Redefining consolidation in primary CNS lymphoma: autologous stem-cell transplantation as the standard
Mené sur 368 patients atteints d'un lymphome primitif du système nerveux central (durée médiane de suivi : 45,3 mois), cet essai de phase III évalue l'efficacité, du point de vue de la survie sans progression, et la toxicité d'un traitement de consolidation par fortes doses de chimiothérapie (carmustine et thiotépa) suivie d'une greffe autologue de cellules souches hématopoïétiques, par rapport à une chimio-immunothérapie non-myéloablative (rituximab, dexaméthasone, étoposide, ifosfamide et carboplatine)
There are core principles that command broad consensus in the initial treatment of patients with primary CNS lymphoma (PCNSL). First, induction should consist of a high-dose methotrexate-based polychemotherapy regimen to elicit tumour response. Second, post-induction therapy following response is needed to prevent relapse.1 Beyond these principles, key practice differences persist without consensus on which chemotherapy agents to combine with methotrexate and the optimal post-induction consolidation strategy. The rarity of PCNSL has often been cited as a barrier to the conduct of the well powered, randomised clinical trials required to answer these questions. In The Lancet, Gerald Illerhaus and colleagues overcome this perceived obstacle with the phase 3 MATRix/IELSG43 study, the largest randomised trial in untreated PCNSL (368 patients enrolled), evaluating consolidation with non-myeloablative chemotherapy versus thiotepa-based myeloablative high-dose chemotherapy and autologous stem-cell transplantation (HCT–ASCT) following MATRix (methotrexate, cytarabine, thiotepa, and rituximab) induction
The Lancet , commentaire, 2026