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.
Radiolabelled meta-iodobenzylguanidine (MIBG) is an effective option in treatment of neuroblastoma (NBL) tumours. We studied feasibility, toxicity and efficacy of upfront131I-MIBG and induction treatment in stage 4 NBL patients.



Retrospective, multi-centre (AMC and EMC) pilot regimen (1/1/2005-2011). Newly diagnosed stage 4 NBL patients, were treated with 2 courses of131I-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.



Thirty-two patients, (median age [range] 2.9 [0-11.4] years), 21 received131I-MIBG therapy, 11 did not because of: MIBG non-avid (N = 5) and poor clinical condition (N = 6). In 95% of eligible patients131I-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 after131I-MIBG therapy. Stem cell harvest in both groups was feasible, neutrophil recovery was comparable, but platelet recovery post MAT, ASCT was slower for131I-MIBG-treated patients. RR post131I-MIBG was 38%, post MAT + ASCT was 71% (131I-MIBG group), 36% (chemotherapy group) and overall 59%.



Induction therapy with131I-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.
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.
K C J M
KC
Kraal
Department of Radiology/Nuclear Medicine, NWZ Alkmaar, Alkmaar, The Netherlands.
G M
GM
Bleeker
Department of Nuclear Medicine, Academic Medical Centre (AMC), Amsterdam, The Netherlands.
B L F
BL
van Eck-Smit
Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.
N K A
NK
van Eijkelenburg
Department of Pediatric Oncology and Hematology, University Children's Hospital, Center for Molecular Medicine Cologne (CMMC), Cologne, Germany.
F
F
Berthold
Department of Pediatric Oncology/Hematology, Erasmus MC (EMC)-Sophia Children's Hospital, Rotterdam, The Netherlands; Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.
M M
MM
van Noesel
Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam, The Netherlands.
H N
HN
Caron
Department of Pediatric Oncology, Emma Children's Hospital, Amsterdam, The Netherlands; Princess Máxima Centre for Pediatric Oncology, Utrecht, The Netherlands.
G A M
GA
Tytgat
D019797:3-Iodobenzylguanidine / Q000627:therapeutic use*; D000008:Abdominal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D009367:Neoplasm Staging; D009447:Neuroblastoma / Q000188:drug therapy* / Q000473:pathology; D010865:Pilot Projects; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D013514:Surgical Procedures, Operative; D013899:Thoracic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D013997:Time Factors; D014182:Transplantation, Autologous
D000970:Antineoplastic Agents; D019653:Myeloablative Agonists; D019797:3-Iodobenzylguanidine
(131)I-MIBG (meta-iodobenzylguanidine); NBL (neuroblastoma)