Leukemia Treatment in Israel

Leukemia (leukemia, blood cancer) is a heterogeneous group of malignant diseases of the hematopoietic system, where immature bone marrow cells displace normal hematopoiesis. The Ichilov (Sourasky) Medical Center in Tel Aviv accepts patients with acute myeloid (AML), acute lymphoblastic (ALL), chronic myeloid (CML), and chronic lymphocytic (CLL) leukemia, including patients after relapse and those who have been denied therapy in other countries. The Hematology Institute at Ichilov works in conjunction with next-generation sequencing laboratories, a bone marrow transplantation department, and a CAR-T program. The diagnostic protocol, including immunophenotyping, karyotyping, and NGS panel, is completed within 5–7 working days. For adult patients, induction "7+3" with targeted additions (midostaurin, gilteritinib, ivosidenib), Hyper-CVAD regimens, blinatumomab, inotuzumab ozogamicin, as well as CAR-T drugs tisagenlecleucel are available. This article discusses how leukemia is treated at Sourasky: from the initial consultation to allogeneic transplantation and MRD monitoring after discharge.

What is this disease

Leukemia is not a single disease but a group of tumors that differ by the type of precursor cell, rate of progression, and molecular profile. The WHO classification distinguishes acute forms (AML and ALL), where the tumor clone is represented by blasts and without treatment the disease is fatal within weeks or months, and chronic forms (CML and CLL), where the course is slower and often allows outpatient therapy for years. According to the Israeli cancer registry and SEER data, the overall incidence of all forms of leukemia in developed countries is 13–15 cases per 100,000 people per year; ALL predominates in children (peak age 2–5 years), while AML, CML, and CLL are predominantly adult diseases, with a median age of onset of 65–70 years for AML and CLL.

Risk factors include prior chemotherapy and radiation therapy (therapy-associated AML), exposure to benzene and petroleum products, ionizing radiation, smoking, hereditary syndromes (Down syndrome, Li-Fraumeni syndrome, Fanconi anemia), myelodysplastic syndrome, and myeloproliferative diseases. For CLL, family predisposition plays a significant role: the risk is increased 6–8 times in close relatives. Key molecular drivers include the BCR-ABL1 translocation (Ph chromosome) in CML and Ph-positive ALL, mutations in FLT3, IDH1/2, NPM1, TP53 in AML, deletions of 17p and mutations in TP53 in CLL. Understanding this biology determines the choice of therapy and prognosis, which is why at Sourasky, the molecular profile of the tumor is established before treatment begins.

The clinical picture consists of a syndrome of suppression of normal hematopoiesis: anemia (weakness, shortness of breath on exertion, pallor), thrombocytopenia (petechiae, nosebleeds, gum bleeding, bruising), neutropenia and associated infections. Bone pain, weight loss, prolonged low-grade fever, night sweats, and enlargement of lymph nodes, liver, and spleen are often present. In CML and some cases of CLL, the diagnosis is made incidentally through blood tests in asymptomatic patients. In some patients with ALL and AML, the first manifestations are severe bacterial infections or hemorrhagic syndrome requiring emergency hospitalization, which is why Ichilov has a 24-hour hematology patient intake line and isolation rooms for neutropenic patients.

Diagnosis at Ichilov Clinic

The diagnostic algorithm at the Sourasky Hematology Institute is structured to obtain a complete disease profile necessary for therapy assignment within 5–7 working days. The first stage involves an extended complete blood count with manual microscopy of the smear, biochemistry with LDH and uric acid, coagulation profile, virological screening (HIV, hepatitis B and C, HTLV-1, CMV, EBV), blood group, and HLA typing for transplantation planning. Simultaneously, a trepanobiopsy of the iliac crest with bone marrow aspiration is performed under local anesthesia; if poorly tolerated, the procedure is done under short-term sedation.

The second stage involves morphological and cytochemical evaluation of the bone marrow, immunophenotyping using multicolor flow cytometry (8–10 colors), allowing the determination of the lineage of cell differentiation (myeloid vs B- vs T-lymphoid), maturation stage, and the presence of prognostic markers (CD34, CD117, CD19, CD22, CD20, CD5, CD23, ZAP-70) in one run. Concurrently, material is collected for cytogenetic studies (karyotyping with G-banding), FISH panel for diagnostically significant rearrangements (BCR-ABL1, MLL/KMT2A, TCF3-PBX1, ETV6-RUNX1, PML-RARA, 11q, 13q, 17p), and an NGS panel for myeloid or lymphoid mutations from 40–70 genes. For CLL, an analysis of IGHV status is added — hypermutated or unmutated, which is critical for prognosis and choice between BTK inhibitors and BCL2 inhibitors.

The third stage is the assessment of prevalence and comorbidity. Adult patients with AML and ALL undergo lumbar puncture to exclude central nervous system leukemia (mandatory for ALL, with simultaneous intrathecal chemotherapy prophylaxis), echocardiography to determine ejection fraction before anthracyclines, lung function tests, and dental sanitation. If there is suspicion of extramedullary involvement or lymphoma involvement, PET-CT or MRI is performed. All results are integrated at an interdisciplinary oncological hematology council, which includes a hematologist, stem cell transplantation physician, pathologist, molecular diagnostics specialist, infectious disease specialist, and, if necessary, a pediatric oncologist. The patient receives a written conclusion with a plan in Russian or English.

Treatment Methods

At Sourasky, a full range of modern approaches proven effective in randomized studies and approved by the FDA/EMA is used. The choice of a specific protocol depends on the subtype of leukemia, molecular profile, age, and comorbidity of the patient.

Induction chemotherapy "7+3" for AML. The classic regimen consists of seven days of continuous infusion of cytarabine plus three days of anthracycline (daunorubicin or idarubicin). In patients under 60 years old, complete remission is achieved in 60–80% of cases. In the presence of FLT3-ITD or FLT3-TKD mutations, midostaurin is added to "7+3", which prolongs the median survival; the RATIFY study showed an absolute advantage in 4-year overall survival of about 7%. For IDH1 mutations, ivosidenib is used, and for IDH2 mutations, enasidenib, including in combination with azacitidine in elderly patients who are not suitable for intensive chemotherapy.

Consolidation and maintenance therapy for AML. After achieving remission, 2–4 courses of high-dose cytarabine (HiDAC) are administered or an allogeneic transplantation is performed depending on the risk group according to the ELN classification. In cases of relapse or refractory course with FLT3 mutation, gilteritinib is prescribed — a selective FLT3 inhibitor that showed a median overall survival of 9.3 months in the ADMIRAL study compared to 5.6 months with salvage chemotherapy. For APL (M3 variant), the standard has become the combination of all-trans retinoic acid (ATRA) with arsenic trioxide (ATO), allowing most patients to achieve long-term remission without intensive chemotherapy.

Induction for acute lymphoblastic leukemia. Adult patients with Ph-negative BCP-ALL and T-ALL are prescribed protocols from the GRAALL group or Hyper-CVAD (cycles A with hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with cycles B — high-dose methotrexate and cytarabine). For patients under 40 years old, pediatric-like protocols such as BFM-like are preferred, yielding better results than classic "adult" regimens. In Ph-positive ALL, a tyrosine kinase inhibitor — imatinib, dasatinib, or ponatinib for T315I mutation — is added to chemotherapy; remission rates reach 90–95%, and most patients are then indicated for allogeneic stem cell transplantation.

Immunotherapy for ALL. Blinatumomab — a bispecific antibody against CD19 and CD3, attracting the patient's own T-lymphocytes to destroy tumor B-cells — is used in MRD-positive remission and in relapsed B-cell ALL. Inotuzumab ozogamicin — a conjugate of anti-CD22 antibody with calicheamicin — shows remission rates of about 80% in relapsed BCP-ALL, where standard chemotherapy is effective in only 30%. Both drugs are available at Sourasky, including as a bridge to transplantation.

CAR-T cell therapy. Tisagenlecleucel (Kymriah) — genetically modified autologous T-cells with a receptor against CD19 — is approved for children and young adults up to 25 years old with refractory or multiply relapsed B-cell ALL. In the global registration study ELIANA, complete remission by 3 months was achieved in 81% of patients who previously did not respond to several lines of therapy. At Ichilov, CAR-T is conducted in an accredited center with a trained team for managing cytokine storms and neurotoxicity.

Treatment of chronic myeloid leukemia. CML is treated with BCR-ABL tyrosine kinase inhibitors on an outpatient basis. First-line treatment is imatinib; if there is insufficient response or high risk, second-generation inhibitors dasatinib, nilotinib, or bosutinib are used. For T315I mutation, the only effective oral drug remains ponatinib; for patients intolerant to other TKIs, asciminib — an allosteric inhibitor with a different binding mechanism — is available. Regular monitoring of BCR-ABL1 by quantitative PCR on the international scale (IS) every 3 months allows for timely detection of loss of response and switching of drugs. In some patients who achieve a deep molecular response MR4.5 for more than two years, an attempt to discontinue therapy under supervision — so-called treatment-free remission — may be possible.

Treatment of chronic lymphocytic leukemia. For CLL, there is no universal "first-line standard": the choice depends on age, comorbidity, TP53/17p status, and IGHV. Ibrutinib, acalabrutinib, and zanubrutinib — covalent BTK inhibitors taken orally for a long duration — have shown advantages over chemoimmunotherapy in progression-free survival in the RESONATE and ELEVATE-TN studies. The combination of venetoclax + obinutuzumab (BCL2 inhibitor with anti-CD20 antibody) provides a fixed-term therapy of 12 months with a high proportion of MRD-negative remissions (CLL14). In cases of double refractoriness to BTK and BCL2 inhibitors, pirtobrutinib (non-covalent BTK inhibitor) and CAR-T drugs available through compassionate use programs are used.

Allogeneic stem cell transplantation. Allogeneic stem cell transplantation remains the only potentially curative method for intermediate and high-risk AML, Ph-positive ALL, refractory forms of CML, and some cases of CLL with del(17p). At Sourasky, transplants are performed from related HLA-matched donors, unrelated donors from international registries, and haploidentical donors (usually a parent or child of the patient) with post-transplant cyclophosphamide. Conditioning is chosen based on age and comorbidity: myeloablative (Bu-Cy, Flu-Bu4) for younger patients, reduced intensity (Flu-Bu2, Flu-Mel) for patients over 55–60 years old. Autologous transplantation for leukemias is less common, mainly in certain intermediate situations.

Monitoring of minimal residual disease (MRD). After achieving clinical-hematological remission at Sourasky, monitoring of minimal residual disease continues using multicolor flow cytometry with a sensitivity of 10⁻⁴–10⁻⁵ or molecularly (quantitative PCR for BCR-ABL1, WT1, PML-RARA fusion gene, NPM1 mutations; NGS-MRD for clono-specific markers). MRD status is an independent prognostic factor: MRD negativity after induction in ALL correlates with a 5-year overall survival of over 70%, while MRD positivity indicates the need for intensification or stem cell transplantation. Monitoring is performed every 3 months for the first 2 years and then every 6 months.

Treatment Program — Stages

Stage 1 — Remote consultation and preparation. After contacting the website, a Russian-speaking coordinator requests discharge summaries, slides, and blocks of previous biopsies, and protocols of previously received treatments. The hematologist provides a preliminary conclusion and assessment of the feasibility of coming, usually within 24–48 hours. At the same time, an invitation for entry is arranged, a hotel near the Sourasky building is booked, and the first day of hospitalization is planned.

Stage 2 — Arrival and diagnosis. In the first 2–3 working days, the patient has blood tests, undergoes a hematologist examination, and if necessary, a trepanobiopsy of the bone marrow. The slides and blocks brought from the country of residence are sent for review in the Sourasky pathology laboratory. By the end of the first week, a complete diagnosis with immunophenotype, karyotype, and NGS profile is formed.

Stage 3 — Council and protocol selection. A multidisciplinary council formulates a treatment plan with alternatives. The patient (and, by agreement, the family) is explained the proposed sequence of courses, expected effectiveness, risks, and costs. Informed consent is signed.

Stage 4 — Active therapy. Induction courses for AML and ALL are conducted inpatient in isolated rooms of the hematology department with positive pressure. Courses of Hyper-CVAD, consolidation, support for ALL, administration of blinatumomab, inotuzumab, and tisagenlecleucel are according to the specific drug protocol. CML and CLL are often managed on an outpatient basis with weekly or monthly visits. Allogeneic stem cell transplantation takes 4–8 weeks of inpatient care plus outpatient monitoring until Day +100.

Stage 5 — Discharge and remote monitoring. After completing the active phase, the patient receives a detailed medical report in English, recommendations for follow-up, a plan for MRD monitoring, and contact details of the attending physician. MRD monitoring and therapy adjustment continue remotely with tests sent from the country of residence to the Sourasky laboratory or accredited partner laboratories.

Prices and Costs

The cost depends on the subtype of leukemia, the volume of molecular diagnostics, the protocol, and the need for transplantation. The ranges applicable for 2026 and calculated for international patients are approximately:

• Initial hematological consultation with examination and review of brought documents — about 550–750 USD.
• Comprehensive diagnostics (trepanobiopsy of the bone marrow, cytology, immunophenotyping, karyotype, FISH panel, myeloid or lymphoid NGS panel) — approximately 6,000–12,000 USD.
• Induction course "7+3" for AML with 4–5 weeks of hospitalization — from 55,000 to 90,000 USD depending on complications and the need for transfusions and antibiotics.
• Course of Hyper-CVAD or BFM-like induction for ALL — from 45,000 to 80,000 USD.
• Targeted and immunotherapy drugs (midostaurin, gilteritinib, ivosidenib, blinatumomab, inotuzumab) — cost is determined by supply and duration of the cycle, often 15,000–60,000 USD per month of therapy.
• Tyrosine kinase inhibitors for CML (imatinib, dasatinib, nilotinib) in outpatient management — from 3,000 to 8,000 USD per month, including PCR monitoring.
• CLL therapy with ibrutinib or the venetoclax + obinutuzumab regimen — approximately 8,000–15,000 USD per month.
• Allogeneic stem cell transplantation from a related donor — from 220,000 to 320,000 USD, from an unrelated or haploidentical donor — from 280,000 to 380,000 USD, including conditioning, infusion, management for the first 100 days, and treatment of mild to moderate graft-versus-host disease.
• CAR-T with tisagenlecleucel — the cost of the drug itself worldwide is about 475,000 USD, the total program with hospitalization and monitoring at Sourasky is calculated individually.

A precise estimate is prepared after diagnosis. Payment is made in stages, with an advance for diagnostics and the first treatment block. All calculations are in USD or in local currency at the current exchange rate.

Leading Doctors in the Field

Dr. Odelia Gur — head of the hematology department at Ichilov (Sourasky) Medical Center. A specialist of the highest category, she diagnoses and treats the entire spectrum of hematological diseases, including acute and chronic leukemias, and manages patients undergoing stem cell transplantation. Actively employs targeted and immunotherapeutic approaches, including BTK inhibitors, BCL2 inhibitors, and bispecific antibodies.

Professor Elizabeth Naparstek — a recognized expert in oncological hematology and stem cell transplantation, one of Israel's leading specialists in allogeneic stem cell transplantation and treatment of refractory forms of leukemia. Oversees complex cases, including those with family history and secondary leukemias after chemotherapy for solid tumors.

Professor Ofer Spielberg — head of the Hematology Institute at Rabin Medical Center, participates in Ichilov councils for complex cases of lymphomas and chronic leukemias. Conducts research in CAR-T therapy and bispecific antibodies, and is involved in international clinical protocols.

Dr. Ilya Kirshner — head of the thrombosis treatment service at Sourasky, manages hematology department patients with concomitant coagulopathies, thrombotic and hemorrhagic complications of chemotherapy. A Russian-speaking specialist, which simplifies communication for patients from the CIS.

FAQ

In what language do doctors communicate?

At Sourasky, there are Russian-speaking coordinators and some doctors speak Russian; all other consultations are conducted through an assigned medical translator present at all consultations. All final reports are issued in English and Russian.

What documents should be brought or sent in advance?

Discharge summaries for the entire observation period, originals or scans of blood test results over time, protocols of previous bone marrow biopsies, slides and paraffin blocks for review, PET-CT and MRI on disks, ECG and echocardiography, vaccination status. The more complete the data, the shorter the diagnostic stage.

How long does the leukemia treatment program at Ichilov last?

Diagnosis takes 5–7 working days. Induction for AML or ALL lasts 4–6 weeks of hospitalization. Consolidation lasts another 2–4 months with alternating inpatient courses and outpatient intervals. For allogeneic stem cell transplantation, the active phase with conditioning and monitoring until Day +100 takes 3–4 months. CML and CLL therapy is long-term, outpatient, with visits to the clinic 1–2 times a year.

Is an advance payment required and how is payment structured?

Yes, an advance is made for the diagnostic block; subsequent stages are paid based on the agreed estimate. During hospitalization, payment is usually made monthly. All invoices are issued in USD; if the actual cost deviates from the preliminary estimate by more than 10%, additional agreement is required.

Is there an interdisciplinary council and is it included in the cost?

Yes. The council, which includes a hematologist, a stem cell transplantation specialist, a pathologist, and a molecular diagnostician, is included in the cost of the diagnostic package. Based on its results, the patient receives a written treatment plan.

Is it possible to obtain a second opinion without coming to Tel Aviv?

Yes. Slides and blocks of biopsies, as well as test results and images can be sent by courier. Within 7–10 working days, you will receive a written expert opinion with recommendations and an estimated cost for treatment if you decide to come.

Does the clinic work with insurance companies?

Ichilov accepts most international insurance policies with prior authorization. The financial department prepares invoices in the format required by the insurer. Patients from the CIS whose insurance does not cover treatment abroad are billed directly.

How is monitoring organized after returning home?

The patient receives a plan for MRD monitoring, a referral form to a local laboratory, and, if necessary, an agreement with a partner laboratory for sending samples to Sourasky. Teleconsultations are held every 3–6 months; if there is concerning dynamics, an unscheduled visit may be possible.

How to obtain a treatment program

To start, send a request through the form on this page or contact a coordinator via messenger. Attach the latest discharge summaries, blood test results, and if already conducted, the myelogram. Within 24–48 hours, a hematologist at Ichilov will provide a preliminary conclusion and assess the feasibility of coming to us. You will then receive a preliminary estimate for diagnostics and the first treatment block, and the coordinator will assist with the invitation, visa, hotel, and transfer. Leukemia treatment at Sourasky (Tel Aviv) provides access to international protocols, comprehensive molecular profiling, and an experienced team guiding patients from induction to long-term MRD monitoring.