If one is good, two is better.

At ASTRO 2019 we learned that increasing the consolidative radiation dose (from 21.6 → 36 Gy) for residual high-risk neuroblastoma doesn’t seem to help. So what about a different type of intensification, say single intensified to tandem autologous stem cell transplant (ASCT)? Remember, that was the central question behind COG ANBL053 that enrolled 652 patients with high-risk neuroblastoma between 2007-2012—impressive considering there are only about 400 cases in the US per year. Less impressive was that only 355 of 535 eligible patients (read: without progression after induction chemo) went on to be randomized to the single versus tandem ASCT approach, primarily due to “physician / patient preference.” Nonetheless, the primary endpoint of event-free survival (EFS) at 3 years was still found to be significantly improved from 48 → 63% with the tandem approach. Interestingly, close to 70% of enrollees subsequently received the target anti-GD2 therapy dinutuximab, and even among this group the tandem approach improved EFS 55 → 73%. TBL: Pending better crystallized molecular subtypes of high-risk neuroblastoma, tandem ASCT is now the go-to strategy for those without progressive disease following induction chemo. | Park, JAMA 2019