title: Treatment and outcomes of patients with relapsed, high-risk neuroblastoma: results of German trials.
abstract: BACKGROUND
  The prognosis of high-risk neuroblastoma patients has improved over the last decades. However, many patients experience relapse after successful initial treatment. We retrospectively analyzed the long-term outcome of relapsed patients of three consecutive national neuroblastoma trials.
  
  
  METHODS
  Patients were included when they fulfilled all of the following criteria: Age at diagnosis being 1 year or older, first diagnosis between 1990 and 2007, stage 4 disease or stage 3 neuroblastoma with MYCN amplification, and relapse or progression after successful first-line autologous stem cell transplantation (ASCT).
  
  
  RESULTS
  A total of 451 high-risk neuroblastoma patients 1 year or older underwent ASCT during first-line treatment, 253 experienced recurrence of disease, 158 received salvage chemotherapy, and 23 of them finally underwent a second ASCT. These 23 patients had a better median survival (2.08 years) and 3-year survival rate from recurrence (43.5 ± 10.9%) compared to 74 patients who had no second chemotherapy (median survival 0.24 years, 3-year survival rate 4.0 ± 2.6%) and 135 patients who underwent second-line chemotherapy but did not undergo second ASCT (median survival of 0.89 years, 3-year survival rate 9.6 ± 2.8%, P < 0.001). By February 2010, 3/23 patients were in complete remission, 3/23 in very good partial remission, 1/23 in partial remission, 14/23 patients died of disease after successful second ASCT, and 2/23 died of complications due to second ASCT.
  
  
  CONCLUSIONS
  Intensive second-line therapy is feasible. A small subgroup of relapsed high-risk neuroblastoma patients may benefit from intensive relapse chemotherapy and second ASCT. The potential of long-term survival justifies clinical trials on intensive second-line treatment.
authors.affiliation: Department of Pediatric Oncology and Hematology, Children's Hospital, University of Cologne, Cologne, Germany. thorsten.simon@uk-koeln.de
authors.forename: Thorsten
authors.initials: T
authors.lastname: Simon
authors.forename: Frank
authors.initials: F
authors.lastname: Berthold
authors.forename: Arndt
authors.initials: A
authors.lastname: Borkhardt
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kremens
authors.forename: Boris
authors.initials: B
authors.lastname: De Carolis
authors.forename: Barbara
authors.initials: B
authors.lastname: Hero
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D006801:Humans; D007223:Infant; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D009447:Neuroblastoma / Q000401:mortality / Q000628:therapy*; D012074:Remission Induction; D012307:Risk Factors; D016879:Salvage Therapy; D033581:Stem Cell Transplantation; D015996:Survival Rate; D016896:Treatment Outcome