At a glance
Chemotherapy for blood cancers is a treatment that uses powerful drugs to kill or slow the growth of cancerous blood cells in the body.
Blood cancers such as leukaemia (cancer of the white blood cells), lymphoma (cancer of the lymphatic system), and myeloma (cancer of plasma cells in the bone marrow) all involve cells that multiply out of control. Chemotherapy drugs travel through the bloodstream and target these fast-dividing cells, disrupting their ability to copy themselves and survive. Because the drugs reach cells throughout the body, chemotherapy can treat cancer even when it has spread to multiple sites.
Medical Condition
Doctors use chemotherapy when blood cancer cells need to be reduced, eliminated, or brought under control. The exact drugs and schedule depend on the type and stage of cancer, the patient's age and overall health, and whether treatment is given to cure, control, or relieve symptoms.
- Acute lymphoblastic leukaemia (ALL), a fast-growing cancer of lymphoid white blood cells
- Acute myeloid leukaemia (AML), a fast-growing cancer of myeloid white blood cells
- Chronic lymphocytic leukaemia (CLL), a slower-growing cancer of mature lymphocytes
- Chronic myeloid leukaemia (CML), particularly in combination with other treatments
- Hodgkin lymphoma, a cancer of specific immune cells called Reed-Sternberg cells
- Non-Hodgkin lymphoma, a large group of lymphatic cancers with varying behaviour
- Multiple myeloma, cancer of plasma cells that produce abnormal antibodies
- Preparation before a stem cell transplant (called conditioning therapy), to clear the bone marrow
Chemotherapy is not always the first or only option. Your haematologist (blood disease specialist) may advise against it or delay it in certain situations.
- Severe infection that has not yet been controlled
- Organ function (heart, liver, or kidney) too impaired to safely process the drugs
- Certain slow-growing cancers where watchful waiting causes less harm than treatment
- Pregnancy, particularly in the first trimester, unless the risk of delaying treatment is very high
Risks & Complications
Chemotherapy drugs affect fast-dividing healthy cells as well as cancer cells, which is why side effects are common and can range from mild to serious.
- Nausea and vomiting, often manageable with anti-nausea medication
- Fatigue (extreme tiredness) that can last throughout the treatment course
- Hair loss, usually temporary; hair typically regrows after treatment ends
- Increased risk of infection due to a drop in white blood cells (neutropenia, meaning too few infection-fighting cells)
- Anaemia (low red blood cell count), causing breathlessness and pale skin
- Easy bruising or bleeding due to low platelets (thrombocytopenia, meaning too few clotting cells)
- Mouth sores and difficulty swallowing
- Loss of appetite and unintended weight loss
- Numbness or tingling in the hands and feet (peripheral neuropathy, nerve damage caused by the drugs)
- Liver or kidney stress, which is why blood tests are checked regularly during treatment
- Increased risk of a second cancer in the years after treatment, though this is uncommon
- Fertility effects: some drugs can affect the ability to have children, so egg or sperm banking is often discussed before treatment starts
Preparation & Procedure
Before chemotherapy starts, the medical team runs a series of assessments to make sure the body can tolerate the drugs and to set a baseline for monitoring changes during treatment.
Patients are usually asked to stop certain medications, particularly blood thinners and anti-inflammatory drugs, before some cycles. Smoking and alcohol are best avoided throughout treatment because they can worsen side effects and interfere with how the body clears the drugs. Fasting requirements depend on the specific drug combination; your care team will give you exact instructions for each cycle.
Tests run before treatment typically include a full blood count, kidney and liver function tests, bone marrow biopsy (taking a small sample of bone marrow to confirm the cancer type and extent), imaging such as CT or PET scans, and heart function tests if certain drugs known to affect the heart are planned. Fertility counselling is also offered before treatment begins.
The procedure itself generally follows these steps, though the exact sequence varies by hospital and drug regimen:
- A port (a small device implanted under the skin) or a central line (a thin tube inserted into a large vein) is placed if multiple cycles are planned, to protect smaller veins from repeated needle insertions
- Blood tests are checked on the day of each cycle to confirm counts are safe enough to proceed
- An anti-nausea medication is given first, usually through a drip
- The chemotherapy drugs are delivered, most often as an intravenous (IV) drip directly into the bloodstream; this can take anywhere from thirty minutes to several hours depending on the regimen
- Some drug combinations also include oral tablets taken at home on specific days of the cycle
- For cancers affecting the brain or spinal fluid, drugs may be injected directly into the fluid surrounding the spine (intrathecal chemotherapy)
- After the infusion, the patient is observed for a short period before going home or being admitted to the ward
Aftercare
Recovery from each chemotherapy cycle is gradual, and the care team monitors blood counts closely because the lowest point, called the nadir (the point at which blood cell numbers drop the most), usually occurs one to two weeks after each infusion.
- Hospital admission may be required after each cycle or only if complications arise, depending on the drug regimen and the patient's baseline health
- Blood count checks are done frequently, often weekly, to catch infections or bleeding risks early
- Fever during a low-count period is treated as a medical emergency; patients are usually advised to go to hospital immediately if temperature rises
- Good hand hygiene and avoiding crowds or people with active infections help reduce the chance of catching illness while the immune system is suppressed
- A high-calorie, nutritious diet is encouraged; a dietitian may be part of the care team
- Gentle activity such as short walks is generally encouraged between cycles when energy allows, as complete bed rest can weaken the body further
- The central line or port site needs to be kept clean and dry, and nurses usually demonstrate the dressing routine before discharge
- Mouth care, such as gentle rinsing with recommended solutions, helps prevent and manage mouth sores
- Follow-up appointments include blood tests and, at set intervals, repeat bone marrow biopsies or scans to assess how well the cancer is responding
- Emotional support through counselling or patient support groups is offered in many centres, as anxiety and low mood are common during long treatment courses
- Fertility follow-up is arranged for patients of reproductive age once treatment is complete
Cost & What Determines It
Chemotherapy for blood cancers is one of the more variable medical expenses a patient can face, because the total cost depends on a long list of factors that differ between individuals, hospitals, and countries.
- Type and stage of blood cancer: aggressive cancers requiring intensive regimens cost more than slow-growing cancers managed with simpler drug combinations
- Number of cycles: a full course can range from a few cycles to two or three years of maintenance therapy
- Drug regimen: some newer targeted drugs or immunotherapy agents added to standard chemotherapy are significantly more expensive than older drug combinations
- Hospital class and country: a university hospital in a high-income country charges differently from a private hospital in a regional medical hub
- Inpatient versus outpatient delivery: cycles that require hospital admission cost more than those given in a day-treatment unit
- Bone marrow biopsy and imaging at each assessment point
- Central line or port placement and maintenance
- Growth factors (injections given to stimulate white blood cell recovery between cycles)
- Blood transfusions or platelet transfusions if needed during treatment
- Anti-nausea, antibiotic, and antifungal supportive medications
- Fertility preservation procedures if chosen before treatment begins
Most hospital packages cover the drug infusions, nursing care, and routine blood monitoring during an agreed number of cycles. Items that are commonly billed separately include emergency admissions for complications such as fever with low white cell count, additional imaging ordered during treatment, specialist consultations outside the core haematology team, and any stem cell transplant if this becomes part of the plan.
BPJS Kesehatan and most Indonesian private insurance policies do not cover treatment received outside Indonesia, so patients who travel abroad for chemotherapy typically pay out of pocket or through an international private health insurance plan that explicitly covers overseas treatment. Before travelling, ask the hospital abroad for a written cost estimate that breaks down each phase of treatment. Unexpected mid-course changes, such as switching drug regimens because of side effects or poor response, can add costs that were not in the original quote, so it is worth asking how those scenarios are handled.
Frequently Asked Questions
How many chemotherapy sessions will I need for blood cancer?
The number of sessions depends on the specific type of blood cancer you have, such as leukaemia, lymphoma, or myeloma, and how your body responds to treatment. Most plans are organised into cycles, each lasting several weeks, and the total number of cycles can range from a few to many months of treatment. Your haematologist (blood cancer specialist) will decide on the schedule after reviewing your diagnosis and test results.
What does chemotherapy feel like, and will I be in pain?
Most people do not feel the chemotherapy drugs entering their body, but side effects can appear in the days that follow, including fatigue, nausea, mouth soreness, and a higher chance of infection. The intensity of these effects varies from person to person and depends on which drugs are used. Your medical team will give you supportive medicines to reduce discomfort and will monitor you closely throughout each cycle.
How soon will I know if the chemotherapy is working?
Doctors usually assess your response after one or two cycles by checking blood counts and sometimes repeating a bone marrow test or imaging scan. Early signs that treatment is working may include improving blood results or shrinking of swollen lymph nodes (glands in the neck, armpit, or groin). If the response is not as expected, your haematologist may adjust the treatment plan.
How much does chemotherapy for blood cancer cost?
The cost varies based on the number of treatment cycles needed, the specific drug regimen your doctor prescribes, whether you need to stay in hospital during infusions, and the class of hospital you choose. Some blood cancer treatments also involve supportive medicines and regular laboratory tests that add to the overall expense. Requesting a written treatment estimate from the hospital is the most reliable way to understand what your care will cost.
This page is general information, not a substitute for medical advice. Every case is different. Your doctor decides what is right for you.
