Long-term efficacy, safety and neurotolerability of MATRix regimen followed by autologous transplant in primary CNS lymphoma: 7-year results of the IELSG32 randomized trial.
Adult
Antineoplastic Combined Chemotherapy Protocols
/ adverse effects
Central Nervous System Neoplasms
/ pathology
Combined Modality Therapy
Cytarabine
Hematopoietic Stem Cell Transplantation
/ methods
Humans
Lymphoma
/ etiology
Methotrexate
Quality of Life
Rituximab
Thiotepa
/ adverse effects
Transplantation, Autologous
/ adverse effects
Journal
Leukemia
ISSN: 1476-5551
Titre abrégé: Leukemia
Pays: England
ID NLM: 8704895
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
received:
12
01
2022
accepted:
20
04
2022
revised:
16
04
2022
pubmed:
14
5
2022
medline:
7
7
2022
entrez:
13
5
2022
Statut:
ppublish
Résumé
219 HIV-negative adults ≤70 years with primary CNS lymphoma (PCNSL) were enrolled in the randomized IELSG32 trial. Enrolled patients were randomly assigned to receive methotrexate-cytarabine (arm A), or methotrexate-cytarabine-rituximab (B), or methotrexate-cytarabine-thiotepa-rituximab (MATRix; arm C). A second randomization allocated patients with responsive/stable disease to whole-brain irradiation (WBRT) or carmustine-thiotepa-conditioned autologous transplantation (ASCT). First results, after a median follow-up of 30 months, showed that MATRix significantly improves outcome, with both WBRT and ASCT being similarly effective. However, sound assessment of overall survival (OS), efficacy of salvage therapy, late complications, secondary tumors, and cognitive impairment requires longer follow-up. Herein, we report the results of this trial at a median follow-up of 88 months. As main findings, MATRix was associated with excellent long-lasting outcome, with a 7-year OS of 21%, 37%, and 56% respectively for arms A, B, and C. Notably, patients treated with MATRix and consolidation had a 7-year OS of 70%. The superiority of arm B on arm A suggests a benefit from the addition of rituximab. Comparable efficacy of WBRT and ASCT was confirmed. Salvage therapy was ineffective; benefit was recorded only in patients with late relapse re-treated with methotrexate. Eight (4%) patients developed a second cancer. Importantly, MATRix and ASCT did not result in higher non-relapse mortality or second tumors incidence. Patients who received WBRT experienced impairment in attentiveness and executive functions, whereas patients undergoing ASCT experienced improvement in these functions as well as in memory and quality of life.
Identifiants
pubmed: 35562406
doi: 10.1038/s41375-022-01582-5
pii: 10.1038/s41375-022-01582-5
doi:
Substances chimiques
Cytarabine
04079A1RDZ
Rituximab
4F4X42SYQ6
Thiotepa
905Z5W3GKH
Methotrexate
YL5FZ2Y5U1
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1870-1878Subventions
Organisme : Cancer Research UK
ID : 12115
Pays : United Kingdom
Organisme : Cancer Research UK
ID : CRUK/10/023
Pays : United Kingdom
Organisme : Cancer Research UK
ID : C36711/A12115
Pays : United Kingdom
Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Nature Limited.
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