# IELSG32 first randomisation: the MATRix regimen (methotrexate, cytarabine, thiotepa, rituximab) in primary CNS lymphoma

Source: https://onco.cc/key-papers/paper-ielsg32-matrix-induction-ferreri-lancet-haematol-2016/  
OnCo record `paper-ielsg32-matrix-induction-ferreri-lancet-haematol-2016` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adding rituximab and thiotepa to methotrexate and cytarabine doubled the complete remission rate for lymphoma confined to the brain, making the four-drug MATRix regimen the standard induction for patients up to 70.

## Summary

First randomisation of the international phase 2 IELSG32 trial: 227 patients aged 18 to 70 with newly diagnosed primary CNS lymphoma were randomised to four courses of methotrexate and cytarabine alone, with rituximab, or with rituximab and thiotepa (MATRix).

At a median follow-up of 30 months the complete remission rate was 49 percent with MATRix against 23 percent with methotrexate-cytarabine alone (hazard ratio 0.46) and 30 percent with rituximab added (hazard ratio 0.61). Grade 4 haematological toxicity was more frequent with MATRix but infections were similar; 13 patients (6 percent) died of toxicity.

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Journal: The Lancet Haematology
- Year: 2016
- DOI: 10.1016/S2352-3026(16)00036-3
- Authors: Ferreri AJ, Cwynarski K, Pulczynski E, et al.
- Findings: Complete remission 49 percent (95% CI 38 to 60) with MATRix, 30 percent (21 to 42) with methotrexate-cytarabine-rituximab, 23 percent (14 to 31) with methotrexate-cytarabine.; Hazard ratio for complete remission 0.46 (0.28 to 0.74) for methotrexate-cytarabine alone against MATRix.; Toxic deaths 6 percent.
- What it means: MATRix became the reference induction for fit patients with primary CNS lymphoma and the control arm of later randomised trials.
- Caveats: Randomised phase 2 design; the trial was not powered for survival.; Patients over 70 were excluded.

## Sources

- Lancet Haematol 2016: https://doi.org/10.1016/S2352-3026(16)00036-3
- PubMed: https://pubmed.ncbi.nlm.nih.gov/27132696/

## Connected records

- cancers: [Primary CNS lymphoma](https://onco.cc/cancers/primary-cns-lymphoma/)
- drugs: [Cytarabine](https://onco.cc/drugs/cytarabine/), [Methotrexate](https://onco.cc/drugs/methotrexate/), [Rituximab](https://onco.cc/drugs/rituximab/), [Thiotepa](https://onco.cc/drugs/thiotepa/)
- trials: [IELSG32](https://onco.cc/trials/ielsg32/)
- journals: [The Lancet Haematology](https://onco.cc/journals/lancet-haematology/)

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