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  • decodeMR Team

Leukemia - An ailment altering human's haema - Q&A session with an Expert

(Focus - India)


An established hematologist from India - Dr. Pawan Kumar Singh connected with the decodeMR team for a short discussion on Leukemia. We hope that the details and the facts shared by the doctor will help our readers in understanding this disease better.


Dr. Pawan Kumar Singh is a hematologist, designated as Senior Consultant & Head, serving currently in Artemis Hospital.




For AML, a lot of targeted molecules are FDA approved as well, and drugs like, enasidenib, Ivosidenib is also available (oral medications). In addition, there is a liposomal 3+7 induction type of chemotherapy.


Thank You Doctor for taking part in our small discussion.

Leukemia is the most common cancer among children and teenagers accounting for almost one out of three cancers. Is there any genetic factor involved?

Dr. Pawan: In most cases of pediatric leukemia, the genetic factors are generally not involved. But there are rare cases (approximately 5% to 10%), where genetic factors have been reported, and usually, they are present in the kids who are of less than one year of age or have down syndrome, and these patients can also develop AML M-7 type of leukemia, plus, there are other specific cytogenetic abnormalities like level two to three abnormalities or ProB ALL. Infant leukemia can have genetic factors involved.

Acute Myeloid Leukemia is considered as one of the deadliest types of leukemia, with a five-year survival rate just above 25%. So, are there any recent advancements or ongoing trials improving survival in AML patients?

Dr. Pawan: In AML treatment, the 25% survival rate of AML treatment is old data. The recent international collaborative data shows 40% to 50%, and some AML cases even do better, like some with lower risk AML do not even need a high level of treatment like bone marrow transplant, plus, a lot of recent advancements are also available.

For AML, a lot of targeted molecules are FDA approved as well, and drugs like, enasidenib, Ivosidenib is also available (oral medications). In addition, there is a liposomal 3+7 induction type of chemotherapy. So, we see a lot of development, occurring in the past 10-15 years, and they are also FDA approved; but some are not available in India as of now. Also, I want to mention that Venetoclax is a very good drug and is showing promising results in the treatment of elderly AML.

When should one consider doing Hematopoietic Stem Cell Transplantation?

Dr. Pawan: For all adult newly diagnosed AML patients who are at intermediate risk or belong to the high-risk category, an allogeneic bone marrow transplant should be done upfront because we know that these patients are not going to do well without the bone marrow transplant.


If a person is diagnosed with Leukemia and the disease is under control, then they should immediately get COVID vaccination. Recent guidelines are also there, which mention that once the patient has recovered and is fit, then they should be given COVID vaccination.

So, doctor, will that be effective in increasing the survival among patients?

Dr. Pawan: Obviously, with the transplant, the outcome of high-risk AML patients can be improved by doing an allogeneic bone marrow transplant.

A research found that patients with leukemia have a uniquely higher risk of developing COVID-19 for multiple reasons associated with both their underlying diagnosis and the treatment as well as patient-specific factor. So, in this context, how has COVID 19 pandemic impacted Leukemia treatment and management in India?

Dr. Pawan: It has definitely impacted the outcome because leukemia patients cannot be managed at home or in daycare services. So, they have to get admitted. And if they develop COVID infection, then the management will be very difficult for these patients because they are in an immunocompromised situation and the COVID infection can be severe in these groups of patients.

If a person is diagnosed with Leukemia and the disease is under control, then they should immediately get COVID vaccination. Recent guidelines are also there, which mention that once the patient has recovered and is fit, then they should be given COVID vaccination.

So, now has it been changed doctor, with the vaccine availability and COVID being under control?

Dr. Pawan: The management of acute leukemia is difficult as compared to chronic leukemia, as it can be managed at home because, nowadays, for CLL treatment, a lot of oral drugs are available in India, like Ibrutinib, acalabrutinib. So, these are the kind of tablets that patients can take at home. So, in this COVID situation, patients also avoid coming to the hospital, and even we as physicians also advise patients not to have frequent hospital visits.


Thus, oral drugs are better than chemotherapies because for chemotherapy a patient has to visit hospital and daycare services. And, for chronic leukemias, the management is possible with oral drugs, but in acute leukemia, the patients have to get admitted to the hospital, as there is no choice for them.

CART-T cell therapies are considered as a new era in cancer immunotherapies. So, could you please share your thoughts on CART-T cell therapies?

Dr. Pawan: Yeah, CART-T cell therapy is very important. We, oncologist and hemato-oncologist, are eagerly waiting for the CART-T cell therapy to be made available in India. Right now, it is not available in India. CAR -T cell therapy has been approved for the treatment of CLL, ALL, and multiple myeloma. I think that maybe in the coming two or three years, the CART-T cell therapy will be available.

For those patients who have multiple relapses, refractory, no medicine, and no treatment are working, even after transplant they have relapses, so, for these group of patients, CART-T cell therapy is very effective, and it should be made available as early as possible. At present, the patient has no choice, and they have to travel abroad to get this therapy and it is very costly.

So, if it is made available in India do you foresee any challenge in the CART-T cell therapies?

Dr. Pawan: If it is made available in India then it has to be cost-effective, we cannot compare the cost of this therapy in the US or Europe to India because they have to bring down the cost so that we can offer this therapy and give benefit to most of the Indian patients. So, this definitely makes it challenging.

Doctor, before we conclude, what is your takeaway message for leukemia patients and caregivers?

Dr. Pawan: My takeaway message for leukemia patients, acute leukemia particularly, including their friends and family members, will be that they should not delay the treatment. It should be started as early as possible from the best center. And the other issue is about the cost because leukemia treatment is costly.

So, with this platform, I want to urge every person who can afford medical insurance, should have all have medical insurances. For this kind of costly treatment (it is not only leukemia), if they have medical insurance then it is going to help them.

So, right now, it is not so popular, and everyone is not going for medical insurance. But, once they are diagnosed, they struggle for money. It is comparatively easier for the patients who are government employees as they can get the treatment facility at a government hospital or government empaneled hospital. For those patients who are paying from their own pocket, it is better to have medical insurance.

Thank you so much Doctor for your insights.

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