High-Dose Chemotherapy with Peripheral Blood Stem Cell Rescue (Stem Cell Transplant) Chemotherapy can be given in low doses, standard doses, high doses, and even very high doses. When very high doses are used, this is called ablative therapy. Special procedures are required to ensure that a child recovers from ablative therapy. Early in the treatment phase, your child’s stem cells will be collected from the peripheral blood using a special machine that filters out stem cells and returns the remaining blood to your child. These important cells are frozen for later use. After the induction therapy has been given and the tumor has been removed by surgery, very high doses of chemotherapy may be given to overwhelm and destroy the remaining neuroblastoma. An unavoidable result of this very high-dose therapy is the weakening of the body’s blood-producing organ, the bone marrow. Your child may be given back his or her own stored stem cells to promote normal body and organ function when the treatment is complete. This is often referred to as stem cell transplant . The process of administering high-dose chemotherapy with peripheral blood stem cell rescue may be done once or twice. When a patient receives their own stem cells back twice, this is referred to as tandem transplant . Radiation Neuroblastoma cells often are very sensitive and easily killed by radiation. Radiation treatment is very precise and given in specially measured amounts by radiation therapy experts. If your child will receive radiation treatment, the radiation oncologist will discuss with you exactly how the radiation will be given and how long the treatments will last. In general, the side effects of radiation are directly related to the area of the body receiving the radiation treatment. Overall, children experience few side effects while they are getting radiation therapy. The more common side effects include tiredness, decreased appetite, nausea, vomiting, diarrhea, and skin irritation. There may be side effects later, again depending on which area receives the radiation treatment. Possible side effects will be discussed with you in detail by your child’s healthcare team. Immunotherapy Immunotherapy may be part of the treatment for your child’s neuroblastoma. Generally, it is used after tumors have been surgically removed, when there is only minimal disease remaining or no evidence of disease, meaning so few neuroblastoma cells are present that they are not visible on scans. This treatment is designed to train the body’s own immune system to find and kill neuroblastoma cells that have survived the treatment already administered. Immunotherapy involves the injection of a substance called a monoclonal antibody into the bloodstream. The monoclonal antibody attaches to a marker on the surface of neuroblastoma cells, which causes the body to see the neuroblastoma cell as foreign and destroy it. The two most common monoclonal antibodies used in the treatment of neuroblastoma are dinutuximab (Unituxin®) and naxitamab. These antibodies usually are given in combination with other agents that stimulate the immune system and make the antibodies more effective. Your team will talk to you about potential side effects your child may experience.
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