Concerned, Mona took Natalie to the pediatrician, who performed a physical exam and ordered a complete blood count (CBC).

Tests showed Natalie's white cell count had topped 350,000 microliters -- several hundred times the normal range of 5,000 to 10,000 microliters -- putting her in the highest-risk category for this disease. ALL is the most common childhood cancer, afflicting more than 3,000 girls and boys nationwide each year.

"The diagnosis took us completely by surprise. We thought she had allergies. I was driving home from the pediatrician's when my husband called my cell phone with the terrible news. We turned right around and headed back to Geisinger in Danville," Mona says.

If left untreated, ALL can quickly spread to the brain, spinal cord, and other parts of the body. Natalie required urgent medical care.

On the afternoon of her diagnosis, Natalie was admitted to the cancer wing in the Pediatric Intensive Care Unit at Janet Weis Children's Hospital. Jagadeesh Ramdas, MD, a board-certified pediatric hematologist/oncologist, was called in.

"When a patient presents with a high white count -- greater than 100,000 to 200,000 microliters -- we consider this a life-threatening oncological emergency. In cases where the white count exceeds 200,000 microliters, the patient's blood vessels become susceptible to develop a clot or to rupture, putting the child at risk for bleeding inside the brain and lungs," explains Dr. Ramdas.

Natalie's treatment began immediately. She received several blood and platelet transfusions throughout her first night in the hospital. The next morning, doctors performed a spinal tap and bone marrow aspiration (using a needle to remove a sample of bone and bone marrow from inside her body) to determine the extent of Natalie's illness. These invasive procedures are painful and scary to young patients, so doctors sedated Natalie to make her as comfortable and relaxed as possible.

Test results showed that 97 percent of the cells tested were cancerous. Natalie's chances of recovery were poor, but the family remained hopeful. Her treatment team pressed on, working frantically to decrease Natalie's white blood cell count.

In addition to intravenous chemotherapy, Natalie received intravenous fluids to hydrate her blood vessels and increase circulation, as well as medicines to prevent kidney failure and bleeding in the brain, two potentially serious complications. She endured frequent blood tests throughout her ordeal.  In a procedure called leukopheresis, Natalie's blood was circulated through a special piece of medical equipment, which separated the white blood cells and returned the remaining blood products back to the patient.

Within 48 hours, Natalie's white count dropped to 170,000 microliters and continued to progressively decline. She also responded well to the initial doses of chemotherapy. Tests showed the cancer was in remission after just seven days on the anticancer agents.

After 21 days of specialized care, Natalie was finally well enough to go home, although her courageous journey of survival was far from over. Natalie would endure two more years of treatment to beat the disease that almost claimed her young life.

"Treatment for this type of cancer is lengthy. It makes a major impact on the whole family," explains Dr. Ramdas. "The family made frequent visits to the clinic for repeat chemotherapy-- and they never missed a single appointment. Natalie was one of our star patients."

Natalie's chemotherapy continued four times a week for a couple of weeks, gradually tapering off to monthly maintenance doses, which lasted through August 2004.

"It was a struggle because we live two hours away. We felt like we were eating, sleeping and getting up and going. It was a trial for our family," says Mona, who runs a family-style restaurant and modular-home business with her husband. A friend who was completing nursing school sometimes helped Mona administer treatments at home.

The prolonged treatment took its toll on the family, especially young Natalie.

"She would blow up like a balloon from the steroids she was taking. She felt nauseous once in a while, but not too often, thanks to medicine prescribed to prevent nausea. Her hair fell out around Christmas 2002 and again in early 2004, but it's growing back nicely now," Mona says.

Blood and platelet transfusions also continued after Natalie's discharge, and the little girl had to wear a surgical mask when she went out in public. Her weakened immune system was vulnerable to infections.

To see Natalie today, you might have difficulty believing her brave battle against ALL. She is cancer free and thriving.

"She's a normal five-year-old. She attends kindergarten at a private school in our community. She rides and shows quarter horses along with her two older sisters, Taiylor, 10, and Hannah, 7. Not too many people would guess her past if they didn't know her," says Mona.