A trial of two combinations of treatment called MATRIX and RICE followed by a stem cell transplant for diffuse B cell lymphoma (MARIETTA)

The trial showed that MATRIX and RICE might be useful treatments for people with diffuse large B cell lymphoma that had spread to the brain and spinal cord.

Trial design
This trial was for people with secondary CNS lymphoma (SCNSL). 

This means they had diffuse large B cell lymphoma (DLBCL) that had grown into the brain or spinal cord (central nervous system, or CNS).

It was for people who had been recently diagnosed with SCNSL and people who had already had treatment. People taking part included those who needed more help with selfcare and those who needed to stay in bed or in a chair for more than half the day. 

This was a phase 2 trial and everyone taking part had the same treatment. The plan was for people to have:

• 3 cycles of MATRIX, followed by
• 3 cycles of RICE and then
• high dose chemotherapy and a stem cell transplant

The exact treatment they had depended on how well they were, the side effects they had and how well the treatment was working.

Results
A total of 75 people had treatment as part of this trial:

• 32 people who had been recently diagnosed with lymphoma
• 43 people who had already had treatment for their lymphoma, but it had continued to grow or come back (recurred)

The research team looked at how well treatment worked. 

They looked at how many people’s lymphoma had not got any worse. This is called progression free survival, or PFS. They found it was:

• nearly 6 of 10 people (58%), a year after joining the trial
• less than 5 out of 10 people (46%), 2 years after joining the trial

MARIETTA bar chart 1

This was a bit higher than they were expecting.

The team also looked at how well people were doing at the end of 3 cycles of MATRIX and 3 cycles of RICE. They found that the lymphoma had:

• gone away completely in 29 people (39%)
• got a bit better in 20 people (27%)

MARIETTA bar chart 2

Of these 49 people, 37 went on to have a stem cell transplant.

When they looked at how many people were living 2 years after joining the trial, they found it was:

• nearly 5 out of 10 people (46%) overall
• more than 7 out of 10 (71%) of those who had not had treatment before
• more than 8 out of 10 (83%) of those who went on to have a stem cell transplant

MARIETTA bar chart 3

Side effects
Everyone taking part had at least 1 side effect from treatment. But many were mild or didn’t last long. The most common side effect was a drop in white blood cells, red blood cells or blood clotting cells (platelets).

Just over 5 out of 10 people (56%) had at least 1 more serious side effect. The most common of the more serious side effects was a drop in white blood cells which led to infection. Most people recovered from this. But 4 people who had a significant drop in white blood cells developed a serious infection which led to sepsis, and they died.

Conclusion
The research team concluded that this combination of treatment was promising for people with secondary CNS lymphoma. This is especially true for those who went on to have a stem cell transplant.

They suggest more work is done to look at this and other combinations of treatment for people to have before they have a stem cell transplant.

Where this information comes from    
We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed ) and published in a medical journal. The figures we quote above were provided by the trial team who did the research. We have not analysed the data ourselves.