Dear Dr. Gamal,

Up to my knowledge, malaria could complicate the clinical presentation of acute leukemic patients. Similarly, leukemia, as a debilitating factor, potentially contribute to more severe falciparum malaria attacks and to its frequent recurrence. However, as you stated above, association studies based on statistical judgement are needed.

Best regards,

Rashad

There are only case reports on it, but there are not studies. Are you planning for it? I would be interested in cooperate. Best regards, Alfonso.

Check this one:

http://www.indianjcancer.com/article.asp?issn=0019-509X;year=2011;volume=48;issue=2;spage=264;epage=265;aulast=Thapliyal

Thank you Dr Alfonso for your answer. Really it is interesting topic , I observed some leukemia cases with recurrent malaria .

We consider it one of the topics for further studies.

i am interested in solving the problem of malaria,though am new to the research world. need to brush up my research skills first. Malaria is an interesting area to me as it effects mostly africans. i think coming up with something that can degrade all the species will be the best solution.

Gamal - I studied ALL and worked for a time with a physician who spent much of his time in Africa as a missionary/provider.  This physician was well read on the subject of malaria and never mentioned a correlation between the two disease states.  There are complications that arise when both are present, but no causative link.  I did find this study that looked for ALL in malaria patients (http://www.ehealthme.com/cs/malaria/acute+lymphocytic+leukemia) and the incidence of ALL, 0.03%, would suggest that there is no clear link.  AML, myeloid leukemia, is much rarer and I did not find any studies.  If you are interested in researching this, the questions you should be asking are - 1. What type of acute leukemia are you looking at ALL/AML (AML as it is rarer would be a more intriguing find) - 2. What are the ages of the patients (ALL is the most common cancer in children, so adult victims would be more intriguing) - 3. Is there any other causative agent more likely to be involved (e.g. are these people taking something (folk cure) for their malaria that could be a topoisomerase inhibitor?)  Topo II inhibitors are found among some leafy greens in the form of bioflavonoids.  Topo II inhibitors are useful as chemotherapeutic agents (e.g. doxorubicin) and have been linked to secondary leukemias that occur after their use.  I could go into the proposed mechanics with you if you so desire.  4. Also consider that you might be on the tail of a bell curve.  This is the case with what some lay folk call "cancer clusters" which people desperately try to attribute to some causative agent, when in fact, a concentration of a rare disease is sometimes well within the realm of chance alone.  All this said, although a link seems unlikely, I would strongly suggest that further work is warranted.  The link between EBV and lymphoma was discovered by an inquisitive and tenacious doctor such as yourself.

Thank you Dr Farnk for very interesting answers and I strongly agree with your explanations.

Regards

There is no well established data about the relation between malaria and acute leukemia but it may be the causative factor which is explanation by Frank Erfurth. In our country Bangladesh, malaria zone area Sylhet  and Chittagong, frequency of acute leukemia is  more than other area.We don't  know the exact cause.

There is relation between immune response and malaria.

Cytokines originating from T-helper cells, natural killer cells and macrophages are major players in the body's response to parasitic infections.1,2 Two CD 4+ T-helper cell subsets exist in mice and probably in man, each of which produces a typical set of cytokines that regulate different immune effector functions and cross-react with each other.1,3,4 T-helper type 1 (Th-1) cells produce IFN-γ, IL-2 and TNF-α. These cytokines activate macrophages, thus contributing to the formation of proinflammatory cytokines such as TNF-α, IL-1 and IL-6, and the induction of cytotoxic immune effector mechanisms of macrophages. By contrast, Th-2 cells produce IL-4, IL-5, IL-10, and IL-13, cytokines that induce a strong antibody response but also inhibit various macrophage functions.1,3,4

The balance between Th-1 and Th-2 cell-mediated immune effector mechanisms is of central importance for the host response to parasitic infections in mice and probably in man.1,2 While Th-1 derived cytokines such as IFN-γ and IL-2 are crucial for effective host defense in the acute phase of certain parasitic infections, increased activity of Th-2 derived cytokines such as IL-4, IL-10 and IL-13 heightens susceptibility to these infections and causes exacerbations. The latter effects may be due to an inhibitory function of IL-4, IL-10 or IL-13 on the production of Th-1 cytokines and on macrophage activation. Th-1 mediated immune effector function appears to be beneficial during early stages of plasmodial infections. In contrast, Th-2 derived cytokines appear to exert a protective role later in chronic infection with plasmodia or in the recovery period.1,5,6

So far it may the the relation between this but it may need more experiment.

1.Romagnani S. The Th1/Th2 paradigm. Immunol Today. 1997;18:263–266

Medline

2.Taylor-Robinson AW, Phillips RS, Severn A, Moncada S, Liew FY. The role of Th1 and Th2 cells in

3.Mosmann TR, Coffman RL. Th1 and Th2 cells: different patterns of lymphokine secretion leads to different functional properties. Ann Rev Immunol. 1989;7:145–173.

CrossRefMedline a rodent malaria infection. Science. 1993; 260:1931–1934.

4.Seder RA, Paul WE. Acquisition of lymphokine-producing phenotype by CD4+ cells. Ann Rev Immunol.1994;12: 635–673.

CrossRefMedline

5.Mellouk S, Hoffman SL, Liu ZZ, DeLaVega P, Billiar T, Nussler AK. Nitric oxide mediated antiplasmodial activity in human and murine hepatocytes by gamma interferon and the parasite itself: enhancement by exogenous tetrahydrobiopterin. Infect Immun. 1994;62:4043–4046.

6.Seguin MC, Klotz FW, Schnieder I, et al. Induction of nitric oxide synthase protects again malaria in mice exposed to irradiated Plasmodium berghei infected mosquitoes: Involvement of interferon-α and CD8+ cells. J Exp Med. 1994;180: 353–358.

Abstract/FREE Full Text

I am not very sure but I think that malaria immunology may provide us with the answer. Plasmodia destroy Erythrocytes during parasites invasion and replication, these activities engage Leukocytes hence, leukemia patients are at a serious disadvantage.  Also Plasmodia selectively invade healthy RBC this is why sickle cell anaemic patients suffer more if they go down with malaria. I hope this helps.

Gamal if you are interested in develop a review on it, I will be interested. I thinki is a highly interesting topic. Best wishes, Alfonso.

Dear dr.Gamal, it is  a very intresting question. If you remember.. it's the same observation when we're working on my thesis. The future study regarding this relation should explain the mechanism by which this parasite produce acute leukemia, not only the statistics. If there is a real relation,  I think that certain carcinogenic products produced by the virulent malaria parasite directly (i.e a new mutant generation) , or by the reaction between the parasite and the immune system that alter the stem cells in bone marrow. 

Best regards

Nohad   

Thank you Dr Nohad

We are working to prepare a review on it

Any follow-up on the studies about the relationship between Malaria and Leukemia?

Which malaria commonly leads to leukemia- Falciparum or Vivax?

Which type of leukemias have been commonly seen- acute myeloid leukemia or acute lymphocytic leukemia?

There is still no certain connection proved between these two diseases. I had a patient who was diagnosed with acute myeloid leukemia several months after completing successfully treatment for malaria quartana. Patient had no leukemia during malaria infection which was confirmed by bone marrow histology, and lately - no malaria was found at the time of leukemia diagnosis. Our search concerning this case showed that although infections, hemopoiesis and leukemic cells may share some common immunologic mechanisms and signal pathways, still no connection between malaria and acute leukemia is proved.

Malaria is not classified as carcinogenic by WHO-IARC (International Agency for Research on Cancer (as is, e.g., hepatitis B for hepatucellular carcinoma or Schistosoma haematobium-infection for bladder cancer). However, there is a strong association of malaria with the occurrence of Burkitt lymphoma, together with EBV, in Africa.

Thank you for the comment, Prof.Meyer!

Thank you Prof. Meyer and Dr. Petkova for your comment. And I accept your opinion.

In my clinic I registed some leukemic patients with H/O recurrent malaria but there is no any confirmation of the relation between leukemia and malaia. There are some posulation but not strong evidents

Example of researcher postulated that the unique pattern of CLL in tropical Africa is the result of recurrent malaria and other infections, leading to both a depression of T -cell control of B-cell proliferation and direct antigenic and mitogenic stimuli to B-cell proliferation: by Alan F Fleming http://www.science-connections.com/trends/human_leukemia/138.htm.htm

Article Use of immunoglobulin gene rearrangements to show clonal lyp...

Article Leukemia with malaria: An unusual presentation

Article Chronic Lymphocytic Leukaemia in Tropical Africa: A Review

I am not very sure about it . Malarial disease is not classified as carcinogenic by WHO

Interesting question. There is evidence to support the relationship between malaria and Burkitts lymphoma, but not acute leukaemia. Nigeria is a malaria endemic area of the world and acute leukaemias are not common. So, if there is a relationship, it would be at best a remote one. Therefore studies are needed to confirm this relationship.

Significant Relationship between malaria and Burkitt's lymphoma....is not yet proven ...... personally I don't think there is no relationship....but drug interactions during management accepted......

AntiMalarial Artemisinin compounds have been reported to have anti-cancer effect however, there is no registetred relationship between malaria and acute leukemia to the best of my knowledge

Thank You

Thank you Mohammed Al-Kurayshi for your comment, we hope that.

Dear Norah Olubunmi Akinola i agree with you,

in addition there are some conclusions about positive relationships between malaria and virus-associated cancers are relatively well documented, the researchers say. Evidence suggests that malaria can alter immune responses by modulating both humoral and cell-mediated immunity. Plasmodium -related cancers are primarily lymphoproliferative, vulnerable to virus reactivation. Epstein-Barr virus (EBV), for example, has been observed in lymphatic and hematologic tumors such as Hodgkin disease and T cell lymphoma, and malaria can reactivate EBV

https://www.mdedge.com/fedprac/article/129545/hematologic-malignancies/what-do-parasites-have-do-leukemia

How the malaria parasite increases the risk of blood cancer

in this link;

https://www.eurekalert.org/pub_releases/2015-08/cp-htm080615.php