Treatment and outcomes of high-risk neuroblastoma in Southeast Asia: a single-institution experience and review of the literature

Abstract

Introduction: In Europe and North America, the majority of children with high-risk neuroblastoma survive the disease. Elsewhere, the treatment outcomes are poor. Methods: A retrospective review of children treated for high-risk neuroblastoma in a single institution in Singapore from 2007 to 2019 was carried out. Treatment consisted of intensive chemotherapy, surgery aimed at gross total resection of residual disease after chemotherapy, consolidation with high-dose therapy followed by autologous stem cell rescue, and radiotherapy to the primary and metastatic sites followed by maintenance treatment with either cis-retinoic acid or anti-disialoganglioside monoclonal antibody therapy. Survival data were examined on certain clinical and laboratory factors. Results: There were 57 children (32 male) treated for high-risk neuroblastoma. Their mean age was 3.9 (range 0.7–14.9) years. The median follow-up time was 5.5 (range 1.8–13.0) years for the surviving patients. There were 31 survivors, with 27 patients surviving in first remission, and the five-year overall survival and event-free survival rates were 52.5% and 47.4%, respectively. On log-rank testing, only the group of 17 patients who were exclusively treated at our centre had a survival advantage. Their five-year overall survival rate compared to patients whose initial chemotherapy was done elsewhere was 81.6% versus 41.1% (P = 0.011), and that of event-free survival was 69.7% versus 36.1% (P = 0.032). Published treatment results were obtained from four countries in Southeast Asia with five-year overall survival rates from 13.5% to 28.2%. Conclusion: Intensified medical and surgical treatment for high-risk neuroblastoma proved to be effective, with superior survival rates compared to previous data from Southeast Asia.

Functionalized GD2 Electrochemical Immunosensor to Diagnose Minimum Residual Disease of Bone Marrow in Neuroblastoma Effectively

“…The long-term survival rate of children with NB in the high-risk group is less than 50% despite aggressive multimodal therapy (radiotherapy, surgery, autologous stem cell transplantation, GD2 (disialoganglioside, GD2) monoclonal antibody, or maintenance therapy with retinoic acid) [4,[6][7][8][9][10][11]. Studies have shown that children with NB in the high-risk group are most likely to develop bone marrow metastasis, and children with NB in the high-risk group are highly susceptible to recurrence because of minimal residual disease (MRD) in the bone marrow [12][13][14][15][16][17][18][19]. Bone marrow-associated neuroblastoma detection is crucial in diagnosing metastasis and recurrence in children with high-risk NB [2,3,8,13,[20][21][22][23][24][25].…”

“…Bone marrow-associated neuroblastoma detection is crucial in diagnosing metastasis and recurrence in children with high-risk NB [2,3,8,13,[20][21][22][23][24][25]. However, there is a lack of consensus on the standard determination of NB bone marrow recurrence and metastasis globally [14][15][16]26], and the existing diagnostic techniques cannot solve the critical clinical challenges in children with high-risk NB.…”