RATIONALE: Iodine I 131 metaiodobenzylguanidine (131I-MIBG) may kill neuroblastoma cells by delivering radiation directly to the tumor. Peripheral stem cell transplantation may be able to replace immune cells that were destroyed by radiation therapy.

PURPOSE: This phase I trial is studying the side effects and best dose of a double infusion of 131I-MIBG followed by autologous stem cell transplantation in treating patients with refractory neuroblastoma.

Condition	Treatment or Intervention	Phase
recurrent neuroblastoma	Drug: filgrastim  Drug: iodine I 131 metaiodobenzylguanidine  Procedure: autologous bone marrow transplantation  Procedure: biological response modifier therapy  Procedure: bone marrow ablation with stem cell support  Procedure: bone marrow transplantation  Procedure: colony-stimulating factor therapy  Procedure: cytokine therapy  Procedure: isotope therapy  Procedure: peripheral blood stem cell transplantation  Procedure: radiation therapy	Phase I

Further Study Details: 

OBJECTIVES: Primary

• Determine the maximum tolerated red marrow radiation dose delivered and associated toxic effects of escalating activity of iodine I 131 metaiodobenzylguanidine (^131I-MIBG) followed by autologous hematopoietic stem cell transplantation in patients with refractory neuroblastoma.
• Determine the number of days after stem cell transplantation to achieve absolute neutrophil count ≥ 500/mm^3 for 3 days and platelet count ≥ 20,000/mm^3 for 3 days (without transfusions) in patients treated with this regimen.

Secondary

• Determine the response rate in patients treated with this regimen, based on lesions measurable by CT or MRI at study entry, patients with ^131I-MIBG scan-positive lesions only, and patients with minimal residual tumor in bone marrow who have complete response by immunocytology and morphology.
• Determine the tumor absorbed radiation dose in patients with measurable soft tissue lesions treated with this regimen.
• Correlate, if possible, TP53 mutations with response in patients with accessible bone marrow tumor treated with ^131I-MIBG.

OUTLINE: This is a dose-escalation, multicenter study.

• Patients receive
• I-MIBG IV over 2 hours on days 0 and 14. Cohorts of 3-6 patients receive escalating doses of ^131I-MIBG until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.
• Stem cell transplantation therapy: Patients undergo autologous peripheral blood stem cell transplantation on day 28. Patients receive filgrastim (G-CSF) IV over 1 hour OR subcutaneously daily beginning on day 28 and continuing until blood counts recover. Patients are followed every 3 months for 1 year and then annually thereafter.

PROJECTED ACCRUAL: A total of 9-18 patients will be accrued for this study within 2 years.

Ages Eligible for Study:  1 Year   -   30 Years,  Genders Eligible for Study:  Both

Criteria

DISEASE CHARACTERISTICS:

• Diagnosis of neuroblastoma
• Confirmed by at least 1 of the following methods:
• Histology
• Clumps of tumor cells in bone marrow with elevated urinary catecholamine metabolites
• High-risk disease
• Poor response to induction therapy OR relapse defined by any of the following:
• No response, stable disease, or mixed response after a minimum of 3 prior courses of chemotherapy
• More than 100 tumor cells per 10^5 nucleated cells on bone marrow immunocytology after at least 3 prior courses of chemotherapy
• Progressive disease at any time during or after therapy
• Patients with massive bone marrow invasion (more than 50% replacement of bone marrow by tumor cells) are allowed
• Must have positive iodine I 131 metaiodobenzylguanidine (^131I-MIBG) within the past 6 weeks or subsequent to any other prior antitumor therapy delivered within the past 6 weeks
• Must meet the following criteria for minimum number of autologous stem cells:
• Purged/unpurged peripheral blood stem cells (PBSC)
• Minimum of 1,000,000/mm^3 CD34-positive cells/kg
• Collected products must have < 1 tumor cell/100,000 normal cells by immunocytology
• PBSC purged with immunomagnetic beads
• Minimum of 1,000,000/mm^3 viable CD34-positive cells/kg
• Collected products must have < 1 tumor cell/100,000 normal cells by immunocytology
• CD34-positive selected PBSC products are not allowed
• Patients who had PBSC collected previously with no immunocytological testing available may use those products provided bone marrow is tumor free by bilateral bone marrow aspirate AND biopsy for morphology is performed within 4 weeks before PBSC collection
• Patients with no tumor involvement in bone marrow at diagnosis and PBSC collection before any disease progression do not require documentation of negative bone marrow morphology
• Concurrent enrollment on NANT-2002-02 (companion dosimetry study) required* NOTE: *Patients who cannot have dosimetry for technical reasons are still eligible for this study

PATIENT CHARACTERISTICS: Age

• 1 to 30

Performance status

• ECOG 0-2

Life expectancy

• Less than 1 year

Hematopoietic

• Absolute neutrophil count ≥ 500/mm^3
• Platelet count ≥ 50,000/mm^3 (without transfusion)
• Hemoglobin ≥ 8 g/dL (transfusion allowed)

Hepatic

• AST and ALT ≤ 5 times normal
• Bilirubin < 2 times normal

Renal

• Creatinine ≤ 1.5 mg/dL
• Glomerular filtration rate OR 12-hour creatinine clearance ≥ 60 mL/min/1.73m^2

Cardiovascular

• Ejection fraction ≥ 55% by echocardiogram or MUGA OR
• Fractional shortening ≥ 30% OR above lower limit of normal by echocardiogram

Pulmonary

• Normal lung function
• No dyspnea at rest
• No exercise intolerance
• No oxygen requirement

Other

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception
• Able to cooperate physically and psychologically with radiation isolation
• No disease of any major organ system that would preclude study participation
• No active infection requiring antivirals, antibiotics, or antifungals
• No weight that would require exceeding a maximum total allowable dose of ^131I-MIBG

PRIOR CONCURRENT THERAPY: Biologic therapy

• At least 2 weeks since prior biologic or other non-myelosuppressive therapy

Chemotherapy

• See Disease Characteristics
• At least 2 weeks since prior chemotherapy
• More than 3 months since prior myeloablative therapy

Endocrine therapy

• Not specified

Radiotherapy

• See Disease Characteristics
• At least 6 months since prior craniospinal, total abdominal, or whole lung radiotherapy
• At least 2 weeks since prior radiotherapy to any site
• No prior total body irradiation
• No prior radiotherapy to > 25% of bone marrow
• No prior ^131I-MIBG

Surgery

• Not specified

Other

• Recovered from all prior therapy
• Concurrent antifungal therapy allowed provided culture and biopsy are negative in suspected radiographic lesions
• Prior re-induction therapy for recurrent tumor allowed
• No concurrent antiretroviral therapy for HIV-positive patients
• No concurrent hemodialysis

California
      Children's Hospital Los Angeles, Los Angeles,  California,  90027-0700,  United States; Recruiting
      Lucile Packard Children's Hospital at Stanford University Medical Center, Palo Alto,  California,  94304,  United States; Recruiting
      UCSF Comprehensive Cancer Center, San Francisco,  California,  94143,  United States; Recruiting
Georgia
      AFLAC Cancer Center and Blood Disorders Service of Children's Healthcare of Atlanta - Egleston Campus, Atlanta,  Georgia,  30322,  United States; Recruiting
Illinois
      Children's Memorial Hospital - Chicago, Chicago,  Illinois,  60614,  United States; Recruiting
Indiana
      Indiana University Cancer Center, Indianapolis,  Indiana,  46202-5289,  United States; Recruiting
Massachusetts
      Dana-Farber/Harvard Cancer Center at Dana Farber Cancer Institute, Boston,  Massachusetts,  02115,  United States; Recruiting
Pennsylvania
      Children's Hospital of Philadelphia, Philadelphia,  Pennsylvania,  19104,  United States; Recruiting

Study chairs or principal investigators

Katherine K. Matthay, MD,  Study Chair,  University of California, San Francisco   
Gregory Yanik, MD,  University of Michigan Comprehensive Cancer Center   
John M. Maris, MD,  Children's Hospital of Philadelphia   

Study ID Numbers:  CDR0000363631; NANT-2000-01; NCT00083135
Record last reviewed:  September 2004
Last Updated:  March 10, 2005
Record first received:  May 14, 2004
ClinicalTrials.gov Identifier:  NCT00083135
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-04-08