MATRix with ASCT: best long-term survival for primary CNS lymphoma

At 7 years of follow-up, MATRix treatment with whole-brain irradiation or autologous stem cell transplantation (ASCT) consolidation showed excellent long-lasting survival in patients with primary central nervous system (CNS) lymphoma in the randomised, phase 2 IELSG32 trial.

Primary CNS lymphoma is an aggressive lymphoma in a special, immune-privileged, and highly sensitive environment. The open-label, randomised, phase 2 IELSG32 trial (NCT01011920) has shown significantly increased efficacy and acceptable safety of the MATRix regimen (i.e. rituximab ± thiotepa plus methotrexate and cytarabine), and comparable efficacy of consolidation with whole-brain irradiation therapy (WBRT) or ASCT in patients ≤70 years of age [1,2]. Dr Gerald Illerhaus (Klinikum der Landeshauptstadt Stuttgart, Germany) presented the updated results at a median follow-up of 88 months (range 77-99 months) [3].

Patients with untreated primary CNS lymphoma (n=219; median age 58 years) were randomly assigned to 4 courses of methotrexate-cytarabine (arm A; n=75), or arm A plus rituximab (arm B; n=69), or arm B plus thiotepa (arm C; MATRix; n=75). Patients with responsive or stable disease were further randomised to one of 2 consolidation arms: either whole-brain irradiation (arm D; n=59) or carmustine-thiotepa/ASCT (arm E; n=59) [2]. Primary endpoints were complete response rate and progression-free survival (PFS). Cognitive function was also assessed.

PFS was statistically significantly better in arm C, with a 7-year PFS of 20% for arm A, 29% for arm B, and 52% for arm C (C vs A P=0.00001; C vs B P=0.01); PFS was similar in both consolidation arms (55% vs 50%; P=0.35). At data cut-off, the 7-year OS was 26% for Arm A, 37% for Arm B, and 56% for Arm C. Again, results were statistically significantly better for arm C (C vs A P=0.00007; C vs B P=0.03); OS was similar in both consolidation arms (63% vs 57%; P=0.17). Patients treated with MATRix plus consolidation treatment had a 7-year OS of 70%, with no difference between whole-brain irradiation or ASCT. Cognitive function assessments showed a clear benefit for ASCT over WBRT in neuropsychological test endpoints attention/executive functions, memory, and quality of life.

In conclusion, the MATRix regimen was associated with superior, long-lasting PFS and OS in primary CNS lymphoma patients. WBRT and ASCT exhibited similar efficacy. However, ASCT was advantageous over WBRT in cognitive function tests and is thus considered preferred first-line therapy.

1. 
   
   1. Ferreri AJM, et al. Lancet Hematol 2016;3(5):e217–27.
   2. Ferreri AJM, et al. Lancet Hematol 2017;4(11):e510–23.
   3. Illerhaus G, et al. MATRix followed by autologous transplant is associated with excellent survival and neurotolerability in primary CNS lymphoma: results of the IELSG32 trial at a median follow-up of 88 months. S219, EHA 2021 Virtual Congress, 9–17 June.

 

Copyright ©2021 Medicom Medical Publishers



Posted on 5 August, 202118 March, 2024