospital:

250 bedded flagship hospital was established in 2006 and it is a state of art multi-super speciality hospital providing a complete spectrum of advanced medical and surgical interventions with a comprehensive mix of inpatient and outpatient services.
The hospital offers around 55 super specialities under one roof and is supported by a team of doctors of international and national repute.
Paras Hospitals, Gurgaon, is also the first NABH accredited corporate hospital of Haryana. It is also the first hospital in the region to have a NABL accredited laboratory.

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Supported with expertise and cutting edge technology, Paras Hospitals, Gurgaon has one of the leading Neurosciences centres in the region with all the facilities under one roof.
It is also one of the few centres where deep-seated tumours are operated upon. Moreover, it is the first private hospital in Delhi NCR to have a standalone Image Guided Tumour Navigation Surgery Technology.
Paras Hospitals understands and abides by its motto-Partners in Health– and aims at becoming the ultimate caregiver for the community.

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Manipal Hospital Bangalore

Number of beds: 600
ICU Beds: 124
Airport Distance: 18 KMs

About Hospital:

Established in the year 1991. Manipal Hospital HAL Airport Road is a multi-specialty hospital.
The hospital has 600 in-patient beds. The NABH and NABL accredited facility is among the top 10 multispecialty hospitals in India.
It is prominent for making use of high tech equipment and systems like IBM Watson technology for oncology patients.

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Manipal Hospital HAL Airport Road offers clinical expertise in over 60 specialties It is world renowned for its high-quality infrastructure and cutting-edge technology.
The medical experts at this hospital offer their skills to both national and international patients. It is the largest healthcare brand in India.
Manipal Hospital is ranked as the Best Hospital in Bangalore for the past 8 years by The Week Magazine.
Ranked among the top 5 hospitals in “INDIA’S MOST CARING HOSPITALS” survey.
The hospital Won the prestigious Golden Peacock National Quality Award 2005 in the Service category.
Manipal Hospital aims at providing supreme and affordable tertiary healthcare to all.

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Max Super Specialist Hospital Saket

Number of beds: 500
ICU Beds: 267
Airport Distance: 13 KM

Brief About:

Max Super Speciality Hospital at Saket is one of the topmost healthcare service
Providers in India. The multi-super speciality hospital has a capacity of over 500 beds, 250 functional beds. It is equipped with state-of-the-art facilities, advanced technologies.
With the help of over 300 leading specialist Doctors, strong nursing staff, and state-of-the-art innovative medical tools.

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Max Hospital, Saket aims to provide the highest standard of medical care to the patients, right from admission and all the way to the patient discharge.
Max Smart Super Speciality Hospital, Saket, offers the advantage of integrated medical care in a multidisciplinary setting provided by a faculty of highly qualiﬁed doctors, nurses, & healthcare professionals.
Max Smart Super Speciality Hospital, Saket, is a regional hub for complex procedures such as neurovascular intervention, targeted cancer treatments, heart surgeries, orthopaedic surgeries, liver & kidney transplant, and fertility treatments.
With over 35 Speciality units, this renowned hospital caters to many patients from different parts of India as well as abroad on an everyday basis.
The super specialty hospital is well known for having Asia’s first and the world’s third BrainSUITE technology.
It is an advanced Neurosurgical operation theatre, which allows the medical team to use MRI during the surgery. This sophisticated technology can be used for various kinds of brain surgery.
Max Hospital group is also the first super speciality tertiary care centre that has the facility for advanced cardiac life support ambulances and air evacuation service.

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Dr. Rela Institute and Medical Centre

Number of beds: 450
ICU Beds: 130
Airport Distance: 8 KMs

About Hospital:

Dr. Rela Institute & Medical Centre was established under the leadership of Prof. Mohamed Rela, a world-renowned surgeon in the field of Liver Surgery and Transplantation.
Dr. Rela made a world-record by performing a Liver Transplantation on a 5-day old baby and made his name in the Guinness Book of Records.
Dr. Mohamed Rela, who has performed more than 4000 liver transplant surgeries.

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Dr. Rela Institute & Medical Centre is a multi-super specialty hospital.
The hospital is committed to being an internationally significant health care system with the state-of-the art infrastructure facilities.
Dr. Rela Institute & Medical Centre houses one of the world’s largest dedicated liver intensive care units.
Dr. Rela Institute & Medical Centre is led and managed by world-renowned doctors who are committed to healthcare.
Hospital has trained team of staff and nurses, who are available 24*7 hours for patients.

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CK Birla Hospital

Number of beds: 75
ICU Beds: 15
Airport Distance: 20 Km

About hospital:

The CK Birla Hospital for Women aims to improve the quality of healthcare with an emphasis on UK NHS guidelines for nurse and midwife training with policies and protocols adapted from UK’s National Institute for Health & Care Excellence (NICE) guidelines.
Our state-of-the-art technology and facilities which have been set up by a team of international consultants.
The hospital, spread over 78,000 sq ft having spacious patient rooms and suites with all amenities, outpatient rooms, advanced labour and recovery rooms, state-of-the-art diagnostics, physiotherapy unit, an advanced IVF unit with a modular egg collection theatre, andrology lab, IVF lab, IUI/embryo transfer facility and a cryo store.

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We offer a complete range of basic and advanced surgical sciences for both women and men.
We offer the most comprehensive program for breast cancer prevention.
We are the only hospital in Gurgaon to offer Medical Tactile Examination of the Breast which uses the enhanced touch of trained visually impaired women for early detection of Breast Cancer under the supervision of our experts.

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We offers these Services

Providing a doctor’s opinion and proper quotation
Selecting the best hospital and doctor as per your case
Arranging a call with the doctor (if the case required)
Visa assistance, Providing Visa Invitation Letter (VIL)
Providing full guidance how to get Visa from your country
Providing total cost including treatment, air tickets, accommodation, and food
Assitance to book flight ticket from your country
Arranging airport pick up/ drop
Providing professional language interpreter
Booking accommodation and guest house as per your budget/ prefrence
Providing help in money exchanging
Providing local sim card
Arranging video consultation with specialist doctor if case requires

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