A case of neuroblastoma relapsing early after high-dose chemotherapy and causing pleural dissemination

Abstract

Here, we describe the case of a 14-month-old boy with a left retroperitoneal tumor that was diagnosed as stage 3 neuroblastoma (image-defined risk-factor-positive, MYCN amplified). He underwent five courses of induction chemotherapy and high-dose chemotherapy comprising busulfan+melphalan, followed by autologous bone marrow transplantation. On day 72 after transplantation, he underwent partial resection, and a histopathological analysis showed surviving viable tumor cells. On day 77, computed tomography (CT) scan showed progression of the primary tumor. Although salvage therapy was performed, CT scan on day 100 showed multiple pleural metastases. Local irradiation of the primary tumor (30.6 Gy/17 fractions) and whole lungs (15 Gy/10 fractions) was also performed. Peritoneal dissemination occurred and he died on day 207. Post-autopsy analysis showed high expression levels of ALK in the primary tumor and autopsy specimens. Neuroblastoma with MYCN amplification and high expression levels of ALK can result in rapid exacerbation, and the introduction of new agents such as ALK inhibitors is warranted.