March 30, 2007; Friday

Charley has had a week off from the chemotherapy. His appetite is gradually recovering. However, overall, his energy is still low. This is the golden opportunity to strengthen his nutrition although it is just a short-term.

Dr. Sallan, Charley’s attending doctor met his parents on Wednesday to discuss the treatment options. There are three options as follows:
a. register the clinical trial which includes Clofarabine, VP-16 and Cytoxan;
b. Clofarabine alone;
c. Adriamycin alone.

We appreciated the remarkable effort of Dr. Sallan and parents’ involvement of decision making. Through the consultation and consensus from the experts at St. Jude Children Cancer Research Hospital, Charley will be given Option B.

Clofarabine was approved by the US FDA in 2004 and is a new drug for Charley. According to the publications, this drug being used as a single agent is able to generate a 30% response rate, including complete remission and partial remission, in pediatric patients with multiple relapsed or refractory acute lymphoblastic leukemia.

For option A, Dr. Sallan had a concern since VP-16 and Cytoxan have been used by Charley either recently or at the bone marrow transplant. They will not probably provide any synergistic efficacy but additional side effects such as liver toxicity. Therefore, “Clofarabine alone” is more appropriate. In terms of its side effects, they may include:

• Nausea and vomiting in about half of all patients
• Diarrhea
• Low blood accounts
• Infections have been common
• Rash
• Allergic reaction with low blood pressure, difficulty breathing, fast heart beat
• Hair loss
• Reversible damage to liver and kidney, but rarely, irreversible.

Regarding Option C, this is sort of a standard treatment for Charley’s situation. Charley can take it now or later.

Clofarabine is an expensive drug and the pre-certification from the insurance company is required. The prescription for Charley aiming for inducing complete remission got the approval this afternoon. It is a 5-day schema for the first course and the bone marrow evaluation will be done at then end of April. Charley will start the first dose on Monday.

Urgent Prayer Request for Charley:
1. The new drug induces a good remission.
2. Improvement of nutrition and immune system.
3. Less side effects: protection on his blood accounts, overcoming nausea and vomiting, etc.

March 24, 2007; Saturday

Charley suddenly developed rashes last night. The doctors examined the rashes which are all over his body. The cause is under the investigation. Charley does enjoy some favorite dishes. However, Benadryl, which is given for itchiness makes him sleep a lot.

It is good that Charley’s Bilirubin decreased some.

Prayer Request for Charley:
* The rashes be diminished.

2007年三月24号， 星期六

昨天晚上，田田突然出现皮疹，检查发现皮疹遍布全身。皮疹原因还在调查当中。田田吃了几种他喜欢的食品, 然而，由于使用 Benadryl 治疗皮疹, 他的睡眠很多。

值得高兴的是田田的胆红素有了一定程度的下降。

请为田田祷告：
消除皮疹

Friday, March 23

This afternoon, Charley's doctors called a parents meeting to inform us of the results of the bone marrow test. It was not good that the blast cells occupied 90% of the countable area in the marrow. It seems the chemotherapy only cleaned the blasts in the blood and helped Charley relieve some symptoms but failed in killing the leukemia in marrow. Therefore, Charley still suffers from persistent leukemia. There is a clinical trial may be available to Charley which includes a new drug, clolar, which the US FDA approved in 2004.

We appreciated friends in Singapore and Suzhou, China sharing their experiences of overcoming the failure of bone marrow transplant and achieving “precious” complete remission in bone marrow. The clinical trial Charley’s doctor intends to register requires normal liver, cardiac, and kidney functions, along with a clean CNS from leukemia. Charley has a higher Bilirubin level partially due to the treatment of peripheral nutrition. It could take up to a week. There is a risk that leukemia may attack again in this window of time while he will be examined by spinal fluid test and echo.

Charley’s appetite gradually comes back but nausea is still bothering him sometimes. Parents, grandmom and friends are busy in preparing his favorite dishes. The Shi family came to play with Charley today. Linda attended the parents meeting and gave us the support

-Deborah and Nehemiah

Prayer Request for Charley:
In addition to Linda’s prayer lists, please add:
* Charley’s Bilirubin recovers to the normal range
* No CNS metastasis
* The energy restores and immune system builds up in order to tolerate the Rx toxicities

2007年三月23号， 星期五

下午，田田的医生又与家长进行会谈，告诉我们骨髓检查的结果。结果不是很好，单位计数面积原始细胞占了90%。化疗好像只是清除了血液里的幼稚细胞，并缓解了一些肝脾和临床症状, 并没有杀死骨髓里的白血病细胞。因此，田田仍被診斷為高抗藥性白血病。美国有一個临床實驗可能適合田田 , 其中包括一種美国FDA在2004年通过的新药clolar,可能是对田田的情况有所帮助。

很感谢从新加坡和中国苏州的朋友分享他们在骨髓移植失败后获得明显缓解的宝贵经验。田田的医生打算进行的临床治疗方案需要田田的心、肝、肾功能良好，而且白血病没有侵犯中枢神经系统。目前田田的胆红素升高部分是由于肠外营养輸液引起, 雖已停用，胆红素降到要求，大概需五至六天。在等待骨髓和超声检查的空档期, 白血病有反复的可能。

田田食欲逐渐好转, 但仍有恶心。父母、佬佬和其他朋友都尽量为他准备适合口味的食物。石先生一家今天来看望田田，孩子們一起玩 legos。Linda也陪伴我們出席了今天的家长会，給予我们精神上很及時的扶持。她所寫的信(英文)表達了父母之心聲。

-Deborah and Nehemiah

请为田田祷告：
除了Linda的祷告内容外，加上：
* 希望田田的胆红素恢复正常
* 没有中枢神经系统的转移
* 恢复精力和免疫功能以能耐受药物的毒副作用

Letter from Linda Shi (Family Friend) - March 23, 2007

Dear friends of Charley,

My children and I were blessed to spend an afternoon with the Cherng family on Friday (3/23).

Charley is brave. He is tired these days and doesn’t have much of an appetite. Pray for his nausea to subside and ability to drink some fresh juices or soup. They are also deciding whether to place a feeding tube or try Ritalin to stimulate appetite. They need God’s guidance for these nutritional decisions. Charley has been waking with nightmares. Pray for Jesus’ peace and the Holy Spirit’s presence to heal any fears or whatever is causing the bad dreams. Make-a-Wish has offered to give Charley a dream trip to Disneyworld. Would you ask God to direct when and if this trip should take place.

Charley will go to a prayer/healing service this Tuesday. We ask that God would hear our intercessions for Charley as well as for Deborah and Nehemiah.

Would you join me in praying that the Lord would grant Deborah and Nehemiah physical strength. Pray for rest (as they sleep on couches in the hospital room with Charley), provision of good meals. Of equal import is to pray for their emotional and spiritual strength and dependence on God. As they ask God the tough questions, I pray His answer would come through the love of the saints. “Christ has no hands but ours.”

Treatment options for Charley also need to be covered in prayer. The medical team has outlined 3 alternatives. An intensive, investigational, protocol combining 3 chemotherapy drugs, a middle ground chemotherapy treatment or comfort measures. The doctor asked some good questions for Deborah and Nehemiah to consider. Ask that God would make clear to them His will for treatment.

At the center of all our hearts is a precious six year old who loves legos and sweet egg custard tarts. He has come to know the love of the Father and the security and love of two devoted parents. May God carry this family and may we persevere to uphold them in prayer.

-Linda

On March 22, 2007; Thursday Morning

Charley will have a bone marrow aspirate and biopsy this morning. The intrathecal therapy (IT) that prevents the metastasis to the Central Nervous System was cancelled due to his low platelet count. This result is very important and will determine the following treatment.

Please pray for:
* the good result of Bone marrow test.

2007年三月22号, 星期四早上
田田今天早上将要进行骨髓穿刺活检。由于田田体内血小板数量太低，用于防止中枢神经转移的鞘内注射治疗被迫取消。今天的骨髓检查结果特别重要，将决定下一个阶段的治疗。

请为田田祷告：
有一个良好的骨髓检查结果

On March 21, 2007; Wednesday

Yesterday, Charley’s attending doctor called a parents meeting right after he came back from an international conference. His overall impression is that Charley shows some improvements clinically. Charley will have a bone marrow test tomorrow in order to evaluate the reality of treatment progress and to formulate the regimen for future courses. We are glad that Charley’s improvement has been on track. However, his platelet is very low today, only 6,000.

Please pray for the safety of:
* Bone marrow aspirate and biopsy
* Intrathecal therapy

2007年三月21号, 星期三
昨天，田田的主治医师刚从国际会议回来后就立即和我们进行了一次会谈。他很吃惊田田在临床上表现出的改善。明天田田将会进行骨髓穿刺检查, 以评价实际的治疗情况，并指导下一步的治疗。我们很高兴田田的临床情况出现改善。但他的血小板还是很低，今天只有6,000。

请为田田祷告：
在骨髓穿刺, 活检以及脊髓鞘内注射治疗过程中，一切平安。

March 17, 2007; Saturday

Charley is fighting for his life so hard these days. Recently, he sleeps more. After reading Charley’s update on the 13th, friends have been either rushing to see Charley or calling/writing to support him.

He had two episodes of fevers yesterday, one in the morning and another at the night. Charley has had persistent fever symptoms for 7 days. It is really worrisome, particularly the possibility of fungal infection. This was the 3rd day Charley receiving AmBisome, the anti-fungal drug, It usually takes a long term to wipe out funguses if Charley has been infected and is able to overcome it.

Yesterday was the first day that his fever was less than 38.5C. Doctors watch closely on the pattern of the peak of each fever. Our “big hope” is to see the fever peak gradually going down.

Charley’s platelet is very low and depends on the transfusion. It is “hopeful” his bone marrow recovers gradually during next couple of weeks. He was given both vincritine and L-asparaginase on Wednesday.

The Pediatric Advance Care Team (PACT) at the hospital begins to take care of Charley. First, they gave the parents consoling. The Make a Wish representative came to visit Charley yesterday.

Urgent Prayer Request for Charley:
1. Infections getting control
2. Nausea improving with good appetite
3. Pain reduced
4. Good blood count coming back.

2007年星期六，三月17号
这些天，田田正在为生命而奮戰 , 与疾病作搏斗。他最近睡眠明显增多。在读了田田13日的日志后，许多朋友不是趕來医院，就是通过打电话或写信表达著急和对田田的關切。

昨天，他又发热两次，那是分别在早上和晚上。田田已经连续7天出现发燒，这真是令人揪心，特别是担心真菌感染。田田使用抗真菌感染剂AmBisome已经第三天，如果田田真是感染了真菌，这通常需要较长时间才能完全消除。

昨天是一周以来田田的体温第一次低于38.5C。 医生严密监视每一次发热的峰值，我们最希望看到发热的峰值逐渐下降。田田的血小板水平很低，一直通过输血补充，多希望在以后的几周里田田的骨髓功能会逐渐恢复。这星期三，已给田田同时注射了vincristine 和PEG L-asparaginase。

医院的儿童重病医护小组（The Pediatric Advance Care Team, PACT) 已经开始看顾田田。他们先给父母进行了咨询。 昨天也有”Make-A-Wish” 的代表访问了田田。

急盼你为田田进行如下祷告:

1. 感染得到控制。
2. 控制恶心，有好的胃口。
3. 降低疼痛。
4. 恢复正常血象。

On Day +178 Charley’s fever continues 田田高燒持續!

Charley keeps having a high fever since last Saturday although he has been treated by 3 antibiotics. He had three episodes of fever today. The second one was 39.6⁰C and Charley complained of being chilly for almost 2 hours. Doctors are really worried that fungus is highly possible as part of infectious sources. It could attack organs such as liver, spleen and lungs. Therefore, Charley will be given the fourth and also the last antibiotic (AmBisome) to fight funguses tomorrow. This drug demands potassium supplement and may cause various side effects. Charley had it in a short period of time but did develop some CNS adverse events during BMT. Overall, Charley is under a serious condition and doctors are not quite optimistic.

We appreciated the Chaplin, Pastor Don and Dr. Leung for praying with us – YES, OUR FAITH IS STRENGTHENING. Ms. Lu, Ms. Qiu and Ms. Kuo came to play with Charley and to comfort the parents. “Charley’s Friends” from Beijing, Shanghai, Hebei, Henan, Los Angeles, Bay Area, New Jersey, Minnesota, Connecticut, Taiwan, all over Massachusetts and many other places sent cards of sympathy, “get well” and gifts, providing counseling or donating supplements. We need your prayer and love to hold Charley in combating the fever and the source of infections today.

從上週末起, 打了三種抗生素, 田田的體溫仍無法回復正常, 他今天還發了三次燒, 當中一次是39.6C度高! 身體還不自主的發抖了兩個小時. 醫生正擔心田田很可能受到黴菌感染, 這種黴菌會攻擊病人的內臟, 後果可能不利後續的治療 . 明天醫生將會給田田服另一種抗生素 (AmBisome), 算是退高燒最後一線的藥 , 且需鉀的補充劑, 這藥有較大的副作用, 田田曾短期服用過. 這種藥物可能會對CNS〔中樞神經系統〕造成傷害. 總言之, 田田病情較緊急! 醫生不怎樂觀.

我們很感謝:駐 院牧師、Don牧師、梁燕城博士和葉時豪叔叔幫我們禱告. 令我們感到信心與毅力更充足. “患 難生忍耐, 忍耐生老 練”, Ms. Lu, Ms. Qiu和 Ms. Kuo都來陪田田玩, 也給我們打氣 . 關切田田的朋友, 有從北京、上海、河北、河南 、洛杉磯、灣區、紐澤西、明尼蘇達、肯尼迪克、台灣、麻州各地和其他地區…都紛紛寄來了問候卡和慰病卡. 也有的寄禮物, 有的打電話, 更有人提供營養補充品 ! 真感人! 田田一定要打嬴這場仗!

今天, 我們需要您愛中的祈禱 : 田田能及時擊退高燒, 消除感染之源!!!

謝謝!!

On Day +175 (March 10, 2007; Saturday morning)

Charley has had a high fever (39.20C) since midnight. We are worried since he already took Tylenol for one hour. The blood sample has been sent for culture.

二零零七年三月十日, 星期六上午

在半夜裡高燒到攝氏39.2 度, 我們有點擔心, 因為田田在一小時前才服過降溫止痛劑 Tylenol。已抽血去做微生物培養。

On Day +174 (March 9, 2007; Friday)

Charley develops side effects of chemotherapy:
1. Low mood and emotion
2. Neuropathy, low extremities pain
3. Low blood counts, including neutropenia
4. Lost hair

Charley had a significant emotional change since the 10th day of chemotherapy (March 2, the morning right after the injection of vincristine and L-asparaginase on D9). Initially, Charley became quite and felt lousy. And then, he began crying sometimes when he felt pain or was asked to take medicine. He is agitated easily since then. In the beginning, doctors thought Charley was not comfortable staying in hospital so they asked his parents for Charley’s outdoor activities. However, we studied the side effects of chemo agents being given and found that both VCR and L-asparaginase list depression as possible adverse event. After presenting this concern, doctors put a request to psychiatrist on March 3. They came this afternoon and no decision has been made.

Nehemiah brought him to a local museum on March 4. Charley got certain degree of stabilization up to yesterday. This morning, Charley’s emotion is almost out of control. It is hard for both his nurses and parents to take care of him.

Doctors are also concerned about neuropathy which is usually caused by vincristine. Charley shows some mild syndromes so the second injection was postponed one day to March 8 (D17).

Overall, Charley keeps responding to the treatment. The absolute blast cells remain absent in his peripheral blood. The spleen size is getting smaller. No need for plasma transfusion over a week. Liver function is within high normal range.

As expected, his neutropenia is getting heavy (zero neutrophil for several days). Charley has a fever almost daily. The platelet transfusion is not as frequent as that of last week. So far, no clinical trial is suitable to Charley as the second line Rx. It is quite challenging and doctors keep working on it.

Visitors and kid friends make Charley happy. Brian and Paulina and their brother’s family came to play with Charley on March 5. Six kids played together at the Resource Room for three hours. Some of them even spoke Mandarin with Charley. Then, we had dinner at a nearby restaurant. Charley was tired but he still wanted to go. Both Brian and Douglas prayed for Charley.

Mr. Mizumoto, volunteer at 6-North, is an artist. He drew together with Charley the whole morning on Thursday. We were amazed by the effective outcome of “art therapy”. Under the attack of diseases, Charley still does his best to manage himself, such as taking routine medicine, eating, drinking, and keeping busy by playing with his transformers and power rangers. He loves listening children pop music and hymnals. Pastor John prepared 2CDs which Charley enjoys.

Friends who have medical backgrounds give us timely advice. Charley’s immune system is weak for a long period of time. It is aimed to build it up so he is able to tolerate the side effects of treatment and defend the leukemia.

We were touched when we read the blog of Mr. Fei Lin (resides in Singapore) recently. He has a similar disease and situation as Charley – a failed bone marrow transplant. His partner found out about Charley’s recurrence and wrote to express their care.

Lastly, we are working on expanding Charley’s webpage to contain the blog function so that more people may participate in our “Help Charley” mission. We deeply appreciate Ms. Min Qiu for serving Charley’s webpage voluntarily while her family was attacked by Lyme Disease (both her husband and her daughter are undergoing treatment). Through the effort of Mrs. Le (English as the second language teacher), Charley’s blog is opened now. Please sign in and feel free to provide your advice and generous support.

Urgent Prayer Request for Charley:
1. Help his high fever
2. The side effects from current treatment are minimized and healed so Charley is compliant to the protocol.
3. Strengthen the immune defense function.
4. Grant wisdom and blessing to the doctors for the second line protocol.

Intercession Link - Prayer Request for someone who cares about Charley:
* Mr. Fei Lin’s recovery from his leukemia treatment.

二零零七年三月九日,星期五

化療給田田帶來的副作用:
1. 情緒不穩: 時而低落, 易怒
2. 神經性病變, 下肢痛
3. 血球數字偏低, 包括嗜中性白血球減少症
4. 脫髮

化療後的第十天, 田田有明顯的情緒變化. ( 三月二日的上午, 就在注射長春新鹼和左旋門冬酶之後發生的.) 開始時, 田田變得安靜, 情緒低落, 接着痛時或要他吃藥, 就吵着,甚至大哭 容易激動。這可能是化療帶來的副作用。醫生也覺得他在醫院裏不舒服, 所以建議他的父母帶他到戶外去活動。總言之, 我們硏究結果, 化療劑 (長春新鹼和左旋門冬酶) 的副作用造成了田田的憂鬱症狀, 當我們對醫生表白我們的憂慮時, 主治醫生便在當天發出會診心理醫生之要求;不巧遇周末,一共等了六天,今天 心理醫生來了, 尚未作任何治療決定。

三月四日, 爸爸帶田田参觀附近一個藝術博物館 也開車到市中心逛逛。幾天來 田田情緒暫時穩一些。但今早他情緖失控, 令家長和護士手足無措。

醫生為顧慮到田田因長春新鹼而引起的輕微神經病變, 所以第二針延了一天, 到三月八日才打。

一般來說,治療藥物對田田有一定效用; 在他的血液裡已沒有幼稚細胞, 脾臟也變小一些, 他已一個禮拜不用輸紅血球, 肝功能也趨向正常化。

就如預期的, 嗜中性白血球減少症愈來愈嚴重, (已經很多天沒有嗜中性白血球細胞) 。田田幾乎每天在發燒, 他的血小板輸血不如上週頻繁。目前沒有進行中的臨床實驗可供田田作第二線的化療, 這對治療小組挑戰極大。

訪客和小孩都能使田田快樂. 三月五日那天, Bryan, Paulina 和Bryan的弟弟都來陪田田玩 ,六個孩子在會客廳裡玩了三個小時, 他們還能跟田田說中國話。之後, 我們就在附近的餐廳吃晚飯, 田田雖然很累, 但他仍然要去。Bryan 和 Douglas都替田田得醫治禱告。

Mr. Mizumoto 在六樓病房區當義工, 是個藝術家, 星期四上午他和田田一起畫畫, 這種”藝術治療”的效果是驚人的。雖然受到疾病的折磨, 田田還是想自己照顧自己, 例如定時吃藥,和飲食; 更不忘玩他的變形金剛和無敵大俠客。他愛聽兒童流行歌曲和讚美詩歌, 約翰牧師為田田錄好的兩片音樂光碟, 他欣賞不已。

有醫學背景的朋友們適時給我們指導, 田田的免疫系統因久病而虛弱, 這免疫系統正需重建, 俾以抵禦血癌和對付化療所導致的副作用。

近日, 拜讀了新加坡 林飛先生的部落格裏寫的文章, 我們很感動。林先生和田田都是得急性淋巴白血病, 於接受骨髓移植後的復發, 網友得知田田舊病復發, 在部落格裏寫下了表達關懷和支持田田的話。(原文附後)

最近, 我們也為田田設了一個有部落格的網頁,目的在讓更多的人参與“援肋田田”的使命. 我們深深的感謝 邱敏女士自願為田田設網頁。 現時, 她的家人受到Lyme 疾病的攻擊 (她的先生和女兒正在接受治療.) 。 經由教田田英文的林老師 (Le, Erin)的努力, 田田的部落格得以開放, 有心人可自由登入並提供您的寶貴意見, 慷慨支持,不吝賜教。謝謝!

謹請各位緊急地為田田祝禱:
· 免除高燒
· 順從議定, 願化療對田田的副作用減到最低程度, 並能早日痊癒
· 增強他的免役系統,俾以扺抗頑癌
· 為醫生們祝禱, 也給予他們大智慧, 早日規劃出下一步治療方案, 包括第二線藥的議定。

代禱網-為關懷田田的朋友祝禱:
· 為林飛先生的白血病痊愈祝禱
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附: 林飛的博客頁
第924天 多雨的新年 2007-02-25 07:14:06

这个春节真是一个多雨的春节，好像从年三十那天开始，就每天都会至少下一场大雨。这几天的天气都形成了一个定式，那就是上午艳阳高照，闷热的很，而到了下午则是瓢泼大雨。闷热的天气让人觉得很难过，我和他不怎么动，都会流不少汗，还是下大雨舒服，凉风习习的，当然前提是不必出门。

春节在华人世界而言，本应是个让人快乐的节日，可是疾病似乎却总不会挑日子。前段时间从网上知道了一个叫做田田的小男孩的故事（有关田田的故事，可以在下面的链接看到：http://helpcharley.byethost15.com/chphp），他因为患上了白血病，3岁时就被亲生父母遗弃北京市朝阳区三里屯的一个水果摊儿上，虽然后来被送到了福利院，但是因为种种原因治疗总不能按照计划很好的进行，造成病情的数次复发。去年他六岁的时候，被一对在美国的华人父母收养了，成为白血病儿被收养的第一人。经过3个月的寻找，终于找到了符合要求的骨髓，并于去年10月份进行了骨髓移植手术。本以为田田从此就能慢慢的恢复健康，找回本应属于他的快乐，没料想，就在今年的2月17日、大年三十除夕夜，他的病情再次复发，骨髓移植彻底失败。我想，现在的田田最需要的已经不再是经济上的援助，他最需要的是大家的祝福与祈祷，所以有心的朋友们，为田田送上一份祝福吧！

由兔猫张贴 http://blog.wenxuecity.com/comment.php?date=200702&postID=43677

Day +169 (March 4, 2007; Sunday)

We have cheerful news to share with you – Charley’s blast count in his peripheral blood is clean today!! His hemocrit has been in normal range for a couple of days. Doctors are encouraged by this promising trend which also includes the size reduction of his liver and spleen. The conclusion will wait until the bone marrow test at the end of this cycle.

We are arranged by the Oncology/Hematology Resource Room to have a tour to a nearby museum this afternoon.

Prayer Request:
1. Charley's whole body is healed though the effective therapy and strength from abundant love and perseverant support surrounding and the above.
2. The spleen is healed sooner to stabilize the hematopoiesis of platelet.
3. Quench fevers and avoid infections.
4. Good Appetite.
5. Strength of parents and grandparents.

On Day +169 (March 3, 2007; Saturday)

Charley endured a week which was full of challenges:
1. The absolute blast cells dropped to 28.
2. Doctors found the chemotherapy is shown some promising based on the tumor lysis tests. It’s encouraging!
3. Charley developed unusual low mood since he got vincristine and L-asparaginase. Because these two drugs could have depression as side effects, doctor has invited psychologist to see Charley.

This afternoon both our dear neighbors Savants family and Elder Rick Frazier came to play with him. Urvi and her brother brought a joyful day to Charley. His mood problem seems all gone. How powerful the healing can be from a genuine friendship.

Pastor John brought the 2nd grade Sunday school’s greeting to Charley. Dr. Leung called in for healing prayer. Mr. Steward Yeh called from Taiwan and Mr. Hechun Bai called from Beijing warm our hearts. Charley’s doctors in Beijing also provide their recommendation based on the past treatment experience. Yesterday, Tzu Chi Charity Boston Branch came to visit Charley. This is their third time bringing their care and support to us, including nutritional consultation and food. Ms. Zhang and Ms. Siskino, representing “China Adoption with Love, MASS”, keep coming to help us. Thanks a lot to all of Charley’s supporting friends.

On Day +167 (March 1, 2007, Thursday)

Charley’s bilirubin (key index for liver function) dropped on Tuesday (D8 of chemo cycle) so his treatment could continue on schedule:
1. Liver function recovered to a level which doctors felt comfortable to give two more chemo drugs, vincristine & L-asparaginase yesterday night (D9).
2. The hepatomegaly improved significantly and spleenomegaly improved some so that his respiratory function gets normal: no more oxygen. In addition, his appetite gets back early this week.
3. Pain is gone.

The attending doctors had a formal meeting with the parents at noon time. The key issues are below:

1. The ongoing chemotherapy (St. Jude’s relapse protocol) is the last convention regimen for Charley. If he failed to it, the choice will be either no further treatment or signing on some experimental drugs if Charley is eligible.

2. The initial evaluation of the current treatment is mixed.
2.a Charley failed the response to steroid therapy in leukemia control during the first four
days of hospitalization and that is considered a poor prognosis.
2.b. Drugs in this regimen have been used before. It is possible, but hard to predict whether Charley has developed drug-resistance or not. At the end of 7-day VP-16 Rx, Charley has some improvement: the absolute blast cells in peripheral blood dropped from 16,250 to 104. However, it is not as the best outcome as a clearance.

3. In consideration of balancing all factors, Charley can be discharged sometimes in the future. Thus, he will be treated by oral antibiotics instead of IV form for fever. So far, his blood cultures have not been found lethal pathogens.

4. One of the major concerns is his low platelet count which caused by leukemia and chemotherapy. The HLA matching test for platelet transfusion does not show the existence of antibody that doctor was suspected. If the leukemia is getting controlled, it needs 2-6 weeks for some improvement on platelet. The repeated transfusion won’t be the resolution. Charley will have adequate service of visiting nurse and ambulance. After discharge, reporting to the medical team whenever Charley has bleeding.