Barbara Watson
4/29/13
CHEM 1010-043
E-portfolio assignment
July 1, 2006 is a day that dramatically changed the lives of the Watson family. It was on this day that we lost my dear sister-in-law, Stephanie to the effects of leukemia.
This 28-year-old wife, and mother of two, was diagnosed with this destructive disease just ten months earlier in September of 2005. It devastated our family. We felt extremely helpless and it was very difficult to watch her suffer through various treatments, including chemotherapy. This experience continues to impact my life in very real and personal ways. It is because of this, that I seek greater understanding of the disease as well as the way it is treated. Though we Stephanie lost her battle, great strides are being made in science to help cure the disease that took her life. Many of these advances are because of the discoveries made in chemistry. I will explore what Leukemia is, the chemicals used in chemotherapy, their effects on our bodies, and what other treatment options are available because of chemistry.
The particular form of Leukemia Stephanie suffered from is called Acute lymphocytic leukemia (ALL), also known as acute lymphoblastic leukemia. The National
Cancer Institute estimates that in the year 2013, there will be About 6,070 new cases of this specific leukemia and 1,430 deaths resulting from it. This particular form begins in white blood cells called lymphocytes found in bone marrow. The disease moves quickly and spreads to other parts of the body, including the Central Nervous System. These

cells reduce the body’s ability to fight infection. If untreated, it can become fatal in just a few short months. Symptoms of ALL include: weight loss, fever, night sweats, fatigue, loss of appetite, feeling tired, feeling weak, feeling dizzy or lightheaded, shortness of breath, recurring infections, bruising easily, bleeding, such as frequent or severe nosebleeds and bleeding gums.
The cause for this kind of cancer is still fairly unknown. Scientists are making great strides in gaining more understanding about ALL. They have noticed that certain
DNA mutations are common in patients with ALL. Though some forms of Leukemia are genetic, Acute lymphocytic leukemia does not seem to be inherited. It is believed that exposure to certain chemicals like benzene as well as exposure to radiation can initiate this cancer. According to the National Cancer Society, “Benzene is a solvent used in the rubber industry, oil refineries, chemical plants, shoe manufacturing, and gasolinerelated industries, and is also present in cigarette smoke, as well as some glues, cleaning products, detergents, art supplies, and paint strippers.” Though the reasons are unknown, this form of Leukemia is more common in white people than African
Americans. It is also more common among men than women.
The standard treatment for Acute lymphocytic leukemia is chemotherapy.
Chemotherapy is the use of drugs to help destroy cancerous cells. These drugs are usually provided through a shot given in the veins, though sometimes they are administered in pill form. Three common drugs used to treat ALL are: Etoposide (VP-
16), Cyclophosphamide (Cytoxan®), and Liposomal vincristine (Marqibo®).

Etoposide also known as VP-16 and its chemical name is demethylepipodophyllotoxin-beta-D-ethylidene glucoside. VP-16 is usually given in an aqueous solution with chemicals such as methyl-4-hydroxybenzoat, propyl-4hydroxybenzoat, benzyl alcohol, sodium chloride, lactulose, and mannitol. It is plant based, made from the bark of the Pacific Yew, and portions of the May apple plant and the Asian "Happy Tree". Etoposide is used to kills cancerous cells in an effort to stop uncontrolled cell division. It is a cell-cycle specific which means it only assaults the cells at certain times in division.
Cyclophosphamide, chemically named 2H-1,3,2,oxazphosphorine 2-oxide monohydrate with the formula C7H15O2N2PCl2 is part of the nitrogen mustard group. Cyclophosphamide is administered after is dissolved in sterile water and then is diluted with glucose, normal saline or Ringer solution. Discovered during the world wars, this was one of the first treatments used to fight cancer. This mustard gas is known as an alkylating agent, which means that during the resting phase of the cell it is the most active.
The chemical name for Vincristine is 22-Oxovincaleukovlastine Sulfate and the formula is C46H56N4O10H2SO4. Like VP-16, it is plant based. It is composed mostly of extracts from the periwinkle plant, Pacific Yew tree, the May Apple plant, and the Asian
"Happy Tree". It is also dispensed in an aqueous solution with chemicals such as methyl-4-hydroxybenzoat, propyl-4-hydroxybenzoat, benzyl alcohol, sodium chloride, lactulose, and mannitol.

Side effects from these drugs used in chemotherapy vary based on dosage and duration of treatment. The most common side effects are hair loss, mouth sores, loss of appetite, nausea and vomiting, diarrhea, increased risk of infections, easy bruising or bleeding, and extreme fatigue. These side effects generally go away after treatment.
Most side effects are a result of low white blood cell counts. Drugs called growth factors can be given to help increase production of white blood cells to help combat these effects. Additional drugs are also often given to help counteract some other side effects like nausea and vomiting. In some cases chemotherapy can damage the kidneys, liver, testicles, ovaries, brain, heart, and lungs. When this damage is severe enough, chemotherapy may be temporarily decreased or stopped.
Other treatment options are available for patients diagnosed with Acute lymphocytic leukemia. There are new drugs available that work differently than chemotherapy. Radiation is another option, as well as bone-marrow transplants.
These new drugs available focus on attacking the Philadelphia chromosome that produces an abnormal protein. This chromosome is found in most ALL patients. These protein attacking drugs include imatinib (Gleevec ® ), dasatinib (Sprycel ® ), nilotinib
(Tasigna ® ), bosutinib (Bosulif ® ), and ponatinib (Iclusig ™ ). These drugs are usually used alonside chemotherapy to help people with ALL to go into remission at a more accelerated rate, and have very mild side effects.
Radiation can also be used to treat ALL cancer patients; it is not as common but is used when the cancer has spread into other parts of the body. Unlike Chemotherapy that attacks cells all over the body, radiation is more localized to specific areas.

Radiation uses beams of radiation to target these specific areas. The procedure itself is usually painless and emits slightly more radiation than an x-ray. Side effects of radiation are skin irritation, hair loss, fatigue, and sometimes nausea and vomiting.
When chemotherapy and other methods are unable to kill the cancerous cells completely, a stem cell transplant is usually recommended. There are two types of transplants; allogeneic and autologous. Allogeneic transplants use stem cells from another person with a close match to the patient. The Autologous transplants remove bone marrow from the patient, and try to purge it of the cancerous cells. These cells are then frozen while further chemotherapy is given, and finally transplanted back into the patient. Short-term side effects of this treatment are very similar to those of chemotherapy. There are some long-term effects that can have damaging results.
According to the American Cancer Society, some of these are” Graft-versus-host disease
(GVHD), damage to the lungs, damage to the ovaries in women, damage to the thyroid gland that causes problems with metabolism, Cataracts (damage to the lens of the eye that can affect vision), bone damage called aseptic necrosis (where the bone dies because of poor blood supply), development of another leukemia (or other type of cancer) several years later.” The most serious of these is the Graft-versus-host disease where the body rejects the new bone marrow and attacks it. This can also be good, however if the leukemia cells are attacked and killed in the process.
There are also many more natural treatments available, but clinical studies are still in their early stages, so their accuracy in curing the disease have not yet been proven. These treatments include changes in diet and the use of natural herbs.

Most of these treatments are available because of chemical discoveries. Our dear
Stephanie suffered through most of these treatments, including a stem cell transplant.
Her donor was an older brother who was an extremely close match for bone marrow tissue. We saw many of the side effects previously mentioned. She lost her hair, was extremely tired, and often jaundice from the damage done to her liver by the chemotherapy and radiation. Ultimately, she developed the Graft-versus-host disease and her body rejected the new bone marrow. This led to the organs in her body slowly shutting down. Stephanie fought hard, but it was time for her to pass on. Though it was extremely difficult to watch Stephanie suffer through it, we were grateful that the various treatments allowed her to stay with us a little longer. It gave her more time to see her children, husband, and family. She was able to spend time making scrapbooks for them, thus enabling her to preserve important memories. For that extra time, I am grateful to the great minds who have spent numberless hours in research of this great cause. It is my hope that further advances in science and chemistry will be made that will be even more successful in curing this destructive disease as well as decreasing the damaging side effects.

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