Neuroblastoma Flashcards Preview

SADL Oncology > Neuroblastoma > Flashcards

Flashcards in Neuroblastoma Deck (17):
1

Name genes associated with familial neuroblastoma and germline mutations associated with NBL

Familial:
- ALK
- PHOX2B

Germline mutations associated with NBL:
- NF-1
-BWS/WT2
- p53
- Noonan
- deletion 1p36 or 1q14

2

Somatic changes with NBL

- whole chromosome gains vs segmental aberrations (whole better)
- MYCN (> 10 copies)
- ALK
- 17q (60%)
- 1p36 - associated with Myc-N
- 11q23
- 14q
- Telomerase mutations (ATRX only in adolescents and TERT)
- ARID1a/1b

3

Classic pathology finding in BM in NBL

Homer-Wright rosette

4

Myoclonic jerking and random eye movements with cerebellar ataxia
- name, treatment, and outcomes

OMA syndrome
- treat with IVIG/steroids or plasmapharesis/ritux
- good tumor outcomes but poor long-term neurodevelopmental outcomes.

5

What % of tumors are MIBG avid and what is another option?

90%
FDG-PET scan recommended
--> PET scan
-> Technicium-99 bone scan can be used at diagnosis but not response as it remains positive for healing bone

6

NBL vs other SRBCT

- Homer-rosette
- cohesive clumps of cells
- S100, CD56 and PGP9.5 on immunostaining
-CD99 negative - ewing's is positive
- CD45 neg - positive in lymphoma

7

Principles of Low risk NBL therapy

EFS/OS > 90%
- surgery is mainstay and complete resection not mandatory
- observation alone - COG study of < 6m old with localized adrenal tumors <3cm
- chemo/rads for life-threatening symp or relapse

8

Principles of Int risk NBL therapy

EFS>85% oS>90%
Surgery - for biopsy
- delayed debulking but complete resection not needed

Chemo:
- 2-8 cycles with duration based on getting >50% reduction
- longer if unfav histology

rads only if emergent- ex. spinal cord compression

9

Principles of HR NBL therapy

Induction:
- chemo 6 cycles
- harvest PBSC after 2 cycles
- surgery after 5 cycles

Consolidation
SCT: tandem
Ext. beam rads regardless of extent of resection (2160Gy)

Maintenance:
- Ch14.18 and isotretinoin

10

INRG definition of MS

Metastatic disease in children younger than 18 months with metastases confined to skin, liver, and/or bone marrow. The primary tumor can be INSS stage 1, 2, or 3

MYC-N non-amplified
11q negative

*if last 2 are positive then high-risk disease

11

What is the Curie score?

Score for assessing extent of MIBG avid disease.

Score > 2 is a negative prognostic factor for HR NBL (both upfront and in response to induction)

- EFS of HR-NBL is 15% with Curie >2 vs 45% < 2. (COG A3973)

12

INSS vs INRG

INSS
- is based on surgical staging,
- 4S up to 12 m and primary tumor must be stage 1/2

INRGSS
- uses image-defined risk factors
- 4S up to 18m and primary can be stage 1/2/3

13

Factors involved in INRG risk group assignment

INRG stage
Age
Histology
Grade of differentiation
Myc-N status
11q
ploidy

divided into very low, low, intermediate and high risk groups

14

INRC response criteria

CR - MIBG negative, < 10mm of primary or LN

PR ->30% decrease in primary tumor, no new lesions, MIBG stable/improve, and 50% reduction in MIBG bone score
* note ANBL 0531 used 50-90% reduction in tumor volume as PR

Progressive disease: new lesion, growth of known lesion > 20%, increase in MIBG score by 1.25% or greater

15

Minimum diagnostic criteria for NBL

Unequivocal pathologic diagnosis

Combination of bone marrow aspirate/trephine biopsy containing unequivocal tumor cells AND elevated HVA/VMA

16

What is the EFS and OS of LR, IR or HR?

Low: EFS > 90% (> 95%), OS 97%

Intermediate: EFS > 85% (80-95%), OS 96%

High: EFS 40-50%, OS 40-50%

17

what are adverse risk factors associated with NBL?

-low VMA to HVA ratio
-Myc-N amplification
-unfavourable INPC
-tumour segmental chromosome aberrations
-infants with tumour diploid DNA content