ENA family looking for leukaemia treatment abroad has usually heard the word “induction” already, but not what matters most: how long it takes, whether the patient can go home between courses, and why one hospital offers chemotherapy while another talks about a transplant straight away.
This page explains how chemotherapy for leukaemia in Germany works: its stages, how long the hospital stay lasts, what helps the patient through it and when transplantation enters the conversation. In short, it is long inpatient treatment following a protocol, not an infusion every three weeks, and the trip is planned around that. For the disease as a whole, see the page on leukaemia treatment in Germany.
Why treatment depends on the type of leukaemia
Treatment depends on the type because leukaemia is not one disease. In the acute forms, immature cells called blasts crowd out normal blood production within weeks, so treatment starts urgently. In the chronic forms the timescale is years, and some patients are watched for a long time without any treatment at all.
In practice, intensive chemotherapy following a protocol, a plan of drugs, doses and check-ups written in advance, remains the basis in acute myeloid and acute lymphoblastic leukaemia. In the lymphoblastic form the protocol is longer and includes prophylaxis of the nervous system, with drugs also given into the spinal fluid. This form has its own page on acute lymphoblastic leukaemia.
In some forms chemotherapy is not the main tool: chronic myeloid leukaemia is now treated mainly with tablets that block one particular protein in the tumour cell, and chronic lymphocytic leukaemia with modern targeted drugs. Those are separate subjects; this page is about intensive chemotherapy in acute leukaemia.
The stages of treatment
Treatment runs in stages: induction, consolidation, maintenance in lymphoblastic leukaemia and, where indicated, a transplant. Induction is the first and most intensive stage, meant to clear the bulk of the leukaemic cells and achieve remission, when standard tests no longer find signs of leukaemia in the blood and bone marrow. It happens in hospital and takes weeks, not days. The method in general is explained on the page on chemotherapy in Germany.
Consolidation follows: repeated courses that secure the result, without which the disease usually returns quickly. In lymphoblastic leukaemia it is followed by long maintenance therapy, which runs for months, mostly as tablets, and is usually given at home under a haematologist’s supervision.
The result is checked by a bone marrow aspiration after the course and by measuring minimal residual disease, a sensitive test that finds single leukaemic cells where an ordinary microscope sees nothing. These results, together with the genetics of the disease, decide whether chemotherapy continues or a transplant is prepared; see the page on stem cell transplantation in Germany.
How it is tolerated and what is done to help
Intensive chemotherapy is hard, and the main danger comes after the infusions. A course is followed by aplasia, when the patient’s own blood cells are barely produced and infection is the real danger. That is why treatment happens on a ward with special rules, and visits are restricted.
Everything rests on supportive care: transfusions of red cells and platelets until the patient’s own blood recovers, antibiotics and antifungals, medication that prevents nausea, a central venous line, a thin tube in a large vein for drugs and blood tests without new needles, and careful nutrition. Teeth are treated before induction: a tooth that hardly hurts now can cause a severe infection, even blood poisoning, during aplasia, when dental treatment itself is far riskier.
Before the first course, doctors discuss fertility preservation with younger patients: chemotherapy can damage fertility, and the decision is made in advance and cannot be taken back. Where possible, men have sperm frozen before treatment; women with acute myeloid leukaemia usually lack the time for hormone stimulation and egg freezing before urgent induction, so this is discussed in remission, before consolidation. This is what the current guideline of the German Society of Haematology and Medical Oncology on acute myeloid leukaemia (in German) advises.
What this means for the trip
For the trip this means that induction cannot be fitted into a week abroad. It means weeks in hospital, often many weeks, then further courses, and no flying between them in the middle of aplasia. So people most often come to Germany either for a second opinion and a review of the diagnosis, or when the whole treatment is planned here from the start.
What can be done quickly is a review of the bone marrow material and the genetic tests in a German laboratory, a clarified risk group and a written plan; sometimes that alone changes the approach without moving the patient. For the money side, see leukaemia treatment cost in Germany: the sums are named by the hospital in its estimate, not by this page.
Where this is treated in Germany
Treatment is concentrated in haematology departments with their own transplant unit and laboratory. Among AlenMed’s partners are München Klinik Bogenhausen, where the department of haematology, oncology, stem cell transplantation and palliative medicine is headed by Prof. Tobias Herold; the Red Cross Hospital in Munich, with its department of internal medicine III (haematology and oncology) and its centre for haematological neoplasms under Prof. Marcus Hentrich; and the University Hospital Freiburg, whose clinic of internal medicine I (haematology, oncology and stem cell transplantation) is headed by Prof. Justus Duyster.
Before starting, ask which protocol will be used, whether the hospital has a transplant unit, who looks after the patient between courses and what is in place if intensive care becomes necessary.
Frequently asked questions
Which drugs are used to treat leukaemia?
The main groups are cytostatics, targeted drugs and supportive medication; the exact regimen is chosen by a haematologist. In acute leukaemia, cytostatics, which destroy rapidly dividing cells, are combined by protocol, with targeted drugs added for certain genetic findings. Chronic myeloid leukaemia is treated with tablets called tyrosine kinase inhibitors, chronic lymphocytic leukaemia with targeted drugs, sometimes plus antibodies. Supportive drugs include antibiotics, antifungals and anti-nausea medication.
How long does chemotherapy for leukaemia take?
It depends on the form of leukaemia and the protocol, but it is always several stages, not one course. Induction takes weeks in hospital, followed by repeated consolidation courses; in acute lymphoblastic leukaemia, maintenance therapy then continues for many months, usually at home. A transplant makes the plan longer. The haematologist sets the schedule once the genetics and the response to the first course are known.
Can the patient go home between chemotherapy courses?
Not in the middle of aplasia: flying is impossible then, and the patient stays in hospital, protected from infection. So treatment in Germany is usually planned either entirely here, with accommodation near the hospital for the whole period, or as a second opinion with a written plan followed at home. When travel is possible is decided by the treating haematologist.
How AlenMed arranges treatment
AlenMed starts with the documents: bone marrow results, slides and blocks, immunophenotyping, cytogenetics and molecular tests, discharge letters and the list of courses already given go to a German haematology department. The doctor says what is confirmed, what has to be repeated on site and what the plan looks like stage by stage. Then come a written estimate, a visa invitation, a place for a companion and an interpreter at appointments and at the discussion of the report.
Plan ahead for long-term accommodation near the hospital, a companion for the whole period, enough of the usual medication and translation of the final documents for the haematologist at home.
This material is for information only and is not an offer. The treatment plan is decided by a doctor at an in-person consultation.
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