Upfront consolidation treatment with 131I-mIBG followed by myeloablative chemotherapy and hematopoietic stem cell transplantation in high-risk neuroblastoma

Importance:131I-metaiodobenzylguanidine(131I-mIBG)has a significant targeted antitumor effect for neuroblastoma.However,currently there is a paucity of data for the use of 131I-mIBG as a"front-line"therapeutic agent in those patients with newly diagnosed high-risk neuroblastoma as part of the conditioning regimen for myeloablative chemotherapy(MAC).Objective:To evaluate the feasibility of upfront consolidation treatment with 131I-mIBG plus MAC and hematopoietic stem cell transplantation(HSCT)in high-risk neuroblastoma patients.Methods:A retrospective,single-center study was conducted from 2003-2019 on newly diagnosed high-risk neuroblastoma patients without progressive disease(PD)after the completion of induction therapy.They received 131I-mIBG infusion and MAC followed by HSCT.Results:A total of 24 high-risk neuroblastoma patients were enrolled with a median age of 3.0 years at diagnosis.After receiving this sequential consolidation treatment,3 of 13 patients who were in partial response(PR)before 131I-mIBG treatment achieved either complete response(CR)(n=1)or very good partial response(VGPR)(n=2)after HSCT.With a median follow-up duration of 13.0 months after 131I-mIBG therapy,the 5-year event-free survival and overall survival rates estimated were 29%and 38%for the entire cohort,and 53%and 67%for the patients who were in CR/VGPR at the time of 131I-mIBG treatment.Interpretation:Upfront consolidation treatment with 131I-mIBG plus MAC and HSCT is feasible and tolerable in high-risk neuroblastoma patients,however the survival benefit of this 131I-mIBG regimen is only observed in the patients who were in CR/VGPR at the time of 131I-mIBG treatment.

Palliative care service in patients with childhood cancer from a tertiary pediatric oncology center

Importance: Pediatric palliative care (PPC) has gained great attention in western countries, however data on Hong Kong children receiving PPC are limited. There are gaps in knowledge about the PPC needs in local children with cancer. Objective: To assess the current situation of PPC service of Hong Kong children with cancer. Methods: We performed a 10-year retrospective review in a tertiary pediatric oncology unit and studied the referral pattern, clinical characteristics and services provided. results: Totally 117 children were referred to PPC Team which constituted 65% deceased children within the study period. The commonest diagnoses were central nervous system tumour (32.5%), leukaemia (25.6%) and neuroblastoma (9.4%). Ninety-one percent of children were referred after the last relapse or stopping curative treatment. The median time of referral to death was 77 days (interquartile range (IQR): 35, 182)The median number of hospital admission after referral was 2 (IQR: 1, 5), with a median of 27 days total hospital stay (IQR: 10, 60). The reasons for admission were palliative chemotherapy (16.1%), pain control (12.1%) and platelet transfusion (11.2%). For the death episode, the median duration of hospital stay was 15 days (IQR: 2, 46). Most patients received oxygen (82.0%), intravenous fluid (81.2%) and intravenous analgesic (52.1%). A total of 111 (94.9%) children died in hospital, 15 had been admitted into intensive care unit (ICU) but only 5 (4.5%) died in ICU. Interpretation: Pain control and platelet transfusion were common reasons of readmission. Death in ICU and at home was uncommon in Hong Kong situation.