HCT-ASCT consolidation in primary CNS lymphoma: 3-year progression-free survival 78% versus 51% in the phase 3 MATRix/IELSG43 trial

A research highlight in Nature Reviews Clinical Oncology endorses high-dose chemotherapy with autologous stem-cell transplantation (HCT-ASCT) as consolidation after induction in eligible patients with primary central nervous system lymphoma. The underlying evidence is the randomised phase 3 MATRix/IELSG43 trial (Lancet 2026), in which 229 patients who had responded to induction were analysed: 3-year progression-free survival was 78% (95% CI 69-85) with HCT-ASCT versus 51% (41-60) with non-myeloablative R-DeVIC consolidation (HR 0.43; 95% CI 0.27-0.68; p=0.0003) at a median follow-up of 45.3 months. The benefit carries a cost: fatal serious adverse events after consolidation occurred in five patients in the transplantation arm (four infections, one pulmonary embolism) versus two in the R-DeVIC arm, and the result applies to patients fit for transplantation who had at least a partial response to induction — not to the whole population with this diagnosis.