Abstract
Despite the use of aggressive chemotherapy, stage 4 high risk neuroblastoma still has very poor prognosis which is estimated at 25%. Metabolic radiotherapy with I131 MIBG appears a feasible option to enhance the effects of chemotherapy. Seventeen patients having MIBG-positive residual disease received 4.1–11.1 mCi/kg of I131 MIBG 7–10 days before initiating the high-dose chemotherapy cycle consisting of busulphan 16 mg/kg and melphalan 140 mg/m2 followed by PBSC infusion. We compared the toxicity in these patients to that seen in 15 control subjects with neuroblastoma who underwent a PBSC transplant without MIBG therapy. We observed greater toxic involvement of the gastrointestinal system in children treated with I131 MIBG: grade 2 or 3 mucositis developed in 13/17 patients treated with I131 MIBG and in 9/15 treated without it. Grade 1–2 gastrointestinal toxicity occurred in 12/17 children given MIBG and in 5/15 of the controls. One child receiving I131 MIBG developed transient interstitial pneumonia. Another child who also received I131 MIBG after PBSC rescue developed fatal pneumonia after the third course of metabolic radiotherapy. Our experience indicates that MIBG can be included in the high-dose chemotherapy regimens followed by PBSC rescue for children with residual neuroblastoma taking up MIBG. Attention should be paid to avoiding lung complications. Prospective studies are needed to demonstrate the real efficacy of this treatment. Bone Marrow Transplantation (2001) 27, 571–574.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Matthay KK, Villablanca JG, Seeger RC et al. Treatment of high risk neuroblastoma with intensive chemotherapy, radiotherapy, autologous bone marrow transplantation, and 13-cis-retinoic acid New Engl J Med 1999 341: 1165–1173
Beirewaltes WH . Treatment of neuroblastoma with 131 I-MIBG: dosimetric problems and prospectives Med Ped Oncol 1987 15: 188–191
Bearman SI, Appelbaum FR, Buckner CD, Petersen FB . Regimen related toxicity in patients undergoing bone marrow transplantation J Clin Oncol 1988 6: 1562–1568
Cunningham SH, Mairs RJ, Wheldon TE et al. Toxicity to neuroblastoma cells and spheroids of benzylguanidine conjugated to radionuclides with short-range emissions Br J Cancer 1998 77: 2061–2068
Mastrangelo S, Tornesello A, Bembo V et al. Radioresistant sensitization of neuroblastoma by cisplatin Med Ped Oncol 2000 35: 77–79
Matthay KK, De Santes K, Hasegawa B et al. Phase I dose escalation of 131I-metaiodobenzylguanidine with autologous bone marrow support in refractory neuroblastoma J Clin Oncol 1998 16: 229–236
Gaze MN, Wheldon TE, O'Donoghue JA et al. Multi-modality megatherapy with [131I]metaiodobenzylguanidine, high dose melphalan and total body irradiation with bone marrow rescue: feasibility study of a new strategy for advanced neuroblastoma Eur J Cancer 1995 31A: 252–256
Klingebiel T, Bader P, Bares R et al. Treatment of neuroblastoma stage 4 with 131I-meta-iodo-benzylguanidine, high dose chemotherapy and immunotherapy. A pilot study Eur J Cancer 1998 34: 1398–1402
Garaventa A, Porta F, Rondelli R et al. Early deaths in children with HSCT. Bone Marrow Transplantation Group of the Italian Association for Pediatric Haematology and Oncology (AIEOP) and Gruppo Italiano Trapianto di Midollo Osseo (GITMO) Bone Marrow Transplant 1992 10: 419–423
Castagnola E, Dallorso S, Rabagliati M et al. Survival after cytomegalovirus pneumonia in two children receiving autologous peripheral blood progenitor cell transplantation (PBPCT) Bone Marrow Transplant 1998 21: 529–531
Garaventa A, Bellagamba O, Lo Piccolo MS et al. 131I-metaiodobenzylguanidine (131I-MIBG) therapy for residual neuroblastoma: a mono-institutional experience with 43 patients Br J Cancer 1999 81: 1378–1384
Press OW, Early JF, Appelbaum FR et al. Phase II trial of I131-B1 (anti-CD20) antibody therapy with autologous stem cell transplantation for relapsed B cell lymphomas Lancet 1995 346: 336–340
Goldberg SS, DeSantes K, Huberty JP et al. Engraftment of myeloablative doses of 131I-metaiodobenzylguanidine followed by autologous bone marrow transplantation for treatment of refractory neuroblastoma Med Ped Oncol 1998 30: 339–346
Ladenstein R, Philip T, Lasset C et al. Multivariate analysis of risk factors in stage 4 neuroblastoma patients over the age of one year treated with megatherapy and stem-cell transplantation: a report from the European Bone Marrow Transplantation Solid Tumor Registry J Clin Oncol 1998 16: 953–965
Barrett A, Nicholls J, Gibson B . Late effects of total body irradiation Radiother Oncol 1987 9: 131–135
Acknowledgements
We thank Mrs Brunella Sciaccaluga and Mrs Milena Dondero for their assistance in the preparation of this manuscript. This study was supported in part by Associazione Italiana per la Lotta al Neuroblastoma, by Centro Nazionale Ricerche (MURST-CNR) and Ricerca Finalizzata RF 99.21.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Miano, M., Garaventa, A., Pizzitola, M. et al. Megatherapy combining I131 metaiodobenzylguanidine and high-dose chemotherapy with haematopoietic progenitor cell rescue for neuroblastoma. Bone Marrow Transplant 27, 571–574 (2001). https://doi.org/10.1038/sj.bmt.1702846
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1702846
Keywords
This article is cited by
-
Current Consensus on I-131 MIBG Therapy
Nuclear Medicine and Molecular Imaging (2018)
-
Tandem high-dose chemotherapy and autologous stem cell transplantation in patients with high-risk neuroblastoma: Results of SMC NB-2004 study
Bone Marrow Transplantation (2013)
-
Adult-onset adrenal ganglioneuroblastoma — Bone metastasis two years after surgery: Report of a case
Surgery Today (2010)
-
28 years of high-dose therapy and SCT for neuroblastoma in Europe: lessons from more than 4000 procedures
Bone Marrow Transplantation (2008)