Oncology Medical News about Neuroblastoma, haploidentical stem cell transplantation, MIBG

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High-dose iodine-131-metaiodobenzylguanidine with haploidentical stem cell transplantation and posttransplant immunotherapy in children with relapsed/refractory neuroblastoma
Biology of Blood and Marrow Transplantation, 07/29/09

Toporski J et al. - In a study to evaluate the feasibility and efficacy of using high-dose iodine-131-metaiodobenzylguanidine (131I-MIBG) followed by reduced-intensity conditioning (RIC) and transplantation of T cell-depleted haploidentical peripheral blood stem cells (designated haplo-SCT) to treat relapsing/refractory neuroblastoma (RRNB), it appears that this procedure is feasible and promising, because 2 of 5 children on that regimen achieved long-lasting remission.

Methods

5 RRNB pts were enrolled: 4 with relapse (3 after autologous SCT) and 1 with induction therapy failure.
The preparative regimen included high-dose 131I-MIBG on day –20, followed by fludarabine (Flu), thiotepa, and melphalan (Mel) from day –8 to –1.
Granulocyte-colony stimulating factor (G-CSF)-mobilized, T cell-depleted haploidentical paternal stem cells were infused on day 0 together with cultured donor mesenchymal stem cells.
A single dose of rituximab was given on day +1.
After cessation of short immunosuppression (mycophenolate, OKT3), 4 children received donor lymphocyte infusion (DLI).

Results

131I-MIBG infusion and RIC were well tolerated.
All pts engrafted; no primary acute graft-versus-host disease (aGVHD) was observed.
4 children developed aGVHD after DLI and were successfully treated.
Analysis of immunologic recovery showed fast reappearance of potentially immunocompetent natural killer (NK) and T cells, which might have acted as effector cells responsible for the graft-versus-tumor (GVT) effect.
2 children are alive and well, with no evidence of disease 40 and 42 mos after transplantation.
1 pt experienced late progression with new bone lesions (sternum) 38 mos after haplo-SCT, and is being treated with local irradiation and reinstituted DLI.
1 pt rejected the graft, was rescued with autologous backup, and died of progressive disease 5 mos after transplantation.
Another child relapsed 7 mos after transplantation and died 5 mos later.

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