Late relapse and prognosis for neuroblastoma patients surviving 5 years or more: A report from the European Neuroblastoma Study Group ?Survey?

Cotterill, SJ; Pearson, Andrew D.J.; Pritchard, Jon; Kohler, Janice A.; Foot, A. B. M.

doi:10.1002/1096-911x(20010101)36:1<235::aid-mpo1057>3.0.co;2-n

Cited by 35 publications

(27 citation statements)

References 15 publications

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“…Some studies have shown that a more chronic course of neuroblastoma after failure of primary therapy seems to be associated with longer times of first remission 16 or older age at diagnosis. 17-19 Cotterill et al 20 identified late relapse in a small subset of high-risk patients; however, this study was unable to predict which factors influence long-term survival given the limited follow-up.…”

Section: Discussionmentioning

confidence: 89%

Clinical and Biologic Features Predictive of Survival After Relapse of Neuroblastoma: A Report From the International Neuroblastoma Risk Group Project

London

Castel

Monclair

et al. 2011

JCO

271

233

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A B S T R A C T PurposeSurvival after neuroblastoma relapse is poor. Understanding the relationship between clinical and biologic features and outcome after relapse may help in selection of optimal therapy. Our aim was to determine which factors were significantly predictive of postrelapse overall survival (OS) in patients with recurrent neuroblastoma-particularly whether time from diagnosis to first relapse (TTFR) was a significant predictor of OS. Patients and MethodsPatients with first relapse/progression were identified in the International Neuroblastoma Risk Group (INRG) database. Time from study enrollment until first event and OS time starting from first event were calculated. Cox regression models were used to calculate the hazard ratio of increased death risk and perform survival tree regression. TTFR was tested in a multivariable Cox model with other factors. ResultsIn the INRG database (N ϭ 8,800), 2,266 patients experienced first progression/relapse. Median time to relapse was 13.2 months (range, 1 day to 11.4 years). Five-year OS from time of first event was 20% (SE, Ϯ 1%). TTFR was statistically significantly associated with OS time in a nonlinear relationship; patients with TTFR of 36 months or longer had the lowest risk of death, followed by patients who relapsed in the period of 0 to less than 6 months or 18 to 36 months. Patients who relapsed between 6 and 18 months after diagnosis had the highest risk of death. TTFR, age, International Neuroblastoma Staging System stage, and MYCN copy number status were independently predictive of postrelapse OS in multivariable analysis. ConclusionAge, stage, MYCN status, and TTFR are significant prognostic factors for postrelapse survival and may help in the design of clinical trials evaluating novel agents.

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Section: Discussionmentioning

confidence: 89%

Clinical and Biologic Features Predictive of Survival After Relapse of Neuroblastoma: A Report From the International Neuroblastoma Risk Group Project

London

Castel

Monclair

et al. 2011

JCO

271

233

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“…[31][32][33][34] Although one reason might be the detection of less extensive relapses through improved surveillance, as with 123 I-MIBG rather than 131 I-MIBG scan, another reason might be the identification of better treatments in recent years, including novel therapies with modest toxicity. Not only do the latter allow good quality of life, but it is plausible that in some patients, they will help achieve cure.…”

Section: Wwwjcoorgmentioning

confidence: 99%

Sensitivity of Surveillance Studies for Detecting Asymptomatic and Unsuspected Relapse of High-Risk Neuroblastoma

Kushner

Krämer

Modak

et al. 2009

JCO

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A B S T R A C T PurposeRelapse-free survival (RFS) is a powerful measure of treatment efficacy. We describe the sensitivity of standard surveillance studies for detecting relapse of neuroblastoma (NB). Patients and MethodsThe patients were in complete/very good partial remission of high-risk NB; routine monitoring revealed asymptomatic and, therefore, unsuspected relapses in 113 patients, whereas 41 patients had symptoms prompting urgent evaluations. Assessments every 2 to 4 months included computed tomography, iodine-131-metaiodobenzylguanidine ( 131 I-MIBG; through November 1999) or iodine-123-metaiodobenzylguanidine ( 123 I-MIBG) scan, urine catecholamines, and bone marrow (BM) histology. Bone scan was routine through 2002.Results 123 I-MIBG scan was the most reliable study for revealing unsuspected relapse; it had an 82% detection rate, which was superior to the rates with 131 I-MIBG scan (64%; P ϭ .1), bone scan (36%; P Ͻ .001), and BM histology (34%; P Ͻ .001). Among asymptomatic patients, 123 I-MIBG scan was the sole positive study indicating relapse in 25 (27%) of 91 patients compared with one (4.5%) of 22 patients for 131 I-MIBG scan (P ϭ .04) and 0% to 6% of patients for each of the other studies (P Ͻ .001). Patients whose monitoring included 123 I-MIBG scan were significantly less likely than patients monitored by 131 I-MIBG scan to have an extensive osteomedullary relapse and had a significantly longer survival from relapse (P Ͻ .001) and from diagnosis (P ϭ .002). They also had significantly longer survival than patients with symptomatic relapses (P ϭ .002). Conclusion123 I-MIBG scan is essential for valid estimation of the duration of RFS of patients with high-risk NB. Without monitoring that includes 123 I-MIBG scan, caution should be used when comparing RFS between institutions and protocols.

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“…Even though late relapse is uncommon, a small number of patients present with first disease recurrence after 5 years and on rare occasions beyond 10 years from diagnosis. Cotterill et al reported that amongst 406 patients who were in first remission five years from diagnosis, 3% subsequently relapsed and most late relapse patients had Stage 4 disease at diagnosis (Cotterill et al, 2001). …”

Section: Clinical Presentation Of Recurrent Nbmentioning

confidence: 99%

“…In these two studies, 28% to 36% of the patients with CNS recurrence had a lumbar puncture during diagnosis. As for late relapse beyond 5 years, a multivariate analysis of 422 patients demonstrated a relative risk of 10.5 for late relapse in patients >12 months with Stage 4 disease at diagnosis, and a relative risk of 4.2 for those with prior relapse (Cotterill et al, 2001). For patients who remained in first remission 5 years from diagnosis, the 10-year progression-free survival (PFS) for patients >12 months with Stage 4 disease at diagnosis was lower for other children (88% vs. 98%).…”

Section: Risk Of Disease Recurrencementioning

confidence: 99%

See 1 more Smart Citation

Recurrent Neuroblastoma

M.S.¹,

Wendy²

2012

Neuroblastoma - Present and Future

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Late relapse and prognosis for neuroblastoma patients surviving 5 years or more: A report from the European Neuroblastoma Study Group ?Survey?

Abstract: The results of this study emphasise the importance of longterm follow-up of patients and the need for late monitoring of clinical trials in children with neuroblastoma. They also provide a baseline for comparison with future and hopefully more effective treatment programmes.

Cited by 35 publications

References 15 publications

Clinical and Biologic Features Predictive of Survival After Relapse of Neuroblastoma: A Report From the International Neuroblastoma Risk Group Project

Clinical and Biologic Features Predictive of Survival After Relapse of Neuroblastoma: A Report From the International Neuroblastoma Risk Group Project

Sensitivity of Surveillance Studies for Detecting Asymptomatic and Unsuspected Relapse of High-Risk Neuroblastoma

Recurrent Neuroblastoma

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