Biopsy Results

Thank you for your prayers, concern and frequent checking for updates.

Ava's biopsy results show that she is still MRD positive. While her numbers went down from last time (her blasts are 0.02% compared to 0.06% last month), the fact that she is MRD positive means that this treatment isn't working as effectively as they would like.

The doctor will consult with the rest of the team tomorrow to confirm the plan at this point, but it looks like they may keep Ava on the ALL treatment despite her being MRD positive. Why not switch to AML treatment? We don't know exactly why, but it may be because they are seeing more T-cells remaining at this point, which is associated more with ALL, or because AML treatment has some similar drugs to what was used before (and neither has gotten Ava to MRD negative).

So, the thought right now is to have Ava skip to the next phase of ALL treatment, called "maintenance." She started on the "consolidation" phase of ALL therapy last month. Consolidation normally involves two rounds of the chemo regimen; Ava has only completed one round. They are thinking of having Ava skip the second round of consolidation due to:

1) the fact that Ava is still MRD positive, so this hasn't been as effective
2) Ava is not a candidate for the drug, Erwinia, which means she wasn't getting the full regimen anyway.

Skipping to the next phase of  maintenance involves getting high-dose methotrexate for 3-4 days as an inpatient. They will likely treat her this way for one month before taking another bone marrow biopsy to evaluate its efficacy and re-evaluate the appropriateness of therapy. It is unclear how many times Ava would need to go in for the methotrexate this next month, but the plan is that she would start next week. The aim is to see if we can get Ava into remission on drugs alone and avoid BMT if at all possible.

So while Ava's news of a MRD positive is a blow, God can still work (and is still at work!), so thank you for your faithful and undying prayers.

We praise God that:
1) Although Ava is MRD positive, her blasts have gone down from last month. Her levels need to be less than 0.01% to be considered MRD negative, so... we're close! (Maybe??)

2) There are still treatment options to consider right now -- options other than BMT.

Please pray:
1) For wisdom regarding Ava's treatment. This seems to be unchartered territory for the medical team, so there isn't a "clear" path for Ava's treatment plan. Please pray that God would make that path clear, in whatever manner He chooses, and that this path would be confirmed all around. We acknowledge that God Himself is the Great Physician. It is His wisdom we seek and healing from His hand we desire.

2) For peace for the Lee family during yet another "waiting" period. There seems to be a whole lot of waiting and uncertainty in leukemia; pray for God's presence to bring the peace that only He can give in times like these. Please pray for Ava to have peace as well, God to bring comfort and drive out all fear.

3)And, of course, complete healing!

Thank you for those who signed up for to deliver meals. We'll adjust the schedule as needed when we find out when Ava will be in the hospital. Thanks for your flexibility.