India is a big country with 1.22 billion people, the population is predicted to have more than 1.53 billion by the end of 2030 and a substantive percentage are still illiterate; Accessibility of health care is non-uniform, with healthcare facilities at equivalence with the best in the world at the the metros and non-existent to rudimentary in many rural areas where patients are at the mercy of ‘Doctors’ who still practice traditional methods. Also only a very small group of population are covered by health / medical insurance.
Most hematologists conceive that Chronic Myeloid Leukemia / Chronic myelogenous leukemia (CML) is the commonest leucaemia in adults in India. CML is a myeloproliferative disorder characterised by increased growth of the granulocytic cell line without the loss of their capacity to differentiate. Accordingly, the peripheral blood cell profile shows an increased number of granulocytes and their immature precursors, including occasional blast cells.
CML progresses through 3 stages, such as :
- Chronic phase where mature cells proliferate
- Accelerated phase where additional cytogenetic abnormalities may occur
- Blast phase immature cells rapidly proliferate.
Approximately 85% of patients are diagnosed in the chronic phase and then progress to the accelerated and blast phases after 3-5 years.
The diagnosis of CML is based on the histopathologic findings in the peripheral blood and the Philadelphia chromosome in bone marrow cells; (Up to now the drug imatinib has been used successfully, but, chromosomal mutation have made the leukaemic cells unresponsive to the drug.)
A recent studies from a group of Indian researchers, brings an interesting insights, behind CML available therapies, according to these new findings “Chewing betel leaf or an alcoholic extract of the betel leaves could help patients from a bone marrow cancer.” A subtance derived from betel leaf may be beneficial to patients who are suffering from a leukaemia in which the bone marrow makes too many white blood cells and the body resists to respond to common drugs.
The research was carried out by the Indian Institute of Chemical Biology (IICB), the Institute of Haematology and Transfusion Medicine, Kolkata, and Piramal Life Sciences.
According to Santu Bandyopadhyay of the department of Cancer Biology and Inflammatory Disorders at IICB, an institute under the Council of Scientific and Industrial Research, “We have conducted a study and seen that the compound hydroxychavicol (HCH) is the major component of the alcoholic extract of the betel leaves and it might contribute, at least in part, to the observed anti-CML activity of the leaf extract.”
According to the study, – Hydroxychavicol (HCH) and its analogues not only induced killing of the cancerous CML cells, it also results to the death of the drug-resistant cancer cells with minimal impairment to normal human peripheral blood mononuclear cells (PBMC) which are an important component of the immune system.
According to sources, CML is primarily an adult disease with a yearly incidence of 1 in 100,000 in India also age at presentation is at least a decade early as compared to the west, patients present with more advanced disease at diagnosis and have a more hapless response to current available therapies in inida this is because of more advanced disease at presentation. The slow-progressing blood and bone marrow disease usually occurs during the middle age, and rarely occurs in children. Up to now the drug imatinib has been used successfully, but, chromosomal mutation have made the leukaemic cells unresponsive to the drug. None of the marketed drug products has been effective in circumventing the responsible mutation – called T315I.
Finally the scientists found that, the alcoholic extract of betel leaves causes the imatinib-resistant cells to undergo “apoptosis” (a self-destructive process), and the extract also shows activity against T315I mutation.