Allogeneic Hematopoietic Stem Cell Transplantation for Relapsed or Refractory High-Risk NBL.

Inclusion Criteria

• •DISEASE CHARACTERISTICS:
• •Diagnosis of high-risk neuroblastoma, meeting one of the following criteria:
• •* Refractory disease, defined as no response, mixed response, or progressive disease after completion of induction therapy administered according to clinical trials COG-A3973 or COG-ANBL0532 (or other similar high-intensity induction regimen)
• •* Relapsed following high-dose chemoradiotherapy including autologous stem cell transplantation
• •Achieved a complete remission (CR), very good partial remission (VGPR), or partial remission (PR) after ≤ 2 different salvage regimens, as defined by the following:
• •* In CR after treatment with some form of salvage therapy (e.g., ¹³¹I-MIBG, antibody-based therapy, or any other COG or NANT salvage-therapy regimen)
• •* In VGPR or PR after salvage therapy
• •* No more than 3 sites of skeletal disease as determined by an ¹²³I-MIBG scan (for regional involvement of the skeleton \[e.g., pelvis, spine\], the tumor involvement should be \< 25% of the site)
• •* Bone marrow involvement (\< 25% neuroblasts) by morphologic exam within the past 2 weeks
• •* Patients with soft tissue disease are eligible provided they exhibit either a VGPR or PR in the primary soft tissue mass and in any sites of metastatic soft tissue disease
• •Disease status meeting one of the following criteria:
• •* Minimal residual disease
• •* Disease considered responsive to a salvage regimen
• •* Stable disease
• •No rapidly progressive disease
• •Donors must meet one of the following criteria:
• •* Matched, related donor (6/6 or 5/6) (bone marrow donor allowed)
• •* HLA-matched unrelated donor (10/10 match on high-resolution \[HR\] typing of HLA-A, B, C, DRB1, and DQB1)
• •* One allele- or antigen-mismatched unrelated donor (9/10 match on HR typing), mismatched at HLA-C only
• •* One allele- or antigen-mismatched unrelated donor (9/10 match on HR typing), mismatched at HLA-A, B, DRB1, or DQB1 (only when HLA-C mismatch is not available)
• •PATIENT CHARACTERISTICS:
• •Karnofsky/Lansky performance status 60-100%
• •ANC \> 500/mm\^3
• •Creatinine clearance or radioisotope GFR ≥ 60 mL/min
• •Total bilirubin \< 3.0 mg/dL
• •AST or ALT \< 5 times upper limit of normal
• •Shortening fraction ≥ 25% by ECHO OR ejection fraction \> 30% by MUGA
• •FEV\_1 and DLCO ≥ 30% OR normal chest x-ray, pulse oximetry, and venous blood gas
• •Negative pregnancy test
• •Fertile patients must use effective contraception
• •HIV negative
• •No active or recent (within the past 30 days) fungal infection
• •No proven or suspected sepsis, pneumonia, or meningitis unless appropriate therapeutic measures have been initiated to control the infection and systemic signs are no longer life-threatening
• •No requirement for oxygen or ventilator support
• •PRIOR CONCURRENT THERAPY:
• •See Disease Characteristics
• •Prior tandem autologous stem cell transplantations (according to clinical trial COG-ANBL0532) allowed
• •No prior allogeneic hematopoietic stem cell transplantation
• •More than 2 months since prior autologous stem cell transplantation, myeloablative therapy, total-body irradiation, whole abdominal radiotherapy, or therapeutic ¹³¹I-MIBG
• •More than 3 weeks since prior chemotherapy, immunotherapy (including anti-GD2 regimen), or biologic response modifiers and recovered
• •More than 2 weeks since prior local radiotherapy to the sites of metastatic disease