Anti-GD2 antibody immunotherapy for high-risk neuroblastoma

Abstract

Background: We report our experience with anti-GD2 immunotherapy using dinutuximab (DIN) with granulocyte colony-stimulating factor (G-CSF) and interleukin-2 (IL-2) in patients with high-risk neuroblastoma (HRNB).

Procedure: We retrospectively examined anti-GD2 immunotherapy adverse events and their management in children with HRNB at our hospital between September 2021 and March 2023.

Results: Eight patients (four males and four females) were included in this study. The median age of patients at the start of immuno­therapy was 4.9 years. Seven patients had complete remission at the start of immunotherapy. We administered 43 cycles (22 cycles of the CSF regimen and 21 cycles of the IL-2 regimen) to eight patients. Seven patients completed all six cycles, and one patient discontinued treatment after the first cycle due to progressive disease. The common terminology criteria for adverse events grade 3 or more hematological adverse events (neutropenia, thrombocytopenia, and anemia) were observed in 7, 5, and 4 cycles, respectively. Additionally, grade 3–4 infusion reactions, capillary leak syndrome, and elevated liver enzymes were observed after 4, 5, and 13 cycles, respectively. Although DIN had to be temporarily discontinued for five cycles, all adverse events were feasible, and immunotherapy was completed in seven patients. During the observation period, five of the eight patients survived without relapse, two patients relapsed at the end of anti-GD2 antibody therapy, and one patient died of the primary disease progression shortly after.

Conclusion: Anti-GD2 immunotherapy is feasible for patients with HRNB.