Factors associated with recurrence and survival length following relapse in patients with neuroblastoma
Session type: Poster sessions
Theme: Epidemiology and prevention
Despite therapeutic advances, survival following relapse for neuroblastoma patients remains poor. We investigated clinical and biological factors associated with length of progression free and overall survival following relapse in UK neuroblastoma patients.
All cases of relapsed neuroblastoma, diagnosed 1990-2010, were identified from four Paediatric Oncology principal treatment centres. Kaplan-Meier and Cox regression analyses were used to calculate post relapse overall survival (PROS), post relapse progression free survival (PRPFS) between relapse and further progression, and to investigate influencing factors.
189 cases were identified from case notes, 159 (84.0%) high risk and 17 (9.0%), unresectable, MYCN non-amplified (non-MNA) intermediate risk (IR). For high risk patients diagnosed >2000, median PROS was 8.4 months (inter quartile range (IQR) =3.0-17.4) and median PRPFS was 4.7 months (IQR=2.1-7.1). For IR, unresectable non-MNA patients, median PROS was 11.8 months (IQR 9.0-51.6) and 5-year PROS was 24% (95% CI 7%-45%). MYCN amplified (MNA) disease and bone marrow metastases at diagnosis were independently associated with worse PROS for high risk cases. 80% of high risk relapses occurred within 2 years of diagnosis compared with 50% of unresectable non-MNA IR disease.
Patients with relapsed HR neuroblastoma should be treatment stratified according to MYCN status and PRPFS should be the primary endpoint in early phase clinical trials. The failure to salvage the majority of IR neuroblastoma is concerning, supporting investigation of intensification of upfront treatment regimens in this group to determine whether their use would diminish likelihood of relapse.