Induction intensity in transplant-eligible primary CNS lymphoma: no survival benefit despite increased toxicity
In brief
More intensive MATRix therapy raised toxicity without improving 2-year survival
In this retrospective study of 355 transplant-eligible patients, 2-year overall survival was similar across three induction regimens, ranging from 79% to 89%, and transplantation rates were also comparable. MATRix was linked to more dose reductions, ICU admissions and treatment-related deaths. The findings favor weighing tolerability, though randomized comparisons are needed to confirm the differences.
- Journal
- Blood advances (Q1)
- Published
- 24 September 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Vanja Zeremski, Jeong-Ok Lee, Robert Puckrin, Farah Yassine, Colin Stewart, Mehdi Hamadani, et al.
- PMID
- 42782308
- DOI
- 10.1182/bloodadvances.2026021352
Why clinicians should know about it
- Picked for Hematology (paper of the day, 26 September 2026): Induction intensity in transplant‑eligible CNS lymphoma
Abstract
Primary central nervous system lymphoma is an aggressive lymphoma for which high-dose chemotherapy followed by autologous stem cell transplantation is standard first-line treatment in eligible patients; however, the optimal induction regimen remains uncertain. We conducted a multicenter international retrospective study across 11 centers including 355 transplant-eligible patients treated with MATRix (n=164), R-MPV/R-MT (n=121), or the reduced-intensity Alberta protocol (n=70). The overall response rate was 89.5%, with a complete response rate of 50.1%. Although complete response rates were higher with R-MPV/R-MT, transplantation rates were similar across regimens (74.4%, 69.4%, and 78.6%, respectively; p=0.36). Two-year overall survival was 79.0%, 89.0%, and 82.1% (p=0.32), and 2-year progression-free survival was 63.7%, 72.6%, and 75.3% (p=0.26) for MATRix, R-MPV/R-MT, and Alberta, respectively. Comparable outcomes were also observed among patients proceeding to transplantation (n=261). Toxicity however differed substantially between regimens: MATRix was associated with higher rates of dose reductions (p=0.006), ICU admissions (p<0.001), and treatment-related mortality (p=0.006). After adjustment for baseline imbalances using inverse probability of treatment weighting, survival outcomes remained comparable across treatment groups, whereas MATRix retained a less favorable toxicity profile. Less intensive induction regimens achieved transplantation and survival outcomes comparable to MATRix while demonstrating superior tolerability, supporting treatment strategies that optimize tolerability without compromising long-term outcomes.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.