Adding Of Naxitamb In Induction Therapy For High Risk Neuroblastoma

Inclusion Criteria:

Neuroblastoma patients who meet certain criteria are eligible for enrollment in the following stages of diagnosis:

1. Children with newly diagnosed stage 4 neuroblastoma according to the InternationalNeuroblastoma Staging System (INSS) who meet the following criteria are eligible forenrollment: i. Age > 18 months (> 547 days) regardless of biologicalcharacteristics; or ii. Age 12-18 months (365-547 days), with one of the followingthree unfavorable biological characteristics (MYCN amplification, pathological typeof poor histopathological prognosis, and/or DNA index = 1); or iii. MYCNamplification (MYCN signal increase > 4 times compared to reference signal)regardless of age or other biological characteristics.

2. Children with newly diagnosed stage 3 INSS neuroblastoma who meet the followingcriteria are eligible for enrollment: i. MYCN amplification (MYCN signal increase > 4 times compared to reference signal) regardless of age or other biologicalcharacteristics; or ii. Age > 18 months (> 547 days), with pathological type of poorhistopathological prognosis regardless of MYCN status.

3. Children with newly diagnosed stage 2A/2B INSS neuroblastoma with MYCN amplification (MYCN signal increase > 4 times compared to reference signal) regardless of age orother biological characteristics. The subject must be aged ≤ 21 years at the time ofinitial diagnosis, and must be aged > 12 months at the time of enrollment.

Exclusion criteria:

Infants less than 1 year old, those aged 12-18 months, INSS stage 4, and all INSS stage 3 patients with favorable biological characteristics (i.e., non-amplified MYCN, good pathological histopathological prognosis, and DNA index >1) are not eligible.

Subjects who have received immunosuppressive treatment (excluding local steroids) within the last 4 weeks prior to enrollment. Subjects who are currently receiving any investigational drug.

Any other medical condition that, in the opinion of the investigator, may interfere with the interpretation of results or affect the subject's ability to provide informed consent, the legal guardian's ability to provide informed consent, and the subject's cooperation and participation in the study, including but not limited to malabsorption syndrome, mental illness, or substance abuse. Subjects with significant comorbidities (any serious medical condition unrelated to cancer or its treatment that is not covered by the detailed exclusion criteria and is expected to interfere with the investigation drug(s) action or significantly increase the severity of the trial treatment toxicity)