IELSG32 first randomisation: the MATRix regimen (methotrexate, cytarabine, thiotepa, rituximab) in primary CNS lymphoma
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.
Overview
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.
- 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.
MATRix became the reference induction for fit patients with primary CNS lymphoma and the control arm of later randomised trials.
- Randomised phase 2 design; the trial was not powered for survival.
- Patients over 70 were excluded.
Similar pages
not linked directly; found by shared links- Key paperIELSG32 second randomisation: whole-brain radiotherapy or autologous stem cell transplant as consolidation in primary CNS lymphoma
Shares The Lancet Haematology, IELSG32, Thiotepa, Primary CNS lymphoma.
- TrialMATRix/IELSG43
Shares Thiotepa, Cytarabine, Primary CNS lymphoma, Methotrexate.
- Key paperMATRix/IELSG43: high-dose chemotherapy and autologous stem cell transplant versus non-myeloablative consolidation in primary CNS lymphoma
Shares Thiotepa, Primary CNS lymphoma.
- TrialA Study of the Efficacy and Safety of Lisocabtagene Maraleucel (Liso-cel) as First-Line Therapy in Adults With Transplant-Ineligible Primary Central Nervous System Lymphoma
Shares Primary CNS lymphoma, Methotrexate, Rituximab.
- TrialSafety and Efficacy of Asciminib in Pediatrics and Young Adults With Relapse/Refractory (r/r) Philadelphia Positive (Ph+) or ABL-class Ph-like Acute Lymphoblastic Leukemia (ALL)
Shares Cytarabine, Methotrexate.
- TargetDihydrofolate reductase (DHFR)
Shares Primary CNS lymphoma, Methotrexate.
- TrialACNS0333
Shares Thiotepa, Methotrexate.
- TrialTRIANGLE
Shares Cytarabine, Rituximab.