MIBG scan scores predict survival in children with high-risk neuroblastoma

Children with high-risk neuroblastoma who still show significant tumor uptake of a specialized imaging tracer before receiving anti-GD2 antibody immunotherapy face substantially worse survival, according to a retrospective cohort study published in Cancer Imaging. The research, conducted in 105 children who had completed consolidation therapy, found that a semi-quantitative measure of disease burden on 123I-MIBG SPECT/CT scans — the Curie score — independently predicted progression-free survival.

The study evaluated patients who underwent standardized 123I-MIBG SPECT/CT imaging within 30 days before starting post-consolidation immunotherapy with either dinutuximab beta or naxitamab. Researchers calculated the pre-treatment Curie score, a measure of MIBG-avid disease sites, and defined its change as the percentage difference between pre- and post-treatment scores. They used univariate and multivariate Cox proportional hazards regression to identify independent predictors of progression-free survival, determined optimal score cutoffs with the Youden index, estimated survival with the Kaplan-Meier method, and compared groups with the log-rank and chi-square tests.

The cutoff that best separated outcomes was a Curie score of 3. Patients whose pre-immunotherapy score exceeded 3 had a one-year progression-free survival rate of 65.0% (±7.8%) compared with 87.9% (±4.0%) for those scoring 3 or below, and a three-year rate of 21.9% (±7.4%) versus 59.2% (±8.1%), with both differences statistically significant (P < 0.001). Axial skeletal and skull metastases on the baseline MIBG scan were also associated with reduced three-year progression-free survival (P = 0.012), although these sites did not remain independently significant in multivariate analysis.

Multivariate modeling confirmed that a pre-immunotherapy Curie score above 3, failure to achieve objective remission after immunotherapy, MYCN amplification, 1p36 deletion, 11q23 deletion, and elevated serum neuron-specific enolase were each independent adverse prognostic factors for progression-free survival, all with P < 0.05. The authors conclude that combining semi-quantitative MIBG imaging with molecular and biochemical markers may enhance risk stratification and support individualized treatment decisions in this population.

The article was published as an open-access, peer-reviewed accepted paper on 28 October 2026, with the final version of record to follow.

Subject of Research: Prognostic value of pre-therapeutic 123I-MIBG SPECT/CT Curie scores in pediatric high-risk neuroblastoma treated with anti-GD2 immunotherapy

Article Title: Prognostic value of pre-therapeutic 123I-MIBG SPECT/CT and Curie score dynamics in pediatric high-risk neuroblastoma undergoing post-consolidation anti-GD2 immunotherapy

Article References: Wang, X., Wang, G., Zhou, Z., Zhang, K., Kan, Y., Wang, W., & Yang, J. (2026). Prognostic value of pre-therapeutic 123I-MIBG SPECT/CT and Curie score dynamics in pediatric high-risk neuroblastoma undergoing post-consolidation anti-GD2 immunotherapy. Cancer Imaging. https://doi.org/10.1186/s40644-026-01148-z

Image Credits: AI Generated

DOI: 10.1186/s40644-026-01148-z

Keywords: neuroblastoma, 123I-MIBG SPECT/CT, Curie score, anti-GD2 immunotherapy, dinutuximab beta, naxitamab, progression-free survival, MYCN amplification, pediatric oncology, risk stratification, prognostic imaging, retrospective cohort study