Urine test result (VMA slightly elevated)

We received the child's urine test results today. Dr Baruchel informed my wife that they were normal and nothing to worry about, even though the childs VMA (vanillyl-mandelic acid) level was 7.8 (initially 120 when diagnosed) where the normal range is supposed to be between 0 - 5. His HVA (homovanillic acid ) level was 9 where the normal rage is 0 - 15.

VMA and HVA are metabolates of neuroblastoma cells and are used as an indicator of the disease. We were hoping that this indicator exhibited perfect results as a child who goes for high dose chemotherapy and stem cell transplant while in remission has a higher probability of cure and not relapsing. I am now researching VMA and its significance. Already came accorss some interesting material, check my neuroblastoma-info blog.

Possible solution to high probability relapse issue, even after complete remission

This is something I was aware of but not explicitly. The below extract clearly hilights the issue and potential solution to the problem;

In spite of the satisfactory frequency of clinical response to first-line therapy in neuroblastoma (NB), complete eradication of NB cells is rarely achieved. As a consequence, the majority of patients with advanced stage NB undergo relapse, which is often resistant to conventional treatment and rapidly overwhelming. Thus, after induction of the apparent remission, new therapeutic strategies are needed to completely eradicate the small number of surviving NB cells and to prevent relapse. We explored the potential of different doses of the anti-GD2 monoclonal antibody (mAb) 14G2a in an experimental metastatic model where a limited number of HTLA-230 human NB cells are injected i.v. into nude mice, leading to extensive metastases and death of animals within 7–8 weeks. Treatment with 14G2a mAb (1–4 mg/kg cumulative dose given as five i.v. daily administrations) dramatically reduced the metastatic spread of NB cells and prolonged the long-term survival of treated mice in a dose-dependent manner. Neither macrophages nor NK cells appeared to contribute to the protective effect of antibody treatment in vivo, suggesting either an involvement of granulocytes or a complement-mediated cytotoxicity towards NB cells. Whatever the effecting mechanism(s) involved, these results strongly support the clinical use of anti-GD2 mAbs after first-line induction regimens.

Reference: Anti-GD2 monoclonal antibody immunotherapy: a promising strategy in the prevention of neuroblastoma relapse

Chemotherapy Cycle 6

This chemo session is same as cycle 1,2,4.
The following drugs are used; cyclophosphamide ?? mg/kg, doxorubicin ?? mg/m(2), and vincristine ?? mg/kg (CAV)

Started on Thursday, 13th March 2008 and finished on 16th March 2008

Tumor resection surgery

We were very worried about the delays that took place. The surgery was originally scheduled for Wednesday 20th February 2008. It was postponed the first time as he had a low platelet count. The procedure was rescheduled for 27th February 2008. The surgeon was very concerned about us making it to the hospital @ 6.30am due to bad winter snow storms, that he requested us to stay the night at the Delta Chelsea hotel across the hospital. In the morning we were all ready to go for the procedure, when 2 emergency cases came in at the same time. The surgeon anticipated the emergency procedure to last about 4 hours, unfortunately it took longer and they had to reschedule our child's procedure again to the coming Monday.

My son finally had tumor resection surgery today 3rd March 2008. The surgeon, Dr Girstle, claims to have successfully removed my sons primary tumor which was slightly larger than an egg. It took him 2 hours to remove the primary tumor but 4 hours to removed the infected lymph nodes. There were a total of 5 specimens (1 tumor and 4 lymph node specimens) removed from within the child.

We got to see our son after about 8.5 hours, the sight of so many more tubes into our child made our hearts sink even more. He now had a new epidural tube for pain control, a chest tube to drain fluids, 2 intravenous lines (one in each hand) and a catheter in his penis to help drain his pee . There was a large L shaped tape on his abdomen, covering the stitches on the surgical incision.

The most traumatic thing for the child was the catheter sticking to his penis. He demanded that it be removed immediately and fell asleep again.