Good Prognosis for Neuroblastoma Patients Diagnosed Before 18 Months of Age
According to three studies published together in the Journal of Clinical Oncology, children between the ages of 12 and 18 months have a good prognosis after treatment for disseminated neuroblastoma. As well, they may not require the intensive treatment currently recommended for children over 12 months of age.
Neuroblastoma is a disease in which cancerous cells form in the nerve tissues of the adrenal gland, neck, chest, or spinal cord. Although neuroblastoma is rare-affecting roughly 650 children and adolescents in the US each year-it is the most common malignancy diagnosed in infants. The severity of neuroblastoma is classified as “high”, “intermediate”, or “low” based on the stage of the tumor, MYCN gene status (amplified vs not amplified), certain other characteristics of the tumor, and the age of the child. Since infants are known to have a better prognosis than older children, an age cut-off of 12 months is often used to classify risk and to make treatment decisions. It’s possible, however, that this age cut-off is too low and that some older children may be receiving more intensive treatment than they actually require.
To assess survival by age among children with stage IV MYCN nonamplified neuroblastoma, researchers evaluated 43 children who were between the ages of 12 and 24 months at diagnosis. The children were treated with intensive chemotherapy with or without autologous bone marrow transplantation. The probability of surviving for six years without recurrence or progression was higher among children 12 to 18 months than among children 19 to 24 months. Seventy-four percent of children 12 to 18 months of age survived for six years without progression or recurrence, compared to 31% of children 19 to 24 months. The researchers conclude, “Children diagnosed with stage IV MYCN-NA neuroblastoma in the second year of life form a transitional group between infants and older children in terms of prognosis.” It’s possible that children 12 to 18 months of age will maintain high survival with less intensive treatment.
A second study reported similar findings for children with stage D MYCN nonamplified neuroblastoma. Among those with hyperdiploid tumors (another favorable prognostic marker), 93% of children 12 to 18 months of age survived for at least four years without progression or recurrence, compared to 38% of children 19 to 24 months. These researchers also conclude that patients 12 to 18 months of age may not require intensive therapy.
Finally, a study of patients with all stages of neuroblastoma suggests that using an age cut-off of roughly 15 months maximizes the prognostic effect of age. The cut-off of 15 months, rather than 12 months, would shift roughly 5% of patients into a less-intensive treatment group.
An editorial that accompanies these three studies notes the importance of confirming these results in future clinical trials, stating, “It will be important to establish that overall survival is not jeopardized by the minimal therapy strategy…” It goes on to state, “If confirmed, many more young children…will be spared the rigors of combined-modality therapies.”
Parents of children who have neuroblastoma may wish to speak with their physician about participating in a clinical trial further evaluating treatment strategies for this disease. Sources of information regarding ongoing clinical trials include the National Cancer Institute (www.cancer.gov).
 Schmidt ML, Lal A, Seeger RC et al. Favorable prognosis for patients 12 to 18 months of age with stage 4 nonamplified MYCN neuroblastoma: A Children’s Cancer Group study. Journal of Clinical Oncology. 2005;23:6474-6480.
 George RE, London WB, Cohn SL et al. Hyperploidy plus nonamplified MYCN confers a favorable prognosis in children 12 to 18 months old with disseminated neuroblastoma: A Pediatric Oncology Group study. Journal of Clinical Oncology. 2005;23:6466-6473.
 London WB, Castleberry RP, Matthay KK et al. Evidence for an age cutoff greater than 365 days for neuroblastoma risk group stratification in the children’s oncology group. Journal of Clinical Oncology. 2005;23:6459-6465.
 Evans AE, D’Angio GJ. Age at diagnosis and prognosis in children with neuroblastoma. Journal of Clinical Oncology. 2005;23:6443-6444.