(Enlarge) In a tense game of life, score one for Serena Lambert. The 4-year-old, playing Chutes and Ladders with her mother, Becky, in a hospital room June 24, has cancer, but has hung tough through chemotherapy, surgery and a bone marrow transplant. Family and friends are planning a benefit for her on July 25 in Roland Park. (Photo courtesy of Nicholas Jbara)

Wrapped in a red blanket, 4-year-old Serena Lambert sat on her hospital bed, playing the board game Chutes and Ladders with her mother and her yoga instructor.

The lead changed hands so many times it was difficult to tell who was ahead.

"Somebody's winning," said Becky Lambert.

"You are, Mommy," Serena said watchfully.

Then it was Serena's turn to spin the dial. She moved 6 spaces.

"Oooh, you get to go up a ladder," said Marley Keller, the yoga instructor.

Serena beamed as she made her move.

"Now, I'm winning," she said.

It's also difficult to tell whether Serena is winning her battle with stage 4 neuroblastoma cancer, an aggressive form of childhood cancer.

The only certainty is that her treatment at Johns Hopkins Hospital's pediatric oncology center and at Memorial Sloan-Kettering Cancer Center, in New York, has cost more than $1 million, which is why Keller is organizing a benefit July 25 at the Evolvewell Healing Arts Center, a yoga studio in Roland Park where Keller sometimes teaches.

Serena, of Towson, was diagnosed just over a year ago, on June 23, 2008, after she inexplicably began to limp and stopped coming to yoga classes. She had been going to St. Paul's Lutheran Preschool, in Timonium, but her family had to take her out.

"It just me hit so hard," said Keller, of Hunt Valley. She said she didn't know what had happened for several months.

"I wanted to do something. I just feel like she's supposed to be around. She has that energy about her."

Neuroblastoma usually affects the adrenal glands, but can occur in any part of the body -- and in Serena's case affected her abdomen, all the vertebra in her spinal column and the bone marrow throughout most of her small body, according to her family and her doctor, Nataliya Buxbaum, a pediatric oncology fellow at Hopkins.

In the past year, Serena has endured seven rounds of chemotherapy, two surgeries, 12 rounds of radiation and, in January, a painful bone marrow transplant that kept her at Hopkins for six weeks. Her hair is still growing back.

Her treatment has cost an estimated $1.5 million -- "and counting," said Lambert, a massage therapist who hasn't worked since her daughter was diagnosed. She said she usually sleeps on a pull-out sofa in Serena's room at Hopkins.

Lambert's fiance, Jeff Whitt, a medical technician for a private company, is still working, and insurance is paying most of Serena's medical bills, though Buxbaum said some of the coverage has been slow in coming.

Uncertain prognosis

Lambert, 38, and Whitt, 47, were supposed to wed in February -- "but our flower girl wasn't feeling up to it," Becky said, smiling in Serena's direction.

The family had high hopes that she would emerge cancer-free from the bone marrow transplant, but scans afterward were positive for cancer.

"Her tumor is not completely gone. She's still not out of the woods," Buxbaum said.

And the treatments, including intensive chemotherapy, are causing side effects such as kidney damage and a slight loss of hearing, Buxbaum said. Bone marrow transplants can be toxic to the kidneys, she said.

Buxbaum said the prognosis is uncertain for Serena.

"It's a terrible disease, but she's definitely a fighter."

"They have a lot of strength," said Matthew Eggan, a Johns Hopkins Medicine clinical social worker who is helping Serena and her family "with their transition to illness."

Serena was back at Hopkins last week to have the kidney problems addressed and to get her weekly checkups, scans and a blood transfusion.

Surrounded by family members, including her grandmother, Abbey Lambert, also of Towson, and a cousin, Austin Bell, 11, Serena often fought fatigue but was ebullient and resilient during a reporter's visit June 24.

Tugging at her mother's arm, she asked, "Mommy, can we go down to the cafeteria?"

She is also a big fan of the hospital's gift shop, she said in an animated interview. She made special mention of Tinker Bell magnets and a pink-and-black stuffed animal, what kind she wasn't sure.

"It was sooooo cute," she said.

In her hospital room, she can play bingo on TV. Pictures she has drawn of princesses are taped to one wall.

She also gets visits from the children's center's clowns, with names like Dr. Boots and Nurse Lovely.

Playing with other children can be tricky, because often one child is feeling bad and the other good, said Abbey Lambert, the grandmother.

Sometimes Serena does yoga in the room. Her family brought a yoga mat (which she sometimes uses to play hopscotch).

On this day, she declined to do yoga, but seemed eager to play Chutes and Ladders.

When her grandmother came into the room, where she had left her cell phone, Serena gave her a message: "Your phone ringed."

"This is a relatively easy hospital stay," her mother said.

Her family has recently started taking her to the Sloan-Kettering cancer center once a month for an experimental treatment.

Sloan-Kettering has a 70 percent success rate in treating neuroblastoma, compared to a 30 percent success rate nationwide, the family said.

They must make the trek to New York by car, rather than train or bus, because other people's germs could contaminate Serena, they said.

Parking at Sloan-Kettering is $45 a day, which is not covered by insurance.

"Serena actually likes going to Sloan-Kettering, because their playroom is gigantic," her grandmother said.

Positive energy

Now the family is gearing up for the fundraiser July 25 from 2-5 p.m. at the Evolvewell studio, 4800 Roland Ave., Suite 301.

Instructors from around the area will teach meditation and children's and adult yoga classes, as well as conduct chair massage, Thai massage and acupuncture demonstrations.

Donations will be accepted for classes and a silent auction will be held with items such as pottery donated by Baltimore Clayworks, in Mt. Washington, Keller said.

Donations can be mailed to the Serena Lambert Pediatric Oncology Fund, P.O. Box 4014, Timonium, Md. 21094.

Meanwhile, Serena faces more treatments, including radioactive iodine therapy, more chemo, monoclonal antibody therapy and the drug Accutane.

But family and friends are also keeping a strong spiritual and religious faith. Already, they printed a pink T-shirt with the words "Team Serena" and the slogan "safe at the feet of Jesus" on the front of the shirt.

On the back are the lyrics to a song a friend wrote when Lambert was pregnant with Serena.

"One thing Marley and I feel very strongly about is positive energy. We really believe that positive energy and prayer help with healing," Lambert said.

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