• Proportion of patients who respond to treatment (partial response and complete response at metastatic sites) as measured by metaiodobenzylguanidine scintigraphy and positron emission tomography and CT imaging [ Designated as safety issue: No ]
  
• Proportion of patients who are able to progress to potentially curative treatment with surgery and further systemic treatment [ Designated as safety issue: No ]
  
• Correlation of tumor dosimetry with response [ Designated as safety issue: No ]
  
• Time to tumor progression [ Designated as safety issue: No ]
  

OBJECTIVES:

• Determine response (partial and complete response at metastatic sites) in children with relapsed stage 4 neuroblastoma or primary resistant high-risk neuroblastoma treated with high-dose iodine I 131 metaiodobenzylguanidine, topotecan hydrochloride, and peripheral blood stem cell transplantation.
• Determine the proportion of patients who, as a result of this treatment, are able to progress to potentially curative surgery and further systemic treatment.
• Correlate tumor dosimetry (to determine whether the tumor absorbed the radiation dose) with response in patients treated with this regimen.
• Determine the time to tumor progression.

OUTLINE: This is an open-label, multicenter study. Patients are stratified according to disease type (relapsed stage 4 vs primary resistant high-risk neuroblastoma).

Patients receive topotecan hydrochloride IV over 30 minutes on days 1-5 and 15-19 and high-dose iodine I 131 metaiodobenzylguanidine (^131I-MIBG) IV over 30 minutes on days 1 and 15. Patients receive autologous CD 34+ peripheral blood stem cells when ^131I-MIBG dosimetry levels reach an acceptable low on days 25-29.

Total whole-body absorbed dose is measured periodically after the first ^131I-MIBG dose is administered and periodically thereafter.

After completion of study treatment, patients are followed periodically for up to 10 years.

PROJECTED ACCRUAL: A total of 67 patients will be accrued for this study.

DISEASE CHARACTERISTICS:

• Confirmed diagnosis of neuroblastoma meeting the 1 of the following criteria:

  • Primary resistant high-risk disease meeting the following criteria:

    • International neuroblastoma staging system (INSS) stage 4, or stage 2 or 3 with myelocytomatosis viral-related oncogene (MycN) amplification

    • Failed to achieve satisfactory remission with induction chemotherapy, defined as one of the following:

      • Less than 50% reduction or > 3 positive sites on iodine I 131 metaiodobenzylguanidine (^131I-MIBG) scintigraphy
      • Persistent cytomorphological positive disease in bone marrow aspirates or trephine biopsies
      • Progressive disease necessitating a change of treatment

  • Relapsed stage 4 disease meeting the following criteria:

    • High-risk neuroblastoma (INSS stage 4, or stage 2 or 3 with MycN amplification)

    • Relapsed after intensive treatment including high-dose chemotherapy and hematopoietic progenitor cell support

      • Patients may be entered at the time of relapse, or at any point subsequently after other treatments
• ^131I-MIBG-positive disease on diagnostic scintigraphy
• Peripheral blood stem cell harvest ≥ 300,000/mm³ CD 34+ cells
• Enrolled in or has been treated on protocol SIOP-NB-2009 or a similar protocol

PATIENT CHARACTERISTICS:

• Glomerular filtration rate ≥ 50 mL/min
• Considered fit enough to undergo proposed study treatment

PRIOR CONCURRENT THERAPY:

• See Disease Characteristics