Scintigraphic response by 123I-metaiodobenzylguanidine scan correlates with event-free survival in high-risk neuroblastoma.
OBJECTIVE
To investigate whether response to induction therapy, evaluated by metaiodobenzylguanadine (MIBG) and bone scintigraphy, correlates with event-free survival (EFS) in children with high-risk neuroblastoma (NB).


METHODS
Twenty-nine high-risk NB patients were treated prospectively with an intensive induction regimen and consolidated with three cycles of high-dose therapy with peripheral blood stem-cell rescue. The scintigraphic response was evaluated by MIBG and bone scans using a semi-quantitative scoring system. The prognostic significance of the imaging scores at diagnosis and following induction therapy was evaluated.


RESULTS
A trend associating worse 4-year EFS rates for patients with versus without osteomedullary uptake on MIBG scintigraphs at diagnosis was seen (35% +/- 11% v 80% +/- 18%, respectively; P =.13). Similarly, patients with positive bone scans at diagnosis had worse EFS than those with negative scans, although the difference did not receive statistical significance (34% +/- 10% v 83% +/- 15%, respectively; P =.06). However, significantly worse EFS was observed in patients with a postinduction MIBG score of >/= 3 compared to those with scores of less than 3 (0% v 58% +/- 11%; P =.002). There was no correlation between bone scan scores and outcome following induction therapy.


CONCLUSIONS
MIBG scores >/= 3 following induction therapy identifies a subset of NB patients who are likely to relapse following three cycles of high-dose therapy with peripheral blood stem-cell rescue, local radiotherapy, and 13-cis-retinoic acid. Alternative therapeutic strategies should be considered for patients with a poor response to induction therapy.
Division of Hematology/Oncology, Department of Pediatrics, Northwestern University, Children's Memorial Hospital, 2300 Children's Plaza, Box #30, Chicago, IL 60614, USA.
Howard M
HM
Katzenstein
Susan L
SL
Cohn
Richard M
RM
Shore
Dianna M E
DM
Bardo
Paul R
PR
Haut
Marie
M
Olszewski
Jennifer
J
Schmoldt
Dachao
D
Liu
Alfred W
AW
Rademaker
Morris
M
Kletzel
D019797:3-Iodobenzylguanidine; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001856:Bone Marrow Examination; D005260:Female; D006801:Humans; D007223:Infant; D007457:Iodine Radioisotopes; D008297:Male; D009447:Neuroblastoma / Q000000981:diagnostic imaging* / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation; D011237:Predictive Value of Tests; D011379:Prognosis; D011877:Radionuclide Imaging; D012074:Remission Induction; D016896:Treatment Outcome
D007457:Iodine Radioisotopes; D019797:3-Iodobenzylguanidine