Multicenter phase 2 trial of high-dose chemotherapy and autoHSCT for PCNSL in older, fit patients

Available treatments for older patients (aged 65 years and older) with primary diffuse large B-cell CNS lymphoma (PCNSL) offer progression-free survival of up to 16 months. The phase 2 MARTA trial, at 15 centers in Germany, evaluated an intensified treatment of high-dose chemotherapy (HDCT) and autologous hematopoietic stem cell transplantation (autoHSCT) for PCNSL in older, fit patients. The patients received two 3-week induction cycles (methotrexate, cytarabine, and rituximab), followede by HDCT (rituximab, busulfan, and thiothepa) and autoHSCT. The 12-month progession-free survival rate (from the start of induction therapy) was 58.8% (95% CI 44.1-70.9). Treatment-related deaths were reported in 6% of patients, all due to infectious complications. The authors conclude that short induction followed by HDCT and autoHSCT is active in selected older patients with newly diagnosed PCNSL.