Monoclonal Antibody Ch14.18, Sargramostim, Aldesleukin, and Isotretinoin After Autologous Stem Cell Transplant in Treating Patients With Neuroblastoma
Condition: High Risk Neuroblastoma
MeSH terms: Neuroblastoma
Intervention: Aldesleukin; Diagnostic Laboratory Biomarker Analysis; Dinutuximab; Isotretinoin; Sargramostim
Intervention description: Given IV; Correlative studies; Given IV; Given PO; Given IV or SC
Intervention MeSH terms: Vitamin A; Aldesleukin; Interleukin-2; Tretinoin; Dinutuximab; Isotretinoin; Sargramostim
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Intervention model: Single Group Assignment
Masking: None (Open Label)
Enrollment: 105.0
Sex: All
Healthy volunteers: No

Summary:

      This phase III trial is studying the side effects of giving monoclonal antibody Ch14.18
      together with sargramostim, aldesleukin, and isotretinoin after autologous stem cell
      transplant in treating patients with neuroblastoma. Monoclonal antibodies, such as Ch14.18,
      may find tumor cells and help kill them. Colony-stimulating factors, such as sargramostim,
      may increase the number of immune cells found in bone marrow or peripheral blood. Aldesleukin
      may stimulate the white blood cells to kill tumor cells. Isotretinoin may help neuroblastoma
      cells become more like normal cells, and to grow and spread more slowly. Giving monoclonal
      antibody Ch14.18 with sargramostim, aldesleukin, and isotretinoin after autologous stem cell
      transplant may be an effective treatment for neuroblastoma.
    

Eligibility criteria:

        Inclusion Criteria:

          -  All patients must be diagnosed with neuroblastoma, and categorized as high-risk at the
             time of diagnosis

          -  At pre-ASCT evaluation, patients must meet the International Neuroblastoma Response
             Criteria (INRC) for complete response (CR), very good partial response (VGPR), or
             partial response (PR) for primary site, soft tissue metastases and bone metastases;
             patients who meet those criteria must also meet the protocol specified criteria for
             bone marrow response as outlined below: =< 10% tumor (of total nucleated cellular
             content) seen on any specimen from a bilateral bone marrow aspirate/biopsy; patients
             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; (Note that, per INRC, this would have been defined
             as an "overall" response of progressive disease [PD])

          -  Prior to enrollment on ANBL0931, a determination of residual disease must be performed
             (tumor imaging studies including metaiodobenzylguanidine [MIBG] scan, computed
             tomography [CT] or magnetic resonance imaging [MRI], bone marrow aspiration and
             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

               -  Patients with residual disease are eligible; biopsy is not required

               -  Patients must not have progressive disease except for protocol specified bone
                  marrow response

          -  All patients must have completed therapy including intensive induction chemotherapy
             followed by ASCT and radiotherapy to be eligible; radiotherapy may be waived for
             patients who either had a small adrenal mass which was completely resected upfront, or
             who never had an identifiable primary tumor

          -  No more than 9 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 9 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

          -  Use Karnofsky for patients > 16 years of age and Lansky for patients =< 16 years of
             age; required patients must have a Lansky or Karnofsky performance scale score of >=
             50%

          -  Patients must have a life expectancy of >= 2 months (8 weeks)

          -  Total absolute phagocyte count (APC = neutrophils + monocytes) is at least 1000/uL

          -  Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70
             mL/min/1.73 m^2 or a serum creatinine based on age/gender as follows:

               -  1 month to < 6 months: 0.4 mg/dL

               -  6 months to < 1 year: 0.5 mg/dL

               -  1 to < 2 years: 0.6 mg/dL

               -  2 to < 6 years: 0.8 mg/dL

               -  6 to < 10 years: 1 mg/dL

               -  10 to < 13 years: 1.2 mg/dL

               -  13 to < 16 years: 1.5 mg/dL (male), 1.4 mg/dL (female)

               -  >= 16 years: 1.7 mg/dL (male), 1.4 mg/dL (female)

          -  Total bilirubin =< 1.5 x upper limit of normal (ULN) for age

          -  Serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) < 5 x
             upper limit of normal (ULN) for age

          -  SOS (sinusoidal obstruction syndrome, formerly known as veno-occlusive disease [VOD]),
             if present, should be stable or improving

          -  Shortening fraction of >= 27% by echocardiogram, or ejection fraction of >= 55% by
             radionuclide angiography

          -  No evidence of dyspnea at rest

          -  If pulmonary function tests (PFTs) are performed, forced expiratory volume in one
             second (FEV1)/forced vital capacity (FVC) > 60% by pulmonary function test

          -  Patients with seizure disorder may be enrolled if on anticonvulsants and well
             controlled

          -  Central nervous system (CNS) toxicity < grade 2

        Exclusion Criteria:

          -  Females of childbearing potential must have a negative pregnancy test

          -  Patients of childbearing potential must agree to use an effective birth control method

          -  Female patients who are lactating must agree to stop breast-feeding

          -  Patients must not have received prior anti-GD2 antibody therapy

          -  Patients must not have received prior vaccine therapy administered as treatment of
             neuroblastoma not routine infectious disease vaccinations