title: Anti-G(D2) antibody treatment of minimal residual stage 4 neuroblastoma diagnosed at more than 1 year of age.
abstract: OBJECTIVE
  To eradicate minimal residual disease with anti-G(D2) monoclonal antibody 3F8 in stage 4 neuroblastoma (NB) diagnosed at more than 1 year of age.
  
  
  METHODS
  Thirty-four patients were treated with 3F8 at the end of chemotherapy. Most had either bone marrow (n=31) or distant bony metastases (n=29). Thirteen patients were treated at second or subsequent remission (group I) and 12 patients in this group had a history of progressive/persistent disease after bone marrow transplantation (BMT); 21 patients were treated in first remission following N6 chemotherapy (group II).
  
  
  RESULTS
  Before 3F8 treatment, 23 patients were in complete remission CR, eight in very good partial remission (VGPR), one in partial remission (PR), and two had microscopic foci in marrow. Twenty-five had evidence of NB by at least one measurement of occult/minimal tumor (iodine 131[(131)I]-3F8 imaging, marrow immunocytology, or marrow reverse-transcriptase polymerase chain reaction [RT-PCR]). Acute self-limited toxicities of 3F8 treatment were severe pain, fever, urticaria, and reversible decreases in blood counts and serum complement levels. There was evidence of response by immunocytology (six of nine), by GAGE RT-PCR (seven of 12), and by (131)I-3F8 scans (six of six). Fourteen patients are alive and 13 (age 1.8 to 7.4 years at diagnosis) are progression-free (40 to 130 months from the initiation of 3F8 treatment) without further systemic therapy, none with late neurologic complications. A transient anti-mouse response or the completion of four 3F8 cycles was associated with significantly better survival.
  
  
  CONCLUSIONS
  Despite high-risk nature of stage 4 NB, long-term remission without autologous (A)BMT can be achieved with 3F8 treatment. Its side effects were short-lived and manageable. The potential benefits of 3F8 in consolidating remission warrant further investigations.
authors.affiliation: Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA. cheungn@mskcc.org
authors.forename: N K
authors.initials: NK
authors.lastname: Cheung
authors.forename: B H
authors.initials: BH
authors.lastname: Kushner
authors.forename: I Y
authors.initials: IY
authors.lastname: Cheung
authors.forename: K
authors.initials: K
authors.lastname: Kramer
authors.forename: A
authors.initials: A
authors.lastname: Canete
authors.forename: W
authors.initials: W
authors.lastname: Gerald
authors.forename: M A
authors.initials: MA
authors.lastname: Bonilla
authors.forename: R
authors.initials: R
authors.lastname: Finn
authors.forename: S J
authors.initials: SJ
authors.lastname: Yeh
authors.forename: S M
authors.initials: SM
authors.lastname: Larson
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D000951:Antigens, Neoplasm / Q000096:biosynthesis; D019046:Bone Marrow Neoplasms / Q000556:secondary; D001859:Bone Neoplasms / Q000556:secondary; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005732:Gangliosides / Q000276:immunology*; D006801:Humans; D007167:Immunotherapy; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D018365:Neoplasm, Residual / Q000628:therapy*; D009447:Neuroblastoma / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D000951:Antigens, Neoplasm; D005732:Gangliosides; C019403:ganglioside, GD2