Do you intensify treatment for patients with double-hit lymphoma or double expressor lymphoma?

My personal practice is that I DO intensify therapy for patients with DHL but not necessarily with DE lymphoma. Generally, the "intensification" of choice is based on age. Young fit patients (for which there are few) with DHL are candidates for CODOX-M/IVAC or DA-REPOCH. Older patients (which the ma...

This is an excellent and hotly debated question in the lymphoma literature. For patients with double hit lymphomas (who make up ~10% of DLBLC, it is still my practice to treat with DA-R-EPOCH. For those with high IPI (which almost all do) or renal/adrenal involvement, I also give CNS prophylaxis.

F...

TREATMENT OF RELAPSED DHL

First determine cell of origin

Lenalidomide and Ibrutinib can be considered. Both cross the blood brain barrier.

Morschhauser F et al. A phase 2, multicentre, single-arm, open-label study to evaluate the safety and efficacy of single-agent lenalidomide (Revlimid^®) in subjects ...

Double-expressing lymphoma (IHC positivity of MYC and either BCL2 and/or BCL6) can be of either non-germinal center or germinal center immunophenotype, although more commonly will be non-GC. While DEL is an adverse prognostic factor, there is no convincing evidence at this time that treatment should...

There is an ongoing clinical trial (NCT03984448) which is testing whether the addition of venetoclax to R-CHOP in double expressors and venetoclax to DA-R-EPOCH in double hit will improve outcomes, PFS primary endpoint, OS secondary endpoint.