• Efficacy at completion of treatment [ Designated as safety issue: No ]
  
• Relapse-free survival every 3 months [ Designated as safety issue: No ]
  

• Compare granulocyte activation in patients treated with short-term vs prolonged daily exposure to sargramostim (GM-CSF) after 4 courses [ Designated as safety issue: No ]
  
• Simplify treatment with consequent reduction in cost [ Designated as safety issue: No ]
  

OBJECTIVES:

• Determine the efficacy of sargramostim (GM-CSF) in enhancing monoclonal antibody 3F8-mediated ablation in patients with high-risk neuroblastoma.
• Determine the prognostic impact of minimal residual bone marrow disease on relapse-free survival of patients treated with this regimen.
• Compare the effects of short-term (2-hour intravenous) vs prolonged (subcutaneous release) daily GM-CSF on granulocyte activation, in order to establish the optimal route for tumor-cell kill in these patients.

OUTLINE: This is an open-label study. Patients are stratified according to evaluable disease (yes [primary refractory bone marrow disease] vs no [no evidence of disease]).

Patients receive sargramostim (GM-CSF) subcutaneously on days -5 to 4 and monoclonal antibody 3F8 IV over 0.5-1.5 hours on days 0-4. Treatment repeats every 3 weeks for 4 courses and then every 8 weeks for up to a total of 24 months in the absence of disease progression, unacceptable toxicity, or positive human anti-mouse antibody (HAMA).

Beginning after 2 courses (or after 1 course if HAMA develops and precludes timely administration of course 2) of GM-CSF and monoclonal antibody 3F8, patients also receive oral isotretinoin twice daily on days 1-14 (when no monoclonal antibody 3F8 is administered). Treatment with isotretinoin repeats approximately every 28 days for 6 courses.

PROJECTED ACCRUAL: A total of 270 patients will be accrued for this study.

DISEASE CHARACTERISTICS:

• Diagnosis of neuroblastoma by histopathology OR bone marrow metastases and high urine catecholamine levels

• High-risk disease, meeting any of the following International Neuroblastoma Staging System stages:

  • Stage 4 with (any age) OR without (over 1 year of age) MYCN amplification
  • MYCN-amplified stage 3 (unresectable, any age)
  • MYCN-amplified stage 4S
• No evidence of disease (i.e., in complete response/remission or very good partial response/remission) OR disease resistant to standard therapy (i.e., incomplete response in bone marrow)
• No progressive disease or MIBG-avid soft tissue tumor

PATIENT CHARACTERISTICS:

• No existing renal, cardiac, hepatic, neurologic, pulmonary, or gastrointestinal toxicity ≥ grade 3
• No human anti-mouse antibody (HAMA) titer greater than 1,000 Elisa units/mL
• No history of allergy to mouse proteins
• No active life-threatening infection
• Not pregnant
• Negative pregnancy test

PRIOR CONCURRENT THERAPY:

• Not specified