| Abstract: | High‐risk neuroblastoma (NB) patients with 11q deletion frequently undergo late but consecutive relapse cycles with fatal outcome. To date, no actionable targets to improve current multimodal treatment have been identified. We analyzed immune microenvironment and genetic profiles of high‐risk NB correlating with 11q immune status. We show in two independent cohorts that 11q‐deleted NB exhibits various immune inhibitory mechanisms, including increased CD4+ resting T cells and M2 macrophages, higher expression of programmed death‐ligand 1, interleukin‐10, transforming growth factor‐beta‐1, and indoleamine 2,3‐dioxygenase 1 (P < 0.05), and also higher chromosomal breakages (P ≤ 0.02) and hemizygosity of immunosuppressive miRNAs than MYCN‐amplified and other 11q‐nondeleted high‐risk NB. We also analyzed benefits of maintenance treatment in 83 high‐risk stage M NB patients focusing on 11q status, either with standard anti‐GD2 immunotherapy (n = 50) or previous retinoic acid‐based therapy alone (n = 33). Immunotherapy associated with higher EFS (50 vs. 30, P = 0.028) and OS (72 vs. 52, P = 0.047) at 3 years in the overall population. Despite benefits from standard anti‐GD2 immunotherapy in high‐risk NB patients, those with 11q deletion still face poor outcome. This NB subgroup displays intratumoral immune suppression profiles, revealing a potential therapeutic strategy with combination immunotherapy to circumvent this immune checkpoint blockade.Abbreviations- 11q‐del
- 11q‐deleted
- ADCC
- antibody‐dependent cellular cytotoxicity
- CDC
- complement‐dependent cytotoxicity
- COJEC
- chemotherapeutic agents cisplatin, vincristine, carboplatin, etoposide, and cyclophosphamide
- CTLA‐4
- cytotoxic T lymphocyte antigen 4
- EFS
- event‐free survival
- FISH
- fluorescence in situ hybridization
- HR
- hazard ratio
- ICI
- immune checkpoint inhibitor
- IDO1
- indoleamine 2,3‐dioxygenase 1
- IFN‐γ
- interferon‐γ
- IL‐10
- interleukin 10
- INRG
- International Neuroblastoma Risk Group
- miR
- microRNA
- MLPA
- multiplex ligation‐dependent probe amplification
- MMR
- mismatch repair
- MNA
- MYCN amplification
- MS
- metastatic special stage
- MSI
- microsatellite instability
- NB
- neuroblastoma
- NCA
- numerical chromosome aberrations
- NOS
- nitric oxide synthase
- OS
- overall survival
- PD‐1
- programmed cell death protein 1
- PD‐L1
- programmed death‐ligand 1
- SCA
- segmental chromosome aberrations
- TAM
- tumor‐associated macrophages
- Tfh
- follicular helper T cells
- TGF‐β
- tumor growth factor‐β
- TMB
- tumor mutational burden
- TME
- tumor microenvironment
- TNF‐α
- tumor necrosis factor‐α
- Treg
- regulatory T cells
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