Leukaemia has been recognized since 1845, when a report was published on a patient who died of the disease which have shown an amplified number of blood cells. Twenty years later it was found that diagnosis of leukaemia could be possible through bone marrow puncture . Leukaemia is one of the most common types of cancer worldwide. Decreased in incidence of infectious diseases and increased human life span caused prevalence of leukaemia. The use of therapeutic herbs in developing countries as cures against leukaemia is prominent

Currently, Denmark has the highest incidence of leukaemia (29% incidence per 100,000 individuals) in the world It was reported that 21, 464 cancer cases (9,400 males and 12,064 females) were diagnosed among Malaysians of all ages in 2003 and the incidence rate for cancer in Malaysia in the year 2003 was 134.3 per 100, 1000 males and 154.2 per 100,000 females

Among of 21, 464 cancer cases the incidence rates of lymphoid leukaemia in Malaysia for both males and females were 2.8 and 1.7 per 100.000 populations, respectively. On the other hand, the incidence rates of myeloid leukaemia in Malaysia for males and females were 3.0 and 2.7 per 100.000 populations, respectively

Leukaemia is diagnosed 10 times more often in adults than in children and more common in males than females . In the year 2000, nearly 2, 56,000 children and adults around the world developed some form of leukaemia, and 2,09,000 died from it . Many factors are related to the development of leukaemia: prior chemotherapy, hereditary syndromes (Down syndrome), ionizing radiation, viruses infection, and smoking. People with leukaemia are treated with a combination of treatment including chemotherapy (main treatment), antibiotic, blood transfusion, radiation therapy, and bone marrow transplantation. Although these treatments have prolonged the survival rate of patients with leukaemia. Some of these treatments are difficult to handle Thus, there is a need to seek for other remedies in combating this disease. Therefore, this review paper is aimed at giving an overview of herbs and fruits which have been demonstrated as therapeutic agent for leukaemia.

The Nature of Leukemia

Leukemia is the term applied to cancers in which one line of bone marrow stem cells that produce white blood cells (leukocytes, the immune system cells) undergo neoplasia. The transformed cells uncontrollably yield an abnormally large amount of the corresponding white blood cells, mainly in an immature form. Also, by proliferating in numbers, the neoplastic stem cells crowd out the other stems cells in the marrow, so that there are fewer of the red cells and platelets, as well as other lines of white blood cells able to be produced. The destructive aspect of the disease is often manifest first by the lack of these other cell types, producing anemia and spontaneous hemorrhage. Eventually, the internal organs (initially the liver and spleen) swell up with the excess white cells, causing further problems. In addition, the leukemic cells usually have substantially reduced immune functions, leading to high incidence of infections (1).

Different types of leukemia are identified by the stem cell line involved. There are two major categories: lymphocyte and myelogenous; the latter is sometimes divided into myelocytic, monocytic, and granulocytic leukemias, depending on the analysis used. Two somewhat similar bone marrow diseases are polycythemia (with excessive production of red blood cells) and thrombocythemia (with excessive production of platelets).

Depending on the severity with which the leukemia manifests, it may be classified as acute or chronic; despite these names, acute leukemia does not have the meaning of a self-limiting temporary disease: without treatment it can be fatal within 2-4 months. Generally, acute leukemia is characterized by very large numbers of immature lymphocytes (known as lymphoblasts) or large numbers of myeloblasts (the “blasts” are immature cells; this leukemic condition is sometimes called myeloblastic leukemia). Chronic leukemias can flare up with an acute phase, producing a huge production of blast cells, yielding a “blast crisis” that is often the fatal phase of the disease.

It is common practice to label the leukemias by initials for easy reference: ALL (acute lymphocytic leukemia), CLL (chronic lymphocytic leukemia), AML (acute myelocytic or myeloblastic leukemia), and CML (chronic myelocytic leukemia). The leukemias are further subdivided according to the patterns of cells seen by microscopic examination of the blood, revealing different cell sizes, degrees of maturation of the cells, cell surface markers (especially immunological components), and proportions of different cell types. These divisions may be of importance, in that the treatment strategies can vary according to the observed condition; the results of these tests can also help the oncologist advise the patient regarding prognosis.

The possible causes of leukemia include exposure to ionizing radiation, exposure to some chemicals (benzene is an established example), and the action of viruses (e.g., HTLV, human T-cell leukemia virus, a type of retrovirus). Genetic factors play a role in susceptibility, especially for the childhood leukemias. Except for the possibility of attempting an antiviral treatment for virus-induced leukemias, the causes of the disease do not shed much light on the treatment to be given. Even in the case of a viral causation, if suppression or elimination of the virus could be accomplished, that might not cure the disease; the cellular transformation that occurred may no longer reversible.

Some cases of chronic leukemia, notably CLL, are sufficiently innocuous that they are left without treatment for a time because the degree of imbalance in blood cell production is within tolerable limits; in most other cases, anticancer drugs are used in an effort to slow its progress. Some new techniques of treating leukemia have been developed, include destroying the cancerous bone marrow (thus eliminating the neoplastic cells) and transplanting healthy bone marrow (grown in the laboratory from donated marrow cells).

Substantial success has been attained in treating acute childhood leukemia, especially ALL, which was, until recently, a major cause of childhood deaths (with peak incidence around 4 years of age). This positive outcome may be the result of two factors: in acute leukemia, the chemotherapeutic drugs have a much stronger effect on the highly active abnormal cells than on the normal cells; and in children the ability to recover normality is better than in older persons. Up to 90% of cases of childhood acute lymphocytic leukemia go into remission with treatment, with about 70% of treated cases gaining long-term survival (2). AML tends to strike in the age range of 15-39 years and has a moderately good response to treatment by bone marrow transplant, though long-term outcomes are not yet known.

Cases of chronic leukemia are poorly managed by modern chemotherapy: the disabling effects of the therapy on the entire physiological function are often as strong as they are on the cancerous cells. Often, the individual must undergo multiple types of interventions, including blood transfusions, antibiotics, and other “supportive therapies.” Progress towards a cure has been difficult. The age of diagnosis for chronic leukemia is typically between 40 and 60 years. Without treatment, chronic leukemia patients are expected to live for 2-6 years from onset of the disease; CML tends to progress more rapidly than CLL. However, about half of the patients with chronic leukemia die within two years of their diagnosis even with treatment. Slightly increased survival time after diagnosis in recent years may be the result of earlier detection more so than successful treatment. Busulfan (a.k.a. Myleran), a drug that has been frequently used for one type of chronic leukemia (granulocytic), commonly produces mean survival times of about 3-4 years. For leukemia in adults, it is reasonable to pursue Chinese medical therapies in an attempt to improve the outcomes.