Still trying to figure out the doses for 6MP and MTX

The protocol strictly says steps of 100%, 75%, 50% and 25% will be taken to adjust doses for 6MP and MTX -- not having any text on what to do when the combination of these numbers do not result in ANC in the therapeutic range of (500, 1500).  From the data our doctor and I put together, it seems MTX either works very slowly on Lucas, or Lucas's ANC is not very sensitive to MTX.  A sweet spot for 6MP is very evident to be between 50% and 75%.  I'm so glad our doctor agrees after this counts crash and chemo hold (15 days and counting), we will never raise 6MP to 75% ever again.  We can try to do 6MP 50% and MTX 75% and see what happens.  There will be three possible outcomes (1) ANC crash again (2) ANC steadily high (3) ANC within range (500, 1500).

If (1), then we will do 50%,50% for both when counts recover, and slowly increase 6MP if counts too high, but never exceed 6MP to be higher than 70%.

If (2), then we will slowly increase 6MP, but never exceed 6MP to be higher than 70%.

If (3), then we will keep that combination!

I'm writing this down so I will suggest this to doctor tomorrow when ANC is (hopefully) above 750.   Lucas is doing rather well regardless of the low counts.  He has been given IVIG whenever his IGG drops below 300, which happens every 2-3 months.  After the one instance of IVIG reaction, it now takes 4.5 hours to finish the IVIG infusion.  IV Pentamidine still takes more than 1 hour to infuse and 1 hour of observation afterwords.  So we spent a full 8 hours in hospital this past Tuesday (2nd 4-week in Cycle 5).

		6MP (%)	MTX (%)		Comments
Cycle 1	8/5/2013	100	100
HOLD	8/23/2013	0	0		plts < 50, ANC < 500
	9/17/2013	50	50		Restarted oral chemo
	10/1/2013	50	75		ANC 3431, increased MTX
	10/15/2013	50	45		ANC decreased to 784, decreased MTX
Cycle 2	10/29/2013	50	50		ANC 2948-no change
	11/19/2013	50	75		ANC 3182
Cycle 3	1/21/2014	50	75		ANC 3040
	2/18/2014	50	75		ANC 528
HOLD	2/28/2014	0	0		ANC 232-admit for fever
	3/12/2014	25	38		ANC 1100, plts 215. Restarted oral chemo
	3/18/2014	50	38		Increased 6MP
Cycle 4	4/15/2014	50	50		ANC 2170, increased MTX
	5/13/2014	75	50		ANC 2450, increased 6MP
	6/10/2014	75	50		ANC 876, Plts 143 -no change
	6/25/2014	75	50		ANC 570
Cycle 5	7/7/2014	75	50		ANC 1155
HOLD	7/24/2014	0	0		ANC 186-admit for fever