Wheatley Carmen
Orthomolecular Oncology and Medicine, UK Reg. Charity 1078066, Oxford, UK.
St Catherine's College, University of Oxford, Oxford, UK.
Cancer Rep (Hoboken). 2025 May;8(5):e70106. doi: 10.1002/cnr2.70106.
Supposed 'spontaneous' remissions in chronic lymphocytic leukaemia (CLL) are extremely rare. By the most stringent immunophenotypic criteria, there are only seven cases to date of unexplained, immune system effected cures. A historic review of this phenomenon is presented as context for this eighth case of CLL immunophenotypic reversal.
A 59-year-old, molecular biologist, stage I CLL, whose diagnosis and recovery were both thoroughly documented, not content to watch and wait, chose to treat himself, after individual tumour susceptibility testing, with evidence based, biological response modifiers, which initially seemed to keep his CLL stable. This included 1 mg of hydroxocobalamin injected i.m. daily. However, after some years his lymphocytosis began slowly to drift upwards. At that point, he was persuaded to change his injection protocol to methylcobalamin, at 50 mg i.m. a day, a dose whose clinical safety is sufficiently well-established, and a form of cobalamin that the research literature shows has anticancer actions.
This change in cobalamin form and dose proved a critical turning point. Complete disappearance of the lymphocytosis also coincided with a severe infection and an even further temporary increase of the parenteral methylcobalamin dose, both catalytic factors. In the 4th and 5th years following this, the patient's repeated immunophenotyping showed no clonal disease present. A brief review of the field of cobalamin in cancer research and treatment is given, with discussion of the various mechanisms by which cobalamins may impact on cancer/CLL. Historic analysis reveals that cyanocobalamin is generally cancer promotional, whereas hydroxocobalamin, methylcobalamin and adenosylcobalamin are cancer protective and cytotoxic. It is hypothesised that the actions of cobalamin in cancer aetiology and oncogenesis/progression are intertwined with those of nitric oxide, which tumours regulate to dupe the immune system to their presence, by causing a functional cobalamin deficiency in the host.
慢性淋巴细胞白血病（CLL）中所谓的“自发”缓解极为罕见。按照最严格的免疫表型标准，迄今为止仅有7例原因不明且免疫系统介导的治愈病例。本文对这一现象进行历史性回顾，以此作为CLL免疫表型逆转这第八个病例的背景。
一名59岁的分子生物学家，处于I期CLL，其诊断和康复过程均有详尽记录。他不满足于观望等待，在进行个体肿瘤易感性检测后，选择根据循证医学，使用生物反应调节剂进行自我治疗，最初这些药物似乎使他的CLL病情保持稳定。这包括每日肌肉注射1毫克羟钴胺素。然而，几年后他的淋巴细胞增多症开始缓慢上升。此时，他被说服将注射方案改为每日肌肉注射50毫克甲钴胺素，该剂量的临床安全性已得到充分证实，并且研究文献表明这种形式的钴胺素具有抗癌作用。
钴胺素形式和剂量的这种改变被证明是一个关键转折点。淋巴细胞增多症完全消失的同时还伴有一次严重感染，并且胃肠外甲钴胺素剂量进一步暂时增加，这两个都是催化因素。在此后的第4年和第5年，患者多次免疫表型检测显示无克隆性疾病。本文简要回顾了钴胺素在癌症研究和治疗领域的情况，并讨论了钴胺素可能影响癌症/CLL的各种机制。历史性分析表明，氰钴胺素通常具有促癌作用，而羟钴胺素、甲钴胺素和腺苷钴胺素具有抗癌和细胞毒性作用。据推测，钴胺素在癌症病因学和肿瘤发生/进展中的作用与一氧化氮的作用相互交织，肿瘤通过导致宿主功能性钴胺素缺乏来调节一氧化氮，从而欺骗免疫系统使其忽略肿瘤的存在。
