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Neuroblastoma Treatment (PDQ®)

  • Updated: 01/14/2014

Table 6. Children’s Oncology Group (COG) Neuroblastoma Low-Risk Group Assignment Schema Used for COG-P9641 and COG-A3961 Studiesa

INSS Stage  Age  MYCN Status  INPC Classification  DNA Ploidyb 
10–21 yAnyAnyAny
2A/2Bc<365 dAnyAnyAny
≥365 d–21 yNonamplifiedAny-
≥365 d–21 yAmplifiedFavorable-
4Sd<365 dNonamplifiedFavorable>1

INPC = International Neuroblastoma Pathologic Classification; INSS = International Neuroblastoma Staging System.
aThe COG-P9641 and COG-A3961 trials established the current standard of care for neuroblastoma patients in terms of risk group assignment and treatment strategies.
bDNA Ploidy: DNA Index (DI) > 1 is favorable, = 1 is unfavorable; hypodiploid tumors (with DI < 1) will be treated as a tumor with a DI > 1 (DI < 1 [hypodiploid] to be considered favorable ploidy).
cINSS stage 2A/2B symptomatic patients with spinal cord compression, neurologic deficits, or other symptoms are treated with immediate chemotherapy for four cycles.
dINSS stage 4S infants with favorable biology and clinical symptoms are treated with immediate chemotherapy until asymptomatic (2–4 cycles). Clinical symptoms include the following: respiratory distress with or without hepatomegaly or cord compression and neurologic deficit or inferior vena cava compression and renal ischemia; or genitourinary obstruction; or gastrointestinal obstruction and vomiting; or coagulopathy with significant clinical hemorrhage unresponsive to replacement therapy.