Biologic F actors D etermine P rognosis i n I nfants W ith Stage I V N euroblastoma: A P rospective C hildren's C ancer Group S tudy

Purpose: A prospective Children’s Cancer Group study, CCG-3881, has been completed to determine if a more accurate prediction of prognosis by biologic features can identify subgroups of infants with stage IV neuroblastoma (NBL) who require differing intensities of treatment. Patients and Methods: One hundred thirty-four infants were registered from June 1989 to August 1995, with a median follow-up of 47.1 months (range, 0 to 88 months). The biologic factors examined were tumor MYCN copy number, Shimada histopathologic classification, serum ferritin, and bone marrow immunocytology (sensitivity, one tumor cell per 10 5 bone marrow cells). Patients treated on CCG-3881 (n 5 116) received four-drug chemotherapy for 9 months (cisplatin, cyclophosphamide, doxorubicin, and etoposide), with surgery and local radiation to residual disease. After January 1991, all subsequent infants with tumor MYCN amplification (n 5 18) were transferred after one cycle of therapy to the high-risk CCG-3891 protocol (open