Dr. Cohen’s Approach to Managing Double-hit Lymphoma

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  • All patients with aggressive non Hodgkin lymphoma should be evaluated for MYC and BCL2/6 gene expression, if possible, by fluorescent in situ hybridization and immunohistochemistry.
  • Several intensive treatment regimens are available. Dr. Cohen favors dose-adjusted R-EPOCH for patients with double-hit lymphomas and for those classified as “double expressors.”
  • All patients should be assessed for central nervous system disease with strong consideration for prophylaxis.
  • Auto transplant’s role has not been established. Dr. Cohen recommends the pros and cons of stem cell transplant be discussed with each patient. ■

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"Double-hit lymphoma” represents a challenging malignancy without a standard-of-care treatment, although outcomes for some patients are better than was once believed, according to Jonathon B. ­Cohen, MD, Assistant Professor of Hematology and Medical Oncology at Emory University, Atlanta. Dr. Cohen...