Consolidation high-dose chemotherapy followed by autologous stem cell transplantation (HCT/ASCT) significantly improved overall survival (OS) and progression-free survival (PFS) compared with consolidation non-myeloablative immuno-chemotherapy in patients with primary CNS lymphoma.
The phase 3 MATRix/IELSG43 trial included immunocompetent patients with newly diagnosed primary CNS lymphoma to receive four cycles of MATRIx immuno-chemotherapy. Responders (N=230) were then randomized 1:1 to receive two cycles of consolidation R-DeVIC immuno-chemotherapy or HCT/ASCT. The chemotherapy regimen consisted of carmustine and thiotepa or busulfan and thiotepa. Prof. Gerald Illerhaus (Klinikum Stuttgart, Germany) presented the PFS results, the primary endpoint of this trial,1 2022 annual meeting of the American Society of Hematology.
After a median follow-up of 45.3 months, the PFS was significantly longer in the HCT/ASCT arm than in the R-DeVIC arm (HR, 0.41; 95% CI, 0.25-0.65; P=0.0002), with corresponding 3-year PFS rates of 79% and 53%. Likewise, OS was improved in the HCT/ASCT arm compared with the R-DeVIC arm (HR, 0.46; 95% CI, 0.26-0.81; P=0.0077). The 3-year OS rates were 86% and 71%, respectively.
Hematologic adverse events (AEs) of grade 3 and 4 appeared to occur more often in the HCT/ASCT arm than in the R-DeVIC arm: neutropenia (75% vs 56%); thrombocytopenia (95% vs 83%); anemia (75% vs 69%). Also, grade 3 and 4 infections (53% vs 14%) and oral mucositis (55% vs 0%) were more prevalent in the HCT/ASCT arm.
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