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Correlation of Early Metastatic Response by¹²³I-Metaiodobenzylguanidine Scintigraphy With Overall Response and Event-Free Survival in Stage IV Neuroblastoma

Katherine K. Matthay, Veronique Edeline, Jean Lumbroso, Marie Laure Tanguy, Bernard Asselain, Jean Michel Zucker, Dominique Valteau-Couanet, Olivier Hartmann, Jean Michon

From the Department of Pediatrics, University of California San Francisco, San Francisco, CA; Departments of Pediatrics, Nuclear Medicine, and Statistics, Institute Curie, and Departments of Pediatrics and Nuclear Medicine, Institute Gustave Roussy, Paris, France.

Address reprint requests to Katherine K. Matthay, MD, Department of Pediatrics, Box 0106, University of California School of Medicine, San Francisco, CA 94143-0106; email: matthayk{at}peds.ucsf.edu.

Purpose: Metaiodobenzylguanidine (MIBG), specifically taken up in cells of sympathetic origin, provides a highly sensitive and specific indicator for the detection of metastases in neuroblastoma. The aim of this study was to correlate early response to therapy by MIBG scan, using a semiquantitative scoring method, with the end induction response and event-free survival (EFS) rate in stage IV neuroblastoma.

Patients and Methods: Seventy-five children older than 1 year and with stage IV neuroblastoma had ¹²³I-MIBG scans at diagnosis, after two and four cycles of induction therapy, and before autologous stem-cell transplantation. The scans were read by two independent observers (concordance > 95%) using a semiquantitative method. Absolute and relative (score divided by initial score) MIBG scores were then correlated with overall pretransplantation response, bone marrow response, and EFS.

Results: The pretransplantation response rate was 81%, and the 3-year EFS rate was 32%, similar to a concomitant group of 375 stage IV patients. The median relative MIBG scores after two, four, and six cycles were 0.5, 0.24, and 0.12, respectively. The probability of having a complete response or very good partial response before transplantation was significantly higher if the relative score after two cycles was ≤ 0.5, or, if after four cycles, the relative score was ≤ 0.24. Patients with a relative score of ≤ 0.5 after two cycles or a score of ≤ 0.24 after four cycles had an improved EFS rate (P = .053 and .045, respectively).

Conclusion: Semiquantitative MIBG score early in therapy provides valuable prognostic information for overall response and EFS, which may be useful in tailoring treatment.

Supported by the Bourse Henri Rothschild grant from the Institute Curie, Paris, France, as well as by donations from the Campini Foundation, the Conner Research Fund, the V Foundation, and the Kasle and Tkalcevik Neuroblastoma Research Fund, all in San Francisco, CA.

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