Inclusion Criteria

DISEASE CHARACTERISTICS:

Inclusion criteria:

- Must have a diagnosis of neuroblastoma by histologic verification and/or
demonstration of tumor cells in the bone marrow with increased urinary catecholamines

- Must have high-risk neuroblastoma AND meets at least one of the following criteria:

- Recurrent or progressive disease at any time

- Biopsy not required, even if there is partial response to intervening
therapy

- Refractory disease (i.e., less than a partial response to frontline therapy,
including a minimum of 4 courses of chemotherapy)

- Biopsy not required

- If the patient has not had previous myeloablative therapy, preference will
be given to NANT-2001-02 (iodine I 131 metaiodobenzylguanidine [^131I-MIBG]
+ CEM)

- Persistent disease after at least a partial response to frontline therapy (i.e.,
patient still has residual disease by MIBG scan, CT/MRI scan, or bone marrow)

- Biopsy required (bone marrow biopsy included) of at least one residual site
demonstrating viable neuroblastoma

- If the patient has not had previous myeloablative therapy, preference will
be given to NANT-2001-02 (^131I-MIBG + CEM)

- Must have evidence of MIBG uptake into tumor at ≥ 1 site within 4 weeks prior to
study entry and subsequent to any intervening therapy

- Must have autologous hematopoietic stem cell product available and it must be free of
tumor cell contamination (0 tumor cells /1,000,000 nucleated cells), cryopreserved,
and available for re-infusion after ^131I-MIBG treatment, if immunocytology has been
performed on the stem cell product

- If immunocytology has not been performed on the stem cell product, then
bilateral bone marrow aspirates and biopsies must have been negative by
morphology within 4 weeks before or after the stem cell collection

- If the patient had no bone marrow disease documented at diagnosis or at any time
prior to peripheral blood stem cell (PBSC) harvest then the criteria for
bilateral bone marrow aspirates/biopsies is waived

- The minimum dose is as follows:

- Purged PBSC 2.0 x 10^6 viable CD34+ cells/kg

- Immuno-magnetically purged cells are permitted

- Unpurged PBSC 2 x 10^6 CD34+ cells/kg (minimum is same for PBSC from
identical twin)

- Cells from identical twins are permitted

- Other allogeneic cells are not allowed

- CD34+ selected cells are not permitted

PATIENT CHARACTERISTICS:

Inclusion criteria:

- Lansky or Karnofsky performance status ≥ 50%

- Life expectancy ≥ 6 weeks

- Hemoglobin ≥ 8 g/dL (transfusion allowed)

- ANC ≥ 750/μL (no hematopoietic growth factors within 7 days of starting irinotecan
hydrochloride)

- Platelet count ≥ 50,000/μL (transfusion independent, defined as no platelet
transfusion for 2 weeks)

- Glomerular filtration rate (GFR) or creatinine clearance ≥ 60 mL/min OR age-adjusted
serum creatinine ≤ 1.5 x normal, according to the following:

- 0.8 mg/dL (≤ 5 years of age)

- 1.0 mg/dL (6 to 10 years of age)

- 1.2 mg/dL (11 to 15 years of age)

- 1.5 mg/dL (≥ 16 years of age)

- Total bilirubin ≤ 1.5 x normal for age

- ALT and AST < 3 x normal for age

- All post-menarchal females must have a negative beta-HCG

- Males and females of reproductive age and childbearing potential must use effective
contraception for the duration of study participation

- Ejection fraction ≥ 55% by echocardiogram or radionuclide MUGA OR fractional
shortening ≥ 27% by echocardiogram

- Normal lung function

- Patients with other ongoing serious medical issues must be approved by the study
chair prior to study registration

Exclusion criteria:

- Pregnancy or breast feeding

- Dyspnea at rest, exercise intolerance, pleural effusion, or oxygen requirement

- Disease of any major organ system that would compromise the patient's ability to
withstand therapy

- Documented allergy to third generation cephalosporins

- Active diarrhea (defined as ≥ grade 2 per CTCAE v3)

- Active or uncontrolled infection, including C. difficile

- Patients on prolonged antifungal therapy are eligible if suspected radiographic
lesions are culture and biopsy negative and patient meets other organ function
criteria

- Patients and/or families who are physically and psychologically unable to cooperate
with the radiation safety isolation

- Patient weight that would require exceeding a maximum total allowable dose of
^131I-MIBG (per institutional guidelines)

- Patients who, in the opinion of the investigator, may not be able to comply with the
safety monitoring requirements of the study

PRIOR CONCURRENT THERAPY:

Inclusion criteria:

- Patients must have fully recovered from the acute toxic effects of all prior
chemotherapy, immunotherapy, or radiotherapy before study entry

- At least 3 weeks since prior myelosuppressive or biologic therapy

- At least 2 weeks since prior radiation therapy

- Radiation therapy should not be given to the only site of measurable or
evaluable disease

- At least 3 months since prior large field radiation therapy (i.e., craniospinal
radiation therapy, total lung radiation therapy, or radiation therapy to > 50% of
marrow space)

- At least 3 months since prior autologous stem cell transplantation

- Must meet adequate bone marrow function postmyeloablative therapy

- At least 7 days since prior cytokines or hematopoietic growth factors

- Prior irinotecan hydrochloride and vincristine therapy allowed provided the patient
recovered to adequate bone marrow function as specified in the protocol

Exclusion criteria:

- Prior ^131I-MIBG

- Prior external beam radiation therapy to the liver or kidneys

- Prior allogeneic stem cell transplantation

- Prior whole abdominal radiation therapy, total-body irradiation, or local radiation
therapy that includes any of the following:

- 1,200 cGy to more than 33% of both kidneys (patient must have at least one
kidney that has not exceeded the dose/volume of radiation listed)

- 1,800 cGy to more than 30% of liver and/or 900 cGy to more than 50% of liver

- Other concurrent cancer chemotherapy or immunomodulating agents (including steroids)

- Steroids may be used in the prevention and treatment of transfusion/infusion
reactions and for the treatment of edema associated with CNS lesions

- Concurrent palliative radiotherapy to localized painful lesions

- Concurrent aprepitant (Emend)

- Concurrent ketoconazole or St. John's wort

- Medications that interfere with MIBG uptake during the week prior to or after MIBG
therapy

- Concurrent enzyme-inducing anticonvulsants (e.g., phenobarbital, phenytoin, or
carbamazepine)

- Nonenzyme-inducing anticonvulsants (e.g., Keppra) may be allowed

- Concurrent hemodialysis

- Any other concurrent anticancer agents or radiation therapy