Results of this study demonstrate a favorable outcome of patients with bilateral WT receiving an individual treatment program. With a tailored approach to treatment according to the tumor response, 77% of our patients were operated before the third month of preoperative chemotherapy. In spite of good survival, 14% of our patients have ESRD.

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The most common adverse events Grade III reported with clofarabine are febrile neutropenia, anorexia, and nausea, observed in about 10% of heavily pretreated patients [3]. Our patient experienced more severe events but no unmanageable toxicity and was able to receive further chemotherapy for a second transplantation providing a new complete remission.In conclusion, this report highlights the efficacy of clofarabine in high-risk leukemia. Above all, it suggests that, if clofarabine administration in the setting of end-stage renal failure may carry significant life-threatening risks, it can be considered whether adequate removal of the drug is provided by CVVHD. The relationship between clofarabine plasma concentration and both efficacy and toxicity remains to be elucidated. Further studies on clofarabine pharmacokinetics in the setting of severe renal impairment are needed to develop appropriate guidelines in this situation.

Recombinant interleukin-2 is used with ch14.18/CHO to improve the cytotoxic activity of NK lymphocytes against neoplastic cells. The efficacy of this treatment is limited by its potential side effects. We report an unusual case of necrotizing enterocolitis associated with the administration of interleukin-2 and ch14.18/CHO in maintenance therapy for localized NMyc amplified neuroblastoma (NBL). This case highlights the potentially significant toxicity of this immunotherapy that is currently being tested in the high-risk NBL-1.5 protocol. Further, short-term, medium-term, and long-term follow-up in this patient population will be warranted to judge the potential benefit of this treatment versus the short-term, medium-term, and long-term side effects in a patient population with an outcome that is better than that of stage 4 NBL patients.

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