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Eur J Cancer. 2017 May;76:188-196. doi: 10.1016/j.ejca.2016.12.013. Epub 2017 Mar 19.

Feasibility, toxicity and response of upfront metaiodobenzylguanidine therapy therapy followed by German Pediatric Oncology Group Neuroblastoma 2004 protocol in newly diagnosed stage 4 neuroblastoma patients.

Author information

1
Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam, The Netherlands; Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands. Electronic address: K.C.J.Kraal@prinsesmaximacentrum.nl.
2
Department of Radiology/Nuclear Medicine, NWZ Alkmaar, Alkmaar, The Netherlands.
3
Department of Nuclear Medicine, Academic Medical Centre (AMC), Amsterdam, The Netherlands.
4
Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.
5
Department of Pediatric Oncology and Hematology, University Children's Hospital, Center for Molecular Medicine Cologne (CMMC), Cologne, Germany.
6
Department of Pediatric Oncology/Hematology, Erasmus MC (EMC)-Sophia Children's Hospital, Rotterdam, The Netherlands; Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.
7
Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam, The Netherlands.
8
Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam, The Netherlands; Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.

Abstract

AIM OF THE STUDY:

Radiolabelled meta-iodobenzylguanidine (MIBG) is an effective option in treatment of neuroblastoma (NBL) tumours. We studied feasibility, toxicity and efficacy of upfront 131I-MIBG and induction treatment in stage 4 NBL patients.

PATIENTS AND METHODS:

Retrospective, multi-centre (AMC and EMC) pilot regimen (1/1/2005-2011). Newly diagnosed stage 4 NBL patients, were treated with 2 courses of 131I-MIBG, GPOH 2004 NBL protocol, myeloablative therapy (MAT) and autologous stem cell rescue (ASCT). 131I-MIBG was administered in a fixed dose. Response rate (RR) was defined as complete remission, very good partial response and partial response.

RESULTS:

Thirty-two patients, (median age [range] 2.9 [0-11.4] years), 21 received 131I-MIBG therapy, 11 did not because of: MIBG non-avid (N = 5) and poor clinical condition (N = 6). In 95% of eligible patients 131I-MIBG treatment was feasible within 2 weeks from diagnosis. Interval between chemotherapy courses was 25 days (131I-MIBG group) versus 22 days (chemotherapy group). No stem cell support was needed after 131I-MIBG therapy. Stem cell harvest in both groups was feasible, neutrophil recovery was comparable, but platelet recovery post MAT, ASCT was slower for 131I-MIBG-treated patients. RR post 131I-MIBG was 38%, post MAT + ASCT was 71% (131I-MIBG group), 36% (chemotherapy group) and overall 59%.

CONCLUSIONS:

Induction therapy with 131I-MIBG before the HR GPOH NB 2004 protocol is feasible, tolerable and effective in newly diagnosed stage 4 NBL patients. 131I-MIBG upfront therapy induces early responses.

KEYWORDS:

(131)I-MIBG (meta-iodobenzylguanidine); NBL (neuroblastoma)

PMID:
28329731
DOI:
10.1016/j.ejca.2016.12.013
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