Megatherapy combining I-131 metaiodobenzylguanidine and high-dose chemotherapy with haematopoietic progenitor cell rescue for neuroblastoma

Despite the use of aggressive chemotherapy, stage 4 high risk neuroblastoma still has very poor prognosis which is estimated at 25%, Metabolic radioth erapy with I-131 MIBG appears a feasible option to enhance the effects of c hemotherapy. Seventeen patients having MIBG-positive residual disease recei ved 4.1-11.1 mCi/kg of I-131 MIBG 7-10 days before initiating the high-dose chemotherapy cycle consisting of busulphan 16 mg/kg and melphalan 140 mg/m (2) followed by PBSC infusion. We compared the toxicity in these patients t o that seen in 15 control subjects with neuroblastoma who underwent a PBSC transplant without MIBG therapy. We observed greater toxic involvement of t he gastrointestinal system in children treated with I-131 MIBG: grade 2 or 3 mucositis developed in 13/17 patients treated with I-131 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 I-131 MIBG developed transient interstitial pneumonia, Another child who also rec eived I-131 MIBG after PBSC rescue developed fatal pneumonia after the thir d course of metabolic radiotherapy, Our experience indicates that MIBG can he included in the high-dose chemotherapy regimens followed by PBSC rescue for children with residual neuroblastoma taking up MIBG, Attention should b e paid