Isotretinoin With or Without Monoclonal Antibody, Interleukin-2, and Sargramostim Following Stem Cell Transplantation in Treating Patients With Neuroblastoma

Inclusion Criteria:

• Diagnosis of neuroblastoma

  • Categorized as high risk at diagnosis; exception: patients who are initially diagnosed as non-high-risk neuroblastoma, but later converted (and/ or relapsed) to high risk neuroblastoma are also eligible

• Meets all of the following criteria:

  • Patients must have completed therapy including intensive induction followed by autologous stem cell transplantation (ASCT) and radiotherapy

    • Radiotherapy may be waived for patients who either have small adrenal masses which are completely resected up front, or who never have an identifiable primary tumor

  • Completed frontline therapies, examples of such therapy includes:

    • Following treatment per COG-A3973 protocol
    • Following treatment per POG-9340-42
    • Following treatment per CCG-3891
    • Following treatment on NANT-2001-02
    • Enrollment on or following treatment per COG-ANBL02P1 protocol
    • Enrollment on or following treatment per ANBL07P1

    • Tandem transplant patients are eligible

      • Following enrollment and treatment on or per COG-ANBL0532
      • Following treatment per POG-9640 protocol
      • Following treatment per COG-ANBL00P1 protocol
      • Following treatment per CHP 594 or DFCI 34-DAT
    • Other frontline therapy with permission from study chairs

• Must meet the International Neuroblastoma Response Criteria (INRC)for CR, VGPR, or PR for primary site, soft tissue metastases, and bone metastases AND must also meet the protocol specified criteria for bone marrow response as follows:

  • No more than 10% tumor (of total nucleated cellular content) seen on any specimen from a bilateral bone marrow aspirate/biopsy
  • Patient who have no tumor seen on the prior bone marrow, and then have ≤ 10% tumor on any of the bilateral marrow aspirate/biopsy specimens done at pre-ASCT and/or pre-enrollment evaluation will also be eligible
• No more than 12 months from the date of starting the first induction chemotherapy after diagnosis to the date of ASCT except for the rare occasions as noted below; for tandem ASCT patients, this will be the date of the FIRST stem cell infusion; exception: For those who are initially diagnosed as non-high risk neuroblastoma, but later converted (and/or relapsed) to high risk neuroblastoma, the 12 months restriction should start from the date of induction therapy for high risk neuroblastoma (not from the initial induction therapy for non-high risk disease), to the date of ASCT

• Prior to enrollment on ANBL0032, a determination of mandatory disease staging must be performed (tumor imaging studies including CT or MRI, MIBG scan, bone marrow aspiration & biopsy); this disease assessment is required for eligibility and should be done preferably within 2 weeks, but must be done within a maximum of 4 weeks before enrollment

  • For those with residual disease before radiotherapy, re-evaluation of irradiated residual tumors is preferably performed at the earliest 5 days after completing radiotherapy; patients with residual disease are eligible; biopsy is not required; patients who have biopsy proven residual disease after ASCT will be enrolled on Stratum 07
  • Patients must not have progressive disease at the time of study enrollment except for protocol specified bone marrow response; these patients will be enrolled on Stratum 07
• Performance status - Lansky 50-100%
• Performance status - Karnofsky 50-100%
• Total absolute phagocyte count (neutrophils and monocytes) ≥ 1,000/mm^3
• Bilirubin ≤ 1.5 times normal
• SGPT ≤ 5 times normal
• Veno-occlusive disease (if present) stable or improving

• Creatinine adjusted according to age as follows:

  • No greater than 0.4 mg/dL (≤ 5 months)
  • No greater than 0.5 mg/dL (6 months - 11 months)
  • No greater than 0.6 mg/dL (1 year- 23 months)
  • No greater than 0.8 mg/dL (2 years- 5 years)
  • No greater than 1.0 mg/dL (6 years- 9 years)
  • No greater than 1.2 mg/dL (10 years- 12 years)
  • No greater than 1.4 mg/dL (13 years and over [female])
  • No greater than 1.5 mg/dL (13 years to 15 years [male])
  • No greater than 1.7 mg/dL (16 years and over [male])
• Creatinine clearance or radioisotope glomerular filtration rate at least 70 mL/min

• Shortening fraction ≥ 30% by echocardiogram, or if shortening fraction abnormal, ejection fraction of >= 55% by gated radionuclide study or echocardiogram

  • Note: The echocardiogram or gated radionuclide study must be performed within 4 weeks prior to enrollment

• FEV1 and FVC > 60% predicted by pulmonary function test; for children who are unable to do PFTs, no evidence of dyspnea at rest and no exercise intolerance should be documented

  • Note: The pulmonary function test must be performed within 4 weeks prior to enrollment
• No evidence of dyspnea at rest, no exercise intolerance
• Not pregnant
• Fertile patients must use effective contraception
• Seizure disorder allowed if well-controlled and on anticonvulsants
• CNS toxicity < grade 2
• No concurrent pentoxifylline
• No more than 1 prior stem cell transplantation
• No other concurrent cytokines or growth factors (e.g., filgrastim [G-CSF] or interferon)
• No IV immunoglobulin G within 2 weeks before, during, and for 1 week after monoclonal antibody Ch14.18 (arm II patients)

• Patients must be enrolled before treatment begins; the date protocol therapy is projected to start must be no later than ten (10) calendar days after the date of study enrollment

  • Patients should be enrolled preferably between Day 56 and Day 85 after PBSC infusion (day from 2nd stem cell infusion for tandem transplant); patients must be enrolled no later than Day 100 after PBSC infusion; enrollment must occur after completion of radiotherapy, and after completion of tumor assessment post-ASCT and radiotherapy; informed consent should be obtained within 3 weeks pre-ASCT up to the time of registration
  • All clinical and laboratory studies for organ functions to determine eligibility must be performed within 7 days prior to enrollment unless otherwise indicated
• No prior anti-GD2 antibody therapy
• No more than 1 prior myeloablative consolidation regimen
• No concurrent myelosuppressive chemotherapy (arm II patients)
• No concurrent corticosteroids unless for life-threatening conditions (e.g., increased intracranial pressure from CNS tumors or life-threatening allergic reactions)
• No radiographic contrast materials during and for at least 1 week after interleukin- 2 (arm II)
• At least 7 days since prior radiotherapy
• No other concurrent anticancer therapy
• No concurrent immunosuppressive drugs (e.g., cyclosporine)