Blood cancers (leukemia, lymphoma and myeloma)

Key points

Blood cancers fall into three main groups: leukemias (cancers of blood-forming cells), lymphomas (cancers of lymphocytes in the lymph nodes and other tissues) and multiple myeloma (cancer of plasma cells) ^{[1, 2]}.
Today, an accurate diagnosis rests on combining the appearance of the cells under the microscope, the immunophenotype (flow cytometry) and genetic features, and this combination determines the choice of treatment ^{[1, 2, 4]}.
Oral targeted drugs have brought long-term disease control to many patients; for example, 10-year survival with imatinib in chronic myeloid leukemia was 83.3% ^[8], and ibrutinib and venetoclax have transformed the treatment of chronic lymphocytic leukemia ^{[9, 21]}.
Hematopoietic stem cell transplantation remains one of the pillars of treatment, especially for high-risk or relapsed disease ^[7].
In relapsed disease, salvage chemotherapy and stem cell transplantation ^{[7, 25]} and drug combinations such as pomalidomide, bortezomib and dexamethasone in myeloma ^[23] are the main options; CAR T-cell therapy and bispecific antibodies are newer options that mobilize the patient's own immune system against the cancer and have improved treatment outcomes in lymphoma, lymphoblastic leukemia and myeloma ^{[11, 14, 15, 16, 17, 18, 19]}.

What are blood cancers?

All blood cells, that is, red blood cells, white blood cells and platelets, are made in the bone marrow from blood-forming stem cells. A blood cancer develops when one of these cells, or a mature immune cell, acquires genetic changes and starts to multiply out of control. The World Health Organization classifies these diseases by the cell of origin and its genetic features ^{[1, 2]}:

Leukemia (blood cancer in the narrow sense): immature or abnormal cells build up in the bone marrow and blood. Its four main types are acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML) and chronic lymphocytic leukemia (CLL).
Lymphoma: a cancer of lymphocytes that usually shows up as enlarged lymph nodes and is divided into two large groups, Hodgkin lymphoma and non-Hodgkin lymphomas (such as diffuse large B-cell lymphoma, or DLBCL).
Multiple myeloma: a cancer of plasma cells (the antibody-producing cells) in the bone marrow that can damage the bones, the kidneys and blood cell production ^[5].

“Acute” types progress rapidly and need urgent treatment, whereas some “chronic” or indolent types may simply be monitored for years ^[3].

Detailed guides to each disease

Leukemia

Acute and chronic types of leukemia, symptoms, diagnosis and the latest treatments, from targeted drugs to immunotherapy. Read the leukemia page

Lymphoma

Hodgkin and non-Hodgkin lymphoma, staging with PET-CT, chemoimmunotherapy and immunotherapy, and novel treatments such as CAR T-cell therapy and bispecific antibodies. Read the lymphoma page

Multiple myeloma

Diagnostic criteria, three-drug and four-drug induction therapy, autologous stem cell transplantation and cellular therapies for relapsed disease. Read the multiple myeloma page

Signs and symptoms

The symptoms of blood cancers are often nonspecific and may be mistaken for more common illnesses. Many of them result from reduced production of normal blood cells in the bone marrow:

Anemia: fatigue, paleness, shortness of breath and palpitations
Fewer healthy white blood cells: frequent or prolonged infections and fever
Low platelets: easy bruising, bleeding gums or nosebleeds, tiny red spots on the skin
Painless enlarged lymph nodes in the neck, armpit or groin (especially in lymphoma)
B symptoms: unexplained fever, drenching night sweats and loss of more than 10% of body weight in 6 months
Bone pain (especially in the back or ribs), fractures after minor trauma, kidney problems or high blood calcium in myeloma ^[5]
An enlarged spleen and a feeling of fullness in the left side of the abdomen

For patients

Warning signs

For patients

When to see a doctor urgently

Fever with severe fatigue, unexplained and widespread bleeding or bruising, or paleness and shortness of breath that get worse over a few days to a few weeks may be a sign of acute leukemia and call for a prompt complete blood count (CBC). Most of these symptoms have benign causes, but they should not be ignored.

Risk factors

In most patients no clear cause of the blood cancer is found, and these diseases are usually neither contagious nor preventable. Some known factors increase the risk:

Older age: most types, except ALL, which is more common in children, occur more often in older adults.
Previous chemotherapy or radiotherapy: the World Health Organization recognizes myeloid neoplasms after cytotoxic therapy as a separate group ^[1].
Inherited genetic predisposition: some inherited mutations predispose to myeloid neoplasms ^[1].
Infections and immunodeficiency: some lymphomas are associated with Epstein–Barr virus (EBV) or immunodeficiency ^[2].
Precancerous conditions: monoclonal gammopathy of undetermined significance (MGUS) and smoldering myeloma are precursors of multiple myeloma and need regular follow-up ^[5].

Diagnosis and staging

Diagnostic pathway for blood cancers

1
Complete blood count (CBC) and peripheral blood smear
The first and simplest test; changes in blood cell counts or the presence of immature cells (blasts) on the blood smear set the direction of further workup. In CLL, the presence of at least 5,000 monoclonal B lymphocytes per microliter of blood is one of the diagnostic criteria ^[3].
2
Bone marrow aspiration and biopsy
Essential for diagnosing acute leukemias and myeloma; it shows the percentage of cancer cells ^{[4, 5]}.
3
Flow cytometry (immunophenotyping)
Identifies cell-surface markers (such as CD19, CD20, CD33 or CD38), pins down the exact type of disease and is also used to assess measurable residual disease (MRD) ^{[1, 2, 4]}.
4
Genetic and molecular testing
Cytogenetics, FISH and gene sequencing (such as BCR::ABL1 in CML and ALL, or FLT3 and NPM1 in AML) determine the diagnosis as well as the risk group and the choice of targeted drug ^{[1, 4]}.
5
Lymph node biopsy and PET-CT in lymphoma
Lymphoma is diagnosed by tissue biopsy, and PET-CT is the standard staging method for FDG-avid lymphomas; in Hodgkin lymphoma and most cases of DLBCL, routine bone marrow biopsy is no longer needed ^[6].
6
Myeloma-specific tests
Serum and urine protein electrophoresis and immunofixation, free light chain assay, and bone imaging (low-dose CT, PET-CT or MRI) ^[5].

Why measurable residual disease (MRD) matters

MRD refers to very small amounts of cancer cells that cannot be seen with routine methods but can be measured with flow cytometry or sensitive molecular methods. Achieving MRD negativity in ALL, CLL and myeloma is associated with better outcomes and is increasingly used in treatment decisions and in trials ^{[3, 4, 12, 20]}.

Treatment options

Active surveillance

In some slow-growing diseases, such as early-stage CLL, starting treatment early brings no benefit, and the patient is followed with regular examinations and tests until criteria for treatment appear ^[3].

Chemotherapy and chemoimmunotherapy

The backbone of treatment for acute leukemias and many lymphomas, often combined with monoclonal antibodies (such as anti-CD20 antibodies) ^{[4, 24]}.

Oral targeted drugs

Tyrosine kinase inhibitors in CML ^[8] and BTK inhibitors such as ibrutinib or BCL2 inhibitors such as venetoclax in CLL ^{[9, 10]} control the disease in many patients without classic chemotherapy.

Radiotherapy

Used in some lymphomas for residual lesions ^[13] and as part of pre-transplant conditioning (total body irradiation) ^[7].

Bispecific antibodies

These drugs bind a T cell with one arm and a cancer cell with the other, directing the T cell to destroy the cancer cell; examples include blinatumomab in ALL, glofitamab in DLBCL and teclistamab in myeloma ^{[11, 18, 19]}.

CAR T-cell therapy

The patient's own T cells are equipped in the laboratory with an artificial receptor that recognizes the cancer cell and are then returned to the body in a single infusion ^{[14, 16, 17]}.

Hematopoietic stem cell transplantation

In autologous transplantation, the patient's own stem cells are collected and frozen; the patient then receives high-dose chemotherapy, and the cells are given back to rebuild the bone marrow. This approach is used especially in multiple myeloma and in relapsed chemosensitive lymphomas ^[7]. In allogeneic transplantation, the cells come from a matched donor (related or unrelated), and the donor's immune cells can eliminate remaining cancer cells; however, it also carries a risk of graft-versus-host disease (GVHD) and infections ^[7]. This approach is used mostly for high-risk or relapsed acute leukemias ^{[4, 7]}.

With the arrival of CAR T-cell therapy and targeted drugs, the role of transplantation is being redefined in some settings; for example, in early-relapsing large B-cell lymphoma, CAR T-cell therapy improved overall survival compared with the standard pathway of chemotherapy and autologous transplantation ^[15].

Leukemias

Treatment regimens and doses: index15 regimens

General features of the main types of leukemia

Disease	Cell of origin and course	Hallmark findings	Main treatment approaches
Acute myeloid leukemia (AML)	Myeloid precursors; rapid course, mostly in older adults	Myeloid blasts in blood and bone marrow; risk group based on genetics ^[4]	Intensive chemotherapy and allogeneic transplantation in eligible patients; lower-intensity and targeted therapies in others ^[4]
Acute lymphoblastic leukemia (ALL)	B- or T-lymphoid precursors; rapid course, the most common childhood cancer	Lymphoblasts; BCR::ABL1 status and MRD determine treatment ^{[1, 2]}	Multiphase chemotherapy, blinatumomab and other immunotherapies, transplantation in high-risk cases ^{[11, 12]}
Chronic myeloid leukemia (CML)	Hematopoietic stem cell; slow course in the chronic phase	BCR::ABL1 fusion gene (Philadelphia chromosome) ^[1]	Oral tyrosine kinase inhibitors such as imatinib ^[8]
Chronic lymphocytic leukemia (CLL)	Mature B lymphocyte; course often slow	≥5,000 monoclonal B lymphocytes per microliter of blood ^[3]	Active surveillance in early stages; when treatment is needed, continuous ibrutinib or fixed-duration targeted therapy such as ibrutinib + venetoclax ^{[3, 9, 21, 26]}

This table is simplified; each type of leukemia has many subtypes, which are described on the leukemia page.

For physicians

Shared safety points

Ibrutinib (with rituximab or venetoclax): monitor blood pressure, arrhythmias (atrial fibrillation) and bleeding ^{[9, 28]}.
Venetoclax (with ibrutinib or obinutuzumab): before initiation, tumor lysis syndrome (TLS) risk assessment and prophylaxis are required (hydration, allopurinol starting 2–3 days beforehand, laboratory monitoring at the 20 mg and 50 mg doses) ^{[21, 30, 32]}; strong CYP3A inhibitors are contraindicated during the venetoclax ramp-up ^[30].
Rituximab and obinutuzumab: hepatitis B screening before initiation ^{[29, 31]}.

For physiciansTreatment regimens and dosing in leukemias, 5 regimens

For physicians

Treatment regimens and dosing in leukemias

Imatinib (CML)

Philadelphia chromosome-positive CML in adultsCycle length: Continuous

Philadelphia chromosome-positive CML in adults

Before prescribing: Shared safety points

Drug	Dose	Route	Schedule
Chronic phase
Imatinib	400 mg once daily	Oral, with food and a large glass of water	Continuous
Accelerated or blast phase
Imatinib	600 mg once daily	Oral	Continuous

Cycle length: Continuous
Duration: Until loss of response or unacceptable toxicity

Other tyrosine kinase inhibitors (dasatinib, nilotinib, bosutinib, ponatinib, asciminib), with their doses and monitoring points, are covered on the leukemia page ^{[8, 27]}.

Evidence: IRIS (2017)

Ibrutinib + rituximab (E1912)

Untreated CLL in patients aged 70 years or younger without del(17p), with CrCl greater than 40 mL/minCycle length: Every 28 days

Untreated CLL in patients aged 70 years or younger without del(17p), with CrCl greater than 40 mL/min ^[9]

Before prescribing: Shared safety points

Drug	Dose	Route	Schedule
Ibrutinib	420 mg once daily	Oral	Continuous from Cycle 1
From Cycle 2 (6 cycles)
Rituximab	50 mg/m² Day 1 and 325 mg/m² Day 2 of Cycle 2; then 500 mg/m²	IV	Day 1 of Cycles 3–7

Cycle length: Every 28 days
Duration: Rituximab: 6 cycles; ibrutinib: until progression or toxicity

Evidence: E1912 (2022), E1912 (2019)

Fixed-duration ibrutinib + venetoclax (GLOW; FLAIR with MRD-guided duration)

Untreated CLLCycle length: Every 28 days

Untreated CLL

Before prescribing: Shared safety points

Drug	Dose	Route	Schedule
Cycles 1–3
Ibrutinib	420 mg once daily	Oral	Continuous
Cycles 4–15
Ibrutinib + venetoclax	Ibrutinib 420 mg; venetoclax with a 5-week ramp-up to 400 mg once daily	Oral	Continuous

Cycle length: Every 28 days
Duration: 15 cycles in GLOW ^[32]; in FLAIR, MRD-guided duration ^[21]

Evidence: FLAIR (2025), GLOW (2023), GLOW (2023)

Venetoclax + obinutuzumab (CLL14)

Untreated CLL (in CLL14, patients with comorbidities)Cycle length: Every 28 days

Untreated CLL (in CLL14, patients with comorbidities) ^[10]

Before prescribing: Shared safety points

Drug	Dose	Route	Schedule
Cycle 1
Obinutuzumab	100 mg Day 1, 900 mg Day 2, 1,000 mg Days 8 and 15	IV	Days 1, 2, 8 and 15
Cycles 2–6
Obinutuzumab	1,000 mg	IV	Day 1
From Day 22 of Cycle 1
Venetoclax	Weekly ramp-up: 20, 50, 100, 200, then 400 mg	Oral, with food	Through the end of Cycle 12 at 400 mg

Cycle length: Every 28 days
Duration: 12 cycles

Premedication before obinutuzumab ^[31].

Evidence: CLL14 (2024), CLL14 (2019)

Blinatumomab in ALL

CD19-positive B-ALL: Ph-negative consolidation (E1910) or relapsed/refractory (TOWER)

Before prescribing: Shared safety points

Drug	Dose	Route	Schedule
Consolidation (E1910)
Blinatumomab	45 kg or more: 28 mcg/day (less than 45 kg: 15 mcg/m²/day)	IV, continuous infusion	Days 1–28, then 14 days off
Relapsed/refractory, Cycle 1
Blinatumomab	9 mcg/day, then 28 mcg/day	IV, continuous infusion	Days 1–7, then Days 8–28
Relapsed/refractory, subsequent cycles
Blinatumomab	28 mcg/day	IV, continuous infusion	Days 1–28

Cycle length: Every 42 days (continued therapy cycles in relapse: every 84 days)
Duration: E1910: 4 cycles of blinatumomab interspersed with consolidation chemotherapy; relapse: up to 2 induction cycles, 3 consolidation cycles and 4 continued therapy cycles

Premedication with dexamethasone 20 mg before the first dose of each cycle, intrathecal prophylaxis, and hospitalization during the first days (relapse: first 9 days of Cycle 1); boxed warning for cytokine release syndrome and neurological toxicity ^{[11, 12, 33]}.

Evidence: E1910 (2024), TOWER (2017)

Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.

Lymphomas

General features of the main types of lymphoma

Disease	Cell of origin and course	Hallmark findings	Main treatment approaches
Hodgkin lymphoma	Reed–Sternberg cells; common in young people	Enlarged lymph nodes, sometimes B symptoms ^{[2, 6]}	Chemotherapy ± radiotherapy; addition of immunotherapy (nivolumab) in advanced disease ^[13]
Diffuse large B-cell lymphoma (DLBCL)	B lymphocyte; aggressive but often curable	Rapidly growing mass in the lymph nodes or outside them ^[2]	First-line R-CHOP chemoimmunotherapy ^[24]; at relapse, salvage chemotherapy and autologous transplantation ^[25] or CAR T-cell therapy and bispecific antibodies ^{[14, 19]}

This table is simplified; lymphomas have many subtypes, which are described on the lymphoma page.

For physiciansTreatment regimens and dosing in lymphomas, 4 regimens

For physicians

Treatment regimens and dosing in lymphomas

R-CHOP

Untreated large B-cell lymphoma (DLBCL)Cycle length: Every 21 days

Untreated large B-cell lymphoma (DLBCL)

Drug	Dose	Route	Schedule
Rituximab	375 mg/m²	IV	Day 1
Cyclophosphamide	750 mg/m²	IV	Day 1
Doxorubicin	50 mg/m²	IV	Day 1
Vincristine	1.4 mg/m²	IV	Day 1
Prednisone	100 mg once daily	Oral	Days 1–5

Cycle length: Every 21 days
Duration: In POLARIX: 6 cycles of R-CHOP followed by 2 cycles of rituximab alone (in LNH98-5: 8 cycles)

The doses are those of the POLARIX control arm as given in the polatuzumab vedotin label; in Pola-R-CHP, vincristine is replaced by polatuzumab vedotin 1.8 mg/kg ^{[24, 34]}. Hepatitis B screening before rituximab ^[29].

Evidence: GELA LNH98-5 (2002)

Nivolumab + AVD (S1826)

Untreated stage III or IV classic Hodgkin lymphoma (age 12 years and older)Cycle length: Every 28 days

Untreated stage III or IV classic Hodgkin lymphoma (age 12 years and older)

Drug	Dose	Route	Schedule
Nivolumab	240 mg over 30 minutes (12–17 years: 3 mg/kg, maximum 240 mg)	IV	Days 1 and 15
Doxorubicin	25 mg/m²	IV	Days 1 and 15
Vinblastine	6 mg/m²	IV	Days 1 and 15
Dacarbazine	375 mg/m²	IV	Days 1 and 15

Cycle length: Every 28 days
Duration: 6 cycles

G-CSF is recommended from Cycle 1; nivolumab should be infused after the AVD drugs. Monitor liver enzymes, creatinine and thyroid function at baseline and periodically for immune-mediated adverse reactions ^{[13, 35]}.

Evidence: SWOG S1826 (2024)

Axicabtagene ciloleucel (CAR-T; ZUMA-7)

Large B-cell lymphoma refractory to first-line therapy or relapsed within 12 months of first-line therapy; or after 2 or more lines of therapyCycle length: One-time

Large B-cell lymphoma refractory to first-line therapy or relapsed within 12 months of first-line therapy; or after 2 or more lines of therapy

Drug	Dose	Route	Schedule
Lymphodepletion
Cyclophosphamide + fludarabine	Cyclophosphamide 500 mg/m² + fludarabine 30 mg/m²	IV	Days -5, -4 and -3 before infusion
Single infusion
Axicabtagene ciloleucel	2 × 10⁶ CAR-positive viable T cells/kg (maximum 2 × 10⁸)	IV	Day 0

Cycle length: One-time
Duration: One-time

Premedication about 1 hour before: acetaminophen 650 mg orally and diphenhydramine 12.5 mg; tocilizumab must be available ^{[14, 37]}.

Evidence: ZUMA-7 (2023), ZUMA-7 (2022)

Glofitamab

Relapsed or refractory DLBCL or LBCL arising from follicular lymphoma after 2 or more lines of therapyCycle length: Every 21 days

Relapsed or refractory DLBCL or LBCL arising from follicular lymphoma after 2 or more lines of therapy

Drug	Dose	Route	Schedule
Cycle 1, Day 1 (pretreatment)
Obinutuzumab	1,000 mg	IV	Day 1
Cycle 1
Glofitamab	2.5 mg (Day 8), 10 mg (Day 15)	IV	Days 8 and 15
Cycles 2–12
Glofitamab	30 mg	IV	Day 1

Cycle length: Every 21 days
Duration: 12 cycles (fixed duration)

Premedication before each dose, including dexamethasone; hospitalization during and for 24 hours after the 2.5 mg dose (and after subsequent doses if CRS occurred previously) ^{[19, 41]}.

Evidence: NP30179 (2022)

Multiple myeloma

General features of multiple myeloma

Disease	Cell of origin and course	Hallmark findings	Main treatment approaches
Multiple myeloma	Plasma cell; chronic course with repeated relapses	≥10% clonal plasma cells plus organ damage (high calcium, kidney failure, anemia, bone lesions) or specific biomarkers ^[5]	Three-drug VRd ^[22] or four-drug D-VRd ^[20] induction, autologous transplantation and maintenance; at relapse, combinations such as pomalidomide + bortezomib + dexamethasone ^[23], followed by CAR T-cell therapy and bispecific antibodies ^{[16, 17, 18]}

More details are on the multiple myeloma page.

For physicians

Shared safety points

CAR T-cell therapy (idecabtagene vicleucel and ciltacabtagene autoleucel): premedicate with acetaminophen and an H1 antihistamine; avoid prophylactic corticosteroids ^{[16, 17, 38, 39]}.

For physiciansTreatment regimens and dosing in multiple myeloma, 6 regimens

For physicians

Treatment regimens and dosing in multiple myeloma

VRd (SWOG S0777)

Newly diagnosed multiple myelomaCycle length: Every 21 days

Newly diagnosed multiple myeloma

Before prescribing: Shared safety points

Drug	Dose	Route	Schedule
Bortezomib	1.3 mg/m²	IV (in S0777)	Days 1, 4, 8 and 11
Lenalidomide	25 mg once daily	Oral	Days 1–14
Dexamethasone	20 mg/day	Oral	Days 1, 2, 4, 5, 8, 9, 11 and 12

Cycle length: Every 21 days
Duration: 8 induction cycles in S0777

The post-induction plan is not stated in the abstract and should follow the multiple myeloma page and guidelines ^[22].

D-VRd (PERSEUS)

Transplant-eligible newly diagnosed multiple myeloma (age 70 years or younger)Cycle length: Every 28 days

Transplant-eligible newly diagnosed multiple myeloma (age 70 years or younger)

Before prescribing: Shared safety points

Drug	Dose	Route	Schedule
Induction (4 cycles) and consolidation (2 cycles)
Subcutaneous daratumumab	1,800 mg (with hyaluronidase 30,000 units)	SC	Induction: weekly in Weeks 1–8, every 2 weeks in Weeks 9–16; consolidation: every 2 weeks
Induction and consolidation
Bortezomib	1.3 mg/m²	SC	Days 1, 4, 8 and 11
Lenalidomide	25 mg once daily	Oral	Days 1–21
Dexamethasone	40 mg	Oral or IV	Days 1–4 and 9–12

Cycle length: Every 28 days
Duration: 4 induction cycles → stem cell collection, high-dose chemotherapy and autologous transplantation → 2 consolidation cycles (within 12 weeks after transplantation)

On daratumumab days, dexamethasone is given as premedication. Daratumumab + lenalidomide maintenance in PERSEUS was investigational, and its effect is not regarded as established in the label ^{[20, 36]}.

Evidence: PERSEUS (2024)

Pomalidomide + bortezomib + dexamethasone (OPTIMISMM)

Relapsed multiple myeloma after 1 to 3 prior lines of therapy including lenalidomideCycle length: Every 21 days

Relapsed multiple myeloma after 1 to 3 prior lines of therapy including lenalidomide

Before prescribing: Shared safety points

Drug	Dose	Route	Schedule
Pomalidomide	4 mg once daily	Oral	Days 1–14
Bortezomib	1.3 mg/m²	IV or SC	Cycles 1–8: Days 1, 4, 8 and 11; then Days 1 and 8
Dexamethasone	20 mg (over 75 years: 10 mg)	Oral	On the day of each bortezomib dose and the day after

Cycle length: Every 21 days
Duration: Per the OPTIMISMM protocol

Doses are taken from the trial abstract ^[23].

Idecabtagene vicleucel (CAR-T; KarMMa-3)

Relapsed or refractory multiple myeloma after 2 or more lines of therapy including an immunomodulatory drug, a proteasome inhibitor and an anti-CD38 antibodyCycle length: One-time

Relapsed or refractory multiple myeloma after 2 or more lines of therapy including an immunomodulatory drug, a proteasome inhibitor and an anti-CD38 antibody

Before prescribing: Shared safety points

Drug	Dose	Route	Schedule
Lymphodepletion
Cyclophosphamide + fludarabine	Cyclophosphamide 300 mg/m² + fludarabine 30 mg/m²	IV	3 days
Single infusion
Idecabtagene vicleucel	300 to 510 × 10⁶ CAR-positive T cells	IV	2 days after completion of lymphodepletion

Cycle length: One-time
Duration: One-time

Ensure tocilizumab is available ^{[16, 38]}.

Evidence: KarMMa-3 (2024), KarMMa-3 (2023)

Ciltacabtagene autoleucel (CAR-T; CARTITUDE-4)

Relapsed or refractory multiple myeloma after at least 1 line of therapy including a proteasome inhibitor and an immunomodulatory drug, refractory to lenalidomideCycle length: One-time

Relapsed or refractory multiple myeloma after at least 1 line of therapy including a proteasome inhibitor and an immunomodulatory drug, refractory to lenalidomide

Before prescribing: Shared safety points

Drug	Dose	Route	Schedule
Lymphodepletion
Cyclophosphamide + fludarabine	Cyclophosphamide 300 mg/m² + fludarabine 30 mg/m² daily	IV	3 days
Single infusion
Ciltacabtagene autoleucel	0.5 to 1.0 × 10⁶ CAR-positive viable T cells/kg (maximum 1 × 10⁸)	IV	2 to 4 days after completion of lymphodepletion

Cycle length: One-time
Duration: One-time

Do not use a leukocyte-depleting filter ^{[17, 39]}.

Evidence: CARTITUDE-4 (2026), CARTITUDE-4 (2023)

Teclistamab monotherapy (MajesTEC-1)

Relapsed or refractory multiple myeloma after at least 4 lines of therapy including a proteasome inhibitor, an immunomodulatory drug and an anti-CD38 antibodyCycle length: Weekly

Relapsed or refractory multiple myeloma after at least 4 lines of therapy including a proteasome inhibitor, an immunomodulatory drug and an anti-CD38 antibody

Before prescribing: Shared safety points

Drug	Dose	Route	Schedule
Step-up dosing
Teclistamab	0.06 mg/kg (Day 1), 0.3 mg/kg (Day 4), 1.5 mg/kg (Day 7)	SC	Days 1, 4 and 7
Continuation
Teclistamab	1.5 mg/kg weekly (after at least 6 months of complete response or better: every 2 weeks)	SC	Weekly

Cycle length: Weekly
Duration: Until progression or unacceptable toxicity

1 to 3 hours before each step-up dose: dexamethasone 16 mg, diphenhydramine 50 mg and acetaminophen 650 to 1,000 mg. Hospitalization for 48 hours after step-up doses 1 and 2. Antiviral prophylaxis against herpes zoster may be considered. The combination of teclistamab with subcutaneous daratumumab for patients after at least 1 line of therapy is also included in the label ^{[18, 40]}.

Evidence: MajesTEC-1 (2022)

For patients

What should I do after diagnosis?

For patients

Patient guide: starting your blood cancer treatment journey1 / 5

Know the exact name of your disease

“Blood cancer” is the name for dozens of different diseases. Ask your doctor exactly what type you have, whether it is acute or chronic, and what your genetic test results have shown.

Not every patient is treated right away

If your disease is slow-growing, your doctor may suggest “active surveillance.” This does not mean you are being neglected; in these cases, starting treatment early brings no benefit, and regular follow-up is the best approach.

Protect yourself from infection

Many treatments weaken the body's defenses. Wash your hands regularly, stay away from people who are sick, and report any fever to your care team right away.

Learn about new treatments

Oral targeted drugs, CAR T-cell therapy and bispecific antibodies have brought great hope to patients who previously had few options. Ask whether these treatments or a clinical trial might be suitable for you.

Look after your mental health and your family

Treatment for blood cancer can take a long time. Getting help from a counselor, support groups and your family is part of treatment, not a sign of weakness.

Frequently asked questions

What is the difference between leukemia and lymphoma?

Leukemia is found mainly in the bone marrow and blood, whereas lymphoma mostly forms in the lymph nodes and lymphatic tissues. The line between them is sometimes thin, however; for example, CLL and small lymphocytic lymphoma are one disease that can present in two ways ^[2].

Is blood cancer curable?

Many types can be cured or kept well under control for years. For example, most people with advanced Hodgkin lymphoma treated with newer therapies are free of disease progression after two years ^[13], and in CML, a 10-year overall survival of 83.3% has been reported with the oral drug imatinib ^[8]. The outlook depends on the type of disease, its genetic features and the patient's age.

Is a bone marrow biopsy always needed for diagnosis?

For acute leukemias and myeloma, usually yes ^{[4, 5]}. In CLL, however, the diagnosis can often be made by flow cytometry of peripheral blood ^[3], and in lymphoma, lymph node biopsy and PET-CT are more important ^[6].

What are the side effects of CAR T-cell therapy?

The most important side effects are cytokine release syndrome (fever, low blood pressure) and neurological side effects (confusion, difficulty speaking), which usually occur in the first days to weeks and can be managed in experienced centers ^{[14, 17]}. For this reason, patients stay under observation near the treatment center for some time after the infusion.

When is a bone marrow transplant needed?

Autologous transplantation is usually used in myeloma and some relapsed lymphomas, and allogeneic transplantation in high-risk or relapsed acute leukemias ^{[4, 7]}. The decision about transplantation depends on the type of disease, the response to treatment, age and general condition.

For physicians

Recent evidence and advances (for physicians)

For physicians2 key findings · Landmark trials in leukemias · +3 more

For physicians

92%

Two-year progression-free survival with nivolumab + AVD in advanced Hodgkin lymphoma

Versus 83% with brentuximab vedotin + AVD; HR 0.45; S1826 ^[13]

54.6%

4-year overall survival with axi-cel in early-relapsing LBCL

Versus 46.0% with standard care; HR 0.73; ZUMA-7 ^[15]

For physicians

Landmark trials in leukemias

Disease	Trial	Intervention	Main result
CLL (untreated, ≤70 years)	E1912	Ibrutinib + rituximab vs FCR	PFS: HR 0.37; overall survival: HR 0.47 (median follow-up 5.8 years) ^[9]
Untreated CLL	FLAIR	Ibrutinib + venetoclax with MRD-guided duration vs FCR and ibrutinib alone	Five-year PFS 93.9% vs 58.1% (FCR) and 79.0% (ibrutinib alone) ^[21]
CLL (with comorbidities)	CLL14	Fixed-duration venetoclax + obinutuzumab	Median PFS 76.2 vs 36.4 months; HR 0.40 (six-year follow-up) ^[10]
MRD-negative B-ALL (30–70 years)	E1910	Addition of blinatumomab to consolidation	Three-year overall survival 85% vs 68%; HR 0.41 ^[12]
Relapsed/refractory B-ALL	TOWER	Blinatumomab vs chemotherapy	Median overall survival 7.7 vs 4.0 months; HR 0.71 ^[11]

For physicians

Landmark trials in lymphomas

Disease	Trial	Intervention	Main result
Early-relapsing LBCL	ZUMA-7	Axicabtagene ciloleucel vs chemotherapy + autologous transplantation	Two-year EFS 41% vs 16%; HR 0.40 ^[14]
DLBCL after ≥2 lines of therapy	Glofitamab phase 2	Glofitamab, a fixed-duration CD20×CD3 bispecific antibody	Complete response 39%; 35% in patients with prior CAR T-cell therapy ^[19]

For physicians

Landmark trials in multiple myeloma

Disease	Trial	Intervention	Main result
Newly diagnosed myeloma (no immediate transplant)	SWOG S0777	Bortezomib + lenalidomide + dexamethasone (VRd) vs lenalidomide + dexamethasone	Median PFS 43 vs 30 months; median overall survival 75 vs 64 months ^[22]
Newly diagnosed myeloma, transplant-eligible	PERSEUS	Daratumumab + VRd (four-drug) vs VRd	MRD negativity 75.2% vs 47.5%; HR for progression or death 0.42 ^[20]
Relapsed myeloma after lenalidomide (1–3 prior lines)	OPTIMISMM	Pomalidomide + bortezomib + dexamethasone vs bortezomib + dexamethasone	Median PFS 11.2 vs 7.1 months; HR 0.61 ^[23]
Relapsed myeloma (2–4 prior lines)	KarMMa-3	Idecabtagene vicleucel vs standard regimens	Median PFS 13.3 vs 4.4 months; HR 0.49 ^[16]
Lenalidomide-refractory myeloma (1–3 prior lines)	CARTITUDE-4	Ciltacabtagene autoleucel vs standard care	HR for progression or death 0.26; MRD negativity 60.6% vs 15.6% ^[17]
Triple-class-exposed myeloma	MajesTEC-1 (phase 1–2)	Teclistamab, a BCMA×CD3 bispecific antibody	Overall response 63.0%; complete response or better 39.4% ^[18]

More details on each disease are on the leukemia, lymphoma and multiple myeloma pages.

For physicians

T-cell-redirecting immunotherapy: benefits and toxicities

Summary

J Clin Oncol · 2014

Summary

References

41 references

Show all references, 24 with a study cardClose the reference list

Numbers in the text, such as ^[1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

1
The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/Dendritic NeoplasmsKhoury JD, Solary E, Abla O, Akkari Y, Alaggio R, Apperley JF, et al · Leukemia · 2022;36:1703-1719
Study card DOI PubMed Back to text: 1 2 3 4 5 6 7 8 9
2
The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid NeoplasmsAlaggio R, Amador C, Anagnostopoulos I, Attygalle AD, Araujo IBO, Berti E, et al · Leukemia · 2022;36:1720-1748
Study card DOI PubMed Back to text: 1 2 3 4 5 6 7 8 9
3
iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLLHallek M, Cheson BD, Catovsky D, Caligaris-Cappio F, Dighiero G, Döhner H, et al · Blood · 2018;131:2745-2760
Study card DOI PubMed Back to text: 1 2 3 4 5 6 7
4
Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELNDöhner H, Wei AH, Appelbaum FR, Craddock C, DiNardo CD, Dombret H, et al · Blood · 2022;140:1345-1377
Study card DOI PubMed Back to text: 1 2 3 4 5 6 7 8 9 10 11
5
International Myeloma Working Group updated criteria for the diagnosis of multiple myelomaRajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, et al · Lancet Oncol · 2014;15:e538-e548
Study card DOI PubMed Back to text: 1 2 3 4 5 6 7
6
Recommendations for initial evaluation, staging, and response assessment of Hodgkin and non-Hodgkin lymphoma: the Lugano classificationCheson BD, Fisher RI, Barrington SF, Cavalli F, Schwartz LH, Zucca E, et al · J Clin Oncol · 2014;32:3059-3068
Study card DOI PubMed Back to text: 1 2 3
7
Hematopoietic Stem-Cell TransplantationCopelan EA · N Engl J Med · 2006;354:1813-1826
Study card DOI PubMed Back to text: 1 2 3 4 5 6 7
8
Long-Term Outcomes of Imatinib Treatment for Chronic Myeloid LeukemiaHochhaus A, Larson RA, Guilhot F, Radich JP, Branford S, Hughes TP, et al · N Engl J Med · 2017;376:917-927
Study card DOI PubMed Back to text: 1 2 3 4 5
9
Long-term outcomes for ibrutinib-rituximab and chemoimmunotherapy in CLL: updated results of the E1912 trialShanafelt TD, Wang XV, Hanson CA, Paietta EM, O'Brien S, Barrientos J, et al · Blood · 2022;140:112-120
Study card DOI PubMed Back to text: 1 2 3 4 5 6
10
Venetoclax-obinutuzumab for previously untreated chronic lymphocytic leukemia: 6-year results of the randomized phase 3 CLL14 studyAl-Sawaf O, Robrecht S, Zhang C, Olivieri S, Chang YM, Fink AM, et al · Blood · 2024;144:1924-1935
Study card DOI PubMed Back to text: 1 2 3
11
Blinatumomab versus Chemotherapy for Advanced Acute Lymphoblastic LeukemiaKantarjian H, Stein A, Gökbuget N, Fielding AK, Schuh AC, Ribera JM, et al · N Engl J Med · 2017;376:836-847
Study card DOI PubMed Back to text: 1 2 3 4 5
12
Blinatumomab for MRD-Negative Acute Lymphoblastic Leukemia in AdultsLitzow MR, Sun Z, Mattison RJ, Paietta EM, Roberts KG, Zhang Y, et al · N Engl J Med · 2024;391:320-333
Study card DOI PubMed Back to text: 1 2 3 4
13
Nivolumab+AVD in Advanced-Stage Classic Hodgkin's LymphomaHerrera AF, LeBlanc M, Castellino SM, Li H, Rutherford SC, Evens AM, et al · N Engl J Med · 2024;391:1379-1389
Study card DOI PubMed Back to text: 1 2 3 4 5
14
Axicabtagene Ciloleucel as Second-Line Therapy for Large B-Cell LymphomaLocke FL, Miklos DB, Jacobson CA, Perales MA, Kersten MJ, Oluwole OO, et al · N Engl J Med · 2022;386:640-654
Study card DOI PubMed Back to text: 1 2 3 4 5 6 7
15
Survival with Axicabtagene Ciloleucel in Large B-Cell LymphomaWestin JR, Oluwole OO, Kersten MJ, Miklos DB, Perales MA, Ghobadi A, et al · N Engl J Med · 2023;389:148-157
Study card DOI PubMed Back to text: 1 2 3 4
16
Ide-cel or Standard Regimens in Relapsed and Refractory Multiple MyelomaRodriguez-Otero P, Ailawadhi S, Arnulf B, Patel K, Cavo M, Nooka AK, et al · N Engl J Med · 2023;388:1002-1014
Study card DOI PubMed Back to text: 1 2 3 4 5 6
17
Cilta-cel or Standard Care in Lenalidomide-Refractory Multiple MyelomaSan-Miguel J, Dhakal B, Yong K, Spencer A, Anguille S, Mateos MV, et al · N Engl J Med · 2023;389:335-347
Study card DOI PubMed Back to text: 1 2 3 4 5 6 7 8 9
18
Teclistamab in Relapsed or Refractory Multiple MyelomaMoreau P, Garfall AL, van de Donk NWCJ, Nahi H, San-Miguel JF, Oriol A, et al · N Engl J Med · 2022;387:495-505
Study card DOI PubMed Back to text: 1 2 3 4 5 6
19
Glofitamab for Relapsed or Refractory Diffuse Large B-Cell LymphomaDickinson MJ, Carlo-Stella C, Morschhauser F, Bachy E, Corradini P, Iacoboni G, et al · N Engl J Med · 2022;387:2220-2231
Study card DOI PubMed Back to text: 1 2 3 4 5
20
Daratumumab, Bortezomib, Lenalidomide, and Dexamethasone for Multiple MyelomaSonneveld P, Dimopoulos MA, Boccadoro M, Quach H, Ho PJ, Beksac M, et al · N Engl J Med · 2024;390:301-313
Study card DOI PubMed Back to text: 1 2 3 4
21
Measurable Residual Disease-Guided Therapy for Chronic Lymphocytic LeukemiaMunir T, Girvan S, Cairns DA, Bloor A, Allsup D, Varghese AM, et al · N Engl J Med · 2025;393:1177-1190
Study card DOI PubMed Back to text: 1 2 3 4 5
22
Bortezomib with lenalidomide and dexamethasone versus lenalidomide and dexamethasone alone in patients with newly diagnosed myeloma without intent for immediate autologous stem-cell transplant (SWOG S0777): a randomised, open-label, phase 3 trialDurie BGM, Hoering A, Abidi MH, Rajkumar SV, Epstein J, Kahanic SP, et al · Lancet · 2017;389:519-527
DOI PubMed Back to text: 1 2 3
23
Pomalidomide, bortezomib, and dexamethasone for patients with relapsed or refractory multiple myeloma previously treated with lenalidomide (OPTIMISMM): a randomised, open-label, phase 3 trialRichardson PG, Oriol A, Beksac M, Liberati AM, Galli M, Schjesvold F, et al · Lancet Oncol · 2019;20:781-794
DOI PubMed Back to text: 1 2 3 4
24
CHOP Chemotherapy plus Rituximab Compared with CHOP Alone in Elderly Patients with Diffuse Large-B-Cell LymphomaCoiffier B, Lepage E, Brière J, Herbrecht R, Tilly H, Bouabdallah R, et al · N Engl J Med · 2002;346:235-242
Study card DOI PubMed Back to text: 1 2 3
25
Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab eraGisselbrecht C, Glass B, Mounier N, Singh Gill D, Linch DC, Trneny M, et al · J Clin Oncol · 2010;28:4184-4190
DOI PubMed Back to text: 1 2
26
EHA Guidelines on management of chronic lymphocytic leukemia and Richter transformationEichhorst B, Ghia P, Bosch F, et al · HemaSphere · 2026
Study card DOI PubMed Back to text
27
GLEEVEC (imatinib mesylate) tablets — Prescribing InformationNovartis Pharmaceuticals Corporation · FDA label · 2026
Source Back to text
28
IMBRUVICA (ibrutinib) capsules, tablets and oral suspension — Prescribing InformationPharmacyclics LLC / Janssen Biotech · FDA label · 2025
Source Back to text
29
RITUXAN (rituximab) injection — Prescribing InformationGenentech, Inc · FDA label · 2025
Source Back to text: 1 2
30
VENCLEXTA (venetoclax) tablets — Prescribing InformationAbbVie Inc · FDA label · 2026
Source Back to text: 1 2
31
GAZYVA (obinutuzumab) injection — Prescribing InformationGenentech, Inc · FDA label · 2026
Source Back to text: 1 2
32
Fixed-duration ibrutinib-venetoclax versus chlorambucil-obinutuzumab in previously untreated chronic lymphocytic leukaemia (GLOW): 4-year follow-up from a multicentre, open-label, randomised, phase 3 trialNiemann CU, Munir T, Moreno C, Owen C, Follows GA, Benjamini O, et al · Lancet Oncol · 2023;24:1423-1433
Study card DOI PubMed Back to text: 1 2
33
BLINCYTO (blinatumomab) for injection — Prescribing InformationAmgen Inc · FDA label · 2026
Source Back to text
34
POLIVY (polatuzumab vedotin-piiq) for injection — Prescribing InformationGenentech, Inc · FDA label · 2026
Source Back to text
35
OPDIVO (nivolumab) injection — Prescribing InformationE.R. Squibb & Sons, L.L.C. (Bristol-Myers Squibb) · FDA label · 2026
Source Back to text
36
DARZALEX FASPRO (daratumumab and hyaluronidase-fihj) injection — Prescribing InformationJanssen Biotech, Inc · FDA label · 2026
Source Back to text
37
YESCARTA (axicabtagene ciloleucel) suspension for intravenous infusion — Prescribing InformationKite Pharma, Inc · FDA label · 2026
Source Back to text
38
ABECMA (idecabtagene vicleucel) suspension for intravenous infusion — Prescribing InformationCelgene Corporation (Bristol-Myers Squibb) · FDA label · 2026
Source Back to text: 1 2
39
CARVYKTI (ciltacabtagene autoleucel) suspension for intravenous infusion — Prescribing InformationJanssen Biotech, Inc · FDA label · 2026
Source Back to text: 1 2
40
TECVAYLI (teclistamab-cqyv) injection — Prescribing InformationJanssen Biotech, Inc · FDA label · 2026
Source Back to text
41
COLUMVI (glofitamab-gxbm) injection — Prescribing InformationGenentech, Inc · FDA label · 2026
Source Back to text

This page is based on reputable scientific sources and was last updated on 21 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Blood cancers (leukemia, lymphoma and myeloma)

Key points

What are blood cancers?

Detailed guides to each disease

Leukemia

Lymphoma

Multiple myeloma

Signs and symptoms

Warning signs

Risk factors

Diagnosis and staging

Diagnostic pathway for blood cancers

Complete blood count (CBC) and peripheral blood smear

Bone marrow aspiration and biopsy

Flow cytometry (immunophenotyping)

Genetic and molecular testing

Lymph node biopsy and PET-CT in lymphoma

Myeloma-specific tests

Treatment options

Active surveillance

Chemotherapy and chemoimmunotherapy

Oral targeted drugs

Radiotherapy

Bispecific antibodies

CAR T-cell therapy

Hematopoietic stem cell transplantation

Leukemias

Treatment regimens and dosing in leukemias

Imatinib (CML)

Ibrutinib + rituximab (E1912)

Fixed-duration ibrutinib + venetoclax (GLOW; FLAIR with MRD-guided duration)

Venetoclax + obinutuzumab (CLL14)

Blinatumomab in ALL

Lymphomas

Treatment regimens and dosing in lymphomas

R-CHOP

Nivolumab + AVD (S1826)

Axicabtagene ciloleucel (CAR-T; ZUMA-7)

Glofitamab

Multiple myeloma

Treatment regimens and dosing in multiple myeloma

VRd (SWOG S0777)

D-VRd (PERSEUS)

Pomalidomide + bortezomib + dexamethasone (OPTIMISMM)

Idecabtagene vicleucel (CAR-T; KarMMa-3)

Ciltacabtagene autoleucel (CAR-T; CARTITUDE-4)

Teclistamab monotherapy (MajesTEC-1)

What should I do after diagnosis?

Know the exact name of your disease

Not every patient is treated right away

Protect yourself from infection

Learn about new treatments

Look after your mental health and your family

Frequently asked questions

Recent evidence and advances (for physicians)

T-cell-redirecting immunotherapy: benefits and toxicities

Scientific evidence

Selected key studies

Long-Term Outcomes of Imatinib Treatment for Chronic Myeloid Leukemia

Long-term outcomes for ibrutinib-rituximab and chemoimmunotherapy in CLL: updated results of the E1912 trial

Measurable Residual Disease-Guided Therapy for Chronic Lymphocytic Leukemia

Long-term follow-up of VIALE-A: Venetoclax and azacitidine in chemotherapy-ineligible untreated acute myeloid leukemia

Nivolumab+AVD in Advanced-Stage Classic Hodgkin's Lymphoma

CHOP Chemotherapy plus Rituximab Compared with CHOP Alone in Elderly Patients with Diffuse Large-B-Cell Lymphoma

Daratumumab, Bortezomib, Lenalidomide, and Dexamethasone for Multiple Myeloma

Blinatumomab for MRD-Negative Acute Lymphoblastic Leukemia in Adults

Blinatumomab versus Chemotherapy for Advanced Acute Lymphoblastic Leukemia

Venetoclax-obinutuzumab for previously untreated chronic lymphocytic leukemia: 6-year results of the randomized phase 3 CLL14 study

Survival with Axicabtagene Ciloleucel in Large B-Cell Lymphoma

Teclistamab in Relapsed or Refractory Multiple Myeloma

Polatuzumab Vedotin in Previously Untreated Diffuse Large B-Cell Lymphoma

Axicabtagene Ciloleucel as Second-Line Therapy for Large B-Cell Lymphoma

Cilta-cel or Standard Care in Lenalidomide-Refractory Multiple Myeloma

Clinical guidelines

EHA Guidelines on management of chronic lymphocytic leukemia and Richter transformation

2025 European LeukemiaNet recommendations for the management of chronic myeloid leukemia

EHA–EMN Evidence-Based Guidelines for diagnosis, treatment and follow-up of patients with multiple myeloma

Lymphomas: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up

Diagnosis, prognostic factors, and assessment of ALL in adults: 2024 ELN recommendations from a European expert panel

Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN