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.