Neuroblastoma update: prognostic factors.

Susan L. Cohn, MD , is an Assistant Professor and Pediatric Hematologist/Oncologist at Children’s Memorial Hospital in Chicago, Illinois. Neuroblastoma, a malignant neoplasm of neural crest origin, accounts for nearly 10% of the pediatric malignancies, and it is the most common extracranial solid malignancy of childhood.’ The studies to date have not clarified the biologic complexity that allows this tumor to have a high rate of spontaneous remission in stage IVS infants, and yet be such a devastating disease in stage IV patients over the age of one year.’ Until recently children with bone metastasis generally had a fatal outcome. However, myeloablative therapy with bone marrow rescue may now offer some hope for these poor prognostic patients. Some children otherwise considered incurable are presently long-term survivors after being treated with bone marrow transplantation (BMT).’ It would be advantageous to be able to select the patients at high risk for a poor outcome with conventional chemotherapy because for them the potential benefit of BMT would outweigh the risk of the procedure. On the other hand, this toxic treatment should be avoided in those patients who have a good chance of cure with conventional chemotherapy and/or surgery. Recently reliable prognostic criteria have been described which allow