My Daughter, was diagnosed with ALL- T in 2006 mid November at TMH , Mumbai. She was 8.5 years old at that time. She underwent initial treatment at TMH in Mumbai . She underwent rest of the treatment at Bhopal Cancer Hospital under DM Oncologist . Protocol 841 was followed. She completed the initial Induction successfully in 2006 end itself and started the consolidation phase in 2007 . During the consolidation and induction phases she had 4-5 packed RBC transfusions and 8-10 platelet transfusions .She completed the entire consolidation phase medication including spinal taps except the last leg of ARAC . At this time her platelets had dropped down to levels of 30,000 to 40,000 and were not recovering .This was around June of 2007. We were advised to wait and watch for the marrow to recover. At this time , my daughter underwent a 2 month course of ayurvedic medication given by Dr (Vaidya) balendu Prakash of Dehradun and in a month her platelets came back to normal levels . This medication was stopped then. At this time, her local oncologist then advised us to let her stabilize and after a month start maintenance phase under Protocol 841. We started this in September 2007 and the maintenance medication ended on 1st June 2009. It is now 1 year and six months since she is off oral chemo and she has completed 4 years from diagnosis in November 2010. During the last 18 months she has had her share of Cough/cold and virals like any child and has been treated with appropriate antibiotics under guidance of her oncologist. She is now 12 years old and full of energy like any school going child. She has been having CBC done every month in the last 18 months and her reading span is as below ( tables also appended below) • Platelets – 1.7 Lacs to 3 lacs - Recent ones are between 2.1 lacs to 3 Lacs • WBC – 10000 – 13500 - Neutrophils and Lymphocytes are in normal ranges unless she has a infection or fever. • HBG – 11.5 – 12 .5 The area I needed advise on was the range of WBC – You can see from the chart below that it is almost constantly above 10000 and has even gone up to 13400 after which it has again come down. Most of the time she has had no fever. Even the last reading which you see of 13800 wbc, she has had only cough and cold with no fever.I have personally spoken to the pathologist who confirmed he has examined peripherals and smear carefully and morphology of cells Is absolutely normal. Her oncologist has suggested it may be a infection and not to worry . He also said he did not see the need of a marrow examination. I have had her throat and ears examined and they seem to be fine. I was slightly worried about this trend of WBC and wanted to consult you. Needed your expert advice on how we should take her case at this time and way ahead. Date     wbc     Neutophil     Lymphocytes     plts     hbg 21/10/2009     12900     76     20     2.14     12 23/12/2009     10100     52     44     2.6     11.5 8/2/2010     10400     55     38     2.2     11.7 2/3/2010     10300     49     39     2.5     11.5 22/3/2010     12900     69     27     2.1     11.9 1/5/2010     10200     55     40     2.2     12 5/6/2010     10500     58     37     2.5     11.8 29/6/2010     13400     52     45     2.5     11.7 30/6/2010     12200     50     44     2.5     11.7 9/7/2010     8600     35     58     2.6     12.1 24/7/2010     10900     68     27     3.1     12.8 6/8/2010     11400     54     40     2.5     12 23/9/2010     12100     71     25     2.5     11.9 22/10/2009     11100     70     24     2.71     12 22/11/2010     13800     58     37     2.88     12.6 Regards Deepak Sethi