David's Clinical Story

October 21st, 1996	David taken to Emergency of Hospital For Sick Children after his walking becomes affected by "chronic constipation" (prior diagnosis by family GP and community General Hospital). MRI reveals a tumor located between the spinal column and cord stretching from T5 to T10. Preliminary diagnosis is Non Hodgkin's Lymphoma.
October 22nd.	Laminectomy performed to biopsy the tumor and relieve pressure on the spinal chord.
October 29th	At disclosure meeting revealed that David has anaplastic B-Cell Large Cell Lymphoma.
October 30th	Treatment begins on POG Protocol 9315 ( Induction Phase ) 5 weekly infusions of Vincristine, Prednisone (Daily), Intrathecal methotrexate (weeks 1,2,4), Adriamycin (weeks 1,4)
December 10th	David declared "In complete remission"
December 14th	Begins maintenance therapy: Cycle 1: Intermediate Dose Methotrexate, High Dose ARA-C, G-CSF Cycle 2: 6 days MP, Vincristine, Adriamycyin, Prednisone (5 days) Treatment rotates between 2 cycles every 3 weeks.
April 4th, 1997	David, along with his sister Mary playing Snoopy, appears as Linus in school production of "You’re a Good Man Charlie Brown" – is featured on front page of Toronto Star and on several tv news reports.
May 9th	Ultra-sound shows small "something" c. 1cm near tail of pancreas. Oncologist not worried – orders thorax ultra sound of original location of disease to placate parents.
June 23rd	Ultra sound performed due to continuous 7 day fever to check for fungus. Spots revealed on liver. Suspected to be fungus.
June 24th	CT performed – spots appear on liver but a mass on the tail of the pancreas is now 3cm.
June 26th	Biopsy of liver confirms relapse. We change oncologists.
June 28th	Begins I.C.E. salvage therapy.
July 16th	Ultra sound shows significant reduction of tumors. Due to slow recovery, David is unable to continue therapy. Round 2 of I.C.E. delayed by 3 weeks.
August 14th	Ultrasound shows tumors progressing again.
August 15th	I.C.E. round 2 begins. New agent Amifostine, to hopefully protect platelet production, administered.
September 4th	CT reveals excellent shrinkage. Chemo again delayed due to poor blood counts. Stem Cell Rescue scheduled for November.
October 2nd	I.C.E. round 3.
October 27th	CT shows tumors progressing. Stem Cell Rescue is cancelled.
November 4th	Salvage therapy #3 begins – Mini- BEAM ( 60% dosage of BEAM protocol )
November 28th	CT shows no improvement.
December 3rd	Biopsy confirms active disease.
December 11th	Salvage therapy #3 - begins experimental Vinblastine therapy ( 6mg per litre² ) once a week.
January 8th, 1998	CT shows significant improvement. Due to poor blood counts, dosage and frequency is decreased.
February 5th	CT shows no change but small lesion in kidneys noted.
February 11th	Biopsy indicates kidney lesion is dead lymphoma.
March 6th	CT shows tumors advancing on liver. Decision made to return to original dose of Vinblastine for 2 weeks.
March 21st	While admitted for fever, small lump noticed by mom on left side below rib cage.
March 23rd	CT shows no change on liver, lump shows up on CT.
March 30th	Biopsy of lump shows it to be tumor. Doctors "shocked" by this development.
April 4th	Salvage Therapy #4 - begins DHAP
April 23rd	CT shows progression of disease.
May 8th	Put on Retinoic Acid as stop gap until able to go on experimental Rebeccaymycin treatment.
May 13	Receives Rebeccaymycin
June 11th	Ultra sound shows continued progression.
June 18th	David receives Navelbine - first patient at the Hospital for Sick Children to receive this drug used primarily for adults.
June 20th	Begins to decline at home. Breathing becomes difficult and he is rushed to local hospital where he passes into eternity at 8:30pm - he will be so sadly missed....