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Randomized Controlled Trial
. 2023 Aug;70(8):e30418.
doi: 10.1002/pbc.30418. Epub 2023 May 18.

Impact of diagnostic and end-of-induction Curie scores with tandem high-dose chemotherapy and autologous transplants for metastatic high-risk neuroblastoma: A report from the Children's Oncology Group

Keri A Streby  1 , Marguerite T Parisi  2   3 , Barry L Shulkin  4 , Brian LaBarre  5 , Rochelle Bagatell  6 , Lisa Diller  7 , Stephan A Grupp  6 , Katherine K Matthay  8 , Stephan D Voss  9 , Alice L Yu  10   11 , Wendy B London  7 , Julie R Park  12 , Gregory A Yanik  13 , Arlene Naranjo  5
Affiliations
Randomized Controlled Trial

Impact of diagnostic and end-of-induction Curie scores with tandem high-dose chemotherapy and autologous transplants for metastatic high-risk neuroblastoma: A report from the Children's Oncology Group

Keri A Streby et al. Pediatr Blood Cancer. 2023 Aug.

Abstract

Background: Diagnostic mIBG (meta-iodobenzylguanidine) scans are an integral component of response assessment in children with high-risk neuroblastoma. The role of end-of-induction (EOI) Curie scores (CS) was previously described in patients undergoing a single course of high-dose chemotherapy (HDC) and autologous hematopoietic cell transplant (AHCT) as consolidation therapy.

Objective: We now examine the prognostic significance of CS in patients randomized to tandem HDC and AHCT on the Children's Oncology Group (COG) trial ANBL0532.

Study design: A retrospective analysis of mIBG scans obtained from patients enrolled in COG ANBL0532 was performed. Evaluable patients had mIBG-avid, International Neuroblastoma Staging System (INSS) stage 4 disease, did not progress during induction therapy, consented to consolidation randomization, and received either single or tandem HDC (n = 80). Optimal CS cut points maximized the outcome difference (≤CS vs. >CS cut-off) according to the Youden index.

Results: For recipients of tandem HDC, the optimal cut point at diagnosis was CS = 12, with superior event-free survival (EFS) from study enrollment for patients with CS ≤ 12 (3-year EFS 74.2% ± 7.9%) versus CS > 12 (59.2% ± 7.1%) (p = .002). At EOI, the optimal cut point was CS = 0, with superior EOI EFS for patients with CS = 0 (72.9% ± 6.4%) versus CS > 0 (46.5% ± 9.1%) (p = .002).

Conclusion: In the setting of tandem transplantation for children with high-risk neuroblastoma, CS at diagnosis and EOI may identify a more favorable patient group. Patients treated with tandem HDC who exhibited a CS ≤ 12 at diagnosis or CS = 0 at EOI had superior EFS compared to those with CS above these cut points.

Keywords: Curie score; mIBG; neuroblastoma; tandem.

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Conflict of interest statement

Conflicts of interest: Keri A. Streby is a consultant for Innervate Radiopharmaceuticals LLC and YmAbs Therapeutics Inc. and Kate Matthay is a consultant for Innervate Radiopharmaceuticals LLC.

Figures

FIGURE 1.
FIGURE 1.. Distribution of Curie Scores at (A) diagnosis, and (B) end of induction for patients treated with tandem high-dose chemotherapy.
FIGURE 2.
FIGURE 2.. Event-free survival by Curie score at diagnosis in patients treated with tandem HDC. EFS by diagnostic CS using: A) Optimal cut point of 12 in all patients. (B) Optimal cut point of 12 in patients with MYCN-amplified neuroblastoma. (C) Optimal cut point of 12 in patients with MYCN-NA neuroblastoma.
EFS= event-free survival, CS= Curie score, HDC= high-dose chemotherapy
FIGURE 3.
FIGURE 3.. Event-free survival by Curie score at end of induction in patients treated with tandem HDC. EFS by EOI CS using: (A) Optimal cut point of 0 in all patients. (B) Optimal cut point of 0 in patients with MYCN-amplified neuroblastoma. (C) Optimal cut point of 0 in patients with MYCN-NA neuroblastoma.
EFS= event-free survival, CS= Curie score, HDC= high-dose chemotherapy, EOI= end of induction
See this image and copyright information in PMC

References

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