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 â€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.
- Ferreri AJM, et al. Lancet Hematol 2016;3(5):e217â27.
- Ferreri AJM, et al. Lancet Hematol 2017;4(11):e510â23.
- 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, 9â17 June.
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Table of Contents: EHA 2021
Featured articles
Lymphoma
Immuno-oncology agents are effective in treating classic Hodgkinâs lymphoma
MATRix with ASCT: best long-term survival for primary CNS lymphoma
Naratuximab emtansine + rituximab safe and effective in diffuse large B-cell lymphoma
The journey ahead for CAR T-cell therapy in r/r follicular lymphoma
ZUMA-5 vs SCHOLAR-5: Axicabtagene ciloleucel significantly improves FL outcome
Promising chemo-free treatment options in r/r DLBCL
Leukaemia
Sabatolimab achieved durable responses in patients with high-risk MDS and AML
Final analysis of EURO-SKI: primary endpoints met in chronic myeloid leukaemia
Favourable outcomes with zanubrutinib versus ibrutinib in patients with r/r CLL
Oral azacitidine improves overall survival in patients with acute myeloid leukaemia
Reduced-intensity conditioning ASCT is effective in older patients with AML
ELEVATE-TN: Acalabrutinib shows long-term efficacy in chronic lymphocytic leukaemia
ELEVATE-RR: Acalabrutinib demonstrates similar efficacy and better safety versus ibrutinib
Fixed 12 cycles and MRD-guided venetoclax consolidation effective in CLL
GLOW: Ibrutinib + venetoclax showed superior PFS as first-line CLL treatment
Myeloma and Myelofibrosis
Novel targets in myelofibrosis: overview of emergent therapies
Immune therapy of multiple myeloma
MAIA results confirm superior efficacy of daratumumab with standard-of-care
ANDROMEDA: Addition of daratumumab showed superior efficacy in patients with AL amyloidosis
Thrombotic and Thrombocytopenic Disorders including COVID-19 related
Acquired TTP: new treatments and updated guidelines
Maternal screening to prevent foetal and neonatal alloimmune thrombocytopenia
Fostamatinib effectively increased platelet counts in immune thrombocytopenic purpura
Physiopathology of coagulopathy in haematological malignancies and COVID-19
Haemostatic abnormalities are associated with mortality in COVID-19
Mechanisms of COVID-19 vaccine-induced thrombotic thrombocytopenia
COVID-19 vaccine-induced immune thrombotic thrombocytopenia: discovery and diagnosis
Haemoglobinopathies
Luspatercept improved anaemia in patients with non-transfusion-dependent ÎČ-thalassaemia
Personalising treatment for sickle cell disease
Gene therapy: A promising approach for hereditary haemoglobinopathies
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