Lymphoblastic leukemia - Chronic lymphocytic leukemia (CLL)

Leukemia is defined as condition of abnormal increase of white blood cells produced by the bone marrow and/or the lymphatic system. Depending to the malignant granulocytes or lymphocytes, leukemia is classified into myelogenous or lymphoblastic leukemia.
Bone marrow is soft tissue inside the hollow center of major bone. including spine, pelvis, under arm, leg. etc.

Types of leukemia
Leukemia can be classified into 2 types
A. Acute leukemia
Acute leukemia is defined as condition of rapid increase in the numbers of extreme immature white blood cells which appear in the blood stream into other parts of the body, including tissue and organs.
1. Acute lymphoblastic leukemia (ALL)
Acute lymphocytic leukemia (ALL) is a type of cancer of the abnormal growth of extreme immature lymphocytes overproduced by the bone marrow and/or lymphatic system. Since it has a tendency to multiply quickly, it can lead to death to other normal white blood cells in the bone marrow and/or lympaphatic system. In ALL, lymphocytes appear immature in blood stream.
Acute lymphoblastic leukemia (ALL) is most common children forms of leukemia with about 80% of all cases.

2. Acute myelogenous leukemia (AML)
Acute myelogenous leukemia (AML) is a cancer of myelogenous lining cause of rapid growth of abnormal granulocytes accumulated in the bone marrow, interfering with the normal blood cells. In AML, granulocytes appear immature in blood stream.


B. Chronic leukemia
Chronic leukemia is defined as condition of slow but still excessive build up of relatively mature abnormal white blood cells. It has a tendency to spread slowly to other parts of the body through bloodstream and/or lymphatic system.
1. Chronic lymphocytic leukemia (CLL)
Chronic lymphocytic leukemia (CLL) is defined as a condition of slow growth and spreading of a group of abnormal white blood cells called B-cell lymphocytes, which fight against infection in our body by produced antibodies. In CLL, B-cell lymphocytes have become abnormal and grow out of control. They appear less immature in the bloodstream.

2. Chronic myelogenous leukemia (CML)
Chronic myelogenous leukemia (CML) is also defined as condition of slow growth and spreading of abnormal granulocytes. In CML, granulocytes have become abnormal and growth uncontrollably in the bone marrow and/or lymphatic system and appear less immature in the blood stream.

Lymphoblastic leukemia
B. Chronic lymphocytic leukemia (CLL)
Chronic lymphocytic leukemia (CLL) is defined as a condition of slow growth and spreading of a group of abnormal white blood cells called B-cell lymphocytes, which fight against infection in our body by produced antibodies. In CLL, B-cell lymphocytes have become abnormal and grow out of control. They appear less immature in the bloodstream.
B.1. Symptoms
Constitutional symptoms
1. Fatigue
Fatigue is a result of not enough red blood cell to transport oxygen to the body cells.
2. Infections
As white blood no longer function normally in fighting against foreign invasion such as virus and bacteria.
3. Unintentional weight loss
Weight loss unintentionally over 10%
4. Loss of appetite
It is one of the symptoms accompanied with cancers
5. Abdominal swelling
Due to spreading of the disease to the lymph nodes or infectious cause of swelling somewhere else in the body
6. Fever
As a result of infection
7. Bruising easily
Due to reduced blood's platelets.
8. Shingles
It may be caused by reactivate of certain virus in your body, such as chicken pot
9. Excessive sweating, night sweats
Night sweats are an early symptom of some cancers, specially in case of CLL.
10. Etc.
Specific symptoms
1. Abnormal bruising
It is normally occurred in the later stage due to immature white blood cells affecting the levels of platelets
2. Enlarged lymph nodes, spleen
In CLL lymph nodes can swell more than 1cm in children and 2 cm in adult.
3. Become too full easily
One the specific symptoms of ALL due to enlarged lymph nodes or spleen pressing onto the abdomen.
4. Etc.

b.2. Causes and risk factors
1. Age
As the cancer is accounted for more than 90% of cases, occurring in adult over age of 50
2. Gender
Men are more likely to develop chronic lymphocytic leukemia than women.
3. Family history
People with a direct family history of chronic lymphocytic leukemia (CLL) or other blood and bone marrow cancers have an increased risk of CLL.
4. Exposure to environment chemicals
Exposure to certain chemicals can increase risk of the disease, including Agent Orange.
5. Etc.

Although it is known that chronic lymphocytic leukemia (CLL) is a result of a genetic mutation in the DNA of blood-producing cells, but what causes this mutation? Doctors aren't certain.

B.3. Diagnosis and tests
If you have some of the symptoms of the above. the first test that your doctor order is a complete blood count after a collection of your medical history and physical examination.
1. Physical examination
In Physical examination, your doctor may investigate for signs of bruising, bleeding, swelling lymph nodes, etc.
2. Complete blood count
Complete blood is very important if your doctor suspected there may be a sign of the development of ALL. The test will reveal to your doctor the degree of abnormal white blood cell red blood cell (anemia) and platelet count (thrombocytopenia).
3. Bone marrow biopsy
The test usually is done in your doctor or in hospital as a outpatient by using a thin, tube-like needle inserted into the hip to withdraw a small sample from bone marrow. The sample will be view under microscopy to look for any abnormality of granulocytes or lymphocytes.
If your doctor suspect that the disease have spread to other tissue or organs, other tests may be required.
4. Other tests if necessary

B.4. Stage of chronic lymphocytic leukemia (CLL)
1. Stage 0
In stage 0 of chronic lymphocytic leukemia (CLL), there are too many less-immature white blood cells in the blood, but there are no other symptoms of leukemia.
2. Stage I
In stage I of chronic lymphocytic leukemia (CLL), there are too many less-immature white blood cells in the blood and the lymph nodes may be larger than normal.
3. Stage II
In stage II of chronic lymphocytic leukemia (CLL), there are too many less-immature white blood cells in the blood, the spleen and the lymph nodes may be larger than normal.
4. Stage III
In stage III of chronic lymphocytic leukemia (CLL), there are too many less-immature white blood cells in the blood and very low red blood cells. The lymph nodes, spleen may be larger than normal.
5. Stage IV
In stage IV of chronic lymphocytic leukemia (CLL), there are too many less-immature white blood cells in the blood and too few platelets and/or red blood cells. The lymph nodes and spleen may be larger than normal.

B.5. Prevention
Increased intake of high amount of antioxidant and foods that enhance the immune system, and living a healthy life style may reduce risk of ALL.
c. 1. Diet
a. Garlic
In the study of Garlic compounds selectively kill childhood pre-B acute lymphoblastic leukemia cells in vitro without reducing T-cell function: Potential therapeutic use in the treatment of ALL. Researchers found that after oral consumption or intravenous dose of garlic extracts to volunteers, serum from these volunteers could be substituted in similar experiments to that described in this manuscript to determine optimal dosage to achieve maximal killing of ALL cells while maintaining Th1 response.
b. Soy extract
In a study, research found that genistein increased the potency of the chemotherapeutic agent bleomycin against the leukemia cell line HL-60, and reduced the damage this agent normally causes to normal lymphocytes, thus it may reduce normal tissue toxicity associated with chemotherapy (Lee R et al 2004).
c. Tomato
Tomato contain high amount of lycopene, a powerful antioxidant that have shown inhibition of leukemia of cell cycle progression and induction of differentiation in HL-60 leukemic cells.

d. Carrot
Carrot contains high amount of beta carotene which has shown to induce appotosis of cancer cells. In study of Cell Cycle Regulation and Induction of Apoptosis by β-carotene, researchers found that in vivo study warrants further confirmation that β-carotene acts as apoptosis agent in cancer cells particularly leukemia cells but not normal cells.

e. Etc.

2. With nutritional supplements
a. Lipoic acid and vitamin D3
Research shows that lipoic acid, used in combination with vitamin D3, support normal (versus cancerous) growth and maturation of leukemia cells (Sokoloski JA et al 1997).

b. GLA and eicosapentaenoic acid (EPA)
In a study, researcher found that GLA and eicosapentaenoic acid (EPA) have been shown to cause death in HL-60 leukemia cells (Gillis RC et al 2002).

c. Epigallocatechin gallate
In a study in 2004 by Dr. Lee, YK, found that Epigallocatechin gallate (EGCG) in green tea blocks the production of vascular endothelial growth factor (VEGF), considered essential for leukemia growth and spread.

d. Lycopene and 1,25-dihydroxyvitamin D3
In a study of Lycopene and 1,25-dihydroxyvitamin D3 cooperate in the inhibition of cell cycle progression and induction of differentiation in HL-60 leukemic cells, researchers found that The combination of low concentrations of lycopene with 1,25-dihydroxyvitamin D3 exhibited a synergistic effect on cell proliferation and differentiation and an additive effect on cell cycle progression. Such synergistic antiproliferative and differentiating effects of lycopene and other compounds found in the diet and in plasma may suggest the inclusion of the carotenoid in the diet as a cancer-preventive measure.

e. Selenium
In a study of Selenium-induced Cytotoxicity of Human Leukemia Cells Interaction with Reduced Glutathione, researchers suggested that Only selenocystine and sodium selenite showed anti-tumor activity, and these were also the only compounds which demonstrated significant redox chemistry, including depletion of cellular glutathione, stimulation of glutathione reductase, and stimulation of oxygen consumption. The interaction of these two compounds with glutathione suggests an intriguing potential role for them in cancer therapy.

g. Etc.
B.5. Treatments
1. In conventional medicine
Normally if there are no symptom of CLL, your doctor may take a wait and see approach. It may surprise a lot of patients, it is considered as a best approach. In certain stage as describing above, treatments are necessary but following the guideline of avoiding infection. Steroids and chemotherapy are 2 most common used therapies to treat Chronic lymphocytic leukemia (CLL), depending to the stage of the disease.
a. Surgery
a.1. Surgery sometime is necessary to remove the spleen.
a.2. Risks and side effects
Surgical and anesthesia risks

b. Target therapy
b.1. In target therapy, certain drugs or substances such as toxins, or radioactive is used to attack specific cancer cells without harming normal cells.
b.2. Risks and side effects
* Weakened immune system system
* Infection
* Slower would healing
* Etc.
c. Biologic therapy or immunotherapy
c.1. Biologic therapy is a type of treatment that use certain substances made in laboratory to enhance the patient's immune system to fight cancer.
c.2. Risks and side effects
*Itches and irritation around the injection area
* Swelling
* Bruising
* Increased tiredness
* Fever
* Etc.
d. Steroids
d.1. Steroids used in Chronic lymphocytic leukemia (CLL) are made artificially and used to control the disease as part of CLL treatments by suppressing the immune system, thus reducing the malignant white blood cells in the blood stream, shrinking lymph nodes and relieving some constitutional symptoms. Steroid drugs including prednisone, prednilone, etc. are taken orally as
tablets. Schedule of taking steroid may be vary depending the stage of the patient.
d.2. Risks and side effects
* Increased appetite
* Skin problem
*Stomach bleeding
* Vomiting may contain blood
* Infection
* Fever
* Etc.
Other than the symptoms of increased appetite, you must consult with your doctor.

e. Chemotherapy
e.1. Chemotherapy drugs such as chlorambucil, clolophosphamide, adriamycin, etc. taken orally are helpful in killing all growing cells by suppressing bone marrow cells and controlling the malignant white blood cells. Dosage are depending to individual case.
e.2. Risks and side effects
* Anemia
* Decreased blood platelet
* Infection
* Bruising or bleeding
* Little blue skin spot
* Etc.
Any above symptom can be serious, please consult with your doctor at once.


2. Herbal medicine
1. Nettle
Nettle or stinging nettle, is a perennial plant growing in temperate and tropical wasteland areas around the world, genus Urtica, belonging to the family Urticaceae. In some studies, research found that nettle's anti-inflammatory actions are attributed to its ability to interrupt the production and actions of inflammation-producing immune cells in the body (cytokines, prostaglandins and leukotreines).

2. St. John's wort
St John's wort is also known as Tipton's Weed, genus Hypericum, belonging to the family Hypericaceae, native to North America, Europe, Turkey, Russia, India, and China. A study published in the journal Cancer stated that an man-made version of hypericin, which naturally occurs in St. John's wort, appears to inhibit the growth of some malignant brain tumors.

3. Absinthe
Absinthe is also known as Wormwood, a distilled, highly alcoholic beverage flowers extracted from leaves of the herb Artemisia absinthium. In a study, researcher at the University of Washington found that wormwood can be used as a promising potential treatment for cancer among the ancient arts of Chinese folk medicine.

4. Celandine
Celandine is a herbaceous perennial plant, genus Chelidonium, belonging to the family Papaveraceae, native to Europe and western Asia and introduced widely in North America.
In a study of Ukrain (Ukrain is an anticancer drug based on the extract of the plant)– a new cancer cure? A systematic review of randomised clinical trials, researcher suggested, according to the data from randomised clinical trials that Ukrain to have potential as an anticancer drug. However, numerous caveats prevent a positive conclusion, and independent rigorous studies are urgently needed.

5. Myrrh
Myrrh is the dried oleo gum resin of a number of Commiphora or dhidin species of trees containing high amount of Boswellic acids. in a study, reported in In Vitro Screening for the Tumoricidal Properties of International Medicinal Herbs showed that Boswellic acids exert direct antiproliferative/pro-apoptotic effects through activation of caspase-3/8/9 and PARP cleavage in HT-29 cells (Liu et al., 2002), human leukemia cells HL-60, K 562, U937, MOLT-4, THP-1 and brain tumor cells LN-18, LN-229 (Hostanska et al., 2002).

6. Etc.

3. Traditional Chinese medicine
a. Shan Dou Gen
Shan Dou Gen is also known as sophora root. The bitter, cold and toxic herb has been used in TCM to hemorrhoids, cancer of the bladder, acute tonsillitis, psoriasis, hepatitis due to viral infection, etc. In a study, researcher found that purified compound Shan Dou Gen induced apoptosis in human leukemia cells and identified it as sophoranone... Our results indicate that sophoranone might be a unique apoptosis-inducing anticancer agent that targets mitochondria." Int J Cancer 2002 Jun 20;99(6):879-90

b. Ling Zhi
Ling Zhi is also known as Reishi mushroom. The sweet and neutral herb has been used in TCM as anti-inflammatory and antioxidation agent and to promote immunomodulary activityand mitochondrial energy production and prevent neuronal loss following cerebral ischemia, etc. In Aaseries of experiments including cell culture and benzidine staining test were undertaken to investigate the effects of Ganoderma lucidum(Leyss ex Fr) Karst Compound(GLC) on the proliferation and differentiation of K562 leukemic cells... It is concluded that GLC may be a good medicine for leukemia therapy." Hunan Yi Ke Da Xue Xue Bao. 1999;24(6):521-4. Chinese.

c. Jie Geng
Jie geng is also known as Platycodon Root. The acrid, bitter and neutral herb has been use in TCM as anti-inflammatory, anti ulcers agent and to inhibit cough, treat bronchitis, sore throat etc., as it stimulates the lung in dispersing and descending functions, transforms phlegm, etc., by enhancing the functions of the lung channels.The Researchers found that Saponins in Jie Geng have been shown to very significantly augment the cytotoxicity of immunotoxins and other targeted toxins directed against human cancer cells.

d. Xia Ku Cao
Xia Ku Cao is also known as Common Selfheal Fruit-Spike. The acrid, bitter and cold herb has ben used in TCM as diuretic, antibiotic agent and to treat hypertension and arteriosclerosis, acute tonsillitis, amnesia, whooping cough etc., as it disperses Liver-Fire and nodules, treat hypotension, etc. by enhancing the functions of liver and gallbladder channels. Researchers found that cyasterone in Xia Ku Cao showed anti tumor activity.

5. Qing hao
Qing hao is also known as wormwood. The bitter and cold herb has been used in TCM to
trea lupus, schistosomiasis, chronic bronchitis (essential oil) to elevate the calcium ions of leukemia white cells, etc. In a study, researcher at the University of Washington researcher found that wormwood can be used as a promising potential treatment for cancer among the ancient arts of Chinese folk medicine.

6. Etc.
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