Reference:
Acute Promyelocytic Leukemia (APL) By Joe Hing Kwok Chu
This is a type of leukemia that can be treated successfully. The therapy was developed in Shanghai, China and has been used in the West for many years with good results. The methods were discovered from the observation on the use traditional Chinese herb formulae.
It was noticed that most cancer patients showed a lower level of natural vitamin A in their blood. It was found that the vitamin A levels of those who were using a classical Chinese herb formula called "xiao chai hu tang" were closer to normal and had higher survivor rate. Thus all-trans-retinoic acid, a vitamin A derivative came to the attention of medical researchers in China.
The most serious problems of APL patients are blood clots (disseminated intravascular coagulation or DIC), bleeding and fungal infection. The risk of thrombosis and bleeding is mainly due to the decline of the total platelets. The risk of fungal infection, especially infection of Aspergillus nigers, is due the lowering of the total functional white cells caused by the disease, chemotherapy and the use of steroids to counter the side effect of ATRA therapy and at the same time of intra venous feeding which is necessary for medication and for the infusion of platelets (when the total platelet count is dangerously low).
The lowering of the total white cells in chemotherapy can be a side effect instead of the goal which many practitioners believe. In the editor's opinion, when the condition has been stabilized Chinese herb to promote platelets and white cells can be used. Use of Chinese herb formulae for fungal infection should also be investigated.
Many medical professionals cannot see the risk of thrombosis because of the high prothrombin time of the APL patients. Actually these are different issues. The hypercoagulopathy (pervasive blood clot) is caused by the thromboplastin - like substance secreted by the abnormal Auer rods of the bone marrow cells. According one statistical source, 60 % of the patients died of bleeding in the brain before receiving treatment. The hypercoagulopathy in the blood vessels causes the drop of the total platelets, thus causes the bleeding. The editor first learned of risk of hypercoagulopathy through a stressful way. The editor was visiting his son in Stanford hospital near midnight and found that his pulse reading (traditional Chinese pulse reading) indicated an eminent pending massive blood clot. Using qi on certain acupoints relieved his symptoms temporarily. The editor raised the issue with a medical student who were on duty and she was not convinced because of the high prothrombin time shown on the blood test reports. While discussing the issue, a nurse arrived with the heparin medication ordered previously by the patient's main doctor .
Another problem is that antifungal drugs are highly toxic. The survival rate in cases of fungal infection in immune deficient patients is low because of the toxicity of antifungal drugs.
All-trans-retinoic Acid (ATRA)
The use of All-trans Retinoic Acid for promoting the forming of bone marrow cells was first published by Prof. Zhen Yi Wang (王正儀) of Shanghai Medical School during the later part of the 80's. This brought the ATRA out of the research stage from the laboratories into clinical use.
This therapy modality is definitely different from the traditional Western approach where the therapy has been focusing on eradicating the cancer cells. Although ATRA cannot eliminate the cancer genes and cannot completely cure the patients of APL but it can lower 85% of the hyper coagulation and achieving the remission rate of 80% to 90% and lower the mortality rate of 85% to less than 10%. Using conventional chemotherapy, the resulting of sepsis caused by the lowering of white cells count, can happen. Compared to using chemotherapy or the highly difficulty of bone marrow transplant, this ATRA therapy is better in many ways, like quality of life of patients are better and without the side effects of chemotherapy. But, the short coming of ATRA therapy is the risk of overproduction of white cells and the rapid development of drug resistance. Thus chemotherapy is still being used in conjunction with ATRA therapy.
Arsenic trioxide (As2O3) Therapy
The use of arsenic trioxide has a long history. Some classical formulae are found in writings dated to the Han dynasty (more than two thousand years). The use of arsenic in modern clinical application is much earlier than the use of ATRA. As early as 1972, in mainland China, arsenic trioxide was being used in myelocytic leukemia. The result was reported in Chinese journals [1] that 22 patients out of 81 were completely in remission, 7 of M2 and 15 of M3. The substance used was extract of arsenic:As2O3 1mg/ml and HgCl 0.01mg/ml. The result was that the Aur rods of promyelocyte gradually disappeared or shrunk. Later it was found that it was especially effective for APL. Subsequently the results were published in various Chinese journals. [2,3] The common discovery was that the remission rates were 60 ~ 70%, regardless of if they were first time patients or refractory patients, or recurring after ATRA or chemotherapy. Later it was discovered that excluding HgCl or just taking arsenic sulfide could achieve the same result. During the 90's the understanding of the apoptosis of cells, the transformation of bone marrow cells and peripheral blood lead to the understanding of the function of arsenic trioxide that causes the apoptosis of cells leading to the cure of APL. The side effects include nausea, vomiting, lack of appetite, diarrhea, numbness in the extremities of limbs, edema in the lower limbs, settlement of skin pigments, abnormal function of the liver. But, because of the low dosage, cirrhosis of the liver or organ exhaustion has never occurred. Later, in vitro experiments also proved that arsenic trioxide also can cause apoptosis of cells, especially promyelocytes.
It is deemed that the first scientific report was written by Hong De Sun (孫洪德) et al of Harbin city, China, in 1992. Thirty two patients with acute promyelocytic leukemia were treated with arsenic trioxide in combination with traditional Chinese medical diagnostics and therapy methods. The results: total remission was 65.6% (21 patients out of 32). 50% survived more than 5 years and 18.8% survived more than 10 years.
In 1995, Shi lin Huang (黃世林) [2] of Da Lian city, China reported using a formula of qing dai
(indigo) containing iong huang (realgar) as main Chinese herb treating 60 APL patients and resulted 98.3% with total remission. The main ingredient of xion huang
is As2S2﹐As2S3 and As4S4 and a small amount of As2O3. Before that there were report of using the formula called "Niu Huang Jie Du Pian" (containing xiong huang) or just using xiong huang (reakgar) by itself to treat APL. The above shows that arsenic compounds are effective in treating APL.
A scientific report on using arsenic trioxide therapy was published by "Chinese Hematology Journal" (中華血液學雜誌) in 1996. It reported using arsenic trioxide therapy on 72 new patients and also on refractory patients. The complete remission rate on the new patients was 73.3% and on on refractory patients was 52.3% .
