Recent Developments in Search of Effective Herbal Medicine for The Treatment of Leukemia

Leukemia is a group of malignant disorders characterized by abnormal leukocytes proliferation and development in the bone marrow and lymphatic system. It is the most prevalent hematologic cancer in adults above 55 years and the most common cancer in the pediatric population, accounting for nearly one-third of the cases. The five-year relative survival rates have enhanced over the years to 65.0% (2011-2017) through the application of therapeutic methodologies of standard chemotherapy. However, the prognosis of leukemia in geriatrics remains poor, with overall survival being only 5–10% in Acute Myeloid Leukemia (AML). Despite introducing new chemotherapeutic medications and hematopoietic stem cell transplantation, the events of cancer relapse, multi-drug resistance, suboptimal response, and severe adverse effects remain significant events for some patients. Thus, it is critical to investigate alternative treatment options with improved efficacy, reduced toxicity, and multitarget combinations of chemotherapeutic medications, maybe with distinct mechanisms involved, to optimize the outcome of leukemia patients. This review discusses the recently studied herbal medicines exhibiting potential apoptosis and anti-cancer effect on the leukemia cell lines. After using PubMed’s Advanced Search features with keywords such as “Herbal Medicine,” “Acute myeloid leukemia,” “Acute lymphocytic leukemia,” “Chronic myeloid leukemia,” “Chronic lymphocytic leukemia,” we refined our search with the publication date range from 2017-2021 and entered articles into this review. Study selection was made based on Cochrane library guidelines to arrive at 13 final articles selection, comprising nine different herbs. The study details underlying mechanisms governing their anti-cancer effects, and corresponding biological effects..

Keywords:Herbal Medicine; Acute myeloid leukemia; Acute lymphocytic leukemia; Chronic myeloid leukemia; Apoptosis

Abbreviations:AAE: Artemisia Annua Extract; ACLE: Annona cherimola leaf extract; AML: Acute myeloid leukemia; ALL: Acute lymphoblastic leukemia; Bax: BLC2 associated X; BLC2: B-cell lymphoma 2; Bcl-xl: B-cell lymphoma-extra-large; BCR-ABL: Breakpoint cluster region-abelson; CLL: Chronic lymphocytic leukemia; CML: Chronic myeloid leukemia; Hsp90: Heat shock protein 90; ERK ½: Extracellular signal regulated protein kinase; EVI1: Ecotropic Viral Integration Site 1 gene; FASN: Fatty acid synthase; FLT3: Fms Related Receptor Tyrosine Kinase 3; FLT3-ITD: ITD mutation in FLT3; G0/G1: Gap 0 phase/ Gap 1 phase; G0/S: Gap 0 phase /Synthesis phase; IC50: Half-maximal inhibitory concentration; ISOL: Isoliquiritigenin; ITD: Internal tandem duplication; LC3: Microtubule-associated protein light chain 3; MAPK: mitogen-activated protein kinase; Mcl-1: Myeloid-cell leukemia 1; MMP: Matrix metalloproteinases; mTOR: Mammalian target of rapamycin; PARP: Poly (ADP-ribose) polymerase-1; PI3K: phosphoinositide 3-kinase; PTEN: Phosphatase and tensin homolog; STAT5: Signal transducer and activator of transcription 5; TKI: tyrosine kinase inhibitor