Remission in a Relapse Case of Acute Promyelocytic Leukaemia for Twenty-two years using Metal Based Ayurvedic Treatment: A Case Report

Abstract

Acute Promyelocytic Leukemia (APML) is a form of blood cancer. The general
symptoms of the disease include anaemia, fatigue, weakness and fever marked by
thrombocytopenia, leucopenia and in some cases pancytopenia. Easy bleeding and
coagulopathy associated with APML make it fatal, if not readily managed. Although
new contemporary treatment options have been able to improve the prognosis in
APML patients to a large extent, relapse of the disease is still noted in some cases. Also,
the conventional therapies have their share of associated adverse effects and not all
patients are physically and psychologically ready to bear them. Some patients, in such
scenario, seek solace in alternative treatment options. In this case report, we discuss a
case of APML who opted for Ayurvedic treatment in relapsed state of the disease. The
patient was treated with metal based Ayurvedic formulations and achieved remission
within weeks. Now the patient completes twenty-two years of disease free survival
without experiencing any side effect. Chemistry, pharmacology and many other aspects
related to the used Ayurvedic formulations remain unknown and need to be explored
systematically.

Full text

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All India Institute of Ayurveda
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An Official Peer Reviewed Publication of
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Journal of
Ayurveda Case Reports
Journal of
Ayurveda Case Reports
Volume 2, Issue 2, April-June 2019
AyuCaRe
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3
Journal of Ayurveda Case Reports Volume 2 Issue 2 April-June 2019
Journal of Ayurveda Case Reports
How to cite: Prakash B, Prakash S, Sharma S, Tiwari S.
Remission in a Relapse Case of Acute Promyelocytic
Leukaemia for Twenty-two years using Metal Based
Ayurvedic Treatment: A Case Report. J AyuCaRe
2019;2(2):3-8.
Introduction
Acute Promyelocytic Leukemia (APML), also termed
as AML-M3, is a variant of Acute Myeloid Leukemia
(AML) and accounts for 5-8% of all AMLs in adults.1 In
95-98% cases, the disease is characterised by a distinct
reciprocal translocation involving chromosome 15 and
17.2 The resulting hybrid oncoprotein known to block
the dierentiation of leukemic promyelocytes, causing
the disorder.2 APML is particularly peculiar due to its
coagulopathic nature, apart from causing leucopenia
Remission in a Relapse Case of Acute Promyelocytic Leukaemia for
Twenty-two years using Metal Based Ayurvedic Treatment: A Case Report
Balendu Prakash*, Shikha Prakash, Shakshi Sharma, Sneha Tiwari
VCPC Research Foundation, Lane C-15, Turner Road, Clement Town, Dehradun, Uarakhand
* Corresponding Author: E-mail–balenduprakash@gmail.com, Mobile: +91 9837028544
ABSTRACT
Acute Promyelocytic Leukemia (APML) is a form of blood cancer. The general
symptoms of the disease include anaemia, fatigue, weakness and fever marked by
thrombocytopenia, leucopenia and in some cases pancytopenia. Easy bleeding and
coagulopathy associated with APML make it fatal, if not readily managed. Although
new contemporary treatment options have been able to improve the prognosis in
APML patients to a large extent, relapse of the disease is still noted in some cases. Also,
the conventional therapies have their share of associated adverse eects and not all
patients are physically and psychologically ready to bear them. Some patients, in such
scenario, seek solace in alternative treatment options. In this case report, we discuss a
case of APML who opted for Ayurvedic treatment in relapsed state of the disease. The
patient was treated with metal based Ayurvedic formulations and achieved remission
within weeks. Now the patient completes twenty-two years of disease free survival
without experiencing any side eect. Chemistry, pharmacology and many other aspects
related to the used Ayurvedic formulations remain unknown and need to be explored
systematically.
Key words
Ayurveda,
Leucopenia,
Leukemia,
Thrombocytopenia
and pancytopenia can be fatal if not diagnosed and
managed timely.3 Investigations done to diagnose
APML include complete blood count and bone marrow
aspiration. Immunophenotyping and cytogenetic tests
may also be carried to decipher the exact type and
course of the disease.
APML is most common in adults in their midlife and
has rare incidences in adults more than 60 years of
age.4 Although APML has overall incidences as low as
0.1/100,000 the disease was considered the most fatal
form of leukaemia with severe bleeding tendency.5 But
with the advent of all-trans retinoic acid (ATRA) and,
more recently, arsenic trioxide (ATO) with or without
chemotherapy in the treatment of APML; the disease
has now evolved as one of the most curable forms of

4 Journal of Ayurveda Case Reports Volume 2 Issue 2 April-June 2019
Prakash B, et al.: Ayurvedic Management or Acute Promyelocytic Leukaemia
leukaemia with 90% remission rates and more than
80% disease free survival rate at six years especially
among low risk groups.6-7 A study carried for a ten years
median period, shows ten year disease free survival
in 77% cases.8 In spite of the improving survival rates,
10-15% relapse rates of APML are still reported.9 The
relapse cases are again treated using ATRA, ATO or a
combination of these with or without chemotherapy,
and stem cell transplantation, whenever possible.7
However, despite yielding promising results, these
therapies pose certain side eects ranging from
severe hematologic toxicity to hyperleukocytosis and
even occurrence of secondary myeloid neoplasms
in few cases.10 Dierentiation syndrome is the most
common and potentially life threatening treatment
related complication associated with these therapies.
Its symptoms include dyspnea, unexplained fever,
hypotension, kidney damage, weight gain and peripheral
edema. Prolongation in QT interval of the cardiac cycle
is another common side eect of ATO therapy.10 Hence,
patients still remain unsatised with the treatment
possibilities for APML and look for alternative treatment
options.
Data on duration of disease free survival in post relapse
cases of APML is limited with the longest known follow
up of twelve years in a case of post second relapse of
the disease treated using herbo–mineral Ayurvedic
formulations.11 Here, a case that opted for Ayurvedic
treatment in a relapsed state of APML under an
Ayurvedic physician in North India has been presented.
Case report
The 33 years old male from New Delhi presented to Tata
Memorial Hospital, Mumbai in April 1994 (Reference
No. BH6477) with fever and abnormal blood prole.
Investigations revealed features of Acute Promyelocytic
Leukemia (ICD 10 code: C92.4) with 96% promyelocytes.
He was treated with oral ATRA for 90 days. He achieved
complete remission after rst three weeks of treatment.
Subsequently, he received four cycles of chemotherapy
between July to November 1994. Bone marrow study
done in January 1995 showed complete remission but
20% metaphases showed presence of t(15;17). Meanwhile,
the patient also developed diabetes mellitus. The disease
relapsed in June 1995 when in follow up investigations,
his Bone Marrow Aspirate (BMA) showed 14% blasts and
50% promyelocytes (Ref No. 208695006; Lab No. E-1492,
Tata Memorial Hospital, Mumbai dated 19-06-1995). The
patient was explained for poor prognosis and advised
to undergo further chemotherapy. Patient and his close
family denied pursuing modern medicines and, instead,
opted for Ayurvedic treatment.
Treatment protocol
The patient presented to the Ayurvedic clinic with
high fever. He had pancytopenia, lymphocytosis, and
Plasmodium vivax infection. Ayurvedic treatment was
started on 14th September 1995 and malarial infection
was managed conservatively. He was advised to take
nearly 2000 calorie diet daily, comprising of a balance
of carbohydrates, proteins and dairy, divided into three
meals and three snacks with eight hours of sleep at night.
The patient was kept in strict isolation with complete
psychological and physical rest. He was restricted from
taking tea, coee, packaged foods and drinks, reheated
food, rened our, onion, garlic and tomatoes. He was
prescribed oral Ayurvedic formulations; Navajeevan11-12
(250 mg three times a day) with water, Kamadudha rasa
powder11,13 (250 mg thrice a day) orally, 21 Tulsi patra
(thrice a day) and Pancharatni arka (50 ml four times a
day), for the initial one month. Later, the medicines and
doses were adjusted periodically as per the clinical signs
and symptoms. Arka (~distillate) of Chandana (Santalum
album Linn.), Gojihva (Onosma bracteatum Wall.) and
Gulab (Rosa centifolia Linn.) (50 ml twice a day) was
prescribed. (Table 1) Pancharatni arka was made up of
200 gm each of Ajmoda (Trachyspermum ammi Linn.),
Khoob kalan [Sysimbrium ocinalis (L) Scop.], Pia papda
[Fumaria indica (Hausskn.)], fresh Guduchi [Tinospora
cordifolia (Willd.) Miers], Katumba jad or Gumma jad
(Leucas cephalotes spreng.) processed in 16 litres of water.
The treatment was carried for 340 days.
Outcome
Marked improvement was noted in the patient after
starting Ayurvedic treatment. Fever subsided within
fteen days of treatment. 35% promyelocytes that were
seen in the blood smear started reducing gradually. The
results of complete blood count (CBC) done on 28th October

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Journal of Ayurveda Case Reports Volume 2 Issue 2 April-June 2019
Prakash B, et al.: Ayurvedic Management or Acute Promyelocytic Leukaemia
Table 1: Details of Ayurvedic formulations prescribed and periodic changes in prescription
Day of treatment Prescription
Day 0 1. Navajeevan (250 mg) tablet thrice a day with water
2. Kamdudha rasa (250 mg) powder thrice a day
3. Tulsi patra 21 leaves thrice a day
4. Pancharatni arka 50 ml four times a day
Day 30 1. Navajeevan (125 mg) tablet thrice a day with water
2. Kamdudha rasa (250 mg) powder thrice a day
3. Pancharatni arka 50 ml four times a day
Day 105 1. Navajeevan (125 mg) tablet twice a day with water
2. Kamdudha rasa (250 mg) powder thrice a day
3. Arka of Chandan + Gojihva + Gulab 50 ml twice a day
Day 150 1. Navajeevan (125 mg) tablet twice a day with water
2. Kamdudha rasa (250 mg) powder thrice a day
3. Prak 2011 500 mg capsule thrice a day with water
4. Arka of chandan + Gojihva + Gulab 50 ml twice a day
Day 270 1. Navajeevan (125 mg) tablet twice a day with water
Day 300 1. Navajeevan (125 mg) tablet twice a day with water
2. Arka of chandan + Gojihva + Gulab 50 ml twice a day
1995 depicted no abnormal cells. Bone marrow aspiration
done after fteen months of starting of Ayurvedic
treatment indicated less than 5% promyelocyte and blast
cells, indicating complete remission of the disease (BMA
done at dated 31/01/1997). The treatment was given
for a period of 340 days, following which he had been
under continuous monitoring. No grade II toxicity of
the treatment was reported in the patient. Subsequent
BMAs showed complete remission of the disease.
He was advised to get blood tests done periodically.
(Graph 1-3) The results of these studies indicate
sustainable improvement in the patient and the patient
is leading a normal life now.
Discussion
Ayurvedic texts have no direct reference of leukaemia.
However, its symptoms have been at times linked to
those of Rakta pia.14 Dhatuvigyana (~science of metals),
under Rasa shastra, emphasises upon the importance of
equilibrium of the seven Dhatus including Gold, Silver,
Copper, Iron, Tin, Lead and Zinc, within the body for
healthy metabolism. The body is made up of seven
Dhatus (
~
tissues). Any imbalance between these Dhatus
leads to initiation of disease process within the body.1
5
Navajeevan is a proprietary formulation based on the
principles of Rasa shastra.16 It is prepared using equal
parts of Rajata bhasma (~calcined silver), Jawahar mohra
(~serpentine stone) pishti and Nirvishi (Delphinium
denudatum Wall.) roots with distillate of Gulab (Rosa
centifolia Linn.), Chandana (Santalum album Linn.),
Gojihva (Onosma bracteatum Wall.) and Lata kasturi
(Hibiscus abelmoschus Linn.). Rajata (~silver) is present
in Majja (~bone marrow) and its imbalance might
disturb the production of many blood components.15
Nirvishi has been described in Ayurvedic texts to have
blood purifying properties. It is used to eliminate eect
of Dushi visha and is also Tridosha shamaka.17 Jawahar
mohra is also used in Pia related disorders and has the
property to eliminate Dushi visha. Kamadudha rasa is a

6 Journal of Ayurveda Case Reports Volume 2 Issue 2 April-June 2019
Prakash B, et al.: Ayurvedic Management or Acute Promyelocytic Leukaemia
Graph 1: Eect of Ayurvedic treatment on total leucocyte count as depicted in periodical blood tests.
Graph 3: Eect of Ayurvedic treatment on total lymphocyte count as observed in periodical blood
count repots.
Graph 2: Eect of Ayurvedic treatment on platelet count.
TLC (/mm3)
Normal range
16000
14000
12000
10000
8000
6000
4000
2000
0
06-09-1995
20-09-1995
26-09-1995
30-09-1995
09-10-1995
11-11-1995
08-12-1995
08-01-1996
14-02-1996
12-03-1996
07-05-1996
14-06-1996
01-07-1996
14-08-1996
11-09-1996
10-10-1996
02-11-1996
28-01-1997
14-02-1997
14-04-1997
07-06-1997
06-09-1997
17-10-1997
29-08-1998
30-01-1999
16-09-1999
24-01-2000
06-04-2000
07-02-2001
12-03-2002
11-12-2008
23-01-2010
07-10-2011
30-07-2012
02-05-2013
28-09-2017
06-09-1995
20-09-1995
26-09-1995
30-09-1995
09-10-1995
11-11-1995
08-12-1995
08-01-1996
14-02-1996
12-03-1996
07-05-1996
14-06-1996
01-07-1996
14-08-1996
11-09-1996
10-10-1996
02-11-1996
28-01-1997
14-02-1997
14-04-1997
07-06-1997
06-09-1997
17-10-1997
29-08-1998
30-01-1999
16-09-1999
24-01-2000
06-04-2000
07-02-2001
12-03-2002
11-12-2008
23-01-2010
07-10-2011
30-07-2012
28-09-2017
80
70
60
50
40
30
20
10
0
Lymphocytes (%)
Normal range
Platelet count (thou/mm3)
06-09-1995
20-09-1995
26-09-1995
30-09-1995
09-10-1995
11-11-1995
08-12-1995
08-01-1996
14-02-1996
12-03-1996
07-05-1996
14-06-1996
01-07-1996
14-08-1996
11-09-1996
10-10-1996
02-11-1996
28-01-1997
14-02-1997
14-04-1997
07-06-1997
06-09-1997
17-10-1997
29-08-1998
30-01-1999
16-09-1999
24-01-2000
06-04-2000
07-02-2001
12-03-2002
11-12-2008
23-01-2010
07-10-2011
30-07-2012
02-05-2013
28-09-2017
400
350
300
250
200
150
100
50
0
Normal range

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Journal of Ayurveda Case Reports Volume 2 Issue 2 April-June 2019
Prakash B, et al.: Ayurvedic Management or Acute Promyelocytic Leukaemia
classical Ayurvedic formulation that is known to restore
the balance of Pia in the body.
The aforesaid formulations with a diet rich in dairy,
seasonal cereals, pulses, fruits and vegetables, low salt
intake and devoid of tea, coee, aerated drinks, reheated
and packed food, was probably able to alter the natural
history of the disease and bring twenty-two years long
ongoing disease free survival without causing any
grade II toxicity. The eect observed in the case study
can be explained hypothetically at this point as intrigue
chemistry of Ayurvedic formulations. However, the
periodical bone marrow examinations, blood prole and
clinical condition of the patient continue to depict long
term therapeutic eect of Ayurvedic formulations in
the successful and sustainable management of relapsed
state of APML.
Rasa shastra that deals with prevention and treatment
of many diseases also deals with Mercury and specied
substances of mineral, plant and animal origin. Most
of these ingredients are moderate to severely toxic
in raw forms. However, tedious methodology not
only eliminates their toxic eect but also converts a
combination of these into a life saviour compound.
This particular branch of Ayurveda has not been much
explored for its therapeutic properties. However,
such anecdotal cases do suggest that it needs to be
investigated thoroughly and larger studies should be
carried to establish the role of the stated formulations
in the management of APML or related disorders. The
medicines stated have also earlier shown encouraging
results in a pilot study conducted under the aegis of
Central Council of Research in Ayurvedic Sciences.18
Conclusion
This case report is a proof of the therapeutic ecacy of
the stated Ayurvedic formulations in the treatment of
APML and needs further merit.
Source of support
None.
Conict of Interest
Both the formulations used in this case are being
prescribed by the corresponding author in his clinical
practice since years. There is no other conict of
interest.
Acknowledgements
We duly acknowledge Late Vaidya Chandra Prakash for
evolving this formula and the patient with his family for
sharing the medical details.
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Published by:
Director
All India Institute of Ayurveda
An Autonomous Organization under the Ministry of AYUSH, Govt. of India
Mathura Road, Gautam Puri, Sarita Vihar, New Delhi - 110076
Phone: 011-29948658
aiiaayucare@gmail.com
An Official Peer Reviewed Publication of
All India Institute of Ayurveda
New Delhi
Journal of
Ayurveda Case Reports
Journal of
Ayurveda Case Reports
Volume 2, Issue 2, April-June 2019
AyuCaRe
AyuCaRe