Emerging Strategies in Treating Double Hit Lymphomas

Clin Lymphoma Myeloma Leuk. 2017 Sep;17(9):563-568. doi: 10.1016/j.clml.2017.06.017. Epub 2017 Jun 21.


Double hit lymphomas (DHLs) are a new category in the World Health Organization newest classification for lymphoid malignancies. DHL encompasses various histologies of lymphomas where the MYC oncogene and either BCL2 or BCL6 oncogenes are present concomitantly. Several observational studies and retrospective series have demonstrated that patients with DHL carry a poor prognosis and respond less and for a shorter duration to standard R-CHOP (rituximab, cyclophosphamide, vincristine, adriamycin, and prednisone). These studies have also proposed that dose intensification (with Burkitt-like regimens such as DA-EPOCH-R [dose-adjusted rituximab, etoposide, vincristine, Adriamycin, cyclophosphamide, and prednisone]) might offer patients with DHL better outcomes and improved prognosis. In this timely review, we discuss incidence of DHL, testing implications of MYC translocation, current treatment strategies, and future directions. Understanding this entity and its therapeutic consequences is essential to improve patients' outcomes.

Keywords: Double expressing lymphoma; High-grade lymphoma; MYC-driven lymphomas; Non-Hodgkin lymphoma; Therapeutic options.

Publication types

  • Review

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / adverse effects
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Cell Transformation, Neoplastic / genetics
  • Consolidation Chemotherapy
  • Gene Expression Regulation, Neoplastic
  • Genetic Variation*
  • Humans
  • Induction Chemotherapy
  • Lymphoma / diagnosis
  • Lymphoma / genetics*
  • Lymphoma / mortality
  • Lymphoma / therapy*
  • Neoplasm Grading
  • Neoplasm Staging
  • Oncogenes*
  • Prognosis
  • Proto-Oncogene Proteins c-bcl-2 / genetics
  • Proto-Oncogene Proteins c-bcl-6 / genetics
  • Proto-Oncogene Proteins c-myc / genetics
  • Recurrence
  • Treatment Outcome


  • Proto-Oncogene Proteins c-bcl-2
  • Proto-Oncogene Proteins c-bcl-6
  • Proto-Oncogene Proteins c-myc