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.