N2001-02: I-MIBG With Intensive Chemotherapy and Autologous Stem Cell Rescue for High-Risk Neuroblastoma

DISEASE CHARACTERISTICS:

* Diagnosis of relapsed or refractory neuroblastoma

  * Histologically confirmed and/or demonstration of tumor cells in bone marrow with elevated urinary catecholamine metabolites
  * High-risk neuroblastoma must meet one of the following:

    * Progressive disease prior to or after completion of induction therapy
    * Mixed response or no response after completion of 4 courses of induction therapy
    * Partial response after 4 courses of induction therapy allowed provided no prior participation in COG-A3973 or other phase III COG trials
* Measurable disease, defined as at least one metaiodobenzylguanidine (MIBG)-avid target lesion determined by diagnostic MIBG scan within 6 weeks of study entry (tumor sites that have received local irradiation within 3 months of study entry are not considered target lesions)

PATIENT CHARACTERISTICS:

Performance status

* Lansky 60-100% OR
* Karnofsky 60-100%

Life expectancy

* At least 2 months

Hematopoietic

* Hemoglobin ≥ 10 g/dL
* Absolute neutrophil count ≥ 750/mm\^3
* Platelet count ≥ 50,000/mm\^3 (if no marrow involvement by morphologic exam/no transfusion allowed) (\> 20,000/mm\^3 if metastatic tumor involvement of marrow by morphologic exam/transfusion allowed)

Hepatic

* Bilirubin \< 1.3 mg/dL
* SGOT and SGPT \< 5 times normal
* Hepatitis B surface antigen negative
* Hepatitis C negative

Renal

* Glomerular filtration rate or creatinine clearance ≥ 60 ml/min
* Creatinine ≤ 1.5 times normal for age as follows:

  * 0.8 mg/dL (for patients ≤ 5 years of age)
  * 1.0 mg/dL (for patients 6 to 10 years of age)
  * 1.2 mg/dL (for patients 11 to 15 years of age)
  * 1.5 mg/dL (for patients \> 15 years of age)

Cardiovascular

* Ejection fraction ≥ 55% by echocardiogram or radionuclide MUGA OR
* Fractional shortening ≥ 27% by echocardiogram

Pulmonary

* Normal lung function defined as no dyspnea at rest and no oxygen requirement OR measured oxygen saturation \> 93% on room air

Other

* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use effective contraception
* No disease of any major organ system that would preclude study compliance
* No concurrent hemodialysis
* No active infection requiring IV antivirals, antibiotics, or antifungals (patients on antifungal therapy are eligible provided they are culture- and biopsy-negative in suspected residual radiographic lesions)
* Patient weight within limits to receive ≤ maximum total allowable dose of \^131I-MIBG

PRIOR CONCURRENT THERAPY:

Biologic therapy

* No prior myeloablative transplantation

  * Prior submyeloablative transplantation allowed at discretion of principal investigator
* More than 3 weeks since prior biologic therapy

Chemotherapy

* More than 3 weeks since prior myelosuppressive chemotherapy (6 weeks for mitomycin C or nitrosoureas)
* No prior melphalan therapy with a total dose of \> 100 mg/m\^2

Radiotherapy

* See Disease Characteristics
* At least 6 weeks since prior radiotherapy (6 months for craniospinal or whole lung radiotherapy)
* No prior total body irradiation
* No prior iodine I 131 MIBG (\^131I-MIBG)
* No prior total abdominal or whole liver radiotherapy
* No prior local radiotherapy, including any of the following:

  * 1200 cGy to more than 33% of both kidneys (patient must have at least one kidney that has not exceeded the dose/volume of radiation listed)
  * 1800 cGy to more than 30% of liver and/or 900 cGy to more than 50% of liver

Other

* Recovered from all prior therapy
* No medications with a potential interference of \^131I-MIBG uptake 1 week before and 2 weeks after completion of \^131I-MIBG