Neuroblastoma - historical

Section editor transclusions

The purpose of this page is to provide references to regimens that are obsolete, outdated, or of historical interest only. As a general rule, this includes the inferior arm(s) of a randomized study, unless said regimens continue to be recommended by trustworthy sources such as the NCCN Guidelines. Is there a regimen missing from this list? See the main neuroblastoma page for current regimens.

2 regimens on this page 2 variants on this page

High Risk

COG ANBL0532 Regimen A

Induction,

Chemotherapy, Cycle 1 (CPM + TOPO)

• Cyclophosphamide (Cytoxan) by the following weight-based criteria:
  • ≤ 12 kg: 13.3 mg/kg iV over 30 to 60 minutes once daily on days 1 through 5
  • > 12 kg: 400 mg/m² IV over 30 to 60 minutes once daily on days 1 through 5

• Topotecan (Hycamtin) 1.2 mg/m² IV over 30 minutes once daily on days 1 through 5

21 Day Cycle

Chemotherapy, Cycle 2 (CPM + TOPO)

• Cyclophosphamide (Cytoxan) by the following weight-based criteria:
  • ≤ 12 kg: 13.3 mg/kg iV over 30 to 60 minutes once daily on days 1 through 5
  • > 12 kg: 400 mg/m² IV over 30 to 60 minutes once daily on days 1 through 5

• Topotecan (Hycamtin) 1.2 mg/m² IV over 30 minutes once daily on days 1 through 5

21 Day Cycle

Supportive Therapy, Cycle 2

• Filgrastim (Neupogen) 5 μg/kg SubQ or IV once daily on Day 6 beginning 24 hours after completion of chemotherapy and continuing until ANC > 1000/μL

• Filgrastim (Neupogen) 10 μg/kg SubQ or IV once daily beginning once ANC > 1000/μL and continuing until PBSC harvest is complete

• PBSC harvest on day 14

21 Day Cycle

Chemotherapy, Cycle 3 (CDDP + ETOP)

• Cisplatin (Platinol) by the following weight-based criteria:
  • ≤ 12 kg: 1.66 mg/kg IV over 1 hour once daily on days 1 through 4
  • > 12 kg: 50 mg/m² IV over 1 hour once daily on days 1 through 4

• Etoposide (Vepesid) by the following weight-based criteria:
  • ≤ 12 kg: 6.67 mg/kg IV over 1 hour once daily on days 1 through 3
  • > 12 kg: 200 mg/m² IV over 1 hour once daily on days 1 through 3

Chemotherapy, Cycle 4 (CPM + DOXO + VCR)

• Cyclophosphamide (Cytoxan) by the following weight-based criteria:
  • ≤ 12 kg: 70 mg/kg iV over 6 hours once daily on days 1 through 2
  • > 12 kg: 2100 mg/m² IV over 6 hours once daily on days 1 through 2

• Vincristine (Oncovin) by the following criteria:
  • < 12 months: 0.017 mg/kg (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 1 through 3
  • ≥ 12 months and > 12 kg: 0.097 mg/m² or 0.022 mg/kg (choose lower dose) (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 1 through 3
  • ≥ 12 months and ≤ 12 kg: 0.022 mg/kg (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 1 through 3

• Doxorubicin (Adriamycin) by the following weight-based criteria:
  • ≤ 12 kg: 0.83 mg/kg iV over 24 hours once daily on days 1 through 3
  • > 12 kg: 25 mg/m² IV over 24 hours once daily on days 1 through 3

21 Day Cycle

Supportive Therapy, Cycle 4 (CPM + DOXO + VCR)

• Mesna (Mesnex) by the following weight-based criteria:
  • ≤ 12 kg: 14 mg/kg IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again at 4 and 8 hours after eachCyclophosphamide (Cytoxan) infusion
  • > 12 kg: 420 mg/m² IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again at 4 and 8 hours after eachCyclophosphamide (Cytoxan) infusion

21 Day Cycle

Chemotherapy, Cycle 5 (CDDP + ETOP)

• Cisplatin (Platinol) by the following weight-based criteria:
  • ≤ 12 kg: 1.66 mg/kg IV over 1 hour once daily on days 1 through 4
  • > 12 kg: 50 mg/m² IV over 1 hour once daily on days 1 through 4

• Etoposide (Vepesid) by the following weight-based criteria:
  • ≤ 12 kg: 6.67 mg/kg IV over 1 hour once daily on days 1 through 3
  • > 12 kg: 200 mg/m² IV over 1 hour once daily on days 1 through 3

21 Day Cycle

Chemotherapy, Cycle 6 (CPM + DOXO + VCR)

• Cyclophosphamide (Cytoxan) by the following weight-based criteria:
  • ≤ 12 kg: 70 mg/kg iV over 6 hours once daily on days 1 through 2
  • > 12 kg: 2100 mg/m² IV over 6 hours once daily on days 1 through 2

• Vincristine (Oncovin) by the following criteria:
  • < 12 months: 0.017 mg/kg (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 1 through 3
  • ≥ 12 months and > 12 kg: 0.097 mg/m² or 0.022 mg/kg (choose lower dose) (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 1 through 3
  • ≥ 12 months and ≤ 12 kg: 0.022 mg/kg (Max Dose of 2 mg in 72 hours) IV over 1 minute or infusion (per institutional policy) once daily before Doxorubicin (Adriamycin) on days 1 through 3

• Doxorubicin (Adriamycin) by the following weight-based criteria:
  • ≤ 12 kg: 0.83 mg/kg iV over 24 hours once daily on days 1 through 3
  • > 12 kg: 25 mg/m² IV over 24 hours once daily on days 1 through 3

21 Day Cycle

Supportive Therapy, Cycle 6 (CPM + DOXO + VCR)

• Mesna (Mesnex) by the following weight-based criteria:
  • ≤ 12 kg: 14 mg/kg IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again at 4 and 8 hours after eachCyclophosphamide (Cytoxan) infusion
  • > 12 kg: 420 mg/m² IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again at 4 and 8 hours after eachCyclophosphamide (Cytoxan) infusion

21 Day Cycle

Consolidation,

Chemotherapy, High Dose with PBSC Support

• Thiotepa (Thioplex) by the following weight-based criteria:
  • ≤ 12 kg: 10 mg/kg IV over 2 hours once daily on days -7, -6, -5
  • > 12 kg: 300 mg//m² IV over 2 hours once daily on days -7, -6, -5

• Cyclophosphamide (Cytoxan) by the following weight-based criteria:
  • ≤ 12 kg: 50mg/kg IV over 1 hour once daily on days -5, -4, -3, -2
  • > 12 kg: 1500 mg/m² IV over 1 hour once daily on days -5, -4, -3, -2

• PBSC on day 0

50 Day Cycle

Supportive therapy,

• Mesna (Mesnex) by the following weight-based criteria:
  • ≤ 12 kg: 10 mg/kg IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again at 4 and 8 hours after eachCyclophosphamide (Cytoxan) infusion
  • > 12 kg: 300 mg/m² IV over 15 minutes immediately prior to each Cyclophosphamide (Cytoxan) dose and again at 4 and 8 hours after eachCyclophosphamide (Cytoxan) infusion

• Filgrastim (Neupogen) 5 μg/kg SubQ or IV once daily starting on day 0 and continuing until post-nadir ANC > 2000/μL for 3 consecutive days

50 Day Cycle

Maintenance, 6 Cycles

Chemotherapy,

• Isotretinoin (Accutane) by the following weight-based criteria:
  • ≤ 12 kg: 5.33 mg/kg (Round dose to nearest 10 mg) PO twice daily on days 1 through 14
  • > 12 kg: 160 mg/m² (Round dose to nearest 10 mg) PO twice daily on days 1 through 14

28 Day Cycle

References

1. COG ANBL0532:Seif AE, Naranjo A, Baker DL, Bunin NJ, Kletzel M, Kretschmar CS, Maris JM, McGrady PW, von Allmen D, Cohn SL, London WB, Park JR, Diller LR, Grupp SA. A pilot study of tandem high-dose chemotherapy with stem cell rescue as consolidation for high-risk neuroblastoma: Children's Oncology Group study ANBL00P1. Bone Marrow Transplant. 2013 Jul;48(7):947-52. link to original article link to PMC article PubMed