Extending potentially curative options for older patients with PCNSL

Substantial progress in the management of patients with primary diffuse large B-cell CNS lymphoma (PCNSL) has been made over recent decades, a rare malignancy that was previously considered incurable. The majority of patients treated with intensive protocols including thiotepa-based high-dose chemotherapy with autologous haematopoietic stem-cell transplantation (HSCT) consolidation can now expect to survive more than 7 years. 1 Ferreri AJM Cwynarski K Pulczynski E et al. 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. Leukemia. 2022; 36: 1870-1878 Crossref PubMed Scopus (40) Google Scholar , 2 Houillier C Dureau S Taillandier L et al. Radiotherapy or autologous stem-cell transplantation for primary CNS lymphoma in patients age 60 years and younger: long-term results of the randomized phase II PRECIS study. J Clin Oncol. 2022; 40: 3692-3698 Crossref Scopus (24) Google Scholar However, the median age at presentation for PCNSL is 65 years, therefore many patients are older or have comorbidities, and have often been excluded from prospective trials. Intensive treatment protocols incorporating autologous HSCT have not been prospectively assessed in patients older than 70 years (in some trials, only patients younger than 60 years have been included), 2 Houillier C Dureau S Taillandier L et al. Radiotherapy or autologous stem-cell transplantation for primary CNS lymphoma in patients age 60 years and younger: long-term results of the randomized phase II PRECIS study. J Clin Oncol. 2022; 40: 3692-3698 Crossref Scopus (24) Google Scholar , 3 Ferreri AJM Cwynarski K Pulczynski E et al. Chemoimmunotherapy with methotrexate, cytarabine, thiotepa, and rituximab (MATRix regimen) in patients with primary CNS lymphoma: results of the first randomisation of the International Extranodal Lymphoma Study Group-32 (IELSG32) phase 2 trial. Lancet Haematol. 2016; 3: e217-e227 Summary Full Text Full Text PDF PubMed Google Scholar and long-term overall survival rates are suboptimal. The MARTA trial, reported in The Lancet Haematology by Elisabeth Schorb and colleagues 4 Schorb E Isbell LK Kerkhoff A et al. High-dose chemotherapy and autologous haematopoietic stem-cell transplantation in older, fit patients with primary diffuse large B-cell CNS lymphoma (MARTA): a single-arm, phase 2 trial. Lancet Haematol. 2024; (published online Jan 29.)https://doi.org/10.1016/S2352-3026(23)00371-X Google Scholar aimed to address this knowledge gap by assessing intensive chemotherapy and autologous HSCT in patients aged 65–80 years with PCNSL. High-dose chemotherapy and autologous haematopoietic stem-cell transplantation in older, fit patients with primary diffuse large B-cell CNS lymphoma (MARTA): a single-arm, phase 2 trialAlthough the primary efficacy threshold was not met, short induction followed by high-dose chemotherapy and autologous HSCT is active in selected older patients with PCNSL and could serve as a benchmark for comparative trials. Full-Text PDF