Evaluation of catecholamine metabolites, mIBG scan, and bone marrow cytology as response markers in stage 4 neuroblastoma

Background. The early biological response has been proved an excellent pred ictor in acute lymphoblastic leukemia and nephroblastoma. We asked whether catecholamine metabolites, mIBG scan, and bone marrow evaluation might be r elevant response markers in disseminated neuroblastoma. Procedure. Three hu ndred sixty-seven unselected stage 4 neuroblastoma patients treated accordi ng the German cooperative trial NB90 were entered into the study. Catechola mine plasma and urine levels were centrally determined by gas chromatograph y/ mass spectrometry. Bone marrow cytology and mIBG scans were evaluated by local investigators. Results. Ar diagnosis, mIBG scan was positive in 306 patients (92%), borderline in seven patients (2%), and negative in 19 patie nts (6%). Bone marrow aspirates were cytologically positive in 292 patients (84%) and negative in 57 patients (16%). Plasma catecholamine levels were elevated in 79% (206 of 260 patients.), urinary levers in 92% (307 of 338 p atients). The outcome of patients with normalized mIBG scan after four cour ses of chemotherapy [5 year EFS (event free survival) 0.22 +/- 0.071 was no t superior to the outcome of patients with still abnormal uptake (5 year EF S 0.30 +/- 0.05). The event free survival of patients with still positive b one marrow aspirates after four courses (0.16 +/- 0.06) was inferior to the EFS of patients with negative bone marrow aspirates (0.26 +/- 0.04, P = 0. 0054). Urinary catecholamine normalization after four cycles of chemotherap y (5 year EFS 0.35 +/- 0.06 Versus 0.26 +/- 0.10) had no influence on outco me, whereas plasma catecholamine normalization after the first (5 year EFS 0.40 +/- 0.09 versus 0.14 +/- 0.07, P = 0.0364) or the fourth cycle (5 year EFS 0.35 +/- 0.06 versus 0.26 +/- 0.10, P = 0.0242) indicated a better out come. Conclusions. These data show that serial plasma catecholamine levels and bone marrow aspirates in the course of the disease are useful toots in predicting outcome. Med. Pediatr. Oncol. 36:220-223, 2001. (C) 2001 Wiley-L iss, Inc.