title: Favorable prognosis for patients 12 to 18 months of age with stage 4 nonamplified MYCN neuroblastoma: a Children's Cancer Group Study.
abstract: OBJECTIVE
  The long-term survival of children between age 12 and 24 months with stage 4 neuroblastoma and nonamplified MYCN (MYCN-NA) has not been defined previously.
  
  
  METHODS
  Survival for stage 4 MYCN-NA neuroblastoma patients enrolled onto Children's Cancer Group (CCG) protocols 321P2 (1986 to 1991) and 3891 (1991 to 1996) was analyzed. Treatment consisted of intensive alkylator-based induction chemotherapy with or without autologous bone marrow transplantation (ABMT) with or without 13 cis-retinoic acid. Survival was analyzed by age strata less than 12, 12 to 18, 18 to 24, and more than 24 months at diagnosis. Patients younger than 12 months were treated on the moderate-intensity CCG protocol 3881.
  
  
  RESULTS
  Forty-three patients with stage 4 MYCN-NA disease enrolled onto CCG-321P2 (n = 17) or CCG-3891 (n = 26) were between 12 and 24 months of age at diagnosis. After a median follow-up of 94 months (range, 4 to 140 months), the 6-year event-free survival (EFS) for the 12- to 18-month age group was superior to that of the 18- to 24-month age group (74% +/- 8% v 31% +/- 12%; P = .008). The EFS for children older than 24 months with stage 4 MYCN-NA neuroblastoma was 23% +/- 3%, and for children younger than 12 months was 92% +/- 3%.
  
  
  CONCLUSIONS
  Children diagnosed with stage 4 MYCN-NA neuroblastoma in the second year of life form a transitional group between infants and older children in terms of prognosis. Patients between 12 and 18 months of age have significantly better long-term survival than that of older children treated with intensive chemotherapy with or without ABMT. These patients may not benefit from additional intensification of therapy beyond that provided in earlier clinical trials and may even maintain this high survival rate with less intensive therapy.
authors.affiliation: Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, IL 60612, USA. mls3@uic.edu
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Schmidt
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Lal
authors.forename: Robert C
authors.initials: RC
authors.lastname: Seeger
authors.forename: John M
authors.initials: JM
authors.lastname: Maris
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shimada
authors.forename: Maura
authors.initials: M
authors.lastname: O'Leary
authors.forename: Robert B
authors.initials: RB
authors.lastname: Gerbing
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Matthay
mesh_terms: D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D002675:Child, Preschool; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005784:Gene Amplification; D015972:Gene Expression Regulation, Neoplastic; D016259:Genes, myc / Q000235:genetics*; D006801:Humans; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000235:genetics / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome