Conclusion

At this point, an accepted treatment for high-risk NB includes multi-cycle induction, early collection of PBSC, testing of the PBSC product for evidence of NB contamination, as complete a surgical resection as can be accomplished without organ sacrifice, HDC/SCR (without clear evidence of one conditioning regimen being superior to another), and local radiotherapy either before or after HDC/SCR followed by treatment with 13-ris retinoic acid. The ongoing COG phase-III trial will help answer the question of whether purging of PBSC will improve the outcome of high-risk NB patients. To determine if intensifying consolidation will further enhance the outcome of high-risk NB patients, a randomized study of single vs tandem cycles of HDC/SCR is under development within the COG.

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