EBMT 2018 | The challenges posed by double-hit lymphoma

Regarding molecular or genetic alterations, we must speak about double hit lymphomas. It represents only a small percentage of all diffuse B-cell lymphomas; a very rare condition associated with a poor prognosis. In these lymphomas, there are at least two chromosomal translocations involving the MYC gene and BCL-2 or BCL-6. These are mostly classified according to the cell of origin of germinal center B-cell lymphomas. The presentation of this disease shows an advanced stage, aggressive disorder involving several organs with unfavorable parameters. The 5-year overall survival of patients with double hit lymphomas is lower than 40 percent, a disappointing survival figure in this group of diffuse B-cell lymphomas. The treatments that are proposed to these patients are associated with poor results and the more intensified the strategies, the higher the toxicity, in particular in elderly patients. Since it is rare, there are no large prospective trials for this group of patients. We are looking for new drugs, specifically molecular mechanisms or CAR T-cell therapy, or other new strategies that could improve the survival of these high-risk patients.