N99-01: Combination Chemotherapy, Radiation Therapy, and Stem Cell Transplantation in Treating Patients With Neuroblastoma

DISEASE CHARACTERISTICS:

• Diagnosis of neuroblastoma as evidenced by one of the following:
• Histological confirmation
• Demonstrates clumps of tumor cells in bone marrow with elevated urinary catecholamine metabolites
• High-risk refractory or residual disease
• Poorly responding disease, meeting 1 of the following criteria:
• Stable disease or partial response after at least 12 weeks of induction therapy
• Bone marrow containing greater than 100 tumor cells per 100,000 normal cells after 12 weeks of induction therapy
• Progressive disease during or after therapy
• At least 1 prior positive iodine I 131 metaiodobenzylguanidine (131 I-MIBG) scan since diagnosis and meets disease status criteria

PATIENT CHARACTERISTICS:

Age:

• 1 to 21 (1 to 20 at diagnosis)

Performance status:

• ECOG 0-2

Life expectancy:

• At least 2 months

Hematopoietic:

• Absolute neutrophil count at least 500/mm^3
• Platelet count at least 20,000/mm^3 (transfusion allowed)
• Hemoglobin at least 8 g/dL (transfusion allowed)

Hepatic:

• Bilirubin normal
• AST/ALT no greater than 3 times normal
• No active hepatitis (for HIV-positive patients only)

Renal:

• Glomerular filtration rate or creatinine clearance at least 60 mL/min
• Creatinine less than 1.5 times normal for age

Cardiovascular:

• Ejection fraction at least 55% OR
• Fractional shortening at least 30%

Pulmonary:

• No dyspnea at rest or exercise intolerance
• No requirement for supplemental oxygen
• No active pneumonia (for HIV-positive patients only)

Other:

• No disease of any major organ system that would preclude study participation
• No other active health problems (for HIV-positive patients only)
• No active infections requiring intravenous antivirals, antibiotics, or antifungals
• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• At least 3 weeks since prior biologic therapy and recovered

Chemotherapy:

• At least 3 weeks since prior chemotherapy and recovered
• No more than 100 mg/m^2 total dose of prior melphalan

Endocrine therapy:

• Not specified

Radiotherapy:

• No prior total body, whole abdominal, or whole liver irradiation
• No prior therapy with 131 I-MIBG
• At least 2 weeks since prior radiotherapy (6 months for prior radiotherapy to craniospinal or whole lung fields or greater than 50% of bone marrow space) and recovered

Surgery:

• Prior surgical resection allowed
• Recovered from prior surgery

Other:

• No prior myeloablative therapy
• Prior submyeloablative therapy with peripheral blood stem cell support allowed
• No concurrent antiretrovirals for HIV-positive patients
• Concurrent prolonged antifungal allowed if culture and biopsy negative in suspected residual radiographic lesions
• No medications that may preclude uptake of 131 I-MIBG for 1 week prior and 2 weeks after administration of study drugs
• No concurrent hemodialysis