Induction therapy with the MATRix regimen in patients with newly diagnosed primary diffuse large B‐cell lymphoma of the central nervous system – an international study of feasibility and efficacy in routine clinical practice

Abstract

Summary The MATRix chemoimmunotherapy regimen is highly effective in patients with newly diagnosed primary diffuse large B‐cell lymphoma of the central nervous system (PCNSL). However, nothing is known about its feasibility and efficacy in everyday practice, where patients are more often older/frailer than those enrolled in clinical trials. We conducted a retrospective study addressing tolerability/efficacy of MATRix in 156 consecutive patients with newly diagnosed PCNSL treated outside a clinical trial. Median age and ECOG Performance Status of considered patients were 62 years (range 28–78) and 2 (range 0–4). The overall response rate after MATRix was 79%. Nine (6%) treatment‐related deaths were recorded. After a median follow‐up of 27.4 months (95% confidence interval [CI] 24.4–31.9%), the two‐year progression‐free and overall survival were 56% (95% CI 48.4–64.9%) and 64.1% (95% CI 56.7–72.5%) respectively. Patients not eligible for the IELSG32 trial were treated with lower dose intensity and had substantially worse outcomes than those fulfilling inclusion criteria. This is the largest series of PCNSL patients treated with MATRix outside a trial and recapitulates the IELSG32 trial outcomes in the non‐trial setting for patients who fit the trial criteria. These data underscore the feasibility and efficacy of MATRix as induction treatment for fit patients in routine practice.

Treatment patterns and disease course of previously untreated Primary Central Nervous System Lymphoma: Feasibility of MTX‐based regimens in clinical routine

“…al. although patients treated within the IELSG43 trial tended to perform better than patients meeting exclusion criteria who were treated with MATRix in clinical routine, this difference was not statistically significant (Figure ) 23 …”

“…Still, therapy of PCNSL in the real‐world setting remains challenging because tumors in the CNS cause severe disturbances of cognitive function and performance status and since many elderly patients are not eligible for clinical trials. A multicenter retrospective analysis of induction therapy with MATRix in routine clinical practice showed significantly worse outcomes for patients not fulfilling the inclusion criteria of the IELSG32 trial 23 . Another single‐center retrospective analysis comparing patients treated with 6 cycles of MTX (4 g/m 2 ) ± whole brain radiotherapy ± ifosfamide in the G‐PCNSL‐SG‐1‐ with patients from clinical routine showed similar trends 24,25 .…”

Primary Central Nervous System T-cell Lymphoma Associated With Hepatitis B and D Virus Coinfection

“…Historically, the prognosis is poor, with a five-year disease-specific survival of 17% [4]. However, with the introduction of newer treatment modalities, this has improved, as a recent study reports overall survival of 65% at two years [9]. Survival analysis is primarily reported for B-cell PCNSL.…”

Guidelines for the diagnosis and management of primary central nervous system diffuse large B‐cell lymphoma

“…Treatment‐related mortality is around 4–7% with MATRix, with most treatment‐related deaths occurring during the first treatment cycle (Ferreri et al , ; Schorb et al , 2017b). Within the IELSG32 study (median age 57 years), the relative dose intensity of cytarabine and thiotepa during remission induction was 78% and 76% respectively, with protocol‐defined reductions predominantly for haematological toxicity.…”

“…Within the IELSG32 study (median age 57 years), the relative dose intensity of cytarabine and thiotepa during remission induction was 78% and 76% respectively, with protocol‐defined reductions predominantly for haematological toxicity. In a recent real world study of outcomes with MATRix chemotherapy (median age 61 years), 23 of 88 included patients would not have met IELSG32 eligibility criteria due to age, performance status or co‐morbidities (Schorb et al , 2017b). Consequently, chemotherapy modifications were more frequent (40–50%) but survival rates were similar to those in IELSG32, with 2‐year OS of 64%.…”