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Long‐Term Real‐World Outcomes of Primary CNS Lymphoma Patients Treated With MATRix Regimen Are Similar to IELSG32 Trial Results

Year: 2025

Type: article

Abstract: Primary central nervous system lymphomas (PCNSL) are rare malignancies with poor survival outcomes. The IELSG32 trial demonstrated efficacy of MATRix chemoimmunotherapy followed by autologous stem cell transplantation (auto-SCT) in PCNSL patients aged ≤ 70 years with a performance status (PS) ECOG ≤ 3. However, long-term real-world results of MATRix/auto-SCT therapy remain limited. This analysis, with a median follow-up of 52 months, aimed to evaluate the outcomes of MATRix-treated PCNSL patients in clinical practice. From 2015 to 2022, 280 PCNSL patients who received systemic therapy were identified in the NiHiL project (NCT03199066). Eighty-eight individuals treated with MATRix entered the analysis. Endpoints included efficacy and safety of induction and consolidation therapy. Seventy-eight patients who met key IELSG32 inclusion criteria (age ≤ 65 years and PS ECOG ≤ 3, or age 66-70 years and PS ECOG ≤ 2) achieved an overall response rate of 82% (complete remission rate 58%) following MATRix regimen. After median follow-up of 52 months, 4-year progression-free survival and overall survival (OS) rates were 53% and 55%, respectively. Forty-six (59%) patients completed MATRix treatment, and 32 (41%) discontinued induction therapy (15 toxicity, 11 infections, 5 progressive diseases, 1 refusal). The treatment-related mortality was 8%. Among 67 patients with responsive/stable disease, 50 underwent consolidation with whole-brain radiotherapy (WBRT, n = 13) or auto-SCT (n = 37). No significant survival differences were observed between WBRT and auto-SCT (4-year OS 84% vs. 74%, HR 0.61, 95% CI 0.16-2.29, p = 0.467). Long-term real-world outcomes of MATRix/auto-SCT therapy are comparable to IELSG32, supporting its use in younger, fit PCNSL patients. CLINICAL TRIAL REGISTRATION: The data in this analysis were collected in the observational Czech non-Hodgkin lymphoma registry "NiHiL" (NCT03199066).

Source: Hematological Oncology

DOI: 10.1002/hon.70142