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Jonathan L Finlay - One of the best experts on this subject based on the ideXlab platform.

  • myeloablative chemotherapy with autologous Bone Marrow Rescue in children and adolescents with recurrent malignant astrocytoma outcome compared with conventional chemotherapy a report from the children s oncology group
    Pediatric Blood & Cancer, 2008
    Co-Authors: Jonathan L Finlay, Ira J Dunkel, Stewart Goldman, James M Boyett, Sharon Gardner, Marc K Rosenblum, Girish Dhall, Allan J Yates, Philip Stanley, Robert A Zimmerman
    Abstract:

    Purpose—Children and adolescents with malignant astrocytomas recurring after initial treatment have a dismal prognosis, with only rare patients surviving one year beyond recurrence. The purpose of this study was to attempt to improve their survival. Methods—Twenty-seven children and adolescents with malignant astrocytomas (17 glioblastoma multiforme and 10 anaplastic astrocytoma) following initial tumor progression, received myeloablative chemotherapy followed by autologous Marrow Rescue with one of three thiotepa and etoposide-based chemotherapy regimens, administered alone (n=11) or combined with carmustine (n=5) or carboplatin (n=11). Time to progression and death following myeloablative chemotherapy for these patients was compared non-randomly with outcome of a contemporaneously treated cohort of similar patients who received only conventional chemotherapy following initial tumor progression. The two cohorts were compared for age, histology, prior therapies, extent of surgical resection at progression and time from initial diagnosis to progression. Results—Five of 27 children (two with glioblastoma multiforme and three with anaplastic astrocytoma) survive event-free from 8.3 to 13.3 years (median of 11.1 years) following myeloablative chemotherapy. Of 56 children with recurrent malignant astrocytoma who received

  • pilot neuropsychological findings from a treatment regimen consisting of intensive chemotherapy and Bone Marrow Rescue for young children with newly diagnosed malignant brain tumors
    Childs Nervous System, 1998
    Co-Authors: Stephen A Sands, Wilfred G Van Gorp, Jonathan L Finlay
    Abstract:

    Ten children (6 girls and 4 boys) who completed a protocol in which their localized brain tumors were successfully treated without cranial irradiation were referred for neuropsychological assessment. At the time of testing, they were disease free without any neuroaxis dissemination or leptomeningeal disease. Tumor types included pineoblastoma, glioblastoma, ependymoma, PNET and medulloblastoma. They had a mean age of 5 years and 8 months (SD = 1.86; range = 2.1–8.9 years) and were an average of 37.8 months post Bone Marrow transplant (SD = 16.42; range = 14–58 months). Neuropsychological data from this study reveal that the mean scores for this nonradiated group of children were within the average range for the following domains: academic achievement tests of reading, spelling and mathematics, verbal and visual memory, visual-motor integration, social-emotional and behavioral functioning. Furthermore, this group of children were performing within the low average range of overall Intelligence, as well as both verbal IQ/verbal reasoning and performance IQ/abstract visual reasoning. On tasks of fine motor dexterity, this group was within the low average range when using their dominant hand; however, they performed within the borderline range when using their non-dominant hand. Of note, this group of children demonstrated significant deficits within the borderline to impaired ranges on language tasks of expressive picture naming and receptive picture vocabulary.

  • myeloablative chemotherapy with autologous Bone Marrow Rescue in young children with recurrent malignant brain tumors
    Journal of Clinical Oncology, 1998
    Co-Authors: S Guruangan, Ira J Dunkel, Stewart Goldman, James Garvin, Mark Rosenblum, James M Boyett, Sharon Gardner, Thomas E Merchant, Smitha V Gollamudi, Jonathan L Finlay
    Abstract:

    PURPOSEThis study evaluates the outcome of myeloablative chemotherapy and autologous Bone Marrow Rescue (ABMR) with or without radiotherapy in children younger than 6 years of age with recurrent malignant brain tumors who had not previously been exposed to conventional fractionated external-beam irradiation.PATIENTS AND METHODSPatients underwent surgery and/or conventional chemotherapy at the time of recurrence to achieve minimal residual disease (two of these patients also underwent local single-fraction gamma-knife radiosurgery). Myeloablative chemotherapy was then administered with carboplatin, thiotepa, and etoposide (16 patients), thiotepa and etoposide (three patients), or thiotepa, etoposide, and carmustine (BCNU; one patient). Autologous Bone Marrow was re-infused 72 hours after chemotherapy. Twelve patients received external-beam irradiation after recovery from ABMR.RESULTSTwenty patients with recurrent brain tumors aged 0.7 to 5.9 years (median, 2.9 years) at ABMR were evaluated. Two patients di...

  • high dose chemotherapy with autologous Bone Marrow Rescue for children with diffuse pontine brain stem tumors
    Journal of Neuro-oncology, 1998
    Co-Authors: Ira J Dunkel, Stewart Goldman, James Garvin, James M Boyett, Lawrence J Ettinger, Allen M Kaplan, Mitchell S Cairo, Jonathan L Finlay
    Abstract:

    Purpose. Diffuse pontine tumors are highly lethal, and there are few long-term survivors with the standard treatment of external beam irradiation. We investigated the effectiveness of high-dose thiotepa and etoposide-based chemotherapy regimens with autologous Bone Marrow Rescue (ABMR) in children with pontine tumors. Patients and methods. Sixteen children with diffuse pontine tumors were treated. Ten had resistant or recurrent tumors. All ten had previously received irradiation; five had also received chemotherapy and one, beta-interferon. Three high-dose chemotherapy regimens were employed. Six patients received three days of thiotepa (300 mg/m2/day) and etoposide (250–500 mg/m2/day) (TE); two received three days of carmustine (BCNU) (200 mg/m2/day divided every 12 hours) followed by TE (BTE); and two received three days of carboplatin (500 mg/m2/day) followed by TE (CTE). Six other patients had newly-diagnosed tumors and had not received any prior treatment. They all received the BTE regimen and subsequently were treated with hyperfractionated irradiation (7200–7800 cGy) beginning approximately six weeks post-ABMR. Results. There were two toxic deaths (13%), both in previously treated patients, due to multiorgan system failure and Candida septicemia in one case each. Median survival of the patients with resistant or recurrent disease was 4.7 months (range 0.1–18.7) from time of ABMR. Median survival of the newly-diagnosed patients was 11.4 months (range 7.6–17.1) from the time of ABMR. Conclusion. High-dose chemotherapy utilizing these regimens followed by ABMR did not appear to prolong survival compared to conventional therapy in these children with pontine tumors. Alternative strategies need to be developed for this highly lethal disease.

  • acute neurologic dysfunction associated with high dose chemotherapy and autologous Bone Marrow Rescue for primary malignant brain tumors
    Pediatric Neurosurgery, 1997
    Co-Authors: Eric D Kramer, Roger J Packer, Jill Ginsberg, Stuart Goldman, Stephen J Thompson, Lisa Bayer, Violet Shen, Richard E Harris, Shakila P Khan, Jonathan L Finlay
    Abstract:

    Acute neurologic complications occurred 103 times in 50 (54%) of 92 patients (primarily children) treated with high-dose chemotherapy and autologous Bone Marrow Rescue for primary central nervous tumo

Ira J Dunkel - One of the best experts on this subject based on the ideXlab platform.

  • myeloablative chemotherapy with autologous Bone Marrow Rescue in children and adolescents with recurrent malignant astrocytoma outcome compared with conventional chemotherapy a report from the children s oncology group
    Pediatric Blood & Cancer, 2008
    Co-Authors: Jonathan L Finlay, Ira J Dunkel, Stewart Goldman, James M Boyett, Sharon Gardner, Marc K Rosenblum, Girish Dhall, Allan J Yates, Philip Stanley, Robert A Zimmerman
    Abstract:

    Purpose—Children and adolescents with malignant astrocytomas recurring after initial treatment have a dismal prognosis, with only rare patients surviving one year beyond recurrence. The purpose of this study was to attempt to improve their survival. Methods—Twenty-seven children and adolescents with malignant astrocytomas (17 glioblastoma multiforme and 10 anaplastic astrocytoma) following initial tumor progression, received myeloablative chemotherapy followed by autologous Marrow Rescue with one of three thiotepa and etoposide-based chemotherapy regimens, administered alone (n=11) or combined with carmustine (n=5) or carboplatin (n=11). Time to progression and death following myeloablative chemotherapy for these patients was compared non-randomly with outcome of a contemporaneously treated cohort of similar patients who received only conventional chemotherapy following initial tumor progression. The two cohorts were compared for age, histology, prior therapies, extent of surgical resection at progression and time from initial diagnosis to progression. Results—Five of 27 children (two with glioblastoma multiforme and three with anaplastic astrocytoma) survive event-free from 8.3 to 13.3 years (median of 11.1 years) following myeloablative chemotherapy. Of 56 children with recurrent malignant astrocytoma who received

  • high dose carmustine thiotepa and etoposide followed by autologous Bone Marrow Rescue for the treatment of high risk central nervous system tumors
    Bone Marrow Transplantation, 2000
    Co-Authors: V Papadakis, Roger J Packer, Ira J Dunkel, Stewart Goldman, L D Cramer, E Kramer, Esperanza B Papadopoulos, M Willoughby, D Baker, J Garvin
    Abstract:

    Forty-two patients (29 newly diagnosed) with high grade gliomas (n = 37), medulloblastoma (n = 2) or non-biopsied tumors (n = 3) with supratentorial (n = 24), brain stem (n = 11), posterior fossa (n = 5) or spinal (n = 2) location were eligible for this study with adequate organ function and no Bone Marrow tumor infiltration. Median patient age was 12.2 years (range, 0.7-46.8). A total of 600 mg/m2 BCNU, 900 mg/m2 thiotepa and 1500 or 750 mg/m2 etoposide (VP-16) was administered followed by autologous Bone Marrow reinfusion (ABMR). Twenty-one newly diagnosed patients received local irradiation (RT) post ABMR. Nine early deaths were observed (21%), as well as one secondary graft failure. Half of the patients aged 18 years or older experienced toxic deaths, whereas only 15% of patients younger than 18 years experienced toxic death (P = 0.05). Of 25 evaluable newly diagnosed patients, 20% achieved complete remission (CR) and 4% partial remission (PR), while 28% remained in continuing complete remission (CCR) and 44% remained with stable disease prior to RT. Of eight evaluable patients with recurrent disease, one achieved CR and two PR, while one remained in CCR and four with stable disease for 1 to 110.2 months. Overall survival was 36%, 24% and 17% at 1, 2 and 3 years following ABMR, with three newly diagnosed patients and one patient treated for recurrent disease being alive, without disease progression 64.4, 67.0, 86.3 and 110.2 months after ABMR, respectively. The combination of high-dose BCNU/ thiotepa/VP-16 has substantial toxicity but definite activity for high risk CNS tumors. Similar protocols with lower toxicity merit further evaluation in both newly diagnosed and recurrent CNS tumors.

  • myeloablative chemotherapy with autologous Bone Marrow Rescue in young children with recurrent malignant brain tumors
    Journal of Clinical Oncology, 1998
    Co-Authors: S Guruangan, Ira J Dunkel, Stewart Goldman, James Garvin, Mark Rosenblum, James M Boyett, Sharon Gardner, Thomas E Merchant, Smitha V Gollamudi, Jonathan L Finlay
    Abstract:

    PURPOSEThis study evaluates the outcome of myeloablative chemotherapy and autologous Bone Marrow Rescue (ABMR) with or without radiotherapy in children younger than 6 years of age with recurrent malignant brain tumors who had not previously been exposed to conventional fractionated external-beam irradiation.PATIENTS AND METHODSPatients underwent surgery and/or conventional chemotherapy at the time of recurrence to achieve minimal residual disease (two of these patients also underwent local single-fraction gamma-knife radiosurgery). Myeloablative chemotherapy was then administered with carboplatin, thiotepa, and etoposide (16 patients), thiotepa and etoposide (three patients), or thiotepa, etoposide, and carmustine (BCNU; one patient). Autologous Bone Marrow was re-infused 72 hours after chemotherapy. Twelve patients received external-beam irradiation after recovery from ABMR.RESULTSTwenty patients with recurrent brain tumors aged 0.7 to 5.9 years (median, 2.9 years) at ABMR were evaluated. Two patients di...

  • high dose chemotherapy with autologous Bone Marrow Rescue for children with diffuse pontine brain stem tumors
    Journal of Neuro-oncology, 1998
    Co-Authors: Ira J Dunkel, Stewart Goldman, James Garvin, James M Boyett, Lawrence J Ettinger, Allen M Kaplan, Mitchell S Cairo, Jonathan L Finlay
    Abstract:

    Purpose. Diffuse pontine tumors are highly lethal, and there are few long-term survivors with the standard treatment of external beam irradiation. We investigated the effectiveness of high-dose thiotepa and etoposide-based chemotherapy regimens with autologous Bone Marrow Rescue (ABMR) in children with pontine tumors. Patients and methods. Sixteen children with diffuse pontine tumors were treated. Ten had resistant or recurrent tumors. All ten had previously received irradiation; five had also received chemotherapy and one, beta-interferon. Three high-dose chemotherapy regimens were employed. Six patients received three days of thiotepa (300 mg/m2/day) and etoposide (250–500 mg/m2/day) (TE); two received three days of carmustine (BCNU) (200 mg/m2/day divided every 12 hours) followed by TE (BTE); and two received three days of carboplatin (500 mg/m2/day) followed by TE (CTE). Six other patients had newly-diagnosed tumors and had not received any prior treatment. They all received the BTE regimen and subsequently were treated with hyperfractionated irradiation (7200–7800 cGy) beginning approximately six weeks post-ABMR. Results. There were two toxic deaths (13%), both in previously treated patients, due to multiorgan system failure and Candida septicemia in one case each. Median survival of the patients with resistant or recurrent disease was 4.7 months (range 0.1–18.7) from time of ABMR. Median survival of the newly-diagnosed patients was 11.4 months (range 7.6–17.1) from the time of ABMR. Conclusion. High-dose chemotherapy utilizing these regimens followed by ABMR did not appear to prolong survival compared to conventional therapy in these children with pontine tumors. Alternative strategies need to be developed for this highly lethal disease.

  • intensive chemotherapy and Bone Marrow Rescue for young children with newly diagnosed malignant brain tumors
    Journal of Clinical Oncology, 1998
    Co-Authors: Warren P Mason, Ira J Dunkel, James Garvin, Sharon Gardner, Alfred C Grovas, Steven Halpern, Glenn Heller, Marc K Rosenblum, David Lyden, Stephen A Sands
    Abstract:

    PURPOSETo evaluate a strategy that avoids radiotherapy in children less than 6 years of age with newly diagnosed malignant brain tumors, by administering myeloablative consolidation chemotherapy with autologous Bone Marrow reconstitution (ABMR) after maximal surgical resection and conventional induction chemotherapy.PATIENTS AND METHODSBetween March 1991 and April 1995, 62 children (median age, 30 months) with newly diagnosed malignant brain tumors were enrolled onto this trial. Children received conventional induction chemotherapy with vincristine, cisplatin, cyclophosphamide, and etoposide, repeated every 3 weeks for five cycles. Children without disease progression on induction chemotherapy were offered consolidation with myeloablative chemotherapy that incorporated carboplatin, thiotepa, and etoposide followed by ABMR. Irradiation was used only for residual tumor at consolidation or for progressive/recurrent disease.RESULTSInduction chemotherapy was well tolerated by most patients; however, progressio...

James Garvin - One of the best experts on this subject based on the ideXlab platform.

  • myeloablative chemotherapy with autologous Bone Marrow Rescue in young children with recurrent malignant brain tumors
    Journal of Clinical Oncology, 1998
    Co-Authors: S Guruangan, Ira J Dunkel, Stewart Goldman, James Garvin, Mark Rosenblum, James M Boyett, Sharon Gardner, Thomas E Merchant, Smitha V Gollamudi, Jonathan L Finlay
    Abstract:

    PURPOSEThis study evaluates the outcome of myeloablative chemotherapy and autologous Bone Marrow Rescue (ABMR) with or without radiotherapy in children younger than 6 years of age with recurrent malignant brain tumors who had not previously been exposed to conventional fractionated external-beam irradiation.PATIENTS AND METHODSPatients underwent surgery and/or conventional chemotherapy at the time of recurrence to achieve minimal residual disease (two of these patients also underwent local single-fraction gamma-knife radiosurgery). Myeloablative chemotherapy was then administered with carboplatin, thiotepa, and etoposide (16 patients), thiotepa and etoposide (three patients), or thiotepa, etoposide, and carmustine (BCNU; one patient). Autologous Bone Marrow was re-infused 72 hours after chemotherapy. Twelve patients received external-beam irradiation after recovery from ABMR.RESULTSTwenty patients with recurrent brain tumors aged 0.7 to 5.9 years (median, 2.9 years) at ABMR were evaluated. Two patients di...

  • high dose chemotherapy with autologous Bone Marrow Rescue for children with diffuse pontine brain stem tumors
    Journal of Neuro-oncology, 1998
    Co-Authors: Ira J Dunkel, Stewart Goldman, James Garvin, James M Boyett, Lawrence J Ettinger, Allen M Kaplan, Mitchell S Cairo, Jonathan L Finlay
    Abstract:

    Purpose. Diffuse pontine tumors are highly lethal, and there are few long-term survivors with the standard treatment of external beam irradiation. We investigated the effectiveness of high-dose thiotepa and etoposide-based chemotherapy regimens with autologous Bone Marrow Rescue (ABMR) in children with pontine tumors. Patients and methods. Sixteen children with diffuse pontine tumors were treated. Ten had resistant or recurrent tumors. All ten had previously received irradiation; five had also received chemotherapy and one, beta-interferon. Three high-dose chemotherapy regimens were employed. Six patients received three days of thiotepa (300 mg/m2/day) and etoposide (250–500 mg/m2/day) (TE); two received three days of carmustine (BCNU) (200 mg/m2/day divided every 12 hours) followed by TE (BTE); and two received three days of carboplatin (500 mg/m2/day) followed by TE (CTE). Six other patients had newly-diagnosed tumors and had not received any prior treatment. They all received the BTE regimen and subsequently were treated with hyperfractionated irradiation (7200–7800 cGy) beginning approximately six weeks post-ABMR. Results. There were two toxic deaths (13%), both in previously treated patients, due to multiorgan system failure and Candida septicemia in one case each. Median survival of the patients with resistant or recurrent disease was 4.7 months (range 0.1–18.7) from time of ABMR. Median survival of the newly-diagnosed patients was 11.4 months (range 7.6–17.1) from the time of ABMR. Conclusion. High-dose chemotherapy utilizing these regimens followed by ABMR did not appear to prolong survival compared to conventional therapy in these children with pontine tumors. Alternative strategies need to be developed for this highly lethal disease.

  • intensive chemotherapy and Bone Marrow Rescue for young children with newly diagnosed malignant brain tumors
    Journal of Clinical Oncology, 1998
    Co-Authors: Warren P Mason, Ira J Dunkel, James Garvin, Sharon Gardner, Alfred C Grovas, Steven Halpern, Glenn Heller, Marc K Rosenblum, David Lyden, Stephen A Sands
    Abstract:

    PURPOSETo evaluate a strategy that avoids radiotherapy in children less than 6 years of age with newly diagnosed malignant brain tumors, by administering myeloablative consolidation chemotherapy with autologous Bone Marrow reconstitution (ABMR) after maximal surgical resection and conventional induction chemotherapy.PATIENTS AND METHODSBetween March 1991 and April 1995, 62 children (median age, 30 months) with newly diagnosed malignant brain tumors were enrolled onto this trial. Children received conventional induction chemotherapy with vincristine, cisplatin, cyclophosphamide, and etoposide, repeated every 3 weeks for five cycles. Children without disease progression on induction chemotherapy were offered consolidation with myeloablative chemotherapy that incorporated carboplatin, thiotepa, and etoposide followed by ABMR. Irradiation was used only for residual tumor at consolidation or for progressive/recurrent disease.RESULTSInduction chemotherapy was well tolerated by most patients; however, progressio...

  • pilot study of high dose thiotepa and etoposide with autologous Bone Marrow Rescue in children and young adults with recurrent cns tumors the children s cancer group
    Journal of Clinical Oncology, 1996
    Co-Authors: Jonathan L Finlay, Stewart Goldman, James Garvin, M C Wong, M Cairo, C August, Bruce H Cohen, P Stanley, R A Zimmerman, B Bostrom
    Abstract:

    PURPOSEThis study was designed to determine the toxicity, radiographic response rate, and outcome following high-dose thiotepa, etoposide, and autologous Bone Marrow Rescue (ABMR) for young patients with recurrent malignant brain tumors.METHODSEligibility criteria required adequate renal, hepatic, and pulmonary function, and no Bone Marrow infiltration. Thiotepa 300 mg/m2 and etoposide 500 mg/ m2 were infused on 3 consecutive days, and autologous Bone Marrow was infused 72 hours following chemotherapy.RESULTSForty-five patients with recurrent high-grade brain tumors, aged 8 months to 36 years (median, 8 years), were treated. Seven patients (16%) died of treatment-related toxicities within 56 days of Marrow reinfusion. Delayed platelet engraftment occurred in 44% of patients who survived beyond day 56. Of 35 patients with radiographically measurable disease who survived at least 28 days following ABMR, there were two complete responses (CRs) and six partial responses (PRs), for an overall response (CRs plu...

Stephen A Sands - One of the best experts on this subject based on the ideXlab platform.

  • pilot neuropsychological findings from a treatment regimen consisting of intensive chemotherapy and Bone Marrow Rescue for young children with newly diagnosed malignant brain tumors
    Childs Nervous System, 1998
    Co-Authors: Stephen A Sands, Wilfred G Van Gorp, Jonathan L Finlay
    Abstract:

    Ten children (6 girls and 4 boys) who completed a protocol in which their localized brain tumors were successfully treated without cranial irradiation were referred for neuropsychological assessment. At the time of testing, they were disease free without any neuroaxis dissemination or leptomeningeal disease. Tumor types included pineoblastoma, glioblastoma, ependymoma, PNET and medulloblastoma. They had a mean age of 5 years and 8 months (SD = 1.86; range = 2.1–8.9 years) and were an average of 37.8 months post Bone Marrow transplant (SD = 16.42; range = 14–58 months). Neuropsychological data from this study reveal that the mean scores for this nonradiated group of children were within the average range for the following domains: academic achievement tests of reading, spelling and mathematics, verbal and visual memory, visual-motor integration, social-emotional and behavioral functioning. Furthermore, this group of children were performing within the low average range of overall Intelligence, as well as both verbal IQ/verbal reasoning and performance IQ/abstract visual reasoning. On tasks of fine motor dexterity, this group was within the low average range when using their dominant hand; however, they performed within the borderline range when using their non-dominant hand. Of note, this group of children demonstrated significant deficits within the borderline to impaired ranges on language tasks of expressive picture naming and receptive picture vocabulary.

  • intensive chemotherapy and Bone Marrow Rescue for young children with newly diagnosed malignant brain tumors
    Journal of Clinical Oncology, 1998
    Co-Authors: Warren P Mason, Ira J Dunkel, James Garvin, Sharon Gardner, Alfred C Grovas, Steven Halpern, Glenn Heller, Marc K Rosenblum, David Lyden, Stephen A Sands
    Abstract:

    PURPOSETo evaluate a strategy that avoids radiotherapy in children less than 6 years of age with newly diagnosed malignant brain tumors, by administering myeloablative consolidation chemotherapy with autologous Bone Marrow reconstitution (ABMR) after maximal surgical resection and conventional induction chemotherapy.PATIENTS AND METHODSBetween March 1991 and April 1995, 62 children (median age, 30 months) with newly diagnosed malignant brain tumors were enrolled onto this trial. Children received conventional induction chemotherapy with vincristine, cisplatin, cyclophosphamide, and etoposide, repeated every 3 weeks for five cycles. Children without disease progression on induction chemotherapy were offered consolidation with myeloablative chemotherapy that incorporated carboplatin, thiotepa, and etoposide followed by ABMR. Irradiation was used only for residual tumor at consolidation or for progressive/recurrent disease.RESULTSInduction chemotherapy was well tolerated by most patients; however, progressio...

A Barrett - One of the best experts on this subject based on the ideXlab platform.

  • multi modality megatherapy with 131i metaiodobenzylguanidine high dose melphalan and total body irradiation with Bone Marrow Rescue feasibility study of a new strategy for advanced neuroblastoma
    European Journal of Cancer, 1995
    Co-Authors: Joseph A Odonoghue, T E Wheldon, M N Gaze, T E Hilditch, S Mcnee, E Simpson, A Barrett
    Abstract:

    New therapeutic approaches are needed for advanced neuroblastoma as few patients are currently curable. We describe an innovative strategy combining [131I]meta-iodobenzylguanidine ([131I]mIBG) therapy with high dose chemotherapy and total body irradiation. The aim of combining these treatments is to overcome the specific limitations of each when used alone to maximise killing of neuroblastoma cells. Five children received combined therapy with [131I]mIBG followed by high dose melphalan and fractionated total body irradiation. Autologous Bone Marrow transplantation was undertaken in 3 patients and allogeneic in 2 patients. One patient received additional localised radiotherapy to residual bulk disease. One patient is alive without relapse 32 months after treatment. 4 patients relapsed after remissions of 9, 10, 14 and 21 months. These results indicate that this combined modality approach is feasible and safe, but further evaluation is necessary to establish whether it has advantages over conventional megatherapy using melphalan alone.