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Treatment of relapsed undifferentiated acute myeloid leukemia (AML-M0) with Ayurvedic therapy

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Vaidya Prakash at VCP Cancer Research Foundation
Vaidya Prakash
  • VCP Cancer Research Foundation
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A 16-year-old boy was detected with acute myeloid leukemia (AML - M0) with bone marrow pathology showing 85% blasts in February 07, 1997. He received two cycles of induction chemotherapy (3+7 protocol) with daunomycin and cytosar, following which he achieved incomplete remission with bone marrow aspirate showing 14% blasts. Subsequently, the patient received two cycles of high-dose cytosine arabinoside Ara-C and achieved remission. However, his disease relapsed on August 29, 1997. Peripheral blood smear showed 6% blast cells and bone marrow showed 40% blast cells. The patient refused further chemotherapy and/or bone marrow transplant and volunteered for Ayurvedic therapy (AYT) advocated by the author from September 09, 1997. Bone marrow studies done after six months of AYT indicated that the disease was in remission. The AYT was continued for five years and stopped. Thereafter, the patient received intermittent maintenance AYT for three months in the next two years. At present, the patient is normal and healthy and has completed 12 years of disease-free survival with AYT.
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56 International Journal of Ayurveda Research | Jan-Mar 2011 | Vol 2 | Issue 1
Prakash: Ayurvedic treatment for relapsed AML
Treatment of relapsed undifferentiated acute
myeloid leukemia (AML-M0) with
Ayurvedic
therapy
Balendu Prakash
V C P Cancer Research Foundation (Scientifi c and Industrial Research Organization), Mandir Marg, Turner Road, Clement Town, Dehradun, India
CASE REPORT
Address for correspondence:
Vaidya Balendu Prakash,
Ipca Traditional Remedies Pvt. Ltd., 142 AB, Charkop Industrial
Estate, Kandivali West, Mumbai – 400 067, India.
E-mail: balenduprakash@gmail.com
Submission Date: 07-06-10 Accepted Date: 01-06-11
INTRODUCTION
Acute myeloid leukemia (AML) is the most common form
of acute leukemia[1] and accounts for 15% of childhood
leukemias.[2] Modern induction chemotherapy results
in complete remission in 50 to 90% of patients with de
novo disease, but between 10 and 25% of patients have
primary refractory disease and the majority of those who
gain remission relapses within 3 years of diagnosis.[3] The
development of drug resistance is the limiting factor in
the therapy of AML. Treatment of relapsed leukemia is
diffi cult and well-controlled trials in this group of patients
are uncommon.[3] There is scanty information available on
long-term disease-free survival in AML patients with second
relapse. We reported a case of high-risk AML patient who
relapsed a second time after undergoing conventional therapy.
Later, he received oral Ayurvedic treatment (AYT) along with
supportive care and recovered.
CASE REPORT
A 16-old-boy was admitted in the Dharamshila Cancer
Hospital and Research Centre, New Delhi, on February 05,
1997 with complaints of bone pains for the last 2 months and
fever for last one month. His bone marrow aspiration study
done earlier from Indraprastha Apollo Hospital on February
07, 1997 suggested acute lymphoblastic leukemia (ALL) L2.
However, immunophenotyping study diagnosed it as AML
– M0. The bone marrow pathology showed 85% blast. The
patient was given two cycles of induction chemotherapy (3+7
protocol) with daunomycin and cytosine arabinoside cytosar
, following which the patient achieved incomplete remission
with bone marrow aspirate showing 14% blast. Subsequently,
patient received two cycles of high-dose cytosine arabinoside
Ara-C . The bone marrow study done on May 21, 1997 after
the completion of fi rst cycle showed less than 1% blast cells.
A 16-year-old boy was detected with acute myeloid leukemia (AML – M0) with bone marrow pathology showing
85% blasts in February 07, 1997. He received two cycles of induction chemotherapy (3+7 protocol) with daunomycin
and cytosar, following which he achieved incomplete remission with bone marrow aspirate showing 14% blasts.
Subsequently, the patient received two cycles of high-dose cytosine arabinoside Ara-C and achieved remission. However,
his disease relapsed on August 29, 1997. Peripheral blood smear showed 6% blast cells and bone marrow showed 40%
blast cells. The patient refused further chemotherapy and/or bone marrow transplant and volunteered for Ayurvedic
therapy (AYT) advocated by the author from September 09, 1997. Bone marrow studies done after six months of AYT
indicated that the disease was in remission. The AYT was continued for fi ve years and stopped. Thereafter, the patient
received intermittent maintenance AYT for three months in the next two years. At present, the patient is normal and
healthy and has completed 12 years of disease-free survival with AYT.
Key words: Ayurvedic, relapsed acute myeloid leukemia
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DOI:
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ABSTRACT
International Journal of Ayurveda Research | Jan-Mar 2011 | Vol 2 | Issue 1 57
Prakash: Ayurvedic treatment for relapsed AML
The patient completed the second cycle of chemotherapy on
June 01, 1997. During chemotherapy, the patient had 3 to
4 episodes of infection for which antibiotic coverage was
given along with supportive care. However, bone marrow
studies done on August 29, 1997 indicated relapse of the
disease. Peripheral blood smear showed 6% blast cells and
bone marrow showed 40% blast cells. The option of further
chemotherapy and/or bone marrow transplant was discussed
with the patient. However, the caregivers of the patient did not
consent for any of the two options. The patient volunteered for
the Ayurvedic therapy that started from September 09, 1997.
The patient was given oral AYT comprising of Navjeevan,
Valapani, Kamdhuda,[4] Prak-20,[5] etc . The patients was
given supportive therapy for fever and infection time to
time after getting culture and drug sensitivity test under
the guidance of a competent MD, modern medicines.
No other Ayurvedic medicines were given. The details
of the medicines are given in Table 1. These medicines
were found to be effective in the treatment of leukemia
patients.[6] The patient was clinically asymptomatic at the time
of the start of the AYT. The patient tolerated the therapy well
and cytopathology studies done about 6 months after the start
of AYT on March 09, 1998 showed about 1% blast cells in
bone marrow, whereas no blast cell was found in peripheral
blood. The patient continued the Ayurvedic therapy with
regular follow-up. Patient was followed up on monthly basis.
Apart from clinical condition, his body weight and CBC were
checked on monthly basis using the same pathology run by a
MD, pathology at Dehradun or Dr lal Path lab in Delhi. The
Table 1: Details of the Ayurvedic medicines
Dose
Medicines Form Dose Frequency
Navajeevan Tablet 125 mg 2 tablets BD
Valipani Tablet 500 mg 2 tablets BD
Kamadudha Rasa Powder 250 mg TDS
Prak-20 Capsule 500 mg 1 capsule BD
Traditional Name English /Scientifi c name Proportion
Composition of Navajeevan Anupan: Water
Rajat Bhasma Silver Bhasma 1 part
Jaharmohra Serpentine stone 1 part
Nirvisha Delphinium denudatum 1 part
Taruni, gulab Rosa centifolia 1 part
Chandan Santalum album 1 part
Gojihva Onosma Bracteatum 1 part
Lata kasturi Hibiscus abelmoschus 1 part
Composition of Valipani Anupan: Water
Shudha Hingul Processed cinnabar 1 part
Suddha Gandhak Processed sulfur 2 part
Loha Bhasma Ferric oxide 1 part
Amla Emblica offi cinalis 3 part
Bhallatak Semecarpus anacardium 1 part
Harad Terminalia chebula 1 part
Ginger Juice Zingiber offi cinale Q.S.
Amla Juice Emblica offi cinalis Q.S.
Madhu Honey 1 part
Composition of Kamadudha Rasa Anupan: Mishri
Mauktik Pishti Mytilus margaritiferus preparation 1 part
Pravala pisti Corallium rubrum preparation 1 part
Mukta sukti pisti Mytilus margaritiferus 1 part
Kapardika bhasma Calcinated and purifi ed Cypraea moneta shells 1 part
Shankha bhasma Calcinated and purifi ed Turbinella rapa shells 1 part
Swarna gairik Calcinated and purifi ed Ochre 1 part
Amrta satva Tinospora cordifolia extract 1 part
Table 1 (Contd...)
58 International Journal of Ayurveda Research | Jan-Mar 2011 | Vol 2 | Issue 1
Prakash: Ayurvedic treatment for relapsed AML
Composition of Prak-20
Common name Scientifi c name Proportion
Sunthi Zingiber offi cinale 12.5 mg
Maricha Piper nigrum 12.5 mg
Pippali Piper longum (fruit) 12.5 mg
Haritaki Terminalia chebula 12.5 mg
Vibhitaki Termnalia bellirica 12.5 mg
Amalaki Emblica offi cinalis 12.5 mg
Chitraka Plumbago zeylanica 12.5 mg
Musta Cyperus rotundus 12.5 mg
Katuki Picrorhiza kurroa 12.5 mg
Devadaru Cedrus deodara 12.5 mg
Vidanga Embelia ribes 12.5 mg
Kulu/Kushta Saussurea lappa 12.5 mg
Haridra Curcuma longa 12.5 mg
Daruharidra Berberis aristata 12.5 mg
Danti Baliospermum montanum 12.5 mg
Indrayav Holarrhena antidysenterica (seeds) 12.5 mg
Pipali mool Piper longum 12.5 mg
Trivrit Ipomoea turpethum 12.5 mg
Punarnava Boerhavia diff usa 25.0 mg
Mandoor Bhasma Ferric oxide 250 mg
Table 1 (Contd...)
peripheral blood smear study done at regular interval did not
show any abnormality. The AYT was continued for fi ve years
and stopped. Thereafter, the patient received intermittent
maintenance AYT, same as mentioned before, in the same
doses for three months in the next two years.
In October 2007, the patient developed a testicular lesion
suspected to be tuberculosis. However, cytology studies of
the lesion, PCR analysis, and semen culture were all negative.
The AYT was restarted for six months from November
2007. At present, the patient is normal and healthy and has
completed 12 years of disease-free survival with AYT.
DISCUSSION
AML can be co-related to Majja Kshaya described in
Ayurveda. There is no concrete reference with me, except the
teaching of my late father who experienced his fi rst success
in early 1960s and made his own interpretations. One may
refer as traditional knowledge or hypothesis. And despite
improvement in the remission rate and overall survival
during the last 20 years or more, disease recurrence remains
the most common cause of treatment failure.[3] In contrast
to ALL, the progress in the therapy of childhood AML
lags behind, with cure rates of approximately 40 to 60%.[2]
Patients try various complementary and alternative medicines
when the conventional options exhaust. Many leukemia
patients in India try Ayurvedic therapy for treatment and
palliation.[7] The present case indicates that the oral
herbomineral Ayurvedic medicines can be effective in
treatment of AML without producing any toxic side effects.
As the patient has not taken any other therapy after his
disease relapsed, we believe that the Ayurvedic therapy was
responsible for the remission of his disease.
ACKNOWLEDGEMENT
The author is thankful to Dr. Sanjoy Kumar Pal of Ipca Traditional
Remedies Pvt. Ltd. for drafting this manuscript.
REFERENCES
1. Kuendgen A, Germing U. Emerging treatment strategies for
acute myeloid leukemia (AML) in the elderly. Cancer Treat
Rev 2009;35:97-120.
2. Styczynski J. Drug resistance in childhood acute myeloid
leukemia Curr Pharm Biotechnol 2007;8:59-75.
3. Kell J. treatment of relapsed acute myeloid leukaemia. Rev
Recent Clin Trials 2006;1:103-11.
4. Prakash B. Indegenous Approach to Combat Cancer. Health
Administrator 2005;17:169-71.
5. Prakash VB, Mukherjee A. Hepato-protective effect of an
Ayurvedic formulation Prak-20 in CCl4 induced toxicity
in rats: Result of three studies. Int J Pharma Clin Res
2010;2:23-7.
6. Effect of metal based Ayurvedic formulations in the
patients of acute pro-myelocytic leukemia (APML): A pilot
International Journal of Ayurveda Research | Jan-Mar 2011 | Vol 2 | Issue 1 59
Prakash: Ayurvedic treatment for relapsed AML
study. Prepared by Central Council for Ayurvedic Research
in Ayurveda and Siddha, Department of AYUSH, Ministry
of Health and Family Welfare, Government of India, New
Delhi. Available from: http://www.padaav.com/content/
Monograph.pdf. [Last accessed on 2010 June 2].
7. Gupta M, Shafi q N, Kumari S, Pandhi P. Pattern and
perception of complementary and alternative medicine
(CAM) among leukemia patients visiting haematology clinic
of a north Indian tertiary care hospital. Pharmacoepidemiol
Drug Saf 2002;11:671-6.
How to cite this article: Prakash B. Treatment of relapsed
undifferentiated acute myeloid leukemia (AML-M0) with Ayurvedic
therapy. Int J Ayurveda Res 2011;2:56-9.
Source of Support: Nil, Confl ict of Interest: None declared.
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Full-text available
  • Sep 2017
Objective This study was conducted to prepare records of medicinal plants used in various traditional practices in Northeast India for the management of different diseases. Introduction Northeastern region comprises the states of Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Tripura, and Sikkim. Topography of the region which is the prime source of diversity of flora and fauna covering the part of natural medicine is from tropical, subtropical, temperate, and alpine regions of vegetation distribution. This topography reflects the occurrence of diverse types of medicinal plants suitable for different climatic conditions. The study deals with the medicinal plants used in the management of various prevalent diseases in Northeast India by the use of locally available herbs. Outcome Medicinal plants distributed in the different climatic zones of Northeast are Aconitum heterophyllum, Acer palmatum, Adiantum capillus veneris, A. lunulatum, Aquilaria malaccensis, Bacopa monnieri, Berberis aristata, B. wal- lichiana, Bergenia ciliata, Curcuma caesia, C. zedoaria, Crateva nurvela, Cordyceps sinensis, Embelia ribes, Emblica officinalis, Gentiana kurroo, Gmelina arborea, Gynocardia odorata, Hydnocarpus kurzii, Nardostachys jatamansi, Panax pseudoginseng, Paris polyphylla, Picrorhiza kurrooa, Rauvolfia serpentina, Rubia manjith, Saraca asoca, Solanum nigrum, Taxus wallichiana, Terminalia arjuna, T. bellerica, T. chebula, T. citrina, Valeriana jatamansi, Zanthoxylum armatum, Z. rhetsa, Zingiber zerumbet, Z. officinale, etc. Conclusion The commercial cultivation, systemic collection for trade is the mode through which local inhabitants may earn money for moving toward prosperity.
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A Comprehensive Review on Śākavarga-group of Vegetables from Classical Texts of Ayurveda
Article
Full-text available
  • Sep 2017
Aim To have a comprehensive review on classification, good collection practices, number, importance, adverse effects, possible botanical identity, and different indications of classical vegetables from 15 different classical texts and lexicons and to present them in a systemic manner. Background Vegetables are an integral part of healthy diet since the Vedic era. For the past few decades, there is a growing interest in assessing the role of vegetables for their health benefits. In various classical texts of Ayurveda, all the vegetables are detailed under a single group termed as śākavarga where the properties and indication of individual plant were described. Authors of classical texts of Ayurveda described the nutritional as well as therapeutic value of all the vegetables in their respective texts. These information have not been critically reviewed and published in a compiled format. A systematic review regarding the identification and use of these classical vegetables is the need of the time. Review results Analysis of data reveals that about 308 śākadravya (vegetables) are described in classical texts. Among them, 156 patraśāka (leafy vegetables), 71 phalaśāka (fruit vegetables), 50 kandaśāka (tuber/root), 30 puspaśāka (flower vegetables), 10 nālaśāka (stem/aerial parts), and one type of samsvedaja śāka (mushrooms) are described. Conclusion Vegetables described under śākavarga in classical texts of Ayurveda can be further studied to understand the mechanism of action to establish their dietetic importance. Clinical significance These vegetables are indicated in 42 different disease conditions where they can be used as pathya (wholesome diet). Some contraindications and precautions to be taken during collection and preparations of the śākadravya are also explained in many of the classical texts.
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Hepato-protective Effect of an Ayurvedic Formulation Prak-20 in CCl 4 Induced Toxicity in Rats: Results of Three Studies
Article
Full-text available
  • Jan 2010
Prak-20 is a proprietary herbo-mineral ayurvedic formulation routinely used for years in the clinical practice of the first author in the treatment of liver ailments. Prak-20 is a judicious combination of nineteen herbs and Mandoor Bhasma. Three experimental studies were carried to evaluate its hepato-protective properties. In the first experiment, Prak-20 was compared vis-à-vis Liv52 in CCl 4 challenged Wister rats. The second study was a single blinded study of Prak-20 in CCl 4 challenged Wister rats. The third experiment was conducted to note the effect of different doses of Prak-20 in CCl 4 challenged albino rats. Serum alkaline phosphatase (ALP), serum alanine transaminase (ALT), serum aspartate transaminase (AST), along with liver histology was done in all animals at the completion of the first two studies. There was no significant elevation of ALT, AST and ALP levels despite CCl 4 exposure in Prak-20 treated animals. Similarly, the histology studies revealed that all animals of the treatment group had regenerating hepatocytes and no necrotic and degenerative changes were noticed in any animal. In the third experiment, ALT and AST levels were studied after 24 and 48 hours of experiment. There was 54 and 37 percent decrease in ALT, AST levels in CCl 4 plus Prak-20 (1.8 gm/d/rat) treated animals, respectively, as compared to CCl 4 treated animals. Prak-20 treated animals also had minimum necrotic changes after seven days. Based on the findings of aforesaid experiments which were carried at three centers, it may be concluded that Prak-20 is a potent hepato-protective herbo-mineral ayurvedic formulation. Further studies are required to understand its mechanism of action.
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Drug Resistance in Childhood Acute Myeloid Leukemia
Article
Full-text available
  • May 2007
  • CURR PHARM BIOTECHNO
Therapy results in childhood AML differ from those of ALL. The development of drug resistance is the limiting factor in the therapy of AML. Different problems of drug resistance in childhood AML, with emphasis to age and in comparison to adult AML are presented. In vitro and in vivo aspects are discussed, together with mechanisms of resistance to cytostatic drugs, focused on clinical relevance of cellular drug resistance profile and its prognostic value. Possibilities of modulation and circumvention of drug resistance are reviewed, with stress on new drugs being tested. Taking into account both children and adults, it seems that age is adversely related to therapy outcome in AML, and the percentage of patients with favorable cytogenetics decreases with age; however, age is positively correlated with multi-drug resistance and the proportion of patients with unfavorable cytogenetics. AML is considered a stem cell disease. BCRP, PGP and MRP's are preferentially expressed in leukemic stem cells, making this disease drug resistant. Cellular drug resistance in AML cells seems to be similar throughout all other age groups, however the higher the age, the worse the outcome. In childhood AML, no drug is more effective in comparison to ALL, and cellular drug resistance is partially related to chromosomal abnormalities. Pediatric AML is equally resistant as adult AML. Pediatric and adult AML, respectively, are possibly equally drug resistant on initial diagnosis and at relapse. In contrast to ALL, the prognostic value of in vitro drug resistance in childhood AML has not been well documented yet.
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Emerging treatment strategies for acute myeloid leukemia (AML) in the elderly
Article
  • Oct 2008
Acute myeloid leukemia (AML) is more prevalent in older adults, with an incidence in the United States of 17.6 per 100,000 for those 65 years of age, compared with an incidence of 1.8 per 100,000 for those <65 years of age. While there have been improvements in survival during the last decade for younger patients, prognosis in elderly patients is still poor; approximately 50% achieve complete responses, but many of them relapse. With increasing age, more patients are suboptimal candidates for standard induction chemotherapy due to poor performance status, pre-existing myelodysplasia, unfavorable cytogenetics, treatment-related AML, multidrug resistance protein expression, and CD34 positivity, which are often characteristic of this patient population. In addition, the presence of comorbid conditions make many treatment options less tolerable for elderly patients. Several investigators have described subgroups showing no benefit after intensive treatment approaches in recent years. However, several novel agents have been developed to treat elderly AML patients. These include new chemotherapeutic agents, such as nucleoside analogs, as well as targeted therapies like farnesyltransferase inhibitors, tyrosine kinase inhibitors, epigenetic drugs, and antibodies. On the other hand new insights into the biology of the disease lead to a better understanding of its heterogeneity. Thus, with a variety of novel substances at hand it is increasingly important to introduce a risk-adapted approach for the optimal management of patients. This review will identify subgroups not likely to benefit from intensive chemotherapy and highlight the efficacy and tolerability of new agents in the treatment of AML.
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Patterns and perceptions of complementary and alternative medicine (CAM) among leukaemia patients visiting haematology clinic of a North Indian tertiary care hospital
Article
  • Dec 2002
The use of complementary and alternative medicine (CAM) in cancer treatments is widespread with substantial number of patients deserting conventional cancer therapies in favour of unproven methods. The present study aimed at discovering the prevalence of use of CAM cancer therapies in leukaemia patients visiting haematology clinic of a north Indian tertiary care hospital. 533 consecutive leukaemia patients were interviewed. Information was gathered about patients' demographics, types of CAM taken, sequence of seeking CAM and conventional medicine, sources of recommendation, reasons of opting for CAM, and areas of satisfaction and dissatisfaction associated with the use of CAM. Patients were also asked if they had informed their doctor about CAM use. Prevalence of CAM use in leukaemia patients was found to be 56.6%. Ayurveda was the most commonly used CAM (33%). Most of the patients sought conventional medicine first, followed by CAM therapies. Fifty-two percent of the patients opted for CAM hoping for a miracle cure and 51% were dissatisfied with these therapies. Family members and neighbours constituted major source of recommendation of CAM therapy. Only 3.8% of the patients had informed their doctors about CAM use. A sizeable percentage of patients receiving conventional treatment for leukaemia also use CAM therapies. Clinicians should not underestimate the value of hopeful attitude in their management of leukaemia patients and ought to be conversant with popular forms of CAM cancer therapies.
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Treatment of Relapsed Acute Myeloid Leukaemia
Article
  • Jun 2006
Acute myeloid leukaemia (AML) is the most common form of acute leukaemia among adults with an incidence that increases with age. Modern induction chemotherapy will result in complete remission in 50-90% of patients with de novo disease, but between 10 and 25% of patients will have primary refractory disease and the majority of those who gain remission will relapse within 3 years of diagnosis. Treatment of relapsed leukaemia is difficult and well-controlled trials in this group of patients are uncommon. Usually, patients are recruited to relatively small phase I and phase II trials examining the potential role for new drug approaches and many combination regimens based around high doses of cytarabine arabinoside, substitution of the anthracyclines mitoxantrone or idarubicin for daunorubicin or using amsacrine have become established. However, these trials are generally unrandomised and produce second CR rates of 10-70% relying on historical controls. This article reviews the results of published randomised trials in relapse and refractory AML. Questions addressed include the role of high dose cytarabine, with or without the addition of etoposide or mitoxantrone, the use of timed sequential chemotherapy regimens, and growth factors as a means to increase leukaemia cell sensitivity and interference with drug resistance proteins.
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Indegenous Approach to Combat Cancer
  • Jan 2005
  • 169-171
  • B Prakash
Prakash B. Indegenous Approach to Combat Cancer. Health Administrator 2005;17:169-71.