# MATRix/IELSG43: high-dose chemotherapy and autologous stem cell transplant versus non-myeloablative consolidation in primary CNS lymphoma

Source: https://onco.cc/key-papers/paper-matrix-ielsg43-asct-consolidation-pcnsl-illerhaus-lancet-2026/  
OnCo record `paper-matrix-ielsg43-asct-consolidation-pcnsl-illerhaus-lancet-2026` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

In the largest trial ever run in lymphoma of the brain, a stem cell transplant after MATRix chemotherapy kept 78 percent of patients free of progression at three years against 51 percent with conventional consolidation chemotherapy, and lengthened survival.

## Summary

Randomised phase 3 trial in 368 patients aged 18 to 70 with newly diagnosed primary CNS lymphoma: after four cycles of MATRix, 230 patients with responding or stable disease were randomised to high-dose carmustine and thiotepa with autologous stem cell transplant or two cycles of R-DeVIC; 229 were analysed.

At a median follow-up of 45.3 months three-year progression-free survival was 78 percent after transplant against 51 percent after R-DeVIC (hazard ratio 0.43, p 0.0003), and overall survival was also improved. Adverse events per patient were 14.6 against 9.3; fatal serious adverse events after consolidation occurred in five transplant patients (infections, pulmonary embolism) and two R-DeVIC patients (acute myeloid leukaemia).

## Fields

- Kind: Key paper
- Last checked: 2026-09-22
- Journal: The Lancet
- Year: 2026
- DOI: 10.1016/S0140-6736(26)00917-7
- Authors: Illerhaus G, Ferreri AJM, Wendler J, et al.
- Findings: Three-year progression-free survival 78 percent (95% CI 69 to 85) with transplant versus 51 percent (41 to 60) with R-DeVIC; hazard ratio 0.43 (0.27 to 0.68), p 0.0003.; Overall survival significantly improved with transplant.; Mean adverse events per patient 14.6 versus 9.3; five versus two fatal serious adverse events after consolidation.
- What it means: High-dose chemotherapy with autologous transplant is the preferred consolidation for fit patients with primary CNS lymphoma who complete MATRix induction.
- Caveats: Only patients up to 70 who responded to induction and were fit for transplant were randomised; a third of enrolled patients never reached randomisation.; Transplant carried more toxicity, including fatal infections.

## Sources

- Lancet 2026: https://doi.org/10.1016/S0140-6736(26)00917-7
- PubMed: https://pubmed.ncbi.nlm.nih.gov/42486133/

## Connected records

- cancers: [Primary CNS lymphoma](https://onco.cc/cancers/primary-cns-lymphoma/)
- drugs: [Carmustine](https://onco.cc/drugs/carmustine/), [Thiotepa](https://onco.cc/drugs/thiotepa/)
- trials: [MATRix/IELSG43](https://onco.cc/trials/ielsg43/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)

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