Pediatric Precision Laboratory Advanced Neuroblastoma Therapy

Inclusion Criteria:

1. Diagnosis: Subjects must have a diagnosis of neuroblastoma or ganglioneuroblastoma
(nodular or intermixed) verified by histology or demonstration of clumps of tumor
cells in bone marrow with elevated urinary catecholamine metabolites. Subjects with
the following disease stages at diagnosis are eligible, if they meet the other
specified criteria:

a) Subjects with newly diagnosed neuroblastoma with INSS Stage 4 are eligible with the
following: i. Age > 18 months (> 547 days) regardless of biologic features or ii. Age
12-18 months (365-547 days) with any of the following 3 unfavorable biologic features
(MYCN amplification, unfavorable pathology and/or DNA index = 1) or iii. MYCN
amplification (> 4-fold increase in MYCN signals as compared to reference signals),
regardless of age or additional biologic features.

b) Subjects with newly diagnosed neuroblastoma with INSS Stage 3 are eligible with the
following: i. MYCN amplification (> 4-fold increase in MYCN signals as compared to
reference signals), regardless of age or additional biologic features or ii. Age > 18
months (> 547 days) with unfavorable pathology, regardless of MYCN status.

c) Subjects with newly diagnosed neuroblastoma with INSS Stage 2A/2B with MYCN
amplification (> 4-fold increase in MYCN signals as compared to reference signals),
regardless of age or additional biologic features.

2. Subjects must be age ≤ 21 years at initial diagnosis

3. Subjects must not have had prior systemic therapy except for localized emergency
radiation to sites of life-threatening or function-threatening disease and/or no more
than 1 cycle of chemotherapy per a low or intermediate risk neuroblastoma regimen (as
per P9641, A3961, ANBL0531, or similar) prior to determination of MYCN amplification
status and histology.

4. Specimens will be obtained only in a non-significant risk manner and not solely for
the purpose of investigational testing.

5. Adequate liver function must be demonstrated, defined as:

1. Total bilirubin ≤ 1.5 x upper limit of normal (ULN) for age AND

2. ALT (SGPT) < 10 x upper limit of normal (ULN) for age

6. Subjects must have adequate renal function defined as a serum creatinine based on
age/gender

7. Adequate Cardiac Function defined as: Shortening fraction of ≥ 27% by echocardiogram,
or Ejection fraction of ≥ 50% by radionuclide evaluation or echocardiogram.

8. Ability to tolerate PBSC collection: No known contraindication to PBSC collection.
Examples of contraindications would include a weight or size less than that determined
to be feasible at the collecting institution, or a physical condition that would limit
the ability of the child to undergo apheresis catheter placement (if necessary) and/or
the apheresis procedure.

9. A negative serum pregnancy test is required for female participants of child bearing
potential (≥13 years of age or after onset of menses)

10. Both male and female post-pubertal study subjects need to agree to use one of the more
effective birth control methods during treatment and for six months after treatment is
stopped. These methods include total abstinence (no sex), oral contraceptives ("the
pill"), an intrauterine device (IUD), levonorgestrol implants (Norplant), or
medroxyprogesterone acetate injections (Depo-provera shots). If one of these cannot be
used, contraceptive foam with a condom is recommended.

11. Informed Consent: All subjects and/or legal guardians must sign informed written
consent. Assent, when appropriate, will be obtained according to institutional
guidelines.

Exclusion Criteria:

1. Subjects who are 12-18 months of age with INSS Stage 4 and all stage 3 subjects with
favorable biologic features (ie, nonamplified MYCN, favorable pathology, and DNA index
> 1) are not eligible.

2. Lactating females are not eligible unless they have agreed not to breastfeed their
infants.

3. Subjects receiving any investigational drug concurrently.

4. Subjects with any other medical condition, including but not limited to malabsorption
syndromes, mental illness or substance abuse, deemed by the Investigator to be likely
to interfere with the interpretation of the results or which would interfere with a
subject's ability to sign or the legal guardian's ability to sign the informed
consent, and subject's ability to cooperate and participate in the study