ANTI-GD(2) ANTIBODY TREATMENT OF MINIMAL RESIDUAL STAGE-4 NEUROBLASTOMA DIAGNOSED AT MORE THAN 1 YEAR OF AGE

Purpose: To eradicate minimal residual disease with anti-Got monoclona l antibody 3F8 in stage 4 neuroblastoma (NB) diagnosed at more than 1 year of age. Patients and Methods: Thirty-four patients were treated w ith 3F8 at the end of chemotherapy. Most had either bone marrow (n = 3 1) or distant bony metastases (n = 29). Thirteen patients were treated at second or subsequent remission (group I) and 12 patients in this g roup had a history of progressive/persistent disease after bone marrow transplantation (BMT); 21 patients were treated in first remission fo llowing N6 chemotherapy (group II). Results: Before 3F8 treatment, 23 patients were in complete remission CR, eight in very good partial rem ission (VGPR), one in partial remission (PR), and two had microscopic foci in marrow. Twenty-five had evidence of NE by at least one measure ment of occult/minimal tumor (iodine 131 [I-131]-3F8 imaging, marrow i mmunocytology, or marrow reverse-transcriptase polymerase chain reacti on [RT-PCR]). Acute self-limited toxicities of 3F8 treatment were seve re pain, fever, urticaria, and reversible decreases in blood counts an d serum complement levels. There was evidence of response by immunocyt ology (six of nine), by GAGE RT-PCR (seven of 12), and by I-131-3F8 sc ans (six of six). Fourteen patients are alive and 13 (age 1.8 to 7.4 y ears at diagnosis) are progression-free (40 to 130 months from the ini tiation of 3F8 treatment) without further systemic therapy, none with late neurologic complications. A transient anti-mouse response or the completion of four 3F8 cycles was associated with significantly better survival. Conclusion: Despite high-risk nature of stage 4 NB, long-te rm remission without autologous (A)BMT can be achieved with 3F8 treatm ent. Its side effects were short-lived and manageable. The potential b enefits of 3F8 in consolidating remission warrant further investigatio ns. J Clin Oncol 16:3053-3060. (C) 1998 by American Society of Clinica l Oncology.