Parallel World Pharmacy Volume 3 Chapter 12 part1
Chapter 12 – Remission Induction Therapy Started (1st to 4th day of illness)
“I will explain the treatment plan… No, let’s think together, brother.”
Falma took care of Palle falling from the chair. Falma respected Palle’s position as a pharmacist and considered it not to be a one-sided treatment.
“Cedric, could you give us a tea?”
Cedric gave a hot tea to Palle and Falma while Lotte immediately put the chocolate. Palle drank the tea and finally felt comfortable.
“Are you really Falma?”
“Where does that knowledge came from? You didn’t learn that from Eleonore right?”
“I had a dream when I was struck by a lightning.”
Falma gave them a reasonable excuse. Palle cannot hide his shock.
“That’s a revelation, isn’t it? … Who is the God that gave you the revelation?”
“I don’t know,” Palle replied.
Palle stood up and went out. Falma stood up to follow his brother while Ellen called to Palle.
“Where are you going?”
“I also want to get struck by lightning!”
“Palle you idiot. You’re going die if you got hit by a lightning!”
Because it’s stupid, Ellen didn’t do it but Palle really do want to get struck by a lightning.
“It won’t be so easy to get hit by a lightning,” Falma added.
Falma’s statement made Palle stopped.
“Eleonore, think about it? The pharmaceutical knowledge that we have learned so far. What is it? If anything, maybe it was meaningless.”
“It’s not meaningless. It’s not pointless.” Falma denied Palle’s words.
“Even the medicine of the past has worked, right?”
“As you say, but more medicines don’t work or even sometimes lead to death…” Ellen supported Palle.
“Falma, write down everything you dreamed of. Tell and explain it to us.”
“Yeah, so I’m doing it now. That’s the text.”
Falma decided to continue the lecture in front of the two 1st-Class Pharmacists.
“I’ll continue explaining. Leukemia has two types according to its progression rate. Chronic Leukemia is a slow-growing leukemia while Acute Leukemia is a fast-growing leukemia that progresses quickly without treatment. It doesn’t mean the acute period will be prolonged and become chronic. It is a completely different disease. Chronic is a condition in which problems arise in the hematopoietic stem cells themselves. While acute is a condition in which an abnormality occurs in the middle of becoming each blood component from the hematopoietic stem cell. So which type of leukemia does brother have?”
By making it a question form, Falma wanted to embed the knowledge in their memory and deepen their understanding. Palle was an excellent student who quickly absorbed and understood what Falma said.
“It’s acute,” Palle replied,
“Isn’t it chronic?”, Ellen said the other way around.
“Acute is the correct answer. There are two ways to get rid of this leukemia cell. What do you think it is?”, Falma asked.
Falma showed an illustration of text of how blood cells and other components mature from hematopoietic stem cells.
“Kill the leukemia cells”
Palle seems to have come up with the way soon.
“You’re right. Give another one. Ellen, think about it.”
“Surrender, what should I do?”
Ellen was quick to give up. As both were excited to know the answer, Falma gave an answer.
“Leukemic cells can become normal white blood cells.”
“Can you do that?”
Palle gets excited and leaned out.
“Can leukemia cells become normal white blood cells? Isn’t it an abnormal cell?” Ellen doubted Falma’s statement.
“Cells in a state that can’t become white blood cells are abnormal. However, if it can become white blood cells, then it will become normal.”
Once all leukemic cells have been converted into white blood cells, it will eventually remove all traces of leukemic cells. It was described that the drug that promotes the maturation of leukemic cells into leukocytes (White Blood Cells) was a substance called All-Trans Retinoic Acid (ATRA).
T/L Note: ATRA helps the promyelocytes affected by APL develop into fully functioning cells (neutrophils). Thus, it reduces the number of leukemic blast cells in the bone marrow. It’s the most important drug in the initial treatment of Acute Promyelocytic Leukemia (APL) which is Palle’s leukemia.
“Is that so?!”
“Wait a minute, isn’t it bad that white blood cells grow too much in the blood, even though it’s normal?” Palle had a good argument.
“The blood cells created don’t stay in the blood all the time. Blood cells have a life span. White blood cells die in a few days. They are destroyed in the spleen. But if that doesn’t work, retinoic acid syndrome will be developed.”
ATRA, a specific drug for this Acute Promyelocytic Leukemia (APL), had side effects.
The leukocytes, which were promoted by ATRA to differentiate (mature) from leukemic cells and were produced in large quantities, as described by Palle, may damage blood vessels or cause heart failure. It was a rare, life-threatening side effect.
However, side effects were common to drugs. You couldn’t be cured if you were afraid.
“That’s why. First, drink ATRA to induce differentiation into leukocytes (promoting maturation)”
T/L Note: Cell differentiation is the process where a cell changes from one cell type to another. In this case, ATRA will induce the leukemic cells to change into a normal white blood cell.