Neuroblastoma is the most common extracranial solid tumor in childhood, with nearly 50% of
patients presenting with widespread metastatic disease. The current treatment for this group
of high-risk patients includes intensive multi-agent chemotherapy (induction) followed by
myeloablative therapy with stem-cell rescue (consolidation) and then treatment of minimal
residual disease (MRD) with isotretinoin. Recently a new standard of care was established by
enhancing the treatment of MRD with the addition of a monoclonal antibody (ch14.18) which
targets a tumor-associated antigen, the disialoganglioside GD2, which is uniformly expressed
by neuroblasts. Despite improvement in 2-year event-free survival (EFS) of 20%, more than
one-third of children with high-risk neuroblastoma (HR defined in) still cannot be cured by
this approach. Therefore, novel therapeutic approaches are needed for this subset of
patients. This study will be a pilot Phase II study of a unique anti-disialoganglioside
(anti-GD2) monoclonal antibody (mAb) called hu14.18K322A, given with induction chemotherapy.
- To study the efficacy [response: complete remission + partial remission (CR+PR)] to two
initial courses of cyclophosphamide and topotecan combined with hu14.18K322A (4
doses/course followed by GM-CSF) in previously untreated children with high-risk
- To study the feasibility of delivering hu14.18K322A to 6 cycles induction chemotherapy
and describe the antitumor activity (CR+PR) of this 6 course induction therapy.
- To estimate local control and pattern of failure associated with intensity modulated
radiation therapy dose delivery in high-risk abdominal neuroblastoma.
- To describe the tolerability of four doses of hu14.18K322A with allogeneic natural
killer (NK) cells from an acceptable parent, in the immediate post-transplant period
[day +2 - +5 after peripheral blood stem cell (PBSC) infusion] in consenting
- To describe the tolerability of hu14.18K322A with interleukin-2 and GM-CSF as treatment
for minimal residual disease (MRD).
The phases of the study are:
1. Screening phase: Tests and evaluations will be done before treatment starts.
2. Induction phase: Includes chemotherapy plus hu14.18K322A mAb. Participants will also
have surgery during this part of the study to remove as much tumor as possible.
3. Consolidation/Intensification phase: Includes high doses of chemotherapy and blood stem
cell transplantation with additional, experimental "minimal residual disease" (MRD)
treatment.. Participants will also get radiation treatment to all sites of the tumor(s)
after recovery from the stem cell transplant.5. Maintenance/MRD treatment phase: With
immune therapy in addition to the standard treatment with the drug isotretinoin.
4. Maintenance/MRD treatment phase: With immune therapy in addition to the standard
treatment with the drug isotretinoin.
PARTICIPANT Inclusion Criteria:
- Participants <19 years of age (eligible until 19th birthday).
- Newly diagnosed, advanced stage, high-risk neuroblastoma defined as one of the
- Children < 1 year with International Neuroblastoma Staging System (INSS) stage
2a, 2b, 3, 4 or 4S disease AND MYCN amplification (>10 copies, or greater than
four-fold increase in MYCN signal as compared to reference signal).
- INSS 2a or 2b disease AND MYCN amplification, regardless of age or additional
- INSS stage 3 AND:
1. MYCN amplification (>10 copies, or greater than four-fold increase in MYCN
signal as compared to reference signal, regardless of age or additional
2. Age > 18 months (> 547 days) with unfavorable pathology, regardless of MYCN
- INSS stage 4 and:
1. MYCN amplification, regardless of age or additional biologic features
2. Age > 18 months (> 547 days) regardless of biologic features
3. Age 12 - 18 months (365 - 547 days) with any of the following three
unfavorable biologic features (MYCN amplification, unfavorable pathology
and/or DNA index =1) or any biologic feature that is indeterminant/unknown
- Children at least 365 days initially diagnosed with: INSS stage 1, 2, 4S who
progressed to a stage 4 without interval chemotherapy.
- Histologic proof of neuroblastoma or positive bone marrow for tumor cells with
increased urine catecholamines.
- Adequate renal and hepatic function (serum creatinine <3 x upper limit of normal for
age, AST< 3 x upper limit of normal).
- No prior therapy, unless an emergency situation requires local tumor treatment
(discuss with principal investigator).
- Written, informed consent according to institutional guidelines.
PARTICIPANT Exclusion Criteria:
- Any evidence, as judged by the investigator, of severe or uncontrolled systemic
disease (e.g., unstable or uncompensated respiratory, cardiac, hepatic, or renal
- Pregnant or breast feeding (female of child-bearing potential).
- Children with INSS 4 disease, age <18 months with all 3 favorable biologic features
(non-amplified MYCN, favorable pathology and DNA index >1).
DONOR Inclusion Criteria:
- Potential donor is a biologic parent
- Potential donor is at least 18 years of age.
Minimum Eligible Age: N/A
Maximum Eligible Age: 18 Years
Eligible Gender: Both