Feasibility, toxicity and response of upfront metaiodobenzylguanidine therapy therapy followed by German Pediatric Oncology Group Neuroblastoma 2004 protocol in newly diagnosed stage 4 neuroblastoma patients.

•In 95% of the eligible patients, meta-iodobenzylguanidine 131I-(MIBG) treatment was feasible within 2 weeks from diagnosis.•Interval between chemotherapy courses was longer in 131I-MIBG-treated patients versus chemotherapy only patients.•Stem cell harvest in both groups was feasible, platelet recovery post myeloablative therapy and autologous stem cell rescue was slower for 131I-MIBG-treated patients.•The response rate post 131I-MIBG was 38%, end of induction 131I-MIBG group 71%, chemotherapy group 36% and overall 59%.