Acute Promyelocytic Leukemia: 37 Years Long Ongoing Survival in a de novo Patient with Metal-Based Ayurvedic Treatment

Abstract

Acute promyelocytic leukemia (APML) is a subtype of acute myeloid leukemia. The condition is clinically marked by anemia, fatigue, weakness, frequent infections, and fever associated with easy bleeding and coagulopathy. The diagnosis is made through bone marrow aspiration exhibiting increased promyelocytes and test for PML-RARα fusion gene. There has been remarkable progress in the treatment of APML in the past few decades with the induction of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO). This has also brought down mortality and relapse rates considerably. Similarly, nearly 90% patients are able to live disease free for about 10 years. However, there are certain hindrances to these treatments majorly due to side effects, relapses, and limited periods of remission associated with ATRA and ATO. Here, a freshly diagnosed case of APML is being reported. The patient was diagnosed in leading medical centers of Aligarh and New Delhi and only treated with blood transfusions in the absence of an established line of treatment in 1982. The patient has completed 37 years long survival without any sign of the disease and any adverse effect. This approach could be considered as an add-on medical therapy for APML.

Full text

THIEME
Case Report Q2
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Acute Promyelocytic Leukemia: 37 Years Long
Ongoing Survival in a de novo Patient with Metal-
Based Ayurvedic Treatment
Balendu Prakash1 Shikha Prakash2 Sneha Tiwari3
1Research Division, VCPC Research Foundation, Rudrapur,
Uttarakhand, India
2Department of Medicine, Padaav-Speciality Ayurvedic Treatment
Centre, Dehradun, Uttarakhand, India
3Department of Clinical Research, VCPC Research Foundation,
Rudrapur, Uttarakhand, India
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Address for correspondence Balendu Prakash, BAMS, Research
Division, VCPC Research Foundation, Prakash Villa,
Beside Rave Cinemas, Danpur, Rudrapur 263153, Uttarakhand,
India (e-mail: balenduprakash@gmail.com).
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Acute promyelocytic leukemia (APML) is a subtype of acute myeloid leukemia. The
condition is clinically marked by anemia, fatigue, weakness, frequent infections, and
fever associated with easy bleeding and coagulopathy. The diagnosis is made through
bone marrow aspiration exhibiting increased promyelocytes and test for PML-RARα
fusion gene. There has been remarkable progress in the treatment of APML in the past
few decades with the induction of all-trans retinoic acid (ATRA) and arsenic trioxide
(ATO). This has also brought down mortality and relapse rates considerably. Similarly,
nearly 90% patients are able to live disease free for about 10 years. However, there
are certain hindrances to these treatments majorly due to side effects, relapses, and
limited periods of remission associated with ATRA and ATO. Here, a freshly diagnosed
case of APML is being reported. The patient was diagnosed in leading medical centers
of Aligarh and New Delhi and only treated with blood transfusions in the absence of
an established line of treatment in 1982. The patient has completed 37 years long
survival without any sign of the disease and any adverse effect. This approach could be
considered as an add-on medical therapy for APML.
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Abstract
Keywords
►APML
►ayurveda
►blood transfusions
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DOI https://doi.org/
10.1055/s-0040-1715765
ISSN 2454-6798.
©2020 Spring Hope Cancer
Foundation & Young Oncologist
Group of Asia
Asian J Oncol
A 10-year-old boy was admitted in the outdoor patient
unit of Jawaharlal Nehru Medical College, Aligarh (OPD No.
C-17891/82) with symptoms of high fever, hematuria, nasal
bleeding, and pallor. He was diagnosed with acute promyelo-
cytic leukemia (APL) using blood picture dated December 2,
1982 (hemoglobin: 8 g%, total leukocyte count: 2,100/mm3,
blast: 8%, promyelocytes: 23%, myelocytes: 2%, polymorphs:
60, and platelets: 15,000/mm3). He was treated with intrave-
nous fluids, frequent blood transfusions, antibiotics, and anti-
pyretic medicines and was referred to the then Department of
Hematology, All India Institute of Medical Sciences, New Delhi
for further management (Ref No. 54092) where his prognosis
was declared to be poor. His family contacted Meerut-based
doctor (Ayurvedacharya), Late Vaidya Chandra Prakash, who
administered his self-prepared silver-based Ayurvedic com-
pound, called Navjeevan, 250 mg thrice a day with 60-mL
mixture of extracts of rose, sandalwood, and gojihwa.1,2 All
conventional treatments along with blood transfusions were
stopped at the commencement of Ayurvedic treatment.
Within 3 hours of the consumption of the Ayurvedic formu-
lation, bleeding stopped. The boy was given ice cap therapy to
bring down the fever. He was kept in complete isolation and
given a balanced diet with more dairy products. Consumption
of tea and coffee was stopped. He received complete hema-
tological remission after 6 weeks of Ayurvedic treatment.
Details of blood tests are presented in ►Table1.Q9

2
Asian Journal of Oncology
Acute Promyelocytic Leukemia Prakash et al.
Since then, all his reports and other biochemical parame-
ters remained within normal limits. No adverse effects were
seen. The boy is a grown-up man now who lives in Dubai with
his family and two children and has completed 37 years of
overall survival (duration of complete remission: 36 years).
APML or AML M3 is characterized by an arrest of leuko-
cyte differentiation at the promyelocyte stage. It has been
considered as the most malignant form of acute leukemia for
decades because of severe bleeding tendency and high rate of
early death, mostly due to disseminated intravascular coagu-
lation or hyperfibrinolysis.3 Earlier studies indicate a median
survival of less than 1 week, ranging from 1 week to 1 month
in APML cases, when patients remained untreated or received
corticosteroids along with whole blood transfusions.4 Great
progress has been made in the last three decades in the
treatment of APML with the intervention of all-trans retinoic
acid (ATRA), arsenic trioxide (ATO), and anthracycline-based
chemotherapy. Still, early deaths in freshly diagnosed cases
and post-therapy relapse remain obstacles in achieving long-
term survival.3 Also, adverse effects associated with conven-
tional treatment are also a cause of concern in many cases.
In the stated background, there is scope to improve exist-
ing therapies or to develop other therapies which could
further escalate the response, duration of remission, and
minimize side effects. The stated case was diagnosed and
treated before the introduction of ATRA and ATO when there
was no established line of treatment. The patient showed
quick and sustainable recovery after the administration of
Ayurvedic formulation and still remains well without experi-
encing any adverse effect. It can easily be concluded that the
stated formulation could have altered the natural history of
the disease and might have brought the longest overall and
disease-free survival in a de novo APML patient.
We are reporting this case with the view that the princi-
ples and formulations of Rasa Shastra in Ayurveda should be
explored further in the prevention and treatment of hemato-
poietic disorders with more emphasis on APML.5 It is impera-
tive to mention that this medicine has not yet been analyzed
for its chemical nature and nomenclature. The dosage, dura-
tion, mode of action also needs to be understood with the
help of modern scientific, biological, and pharmacological
tools.
Note
B.P. has US and European patents issued for innovation
and formulation in use.
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Conict of Interest
None declared.
References
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ment in a high risk acute promyelocytic leukemia patient with
second relapse: 12 years follow up. J Ayurveda Integr Med
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2 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
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myelocytic leukemia: optimization and obstruction. Int J
Hematol 2014;100(1):38–50
4 Coombs CC, Tavakkoli M, Tallman MS. Acute promyelocytic
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5 Savrikar SS, Ravishankar B. Introduction to ‘Rasashaastra’ the
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Table 1 Results of blood tests conducted
Date Hb (g%) TLC (/mm3) Platelets (/mm3) Immature cells
Pretreatment
December 02, 1982 8 2,100 Inadequate (15,000) 33% (Blasts: 8%, Promyelocytes:
23%, Myelocytes: 2%)
December 15, 1982 10.5 5,650 Inadequate 64% (Promyelocytes: 61%,
Myelocytes: 3%)
December 21, 1982 12.5 6,650 Inadequate 42% (Blasts: 1%, Promyelocytes:
40%, Myelocytes: 1%)
Post-treatment
December 27, 1982 8.5 800 Inadequate (21,000) –
November 21, 1983 11 8,500 Adequate
November 02, 2019 15 6,300 Adequate (2,88,000)
Abbreviations: Hb, hemoglobin; TLC, total leukocyte count.