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

Cancer type:

Blood cancers
High grade lymphoma
Lymphoma
Non-Hodgkin lymphoma

Status:

Results

Phase:

Phase 2

This trial was for people with diffuse B cell lymphoma that had spread to the brain or spinal cord. It was supported by Cancer Research UK.

The trial was open for people to join between 2015 and 2018, and the team published the results in 2021.

More about this trial

Diffuse large B cell lymphoma (DLBCL) is a type of non Hodgkin lymphoma. When this trial was done, doctors usually treated DLBCL with chemotherapy and a targeted cancer drug called rituximab. Some people then had high dose chemotherapy followed by a stem cell transplant.

Although rare, lymphoma can spread to the brain or spinal cord. This is called secondary central nervous system lymphoma (SCNSL). It can be more difficult to treat.

In this trial, doctors looked at giving 2 different combinations of drug treatment:

  • MATRIX - methotrexate, rituximab, cytarabine and thiotepa
  • RICE - rituximab, ifosfamide, carboplatin and etoposide

These combinations of treatment were already being used to treat other types of non Hodgkin lymphoma at the time. But the trial team wanted to find out how well they worked for people with SCNSL.

People taking part had 3 cycles of MATRIX followed by 3 cycles of RICE. Some people whose lymphoma responded well to treatment then went on to have more chemotherapy and a stem cell transplant.  

The main aims of the trial were to find out:

  • whether these combinations of treatment helped people with SCNSL 
  • more about the side effects

Summary of results

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

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%)

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

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 Open a glossary item) 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.

Recruitment start:

Recruitment end:

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Chief Investigator

Dr Kate Cwynarski

Supported by

Cancer Research UK
International Extranodal Lymphoma Study Group (IELSG)
Stand Up to Cancer
University of Southampton Clinical Trials Unit (CTU)

Other information

This is Cancer Research UK trial number CRUK/14/044.

Freephone 0808 800 4040

Last review date

CRUK internal database number:

14697

Please note - unless we state otherwise in the summary, you need to talk to your doctor about joining a trial.

Cara took part in a clinical trial

A picture of Cara

"I am glad that taking part in a trial might help others on their own cancer journey.”

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