Stage 4N neuroblastoma before and during the era of anti-G D2 immunotherapy.

Autor: Kushner BH; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA., LaQuaglia MP; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Cardenas FI; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Basu EM; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Gerstle JT; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Kramer K; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Roberts SS; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Wolden SL; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Cheung NV; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA., Modak S; Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
Jazyk: angličtina
Zdroj: International journal of cancer [Int J Cancer] 2023 Dec 15; Vol. 153 (12), pp. 2019-2031. Date of Electronic Publication: 2023 Aug 21.
DOI: 10.1002/ijc.34693
Abstrakt: Patients with stage 4N neuroblastoma (distant metastases limited to lymph nodes) stand out as virtually the only survivors of high-risk neuroblastoma (HR-NB) before myeloablative therapy (MAT) and immunotherapy with anti-G D2 monoclonal antibodies (mAbs) became standard. Because no report presents more recent results with 4N, we analyzed our large 4N experience. All 51 pediatric 4N patients (<18 years old) diagnosed 1985 to 2021 were reviewed. HR-NB included MYCN-nonamplified 4N diagnosed at age ≥18 months and MYCN-amplified 4N. Among 34 MYCN-nonamplified high-risk patients, 20 are relapse-free 1.5+ to 37.5+ (median 12.5+) years post-diagnosis, including 13 without prior MAT and 5 treated with little (1 cycle; n = 2) or no mAb (n = 3), while 14 patients (7 post-MAT, 8 post-mAbs) relapsed (all soft tissue). Of 15 MYCN-amplified 4N patients, 7 are relapse-free 2.1+ to 26.4+ (median 11.6+) years from the start of chemotherapy (all received mAbs; 3 underwent MAT) and 4 are in second remission 4.2+ to 21.8+ years postrelapse (all soft tissue). Statistical analyses showed no significant association of survival with either MAT or mAbs for MYCN-nonamplified HR-NB; small numbers prevented these analyses for MYCN-amplified patients. The two patients with intermediate-risk 4N (14-months-old) are relapse-free 7+ years postresection of primary tumors; distant disease spontaneously regressed. The natural history of 4N is marked by NB confined to soft tissue without early relapse in bones or bone marrow, where mAbs have proven efficacy. These findings plus curability without MAT, as seen elsewhere and at our center, support consideration of treatment reduction for MYCN-nonamplified 4N.
(© 2023 UICC.)
Databáze: MEDLINE
Externí odkaz: