A Clinician's Approach to Double-Hit Lymphoma: Identification, Evaluation, and Management

Double-hit lymphomas have concurrent rearrangements of CMYC and BCL2 or occasionally BCL6. Although double-hit lymphomas are a part of the mature B-cell lymphoma lineage, they have an aggressive clinical course that is complicated by an extremely poor response to standard therapy for aggressive non-Hodgkin lymphoma. Overall survival is short for many patients with double-hit lymphomas, which reinforces the importance of identifying appropriate therapies for these patients. Fortunately, recent reports have demonstrated improved outcomes with the use of intensive induction therapies. This article discusses the biology, therapeutic considerations, treatment opinions, possible role of autologous stem-cell transplant, and need for ongoing clinical trials for this subgroup of patients with lymphoma.